Senate Standing Committee on Rules

All right, we are going to begin. The Senate Committee on Rules will come to order. Before we begin with today's agenda, let's establish quorum.

[Roll Call]

Okay, so, a quorum has been established and I—before we go into the appointees, I think I'm going to pass it over to our Vice Chair.

Thank you, Madam Pro Tem. I wasn't here last week for your first meeting, and you are the third Pro Tem that I will have the honor of serving on rolls with, and I just wanted to tell you that although we may not agree on all policy, I think that you are going to be one of the most fair, problem solution-orientated people that I've been able to work with in this building.

And I just wanted to thank you for letting me stay on rules and be your partner in crime on this Committee, which is pretty hairy sometimes, to say the least. Run from Ms. Contreras when she shows up with a particular color of an envelope. We all know that. We know that's all bad news.

But it's exciting to be on this Committee with you. And I just—thank you for letting me say a few words since I was gone your first meeting last week.

Thank you, Madam Vice Chair, and I really appreciate your words and your partnership. I think that for all of our colleagues on rules, the partnership, I think that this is really is important that we're able to work together. And we have been.

And I think folks also know that sometimes we come at it from very different lens and perspectives, but we are there every day to figure out what to do next and how to work with our community. So, thank you, Madam Vice Chair. With those kind words, we are going to start with the not required to appear appointee.

So, if there are no objections, I'd like to take up first on today's agenda. Governor's appointee not required to appear, Item 2c, the appointment for...as a member of the Boating and Waterways Commission. I'll entertain a motion. Thank you. That motion has been moved by Senator Grove. Secretary, please call the roll.

[Roll Call]

All right, thank you. That item is approved. Five to zero. Next, I'd like to take up on the governor's appointees not required to appear, Item 2D, Peter Stern for the California Horse Racing Board. I'll entertain a motion. Thank you, Senator Grove, for the motion. Secretary, please call the roll.

[Roll Call]

All right, that motion is approved. Five to zero. And the last item for the governor's appointees not required to appear is item 2E, Deanne White for the State Mining and Geology Board. Thank you very much, Senator Grove, for making the motion for that. Secretary, please call the roll.

[Roll Call]

All right, thank you. That item is approved. Five, zero. Next, I'd like to take up item three, reference to the of bills, two committees. I'll entertain a motion. Thank you, Senator Grove, for that motion. Secretary, please call the roll.

[Roll Call]

All right, that motion is approved. Our final items before we turn to the Governor's appointees are items 4 through 10 for floor acknowledgments. I'll entertain a motion. Thank you, Senator Grove, for the motion. Secretary, please call the roll.

[Roll Call]

All right, so that is, that motion is approved. 5 to 0. So, now, we're going to go ahead and return to the governor's appointees required to appear. We'll start off with Item 1A, the appointment of Tyler Sadwith as Chief Deputy Director of Healthcare Programs, Department of Healthcare Services. Welcome. Thank you. Thank you, Mr. Sadwith, you'll have the opportunity to provide one to two minutes in your opening testimony to this Committee.

Committee will then open it up to the Committee Members to ask questions in advance. In your opening, you're welcome to introduce any guest that you'd like. So, we'll go ahead and begin when you're ready.

Thank you, Madam Chair, and thank you, Members, for the opportunity to appear before you today. I'm Tyler Sadwith, and I'm honored to be considered for Chief Deputy Director for Healthcare Programs at the California Department of Healthcare Services. I'm proud to be joined virtually by my family, and I thank them for their love and support.

I also want to thank Governor Newsom for the opportunity to serve the people of California. The mission of Medi-Cal is clear, to ensure timely, equitable care for the 14 million Californians who rely on us. Children, older adults, people with disabilities, and working families. If confirmed, I will focus on two priorities to fulfill this mission.

First, safeguarding access and equity as we navigate a changing federal landscape. Ensuring that Medi Cal members and providers remain protected and supported to the maximum extent possible. Second, continuing the transformation of Medi Cal through CalAim and the transformation of California's behavioral health system through Governor Newsom's Mental Health for All Initiative.

My commitment to this work is deeply personal. I serve as power of attorney for a parent who is unable to live independently or manage their affairs due to brain damage from substance use disorder. I also have a family member living with serious mental iIllness.

Crisis Services and 51-50s are not just policy concepts to me, they have been my reality, yet I have seen how Medi Cal and other programs that my Department administers can change a life. I know firsthand how having access to care and how having the right supports available can help people reclaim their lives. That is why I accepted this appointment.

Thank you for your consideration and I welcome your questions.

Thank you very much, Mr. Sadwith. Member—all right, so we're going to go ahead and begin with Senator Reyes.

Thank you very much, Madam PT. Mr. Sadwith, I want to thank you for taking time to meet with me to discuss your appointment. I am very impressed with the commitment you have to the people of California. The issues that we discussed, I appreciated your response and I must tell you that with my last question, why do you want this job? I do want to ask it today here with my colleagues.

Thank you, Senator, and thank you for reaching out. It was a privilege to get to know you yesterday in our conversation. I want this job because I can think of no better opportunity to impact people's lives for the better at the scale right now of 14 million Californians.

I shared with you in our conversation that my first foray into healthcare policy, I was an undergraduate in college. I was working at a health plan serving dually eligible members, so, individuals enrolled in Medicare and Medicaid aged over 65, low income, complex medical conditions.

And my first task was to call all 400 members and ask them if they were satisfied, if they had any issues, if they were getting the services that their doctor recommended. And that experience impacted me personally.

It was truly illuminating and powerful to hear from these members, hear from them directly, hear about their lives, hear about the appreciation that they showed for their ability to access health care. Sometimes they would pass the phone around to different family members who would all thank me for the work that the plan did.

And to be honest, I have never lost sight of that feeling. And honestly, that's why I'm here. We spend a lot of money in health care. It's 20% of our economy. There's a lot of resources in the healthcare space, and I think that having access to health care helps people thrive in their life.

It helps families feel reassured. It helps people participate in their community. It contributes to the economic vitality of society. This moment of time is extremely challenging. It's very hard right now with a lot of the state budget condition being what it is and with the federal changes.

And right now, if I were to walk away, I would regret it forever because someone has to try to weather the storm and protect the program and make sure that people are able to get the get the care that they need. So, that's why I'm here.

I would say that after my discussion with you and also through to RPT, your commitment to the programs, your commitment to the people of California is laudable, and I think that that's something that I know that the Governor took into account as he nominated you.

Thank you, Senator.

Thank you, Senator Reyes. Senator Laird.

Thank you and I'm sorry we didn't have a chance to meet. I was going to ask a couple of questions on.

Just sort of some of the things that are in your purview. But one is a lot of us are concerned about the financial health of hospitals, and some of us in particular have rural hospitals in our district.

And I was going to ask what lessons you have drawn from sort of recent closures and in at least one case, a reopening, and are there ways that the Department can improve early warning or contingency planning or expectations for the managed care plans when you're dealing with this?

Thank you, Senator, for the question. It's an incredibly important question. The issues impacting hospitals, a number of hospitals and rural hospitals in particular, that predated HR 1. Those pressures are compounded by some of the changes in Medicaid funding and financing that are being implemented as a result of the law.

We work at the Department in close partnership with other state partners, including the Department of Healthcare Access and Information, which previously administered a distressed hospital loan program. So we have lessons learned from that. What we do right now is try to stay in close contact with those hospitals that are facing financial distress and have financial risk.

We work collaboratively with the managed care plans in Medi Cal that have contracts with those hospitals to see how we can support those plans to potentially expedite payments to the hospitals.

We try to provide those managed care plans with data on an accelerated or expedited timeline so those plans know sort of the revenue forecast that they can expect from us prior to that information sort of being made available to them on a routine basis.

That then allows them a degree of comfort to try to expedite payments based on their anticipated revenue from us. Of course, on the fee for service side, where we make payments directly, anytime a hospital reaches out or we're aware of a distressed hospital, we see what pending claims are sitting with us so that we can expedite those.

And if there's claims that need to be resubmitted or cleaned up before they can be adjudicated, we work with the hospital to do so. We are taking steps to expedite the timeline for making what are called state directed payments.

A lot of hospital funding in Medi Cal is sort of flows through a financing mechanism called state directed payments, where Medi Cal managed care plans have to make certain payments above and beyond the negotiated rates that they have with hospitals based on their capitation rate.

So over sort of a, you know, two year period or so, we are compressing the standard timeline that it normally takes us to make those state directed payments to help out with hospital cash flow issues.

Recently, we are partnering with other departments in the California Health and Human Services Agency to form sort of a hospital monitoring list so that we are all coordinated across across the agency so that we can address these issues more proactively as they arise.

I appreciate that. And sometimes by other colleagues, I'm instructed to ask at Rules if you will return a phone call. You look shocked, but there are a few colleagues that don't do that in various places. And this is a chance when you're up for confirmation, I get you on the record to do that.

But it seems to me you're leaning to the mic and you will do that.

Yes, Senator, absolutely.

And on this particular issue, I mean the one that I'm most familiar with, that I actually spent six months working to save and did a bill to create a hospital district and we raised a lot of money to, to make it all happen. They we saved the hospital. They passed a bond.

This was the year that is the first year. In six or seven years they're going to be in the black. And now the changes that have gone on put them back to where they were when we saved them.

And so while you just made a very articulate statement of all the programs that you work with, I think what we're really looking for is a higher level commitment to do anything within your power to work with the hospital or us or who the stakeholders are to expedite things, to do whatever it takes.

Because I know that now the one is in a that I'm working closely with is down to a matter of days in cash flow. And so what you said about expediting payments really makes a fundamental difference. So I will just look forward to that and your commitment to return my call when I call you about that.

The other thing to ask about is there the changes I'm going to ask about sort of the changes in federal law that deal with more frequent redeterminations and work requirements in the aid programs.

And how will you work with the counties to make sure that we're not having avoidable losses of coverage while there are more frequent determinations in those things going on in the program?

That's an excellent and important question, Senator. Thank you.

I would say that focusing on some of the changes in the federal law related to eligibility, in particular the new work requirements policy and the increased frequency of redeterminations for the 5 million Californians enrolled in the adult expansion group in Medi Cal is one of the top priorities in my role right now.

We are estimating at full implementation that work requirements may lead to up to 1.4 million Medi Cal members losing coverage. And we estimate that at full implementation, up to 400,000 MEDI CAL Members may lose coverage as a result of the six month redeterminations.

So what we have been doing since July 4th, when the bill was signed into law, has been developing a comprehensive strategy to minimize disenrollments to the maximum extent that we can. Doing things at the state level and in partnership with county social services offices.

I'd be happy to share some information about the approach that we're taking if that would be helpful.

I think it will be over time. And we. We had our first major budget oversight hearing this morning and we went through as much as we could in a limited number of hours. And your General area was front and center for a lot of the discussions.

And we will really want to work because I don't think we have the resources to backfill. But are there places where people are going to lose medical care and some sort of triage on our part can protect it? And the managed care plans are so important to.

I mean, our local one actually contributed a few million dollars to keep that hospital open. They really prioritized the care and stretched the resources and do things in ways that it wouldn't happen if we're just a straight fee for service. And so we will really want to work with you on that.

I just appreciate your response to the questions and I look forward to supporting you at the right time. Thank you, Madam Chair.

Thank you, Senator Laird. Senator Grove.

Thank you. Thank you, Madam Pro Tem. Good afternoon. Welcome to the Rules Committee. I do have some questions. I'm going to follow up on some of the questions that my colleague answered because I am the representative of several financially distressed hospitals in the area which have a large Medi Cal population rate.

And contrary to what a lot of my colleagues think, I don't have a billion dollar donor that wants to put their name on a building and to save our hospitals. And we can't write enough commercial insurance to offset the 70-75% sometimes 80% of Medi Cal patients that are treated in some of our Central Valley hospitals.

So it's a big issue. I worked on the financial distress load program. I'm grateful they gave my hospitals money that they have to pay back but being delayed and you know, every year they get an extension. So I'm grateful for that. I understand there's another $300 million available to that program this year.

I guess my question is, although I appreciate that I do, I'm not looking to give torse in the mouth. But I am a small business owner. They get tired of hearing that in this Committee and we fix things.

And to fix this, running a hospital or any type of medical facility that accepts Medi Cal is a pathway to bankruptcy. You cannot treat somebody and it costs you a dollar and you get 60 cents or whatever the cent is on that return for your investment. For providers, we worked on the MCO tax.

That money has not gone to providers except for one time, but it looks like it's going to be swept again this year in the budget. How do we fix the reimbursement rate for Medi Cal providers so that they continue to take care of the most vulnerable and needy in our community?

Thank you, Senator. It's a really important question and again cannot overstate how critical it is that we think collectively about maintaining rural hospitals in key communities which are vital points of access. And we know that these, they were facing risks even before the federal law.

Just to provide a little bit of context about steps we were taking on the reimbursement REITs issue which you raised before HR1 passed, we had worked with our federal partners at CMS to implement rate increases for hospitals through the state directed payments that I mentioned.

And we actually brought the Medi Cal reimbursement rates to exceed Medicare rates and brought them close to average commercial rates so that hospitals wouldn't have to use commercial payers to write off the cost of Medi Cal. What year was that they were submitted in recent years? We can follow up with the details. Senator.

The issue though, the reason I bring that up is because HR 1 imposes new limitations on reimbursement rates in state directed payments to not exceed Medicare. And so what that means is that that strategy that we were taking is no longer permissible with federal law.

So we will be over a multi year period required to reduce those reimbursement rates back to the, to the Medicare level to comply with HR 1. There is another opportunity right now.

It's not permanent, but I think in light of some of those changes in the law that impact rural hospitals and rural healthcare disproportionately, Congress invested sort of a significant amount of money in the Rural Health Transformation Program which will be appropriated to states on a rolling basis over a five year period.

And the California Department of Health Care Access and Information received notice of an award late last calendar year for a little bit over $200 million. And I know that's right, Senator. So they plan to implement the projects that they propose in that application.

I think the goal of that is not, you know, according to guidance from the Federal Government, the goal is not to just sort of supplant lost funding, but they're looking at more comprehensive healthcare strategies.

So I'm glad you brought that up. I'm going to come back to that. I was aware of the $50 billion over five years and that California was awarded 223 million. That was my next question, but you answered it. Are we going to implement that in the rural health care area that we have in our state?

Because it's specifically for rural health care. I do want to make a distinction between rural and urban. And you know, when I first came up here, I was, I wanted to work on oil and ag. I want to feed and fuel the nation. Right? That's, that's what my district is. We're good at it. We're the experts.

Top three food producing counties, number one oil and energy producing county. So that's how I came up here. And I found myself working with my colleagues across the aisle, specifically Senator Caballero, because of what happened in Madera and you know, with the hospital closure and on financially distressed hospitals.

And so there's a big significant difference that I didn't know that I learned through that process between rural and urban. For instance, Ridgecrest is two and a half hours from any other hospital. But because of its population base and its geographical location to 395, it's considered urban. So not qualified for those benefits that rural hospitals allow.

But it's an isolated community and it's an hour and a half down a canyon road that has a hundred foot drop down into the, you know, it's obviously a lot of times it's blocked off because of rock falling or you have to go all the way out on 58, which takes almost two and a half hours to three hours to get to Bakersfield for treatment.

So is there, I don't know if it has to be a legislative fix. I'm just asking, if you don't know, you can get back to me. Is that a regulatory fix where you guys can incorporate urban hospitals?

Because there are some also in Senator Richardson's district and a couple of other my colleagues, districts as well that comply with this, where the rule stuff doesn't help us in some areas that are very, very isolated, but it doesn't qualify. Is that a regulatory fix or is that a legislative fix?

Thank you, Senator. So I think it would probably depend on sort of the program or the funding in question. So I'll just give two examples if that's Helpful. In Medi Cal we have hospital payment rates that vary according to urban or rural hospitals based on the federal designation.

So for hospitals that receive a federal designation from CMS as a rural hospital, they're eligible to receive slightly enhanced payment rates relative to urban. There's a two step process. The first is they have to, I think receive some type of designation from, I believe it's the California Department of Public Health.

And then they have to receive that from cms. So I think that's a federal issue predominantly. So that's a federal regulatory issue for that specific issue. For something like the Rural Health Transformation Program, it would probably depend on the terms of the grant that CMS awarded to hcai.

I would imagine there's slightly more flexibility, but I would have to sort of defer to the terms and to HCAI for that specific issue. I think the short story is it might depend on the specific context.

So when you get an opportunity to do that, would you be in contact with my office? And I figured I called you to get. Get that information. You would answer your phone and give it to me.

Absolutely, Senator.

Sorry. Do that. Going back to. Going back to, you know, benefits in ways that benefit Californians and that. Actually, I'd like to share some information with you. And actually it was a study done by Fresno Community Hospital and they had a volunteer program.

And what they did is that they asked their employees if they would participate in and if you wanted to automatically voluntarily enroll. 355 employees enrolled that had diabetes, right? 355. They saved $5.3 million on base health care expenses from the previous year to the current year. And they did it just by changing people's the way they eat.

Like I used to just bring chocolate to these meetings because sometimes these meetings are pretty hairy. But today I brought halos, not cuties, halos. And I brought some pistachios. So it's about changing your attitude or your intake on life and the things that you. Instead of chips, you eat nuts or different things like that.

So that's what they did. If they did a numbers total based on the high population of Medi Cal. If they did a pilot program and Medi Cal patients were opted, not forced, but opted to implement some of these free strategies to this is how you could eat better if you did this or whatever. Just educating the public.

If the same percentage of people participated from Medi Cal to the employees, that about 14% participate. If 14% participate in the Medi Cal population, the savings would be 1.54 billion. Dollars annually. Are those innovative solutions you're looking for? Are we just going to settle for the status quo and just keep paying people to be on?

You know, sometimes I think it's substandard care, too. My office gets a lot of phone calls. You know, they won't take Medi Cal. They won't take Medi Cal, they won't take Medicare.

We have to do this, and we have to call a doctor to go into that hospital and get hospital privileges so that that person can get treatment for something that's going to cost a lot of money down the future versus a preventative measure. So my office takes. I mean, I'm sure all of us do on constituent services.

So, number one, can I give that to you? Number two, will you look at it? And number three, can you address that question on innovative ways that you think might help reduce the cost of Medi Cal in our communities?

Absolutely, Senator, thank you for the question. I'd be happy to take a look at the pilot and the studies. It might be helpful to highlight that that exact innovative idea is actually part of Medi Cal today under Cal Aim, and it's proving effective. The data is in.

So under Calaim, the goal is actually to do what you just said, which is go upstream and provide preventative sort of interventions that address lifestyle so that we can ultimately save on expensive health care costs that can be avoided and improve patient outcomes.

So under Cal Aim, we have 14 community supports that really address social health, things like food. So medically tailored meals and medically supportive food for people with qualifying health conditions like diabetes is a Medi Cal service that every managed care plan has the ability to opt into.

Over the first four years of implementation, we have seen quarter over quarter and year over year growth and utilization of these services. Medically tailored meals is one of the services with the highest utilization. We have data showing that these community supports are cost effective.

And what that means is they are substituting for more expensive, avoidable health care services, mostly inpatient hospital stays, visits to the emergency Department and stays in nursing facilities. And by and large, they are saving the state and the Federal Government money when they're available to Members.

Thank you very much for that. The last question that I have, thank you for your indulgence, Madam. Probate is the California state auditor issued a report December 2025 of the Medi Cal still has problems, eligibility errors, and they estimated it could be billions of improper payments.

Do you have someone in place, a team in place that's going through and I don't know through the computer systems to validate that and make sure that we aren't expending money where we shouldn't expend money.

Thank you, Senator. Yeah. Ensuring appropriate Medi Cal eligibility enrollment is crucial not only today, but also in light of a number of the changes to the eligibility rules that will be implemented as part of not only the state budget solutions, but the HR 1 federal law as well.

So we are providing extensive technical assistance to counties and coming up with ideas for sort of supports to support counties to increase productivity given limited caseworker staff and the increased volume of processing that is in store for them. We do strong oversight. We perform sort of targeted. Targeted audits and oversight of counties based on performance data.

And we go in and we sample case files and we review based on the information that a Member provided or someone seeking Medi Cal Enrollment, what actions did the county take and were they in compliance with state and federal rules and then obviously provide technical assistance and.

And sometimes corrective action to the counties to make sure that they are administering eligibility appropriately.

Thank you. One more time. You're going to pick up our phone call, right?

Of course, Senator. Yes.

Thank you. Thank you. I look forward to supporting you. All right, Senator Jones, thank you.

I just wanted to follow up a couple of questions on the fraud question. For years, the Department of Healthcare Services used to publish a Medi Cal fraud report.

Unfortunately, the last year that that report was required by the state budget, meaning the Legislature asked for it, was 2020, just before we embarked on the very large and controversial eligibility expansion to undocumented individuals.

The Centers for Medicare and Medicaid Services recently noted that the audits have that their audits have uncovered In California alone, $1.31 billion in unlawful federal Medicaid spending. Spending on non emergency health care for illegal immigrants.

Given the governor's renewed efforts to combat fraud in the state government, do you think it's time to restart that Medi Cal fraud control report?

Thank you, Senator. I will take that back. I was not aware that we stopped publishing it. So I look forward to learning why we stopped publishing it and if we can continue to provide transparency.

Yeah, my information says the last year it was done was 2020 and it was eliminated through a budget act from the Legislature asking for it to be done. So I would appreciate your feedback on that because I think it is something that the Legislature should ask for again. I appreciate that. And then kind of talking about the.

And you may need to get back to me on this as well. Regarding the staff working on that fraud Report. The last Medi Cal Fraud Report. Over 25% of the staff in the audits and investigations unit were focused on anti fraud activities. And almost 60% of the staff in the provider enrollment were conducting anti fraud activities.

Do you know if, regardless of the report, are those anti fraud activities still happening and those measures being taken to reduce and remove the fraud?

Thank you, Senator for the question. While I can't specic speak to the specific sort of compositions that you cited, we'd be happy to follow up to confirm it. I can say that within the audits and investigation team that you mentioned, that team alone represents 15% of our entire Department staff.

I think that reflects that program integrity is a top priority for the Department. We have a number of measures in place to combat fraud, waste and abuse and ensure Medi Cal is the last payer, the payer of last resort. So we have, we have all the.

All the measures that were in place years ago and even more today.

Okay, I'll have my staff follow up with those specific numbers so they can get back to us. And I appreciate that. Thank you. Thank you, Senator.

Senator Laird.

Just one follow up question, Senator Grove triggered me, which she does on occasion. And a very long time ago I looked at your age on this about the time you arrived on the scene. I was running.

That's completely inappropriate.

I was running an AIDS service agency. It was at the height of the epidemic. We could not get a single Medi Cal dental provider in our county to accept medical. Our dental program were bus tickets to San Francisco that, that where somebody would be seen. Do you.

We have, we have talked about eligibility here, but we haven't talked about whether there's work on access and if a case that actually led to us organizing and establishing a large low income dental clinic locally. If you get reports of things like that, do you have anything in your bureaucratic arsenal to deal with it?

Thank you, Senator for the question. Access in General is important and access to dental care is. Is in particular important because we do hear that finding, you know, dentists that accept medical is harder than some of the other healthcare professional types under Cal Aim. A number of steps were taken or introduced to solve that very problem.

And to increase access to dental care for Medi Cal Members. We expanded the scope of benefits that are covered to help entice new providers to opt in to participate. We implemented community health workers as a new provider type in dental settings because we heard from dentists that that was important.

We introduced financial incentives for dentists to join and pay for performance Opportunities for dentists based on sort of performance outcomes. We have loan repayment programs available to entice them to join the Medi Cal provider network. And then we've started testing out new innovative models of integrating the dental benefit into managed care.

So Health Plan Plan San Mateo right now is a managed care plan that opted to also be responsible for covering and administering the dental benefit for their Members. And what they have shared through preliminary data is, you know, increases in dentists serving Members in the county and increases in Member engagement and access.

Thank you. That's a very encouraging answer, I imagine. And if we encounter anything like that remotely. Yes, you'll be on the phone with Senator Grove, but I'll try to catch the next call.

I can put you into a three way with us, merge it. Thank you very much.

Thank you. Thank you so much. I'm going to build on just a couple questions that my colleagues have asked. You know, there was a little talk about the rural hospitals and I represented. You know, parts of my district also have rural limitations. Right. Like there's just not access there. It's not just a hospital.

The other area that I'd like for you to just talk a little bit about is labor and delivery departments. That has also been something that we have seen over the course of year.

I almost feel like for my district that's where it starts and then it builds like it's one Department then another and all of a sudden you're talking about, about a full closure. So can you speak a little bit to labor and delivery departments in rural, you know, California in particular, the Central Valley?

There's been impacts just a little bit more on that specific piece.

Thank you, Senator. Yeah. We know that the concerns surrounding labor and delivery units closing or the prospect of their closing is a serious issue. So we've been engaging on that. We have taken some steps in the Medi Cal program to help sort of mitigate that concern.

We have expanded the types of sort of provider settings that can help with pregnant and postpartum care, including freestanding birth centers, expanding the availability of midwives to provide care to help sort of alleviate the pressure on hospital based labor and delivery units.

Specifically to meet the needs of Members, we applied for a federal grant from CMS, the Medicare and Medicaid Innovation center at CMS. It's a 10 year grant called Transforming Maternal and Infant Health. It is being piloted in five counties with a focus in Central Valley counties.

And through that program we will bring together managed care plans, hospitals, OB GYN and other maternal care providers and other Key partners that support pregnant, postpartum and birthing mothers.

To address the concerns you raise and a number of other concerns that we've heard from this population, we also recently issued a Birthing Care Pathways report that was informed by direct, sustained engagement with a group of pregnant and parenting mothers who provided extensive feedback to us directly about their experience.

And that led to a set of over 40 policy changes that we are making as a result of that and a number of other policy opportunities for further explanation. Saving labor and delivery units from closing, you know, specifically is not, you know, there aren't 46 policies around that specifically.

But we are really trying to home in on better meeting the needs of this population and providing access to the care that they need.

Thank you. And at the appropriate time, I'd love to hear more about what some of those policy recommendations are for, you know, throughout the state. The other thing that has been touched upon is Cal Aim.

And so I am actually you, recently the Department, not you personally, but maybe yes, you submitted an evaluation to the Federal Government about Cal Aim. And I'm wondering if you can speak a little bit to the findings and whether or not that's going to impact the direction for 2026.

Are there elements of this work there that might help us understand where this is going for this year?

Thank you, Senator. That's a terrific question. And so, you know, for full context, Cal Aim is a multi year initiative to transform Medi Cal and make it more person centered, coordinated and equitable. And we use a variety of federal and state authorities to implement Cal Aim. A major federal authority is what's called a Section 1115 waiver.

And so the report that you were mentioning is a interim evaluation report of our Calaim section 1115 waiver. We submitted it to the Federal Government towards the end of last calendar year because it's an interim report and the summative or final evaluation report is due to CMS 18 months after the 5 year period ends.

Independent evaluators take their time and there are a lot of data lags. And so what that means is that the interim evaluation report is helpful, but it's not conclusive in terms of the impact that the interventions are having on Members healthcare utilization or costs. They show early implementation efforts.

They show the impact that the PATH initiative providing access and transforming health, which was a $1.85 billion investment to help community based organizations and providers develop their capacity, sort of one time capacity development grant so that they can participate in Cal Aim. The report does have findings on that and it shows it was effective.

It shows that those grants led to more providers joining Medi Cal, more of those providers participating in Cal Aim delivering the services. So that's sort of one key finding. Separate and apart from the independent evaluation, we do have some internal analysis that we've conducted on Cal Aim.

And importantly, we've found that services like enhanced care management and community supports, which are pillars of Cal Aim, are effective. They are reducing visits to the emergency Department, they were reducing inpatient hospitalizations and they are reducing the length of hospital stays. They are reducing skilled nursing facility visits, and they are saving money.

So we have that type of analysis and there are other aspects of Calaim, for example, contingency management. We were the first state in the nation to receive federal approval to implement that as really the only evidence based intervention for stimulant use disorder. We have very positive findings from that as well.

But I don't know off hand if those are in the interim evaluation. I can get back to you on that.

Great. Thank you very much for that. And I'll close with just saying that, you know, part of the reason that we ask this question and, you know, we smile a little bit about is getting back to the Legislature. There's truth to this.

You know, I think that the Legislature has watched this process go through and we really want to be partners in this. And in order to be partners, it means we have to have communication and understanding and data and be able to use that through the legislative process we have in hand.

So I will just close with saying, you know, we smile about it, that we want to make sure you do answer our calls or get back to us in a way that is really in the best interest of Californians to be able to have this communication. It's not just because we want to call one day.

It is certainly because we care about an issue that's in front of us and you and your agency and the Department are one that help us fill in the gaps when we need to fill in the gaps in order to figure out how to move through the legislative process.

So I will add that to the kind of jokes we've had a little bit about the calls and say that it is something that is important to us in the legislatures, in the Legislature specifically. So I want to thank you for, you know, make being aware of that and your role in communicating with us. So thank you.

Absolutely, Senator, thank you.

Thank you. All right. Seeing no additional comments here from the dais, I am going to welcome public comment. So we will Take public comment at this time on this appointment.

Members of the public wishing to testify and support are welcome to step forward to the microphone and we just ask that you state your name, your position and your affiliation.

Thank you very much, Madam Chair and Members. Vanessa Kahina with KP Public affairs on behalf of CalPACE. The programs of all inclusive care for the elderly.

In our work with DHCS, we have experienced Mr. Sadwith as steady, thoughtful leader who understands both the complexity of Medi Cal programs and the real world impact policy decisions that they have on providers and the people whom we serve. Mr. Sad with values, meaningful stakeholder engagement, asks the right questions and approaches challenges with solutions oriented mindset.

At a time of significant change in Medi Cal and growing demand for community based care, Mr. Sadwith's leadership provides consistency, credibility and collaboration. For those reasons, we support his nomination. Thank you.

Hi. Justin Garrett with the California State Association of Counties in support of the confirmation of Mr. Sadwith. He has a keen understanding of the vital role that counties play in the behavioral health system and in the enrollment and retention for Medi Cal. He's a strong partner of county efforts and always open to counties and working together.

At this time of significant transformation for our state's behavioral health system and challenges facing Medi Cal and overall health care system, his leadership and expertise will be more important than ever. And for those reasons we support his confirmation. Thank you.

Good afternoon Madam Pro Tem and Members. Connie Delgado on behalf of the District Hospital Leadership Forum. These are the 33 district and municipal hospitals. Some of the conversations you had today were about some of these hospitals that I represent. We're here in support of. Mr. Sadwith has a very rich and deep understanding of Medi Cal programs.

He brings with him operational expertise. Our Members look forward to collaborating with him in the future and especially during this really pivotal time for patients and providers. And we look forward to meeting those needs, especially for those of the most vulnerable communities. We hope that you appoint him today. Thank you.

Thank you. Good afternoon, Madam Chair. Jessica Moran with Capital Advocacy on behalf of Paroteam Par Team is in support of Mr. Sadwith's appointment. Para Team is a community care hub who works with CBOs and the medical managed care. Medical managed care. Excuse me. To deliver Cal Aims Essential Enhanced care management benefit.

Looking forward to continue working with Tyler to continue making Medi Cal more equitable and whole person care centered. Thank you.

Thank you.

Good afternoon. Katie Rodriguez with the California Association of Public Hospitals and Health Systems. We represent the 17 public hospitals and health systems. There's 43 public hospitals and over 150 clinics. And here in support of Tyler's confirmation, he brings deep expertise in medical and behavioral health.

And as others have mentioned, has been a really wonderful partner as we all navigate what is happening on HR 1. The low provider rates, as Senator Grove mentioned. Tyler and Mr. Sadwith and his colleagues have been wonderful colleagues.

We look forward to figuring out how to address the deep cuts we're all experiencing from HR 1 and protecting access to coverage for our Californians. Thank you.

Thank you.

Thank you. Good afternoon. I'm Farrah McDade Ting from the County Health Executives Association of California in strong support of Mr. Sadwith's appointment today. He has a broad expertise in Medi Cal. And the challenges facing Medi Cal here in California today are significant.

We would want no other person in his position, and we're lucky that he wants to do it. And we look forward to working with him as we try to figure out what to do with Medi Cal. Thank you.

Thank you.

Good afternoon, Chair and Members. Amar Rashid. On behalf of the California County Behavioral Health Directors association, representing the public behavioral health infrastructure here across the state, and in strong support of Mr. Sadwith's confirmation today. He's been an incredible partner for county behavioral health agencies over the last couple of years. And we look forward to continuing that partnership. Thank you all so much.

Thank you. All right, any witnesses and opposition in the room, please come forward. All right. See, no witnesses in opposition. I want to thank all of our public comment, all of those who have provided public comment today. And so we'll bring it back for any final thoughts or questions from the dais.

Thank you. Madam Pro Tem, I move that we move the confery to the full floor for a vote.

Thank you very much. Vice Chair Grove has made the motion, so can we please call the roll?

[Roll Call]

The appointment has been approved to move to the full Senate for confirmation with five aye votes. Thank you very much for being here today. Thank you and congratulations. Next, we will turn to the governor's appointee required to appear. Item 1b. The appointment of Chris Thayer, Ph.D. as Director, Office of Environmental Health, Hazard and Assessment. Welcome, Dr. Thayer.

You will have the opportunity to provide one to two minutes for your opening testimony to the Committee. We'll then open it up for Committee Members to Ask questions in advance of comments in your opening.

You are welcome to introduce any guest that you have with you, and we'll go ahead and keep some time here, but you're welcome to begin whenever you're ready.

All right, thank you. Thank you, President Pro Tem and Honorary Members. It's a real honor and a privilege to have this appointment from Governor Newsom to serve in the Director of Office of Environmental Health Hazard Assessment, we call OEHA.

I want to extend my thanks to Secretary Garcia, others in the Cal EPA family, oeha, my family and friends, for their support.

So for the past 30 years, my work in environmental health has really had one core goal, and that is to try to translate complex science into actionable information that helps protect people and the environment, and to do so in a way that maximizes transparency, scientific rigor, engagement, and efficiency.

Before joining OEHA in May of last year, I spent more than two decades in federal service, first at the Division of the National Toxicology Program, which is headquartered at one of the NIH Institutes, and then at the US EPA in the Office of Research and Development.

The role of OEHA at the state level is similar to the positions I've held at the federal level in that those positions were not regulatory. The goal of those programs was to provide the foundational science support that helps inform regulatory and other actions. So OEHA serves that same role within California.

So as Director, my primary mission would be to ensure that OEHA continues to deliver trusted, high quality analyses that support California and to do so in a way that's transparent and really has extensive public and community engagement.

I would also look to continue oeha's tradition of scientific innovation, including systematic review methodology in terms of how we do assessment, community informed research and tool development, and new methods to evaluate chemical assessments. So in closing, if confirmed as Director, I would commit to leading with integrity, transparency, accountability.

So thank you for your consideration and I'm happy to take any questions.

Thank you very much. We will turn it to Committee Members for questions or comments. Vice Chair Grove, thank you.

Welcome to the Rules Committee, the first one I've had the opportunity to attend this year because I was gone last week. But, you know, in your opening comments, you talked about having science be a huge part of the analysis that you make and the determination of policy that you would, you know, not policy that you wouldn't.

You would, I guess, information that you provide to us for policy making and also on the regulatory side for what you're overseeing with oeha, or actually that Was in the federal. So anyways, back to this office. Environmental of health hazards assessments. I apologize. And you call it oeha.

I looked at some of the background that you do and a lot of your background in science is based on models and not real world exposure. That's data available. I'm going to give you a perfect example.

A few years ago this Legislature passed fifth line monitoring for refineries which was a policy that no other state has in the fence line monitoring there we are down to two refineries in my district we used to have 20, now we're down to eight in the state. Two of them are my district, one of them has to.

When you go around the facility, they're 25 foot towers. They have these big laser guns that shoot lasers from corner to corner. It looks like a, like a spaceship combat zone. It's the most bizarre thing you've ever seen when you're standing out there watching it.

They're required to test for, analyze and give data information to the state on 26 constituents, the facility and what they do. Now there is a 99.9% chance that they will not produce any of those constituents.

And there is a very minimal chance like less than 1% that there is a possibility with when they run nitrogen to clean the lines, they will produce five of those constituents. So the science behind what they do for decades, three generations says they will never meet the constituent requirement that is required by your guys office.

Okay, how come we're not using science on real world data to say well if you don't produce these certain things, it's obviously those things won't produce a carcinogen or something that will be impacted in the air that we want a constituent we want you to test for.

So if they're never going to produce it, why are we requiring to go through the $5 million to install it and $250,000 a year to maintain it if you make all your decisions based on real science.

So oehot's role is really in the health assessment, not so much in the requiring of the exposure monitor, but the.

Requirement is there for health protection which doesn't exist like it's. The health protection is to protect the community from these constituents that don't exist at this facility that the facility is required to test for.

We do rely on our sort of partner agencies and communities to sort of help inform what would be sort of the priority contaminants. And so I appreciate your perspective on that. So for us it would really be more when something is identified As a priority to try to characterize the health concerns.

It sounds like you're saying there's a gap in terms of the process for identifying what's a priority or deprioritizing. That's a little bit outside of our lane.

But I would say that some of what you're, when you were leading off talking about use of models, I can elaborate a little bit more about models in terms of health characterization.

So you can talk about models in the healthcare characterization piece, because there's a lot of real world data out there that happens every single day and you're still using models and that's not true science. That's an estimation based on the best factual evidence that you can find instead of using the real world data that's available out there.

Right. So in the context of health hazard assessments, ideally you have real data. Ideally, Ideally. Ideally. Typically for health hazard assessment, a lot of that would come from an animal toxicology study, sometimes human studies, but it's real data.

There's a shift in environmental health, it's at the research level doing less of that kind of work, which forces us as assessors to confront the reality of dealing with more modeled or indirect evidence. And so it's a transition, but again, it's not California specific, it's not OEHA specific, It's an international shift that we have to embrace.

And so some of the ways that we're thinking about that, especially when you're dealing with this shift, is to do careful, iterative science.

So as you embrace new methods, getting scientific review of the methodology, being clear on the assumptions, the underlying uncertainties, making sure we communicate that, and then hopefully in that way, this information, even if it's not traditional, so to speak, you still use it, maybe call it screening level, but you retain the credibility because you recognize it is what it is.

So you guys, you're going to make assessments based on non real world data that's available and you're going to continue to use models for what reason? You said you had transitioned away from the actual real data. What was the transition for?

I can give you some examples. In not case, it's not always models. In some cases it's more cell based studies rather than whole animal studies data. But indirect PFAs, there's what, over 10,000 PFAs we have data on probably a handful in terms of robust data sets.

So if we want to draw any inferences about what other PFAs in this very large and complicated class might be of concern, we have to do inferences. For example, this particular PFAS looks a lot like that one chemically. Can we make an inference that is going to have the same hazard characteristics? So that's one example.

When you're dealing with the volume of chemicals, you think about ways they refer to sometimes as read across. I started to get analysis, so I.

Wasn'T going to bring up PFAs. But since you did PFAS and Forever chemicals is what they're related to or what they're commonly used as. They just did a recent study in the San Francisco Bay that 91% of the fish were contaminated with forever chemicals or PFAS. Right.

And that's because of the wastewater sewage plants that dump their literally shit into the bay and then they use water to flush it out. The whole thing.

That chemical study was done by the UC Berkeley system and it actually says in there, and the results are right here, 91% of the fish in the Bay Area are contaminated with Forever chemicals or pfas. So to me, that's a real word study.

I mean, if you have the opportunity to go, you know, catch 10 fish out there and nine of them out of the 10 are going to be contaminated with PFAS, that's a real word study versus a model based on information that you bring in that says, oh, no, PFAS isn't contaminated in the San Francisco Bay.

We have an indigenous delta. Whatever the excuses are for the reason we have the contamination in the Bay, why would you not use real world wattles? I guess that's my. That's just an example. You brought up PFAs. That's why I brought it up to you. To me.

I mean, obviously, if it looks like a duck and it walks like a duck and it quacks like a duck, it's a duck. You can't put a chicken in that place. And I know it's a silly analogy and say it could be a duck. You know, we could model that if we extended its beak.

I mean, it seems like to me, it's like it's falsifying information and you're making decisions based on the way our businesses have to do business to treat health concerns, which I don't think any of our businesses want to create a health hazard. But we are.

You know, we as in the business community, are trying to figure out a way how to survive California. We just had one company write a billion dollars worth of contracts off just to get out of here. Just got a Fortune 20 company, got out of here for a billion dollars.

Another company is doing operations in Syria because there's more certainty in Syria than there is in the state of California.

And the only reason I bring this up to you is because these industries are accused of creating health hazards when nobody's using the real science regarding feet from a well service or whatever the issue is, I'm not trying to be specific and create conflict with what we have up here on the dais, but I'm just trying to say is that I would like somebody sitting before me that is as intelligent as you are, as qualified as you are to make your decisions and recommendations based on real world science and not some model that somebody in a back room that's never held a real world job or dealt with any type of industry whatsoever to make that decision, if that makes sense.

Because I think life experience matter.

Yeah, and I would offer too. So OEHA is more sort of the science arm.

And so what that means in terms of our role in terms of this ecosystem of risk characterization and management is that, you know, we do analyses that we develop analyses that are transparent and in terms of the methods and the results, characterizing the assumptions and uncertainties based on assumptions. Well, I'll come back to that in a second.

And then the idea is that this information is available to regulators and policymakers who think about more of the impacts, who think about the feasibility of the impacts. So we're trying to provide the reliable science piece to a bigger policy question, a bigger regulatory question.

Yeah, but we make decisions based on that information that you give us and that information is not based on real world science. You could look at both of us and say we're Caucasian, he's probably Norwegian. But you wouldn't know that unless you did a 23andMe or a DNA study.

But you're making an assumption on that and that's what you're doing when you make, when you, when your guys Department makes, you know, recommendations for policy based on health risk that are based on models, that's false, fake information that you, you bring up and calculate and it's not real world things.

So I, I guess we're, I'm not communicating with, I don't think very well about what my concern is and I'm not getting where you're coming from. And so I'll just pass my questions on to somebody else.

But I really, I mean I don't have a college degree, barely graduated high school, but to me, real world experience and real world stuff that's out there, whether it's PFAS in the bay or whatever it is that data is available. There's several studies on it.

It says that 91% of the contaminants in the bay, the fish out there, 91% are contaminated with forever chemicals. I didn't do that study. Some liberal organization did that study. So it's, you know, it's got to be believable in some cases. And the data is there. They've transparency put it out there and.

But yet we're still using models. And again, not just that specific thing, that we're using models and assumptions from some brilliant scientist. I get it in the back room, but we're not using real world data. And that's my concern.

So I apologize maybe 1.0 and I'll see if I can clarify it, we can move on. But I would say that. So one is what you've described about PFAS in the fish, that's more of an exposure. You know, our work is characterizing the health outcomes for a number of PFAs.

There is quite a lot of data, absolutely a lot of data in terms of the health characterization. And we have, you know, the Federal Government, we have developed values based on, you know, very solid, real evidence.

The extrapolation I was talking about are what happens to the PFAs that are more emerging and we find it in the environment, but we have no health information. And that's what happens when you have a class that has more than 10,000 Members.

And I get it, but just like when we have wildfires, right? There's got to be a health impact to the communities that live through wildfire after wildfire. Have asthma rates gone up, have medical costs gone up in those communities because of the contaminants and the toxins that are related to wildfires in communities.

You know, the creek fire in my district is one of the largest fires that we've had in California. There's no health impact studies on that because I don't know why, you know, we've looked and there's no research or health studies on that.

But if somebody does do a health study on that, I want you to go out and interview the people and look at the medical providing records.

I don't want somebody in a back office to say, you know, with 36 million parts per million of toxic such and such, whatever it is in the atmosphere, it could create a possibility of 2% of increase in asthma rates.

I want you to go out and find out if there's asthma rates like I want you to look in real world stuff and not just from a backroom chemistry lab. If that makes Sense. Sorry. Thank you. Thank you for your indulgence.

Thank you. We're going to go to Senator Laird next.

Thank you. I want to follow up on a little bit of the exchange that just happened, although I noted that she said that something prepared by a liberal organization was believable and we should quit right after that. But the thing that. And by the way, thank you for meeting with me. I appreciated the meeting and the conversation.

The role of a WEHA is to provide the science, but it's a regulatory agency of some sort that decides whether to regulate based on the science you provide. You don't actually develop any of the regulations related to the science science you produce, do you?

That's correct. We do not.

Okay. In. In that then leads to another question I was going to ask anyway, which is how do you relate to agencies in the state government, particularly those outside of Epa, because you are within Epa? How do you relate to them when you provide the science?

And they might have to do regulation or public announcements or any of a number of things. What's the relationship as that proceeds?

Well, it depends on the topic. But for example, you know, with California Department of Public Health, we work together in consultation to determine whether there should be recreational or commercial fishery advisories for marine algal biotoxin domoic acid. And we give sort of that joint consultation report to Department of Fish and Wildlife.

So that's one example of a very structured process for that, that specific scenario.

And then they have a little knowledge of this, and I won't mention why, because Senator Grove will twitch. But. But then they make the decision based on what you've determined about demoic action, about acid, about whether to close the fishery or limit the eating or things based on the science you've developed. Correct. Okay.

And that's very good information and I think important information to know. Then the other thing I wanted to ask you about, that we talked about yesterday, we're on, I believe, getting to or about to the fifth iteration of Enviro screen.

And it is a tool to determine just environmental hazards that might exist in different census tracts or zip codes or places. And I described to you in one of the earlier versions, having it set up for me in a conference room. And I think at the time it was done on zip code.

And I knew there's a disadvantaged community where there's Chrome 6 and they can't drink the water and it's in the same zip code as me, where there are not the same hazards in the water system where I live 10 miles away.

And yet I wanted to know that if you were identifying the hazards for that disadvantaged community, they were identified in a way that they could, you know, act. So where are we and what improvements are going to be incorporated or looked at at the latest version of Environment Screen?

Well, first I'm pretty excited to say that there should be a release very soon of a draft of Enviro 5.0. So the analysis is done at the census level, not the zip code level. So more granular. And in this update we'll be using Census information from 2020.

I believe there will be about 1,000 new census codes in there. So in some sense you may find certain sort of census based conclusions from prior versions where now they may be different because that census tract is now split and two. But that'll be, it'll be a very. Again, that should be coming very soon.

And, and you're never really done. You'll take feedback and you'll decide if there's still improvements and if, if there's an additional iteration that needs to be done of it. Is that part of it?

Yes, exactly. It's designed to be Evergreen.

Okay, and then one last question.

In what we talked about yesterday, you know, I had the experience of just a year ago this week, the battery storage fire in Moss Landing, and there was science released to the county and other local entities and, and the county was feeling this obligation from all the constituents that said, we don't know what's happening.

We want whatever you get out there the minute you get it. And it was released to them with no context. So it didn't tell you what it meant. I mean, I remember looking at it and thinking, I can't tell if this is bad.

And so when you do some releases like that, and that came through, I think the Department of Toxic Substance Control, when you do releases like that, what work or context do you attach to it to allow a rank and file person to understand what it really means?

We do focus a lot on risk communication. You know, we do in particular with emergency responses. Our role may be to sort of help analyze exposure in the context of health values, to either directly communicate with the community or to provide that communication support to other agencies when we do it ourselves.

It's actually something that we're very invested in in terms of making sure our scientists can talk to a variety of audiences and they're able to kind of contextualize what the risk values mean.

Okay, I would just identify that that is just a very important issue in an ongoing basis to make sure that people get it.

I know the Chair has had issues of oil spills in her district and I know there was a long perchlorate contamination issue in someone else's district as well as mine and people didn't know, they didn't understand what the impacts were on different readings. So I really appreciate that. Thank you very much.

And thank you again for meeting us today. And just to elaborate a little bit more, that's actually a very large part of what we're doing right now. Now in terms of our professional development, we have regular seminar series about risk communication. We have exercises.

Everything from giving your mission in a minute to giving people real time opportunities to do the risk communication and having that sounding board of others in OEHA to help shape it. We've had about, since 2022, about 50 new people.

You know, we're a small agency of about 140, but really trying to sort of develop the skills that the scientists do be able to communicate is again a very significant part of our portfolio.

Thank you.

Thank you, Senator Reyes.

Thank you. I think with the apparent elimination of Epa. I'm glad you left them and I'm glad you're here with us. It's so important to be able to provide for the community those tools they need. I will share that.

Even before I was elected to the Assembly, the Calenviro screen was so important to review and to explain it to the people who knew they were breathing the worst air.

And then when they could see how dark they were on the Calenviros screen, they realized somebody got it, somebody was helping them to not have to prove it every single time they could. Look at the Calen virus screen.

Now, when you look at a few things that are considered the pollution burden, population characteristics, when socioeconomic factors were included, did that include the price of homes?

And I ask because there were some areas in California without pointing fingers, who felt that they should be included in a different way because they may have had the breeze of the ocean to clear out their air. It was difficult for people to live there because of the price of their homes.

I don't believe it was included originally and I don't want to miss no, it was not about whether it's included in the current version, it is or.

It was unless it was eliminated. I haven't seen a 4.0. It was in 3.0. I appreciate my colleagues comments about real world world experience and using the science.

But I also appreciate your response because putting together those things that need to be considered in determining and I'll go back to Calviro screen, the air that we're breathing, the particulate matter, so many things that we all understood, but it's the cumulative effect of so many of those.

And I emphasize it a lot because in the Inland Empire we have been a dump zone for a long time. And I sincerely appreciate that we're able to use Calmviro screened without having to do our own research, which we absolutely could not afford to do. So thank you for that.

On Prop 65, something that also falls under your Department, I understand that there were a number of companies who, when they knew that they would now have to advertise Prop 65 warnings, they self they removed that particular ingredient, that particular toxin. Would you tell us about that?

Yeah, actually, I think so. You know, there was a survey earlier this year that kind of affirmed what a number of us suspected, that when a company is aware that they have a product that has a Prop 65 Lucid chemicals, about 80% of them will reformulate to either reduce or eliminate the listed chemical.

And so this is not a ban, it's not a limit, it's a warning. And we consider that a good thing. I think when you look back historically within Prop 65, you can find real impacts our work on lead in terms of removing reducing lead in baby formulas, children's product, jewelry. So again, kind of a success.

Just going back on sort of the impact of the reformulation. There has also been evidence that the amount of the chemical in people's bodies for some of the listed chemicals are going down over time, presumably because they're being used less frequently in consumer products.

And so again, I think that comes from the awareness that businesses have about a concern for a chemical that's translating into, I think, very tangible positive.

Without a doubt, it is a tangible positive and I, I do want to thank the Department for bringing that to our attention. I also appreciate those companies who said I wasn't aware that that was in the product that we were presenting to the public and did it on their own and the percentage was so high.

And appreciate that we're noticing the difference in these chemicals in the bodies of people. My last question, Madam pt.

Does the community engagement complement now the work of local boards or do you see times where the boards and I'm talking about local air and water boards, where the boards serve, where your board serves as a safety net for community members who feel they aren't being heard by the locals.

Again, I've been here since May, I would say more complimentary.

Okay, I would like to know more about that because Oftentimes and you don't have to answer now since you've only been there since May, but to see if this is something that is working.

And again, I go back to the Prop 65 because we know that is working, but your work with the local air and water boards and community comment seems that clearly would complement it. Is it something that we should continue and why should we continue it?

And that I would leave to you to at some time in the future to provide some information on that.

I will say community engagement is, you know, really a strong part of WIHA philosophy. Even with tools like Enviro Screen. And we have a new tool out Cal Heat Score, a lot of those are being developed.

We call it sort of community co design explicitly to kind of think about capturing people's lived experience, making the tools more useful. And so I would say again, sort of learning more about oeha. If anything, I think there's like a doubling down of that community engagement to help really inform our research and tool development.

And I think we get a lot.

Of positive response, real world experiences from them. Thank you.

Senator Jones.

Thank you. I'd like to. Well, first of all, welcome to California. I'm sure the Governor appreciates you bucking the trend of folks leaving California. My family came this direction in 1978 and I'm the remaining Jones in my family. Everybody else has gone back to Colorado. But welcome to California.

Thank you.

I wanted to follow up on the Cal Enviro Screen and Then also Prop 65, specifically on the Cal Enviro screen. That program was put in place in 2013. And are you.

Is your Department able to say that since 2013 the communities that were identified in the top 25% of, I guess endangered communities have moved out of that top 25% have been helped by the Cal Enviro Screen program? You know, we've spent billions of dollars on this program over the last 13 years.

What kind of success story can you share with us from that program?

I will share that I believe that particulate matter, there have been some decreases in particulate matter, which is, you know, very sort of tightly linked to a number of health outcomes. That's a real success. In terms of. I think you were asking sort of how consistent are the.

Well, I think more specifically, specifically to my question, is the communities that were originally identified in 2013, have those communities been improved by this program?

I would probably have to get back to you on whether there was sort of an analysis of that to a.

Degree and I appreciate that.

I'd like to copy of whatever you provide.

Yeah. Thank you. And typically that's how when one of us requests something, we like for it to be shared to all of us. So thank you. Do you need my staff to follow up with you on what those communities were or at that time or. I'm sure your staff can figure it out.

Yeah, I think we can follow up.

Okay. Prop 65. This is more of a General comment and question. Maybe, you know, when Prop 65 was first put in place, I believe it had good intentions. You know, it started to move in the direction of eliminating these hazardous chemicals that were well known at the time. Over a period of time.

It became a trial attorney's windfall in what I would argue a lot of times, most of the time, frivolous lawsuits. Of course, some of the lawsuits weren't frivolous and were, you know, part of the program.

And now it's moved into where it's almost a study of the ridiculousness of the absurd to now where just about anything you buy in California has a Prop 65 warning label on it. Because that's just the. It's easier to put a sticker on it than worry about whether you actually have a chemical that is harmful or not.

I mean, the ones that crack me up is when I'm. There's certain historical buildings in San Diego and I'm sure other places of the state as well that have outside porticos that have a brass plaque anchored into the wall saying that this building may or may not contain chemicals deemed hazardous by Prop 65.

I had a serious conversation with some folks earlier today about just running an initiative to undo Prop 65. Now that might be absurd to the other direction. I just wanted to get your general thoughts on where we are with Prop 65. Is it still working the way it was intended?

Is there some changes that you and your team would recommend and just some general thoughts.

Yeah. So one, we've spoken a little bit about the successes. So that's a good thing. But I would say that, you know, OEHA has publicly said, and I also agree with this, that the over warning is an issue. Right.

And sometimes it may be triggered by and for those of you who don't know, so proposition 65, we implement it, which means we do the science and the guidance. We do not enforce it. We don't enforce it. That's sort of partner agencies like the attorney general, district offices and then private enforcement.

That said, we have a very vested interest in making sure that it's enforced, implemented in a way that really goes back to the original goals, informed choices making, giving people meaningful information. So we've done a number of things to try to see if we can help with this.

So we've had in the past year we had a couple of workshops for businesses so they understand the implementation of it. I think we had over 700 people join 40 countries, 43 states. I might have flipped those around. But widely attended. We've hired an ombuds person.

We have adjusted our warnings so that even short, every warning lists the chemical. So it's not just the building. There's something a little bit more specific. We can do safe harbor levels, which is where you identify an amount that there's not a concern for cancer or reproductive effects. And then products below that amount don't have to warn.

We can do safe use determinations where we work with the business to understand the amount of the chemical in their product to help them determine whether or not a warning is required. So we're trying to do a lot of educational outreach. We've updated our website.

We've got really positive feedback that it's easier for people to find information including like sample warnings. Another thing that we've done to maybe try to, you know, be a little bit more pragmatic and bring some common sense into the warning is information letters or regulations. So for example, arsenic can have background.

I mean rice, rice can have background levels of arsenic. And we have an information letter regulation indicating that if it's just background level, no mourning is required. We have another one with vinyl acetate, a very sort of recently listed chemical where.

And this may be a little bit of, a little bit of a science rabbit hole, but I think it, I hope you get the point that we're. What I'm trying to say is I think we're going to be doing more of the examples that I'm going to give you right now.

So here vinyl acetate, the monomer was listed. Monomer. Think about like a free floating brick. It's just out there able to interact with your body. The form of vinyl acetate that's found in more consumer products is a polymer like a brick wall or a copolymer. So it's not really free to interact with the body.

The monomer that was listed is not often used in consumer products because it's reactive and not stable. So we came out with an information letter clarifying the listing was for the monomer and that you couldn't just sort of point to a product and say it's a polymer. Ta Da.

You had to Sort of demonstrate that there was exposure to the monomer. So I think that, that hopefully doing more of these information letters might put some guardrails because it raised the bar for the kind of exposure information that would be required to try to do a violation notification.

And I appreciate that and that. And from the science side, I'm not sure that I have too much of a challenge with Prop 65. You know, my concern is from the legal side and you know, you said the private right of action, that's the problem with Prop 65.

And, but it was, you know, it was done on purpose, it was intended to be that way. And so I think, you know, moving forward it would be, I think instructive for the Legislature to hear from your office at some point in time, you know, some tune ups that we can do to Prop 65.

Of course we'd have to, you know, run that as an amendment and put it on the ballot for a vote. But I think the public in California has gotten to the point where they just realized Prop 65 is a joke.

I do want to underscore one of the things that my colleague from Bakersfield was trying to get had gotten to, I believe is the modeling aspect of some of the policies that are made by this Legislature. Now I'm not going to blame your Department or any, any state Department for providing the models that the Legislature asks for.

I'm going to put the blame on the Legislature for taking those models and writing policy based on them if they're not backed up by legitimate investigative science. But I think it's important that you have a voice when you're dealing with the Legislature on those models that, and I'm sure you would do this again.

I put the blame on the Legislature to understand that. And one of the most frustrating conversations in my leg, in my legislative experience was when I was in the Assembly and I think we were debating cap and trade at the time.

The original cap and trade, you know, we tried to change it to cap and invest, but it's actually cap install is what it is. You know, the argument at the time was when we get to this air standard, 1990 air standard, you know, everything will be beautiful and perfect in California.

And nobody could tell me where is this mythical jar of 1990 air, that when we get to that standard, we can open it up and compare the 1990 Air to whatever year we're in.

And I think a lot of people could argue that in lots of places in California the air today is much cleaner than it was in 1990. Well, come to find out, it's just all modeling. You know, this 1990 air thing is all modeling. There's no science there. I mean, there's, you know, some computer science, I suppose.

And so that's, we've, we've built in California and like this frustration is obviously not, I'm venting a little bit right now. We've built an entire false economy on these models for cap and trade and for greenhouse gas emissions and, you know, everything else that these numbers may or may not be accurate.

So I just wanted all that to say I'm as concerned as my, my colleague from Bakersfield on the modeling and the policymakers using that to make policy that could negatively impact our constituents. Thank you for tolerating that.

I appreciate it and happy to follow up on Prop 65. And if I, if it's okay, maybe I can elaborate a little bit about the modeling since it's come up a few times.

So again, our world in oeha, it's not so much, we don't do so much of the exposure modeling, but in terms of characterizing the health concerns, we don't have a choice. We have a choice, but it's not like we're doing it alone.

A lot of the chemical companies are also recognizing and sort of using, we call it alternative data, which could be cell based, it could be model based. It's. The field is moving that way. So as we think about how to sort of use these methods, it's not.

We actually do that in conjunction with the chemical companies as they think about using this information to sort of determine the safety. So it's sort of across the whole ecosystem, if you will, of people who are in this space, we have to get our heads around it.

But I think one of the things that's really come through here, and we recognize this, we're still kind of thinking about the research to do it, to apply the methods. And we know there's going to be this whole other level. How do you communicate that to policymakers, to regulators, to communities? So we know.

And that's not going to be a one and done and that will probably take several years, but we are anticipating that that will be sort of, it has to be part of this shift in terms of acknowledging that the kind of evidence that we have relied on is not going to be there.

Thank you. So thank you colleagues for your comments and feedback. I will try to be quick in that.

The calenviro screen and the reason, I think you've heard several questions about it is because I have been in many debates about how we use, how we, the Legislature chooses to use the calenviro screen to make recommendations on policy and certainly the inputs and outputs of what we generate from the cal enviro screen.

And we know there's been many iterations of it has been. I mean it's informed policy. So that is why I think there have been many questions about it because it informs policy. And when this particular tool, I think it is a tool, I think it signals, I think it's not.

I don't know of any research tool that is, that doesn't need some updating. Right. Because life changes, updates. And so there's no, you know, eternal certainty in anything. It is a tool that is updated and we're able to use that.

But so I emphasize that because I think that across the Legislature and different parts of our state, the cal enviro screen is interpreted differently, in particular because of the policy implications it has for our communities and the way that we, the Legislature chooses to use something that we don't create.

But there are a lot of folks in the Legislature that have opinions and thoughts about it.

And so I will echo some of what has been said, but also just by encouraging us to be to better understand it in terms of what's going in and what's going out and what's being considered when there are certain communities that are being classified as having different levels of impacts from the environment.

So that's what I will say. I also just want to touch on research gaps.

In a former lifetime I worked at University of California system and certainly was so appreciative of the partnership that the state and the federal level and also with the private sector, we had these great partnerships in terms of, and you alluded to this, that being able to collaborate on research and being able to use that research and expand on it in this moment in time, there are research gaps and some of that partnership, whether it's with the federal state, you know, private sector has shifted.

Has shifted. And so I'm wondering if you can speak to those gaps and research gaps in this particular space and where you think one, those gaps exist, but two, where we could, you know, solve for some of these gaps that exist.

Generally speaking, yeah, I think it'll be every tool in the toolbox approach in terms of the gaps. But yeah, I think the number of requests to sort of meet with different universities in the California system to talk specifically about how do we make sure our research is used, it has impact.

And so it's a two way street and so I think that we're being. I'm very encouraged and excited by those conversations.

We've even talked about sort of having meetings where again, really sort of talking about to the researchers and then sort of the users and the government side about how to make sure there's a sight line toward impact.

I will say also, too kind of going back to every tool in the toolbox as the dust is settling in the federal space or starting to settle. You know, there are new partnership opportunities.

Some of the people that I worked with before who are very committed to filling research gaps are now maybe in sort of the private sector or in nonprofit sector, but have the capability to do research. And so those are very exciting opportunities as well. And so I think. And we're also trying to really partner with other states.

Many states are confronted with the same chemical issues and which means that we have probably the same research gaps.

And if we're able to connect and speak with one voice about what the research gaps are, then I think we will have more success in getting those research gaps met, whether it be through partnerships with universities, Federal Government, some of these new entities that are cropping up.

Great, thank you. And I don't know if you can speak to any of the specific subject matters that maybe you're seeing that there could be research gaps where you have these opportunities. I'm just curious, you know, what comes to mind when you're thinking of these gaps?

Pfas. That's one, I think, another one, some of these alternative methods. Because again, it's a challenge, but it's not just our challenge. So I've actually had some very productive conversations with Texas. They have the same challenge. They have the same challenge. And so that's, it's really more methodology.

But we're envisioning ways that we can at the state level, have our frontline assessors grow to understand how to use some of these changing technologies and having conversations back and forth real time, you know, what are the uncertainties, the assumptions? Are they bridged too far in some cases?

So I think those would be sort of two specific ones that I don't want to jinx anything, but I think we've got some momentum there and just going back to enviro screen. So we will, when we release a draft, there will be webinars, there will be workshops, there will be sort of a lot of outreach.

So I think that it won't just be, you know, a draft that's dumped without no ability to sort of discuss and reflect on what it means.

Thank you. Thank you for that. And just as a reminder, anything that you would like to have to ensure that the Committee has, whether it's to one Member or all, if you'd like to just send it to Lisa Chin so she can get it, she can make sure that every member of the Committee has it.

And I think everybody would appreciate it. Thank you. Seeing no other questions or comments, I'm going to invite any Members of the public. So thank you for that. Any Members of the public to please that are here in support to please come forward. Just state your name, you know your affiliation, whatever brief comments you have. Thank you.

Good afternoon, I'm Susan Little. I'm the California Legislative Director for the Environmental Working Group. And I'm pleased to be here today to lend our support to Dr. Thayer's candidacy and confirmation to be the Director of OEHA. Dr. Thayer has a storied background directing scientific analyses at the US epa or we are lucky to steal her away.

And we believe that she'll bring her legacy of transparency and integrity to OEHA's programs.

And I just want to just also say that the Environmental Working Group shares the committee's concerns about PFAS contamination and are hopeful that Dr. Thayer's leadership and her know how will bring the expertise needed to the state to grapple with this issue and find some good solid solutions. Thank you very much.

Thank you.

Good afternoon. My name is Nancy Biermeier. I'm Director of Program and Policy for Breast Cancer Prevention Partners. We're a national organization working to reduce the risk of breast cancer by eliminating exposures to chemicals that have been linked to the disease. As a science based organization, we absolutely depend on the research done by OEHA.

And I wanted to just take a minute to highlight one of the programs that hasn't been talked about that OEHA is a partner agency in, and that's the California Biomonitoring Program. There have been questions about real world data.

There's nothing more real world than measuring the level of chemicals in humans in their blood, in their urine, in their breast milk. And those are the kind of studies that can show us whether the policies that you pass work or not.

When California passed a law banning certain flame retardants, there was a study done 10 years later that showed the drop of those flame retardants in breast milk. And I can tell you as a breast cancer organization, that matters a lot to us. We know that policy worked.

So I wanted to just highlight that program in addition to Prop 65 and Enviro screen all very, very important programs that don't happen without OEHA.

In the face of the devastating cuts that have been leveled on programs like the Office of Research and Development at the Epa, it is more important than ever for California to step into that breach. For California to provide that scientific integrity and leadership, not just for our state, but for the country.

And we have absolute confidence that Dr. Thayer's deep experience, including at the EPA, her commitment to transparency and her unwavering scientific integrity make her exactly the right person for this job.

At this moment, on behalf of Breast Cancer Prevention partners Clean Water Action and the Natural Resources Defense Council, we urge you to confirm Dr. Thayer to this position. Thank you.

Thank you. All right. Seeing no additional members of the public here in support. Are there any members of the public here in opposition?

I know.

All right, seeing. Then we're going to bring it back to the dais.

Yes, I would move. We approve the appointment and forward it to the central to the Senate floor for a full vote.

Thank you very much, Senator Laird, for the motion. And we will go ahead and call the roll.

[Roll Call] 3 to 1. All right.

That appointment has been approved to move to the full Senate for confirmation with a 3 to 1 vote. So thank you very much and congratulations.

Thank you. So this concludes today's public portion of the agenda. To all individuals who spoke in public testimony today, thank you very much for your comments, for your feedback, for your suggestions. They are important to us and we appreciate your participation. And so to everybody else here in this room, thank you for your patience.

Thank you.

We are adjourning the public segment of Senate Rules Committee and we'll be convening Executive session. We will take a few minutes while the room clears before we begin the Executive session.