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

Sub 3 on health and Human Services will convene in a minute.

Good morning everyone. Welcome back to the Senator Menjivar Show. We are back here. My colleague and I were playing musical chairs with what we Chair each year. So we've traded spots this year. Excited to be back to leading these conversations. But the downfall is now we're just going to have longer meetings now.

So pros and cons to everything, right? All right, so today's first meeting on sub three is going to go over seven different departments. I'll list them out as they come up. We will do public comment at the end of the entire hearing. That might change throughout each hearing depending on the topics.

We might cut in public comment as we move forward after individual topics. But for today, we'll keep it at the end. Okay, let's get this party started with our overall Cal HHS to come on up. I invite Department of Finance up, LAO, Department heads. Get started with the overview of California Health and Human Services Agency.

Good morning Madam Chair and Members. My name is Sam Lui. I'm the Deputy Secretary for Program and Fiscal Affairs here at the California Health and Human Services Agency.

Before I begin today's prepared remarks, I want to first acknowledge the many hands across our 12 departments, four offices and 38,000 employees across our state, each of whom played key roles in shaping the budget and most importantly in delivering care to our Californians.

Today I'll be providing a high level overview of agency's mission and strategic priorities, funding and respond to the committee's questions and in the weeks ahead wanted to thank the Committee in advance as well as our valued stakeholders who are here today for their consideration of our departments and offices, proposed budget and trailer Bill proposals.

We're collectively working together, arms linked to defend, stabilize, and protect our core services and programs. It's more clear than ever that our values are worth fighting for. These are really important when taken in totality with all of the incoming from the Federal Government.

And we're fighting back proudly with our agency alone representing nearly a third of all litigation that's been filed against the Federal Government and through creative and intentional partnerships like the West Coast Health Alliance. This is the California way.

Even in setting aside the Prop 98 guarantee, HHS departments and programs actually represent nearly 59.1% of the entire state budget. Our overall budget reflects 343.6 billion, of which 94.4 billion is General Fund in 26 and 27.

This figure underscores the criticality of what is at stake and most importantly, whom we are fighting for this state thrives when our people do through access high quality, affordable care through our workforce programs, cutting edge technologies and connecting our systems of care.

Our mission is to work with cities, counties and communities as well as with the public, private, faith and educational partners to make California a healthy, vibrant, inclusive place to live, work, play and learn each day. We consider the cultural and socioeconomic drivers that impact people's lives across the lifespan.

Aligning and integrating programs to meet these individual needs and program centered programming honors these needs and preferences and values of those who are being served as well as respects the dignity and autonomy of individuals and families. I'll be sharing with you our five strategic priorities, the first of which is to build a healthy California.

We know and have done this through significant investment in behavioral health workforce either in 988 and also with the Prop 1 funding protecting the future of public health as well as key investments in reproductive and health rights. The second is to integrate health, housing and human services. The third, strengthening social well being, equity and economic resilience.

The fourth, advancing the well being of children and youth. And we've seen this with the Children and Youth Behavioral Health Initiative which is our $4.7 billion effort across five years to ensure that every California aged 0 to 25 has increased access to mental health and substance use supports.

And lastly to build an age and disability friendly state for all we know that in just four years time one in four Californians is going to be over age 60 and we need to meet that modernizing our aging network to meet that demographic imperative.

Agency serves as this connective tissue that coordinates the cross disciplinary policy and our program impacts. The agenda really lays out for us quite well those 12 departments and four offices. And overall I'm going to just speak at a high level of what our budget.

So we have about $94 billion across all of CALHHS, of which 81.7 billion is for DHCS. So that's about 57%, 25.9 billion. So about 18% goes to social services, and 13.4 billion, about 9.4%, is for developmental services. For the agency-specific budget, we have about 1.2 billion in total funds, 243 million of which is state funds.

It's a mix of general and special funds. And there are a total of about 533.5 positions. A majority of those positions are with the Office of Technology and Solutions Integration. And I know the Committee had asked about CalHEERS, which is our California Healthcare Eligibility enrollment and retention system.

I would like to introduce Lorna Eby, who's a Deputy Director for CalHEERS, who will be able to respond to any of the more technical questions.

So to the specific question that was in the agenda, this is actually just a technical adjustment that aligns OTSI's expenditure authority with the funding that its sponsor departments from DHCS and Covered California have included as part of the compliance for HR1.

These are some of the system changes that are needed to comply, as well as some of the data quality compliance efforts and related eligibility functionality. How the funding is going to be split is about 86/14, 86% for DHCS and then a 14% for Covered California. That concludes my prepared remarks.

I just want to say again that it's undoubtedly an all hands on deck moment. We look forward to partnering with you and all of our stakeholders here today and in the coming months and years ahead to make sure that we can showcase each of our departments and office's work in uplifting our communities. Thank you.

Before we go over to the second question that you'll be responding, I see new faces. Who's with? Who's with who?

Xin Ma with the Legislative Analyst Office.

Okay. You're due.

Gabriel Ordaz with the Department of Finance.

Okay. Is there anything LAO would like to add to the overview?

We have nothing further to add. Thank you.

Perfect. I'll turn it back to you, ma'am, for question number two.

Actually, I.

Oh, is it just technical? Can you elaborate on that a little bit more?

On the solutions or the technical requirements specifically, Madam Chair,

On the second question to. Thank you.

Certainly. So it was a technical adjustment of that 60 million. It wasn't actually a new budget request or an ask that was tied to this. It just reflects a new commensurate spending authority that was already budgeted for the DHCS and the Covered California side. And so you'll see that corresponding request in the OTSI budget.

Okay. So it's again, it's simply an expenditure authority. The budget is already provided by our.

Is it already allocated?

It's already allocated, yes. DHCS is included in their May revise for 26-27 and ongoing. And Covered California also is contributing their budget, which they plan for on an annual basis.

Perfect. Thank you. Thank you. No further questions.

Thank you, Madam Chair.

Moving on to issue number two. Sir, if you want to just swing a chair over, you can stay up here.

Big party. Judge, go ahead.

Good morning. Thank you for this opportunity to present. As you can see, I have the experts from my team here and we're going to start off with Deputy Director Alani Jackson, who will handle the first question about the budget.

Good morning. In response to the agenda item, a brief overview of our proposed 26-27 budget, it is projected there will be Based on the Governor's budget, it is projected there will be $240.77 million to OYCR, of which $227 million comes from the General Fund. We were also allocated priority or position authority for 39 positions.

Two of these are new positions. And the justification for our budget change proposal will be covered by our Ombuds personnel Lisa Hartz later today. And a majority of our budget is for Juvenile Justice Realignment Block Grant funds and local assistance dollars.

The remainder of our budget, about 19.7 million of our projected budget, is for state operations, technical assistance grants and support to counties for providing juvenile data, as well as the remainder roughly is for personnel costs and state operations contracts. Any questions?

If not, I will pass it over to our Data and Research Division chief Kamilah Holloway to answer the committee's questions about DJJ Realignment Report.

Good morning. To begin, hopefully I'm coming through. Okay, to begin, I'd like to acknowledge the PowerPoint slides that were provided and that we can revisit those slides when and if requested. And now I will give the main findings. So OICR is SB823.

DJJ realignment report finds that California has successfully shifted responsibility for youth formally committed to DJJ from the state to county based systems. However, implementation, quality and readiness vary widely across counties. While secure youth treatment facilities are now the primary placement, many counties continue to adapt legacy facilities and systems to meet SB823's rehabilitative intent.

Qualitative findings highlight that youth outcomes are strongly influenced by relationships, continuity of care and individualized treatment. While quantitative data shows variation in SYTF utilization, transitions to less restrictive programs and returns to custody data, infrastructure gaps currently limit the state's ability to track long term outcomes consistently.

I'm going to go ahead and address these very specific questions you have about our recommendations around the SYTFs, the SYTF programming, the IRPs, the review hearings and the LRPs, and then the reentry and support. So you asked specifically what the recommendations of OIC are for SYTF settings.

As you know, we are launching in our fifth year, and we have a lot of lessons learned. And then we also have our five-year Realignment Report that has some general recommendations, but specifically to SYTF settings.

I have three recommendations based on the number of contacts that our Ombuds Division receives each year and the fact that adolescents spend most their most critical formative years in the facility. Now, we would recommend that each facility conduct regular climate surveys of of the youth and staff to monitor and improve conditions of confinement where indicated.

The second recommendation is that each facility it would be a best practice for them to have a Youth Advisory Council.

We're finding that not only do we have a statewide Youth Advisory Board, but facilities that have a Youth Advisory Council that have learned to communicate with probation leadership and in an organized, predictable and respectful way are highly successful ways of keeping the facility climate in good shape.

We also recommend robust incentive based behavioral management programs that are implemented by Behavioral Health, County Office of Education and Probation. These are best practice for safe, secure and thriving facility environments. Most schools both in and out of facilities in California use a positive behavior intervention and support PBIS as a model.

San Luis Obispo is a great example of where the juvenile court schools implemented PBIS and probation adopted it for the full facility. San Luis Obispo is a model for the state with regard to SYTF programming.

Core programming may include dual enrollment and higher education access, vocational training and CTE opportunities, life skills, financial literacy, behavioral health, wellness support, substance use disorder services, restorative justice and access to credible messengers.

Whenever a facility can partner with Department of Rehabilitation, Rising Scholars, Underground Scholars and Project Rebound, we see that youth are obtaining AA BA degrees, certifications that give them life skills for once they are released and often these are Adolescent youth are stepping into a life as a student with an automatic support system when they partner with these other state resources.

With regard to the individual rehabilitation plan. This is a living document and it should follow the youth during their time in the SYTF and into the LRP and to continue support after they complete their baseline term and are placed for reentry supervision. We recommend that the IRPS guide placement decisions, services and transition.

IRPS should clearly link to treatment needs, progress indicators and readiness for stepping into the community. With regard to. Do you have a question? Okay. Okay.

With regard to the progress review hearings, in the spirit of the collaborative court model, highly successful therapeutic court model, we recommend that the multidisciplinary team be convened prior to a progress review to discuss modifications to the IRP baseline term reductions and the progress of working towards an lrp.

At the progress review hearing, the party should be given a report detailing these discussions. We recommend that progress review hearings serve as substantive forums for assessing youth progress and readiness for less restricted placement. We recommend that courts receive timely, meaningful information to support consistent and informed decision making.

With regard to LRPs we have seen a myriad of LRP options develop over the last two years throughout the state.

We promote promising practices for community based residential transitional housing practices linking the LRP directly to college attendance and or vocational training along with highly structured ongoing treatment rehabilitative goals to support the youth's success, coupled with one-to-one credible messenger mentoring.

We are available to provide technical assistance to assist counties and CBOs in how to leverage existing resources to fund these initiatives. We recognize that building this new opportunity to live in a community while completing one's baseline term is complex and requires identified funding and warrants careful planning by all the stakeholders to be successful.

With regard to transitional planning and reentry support, if not already being done, we recommend counties conduct a new assessment to inform modifications to the IRP within the 90 days of release to align with the Calaim Justice Initiative 90 day in reach provisions.

This would be a transitional assessment that includes supportive and rehabilitative services needed in the community which may be different than the needs for an IRP, for example Permanent housing, family reunification, long-term transportation, and mental health needs.

With regard to what data would assist in tracking youth outcomes or we do give an overview in the package that you have received, but OICR identifies the need for integrated longitudinal data systems that track youth outcomes beyond placement counts.

Relevant data includes recidivism time spent in placements, how long youth are spending in custody prior to adjudication transition to LRP and subsequent returns to custody, and why educational engagement, Behavioral Health Service continuity and equity indicators Cross System data integration is essential to evaluate long term outcomes and system performance.

OICR is in the middle of developing a data dashboard, a system wide a statewide data dashboard that will include county by county integration of data. Much of it is already in the public domain, but the items that I cited would be particularly helpful to tracking how well we're doing with SB823.

And if there are no further questions for me, I would like to go back to Camilla Holloway to answer questions that you have about net widening.

I'm just going to save my questions till the end.

Okay,

There we go.

So for your question regarding net widening and how OICR will continue to monitor signs and implications of potential net widening. The available data does not show net widening. Directing the Subcommittee's attention to our last slide, beginning with fiscal year 2024-25 AB 169 enables OICR to receive data twice a year regarding the respective number of SYTF commitments.

According to our most recent AB169 data, the average number of SYTF commitments is approximately the same as the average number of DJJ commitments prior to realignment. So we're at 333 versus 334 at least.

Some if not all of the rise in commitments in fiscal year 2022-23 and 2023-24 may be the result of legislation such as Assembly Bill 2361, which raised the legal standard and shifted the burden of proof for transfers to adult court. This Bill applied retroactively, allowing some youth to return to the juvenile system.

Additionally, the number of youth committed to an SYTF rose between 2021-22 and 2022-23 due to 140 youth returning from the Division of Juvenile Justice to SYTFs as DJJ facilities closed. Commitments declined in fiscal year 2023-24 and 2024-25 to 386 and 333 respectively.

The number of youth adjudicated for 707B offenses and PC 290.008 offenses increased between 2021-22 and 2023-24 but decreased by year 2024-25.

Some increases in 707 adjudications and SYTF commitments may include youth previously transferred to adult court who were returned to juvenile court following legislative changes, but the available data does not allow OYCR to identify how many youth were returned each year. OYCR continues to monitor for signs of potential net widening through our semiannual AB169 data.

I will now turn this back to Deputy Director Alani Jackson to answer questions regarding Title two.

Great. Thank you Kamilah. So a brief description of the pending issues with Federal Title II grant funds. As you know, OICR became the designated state agency to be in charge of the Federal formula grants from the Office of Juvenile Justice and Delinquency Prevention.

On July 1st of 2024 we received, applied for and received the Federal Year 24 Grant Award which covers 10-1-2024 to September 30th, 2025, the transition to OICR as the DSA from BSCC. The prior DSA occurred mid three year cycle of grant awards that they already had. So the challenge that we are facing is multi pronged.

One is our grant award for the funding that we received. We cannot start paying until October 1st for work performed 10-1-2024 and ahead. So there's three month period July 1st of 24 to 9-30-24 that we don't have the ability to pay grantees subrecipients as they're referred to for invoices that were received for work that was performed.

So that's one challenge. Another challenge is that our grant award wasn't actually fully approved from the Federal Government until April 15th of 2025. So they have limited our ability to pay grantees for work performed within our award period from October 1, 2024 to April 15, 2025.

Then lastly, another prong in this challenge is that the solicitation that the Federal Government has to post for us to be able to apply for for future funding. So another $4.1 million, another $4.1 million for federal award year 25 and federal award year 26 has not been posted yet.

There has been no solicitation offered from the Federal Government to date. They say it's coming. We don't have a date to to look for. We check daily for that release that impacts grantees also who are award recipients. Because we only received $4.1 million, we only received one award period's worth of funding.

So that is the challenge that communities are facing who are Title II sub recipients of the Title II grant award. We have put in a request for for a retroactive authority to spend during our full grant award period.

So for 10-1-24th to April 15th, 2025, we are pending a decision from the Federal Government to enable us to do so. We also partnered with BSCC as part of the transition of the DSA going from them to us.

We submitted a request for an administrative funding adjustment is what it's formally called to transition the unspent funds from the Title II grant awards that BSEC had to OIC. That was submitted back in November of 24 and we are still pending decision from OJJDP and that is roughly around $14 million that should have that.

We are, we are anticipating coming to us. I know you're gonna say question. Okay, I will pass it back over to Kamilah.

Okay, so next I will be providing a brief update on OYCR's work with counties and the Department of Finance to implement the JJRBG funding formula beginning July 1, 2026. So the JJRBG funding formula will be distributed consistent with statute. OICR continues to engage with stakeholders to discuss the funding, the formula revisions and implementation.

OICR offers designated office hours and is available to answer questions from stakeholders at any time specifically about the JJRBG data submission. And by May of this year, OYCR will have data that will be compiled for the use of calculating the 2026-2027 JJRBG allocations. And now I will pass this over to Elisa Hartz or OYCR's Ombudsman.

Yeah, we'll, wait a little bit. That's. We're still. I'll be the next item. Okay. Does LAO have anything to add?

Orlando Sanchez with the LAO. No comments at this time.

Okay, great. So I'll start, I'll go backwards. We'll start with the JJRBG funding in particular LA County, given the fact that a lot of the youth are moving from Los Padrinos to Barry J. Nydorf and Barry J. Nydorf was never, now under the new law, won't be eligible for funding because they've been found unsuitable.

Is LA County now going to be in a situation where they're going to have youth in two facilities that they won't be able to provide funding for?

What I can say is that that is a very. That's a county decision. The money goes out to the county, to the Board of Supervisors, the CEO and the county is responsible for adhering to the statute. So it we don't allow them.

Won't allow the Board of Supervisors to provide funding to an unsuitable location.

That would be. Yes, that would be what the statute says. And we are not involved in how counties end up allocating their funds or to whom.

Will all YCRB engaged in how services are going to be, how effective services are going to be given now that they're not going to be able to utilize JRPG funds.

Well, we will continue to get annual reports on and part of the annual report is to tell us how they're using their funds. Not of course a line by line, but generally. So we would expect to see how those funds are being spent and where in the JJRBG annual report.

Okay, so we'll wait till next year to see how the lack of funding is going to impact.

Yes. And the county may pull dollars from other places, as you know. So it really is a very intricate local puzzle.

Okay. Just concern, I mean they're cutting 50 million just today on public clinics. So I don't think they're going to have be able to find funding elsewhere.

So the lack of available fundings in particular for our problem child, that is LA County, I think shouldn't wait for a whole year, maybe this is for you, Madam Ombudsperson, but shouldn't wait for a whole year just to see how the services are going to be provided there. So Title two grant funds.

It just seems like a really terrible situation to be in. It doesn't seem like there's a solution to this. We're just beholden to the ability for the Federal Government to allow us to transfer the $14 million. And that seems to be it. Is that correct?

We are trying. We are exploring any possible alternate option that would allow a state solution to access the unspent funds.

We have had many, many meetings on this. This is a very big deal to us. We've had meetings internally, we've had meetings with the Department of Finance, we've had meetings with bscc and we are committed to finding a solution. And, and so that is something that we're not going to let rest.

This is something that's on our minds every day. And so we will continue to keep you aware of how we move forward.

Okay, great. And because we're not, the new application is not open for the additional 4.1. Does that mean we can't like those vendors will no longer provide services or are they going to continue to do it with the hopes that we will one day?

So there has been at least one of the 12 subrecipients who has stopped providing services because it's, you know, unfeasible. They have been kind of trying to hold on until funding was released. The other we have also tried, one of our initiatives with an OACR is the Justice Serving Network.

And it's cohorts of community based organizations that are being connected to ways to become enrolled medical providers for also, you know, funding sustainability. So we did also create a cohort of the 12 subrecipients to try to also as a means to find additional funding in the absence of the Title 2 funding being released.

So as Director mentioned, we are trying to see what else we can do at the state level to, to give the CEOs, you know, the funds and find pathways to get them the funding that they deserve for the services that they've been providing through this grant.

Okay, thank you. Moving into net widening, I do recognize the perspective of oicr, but I'm wondering if certain counties have gone from, if certain counties have increased, you know, from sending to DJJ to now a higher threshold of SYTFs. Are we looking at individual county trends and net widening?

And connected to the question, I know in the report, one of the, in the appendix, one of the stakeholder recommendations was a statewide definition of net widening. So that we don't have a. This is our perspective. This is your perspective of what net widening is. Would that be helpful to have a state, statewide definition on that?

Yes, I do agree. We have provided kind of in all of our presentations that we've had on the DJJ realignment report what the net widening concept is. And we also, I do agree, should have a standard definition easily available when asked. And I also wanted to address your question about individual county examination.

That is something that we plan to do. As Director Lucero mentioned. We will be having a dashboard that will be presenting the data by county. We'll also have an internal dashboard that we plan to use to provide internal guidance around site visits and technical assistance to counties.

We also have within our upcoming report, the AB169 report that will be posted this year, we'll be examining by county and by region some of the differences that we're seeing in commitments and to transfers to IRPs.

Can OYCR, alongside with stakeholders do that statewide definition, or do you need statutory authority to define net widening?

I mean, we are certainly open to doing that and could get we are in regular contact with our critical stakeholders like CPAC and CAYCJ, so we could certainly do that. And I do think that ultimately, however, it is just like the term recidivism. It is something different to other.

You know, everybody has a lens on what that means. And I think that we're finding that the net widening definition too could have a different lens from our different stakeholders. But we are certainly open to doing that.

And now that we do have our data research and policy chief, who I know is developing relationships throughout the state, I think that that is something that her team could work on.

Thank you. My final topic is on the report. You know, and I've seen OYCR does briefs, reports, webinars that are shared, but in the actual report, Judge, let me say what you shared with us. Great recommendations, but that's not really in the report. The public-facing report, the actual report fell a little short.

The recommendations you shared with the community right now go into more details, which I would have loved to have seen in the actual report. Because if I'm not mistaken, when I read the policy recommendations out of the report were three things. Create a work group, talk to stakeholders and create a task force.

When in fact I thought the OYCR is the actual group that creates recommendations versus recommending to us to create more task groups and more working groups. What you shared, I would have I felt like that's what the report should have had. The appendix you have in the report actually went into more details of what you talked about.

So I just want to know where the misconnection is of what you shared with us and what's in the report?

Well, I think I was looking more at the detailed. The report was the high level feedback from the stakeholders. As you also saw in the handout. We give an overview of who was involved in the report.

So what we tried to do is we tried to make sure that we got the perspective of our critical partners, probation, other government partners, defenders, judges, youth, and then public, sorry, youth advocates. So what you saw in the body of the report was the compilation of feedback from the folks who were interviewed for the report.

And what I'll have to tell you, we did struggle with how to answer that question today. We weren't sure if you were wanting us to just tell you what the report said or what we saw and heard and continue to hear because this report was done, I think they stopped gathering data, applied survey research last May.

And this is a very dynamic area. So we continue to get more information and look at how to hone the rollout of SB823 more every day.

And so that's why today we struggle with do we tell them what we want to say about each of the topics that you pulled out or, or do we just go back to the generalizations that we made in the report and that was what we learned from the field.

I would say, you know, the goal of creating these, you know, one of the goals of OYCR, you know, is to guide a statewide approach.

And if this is what the state is receiving in the report and this is where my colleagues get and we don't all get to hear what you shared, then we're going to go off of the report.

It'd be useful to have what you shared with us judge in those reports because that's what we turn to for possible legislation and policy intervention. So that's. So I'm grateful that you were able to bring that in this Committee in the next report. That's the kind of details that would be helpful in the report.

Thank you. I appreciate that, Madam Colleague.

Okay. Thank you so much. Moving on to issue number three.

Good morning, Senators. My name is Alisa Hartz and I'm OYCR ombudsperson. And I'm joined by my colleague Ahmed Nem. I'm offering a brief overview of the Ombudsperson workload, BCP, which addresses the rising workload resulting from the increased authority of the division and the increase in the number of complaints to date.

So as of February 23, the Ombuds Person Division has received 1,025 complaints. And every year since its establishment in 2022, it has received an increasing number.

In 2024, as reflected in our report to the Legislature, The Division received 296 complaints, conducted 84 site visits, mailed out 5,711 Youth Bill of Rights Coasters and 39,315 brochures, and we handled 2,490 helpline calls. In 2025, the Division received over 400 complaints, which is a 40% increase from 2024.

We conducted 99 site visits, which is a 70% increase in investigative site visits from 2024, and we handled over 2,500 helpline calls in 2024. As reflected in our report to the Legislature, about half of the complaints took over 120 days or more to resolve, which far exceeds our target of a maximum duration of 60 days.

While there are many reasons that a case may remain open for 60 days, including delays in receiving records and the time necessary to implement a complaint resolution, workload challenges unnecessarily impede and delay the timely investigation and substantiation of complaints. The BCP is seeking two additional positions, one attorney 3 and one analyst 2.

These two positions are expected to help reduce the time needed to complete complaint investigations, improve the quality of investigations, expand our training capacity and increase the independence of the Ombuds Division consistent with professional standards. The Subcommitee specifically asked for more information on legal interpretation issues that we have encountered with counties regarding our access to youth and records.

There are several statutory elements where certain counties, probation departments and county council have divergent statutory interpretations that impact our site visits and investigations.

In at least one site visit we have been prevented from meeting with youth in groups due to a statutory interpretation relating to our access to youth, taking the position that we can only meet with youth individually. Most departments allow us to meet with youth in groups or in any form that we that we would like.

This makes our site visits less efficient and effective and will prevent our ability to conduct Youth Bill of Rights trainings as we intend to do and as we're planning to roll out hopefully this year.

We have heard also that some counties believe that they do not need to post the Youth Bill of Rights posters or provide the brochures that OICR prepared and that they can simply post a copy of the statute and pass out copies of the statutory language.

The materials that we prepared are written in youth friendly language as we were required to do by statute and are geared towards assisting youth in understanding their rights. There are also diverging views among County Council about our access to records.

We frequently request Youth Grievances and Their Resolution to understand how the facility responded to the issue raised by the youth. In one county, we have been repeatedly denied access to certain grievances that name staff because they have been designated as personnel records legally required to be kept confidential.

Under Welfare and institutions code 2200 D4, youth regularly file grievances against detention officers alleging abuse, discrimination, inconsistent discipline, disrespectful treatment, retaliation, and excessive use of force, among other issues. And indeed, we encourage youth to file grievances to allow for local resolution when possible.

Not being able to access these records means investigations will be delayed, credible complaints may not be substantiated, and investigations will lack an understanding of how departments are responding to youth grievances, which is often a critical part of our investigation.

There are also complex issues with County Council when our request for records causes or relates to ongoing internal affairs investigations. Some counties provide records, such as videos and incident reports during their internal affairs investigation, while other counties provide them only at the end of their own process.

The Attorney 3 position in particular will be vital in supporting records requests, review and enhance investigations, engage with County Council and youth defenders, and provide legal counsel to the ombudsperson.

LAO, anything to add?

Thank you, Madam Chair. Orlando Sanchez with the LAO. We have no specific concerns with this proposal at this time, but we do want to note that this would create ongoing General Fund commitments.

And given the state's budget condition and that the state's facing in future years, the state will have to find ongoing solutions if this proposal is approved to offset that in the future. Thank you and happy to take questions.

Thank you for that flag. Thank you for that robust background on that. Appreciate it.

Thank you so much for your presentation. Just, you know, just from listening to you, it seems like there's a lot of roadblocks, a lot of obstacles to you actually being able to complete these investigations in a timely manner. So what is it that we can do for, from a legislative standpoint to assist in that?

Well, I think, excuse me, first of all, endorsing the BCP that we've presented will be very helpful in providing us more staff and more resources. I think there are potentially a few statutory tweaks that could help us just increase the consistency among the responses from departments.

I think you have 58 counties, 58 county council, 58 probation departments, and this is a new thing. It's the first time there's been a statewide ombudsperson who has the ability to investigate complaints in local jurisdictions. So I think it's normal that there would be some kind of cleanup needed in order to ensure consistency across the state.

That already happened to a large extent with AB505, and it's been really helpful. But there are still some remaining issues. Some of the issues are a little bit thornier relating to the personnel matters, which I think we're still working through with individual counties.

So are there certain counties in which it has seemed to be more seamless and less obstacles? Because, I mean, personnel issues should be the same in every county. It's just how you manage them. So just wondering if there are certain counties that are doing a better job than others.

Yes. Many counties are being highly responsive to our requests and are giving us, for instance, full access to grievances without regard to the personnel. This argument that there's a personnel matter which we. We would disagree with.

Okay. And it might be nice if you could provide the Committee with the list of those counties that have better practices so we can figure out if there's anything that we need to do to make all counties aligned. Thank you.

Thank you so much, Senator. Appreciate that. Thank you for presentation.

Thank you.

We're now moving into the Next Department, State Council on Developmental Disabilities, issue four.

Good morning. Thank you. Chair Menjivar and the Committee. We had three items. We'll start with the overview of our Department and our budget impacts and that will be with Nan Chen.

Good morning. Nan Chen, Chief Financial Officer for the Department. The 26-27 proposed budget for the Department is $1.2 billion, an increase of 22 million total funds from the 2025 enacted budget. The primary increase is primarily due to two significant budget adjustments.

The first is an increase of 17.6 million, 6 million General Fund for the restoration of a two year limited term reduction to local child support agency funding enacted in the 2024 Budget act as a result of LCSA underspending. As discussed in the agenda, DCSS anticipates that past underspending has dissipated and LCSAs are fully utilizing available resources.

This augmentation is needed to maintain existing staffing levels due to upcoming staffing cost increases. The second adjustment is an increase of 4.6 million federal funds due to an estimated increase in federal performance incentives. The total federal performance incentive pool is adjusted annually based on national CPI or Consumer Price Index.

The total incentive pool has increased significantly due to past CPI levels. Therefore, California's share has also increased as CPI has fallen from those elevated levels. The Department does not anticipate similar significant increases in upcoming fiscal years. Happy to take any questions.

Thank you, Madam Chair. Ginny Bello with the Analyst Office. As you heard, there are no new major proposals in the Department of Child Support Services.

There is this restoration of the 17 million total fund, 6 million General Fund for local child support agencies Administration and that was part of a multi year effort actually to increase Administration for local child support agencies that started back in 2019-20 and the idea was that the local child support agencies had been frozen when they're at administrative funding for a couple of decades at that point.

And so there was this multi year approach to increase funding that was supposed to happen over three years. It was about 168 million total funds, 57 million General Fund was the thought at the time. But because of budget situations, there have been pauses in that. There have been the recent temporary reduction that we did.

And so what you're seeing here now is that restoration of 6 million or 17 million total funds is sort of in that vein. In that effort it would get you to about 90% of that original phased in request. That said, it is a bit of a moving target because of the way the administrative funding structure works.

It really looks to see, well, how much does it cost local child support agencies to have enough funding to staff cases at roughly about 180 cases per staff. And so that's a moving target. Right, because every year that increase, that cost of doing business increases. So that's implicitly built into their calculations.

So it's just something to be mindful of as you're thinking about this and what it means to fully fund the Administration of child support at the local level.

And even if we get to that ultimate goal that what they said was fully funding it, there will still be these pressures related to cost of doing business that you hear across all human services programs. Right. You'll hear it in CalFresh as we're talking about HR1. So that's very similar in that way.

Thank you so much for the additional background. I struggled a little with this, not BCP, just restoration, because the cases continue to go down and the increase is only for, like you mentioned, cost of living, salary, benefits. So workload is going down, but the cost to keep the person in the work is going high. That's bad government.

Absolutely bad government. In every other Department that sub three sees, any scenario like this gets cut. Every other Department that is in this scenario gets cut. Workload is down. They get cut. Funding in CalWorks for employer, it's not being utilized fully gets cut.

I'm just really curious as to why this Department in particular does not get the same treatment as all the other departments and how we approach our funding. Department of Finance I think this is a question for you.

If the Federal Government is going to augment already with 4.6 million, that's an additional that they didn't have the past couple years. Given the caseload, I don't see it how we justify an additional $6 million from General Fund.

Christopher Odneal, Department of Finance I think what you're seeing in this budget and this restoration is the sunset of that temporary reduction the last two years.

And I think based on our conversations with the Department and seeing the trend line of LCSAs and their spending, you know, we've left that sunset in place and the funding coming back online, but cases are decreasing.

What is increasing outside of salary, benefits and cost of living?

Can I add?

Sure.

So one thing to kind of highlight is that the child support program in California is arranged a little bit differently than other social welfare programs. And so from the county perspective, they see the child support program as a state federal responsibility, even though it's locally operated.

And so the county staff, when the state, for example, does an adjustment for state salaries that's going up, they don't include anything for the county positions, because they're technically not state staff.

And then the same thing kind of happens at the local level as well, is that when a local county negotiates a new union agreement, they don't actually provide any funding to our local child support agencies.

And so the only way to just kind of maintain staffing levels, to just maintain operations, they have to either cut positions or receive new funding. And so in effect, if we provide additional funding each year to offset those cost increases, then in effect there's a reduction of positions.

And the LCSAs have kind of done that historically for decades since the inception of the program. And only recently have we been trying to sort of provide some additional funding to offset that erosion.

And so really when you look at from like roughly 2020 to about now, there's been about a 30% increase in staffing costs just for salaries and benefits, which is greatly higher than anything we've seen in the past.

And so the kind of what LAO was talking about earlier, we've been adding funding and that's really just to keep up. And so since the funding methodology kind of lays out what the staff ratio should be, there's actually not enough staff to handle the casework that's needed.

And we're just doing what we can to kind of get by each year. And so if we were to not receive additional funding, that would just be another pain on top of that difficulty. And we would see challenges in service delivery and erosion and things like that.

What's the difference between this and every other Department that's struggling with the same thing?

I just want to add, please correct me if I'm mistaken, but the decline is a lot slower or lower than the need for salary adjustments for the counties.

What do you mean? Sorry?

Yeah, so historically, just recently, in these last couple of years, we've had a decent decreased about 45,000 cases. But that's a one time decrease tied to the closure of foster care cases. When we kind of look further back, our caseload has been declining, but only about 1, maybe 2% each year, depending on which year.

But usually costs have been growing higher than that. Roughly 3 or 4% each year, especially these last couple of fiscal years.

Over the past three years, overall caseload has declined by about 60 to 70,000 cases.

Yes. And that's that time window that includes the 45,000 cases from foster care. But once you kind of take that out, really over a three year period, you're losing about maybe just 10,000 cases out of approximately a million.

And so that roughly 1% decrease in caseload is quite small compared to a 3 or 4% increase in cost. So we need something to cover up.

I get that, but that's a terrible phrase. You know where the staffing cost is 3 to 4% outpacing the decline of the the cases. So you're still outpacing the cost of actual services being delivered.

Chair Menjivar, If I could add Director Kristen Erickson Donadee for the Department prior to the decrease, that two year decrease in the funding, we were seeing some increases in caseload which were due to the local agencies and our staff having the capacity capacity to raise awareness of the program.

Child support operates as a critical safety net program and research that we are working to finalize shows that it is a great program for cost avoidance. So individuals that receive child support need less in public benefits such as CalWorks and CalFresh.

And so our ability to raise awareness of the program is deeply impacted by the funding decreases to the local staffing levels. Without those funds they were not able to do more of the outreach which raises awareness of the program and drives the caseload increase. So we can help people lift their children out of poverty.

Even without the 6 million General Fund you're getting a 4.6 federal increase. That's still more than the past two years. So it's still in a better position given the time given the structural deficit that rent. So I'm just wondering regardless of General Fund, you're still going to get money from the Federal Government.

That's a huge win the state can get without adding to the General Fund. I don't see another. You know, it's not. You're in a situation that no other really departments are. You're getting money regardless. Do we have to tap into the General Fund right now given the PCP's, you know, Department of Finance of other departments needing. So just a thought as we continue these conversations.

Yeah, we can certainly take that back, Senator. I think and my colleagues at the Department also speaking to the caseload ratio and trying to get to 180. We haven't quite hit that yet either. Right. We're closer to 200. So that's another consideration too is like as we're kind of looking at those staffing ratios as well.

We're still trying to achieve that 180 that was.

Yeah. But you're going to say this to me and I'm going to throw back. We have not met child care slots that have been promised for years.

So you can't pick and choose if we're not going to meet there then, you know, so it's hard for me to take that and, and then later talk about the things we're not meeting.

Okay, we'll take that back, Senator.

Thank you so much. Appreciate it. Moving on to Department of Public Health. Oh no, just kidding. Did I miss something?

One other question for them.

That was my. That was me. Sorry. Yes, you do. There we go. CalWorks. Yeah. Pass through a lot. Oh, I forgot all that. Yes, our pass through.

Thank you, Madam Chair. Kristen Erickson Donadee for the Department. We'd recently issued the supplemental report and want to give a briefing of the findings there given the timeline before our hearing here. So this report examines the cost that it would take to move to a full pass through process.

So the background is that families who receive CalWorks benefits must assign their rights to child support. There are good cause provisions where if it would potentially pose harm to the family, we can avoid a Referral from the CalWorks program to child support if it would harm them.

So our Department establishes and enforces each these child support orders, they represent approximately one fifth of our current caseload, which is exponentially higher for California than in other states. So there are about 200,000 open cases that are currently assisted under current law.

We pass through the first up to $100 for families with one child and $200 for families with two or more children. And that is on collections that are applied to the current monthly support. As we see in the report, we are passing through approximately 2 million or $2.67 million each month to these families.

That money is also disregarded from their income for purposes of determining their eligibility and their grant amounts. There is a rising trend across the nation to moving to a full pass through concept.

Since May 2024 for families who are formally assisted, California has been passing through all amounts collected that apply to those arrears back support that is owed to the government. So we've passed through about $200 million to families in that formerly assisted category.

And that's under a federal law option that does not require us to pay the federal share, which is 50% of those collections and the remainder is retained by the state.

So for the currently assisted families, anything that we pass through above that $100 to $200, we would have to account for the federal share of those collections the that 50%. So this report talks about how much could be increased if we pass through all of the funds.

So that would be the amount that was owed and collected for their current monthly support. In addition to anything that applied to past due support. So we see a big spike each year around March to May where we are intercepting federal and state tax refunds. Those account for a fair amount of collections for these people families.

So if we pass through everything, that could be an average of $11.5 million a month to these families.

And there has been further research in collaboration with the Department of Social Services about potential mitigation impacts and the options that exist to increase the disregard from income on their side or to keep it at the $100 or $200 range. So the cost to do full pass through would be about $150 million annually in state General Fund.

Alternatively, the state has options to pass through the state and county portion and that would cost approximately $80 million each year in General Fund costs in addition to one time automation and training costs. Happy to take any questions you may have.

On that last point. You just. Oh, so sorry. Go ahead.

I was just going to say we're reviewing the report. We'll let you know if we have any issues to raise.

Thank you so much. I apologize. On the last point you just mentioned on the automation, how much do. Because you said three to five years to implement it, how much is it going to cost us in the front end to the investment in automation?

I would estimate 3 to 5 million dollars in automation costs. Understanding that it requires change on both the child support case management system as well as calsos.

Okay. And is that the same automation that would be needed if for some reason one day are we phasing just the 80 million portion of the state and county fund or do you have to do a different approach?

I think that the cost would likely be the same for the automation. It just would be done differently in terms of bifurcating that cost and passing through the state portion versus the state and federal portions. Okay, perfect.

The report also mentioned, I think page eight of the report around you saw that some of the previously assisted when they got that pass through they came out of poverty.

Are we tracking how many people this is impacting and moving people out of poverty? Just to further help us when we're asking for this, like look, it's people are coming out of poverty.

Absolutely. I think the really interesting thing to see is the number of people. And when we look at the disproportionality we see in the child support program as well to see people lifted out of poverty, we don't have great data right now on the income of the person who receives that support.

We would like to as part of our impact office work through looking at a lived experience advisory council where we can speak to our participants directly and ask them about those impacts.

So that might also be some of the hindering if we want to do a currently assisted families how much of them could be lifted out of poverty?

I think that is well known in terms of the combined research with the Department of Social Services and and DCSS. There are two different reports that were done and that one was sent in about October from the Department of Social Services and that looked at potential mitigation impacts.

If we increased the disregard folks would time out on aid because there was a 60 month time clock limit for receiving cash aid. But by receiving both the cash aid and the child support they would more likely be able to reach financial stability faster.

Wow. Do you have by any chance in that October report the amount of people that would beat that threshold of the currently assisted?

They did have some estimates. This is. I'd have to find the page for that. They do have some fiscal estimates for the number of people that they believe would be timed out on aid due to.

There is an unticking concept that we have in California where any amount of recoupment it kind of gives the person back a month of eligibility if that amount is repaid. So with the arrears pass through those months do not untick because it's not recouped, it's paid to the family.

So the same would happen for the currently assisted family. So they would time out of aid. But that's because they reach financial stability.

Does have we looked at if redoing that for the currently assisted families getting them out of that. Is that in a sense a savings if they're no longer on CalWorks?

Yes. This report, that supplemental report from Social Services does provide an estimate of savings in terms of CalWorks benefits from full pass through of child support.

So it's an annual investment of 150 but it will be less overall because they won't be on CalWorks.

I think it would still be. There would still be cost associated with it. So it wouldn't entirely pay for. It wouldn't be cost neutral. Exactly. Okay. All right. Thank you so much for that.

Thank you. Now we can move on Department of Public Health.

Hi. Good morning. You may begin.

Helped turn that on. Yes, good. Actually, it's. Yes, still. Morning, chair numbers. I'm Dr. Erica Pan. I'm honored to serve as your state Public Health Officer and Director of the California Department of Public Health the last year.

And I want to thank you, Chair Menjivar, the Legislature, and this Committee for the opportunity to share an overview of CDPH and some highlights on the state of the public health in California and for your ongoing partnership to protect public health and just process.

I think I was going to combine issue 12 and 13 a bit and then we could go.

That is correct. Yes.

Okay. So as far as an overview of the budget and program, just briefly. CDPH works to protect the public's health and shape positive health outcomes for individuals, families and thriving communities.

We do this in close collaboration with local health departments and state, federal, private, and community partners 24/7. As far as thinking about the CDPH programs as an overview, you can think about them in three big categories. Monitoring, protecting, and promoting health.

In the monitor category, maintaining vital records and statistics ensuring accurate statewide birth and death data tracking reportable diseases and other significant public health diseases and threats and issues and then protecting, preventing and controlling infectious diseases through education, surveillance and response safeguarding environmental and consumer health, including food safety and broader environmental health protections. Protecting patients' safety by oversight of healthcare settings and quality standards, preparing for and responding to public health threats and emergencies, strengthening readiness and resilience across communities, and delivering reliable public health laboratory services and timely information about health threats to guide decisions.

Promoting health requires thinking about policies, systems, and environmental approaches to promote health and prevent chronic conditions such as heart disease, cancer, asthma, diabetes, and obesity via statewide prevention and health promotion programs. We also, underlying all of this, always work to advance health equity by focusing on disproportionately impacted communities and reducing disparities in outcomes.

For 26-27, our CDPH budget includes $5.1 billion. This includes $626 million of General, $2.2 billion of special funds, Federal funds is $2.3 billion, and of note, about 45% of our total budget. Our state operations total is 1.8 billion, so about a third 35% and our local assistance total is $3.3 billion.

Moving to the state of public health testimony, I want to just sort of convey that as your state public health officer, I consider the whole state of California as my patient and today I'm here to share some highlights on the health status of the state and trends in California.

You will be getting a very detailed written highlight and full State of Public Health report and there's a lot of very detailed information in there about California's population health status throughout the life course. Our full report identifies opportunities for population health improvement and highlights public health emergency responses and shares strategies and programs that address these areas.

This morning I'd like to just start with some highlights in our major public health achievements and progress. We can be grateful that public health investments and other efforts have contributed to significant and measurable improvements in the health of Californians for the past 50 plus years.

In 2024, all cause mortality, cancer death rates and cardiovascular death rates dropped to all time lows and life expectancy reached an all time high.

California can be proud to say that we have one of the lowest all cause mortality rates, infant mortality rates and the highest life expectancy in the nation thanks to the successes of public health, health care and improved access to social drivers like education and healthy food that promote good health.

I'm also very pleased to report we have finally turned the curve on overdose deaths, which decreased in 2024 for the first time in 14. Collective efforts to increase access to naloxone, harm reduction services, substance use prevention and treatment, and culturally responsive community supports have all contributed, but we still have work to do.

We have now also achieved a consistent decline in sexually transmitted infections, including congenital syphilis since 2021 after we saw dramatic increases since 2010. While this is also finally improving, these decreases are still three times higher than a decade ago.

These decreases follow significant state and federal investments for public health to meet patients where they are and effectively test, treat and prevent syphilis, along with updated screening and post exposure medicine recommendations.

California should also be proud that we lead on nutrition policy through Executive action and first in the Nation legislation and in AB 1264 to define and limit the harms associated with ultra processed foods and other harmful ingredients, phasing them out of school lunches by 2032.

While we made significant progress in those areas, there are concerning issues we must address. Behavioral and mental health conditions are the major and increasing contributors to years lived with disability, hospitalizations and years of life lost.

Earlier, I mentioned decreasing death rates in many areas, yet we're seeing increasing death rates in adults age 25 to 44 years old driven by overdoses. When we look at impacts based on years of life lost, we see road injury, homicide and suicide are additional leading causes for this age group.

Statewide initiatives like the Children and Youth Behavioral Initiative 988 Suicide and Crisis Lifeline, suicide prevention and substance abuse prevention and treatment are all important to address this concerning trend and thankfully through the Behavioral Health Services Act, California will dedicate prevention funding for the first time to public health to lead a statewide population based prevention approach where we can resource efforts earlier to promote social connection, resilience and other prevention strategies.

While California's infant and pregnancy related mortality rates rank among the lowest in the US severe maternal morbidity trends have increased between 2016-2023 and although pregnancy related mortality has improved post pandemic at 15 per 100,000 births in 2022, it is still higher than it was a decade prior when it was 9.5 deaths per 100 births.

Specifically, ongoing unacceptable racial disparities in pregnancy related and infant mortality with black populations experiencing significantly worse outcomes must be addressed to turn these overall trends around. CDPH works with partners through programs like the Perinatal Equity Initiative and recently released our Black Birth Equity Action Plan to ident best practices and lays out a roadmap to close these gaps.

It's also important in public health and in this report to note that place matters. We see concerning disparities by region and place. For example, death rates were higher and life expectancy lower in rural areas compared to urban and coastal areas. Within counties, we can also see huge gaps.

For example, within LA County, the life expectancy in Redondo Beach is about 88 compared to the life expectancy in the Compton area which is 73. That's a 15-year gap. Identifying these gaps in health outcomes allows us to explore what are driving these health challenges and tailor prevention strategies and actions accordingly.

I also need to emphasize that we continue to see increasing frequency and complexity of public health emergencies that we must stay prepared to respond. Our Emergency Response Center was activated for over 32 different and overlapping emergencies over the past five years. Given the overlaps, the cumulative days of activation added up to more than the five years.

We need a trained and resilient workforce and stable systems to support these public health emergency responses. Maintaining capacity to sustain these health outcomes we've gained is hard enough in public health.

But amidst increasing natural disasters and public health emergencies, federal threats, and the acceleration in technology at an exponential pace around us, it's more important than ever to both preserve the resources we can and think creatively to innovate. We're really grateful for the future of public health investment to support previous gaps magnified during the pandemic.

California is better prepared to communicate, coordinate policies, advance equity and community engagement, and respond to public health emergencies, including these federal actions.

For example, the future public health allowed for a swift and coordinated bird flu H5N1 state and local response with enhanced rapid disease detection and investigation, education and outreach and strengthened our multi-sector collaboration after the devastating LA fires, the Eaton fire shelter outbreak, and infection control, response and recovery were possible with future public health-funded staff.

Other examples of the impacts of these investments include a CDPH wide intelligence hub and expanded emergency response training, exercise and evaluation at the local level.

The Future Public Health supports mobile health staff to better reach and serve residents in rural, underserved and isolated areas, meet the health and social services needs of farm workers and has supported effective management of a large Hepatitis A outbreak among the homeless, to name just a few examples.

Support for sustainable and modernized data systems remain critical to help us track, investigate and manage cases, contacts and outbreaks, manage vaccines and monitor and respond to these health trends to protect the public. Public health cannot do our job alone as we navigate the volatility and challenge of this moment.

We will continue our cross sector collaboration, innovation and communication. And we're grateful for our talented and dedicated public health workforce, support from the Legislature and the Governor and the opportunities amidst other world class leaders in our great state to forge ahead together to build a healthy California for all.

Thank you for this opportunity to share California's health status. So I can pause there before we go to other questions. I have a lot of responses about our federal response too. So we could either do that next or we can talk about this for a second.

Let me just do some questions on the report. What is California's life expectancy? I know you gave two cities do you have it for all of California?

And we will have some leave behind graphics that sort of pulled out from that report. But let me see if I can look quickly here. Our total life expectancy looking at one graphic is a little bit over 80. But there's some graphics in that report and we are definitely going to pull out some of that.

And you have like in the report you can find every city's life expectancy.

Not in the actual report you cannot find every city. No. But we do have a geographic map showing sort of by regions. Yeah.

Great. And then on the behavioral health, those are the trends where we're going the opposite way. Is there an age group in particular that you found that?

Yes. As far as death rates, 25 to 44 year olds we have increasing death rates and the leading cause of death is overdoses in that age range.

Wow. Okay. And then in the graph it shows, you know, the allocation of where the funding comes and last year 45. The past couple years has been 35 to 45 from the Federal Government.

I know, given all the attacks, and I don't know if this is part of your next presentation, what do we anticipate that percentage should look like for this upcoming year?

It has been a roller coaster and I am going to talk a little bit and sort of the next question, you know, we the main cut so far that has actually happened and not been sort of blocked by either legal intervention or others was our nutrition and physical activity branch in HR1.

The rest of it, the congressional budget that passed. Actually it was fairly level. But then we had this threat of terminations last week. And I can talk more in detail about that in a moment.

And then wanted to ask you about, you know, tobacco use and smoking is here in part of the report, prevention. Are we looking at youth in particular and the uptake in vaping as an issue under public health?

Yes, our tobacco control group does look at vaping as well. And yes, is seeing sort of a replacement of cigarettes with vaping.

And the report that you do, you know, is it like policy recommendations that come out of it or here's the data, everyone figure it out.

It's sort of a mix in this report, as you can see. It's quite detailed about both the data and then we do highlight some of the programs that we have or we work with partners on. There's some highlights on sort of achievements. There's, you know, and then we do have different sort of roadmaps for different things.

I mentioned the Black Birth Equity Action Plan. We have a violence prevention roadmap now. So there's sort of highlights in different areas. Some of of them have more information than others about sort of actual interventions or strategies.

And are you going to. I'm just trying to see if the questions you're supposed to answer. Yeah, I think you're going to talk about the West Coast Health Alliance.

Yeah, maybe. Can I talk a little bit about federal sort of response? And then they're happy to answer questions about this, too. And admittedly I had kind of combined them in the anyway.

So I think as I think about the state of public health in general, the reality is in California and in our nation, our public health system is under attack. Our investments in prevention, protection, and improvements in health over the past few decades are all at risk due to these federal actions.

And we've always experienced sort of cycles of boluses of resources during and after a public health threat, followed by dwindling and reduced support in funding. But I've never before witnessed such intentional and methodical attempts to dismantle of the entire system specifically related to federal funding.

In your question, it's important to know that when you look at a CDC budget, 80% of that money goes to state and local health departments. So when you see a potential cut of half, that means, you know, a huge, huge cut.

And so that's what we were facing in the middle of last year and then I already highlighted but just to reiterate, about two thirds of our budget does go to local partners and then you've already asked about the 45%. So that's been for the last couple of years stable and again, we've just been watching up and down.

But we've been on an unpredictable and stormy course with multiple threats of funding cuts over the past year. The last March and again just this month, there were proposed rescissions of large and critical grants adding up to hundreds of millions of dollars and funding hundreds of positions at the state and local level.

And then thinking about policies and loss of federal public health leadership. The dramatic dismissal of experienced public health leaders and programs of the level have far reaching impacts including loss of technical assistance, reliable data, data privacy and other federal policies have been based on misleading information and unsupported claims.

This has also sowed a lot of confusion and public distrust in science, medicine and public health. One of the most alarming areas is the devolving federal vaccine policy changes which can impact vaccine access and uptake. And I'm thankful for our strong immunization policies in California that have kept our communities safe from large outbreaks.

But this success is at risk. We are seeing the highest levels of measles cases, outbreaks, hospitalizations and deaths in the United States in 30 years, driven by populations with low vaccination rates. In California, it says the end of February we already have almost as many cases in 2026 as we had all of last year.

And now we've had our first two small but two outbreaks for the first time in five years, all in unvaccinated individuals. These declines in vaccination rates can result in preventable missed school and work and a greater burden on the health care system.

A study over a 29 year period estimated that childhood vaccinations have prevented over 60 million infections, 4 million hospitalizations and 135,000 deaths to the tune of these are all estimates, but 65 billion of healthcare costs averted and 324 billion in societal costs averted for an estimate in California.

I'm very proud and thankful to be part of our California efforts to maintain evidence based vaccine policies and appreciate the partnership with this Legislature to pass AB144 to ensure Californians have access to life saving vaccines and screenings based on credible medical evidence. And I'll talk a little bit later about the timeline of that.

I know you had questions, so we've been fighting to sustain these hard earned public health achievements in the past several decades and maintain these capacities gained from resources added in the public health system overall during the pandemic.

And what we've been doing as a reaction to this over the last year that I've been Director is refreshing our strategic priorities and really focusing on reimagining public health during this pivotal time. Reimagining includes prioritizing our most impactful efforts that are unique to our role and optimizing with a focus on efficiencies, partnerships, leveraging technology and creativity.

And last December we did launch, the Administration launched the Public Health Network Information Exchange or the Phoenix Initiative and we are partnering with national public health leaders to promote a more modernized and sustainable public health infrastructure.

Phoenix is going to strengthen our public health innovation, collaboration and communication across sectors and at the state, national and actually global level.

Because of its loss in federal leadership over these past six months, we've formed partnerships including the West Coast health alliance, the four states of Hawaii, Washington, Oregon, a larger governor's public health alliance of 15 states, and we've joined the World Health Organization's Global Outbreak Alert and Response Network last September.

Within California, we've created a Cross Sector Public Health for All Californians Together coalition and with joint leadership with covered California and our agency and UCSF to develop a cross sector network of public health and clinical professionals, health systems, academic and community partners to support public health and again strengthen partnerships so we can be stronger together.

And communication is more important now than ever as well. Thus we're working with the FACT coalition and organization called Your Local Epidemiologist, which is also based here in San Diego, to formalize a community messenger network and better listen and respond to California's health questions and concerns with a project called Project Stethoscope.

So I mentioned that the state is my patient and we're trying to listen more and also listening by using, you know, meeting the moment and how communications have changed. We're looking at social media monitoring, community driven insights and targeted research because doing the traditional ways of media and outreach are not reaching people where they are.

And then briefly I'll just kind of talk about the AB144 timelines and can turn to questions. So we did with AB144, we created a brand new website. It's called Public Health for All, and it's a location where we are posting all of the immunization and preventative service recommendations pursuant to Health and Safety Code 120164.

And this is the resource for the public health insurers and other stakeholders to look. So the minor changes we've made to the baseline immunization recommendations followed updates issued by the American Academy of Pediatrics and the American Academy of Family Physicians.

So September we posted updated recommendations for Covid flu and RSB vaccines in alignment with the aap, aafp and of course that was in jointly with the West Coast Health alliance as well. And then in December 2025 we adopted UPD recommendations for adult immunizations that the American Academy of Family Practitioners has.

And then January, when the AFP updated their regular annual routine immunizations, we adopted that childhood adolescent immunization. So we provide information to public and stakeholders following changes in federal immunization recommendations, including highlighting what we have not adopted. So there were big changes in the federal immunization schedule in January that we have not adopted.

So with AB144, that website is where people can look to on what they should have access to what health insurance regulated in California needs to cover. And we also have adopted a few new recommendations for preventive services from the US Preventive Services Task Force, post that January 1, 2025 date there.

One related to breastfeeding, some osteoporosis, and some other screening for another disease I'm forgetting, and these were very minor updates and deemed to be consistent with evidence-based health guidelines. And we do have a procedure for making updated changes to immunization burden services recommendations, we'll post on the website.

And of course submission to OAL and filing of recommendations with Secretary of State to meet the statutory requirements. Maybe I'll pause then in gear two and see what other questions you have about that.

No, on that part, I'm good. Okay, we can move.

Keep moving on. Okay, so there was a question here about silicosis. Yep. Okay, so we continue to conduct multi source surveillance for silicosis with an emphasis on engineered and artificial stone used to fabricate quartz countertops. As of February 19, we have confirmed 515 cases of engineered stone silicosis, including 29 deaths and 55 lung transplants.

In 2025 alone there were 215 cases, more than any previous year and 44 cases already in this first couple months of 2026. Nearly all cases have occurred in Latino men and the median age is 46. We do have a dashboard now on our website as well that's tracking this.

And we recently published a paper on this in the American Journal of Public Health just to highlight for everyone.

I know you're well aware, but want to and thanks for your partnership on many of these things and leadership in this February 2025, Cal OSHA permanently amended its silica standard and prohibits dry cutting of engineered stone, requires advanced respiratory protection, and added chest CT, CAT scans to medical surveillance requirements.

We now have the strictest requirements in the nation and the only occupational health standard for any exposure that requires that more sensitive chest CAT scan rather than a chest X ray. And then in June 2025, we made silicosis reportable in California, so now we can track this even more closely.

And then in October, Governor Newsom signed SB20, which is a silicosis training, outreach, and prevention stop act. And this assigned responsibilities to our Department related to surveillance, education, and technical assistance, and improves the data sharing between CDPH, Cal OSHA, and our local health Department partners.

And we do have four additional positions in the OCK Health Branch that were included in the 26-27 Governor's Budget. And then in November, as far as the last sort of thing that we've done more recently is another health provider alert that was released.

We had done one in July of 2023, but we issued it again to just increase awareness with providers, especially occupational health providers and local health departments, about these growing case numbers and the requirements to report so that we can investigate and track this.

There was also information on diagnosis and just how to report to us and information dissemination.

I've visited the dashboard, just quickly refreshing my memory last night. And yet it seems like we might be on track to surpass our 2025 cases.

What more you know, I know Cal OSHA plays a big role in this, so, you know, not all the illnesses here, but is there a bigger role CDPH can play in this with silicosis?

I think our role in general is really about training and education and working with awareness.

In those categories you just gave, like what more can be done?

Our occupational health team has been working really closely with Cal OSHA and others that sort of take care and doing a lot more outreach to communities and to healthcare providers.

Even one of the reports from CDPH I saw maybe was on the actual report. Yeah, it was on the actual report. Yes. Perfect. On page 106 of the actual report, it said that it's really hard to prevent. If I'm not mistaken, give me a second here.

While you're looking. I can just acknowledge that these are very, very fine particles. So it is very hard to prevent. It's an inhaled, you know, imagine sort of, you know, cutting silicone, and it's just very, very fine particles that it's very easy to.

Controlling exposures to levels low enough to prevent disease is technically challenging, costly, and rarely feasible. So it just seems like we're going to continue to have cases. I just, I don't want to see more of these young men die. I'd love to continue just to find actual solutions here.

I mean, I guess the only thing you would do is ban it, but, like, I'm just trying to find another, another solution in this space. So I'd love to have you as a partner in that space.

Yes, happy to talk offline around that. And some of this increased resources will help us do more outreach on this too. That, of course, just came.

Maybe wait a little bit since it just kicked in. Okay, Question four, please.

Sure. Question four. So an update on the Transgender, Non Conforming, Intersex Wellness and Equity Fund. So, since 2022, there's been a total of $27.1 million that has been transferred to the two spirit, transgender, gender, Non Conforming and Intersex Wellness and Equity Fund. We call it the 2TGI Fund for short. And let's see.

And there's $10.3 million in FY22-23, of which 6.8 million was reappropriated in 25-26 for expenditure through 27-28, $12.3 million in FY25-26 for expenditure through FY28-29, and then 4.5 million in the FY25-26 transfer from the ADAP drugs assistance program. To date, we've awarded 80% of the local assistance funds appropriated to that fund.

And this includes 40 grants to 23 community based organizations totaling 21.6 million. And these fund programs as outlined in the code. We're in early stages of planning for the release of the remaining 5.47 million, plus an additional $9 million representing the planned transfers from the ADAP fund in each of the next two years.

And we'll be issuing additional requests for applications in FY26-27 that will allow TGI serving organizations, as defined in statute, to apply for programs that include the expanded categories approved in last year's AB 1487.

So that would include diversion programs, supporting transitional age to TGI youth programs, providing resettlement and social integration for two TGI asylees and immigrants and workforce development training. And then we'll publish these RFAs for new and existing funding categories. Eligible community based organizations will drive the geographic and topical distribution of funding and services.

And then our state ops funds are the resources to administer this fund.

80%. Okay, perfect. Thank you. Sure. And the last question.

Sure. The last question. I think I partially answered it in just sort of what we've been doing and I think, you know, we're actively assessing how to mitigate these possible impacts.

We did have again an informal threat last week to some of these HIV prevention and STD prevention and control grants last week that then we never actually got the full notice of awards but we were told that Congress is notified. So this is part of our roller coaster.

But we are, you know again evaluating possibility of leveraging part of that 65

The last week one didn't come to fruition?

No, they did not ever even issue the actual terminations because then the lawsuit was filed and my understanding is that's applicable.

So we we got terminations for the public health infrastructure grant and the climate related grant and then we also got a follow up showing that those were rescinded and then the other notices were informal to Congress but we never got formal notifications.

But that's where the waste is if anyone's. Yeah. Okay. Thank you. Perfect. Will anything to add to any of that?

Will Owens, Legislative Analysis Office. Nothing specific to add to any of the presentation on these informational items, but just wanted to flag that given the chair's interest in the rise in mortality among young adults 22 to 45 generally.

Recently our office released a write up on that specific mortality increase age range, specifically focusing on the overdose deaths and some of the nuances within that. So through the chair we'd be happy to pass that forward. Yes.

Thank you. Thank you. Will appreciate it. Thank you for the presentation on those two items. Moving into issue 14,