Assembly Standing Committee on Health

Of Tuesday, July 1st. Before we begin, I want to make sure everyone understands our Committee procedures to ensure we maintain order and run a fair and efficient hearing with the goal of hearing as much from the public within the limits of our time.

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

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

Main support and opposition will be allowed two main witnesses for a maximum of two minutes each. As a reminder, primary witnesses in support must be those accompanying the author or who otherwise have registered a support position with the Committee.

And the primary witness in opposition must have their opposition registered with the Committee per the instructions on our website. All other support and opposition can be stated at the standing mic. When called upon to simply state name, affiliation and position. All testimony comments are limited to the Bill at hand. Some housekeeping items.

I would like to note that file item 2, SB 68, Menjivar, has been pulled from today's hearing on the consent calendar. The proposed consent calendar for this hearing includes item 3, SB83, Umberg with a motion of do passes, amended to appropriations. Item 7, SB338, Becker with a motion of do passes, amended to appropriations.

Item 11, SB 669, Mcguire with a motion of do pass, as amended to appropriations. Any Member of the Committee may remove a Bill from consent. With that we hear items in file item order. We will start as a Subcommitee of the full Committee. And we will begin with item one, SB32, by Weber Pierson. Whenever you're ready, Senator.

Thank you. Good afternoon, Madam Chair and committee members. Today I will be presenting SB 32, which requires clear time and distance standards to be established for perinatal units and medical and commercial plans. California is facing a serious maternal health crisis.

In the last decade alone, more than 50 hospitals across the state have shut down or suspended their labor and delivery services, creating maternity care deserts. Too many expectant mothers are now forced to travel long distances to reach hospitals equipped to safely deliver babies, sometimes over an hour or 100 miles.

I cannot stress enough how dangerous these delays can be. Lack of timely access significantly increases risk for premature births, untreated hypertension and maternal deaths, especially for rural and minority communities. While health plans must meet time and distance standards for primary care and specialty care and hospitals, no such standards exist for labor and delivery units.

This gap allows plans to list OBGYNs as quote and network without guaranteeing access to actual delivery services. This representation of access can cause confusion and delay in critical care. A mother's health must always come before any administrative barriers. Some may argue that this bill doesn't fix the root cause of maternity ward closures.

And while that's true that a health plan does not directly make the final decision, financial strain is credited as a major factor in these closures. Secure and sustainable contracts can be vital to ensuring predictable reimbursement and steady patient volume, especially for safety net and under resourced hospitals.

Specifically, this bill would encourage plans to engage more proactively in sustaining labor and delivery services by requiring the Department of Healthcare Services, Department of Health, Managed Healthcare, and the Department of Insurance to engage in a robust, comprehensive stakeholder process to delivery time and distance standards for labor and delivery units.

Enforceable standards will push health plans to find creative solutions to maintain health networks adequacy and address maternity ward closures. Instead of defaulting to the status quo, SB 32 mandates good faith efforts from plans to maintain networks that reflect the real needs of pregnant patients and prevent dangerous gaps in access.

To be clear, this bill will not be the only thing that fix this multifaceted, complex issue surrounding maternity ward closures. But it is one of the pieces of the puzzle. By requiring timely access to perinatal units, we promote accountability, drive innovation and prioritize patient safety and equity. SB 32 reflects a simple truth.

Healthy births are the foundation of healthy communities. With me today, I have Dr. Patrice Trowbridge, an OBGYN representing the American College of Obstetricians and Gynecologists, and Vanessa Gonzalez with the California Hospital Association. Respectfully, I ask for an aye vote.

Thank you. You'll each have two minutes each.

Good afternoon, Madam Chair Members. My name is Patrice Trowbridge - Dr. Patrice Trowbridge. I'm an OBGYN testifying on behalf of ACOG District 9 and strong support of SB 32. Every day and labor and delivery, we walk a tightrope of predictability and the unexpected. A healthy pregnancy can escalate in minutes.

A baby in distress, sudden hemorrhage, other undiagnosed complications. These aren't rare or extreme cases. They're part of our daily reality in obstetric care. That's why immediate access to a property equipped with labor and delivery unit isn't a luxury, it's a medical necessity.

Unfortunately, too many of my colleagues and patients now face a deeply troubling trend, and that's the disappearance of nearby maternity wards in care. When a patient in active labor has no in network facility within reach, the results can be devastating.

Not just delays in care, but increased preterm bursts, undiagnosed and unmanaged hypertension, and maternal deaths that were preventable. When time is the most critical factor, the absence of proximity becomes a life-threatening risk. Today, health plans are required to ensure timely access to broad array of services.

But the very setting where births occur, the perinatal unit, is missing from those standards. SB 32 would fix that and ensure health plans make the same good faith effort to secure local labor and delivery access as they do for other types of care. To be clear, this is not about mandating new facilities overnight.

It's about transparency, accountability, and making sure health plans do their part to maintain a functional network for one of the most basic human experiences, which is childbirth. As physicians, we are asked to do everything we can to safeguard our patients health to do no harm. And we're simply asking the same for our health plans.

We ask for an aye vote.

Thank you. You'll have two minutes.

Good afternoon. Vanessa Gonzalez with the California Hospital Association here in support of SB 32. Declining birth rates, workforce shortages and financial instability have left some hospitals with no choice but to close maternity care services in order to keep their doors open.

This of course, is a significant concern and we need all stakeholders working together to look at how we can preserve and expand labor and delivery care. One tool to help achieve this is the adoption and meaningful enforcement of timely access standards for labor and delivery units.

As proposed in SB 32, California has implemented network adequacy standards to ensure health plan enrollees have timely access to the care that they need. While plans are currently subject to general hospital network adequacy requirements, there are currently no specific time and distance standards for hospital-based labor and delivery units.

By establishing specific enforceable time and distance standards for L&D surfaces, SB 32 will help ensure that patients have access to safe, high quality maternity care.

While SB 32 alone will not solve all of the challenges, establishing this new standard is a critical first step toward identifying and addressing gaps in access as well as holding not only providers accountable, but health plans as well. For these reasons, we respectfully request your aye vote.

Thank you.

Thank you. Are there any others in the hearing room and support? Please come forward with your name, affiliation and your position.

Thank Madam Chair. Ryan Spencer, on behalf of the California Medical Association, and support. Thank you.

Madam Chair and members, Tim Madden representing the California Chapter of the American College of Emergency Physicians; in support.

Good afternoon. Karen Stout here on behalf of the California Nurse-Midwives Association, and support.

Thank you. Are there any primary witnesses in opposition to this bill? Seeing none. Any in the hearing who would like to offer a me-too in opposition? Seeing none. I will bring it back to the Committee for comments or questions. Assemblymember Patel.

I have just a brief comment. I know the - you know how critical it is to make sure we have maternal care healthcare, and this impacts not only rural regions, but also sometimes suburban regions. And I appreciate the hard work you're putting into this and the appropriate time.

I'd like to make the motion to move the bill.

I'm sorry. I went too fast. Any in opposition, please?

Thank you. Sorry. Darby Kernan for the Local Health Plans of California, in opposition. Thank you.

Thank you. Any other members with comments or questions on this bill? Thank you. I appreciate the opposition that we heard. As Senator, I know that since you have joined the legislature; you've sought to make sure that your expertise as a practicing OBGYN can be something that we are able to rely on.

And I want to thank you for being very, very dogged and persistent about ensuring that we have access to maternal care and your leadership in this work.

Over so many years, we've heard certainly seen the news reports that the recent closures in our maternity wards and hospital labor and delivery services are something that we really have to examine and do something about very critically. And I appreciate your willingness to keep moving us forward in this regard. With that, do you have any closing remarks?

Want to thank the chair and the committee for working with us on this bill and allowing for it to be heard. This, unfortunately, is something that has probably touched each and every legislature and each district, whether it's rural or urban or suburban.

And this is a trend that has to stop for the health of our entire state. And with that, I respectfully ask for an aye vote at the appropriate time on SB 32. Thank you.

We have a motion to consider, seconded by Sanchez. At the same time, and when we are able to have a full committee, we will be able to vote on this bill. Thank you so much.

And we will move on to your second item. Item 9, SB 646, by Weber Pierson on prenatal multivitamins.

All right. Good afternoon. Thank you for the opportunity to present today. I want to extend my sincere thanks for the Committee and staff for their thoughtful engagement on this Bill. We accept the Committee amendments which will provide for the clarity and strengthen the overall Bill.

I am here to present SB 646, which would help protect maternal and fetal health by addressing toxic element contamination in prenatal vitamins, a critical but currently unregulated health risk. Prenatal vitamins are essential to supporting healthy pregnancies.

They provide vital nutrients like folic acid, iron, iodine, and are recommended in nearly every medical association for preventing birth defects and pregnancy complications. But we must also ensure that these multivitamins do not expose pregnant individuals or their babies to toxic substance.

Unfortunately, recent studies have revealed alarming levels of heavy metals including lead, arsenic, cadmium, and mercury, in prenatal vitamins. The GAO found lead in half all sampled prenatal vitamins and other independent studies have found products exceeding California's Proposition 65 limits. These toxic elements are well documented environmental contaminants.

Lead, for example, is unsafe at any level of exposure and even low levels during pregnancy are associated with miscarriage, stillbirth, low birth weight, and long-term developmental harm for the child. Despite this, there are currently no federal or state regulations requiring manufacturers to test prenatal vitamins for toxic elements or to disclose the results to consumers.

SB 646 fills the gaps by requiring manufacturers to test each lot of the bulk prenatal vitamin product for lead, arsenic, cadmium, and mercury. It would require public disclosure of testing results online beginning January 1st, 2027, and would prohibit the sale or distribution of non-compliant prenatal vitamin products in the State of California.

This Bill does not ban prenatal vitamins that may have toxic elements. It simply ensures that they are tested and transparent of their contents. It gives consumers and health providers the information they need to choose a safer option and incentivizes manufacturers to clean up their chains, other supply chains, and prioritize low-toxicity sourcing.

SB 646 simply empowers consumers with the truth. It aligns with federal testing definition and complements existing GMP protocols. We are also in open and ongoing discussions with stakeholders who have raised concerns about the Bill and we do remain committed to finding common ground and strengthening the Bill when needed.

Providing testimony here for SB 646 is Susan Little, Senior Legislative Advocate, for Environmental Working Group, and Dr. Trowbridge is staying with us, representing ACOG. I request an aye vote. Thank you.

Thank you. You'll each have two minutes.

All right. Good afternoon. Dr. Trowbridge, again, representing ACOG District 9. So, SB 646 is a critical measure to protect maternal and fetal health by ensuring both transparency and safety in our prenatal vitamins. One of the first questions I get at a prenatal visit is what prenatal vitamin should I take and what foods should I avoid?

Those are all important to us. As a physician, I routinely counsel my patients on the importance of prenatal vitamins. They're essential, again, as Dr. Weber said, for fetal development, maternal wellbeing, and it's simply—they're not adequate in an American diet.

These vitamins provide key nutrients like folic acid, iron, other micronutrients that help reduce the risk of birth defects, low birth weight, other pregnancy complications. They're essential to our care. Also, essential to prenatal care is counseling what to avoid.

I tell my patients that they should avoid foods that are high in like mercury or highly processed foods that may be higher in arsenic like salmon, but they unknowingly are likely ingesting mercury and other toxic elements in their prenatal vitamins.

When I make recommendations to my patients, I need to be certain that what I advise is both effective and safe. It's a matter of trust between a physician and a patient and that's why SB 646 is so important.

Recent studies have shown this deeply troubling information that these toxic elements have been found in prenatal vitamins and they're not negligible contaminants. Even low-level exposures can harm a developing fetus and cause these birth defects and delay developmental disorders—cause developmental disorders and developmental delays.

Given these risks, both patients and providers must have access to accurate and timely information about what's in these products before a recommendation or a purchase is made. This Bill is simple. It's just demanding transparency and it requires manufacturers to test their products and disclose the results so people can make informed decisions.

For these reasons, ACOG urges you to support SB 646 to empower consumers and protect future generations from preventable toxic exposures. I appreciate your time and I'm asking for an aye vote on this.

Thank you.

Good afternoon. My name is Susan Little. I'm the California Legislative Director for the Environmental Working Group, one of the co-sponsors of SB 646. Because toxic elements can harm children's nervous systems, extra caution should be taken to ensure that developing fetuses are not exposed to these elements.

However, the University of Miami study of over 150 prenatal vitamin products showed that the vast majority contained lead and cadmium and 75% contained more lead than the FDA allows in candy. Unfortunately, the state's Proposition 65 warning system does not give consumers helpful information about toxic elements in prenatal vitamins.

The Proposition 65 warning labels for reproductive harm caused by lead and cadmium are decades old and non-existent for mercury and arsenic and do not represent the most recent public health findings.

For instance, years after the Proposition 65 reproductive toxicity threshold for lead was set by state agencies, the Centers for Disease Control determined that there is no safe level of lead for children. But the threshold for Prop 65 threshold for lead was not updated, so consumers need better information.

Responsible prenatal vitamin companies already test for heavy metals, but no uniform standard or mandate requires it and most manufacturers do not publicly disclose their results. If enacted, SB 646 would empower consumers with crucial information while pushing companies to reduce contamination and improve product safety. Please support this Bill. Thank you.

Thank you. Are there any others in the hearing room who would like to offer their supports?

Ryan Spencer, on behalf of the California Academy of Family Physicians, in support.

Roxanne Gould with the American Nurses Association California, in support.

Karen Stout, on behalf of the California Nurse Midwives Association, in support.

Angela Hill, with the California Medical Association, in support.

Angela Pontus, on behalf of Planned Parenthood Affiliates of California, in support.

Zoe Tanner, on behalf of the California WIC Association, in support.

Nora Angelou with Children Now, in support.

And Christopher Sanchez with the Consumer Federation of California, in support.

Thank you. Are there any primary witnesses in opposition? Please come forward.

Thank you. You'll each have two minutes.

Margie Lee here on behalf of the Council for Responsible Nutrition. Good afternoon, chair and members. CRN is the leading trade association representing dietary supplements and functional food manufacturers as well as ingredient suppliers. While we appreciate the senator's intent with SB 646. Unfortunately, CRN is opposed unless amended.

Let me start by saying that manufacturers do not add these elements to their prenatal vitamins. Rather, many of the ingredients in prenatal vitamins, including critical nutrients such as calcium and magnesium, come from natural sources in the soil, many of which these elements, heavy elements, are ubiquitous.

So the same is true for fruits and vegetables, many of which contain trace levels of these elements due to soil uptake. We have two primary concerns that the bill is drafted. First, we're concerned that the bill may dissuade expectant mothers from taking prenatal vitamins when they see that they can contain heavy metals.

But perhaps more importantly, we're very concerned that the bill would attract expectant mothers to purchase prenatal vitamins that contain no or insufficient critical nutrients like calcium and magnesium. To provide an example of this, proponents of this measure have pointed to prenatal vitamins that contain or are promoting low heavy metal content.

But those prenatal vitamins don't contain sufficient levels of critical nutrients that expectant mothers need. For example, one contains no calcium and insufficient levels of magnesium. Another contains no magnesium, omega 3s, and insufficient levels of calcium. So in the end, expectant mothers taking those prenatal vitamins, we need to make up those shortfalls through their diet, eating significant amounts of food such as leafy greens, which also contain heavy level exposure.

The Senate Environmental Quality Committee analysis contemplated this, noting that if this bill were to be enacted, it's possible that manufacturers will remove key ingredients to lower levels of contamination while also removing critical nutrients if they're not available in other ingredients.

Analysis further stated that more engagement surrounding this concern will be necessary to ensure that by protecting pregnant individuals, policies aren't inadvertently hurting them. We know that we share this concern with the senator, and we are very confident that we can get to a right place and strike a right balance with this bill.

So looking forward to continued constructive dialogue.

Thank you. You'll have two minutes.

Good afternoon. Trent Smith, on behalf of the Consumer Healthcare Products Association, which is the companies who manufacture over the counter drugs and dietary supplements, like to associate my comments with Ms. Lee's comments.

We are concerned that if this bill were enacted as it currently is drafted, that it will become a detriment to public health rather than a positive in the fact that, again, expectant mothers may be attracted to a particular product that's marketed as heavy metal free but may not contain the nutrients that I think we all can agree on are important for an expectant mother, especially when you consider some of the products that we consume on a daily basis.

And the doctors recommend spinach, leafy greens, all contain traces of heavy metals, and yet we're not contemplating any labeling requirements for those types of products. I think most people agree those are good, healthy products and dietary supplements, prenatal vitamins in particular, have been used safely for decades.

And we want people to continue to use those products for good health. And we're just afraid that this could be misinterpreted by consumers and have the opposite effect of what I think the author intends. So we remain opposed.

We have had discussions with the author going back to the senate and we're now here in the assembly and hopefully we can come to a resolution very, very soon. Thank you.

Thank you. Are there any others in opposition? Please come forward.

Madam Chair, Anthony Molina on behalf of the Natural Products Association in opposition. Thank you.

Thank you. Seeing no other opposition, I will bring it back to the committee for any questions or comments. Assemblymember Schiavo.

Thank you. I want to thank the author for this. It's pretty shocking, the statistics that you shared and really concerning. I guess, can you address the comments made by opposition? I hear them saying trace elements, trace elements. So what is there a difference between what you're trying to require and what they're talking about is in spinach.

Thank you. I will let Susan Little answer that from the Environmental Working Group.

Of course. So trace elements of these toxic. Excuse me, low levels of these toxic elements can be found in different source elements, sources, but it all depends upon what the, where the origin of the sources are.

For instance, in the study that was done by the University of Miami, they found that 25% of the prenatal vitamins had less than 18 part per billion lead, and some of them had as high as 900 parts per billion lead. So it's all about the source materials, the raw materials that are acquired.

And many of these companies already test their source materials to make sure that they have low levels of these toxic elements. And that's essentially what would be needed, is for them to just be more cognizant and more intentional about the source materials they use to create, to produce their vitamins.

And to that point, like I stated in, in my opening statement, this is not a bill that prohibits any prenatal vitamin. However, it does require more transparency and openness for providers and also for patients.

So that if I'm going and I'm seeing something that has less toxic chemicals or elements in there, I may choose that one that does have the full gamut of all of the nutrients that I need and that my OBGYN is recommending, but has less than another one that has, as she was stating, you know, nine times more than what the other one has.

So this is about transparency. This is about patients having the opportunity to choose something that is safer and healthier and ultimately hoping that since you can find some that do a better job, that have all of the nutrients that are needed, that more people would source from a something that was cleaner and safer.

Thank you. Assembly Member Krell.

Thanks so much for your expertise on this and for bringing this bill. Senator, this is a follow up on my colleague's question and I guess just kind of thinking through the opposition argument here. Are you not concerned that products may forego important nutrients like calcium because they're concerned that then they would have to also disclose lead and that could dissuade patients from seeking those products?

Thank you so very much for that question.

I am not concerned that a prenatal vitamin would then automatically or company would say, well, we're not going to include calcium or something, because as a pregnant patient or even as a patient, I'm looking at the bottle to see not only are there potential toxic elements if this bill were to pass, but also what elements are in there.

And so if I see a key ingredient missing, then I would not purchase it. Just like now. When you're getting a prenatal vitamin, you're looking for something or a vitamin and you're looking for something specific. If you go to one that doesn't have what you're looking for, you won't purchase it.

You'll get one that has all of the elements that you're looking for.

Assemblymember Patel.

Thank you for bringing this bill forward. There have been multiple times in my life where I've had to go hunt for prenatal vitamins that have all the things that my physician recommended that I had in them.

And thankfully I was able to find those specific bottles with the omega and the appropriate amounts of folate and everything else. I appreciate you bringing this bill forward.

I do have a couple of questions and I think I see that you are working with the opposition to make sure we do get this right, because we want to make sure that the product supply chain is available.

I'm guessing we're working on making sure that when this law takes effect that there will be manufacturers out there making it.

So what do you see as the cost benefit analysis between getting enough of these nutrients and perhaps having patients pay a little bit more to find that more pure sourcing of those minerals and vitamins in a prenatal vitamin pill? Versus the cost, frankly, of being exposed to higher levels prenatally of lead and whatever other arsenic.

I will let Susan Little answer it in just a moment. I see her looking at me, but I think what we're seeing right now is, unfortunately, another area of inequity based on socioeconomic incomes.

So right now you may be able to go and find that one that has all of the nutrients that you need and is sourced by a more environmentally company conscious company that has less toxic, toxic materials, where someone who doesn't have those resources has to go and get something that has much more heavy metals in order to get that.

So this is something that would allow for, like I said, transparency with the hope that everyone in the very near future would be sourcing from more environmentally conscious areas where all of the toxicity levels will be as low as possible and everyone, regardless of your socioeconomic status, will be able to get the same type of prenatal vitamin.

And that's not what we're seeing today. In our first hearing, we had Hilary Swank come in and testify on behalf of this bill. And what she can look for is very different than what the vast majority of pregnant women can get. But I will turn it over to Susan Little.

I'll just add that the bill that was similar to this, that was passed several years ago, that requires testing and disclosure for baby food, that has since been implemented. And we have not seen a rise in cost of baby food, nor have we seen people not buy baby food, nor have we seen a lack of baby food.

So I think what we've seen instead is that companies are being more intentional about their raw materials and have been working to reduce their levels of these toxic elements in those products.

Thank you for pointing out that other example. I think that's helpful when we talk about what the opposition is concerned about. It's helpful to know that we do have very responsible manufacturers who will work to make sure that the basic ingredients meet the levels of purity required and are necessary for women who are pregnant. Another basic question.

And, senator, maybe you can help me understand this. I just don't know the answer to this question. I could probably look it up, but you're the expert in the room. I'm guessing prenatal vitamins aren't. Are they covered under MediCal or insurance currently?

Generally not, but occasionally they are. And so anytime like I can send a prescription, I try to, but often it ends up being an over the counter and then the prescription is limited to whatever that pharmacy has in supply.

It's like a 1, 1 item shop and we often don't even know what that like item is going to be.

Yeah, it's very insurance dependent. The vast majority of patients do end up paying for it over the counter and those that do are able to get it from prescription. It is a basic generic type. And so again, this bill would actually assist in those individuals as well.

Certainly the equity issue is very important to me, making sure all mothers have access to appropriate prenatal care. Thank you.

Thank you for that question. I actually was just conferring with our consultant, our chief consultant here because we did just in the state of California in the budget act that we just passed is under review whether or not MediCal would cover over the counter prenatal vitamins.

And I think that's something that we have our budget sub chair here who's going to sure look into that more. Senator, I want to thank you for bringing forward this bill. It was certainly offered a lot of robust conversations in committee and with some of the stakeholders involved here.

I think one of the areas that was raised by the opposition that I also think warrants some addressing is this concept that the prenatal vitamins that are currently on the market that do not have the trace levels of lead, arsenic, cadmium, and mercury and others also do not have the requisite level of nutritional value that they need in order to be considered a prenatal vitamin.

This bill as it stands now, I think our recommendation was that that essentially kind of falls outside of the four corners of this piece of legislation. But can you just speak to the need to also address that product out there that doesn't have the correct levels that we need?

Yeah, so those are, that is a part of our discussion because we definitely don't want anyone to be taking any prenatal vitamins that do not have the basic elements that you need or that we as obgyns recommend. And so that has been a part of our conversation and we, we will figure out how to fix that.

Great, I appreciate that. And I also just want to thank you for bringing this forward. We had a similar bill last year on a related topic. Well, actually it had nothing to do with vitamins but had to do with what pregnant people ingest, and they turn out to be very complicated.

So I always appreciate when we have a practitioner who can walk us through the implications of these pieces of legislation to be able to move forward. I just want to ask another question, if it's okay.

So what, as an OBGYN, do you tell your patients regarding prenatal vitamins and the consumption of their other kind of the rest of their diet?

So I think my colleague kind of touched on that. As to what we say, we definitely recommend prenatal vitamins. And. And honestly, prior to this bill, I hadn't even thought about the fact that there were toxic levels of mercury and cadmium and all of those things. So definitely recommend prenatal vitamins actually prior to conception.

I mean, before you get pregnant. And you have to be very careful of very processed foods, deli meats, watch the amount of salmon, and other kind of fishes that you're eating because of the contamination that they have.

But there's no expectation that a prenatal vitamin provides all of the nutrients.

Oh, no. No. And we definitely never tell anyone that all you need to do is only take prenatal vitamins. You definitely need to continue with your regular fruits and vegetables and your. And your leafy, you know, your greens and things like that.

But we never, never tell anyone that all you need is your prenatal vitamin, just like we don't tell people all you need is daily multivitamin.

And it is the case that some of those leafy greens might also contain the trace elements that we.

Depending on where they're sourced from.

Yeah, well, thank you for that. I appreciate that. I think we have quorum now, so we'll establish quorum so that we can vote on the, on the bill.

[roll call]

We have a quorum and for SB 646. Senator, would you like to close?

Really appreciate the robust conversation we've had here and respectfully ask for an I vote on SB 646.

Moved by Chen. Seconded by Krell. Secretary, please call the roll.

The motion is due pass is amended to Environmental, Safety, and Toxic Materials Committee.

[roll call]

That measure's out. And while the Senator is still here, we'll go back to file item 1, SB32. That has a motion and a second. Please call the roll.

[Roll Call]

That measures out as well. Thank you so much, Senator. We'll move on now to a vote on the consent calendar moved by Coloza, seconded by Patel. Please call the roll.

[Roll Call]

The consent calendar is out. We'll move on now to item 5, SB313 by Cervantes. Thank you, Senator. Whenever you're ready.

Thank you, Madam Chair and committee members, for the opportunity to present Senate Bill 313. I'm committed to continuing to work with the Department of Public Health to ensure the confidentiality of parent birthplace information is upheld by this bill and to explore any further avenues necessary to ensure its intent is met.

SB 313 is a vital step toward protecting the privacy and security of California families. It makes a straightforward but important change. It moves the birthplace of a child's parent from the publicly accessible portion of a birth certificate to the confidential section, accessible only by authorized individuals. This is more than an administrative fix.

It's a matter of personal privacy and data security, especially in a time when sensitive information is too often weaponized. What might seem like a small detail, the birthplace of a parent, can be misused to target, profile, or discriminate.

Current law requires each live birth to be registered with the local registrar of births and deaths for the district in which the birth occurred and prescribe specific information to be listed within on a certificate of live birth, including the full name, the sex of the child and the full name, birthplace, and date of birth of each parent.

This bill does not interfere with data collection or public health reporting. It simply ensures that information such as parents' birthplace is treated like any other sensitive personal data, kept confidential, but still available to authorized public health officials and researchers as needed.

The California Department of Public Health already maintains a confidential section on each birth certificate for public health purposes. This bill moves the birthplace information of the parents to that protected section aligning with Best Practices for Data Privacy. it is important to note SB 313 does not limit the Department of Public Health or the Office of Vital Records from verifying documents or authenticating certificates. It preserves their authority while enhancing legal safeguards around personal information.

Additionally, the parents, the child, and any person who has petitioned to adopt the child can obtain a copy of the confidential portion of the birth certificate so official proof of the parent's place of birth will still be available to the child in their birth or adopted parents if needed.

SB 13 is about balance, preserving the integrity of public health data while fiercely protecting personal privacy. It upholds our values and reflects our responsibility to defend every Californian's right to dignity and security. It is narrowly tailored approach that balances transparency with privacy and respectfully asks for your aye vote.

Thank you, Senator. Are there any others in support of this measure would like to speak on the bill.

Rosenberg. On behalf of Oakland Privacy, we support the Bill and we've asked for one little tweak in the language and we'll be talking to the author more about that.

Thank you. Are there any primary witnesses in opposition to this Bill? Seeing none. Are there any in the hearing room who would like to oppose this Bill? Seeing none. I will bring it back to the Committee for comments or questions. Moved by Crell, seconded by Addis. Senator, I want to thank you for bringing forward this Bill.

Certainly in this current environment, it's incredibly important that we are looking at the full protection of all of our rights and citizenship as Californians. Certainly with the Federal Government Administration removing other forms of legal status as a precursor to deportation, this type of Bill is all the more important for our Californians here.

And I want to thank you for your leadership in bringing this forward. With that, would you like to close?

Thank you so much, Madam Chair, for the support and your continued leadership. Respectfully asf for your aye vote.

Thank you. We have a motion and a second. Secretary, please call the roll.

[Roll Call]

That measures on call. Senator, thank you. We can move on now to item number four, SB 297 by Hurtado. Senator. Senator.

No. Yeah, there we go. Good afternoon, Madam Chair and members of the committee. Today I'm here to present SB 297, which requires the California Department of Public Health to annually analyze and identify regions with high rates of valley fever and to publish a list of high incidence regions.

At the outset, I would like to thank the Chair and committee staff for working with our office to strengthen this bill. We will be taking the proposed committee amendments in Assembly Judiciary. As many of you know, the Central Valley home to many farm workers, many of them also often battling valley fever. Many of them go undiagnosed, untreated.

And there's a lot of heartbreaking stories of workers pushing through weeks of illness just to keep food on our tables. They deserve better. As climate change expands, valley fever is no longer a regional issue. Cases are rising, especially among outdoor workers and vulnerable populations. Yet the disease remains widely under diagnosed. This is not just a health issue.

It's an economic one. Missed worked high medical bills and long-term health problems hurt our workforce and our communities. About 200 Americans die each year from valley fever. More action needs to be taken. Today I have with me Dr. Thompson, the leading expert in valley fever and fungal diseases from UC Davis.

Thank you, Doctor. You'll have two minutes.

Hi, good afternoon. I'm Dr. George Thompson. I'm a Professor of Medicine at UC Davis Medical Center and I'm the Director of the UC Davis Center for Valley Fever. And I'm tasked with the research and care of patients with the most severe forms of disease from not only locally but across the globe.

With the advent of telemedicine, there's some essential parts of this bill I think are really important. Valley fever, as most of you know, is named after the Central Valley of California where it's got its name. But the biggest incidence and change is in San Luis Obispo County.

Now the disease has very quickly spread to new areas of California and also far northward. We see cases now locally acquired in Redding. And with climate change, we're seeing cases move further and further from their typical regions, such as in South Sacramento when we have wind events and other storms. We see locally acquired cases now as well.

So, a further understanding of the epidemiology disease is really a big part of this with what's tasked with the California Department of Health with testing and reporting; I think that's really essential as we can educate physicians and patients alike. A lot of our physicians do move from non-California places here.

So how to educate both them and the patients is really of paramount importance in this. And then the complicated patients I see are typically those who have a delayed diagnosis. So having those patients diagnosed earlier is really essential for the care of these patients.

If we can get them on therapy earlier, their symptoms will presumably decrease more rapidly and get them back to work, back to school and the things they need to be doing. Thanks so much.

Thank you so much. Are there any others in support of this bill? Please come forward.

Nasset Short on behalf of St. Agnes Medical Center, in support.

Thank you. Are there any primary witnesses in opposition? Thank you. You have two minutes.

Hi. Angela Hill, California Medical Association. I'd like to start by thanking the author and the Committee staff for their work on this bill. CME is just reviewing those amendments and just have a couple outstanding items and then with that we'll move to a neutral position. Again, really want to thank the committee.

And the author for all of her work. Thank you.

Thank you. Are there any others in opposition? Seeing none. I'll bring it back to the committee for any - oh.

Thank you. Madam Chair. My apologies. I'm Farrah McDaid Ting on behalf of the County Health Executives Association of California. We're opposed unless amended. We appreciate the author's work with us. As well as the committee staff's analysis on this bill. But there is a new mandate for local health jurisdictions -

Thank you for your testimony.

Thank you.

Seeing no others, I will bring it back to committee for any comments or questions. Assemblymember Addis.

I want to thank the author for bringing this forward. I know that Valley fever started in the Central Valley, but it has quickly spread to the Central Coast where I represent in Monterrey and San Luis Obispo and much to the southern part of the Central Coast. And so really appreciate all that we can do to get a hold on this.

It's been very, very detrimental to our communities. So, thank you and I support and I'm happy to move the bill.

Moved by Addis. Seconded by Patel.

Oh, sorry, a question. Go ahead. Assembly Member Patel.

Thank you for bringing this bill forward. It addresses a critical concern, and I see you care very deeply about your community, and I like to see when bills come directly from work in the community. I do have a few questions.

Looking through the bill in light of you accepting amendments that are coming your way from the opposition or being open to that. What does adding a screening - what is the screening? What does adding a screening mean when we say that there will be a screening or a test when a patient comes in?

Yeah, that's a great question. So, we in partnership with the CDC, have proposed, and it's been published now, the algorithm for screening for all patients. It's a simple blood test. There's a very rapid one that's done at the large reference labs around the country. And then there's a confirmatory test after that.

And that's done by three labs around the country. So, I don't think there's a workflow issue. All those labs could easily handle 100-fold more volume.

So, does that mean when a patient comes in and presents with fever of some kind, not knowing the source of that fever, they would automatically be sent to LabCorp or some kind of lab, maybe an internal clinic lab for a blood draw, be sent home, quarantine? I don't know. It's not contagious.

Not contagious; no.

And then wait two days for their report to come back?

Yeah, that's a - that's a big debate actually in our field is what do you do in the interim before those results come back. And that's very physician dependent. Some will go ahead and treat people empirically for valley fever, even before the tests are back and some don't.

And that really depends on how sick the patient is at that time. You know, if they're going to be in the hospital, they're probably going to be treated initially and then when the test returns, we can tailor that accordingly.

And then this would be - it wouldn't be automatic. It would be based on what their exposure might have been.

Yeah, I think based on symptoms. So, in CDC and us, we wrote a paper actually in the Annals of Internal Medicine that took to task a little bit our national pneumonia guideline because they're very East Coast focused. But in the Central valley of California, if you have pneumonia, there's a 1 in 4 chance it's valley fever.

And that's across the board, every ER urgent care clinic. So, if your incidence is that high, really, all those patients should be tested for valley fever to avoid these three-to-four-month delays in diagnosis that's so frequent in these patients.

Okay, thank you. I'm from San Diego, so valley fever certainly hasn't reached us; yet is the operative word. But we don't see a lot of this in San Diego, so a lot of this is new to me. What is the enforcement mechanism?

If this is going to be a new requirement that physicians provide, how do we ensure that patients are getting this screening?

I can tell you my opinion, but I think giving physicians their data and compared to their peers is the most effective thing to do.

Typically, it's not as heavy handed and there's a little bit of embarrassment, frankly, when they see, "Oh, my peers are testing this percent with this percent of positivity, which shows they're pretty good at telling who has the disease." And you do like to compare yourself to your peers.

I think that would be the best sort of measurement for success with this.

Thank you. And then I'm assuming that the testing, the screening is covered under current health insurance and Medi-Cal as well. Is that correct? Okay.

And then with all of this in mind, I want some assurance that you're going to continue to work with opposition. Our medical providers do have boots on the ground experience of what this all entails and look forward to seeing that work come forward as it approaches the Assembly Floor.

Yes, absolutely. You have my commitment. I'll continue to working with anyone that has any concerns. I always have an open-door policy. And I will say that part of the reason why I bring this bill forward, I have a different bill also that focuses more on wastewater testing.

But part of it goes back to people in this region that where there's high, you know, incidence rates Just the information is not there, and the testing is not adequately there either. And so, we're just trying to do more for the people in those regions with high incidence rates and hoping to have your support today.

Thank you. Thank you. One final question. How do symptoms of valley fever differ from other flu-like symptoms? How would a patient know to not just rest it off, but to instead go seek medical care where they can be provided an antifungal?

Yeah. The symptoms are almost identical for the vast majority of patients. They have a fair range, they can be very mild, or they can have pneumonia and be admitted to the hospital for uncomplicated pulmonary infections. There's a few that are really key.

Like if they have nodules over their legs, that's almost always valley fever in the appropriate clinical circumstance. And then they have a particular blood cell type that pops up on their blood work that suggests it's valley fever. But that's not always present. It's probably only present about 5 to 15% of patients. Other than that, the symptoms overlap.

So COVID was a big problem to diagnose valley fever. We couldn't tell if this COVID is this valley fever. Is it from the wildfire smoke that year? So, the symptoms are indistinguishable for most patients.

Thank you.

Thank you, Senator. I think I very much appreciate you bringing this forward.

And my sense is after we've had an opportunity to consider the well put forward the amendments that you are accepting this bill and the screening and subsequent testing for valley fever also very much, very closely mirror what is in place already for TB and hepatitis B and C.

And my understanding is that the concerns raised by the tweeners right now really more relate to issues that are under the purview of Judiciary, less so in this committee is my understanding. So, with that, I want to thank you for bringing this forward. I did have a -

While we were reviewing this bill, there was this kind of potentially subjective point around the high incidence of, you know, where it exists and where it should be tested.

And very helpful to hear from the testimony, witness testimony here that we're also seeing incidents of this grow in San Luis Obispo and Redding and even in parts of South Sacramento. So, this is a growing concern.

I know that this was born out of your deep concern for your constituents but want to thank you for being concerned for others that are going to be facing this as well. With that, Senator, would you like to close?

Thank you for the questions, for your work in improving this measure and I respectfully ask for an aye vote.

Thank you, and this is getting going next to Judiciary. We have a motion by Addis, second by Krell. With that Secretary, can you please call?

The roll motion is do pass to the Judiciary Committee. [Roll Call].

That measures on call. We'll move on now to item number 6, SB 324 by Menjivar, regarding Medi-Cal, enhanced care management, and community supports. Whenever you're ready, Senator. Senator, press the button.

It's been a whole year since I've been here. Okay, thank you, Madam Chair. I'm going to be here on this chair for the next three presentations. So, bear with me. On—the first one is SB 324.

Colleagues, we've all, for decades been wanting to just revisit, to modernize, to reinvent, to ensure that Medi-Cal is really reaching everybody's needs. It's holistic. The approach gets out—not just the one concern that people come to see providers with, but what is causing that concern.

And CAL AIM aimed to do that, to ensure that we do an enhanced care management approach that is sort of a full-service partnership approach, that the individual is getting everything that they need. Now, enhanced care management are individuals that are contracted with our managed care plans to do this work, to meet the community member where they're at.

And the whole intent was that they would be in the community themselves, that they would look like the community. They would be those trusted messengers. Perhaps those are the promotoras, community health workers that people know so well.

However, recent studies and reports have showed that more than 50% of the contracts that managed care plans are contracted with are for-profit entities. And it's trending up to 67%. And of that, approximately 13 or 15—15%—are those that are getting contractors out of the state.

So, what you have in your community are managed care plans that are contracting with entities in Arizona and other states to provide care in your backyard. I think we need to change that.

The whole intent, again, like I mentioned, is for our managed care plans to reach out and contract with entities that are in people's backyards that know them, that have a physical person presence there. So, that's what SB 324 is looking to do.

We want to make sure that we require Medi-Cal plans to contract with community providers if they are available in that county, have experience providing that service, and meet other Medi-Cal provider requirements. We want to standardize and streamline templates. We want to make it as easy as possible.

Recognizing that not all nonprofits are used to contracting with managed care health plans are used to getting funds on a grant basis, we want to make it easier for them to contract with them. We want to require DHCS to issue guidance to clarify how community providers may use an intermediary to assist with planned contracting and claims.

What exists in California are called hub models. These are the entities that come in and help the nonprofits do—have them do the service—and these hub models do the administrative work, the billing, that these community partners just don't have experience with. And we want DHCS to publish additional data about hands care management and community supports and resources.

And lastly, we want to require DHCS to review that data to ensure that the plans are contracting with an appropriate level of community providers. Bottom line colleagues, we want to make sure that the entities that are being contracted to do this work to uplift are most vulnerable are from the communities.

They know the community and know what are the issues are present in this community. Madam Chair, now, I would like to turn over to my witness for testimony.

Thank you. You'll each have two minutes.

Hello. It'll just be me speaking, so I might be a couple seconds over the 2 minute mark. Thank you for the opportunity to speak about SB 324 and the importance of prioritizing local nonprofit CBOs for CAL AIM contracting. My name is Gianna Wright. I'm a Senior Assistant Director at a local nonprofit called East Bay Innovations.

We serve clients throughout Alameda County who are medically complex, experiencing homelessness, primarily seniors and people of color with little to no social supports. As a nonprofit working with clients in the same communities that we work and live in, our services are more effective because of our familiarity with local resources and our experiences within these systems.

We've established strong working relationships with local affordable housing CBOs and housing authorities. That's led to securing 140 units for people living in skilled nursing facilities. Being able to visit these skilled nursing facilities in person has really helped us develop strong relationships with the staff members and has allowed for more effective collaboration efforts in the transition process.

Through the utilization of community supports and our experience within these local systems, we've been successful in transitioning 12 clients in just the last three months from these nursing facilities to independent housing. And we've also transitioned more than 300 individuals over the past 15 years to ensure the safety of our clients in their units.

We've built relationships with local contractors who have expertise in modifying units to meet each person's unique accessibility needs. We also know the medical clinics and the providers very well, so we're able to assist clients making informed decisions about their healthcare needs and what would be a good match for them.

We have a partnership with a pharmacy that provides multi-dose packaging and offers delivery which results in reduced medication-related ER visits for our clients. We assist our clients in accessing a wide variety of local resources and services including transportation, food resources, mental health supports, caregiver connections.

Really just anything they need to ensure they can live independently and avoid institutionalization. Meeting clients in person is a crucial aspect of providing successful transition services and ECM case management, as opposed to services that are mainly delivered by phone or zoom.

When we interact in person, whether it's with the clients, their providers, we can build relationships based on trust and our services are more effective. For example, over the phone, clients may tell us they don't need help, they're doing okay, but when we visit them in person, we see that that's not the case.

Maybe their unit is unkempt and there's safety issues. So, then, we're able to intervene, see what gaps in their care plans they have and adjust accordingly. Being able to assess clients in person is the only way to have an effective care plan, giving them the best chance to thrive and avoid unnecessary hospitalizations. Thank you.

Just my last little thing. We live and work in Alameda County. So, we feel as though we're the most qualified and prime to deliver these services and advocate for our underrepresented and marginalized community members. Thank you very much.

Thank you.

Just here for technical support.

I forgot to say I am taking the Committee amendments.

Thank you. Appreciate it. Are there others in support?

Yes. Darby Kernan, on behalf of Series Community Project, has pulled together over 40 community based organizations. We are called the CBO Medi-Cal Coalition. We're in support of SB 324 as well as for Community Health Works and Leading Age California. Thank you.

Thanks.

Good afternoon, Madam Chair and Members. Jennifer Fearing here on behalf of California Association of Nonprofits, Cal Nonprofits, a proud member of the Coalition and co-sponsor. We urge your support.

Vanessa Hina on behalf of...the statewide network of promotoras and community health workers, here in support.

...with the California Alliance of Child and Family Service, in support as a proud co-sponsor.

Kim Lewis on behalf of Espirinet and the California Coalition for Youth, in support.

Whitney Francis with the Western Center on Law and Poverty, in support.

Katie Jennings, on behalf of the Children's Partnership, in support.

Danielle Parsons, with the California Assisted Living Association, in support.

Good afternoon. Andrea Mavisca, on behalf of CPCA Advocates, in support.

Good afternoon. Omar Altamimi, on behalf of the California Pan Ethnic Health Network, in support.

David Knight, the California Community Action Partnership Association, in support.

Hi. Jason Moriarty, Partners in Care Foundation, a community-based organization and hub, in support.

Hi. Andrea Doss, Senior Assistant Director with East Bay Innovations, in support of this Bill.

Thank you. Are there any primary witnesses in opposition? Please come forward.

Good afternoon, Mira Morton here with the California Children's Hospital Association in an opposed unless amended position. I want to appreciate the author staff, and the Committee staff's help over the last couple of days. I think we do have amendments in the Committee amendments that will address our concerns.

Children's hospitals are not considered community providers or local entities and so we wanted to ensure that they could continue to provide ECM services to children in the California Children's Services Program. They're currently prioritized for presumptive authorization under DHCS's policy and the Committee amendments will help ensure that that policy can continue to be enforced.

So, we will likely be removing our opposition once those amendments are in print. Thank you.

Hello. Rebecca Sullivan, Local Health Plans of California. We have an opposed unless amended position today but want to thank the author and the sponsors for some really great dialogue recently and hopeful that we can get to a place of resolution.

Thank you. Any others who would offer a me too in opposition? Seeing none. I will bring it back to the Committee for any comments or questions. Assemblymember Patel.

Thank you for bringing this Bill forward. I share a lot of your concerns with not being able to rely on our community providers who are known and trusted by the patients in the community. Also, your concerns around privatization and out of state providers providing that care. I share those concerns with you.

I am—my questions were really regarding the children's hospital and that presumptive care part of it. So, thank you for accepting those amendments and thank you to our Chair for leading that conversation with the author. I would like to move the Bill.

Moved by Patel, seconded by Sanchez. Assemblymember Caloza.

Thank you, Chair Bonta. Also just wanted to echo similar comments to Assemblymember Patel.

I thank the author for your work on this and thank you for working with some of the concerns from the opposition and just wanted to say I appreciate your thoughtfulness in why we need a Bill like this and how important of having, you know, community based organizations at the table, especially those like the promotoras that you mentioned.

And I think you and I, our paths cross in the LA Mayor's Office when we were doing the Health for All implementation and how important that uptake is for a lot of the health initiatives and programs that we're working to implement at the local level.

So, I would also love to be added as a coauthor and thanks for addressing the concerns from the children's hospitals. Thank you, Chair.

Thank you. Senator, thank you for bringing this Bill forward. I think the vision for CAL AIM was one where we would have local community-based organizations really being able to provide the frontline services and direct community supports to that we know are so critical.

And I want to thank you for bringing forth this Bill and for working with the Committee to look at some of the concerns that we had on a couple of aspects in strengthening this Bill for sure. With that, would you like to close?

Thank you so much, Madam Chair. We're working with, working with me and my team on getting, you know, especially Children's Hospital LA, an entity that is really necessary and beneficial for so many other individuals. The goal wasn't to exclude them, but the goal was just to elevate the local community-based organizations.

Assemblymember Caloza, you hit it on the nail. Given my small experience in the community with nonprofits and seeing the work firsthand of how beneficial it is to have those trusted messengers bringing that health information to the communities and having them actually open the door for them is imperative to ensure that we're elevating our most vulnerable.

With that, respectfully asking for an aye vote.

Thank you. We have a motion, a second. Please call the roll.

[Roll Call]

That measure's on call, Senator. We will move on now to your second item for the hearing, item number eight, SB 418.

Great. SB 418, now amended, has two crucial provisions. It's looking to continue access to essential healthcare in California. The first one, it's looking to codify Section 1557 of the Affordable Care Act into state law, and Section 1557 is very--it touches on a lot of things, and one of the things that it does is enshrines basic protections from discrimination in any health program or activity that receives government funding.

So what does that mean? You can't be discriminated based on your ethnicity, your race, your sex, your sexual orientation, your gender, and so forth. The second part of this provision that was added in the second House here is that we're looking to do what was done years ago with SB 999, where people were--where individuals were allowed to get a prescription of up to 12 months for contraception.

But in this case, we want to make sure that that same could apply for individuals who depend on hormone therapy--HRT, as I'll be mentioning moving forward--to be able, given a provider prescription deemed medically necessary, a prescription of up to 12 months to obtain HRT and have it be covered by health plans.

So why is this needed? Well, in the six months, a lot of executive orders have come down and one of the executive orders looked to direct, to do research on how we can remove or how the federal government can remove Section 1557 from the ACA.

Obviously, State of California, we lead and are proud ourselves in ensuring that we are always leading with anti-discrimination in anything we do, especially when it comes to healthcare. That's a human basic right and we shouldn't discriminate anyone, regardless of anything.

Additionally, a lot of misleading and false information aimed at restricting gender-affirming care has had grave consequences in California, and it doesn't just impact the LGBTQ plus community. When we think about gender-affirming care, we're also grouping in individuals who are eligible to have menopause. Makes up about 51% of our population.

Hormone--our HRT is used for women who are perimenopause or in menopause, has endless amount of studies that show the benefits in reducing the impacts or the symptoms that are associated with menopause, but what's happening right now is that the wait time on average is six months to see a provider.

People are worried that they're gonna get their prescriptions, have--be cut off in the middle of their treatment, and when it comes to LGBTQ plus individuals, predominantly trans individuals, you have to be on HRT for two years before you're eligible for gender-affirming care. If you're cut off, that time, that clock starts all over again.

So it's imperative that we lead with something that is not unprecedented, that's been done already before, ensuring that we bring some relief to individuals who depend on this, and we wouldn't be the first state. The State of Washington has already pushed forward legislation that would allow up to 12 months of HRT for individuals.

And again, these are individuals that, yes, are trans, but also people who are undergoing cancer treatment, and like I mentioned, menopause individuals who have hormone deficiency, needing treatment for conditions like hyperthyroidism. People are stockpiling hormones, they're rationing their hormones, and they're seeking care in an unregulated market.

This bill will help to first--to one: enshrine anti-discrimination in our statute and allow for the 12-month prescription. Madam Chair, now I'd like to turn over to my witnesses who will speak in support of this. Thank you.

You'll each have two minutes.

Thank you. Thank you and good afternoon. My name is Christine Smith. I'm a lesbian cisgender woman and an IVF patient. I'm also a Policy and Legislative Advocate at Health Access California who does support this bill. I'm proud to be here to support SB 418.

IVF in general and specifically hormonal medications have faced federal threats, but these threats to transgender people have the capacity to also threaten cisgender people, including people undergoing IVF. I started my fertility journey in 2021. As anyone undergoing fertility services can attest, this process is hard financially, emotionally, and physically.

I am thankful to have had access to both fertility services and medications, including estrogen. In June of 2022, I had my first IVF transfer, which resulted in an early miscarriage. Further testing showed endometriosis, so I was placed into chemically-induced menopause for two months to limit my body's production of estrogen.

In January 2023, prior to my next IVF transfer, I started twice a week intramuscular estrogen shots along with daily progesterone shots, as well as a combined progesterone and estrogen daily medication. Thankfully, the transfer was successful and I continued these shots and medications until 11 weeks of pregnancy. I'm grateful for the access to these medications.

They supported the growth and development of my beautiful daughter, now a toddler. In January 2025, in order to give my daughter a sibling, I repeated this process. I'm in the middle of another transfer cycle, including daily intramuscular shots and twice weekly estrogen. With luck and science, this will support another sweet kiddo who will be able to play and laugh with their big sister. I urge you to support this important bill.

Thank you.

Good afternoon, Madam Chair, committee members. Jonathan Clay, here on behalf of Trans Family Support Services and the Alliance for Trans Youth Rights, proud to be co-sponsors on this important measure. Trans Family Support Services represents--works directly with around 2,500 families both in San Diego and throughout California.

We even work with families outside of California, nationwide. The number one issue facing our families are that they're worried about the rollback of healthcare options by the current federal administration.

Between the federal administration pushing policies that target transgender people of all ages or the pullback by providers in providing necessary healthcare or those providers limiting access to that healthcare, our families are extremely concerned about how they will ensure that they have access to healthcare for their families.

Many think about trying to, as the Senator talked about, stockpile these medications in order to ensure that they have timely access to it. This ties into also the federal administration making decisions that get challenged in courts, which again, then creates some uncertainty around those families being able to access these necessary medications. Great example is that court process.

Our families are worried about being caught in limbo while the federal administration takes actions related to patient rights, which necessitates the involvement of the courts. Having more than one month's supply of necessary medications is very critical for that, same with if you happen to be a family going to one of the providers that have pulled back, that scramble to try and find a new system that will provide that healthcare or doctors. Again, having that more than one or two months worth of supply is very critical.

So in short, SB 418 ensures that all people have access to necessary healthcare here in California. SB 418 also allows for a longer supply of necessary medicine, but nothing in the bill gets in between the dialogue between a family and their healthcare provider about what's necessary in that process. It just provides that option for being able to have a longer supply of the medication. Thank you.

Thank you. Are there others in support? Please come forward with your name, affiliation, and position on the bill.

Good afternoon, Madam Chair and members. Kathy Van Osten, on behalf of the American Association of University Women of California, in strong support.

Vanessa Cajina, on behalf of the California Academy of Family Physicians, here in support.

Whitney Francis with the Western Center on Law and Poverty, in support.

Tracy Rosenberg, on behalf of Oakland Privacy, in support.

Katie Jennings, on behalf of the Children's Partnership, in support. Thank you.

Sumaya Nahar, on behalf of the California Dental Association, in support.

Malik Bynum, on behalf of the County Behavioral Health Directors Association, in support.

Angela Pontes, on behalf of Planned Parenthood Affiliates of California, in strong support.

Matt Lege with SEIU California, in support.

Craig Pulsipher, on behalf of Equality California, proud co-sponsor, in strong support.

Nora Angeles with Children Now, in support.

Sofia Bastida with PODER SF, in strong support.

Guadalupe Rojas, on behalf of Mid-City CAN, the Women's Foundation California, in support.

Andrea Amavisca with CPCA Advocates, in support.

Omar Altamimi, on behalf of the California Pan-Ethnic Health Network, in support.

Alison Pennington, community member, in support.

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

Thank you. Are there any primary witnesses in opposition? Please come forward to the desk here. Thank you. You'll each have two minutes. You have to press the button to make sure the microphone is on.

Is this on?

It is now. Thank you.

Good afternoon. I'm Beverley Talbott. I speak today as a member of Our Duty and as a football-playing tomboy who grew up to be a lesbian. Most gender-dysphoric adolescents are same-sex attracted, 70% of girls, 60% of boys, and a whopping 69 out of 70 kids in the Dutch study that pioneered pediatric gender care.

Same-sex feelings can lead to confusion about one's identity during the tumult of adolescence. I remember it well, but instead of being allowed to grow up gay as I was, today's masculine girls and feminine boys are told that they should be and can be the other sex. This lie is the true conversion therapy, and SB 418 requires insurers to pay for it.

By defining discrimination on the basis of sex to include gender identity, this bill conflates medically necessary treatment with irreversible interventions on children who have no physical pathology. An insurance plan that covers testosterone for a boy with hypogonadism must cover it for a girl who says she's a boy.

A plan that covers mastectomy for a woman with breast cancer must cover it for a woman who identifies as a man. This bill aids and abets treatments that the Department of Health and Human Services has found to cause or contribute to sterility, sexual dysfunction, bone loss, cognitive damage, incontinence, stroke, vaginal atrophy, and profound regret.

No evidence shows these treatments reduce suicide risk among gender-dysphoric youth, as was once claimed. Yet even as public opposition grows, SB 418 doubles down, forcing insurers to pay for care that causes harm. But California doesn't need to do this. Now is the time for your committee to lead your colleagues out of the partisan muck. Vote no on harmful, homophobic SB 418. You'll be surprised at how many people on both sides of the aisle will support you.

Thank you.

Hello. I'm Sherry Meek Brown from Oakland. I'm a member of CAUSE: Californians United for Sex-Based Evidence in Policy and Law, and I'm honored to testify before my own Assemblywoman, Chair Bonta, and all members of this committee.

Senate Bill 418 creates an impossible conflict between state and federal law that will end up devastating healthcare access for all Californians. By attempting to circumvent President Trump's Executive Order 14187, this bill forces insurance companies and healthcare providers into an untenable position. Consider Kaiser Permanente, California's largest healthcare provider and insurer.

If Kaiser continues providing sex trait modifications to minors, they risk losing millions in federal funding. If they stop these prescriptions and procedures, they face costly grievances under SB 418. SB 418 exerts state pressure on healthcare providers to continue to medically intervene with drugs, hormones, and surgeries based on self-declared identities.

Even as under increased scrutiny, the claimed evidence for such interventions shimmers away like a mirage. Kaiser has already been sued by at least three detransitioners. As awareness grows that sex trait modification interventions carry immense risks and lack scientific support, more lawsuits are inevitable. Concern over the financial burden could force insurers and providers to leave California entirely.

SB 418 also puts Medicaid and Medicare coverage at risk by placing California law in direct conflict with federal guidelines. Insurers and providers cannot simultaneously comply with federal funding requirements and SB 418's mandates. California can't afford the economic chaos that SB 418 will create. Vote no to preserve healthcare access and market stability for all Californians. Thank you.

Thank you. Are there others in opposition in the hearing room who would like to offer a #MeToo?

Hello. My name is Patricia Huey. I'm a lesbian. I'm a member of Democrats for an Informed Approach to Gender and Women Are Real, and I am in opposition to this bill. Thank you.

Hi. Meg Madden, on behalf of CAUSE: Californians United for Sex-Based Evidence in Policy and Law, Women Are Real, and DIAG: Democrats for an Informed Approach to Gender, in opposition to SB 418. Thank you.

Thank you. Seeing no other opposition, we will bring it back to the committee for any questions or comments. Assembly Member Addis.

Thank you. I want to thank the author and happy to move the bill as well, but having a bill that is around transgender wellness, I just want to acknowledge how important it is that these therapies have consistency.

One of the things that I hear most from folks, particularly right now, is that fear that their medical care is going to be cut off midstream and the detrimental health effects, particularly for folks that have hormone replacement therapy and how difficult that is for them, and that that in turn can cause mental health issues, a lot of fear, a lot of anxiety around what's going on, and that these constant attacks on personhood are really what is causing a lot of the mental health issues that many people in the transgender community are experiencing. So I want to thank you.

In addition to the importance in your story around IVF--is such an important story as well and an important experience and we have to continue that coverage--but just want to thank the author for your thoughtfulness on this and appreciate what you've done here and what you're trying to do here.

We have a motion by Addis, seconded by Rodriguez. Senator, I want to thank you for bringing forward this bill. I certainly understand--or the opposition's position. I certainly don't agree with it myself. I've asked to be a co-author on this bill. I hope that you will accept that.

I want to appreciate that you have really put forward a piece of legislation that is needed, as so many people who are currently on hormone replacement therapy are very concerned about whether or not they will be able to continue their healthcare in the way that they need to.

I think we've heard from many constituents and people in this Health Committee about the fact that HRT needs to be something that is continuous and incredibly detrimental if it's not able to be continuous, and given the kind of environment that we are in, I think it's very important, as Assembly Member Addis expressed, to ensure that we can provide that healthcare for people.

And I want to just echo the comments made by the witness around ensuring that we are structuring this piece of legislation in a way that will ensure that healthcare providers will still be able to be in communication and under the supervision of those people who are on hormone replacement therapy, and I want to thank you for continuing, continuing your leadership in this area. With that, Senator, would you like to close?

Thank you. I feel like I need to lead with, I'm a lesbian--kept hearing that--but--went over someone's head. No, I think it's super important. I think what we do here in this body is we always put policy in front of us that is data-driven, that has empirical research behind it, proving what works and what doesn't work.

There's endless amount of studies that show that when we do invest in preventative measures, when we invest in things that are holistic and to the needs of the individual, we are uplifting their lives. We're making their lives better.

There are studies after studies that show that lack of access to certain things can impact someone's mental health, can lead to someone taking their own life, can lead to someone thinking that they're not as important as someone else. SB 418 does not mandate coverage for a procedure, does not mandate coverage for X, Y, and Z.

There's no coverage mandates of procedures or surgeries in SB 418. It just says that if you're offering something to Sally, you should also offer it to Martha. If you're offering it to Billy, then Pedro should get it, too. We just want to make sure that we're not discriminating in what is offered.

Additionally, there are religious exemptions like they exist now in the State of California that also apply to SB 418. As long as the employer is not offering something, they just--they don't have to offer it--but if they start offering to one demographic, they're going to have to offer it to everyone.

They can't discriminate based on the list that I've said before. Again, a lot of this is already happening in California, but we are worried that things that are happening in D.C. are just going to want to undo a lot of our investments. With that, respectfully asking for an aye vote.

Thank you. You have a motion and a second. Secretary, please call the roll.

The motion is do pass to the Committee on Business and Professions. [Roll Call].

That is out and on to business and professions. Thank you, Senator. We'll move on to your last item, which is item number 10, SB 660 regarding California Health and Human Services Data Exchange Framework.

Well, first off, thank you to the Committee for your very thorough analysis of this. And I hope every Committee Member read all 30 pages of the analysis and have no questions at the end because it really got to every corner of this Bill. Very thankful for that.

Due to the Committee, due to this Bill being double referred to, I cannot take any amendments in this Committee. But these are the things that I have committed to in agreement with the Chair that will be taken in the next Committee.

We will be addressing the technical, some technical issues, and we'll be ensuring that there is a public comment before new policies and procedures are adopted. We will also be requiring an appeals process as part of any oversight that will be developed by HCAI through regulations and approved by the board. So what does SB 660 do?

Well, for many years I always questioned why is it so difficult for entities to know what is happening at another hospital? Why is it that when I go into a provider, even though I visited someone else, why can't those records be shared here?

Why do I have to go through the whole let me tell you my story and share this, all this information? Well, it's because before it was entities, providers, signatories didn't have to share data. And we all know that the more we share information, the better access, I mean, the better service we can provide to an individual.

So while the data exchange framework already has existed in past of the intent that we should have health care providers share health data with each other and to some extent, some social service data, what we don't have right now is a body that's going to create the procedures, the policies of how this data is going to be shared with everybody.

Who's going to come together and say this is a violation, who's going to come together and say, hey, we've passed this already and a lot of entities should have already started sharing data as of January 2024. But why haven't you done it yet? And what this SB 660 is looking to do is create that body.

And we want to create a body that has experts at the table, from consumer advocates to someone from the Secretary of CalHHS to those other appointees, from the Governor, your body and my body. Now, creating a body, a governing body has been a bit difficult. You know, everyone wants a piece of the pie.

I want to be at that table. I don't want that person at the table. That person should be at the table, but should have limited access to how they vote. It has been very difficult.

I'm not going to say we've landed the plane yet because we've amended, we've decreased, we've added, and we're still trying to find that sweet spot of who should be at the table. But this is what I've, my intent here is. Who should be at the table should have the ability to share their concerns.

If we're asking signatories, hospitals, clinics, skilled nursing facilities to share data, we want them at the table to let us know what's going to be successful.

We don't want people at the table to have no experience in those entities, to come up with rules that perhaps aren't going to be applicable or aren't going to be feasible for a signatory. So we want them at the table and we want their expertise.

This data exchange across the health sector will eliminate redundant and costly test appointments. It's going to avoid unnecessary hospitalizations, readmissions, deliver more effective, coordinated care across settings. Now, you've probably heard the concerns of like, wait, what about smaller entities? What about the SNF's? They don't have the ability to do this.

Current law and procedures, the data exchange framework already says that if you don't have the mechanism to provide electronic records, you don't have to do this. That's already in the policies and procedures. But if you have electronic portal to provide electronic data and you just are choosing not to do it, then you will be found in violation.

But you don't have to meet the timelines imposed by this Bill if you do not have the mechanism. This only exists if you have that in place.

Lastly, while there's so much, so much technical provisions to this Bill, the end goal is still all the same. Entities that have started from 2024 to sign up to those smaller entities that just signed up in January of 2026 have signed a contract, sometimes with the Department, as a commitment to continue contracting with the Department to say they're going to data exchange, but aren't really doing it.

The governing board is going to bring some accountability, some transparency, some nudging of these entities to ensure we're sharing that data, so that if someone goes to Assemblymember Patel's hospital in San Diego and for some reason they move to LA, that data can be shared over there and they don't have to restart the services of health care.

Colleagues. I ended up there and now would like to turn over to my witnesses who would speak in support. I have some technical here and some who are actually going to speak and I'll just let them, who's who.

You'll each have two minutes.

Great. Good afternoon.

Yes, please press the button.

Good afternoon, Members of the Health Committee in the Assembly and thank you so much, Chair Bonta, for welcoming us and giving us the opportunity. My name is Max Perret. I work at Aliados Health. I'm our Senior Director of Policy and External Affairs and we're a consortium of community health centers across Northern California.

Four years ago, when California first established the data exchange framework, we did wonder if we were truly included. The broad label of provider organizations and medical groups didn't clearly reflect the unique role of health centers across our state.

Since then at Aliados Health, we've supported our member health centers in signing the Data Exchange Framework and beginning implementation of the agreement, including securing a DXF grant to connect to a qualified health information organization. We know that a robust, secure data sharing isn't just a technical goal. It's fundamental to delivering high quality, timely and equitable care.

Health center teams are ready to do their part, but they need confidence that others, hospitals, health plans and other providers are committed to doing theirs.

Without governance or accountability, it's been a challenge for individual organizations to make progress without all partners viewing the Data Exchange Framework as a necessary priority, even if they care deeply about the benefits to patients and providers. That's why we support SB 660.

By explicitly naming clinics as a required part of the Data Exchange Framework and Creating real accountability, SB 660 strengthens trust, ensures consistency and honors the vital role that health centers play in California's health ecosystem.

SB 660 has also recently been amended to reflect CalHHS's reorganization to transfer the Data Exchange Framework to the Department of Healthcare Access and Information in alignment with their mission of providing access, affordability and quality. Thank you so much for your consideration and we urge you to vote aye.

Thank you. Your next witness will have two minutes. Please press the button.

Good afternoon Members of the Committee, Madam Chair, I'm Jason Moriarty, the Senior Director of Quality and Compliance at Partners in Care Foundation. We're a non profit community based organization. We're both a service provider and a hub.

So we represent over 100 smaller agencies than us in providing services like CalAIM, Enhanced Care Management, Community Supports, Home and Community Based Alternatives, MSSP Waiver and a number of other short term services. We link social determinants of health to healthcare so that we can address the whole person.

We do that by providing case management, transitional care, home and community based services. We do that to low income older adults and individuals with complex medical and social needs. We're proud to say that Partners in Care Foundation is one of the first social services organizations to sign the California Data Sharing Agreement and join the Data Exchange Framework.

We did so because we believe whole person care can't happen without real time data sharing between healthcare and community based providers. Through a recent pilot in Los Angeles, partnered with a DXF Qualified Health Information Exchange to exchange information for our CALAIM Enhanced Care Management clients.

This pilot helped enhance our care coordination, reduce redundancy in services and contributed to over 50% reduction in hospital readmissions. We did that by replacing outdated faxing, emailing and paper copies of discharge information with real time discharge alerts. Our ECM clients are often older adults with multiple chronic conditions who've been hospitalized many times.

But seamless real time data exchange to social services at the point of discharge is still the exception, not the norm, and not because these services aren't available, but because our systems don't always talk to each other.

The data exchange framework is essential to break down information silos and establish connected networks in California for a coordinated, safe, high quality care that Californians deserve. The data exchange framework doesn't just allow us to provide better services, but it also allows us to evaluate the effectiveness and to promote the effectiveness of the services we provide. Thank you.

With that, are there any others in support?

Greg Hurner on behalf of San Diego Health Connect in support. Thank you.

Emily Cossio representing Blue Path Health in support. Thank you.

Vanessa Kahina on behalf of the California. Academy of Family Physicians here in support.

Amanda Kirchner, County Welfare Directors in support.

Good afternoon. Tim Valderrama with the Weideman Group on. Behalf of Unite Us, Manifest Medex and SEIU State Council in support.

Good afternoon. Katie Van Deynze with Health Access California. We are in a supportive and amended position and appreciate the work on our requested amendments to date and ongoing conversations. Thank you.

Omar Altamimi with the California Pan Ethnic Health Network also in a support of amended positions and thank the author for the conversations that we've had and the conversations we will have. Thank you.

Zoe Tanner on behalf of the California Wic Association in support

Jenny Rocha with CPCA advocates in support.

Good afternoon Madam Chair and Members. Andres Ramirez on behalf of Blue Shield of California in very strong support.

Good afternoon Chair and Members. Jonathan Munoz on behalf of Inland Empire Health Plan which serves roughly 1.6 million medical Members in strong support.

Good afternoon. Whitney Francis with the Western center on Law and Poverty. We have a support if amend position and are very grateful to the author for continuing to work with us. Thank you.

Are there any primary witnesses in opposition please come forward? Seeing none. Any others opposed who would like to offer me to please come forward? Moved by Majority Leader seconded by Chen.

Good afternoon Madam Chair and Members. Connie Delgado on behalf of Point Click Care with an opposing less amended position. Hoping to continue conversations. Thank you.

Good afternoon. Mark Farouk on behalf of the California. Hospital Association we have a concerns position. Appreciate the comments of the author earlier and the previous discussions and the future dscussions will have to resolve remaining issues. Thank you.

Thank you. With that, I will bring it back to the Committee for any comment or questions.

Senator, I want to thank you for working so diligently with our Committee to make sure that this Bill, as you kind of indicated, strikes the perfect spot of making sure that we're able to move the Bill, move forward with this very important data exchange framework.

You know, the fact that we have been years in the making around the data exchange framework and have many signatories, but certainly don't have the fidelity of implementation that would really ensure that we have the kind of transferability of data to support patient care is continuing to be a concern.

So I very much appreciate you moving forward on this. At the end of the day, we not only are concerned with patient care, but also in the improvement of care and the reduction of costs within our healthcare system. And something like a data exchange framework ensures that we have the ability to do that.

The recommendation is an aye on this Bill with a do pass motion with amendments planned to be taken in Privacy Committee, which you will see next. With that, would you like to close?

I guess I was right. The robust analysis left no questions to be made by the Committee Members. With that, respectfully asking for an aye vote.

That's how we roll in this Committee Senator. With that, Secretary, please call the roll.

The motion is due pass to the Committee on Privacy and Consumer Protection. [Roll Call]

Chair. That measure is out. Thank you. We've dispensed with all of the items now, so we will go back and vote for absent Members. We will start with the consent calendar.

[Roll Call]

That measure still out. The consent calendar is still out. We'll move on to item number one, SB32 for lifting the call on that one.

[Roll Call]

That measure is now out. We'll move on to item number four, SB297. Hurtado. This is lifting the call Aguirre, Curry.

[Roll Call]

That measure is now out. Moving on to item number five. SB 313. Lifting the call.

[Roll Call]

That measure is now out. Item number six. SB324. Lifting the call.

[Roll Call]

That measure is now out. Moving on to item number eight. SB418 for add ons.

[Roll Call]

That measure is now out. Item number nine. SB646 for add ons.

[Roll Call]

That measure is now out. Item number nine for add ons. SB. zero, sorry. Item number 10, SB 660 for add ons on call, please call the roll.

[Roll Call]

And the item number 11 is a consent calendar which we've already dispensed with with that. zero, I will take that back. I have not said the magic words. We'll leave the role open for add ons.

For add ons. Item number 6, SB 324.

Carrillo. Carrillo, I.

Item number 8 for add ons, SB 418 Carrillo.

Carrillo. Carrillo, I.

Item number 10, SB 660.

Carrillo. Carrillo, I.

Thank you, Assembly Member. With that, our Health Committee hearing is adjourned.