Assembly Standing Committee on Health

Good afternoon, and welcome to the Assembly Health Committee's hearing on Tuesday, April 21. Before we begin, I wanna make sure everyone understands our committee procedures to ensure we maintain order and run a fair and efficient hearing with the goal of hearing as much from the public within the limits of our time. We seek to protect the right of all who participate in the legislative process so that we can have effective deliberation on the critical issues facing California.

Rules of conduct by members of the public include no engaging in conduct that disrupts, disturbs, or otherwise impedes the orderly conduct of this hearing, engaging in personal attacks of members of this committee, authors, staff, or other witnesses, talking or loud noises from the audience. Please be aware that violations of these rules may subject you to removal or other enforcement processes.

If you are providing witness testimony at this hearing, all witnesses will be testifying in person. Main support and opposition will be allowed two main witnesses for a maximum of two minutes each. As a reminder, primary witnesses and support must be those accompanying the author or who otherwise have registered a support position with the committee. And the primary witnesses in opposition must have their opposition registered with the committee per the instructions on our website.

All other support and opposition can be stated at the standing mic when we call upon to simp you to simply state your name, affiliation, and position.

All testimony comments are limited to the bill at hand. For special order of business today, we have in today's hearing, we'll begin with a special order of business to allow members of the committee to consider and for members of the public to express their opinions about AB 1973 by Agi or Curry. We realize that many people have traveled to Sacramento to voice their opinions and we want to hear from you. But, unfortunately, our time to hear this matter is not unlimited.

We will dispense with the special order at 02:00 as the committee has 31 other bills to hear on the regular agenda.

For additional housekeeping housekeeping, I would like to note item number 19 AB 2029 has been pulled from today's hearing agenda and will not be heard. I would also like to note the speaker has appointed assembly member Rogers to be a substitute for assembly member Celeste Rodriguez for today's hearing. The following bills are proposed for consent for today's hearing. Any members of the committee may remove a bill from the consent agenda.

We have item number four, AB 1670 by Arambula with a motion of do pass as amended to appropriations.

Item number seven, AB 1717 by Castillo with a motion of do pass as amended to appropriations. Item number eight, AB 1779 by Davies with a motion of do pass as amended to appropriations. Item nine, AB 1811 by Rogers with a motion of do pass to appropriations. Item 12, AB 1882 by Ellis with a motion of do pass to appropriations. Item 17, AB 1988 by Pellerin with a motion of do pass to appropriations.

Item 18, AB 2,009 by Chen with a motion of do pass as amended to appropriations. Item twenty two forty by Stephanie with a motion of do pass to appropriations. Item twenty three eighty two by Patterson with a motion of do pass as amended to appropriations. Item 28, AB 2527 by Hoover with a motion of do pass to appropriations. Item number 29, AB 2538 by Macedo with a motion of do pass to appropriations.

Item 30, AB 2565 by Wallis with a motion of do pass as amended to appropriations. And item 31, AB 2594 by Lowenthal with a motion of do pass as amended to appropriations. That confirms the consent calendar as proposed, and we will now move on to our special order of business, AB 1973 by Agi R. Curry. With abortion regarding abortion and authorized procedures, we will start as a subcommittee until we have quorum. Thank you, majority leader, whenever you're ready.

Thank you, Madam Chair and members. In the years since the Dobbs decision, California has led the nation in protecting reproductive freedom. But even with those protections, gaps in act, in access to care still remain. The reality is simple. We already have a workforce that is trained, qualified, and ready to provide this care, but they are restricted in their ability to do so.

Nurse practitioners, certified nurse midwives, and physician assistants, also known as advanced practice clinicians or APCs, receive extensive education and training. They are already safely providing a range of reproductive health services in California today. They've demonstrated their competency and training, but state law has not kept up. Current law puts outdated limits on what these providers can do regardless of their training or their patients' needs. These restrictions mean patients are turned away or forced to wait for longer care.

And for patients, delays have real consequences. Longer travel, more time off from work, higher cost, and even missing the window to receive the care altogether. AB 1973 is about fixing these issues. It updates state law to allow APCs to practice to the full extent of their training and proven competency. This bill is a common sense update, one that allows the state to fully use a skilled workforce that patients trust.

At a time when access to health care is under pressure nationwide, we should be removing barriers, not maintaining outdated ones. AB 1973 ensures patients get timely care from providers who are already trained, competent, and serving their communities. With me today, I have Dr. Tania Basu, an OB-GYN, and Asmara Gebre, excuse me, a certified nurse midwife. Welcome.

Thank you. Go ahead. You'll have two minutes. Great.

Good afternoon, Chair and members of the committee. My name is Dr. Taina Basu, I'm a board-certified obstetrician-gynecologist and complex family planning specialist with over fifteen years of clinical experience, and I train and work alongside nurse practitioners, certified nurse-midwives, and PAs to provide high-quality evidence-based abortion care. I am here today in strong support of AB 1973.

This bill modernizes California law by explicitly including certified nurse midwives and PAs as advanced practice clinicians and by removing outdated restrictions that prevent trained APCs from providing procedural abortion care.

The evidence is clear. Abortion care is safe, and appropriately trained advanced practice Clinicians provide this care with the same safety, quality, and patient satisfaction outcomes as physicians. Our Clinicians at Planned Parenthood Northern California participated in the landmark research that established this fact, and APCs have safely provided abortion care in our clinics for many years. Advanced Practice Clinicians are essential to our state's reproductive health care system, especially as California faces widespread shortages of OB-GYNs and primary care physicians.

These shortages are most severe in rural and low income communities where people already face significant barriers to care.

Limiting APCs based on outdated, nonscientific rules only worsen these disparities and delays time sensitive care. We know well that in many areas of the state, there are physician shortages or fewer health care providers who are trained or willing to provide abortion care. I have personally seen patients travel two to three hours for procedural abortion care, which includes miscarriage management due to the widening maternity and abortion care deserts in our state.

AB 1973 removes artificial barriers, expands the capacity of California's existing trained workforce, and ensures patients receive timely evidence based care no matter where they live. I respectfully urge your support for this bill.

Thank you.

Good morning, Chair, members. My name is Asmara Gebre, and I'm a certified nurse-midwife with eight years of experience practicing at San Francisco General Hospital. I'm an Associate Clinical Professor at UCSF, and I'm the founder of Black Centering Group Prenatal Care in San Francisco and the founder of the Black Middletree Fellowship in California, named in tribute to black midwives who provide full scope reproductive health care, including abortion care, in this country long before it was criminalized.

The fellowship received 3,500,000 from the state to train midwives in abortion care. I am here in strong support of AB 1973. Physicians have trained me, and I have consulted with physicians throughout my entire career. That consultation is how midwifery works, and it's how AB 1973 will work.

The bill preserves consultation, referrals, and transfer protocols for care beyond the first trimester. Through the Black Midway Free Fellowship, I have provided care up to thirteen weeks and six days. I have the knowledge and the clinical foundation to be trained beyond that, but current law prohibits it. So I step back and my physician colleagues take over. The training pathway exists.

The physicians willing to train me exist. The statue is what where it stops. I'm about to launch the a midwifery led clinic, including abortion care, the first in our institution. Patients come to midwifery care for continuity, cultural concordance, for relationships that span pregnancies. If I have a patient that I need to care for and their procedure is at fourteen weeks or beyond, current law forces me to hand them off to a stranger.

Many of our patients do not need a different provider. They need continuity. The law says otherwise. AB 1973 updates outdated language, allows trained CNMs, NPs, and PAs to provide procedural abortion beyond the first trimester with physician consultation, protocols, and preserves rigorous hand on clinical training with no online shortcuts. The evidence shows that APCs provide abortions with safety and patient satisfaction equivalent to physicians.

AB 1973 aligns the law with our training. I respectfully, request that you also support this bill. Thank you.

Thank you. We will now move to any in the hearing room who would like to offer and support. Please go ahead.

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

Good afternoon, Chair and members, Sosan Madanat, at W Strategies, here on behalf of the California Nurse Midwives Association, a proud cosponsor in support. Thank you.

Kasha Hunt with Political Solutions here on behalf of the Physicians Academy. Actually, I'm sorry. The California Academy of Physician Associates. Sorry.

Bethany Golden, the Co-director of Reproductive Health Service Corps and Midwife at Teach. We are also cosponsors, and we strongly support this bill.

Kimberly Robinson, I am with Black Women for Wellness Action Project and we are also a cosponsor and strongly support this bill.

Thank you. Dylan Elliott on behalf of the city and county of San Francisco in support.

Good afternoon, Chair and members. Keshav Kumar with Lighthouse Public Affairs on behalf of Reproductive Freedom for All, in strong support and appreciation of the author's work.

Chair members, Kathy Mossburg, on behalf of Essential Access Health, cosponsor, in strong support.

Good afternoon. Symphoni Barbee on behalf of the ACLU Cal Action in support.

Good afternoon. Jessica Moran, on behalf of the California Association for Nurse Practitioners, in support.

Jeanette Stephenson, an individual citizen of California. I support this bill and CalCare. Thank you.

Thank you. We will move on now to any primary witnesses who are opposed to this bill. Please come forward. Thank you so much. You'll have two months, two minutes each.

You'll have to press the button so we can hear you.

Good afternoon, Chair and members. My name is Mindy Hertzel with Sierra Pregnancy and Health. I'm a registered nurse with a certification in inpatient obstetrics, and I'm here today to oppose AB 1973. This bill would allow mid level providers who do not have formal surgical training to perform second and third trimester abortions, procedures that carry significant medical risk and require advanced clinical judgment and experience.

I've spent my career caring for women, many in high risk situations, and I've seen how quickly complications can arise, especially later in pregnancy.

Second and third trimester abortions are not simple procedures. Risks include hemorrhage, infection, uterine perforation, cervical laceration, amniotic embolism, and more, all of which are life threatening. When complications occur, they escalate quickly and require immediate experienced interdisciplinary intervention. I'll never forget experiencing what it looks like to call a code on a patient experiencing an amniotic embolism.

It took our entire unit of nurses, anesthesiologists, the hospital rapid response team, and multiple physicians experienced in labor and delivery to perform the c section, stabilize her, and transport her to critical care.

The response was immediate and extensive. Had she not been in a facility equipped with teams of people prepared to respond to such emergencies, I hate to think of what the outcome would have been. Expanding these abortion services into a setting less prepared than that would be catastrophic. That's why this bill is so concerning. It expands who can perform higher risk procedures by lowering standards.

When something goes wrong, it's not theoretical. It's someone's daughter, someone's partner, someone's whole future. Access should never come at the expense of safety and should never be just one option. Vulnerable patients should not receive a lower standard of care. They deserve the highest level of medical expertise, not increased exposure to risk.

Women deserve honesty, dignity, and safe medical care, especially when the stakes are this high. Expanding these procedures to less experienced providers moves us in the wrong direction. For these reasons, I respectfully urge you to oppose AB1973. Thank you for your time.

Thank you. Please go ahead. You'll have two minutes.

Chair members, my name is Greg Burt, Vice President of the California Family Council, and we are opposed to a AB 1973. Every other area of medicine holds firm on surgical training requirements. No one in this building would propose letting nurse practitioners perform cancer surgery to expand access to underserved communities. The legislature would reject that immediately. So why does abortion get special exemption?

What is it about this procedure that causes otherwise careful legislators to set aside their thinking and that they apply everywhere else in medicine? That brings me to another question. Why aren't we demanding that underserved women receive care at a same standard as wealthier communities? Expanding access by lowering standard is not compassion. It is telling vulnerable women they deserve less.

And what procedures are we expanding? Second and third trimester abortions. Public opposition to abortion sharply grows worse as pregnancy advances because the humanity of the child is harder to deny. Organ systems are formed. Many of these babies can survive outside the womb.

These are developed children and the methods are brutal. Expanding who performs them does not make it less troubling. It simply sears our consciences by normalizing what should normally horrify us. And finally, why is the preoccupation always with expanding abortion and not with supporting mothers who might choose differently with real help? There are more families wanting to adopt than children available.

Where are the bills promoting adoption? The lopsidedness of this legislature attention should trouble all of us, and that's why we observe ask for a no vote on AB 1973. Thank you.

Thank you. We'll move now to anyone in the room who would like to register opposition to the bill. Please come forward. You'll have to indicate your name, affiliation, and your position on the bill.

Good afternoon. Matt Newton with, Pastor at River City Christian Church, and I strongly oppose this bill.

Thank you. Seeing no other opposition, we will bring it back to me and you, majority leader, to be able to discuss this bill. I did want to have you address some of the concerns raised by the opposition, particularly around the training or the specific training that needs to be offered or required to actually be conducted for people, nurse midwives and qualified nurse practitioners who are seeking the ability to do these, and physician assistants who are seeking the ability to perform these abortions.

And then if you could also and find if you want it to be in your closing, speak to the need to have NPs and CNMs actually engage in establishing consultation, collaborations, and referrals for procedures that are beyond the scope of their education, training, and experience consistent with the existing law.

Great. Thanks.

I can speak directly to the training since I train APCs myself. There is a really rigorous curriculum that we, that we follow, one that is published by Teach, and it is very hands-on. There's a didactics proportion, and we also review what is appropriate to the setting in which abortion care is provided and when it is appropriate to refer for higher level of care, specifically around complex cases, and when it's appropriate to consult. So all of that is very rigorous.

It's a lot of hands on training, a lot of proctoring, a lot of going through drills for emergency procedures and handling that.

So I feel very confident that the training that is provided for APC level providers. Much that surpasses, to be honest, other OB-GYNs and residency programs throughout our state. So this is a very specific type of training and a very well established curriculum that is available nationwide.

And just to jump on to that too is that just wanna remember that the bill ensures that there are protocols that are in place for the transfer of care and collaboration on it with the other medical professionals for the cases that go beyond the clinical scope, training, and experience, including any complications or situations that require high levels of care.

Thank you. I think that it fully addresses the questions that were raised by the opposition. And I thank you, majority leader, for always bringing forward an opportunity for us to make sure that we're providing health care to all.

And at a time when we have a reduction in health care access and an attack on our ability to offer women's health care and reproductive care to so many in the state of California, I'm very thankful that you are continuing to find opportunities for people to be able to get the care that they fully deserve. With that, would you like to close?

I would. I wanna thank, thank you very much and thank you for your team that have reviewed this bill and for the thoughtful discussion. We absolutely all share the goal of ensuring patient safety and strong coordination of care, and I'm committed to continuing conversations with stakeholders to address any remaining concerns. At its core, let's face it, this bill is about aligning our laws with reality. APCs are already trained, they're competent, and delivering this care safely.

AB 1973 simply allows these providers to do their jobs to the full extent of their training, so patients can get care when they need it. With that, I respectfully ask for your aye vote.

Thank you. And the bill will be considered when we have a quorum.

Great.

And for the sake of you being the only other committee member in the room, I'm gonna ask that you come back and join us on the dais Okay. If that's okay.

Sure. I can wait.

Okay. Thank you. And in the meantime, we will hear assembly member, item number three, assembly member Arambula AB 1558. Whenever you're ready, please go ahead and start, Assemblymember.

Thank you, madam chair and members. I'd like to begin by thanking the chair and the committee staff for their work on this bill. Historically, emergency responses during natural disasters and public health crises have faced challenges in efficiently integrating volunteer health professionals. Currently, the Emergency Medical Services Act, EMSA, manages emergency medicine medical planning and the state's disaster health care volunteers system.

Although the state allowed a temporary work around during the Los Angeles wildfires, officials made it clear that this work around would need to be requested and approved separately for each future disaster.

This case by case approach creates uncertainty and slows emergency response. This is harmful because the need for medical care is often the greatest at the very beginning of a disaster when first responders, hospitals, and local health systems are also stretched thinner. People who are injured, displaced, elderly, or living in disaster impacted areas face higher risks without care in this critical window.

AB 1558 addresses this issue and enhances California's emergency response system by reducing administrative delays that prevents licensed out of state health professionals from helping in the aftermath of a disaster. Here with me to testify in support of Assembly Bill fifteen fifty eight is Sarah Cannon, the legislative counsel for Uniform Law Commission, and Deborah Harper, an RN, and the American Red Cross Regional Disaster Health Services Program Lead.

Thank you. You'll each have two minutes.

Thank you, madam chair and members of the committee. My name is Sarah Cannon, and I am legislative counsel for the Uniform Law Commission. The Uniform Law Commission is in strong support of AB 1558 to enact the Uniform Emergency Volunteer Health Practitioners Act. This act enables the swift deployment and use of qualified volunteer health practitioners, veterinary providers, and morticians during a declared emergency while under the supervision of the Emergency Medical Services Authority.

The act was drafted by the Uniform Law Commission in response to the legal and operational failures that were exposed by Hurricanes Katrina and Rita.

During those emergencies, licensed professionals from other states were willing and able to help, but many were delayed or denied because states lacked a clear system for recognizing out of state licenses and integrating volunteers into emergency response operations. AB 1558 is best understood as a natural extension of existing state and federal law. I like to think of it as a fail safe. It does not replace the Emergency Management Assistant Compact or EMAC, and it does not displace California's current emergency authorities.

Instead, it fills a gap that EMAC does not adequately address the rapid deployment of volunteer health practitioners serving through nongovernmental organizations and relief entities, including the Red Cross, which play a vital role in emergency response.

It ensures that when California faces extraordinary demand or a catastrophic breakdown communication, qualified volunteers can be brought in quickly under clear legal rules. The act extends to volunteers who are not formally a part of a deploying state's forces the same core benefits and protection that EMAC grants those forces. So long as the volunteers are registered to recognize systems, verified as licensed and in good standing, deployed through host entities coordinating with emergency management authorities, and acting within the limits imposed by the state.

The act has been endorsed by a broad range of health care, public health, and disaster relief organizations. And to date, it has been enacted in 19 jurisdictions, including Washington and Nevada.

We request your support of AB 1558, and I welcome any questions you may have.

Thank you so much.

To the chair excuse me.

To the chair and member of the committees, my name is Deborah Harper. I'm a registered nurse licensed in the state of California, and I've had the honor of serving as a volunteer with the American Red Cross for thirteen years. I am here today in strong support of AB 1558. I wanna speak to you though not just as a Red Cross volunteer, but as a California licensed health practitioner who has worked alongside colleagues from across the country in this field.

I have deployed with the Red Cross to disaster responses where the scale of need far surpassed California's local capacity to respond.

During those deployments, I worked alongside nurses, physicians, other licensed health practitioners from across states, all whom were skilled, credentialed professionals who showed up ready to help. What I witnessed firsthand is that in a disaster, a person in crisis does not ask which state authorized your license. They want to know that you are there to help and that you are there to care. I myself have responded to disaster events deploying more than 30 times in my volunteer role, most of those events right here in California.

Whether it's been for wildfires, for atmospheric river flooding, extreme heat, or blizzards, as someone who arrives at the shelters, who has boots on the ground and sees the immediate needs of our community, of our citizens firsthand, it is very clear to me, California cannot and should not expect to face its next major emergency alone.

We need to be able to quickly ramp up to have additional licensed healthcare practitioners who are disaster emergency trained who can step in quickly to aid our citizens. We need a legal structure that matches the operational reality of disaster response. Right now, California lacks a consistent streamline mechanism for authorizing qualified out of state volunteer health practitioners to provide care during declared emergencies. While well intentioned, this creates uncertainty and unneeded delays exactly when speed and decisiveness matters most.

Volunteer health organizations like Red Cross already conduct rigorous primary source credentialing.

We verify licenses, maintain up to date rosters, provide emergency specific training, and carry appropriate liability protections. Our volunteers don't arrive unvetted. They arrive prepared. They arrive ready to hit the ground, ready to help. However, without a clear legal framework like that provided in AB 1558, even thoroughly credentialed out of state practitioners can face ambiguity about their legal authority to act.

Thank you.

Thank you.

We will now hear from any, in the hearing room who would like to offer support for the bill. Please come forward with your name, affiliation, and position. Seeing none, we can move to any primary opposition. Witnesses, seeing none. Any of those in the hearing room who would like to offer a me too?

Seeing none, I will bring it back to committee for any comments or questions. I also do not have any questions. I wanna thank the author for working with our committee staff to be able to make sure that we have this bill. And I appreciate, Assemblymember, your efforts to make sure that we have the resources that we need in times of crisis, which we know California is just crossing all fingers, toes, and saying all the kinds of prayers to make sure that that doesn't happen.

But I think when it does, it's important that we have the right structure to be able to support us.

With that, would you like to close?

Thank you, madam chair. Ultimately, this bill is about expediting access of out of state licensees to assist us during the next natural disaster to make sure that we have care after the next climate crisis that faces our state. I respectfully ask for an aye vote when it's appropriate.

Thank you so much. And that will be considered. We are going to move on now to item number 23, AB 2282 by Alanis.

Thank you so much. And that will be considered. We are going to move on now to item number 23, AB 2282 by Alanis.

Afternoon, assembly member, whenever you're ready.

Thank you, Madam Chair. First off, I'd like to thank you and your committee for the work on AB 2282. I would gladly accept committee amendments to require Del Puerto Health Care District to report to the Department of Health Care Access and Information. AB 2282 addresses the lack of access to emergency health care services in the city of Paterson and the surrounding communities in my district.

This bill would require the Department of Public Health to issue a special permit to Del Puerto Healthcare District to operate a rural emergency stabilization center in Paterson while the permanent hospital is being built.

This would temporarily waive, licensure's requirements for general acute care hospitals if specific conditions are met. And one of one of those conditions is that the Del Puerto HCD must maintain written transport and transfer agreements agreements with all licensed general acute care hospitals within a 30 mile radius that maintain a licensed emergency department.

My office has worked with committee staff and stakeholders on amendments to clarify that Del Puerto HCD would be the operator of this emergency stabilization center and that the stabilization center would be a temporary and alternative solution for residents in Western San Jose County to access emergency health care services. To clarify, this bill as written does not create a freestanding emergency department.

Right now, residents of Patterson and surrounding areas must travel over 20 miles to reach the nearest full service hospital or trauma center, which has created significant barriers to accessing health care.

AB 2282 is a temporary solution that would allow patients to be treated for emergency health care conditions until a permanent hospital is constructed. The permit authorized by this bill cannot exceed a combined total of ten years unless the new hospital is being constructed. This bill is sponsored by the Del Puerto Health Care District. And with me today to testify in support is Jim Whitworth with the Patterson District Ambulance.

And also with me today is Sarah Bridge with the Associate Association of Health Care Districts for technical assistance.

Thank you.

Thank you.

Madam chair

Please press the button.

Madam Chair, members of the committee, my name is Jim Whitworth, clinical education manager for Patterson District Ambulance Del Porto Healthcare's, district. I've worked in Stanislaus County for twenty five years across the spectrum of emergency transport and ambulance, fire, and air transport, and the, EMS regulatory agency now in management overseeing clinical operations. Patterson District Ambulance serves as a community where AB 2282 would make the most difference.

I want to give this committee a clear picture of what emergency response looks like from our side. The nearest acute care hospital is a minimum of twenty five to thirty minutes from Patterson under normal conditions.

That is a long time in a medical emergency. But transport time is only part of one of the equation. When we transport a patient from Patterson to a hospital, the ambulance is out of service for a minimum of one to two hours, and oftentimes much longer due to APOD, ambulance patient offload times that you're familiar with. While we're waiting for our patients to be admitted, community is sometimes without an ambulance, without mutual aid agreements, which we have, and other emergency calls come in.

That person who is also having an emergency has to wait.

Statewide, eighty five percent of our emergency department visits do not result in hospital admission, meaning a significant share of patients we transport could be appropriately evaluated and stabilized closer to home. I could give you countless examples of times when a facility like the one envisioned in AB 2282 would have made a real difference for people we serve in Patterson. Ambulance and EMS teams can only do so much with the equipment medications we carry on board, and that includes the critical care aspects as well.

We provide clinical care in the field, but better outcomes often depend on how quickly a patient can reach the next level of treatment. I've helped stabilize hundreds of heart attack, stroke patients heart attack and stroke patients, but there are life saving medications interventions we simply cannot provide in the back of an ambulance.

A local stabilization center would allow patients to begin treatment much sooner right here in Paterson. In cardiac and stroke care

Thank you so much. We're at time.

Thank you, Madam Chair, member of Sarah Bridge on behalf of the Association of California Health Care Districts here in support of AB 2282. For the sake of time in the hearing, I'll yield my time back to the committee, but happy to answer any technical questions related to health care districts or the bill. Thank you.

Thank you. Are there any others in the hearing room who would like to offer support? Seeing none, we will move on any to any primary witnesses in opposition. Seeing none, if there are any in the hearing room who would like to offer an additional position, please come forward.

Thank you, madam chair. Tim Madden representing the California chapter of the American College of Emergency Physicians. We apologize for our late middle of our opposed letter, but we are opposed. We appreciate the conversations we've had, with the sponsors on the bill and look forward to continue those conversations.

Thank you. Any others in opposition? Seeing none, I will bring it back to the committee for any comments or questions. I will comment and say, Assemblymember Alanis, I wanna thank you for bringing forward this this bill.

I spent the interim going up and down the state of California really trying to figure out how we might be able to stabilize our health care infrastructure at a time when we so critically needed it and got to spend some time in rural counties like yours, Stanislaus, that had challenges going into the changes that were made to HR 1 in terms of whether or not they would be able to provide service and care.

And I wanna thank your witness, mister Wentworth, who captain? Captain manager went went went went Wentworth who really outlined the critical need to be able to set up something. I also just wanna say that you have offered a very creative solution to a vexatious problem, making sure that we have emergency services while also balancing the need to ensure that we are not waiting indefinitely for our hospitals to be built because that ultimately is the kind of infrastructure that we need.

So with that, I would like to ask to be a co author on your bill. And if you will have me and know that this type of bill, which is very specific to your community, will certainly go a long way in terms of providing some stability at a critical time for emergency services.

I wanna thank you for your testimony coming forward. With that, would you like to close?

Yes, madam chair. Thank you. And I appreciate those words. And as my witnesses has presented that it it is a big problem. And I'm sure it's not just in my district, but others as well.

And I hope maybe this will be a great model for them also to help until they can get their hospitals for their areas as well. So with that, I ask for your aye vote or your vote when it's time. Thank you.

Thank you. And we can list a motion in a second now. Motion by Johnson, seconded by Agara Curry. Thank you.

Thank you.

We will consider it when we have quorum. Thank you. Gonna move on in file item order to a b item number 10AB1843 by El Hawari. Please go ahead whenever you're ready, assembly member. And for those who are watching, we are going to be taking assembly member Krell's bill after this.

Good afternoon, madam chair and members. I am proud to present AB 1843, a bill that removes unnecessary administrative barriers and ensures Californians can access life saving hepatitis c treatment without delay. Hepatitis c is a serious but curable disease. We're seeing nearly fifteen hundred deaths each year in California even though treatment today cures over ninety five percent of cases in as little as eight to twelve weeks. The problem is not just the treatment.

It's the access. Right now, too many people face delays because of prior authorization, unnecessary testing, and insurance requirements that don't improve care, but just slow it down. AB 1843 aligns health plans with current medical guidelines and removes those barriers so patients can get treated when they need it. When treatment is delayed, people get sicker and something that could have been cured becomes harder to treat. According to the CHBURP analysis, the bill's impact on monthly premiums is negligible at most between 0.02 excuse me.

Between 0.2¢and, a little over 1¢per member. This bill also builds on the progress we have already made. Medi Cal eliminated prior authorization for hepatitis c treatment in 2024. AB 1843 extends that approach more broadly so more Californians can benefit. And this matters most for the community disproportionately impacted including people of color, folks experiencing homelessness, LGBTQ plus individuals, and people who struggle with substance abuse who already face barriers to care.

Expanding access not only saves lives, but it also reduces long term health care costs by preventing more serious and expensive conditions down the line. No one should suffer from a disease that's curable. Testifying with me today is Heather Lopez, lead caseworker at project HCV Connect, and Jonathan Foxweig, director of health justice policy with SF AIDS Foundation.

Thank you. I'll have two minutes.

Thank you, Chair Bonta, committee members. Again, my name is Jonathan Froxwike. I'm the director of health justice policy with San Francisco AIDS Foundation, which is a cosponsor of this legislation. As providers of hepatitis c treatment, we at SF AIDS Foundation see firsthand the transformative impact that accessing a hep c cure can have on a person's life. Unfortunately, many insurance companies in California prevent people living with hepatitis c from getting cured by requiring prior authorization for these drugs.

Requiring prior authorization or PA for hep c treatment conflicts with the definitive medical guidelines on hepatitis c in The US, which recommend timely treatment for almost all people living with the disease. Many insurers also request information or procedures that are not recommended, but are costly and dangerous, like liver biopsies. These insurance company hoops often result in people living with hep c not getting cured. About two thirds of people who have private insurance and are diagnosed with hepatitis c don't start treatment within about a year. PA is one reason why.

AB 1843 addresses this issue by, first, prohibiting insurers from requiring PA for most hep c treatment drugs, and second, requiring that insurers PA processes align with medical guidelines. Treating hepatitis c saves the health care system money. This is just common sense. The cost of a single eight to twelve week course of medication is much lower than the cost of treating a lifetime of complications like cirrhosis and liver failure.

The CHURRP analysis of AB 1843 found that for every person cured of Hep C, the healthcare system saves $7,650 every year.

The analysis also found that the bill would have a negligible impact on health insurance premiums. Given this cost effectiveness, we strongly encourage you to advance AB 1843. Thank you for your consideration, and I'm happy to answer any questions you may have.

Thank you. You'll have two minutes.

Good afternoon.

My name is Heather Lopez, and I'm a recent master of public health graduate from USC. I currently serve as a lead caseworker for Project HCV Connect, a Los Angeles based program that links residents' security of hepatitis c treatment. Hepatitis c is a significant public health communicable disease problem. It currently affects four hundred thousand Californians. And in our program, we see that two thirds of our residents remain untreated.

And a major barrier to treatment that we see is proauthorization. I spend hours talking to our untreated California residents. I sit on the phone with them and hear their stories of how some have lived with the virus for over twenty years, putting off getting treatment due to financial constraints, constant appointments for the next and next test, and who are overwhelmed by the system and the requirements they know they will inevitably face. I know how thankful they are for our help. Our residents want to be treated.

As a caseworker, I can get them to their appointment and in the door to the doctor's office, and the physician I work with wants to and is ready to treat them immediately. However, it is the inevitable next pro authorization step that gets in all of our way. In our work, we've seen that these insurance imposed requirements can mandate dangerous and unnecessary procedures.

These include liver biopsies, where one in ten patients might be at risk for life threatening bleeding, and costly genotype testing, which can run patients hundreds of dollars out of pocket. Even though leading medications are Pan Genotypic, it can work regardless of the genotype.

Beyond the patient burden already, prior authorizations exhaust our medical teams. My colleagues spend up to thirteen hours per case chasing faxes, labs, providers, and patients fighting for a prior authorization approval. With your support, and I vote on this bill, we can align with evidence based care, ensure health equity, and get hundreds of thousands of Californians secure. Thank you.

Thank you. Are there any others in the room who would like to offer support? Please come forward with your name, affiliation, and position on the bill.

Chair and members, Kathy Mossberg with APLA Health and Support.

Chair and members, Clara McDade-Ting on behalf of the County Health Executives Association of California in support.

Hi there. Zach Flowers with the Health Officer Association in support.

Hi. I'm Karen Chiu. We tar RN, and I support.

With California Life Sciences in support.

Good afternoon. Bindu Mukhamala, policy manager with the National Association of Social Workers, California chapter in support.

Thank you. We will now move on to any primary witnesses in opposition. Please come forward.

Thank you. Cassidy Heckman on behalf of the California Association of Health Plans. I wanna start by thanking the author, her staff, and the sponsor for their early engagement with us on this issue. However, we must respectfully oppose it today. First, we are opposed opposed to the provision of the bill that impacts a health plan's ability to conduct prior authorization.

The legislator just passed SB 306, which institutes a regulatory process for prior authorization. We urge the legislator to pause any legislation on this issue and let the law and the regulatory process play out as intended. We are also concerned with codifying clinical criteria into law. While guidelines can help establish the efficacy and safety of diagnostic testing or therapeutic interventions, codifying them into law is problematic because populations may differ and treatment evidence may evolve.

Additionally, our organizations continue to remain concerned with the high cost of prescription drugs.

CHBURP notes that the average cost of these drugs, which are one time treatment, can be as high as $33,000. When the legislator considers prescription drug mandates that affect the health plan's ability to manage the cost associated with prescription drugs, we respectfully urge careful consideration of the price and any impact on health care premiums. For these reasons, we are opposed. Thank you.

Good afternoon, chair and members. Matt Aiken on behalf of the Association of California Life and Health Insurance Companies, also respectfully in opposition to assembly bill 1843. I would like to align my comments with my colleague at Cap and reiterate our concerns with the impacts that these mandate bills have on premiums at a time when health care affordability is already a major concern for Californians.

This bill was one of 11 health, excuse me, health benefit mandates introduced this year that cumulative cumulatively would increase premiums by more than half $1,000,000,000. Rising health care costs are already placing immense pressure on millions of Californians, and many are being pushed to the point of dropping coverage altogether.

An issue this committee has examined in multiple informational hearings this year. Finally, selectively mandating special coverage rules for certain conditions creates a discriminatory system where some conditions and services are favored over others, raising real equity concerns across the health care system. For these reasons, we are respectfully opposed to the bill. Thank you.

Any in the hearing room who would like to offer an opposition? Seeing none, I will bring it back to the committee for any comments or questions. I did have one come question for the opposition. What is the per member per month impact to premiums that is outlined in CHBURP on this bill?

I'll have to take a moment to look at my CHBURP analysis. But, you know, we do hear the arguments that were being made. However, you know, this is gonna be a hearing where

I'd like you to respond to my question

Okay, I'm gonna need a a second to find the

Take your time.

I believe if I'm looking at the right table, it says and correct me if I'm wrong, chair and committee, on page 15, .0020 to .0134. Is that correct?

So that's .0020 to .0134 of a cent. Right?

Correct.

Yeah. So is there any world in which the health plans will have a different position on these mandate bills?

.0010.

I appreciate do you wanna?

And I completely understand, Chair. I think our issue with a lot of these mandates is that we're we're seeing them year after year, and I think there was, I don't wanna misquote the numbers that were presented in an informational hearing, but some people are seeing in the last decade over $500 a month that their premiums have gone up. And I know that, you know, when we're looking at something as minuscule was a cent, it's hard. I get that.

But I think our point is we wanna be looking at ways to lower these premiums, not just slow the growth.

And I know that Oka is looking at a spending target. We support that. We've been very supportive. But I think the overall over many years, just limiting the growth, we're seeing people really really struggle with this. And I think, you know, again, the cumulative impact is is small as this one may be.

It's just a real concern and and, you know, our point, there are 11 that were over over half $1,000,000,000 this year.

On this one, if you were to actually even consider the cumulative effect of bills that had a range of point .001% to whatever that other thing is, if you had five bills over the course of the years that had that range of impact, you still wouldn't even be getting to 1¢.

So at some point, I appreciate the conversation around the aggregates costs and certainly, other members of this committee and in the legislature will know how hard we are being to ensure that we are limiting the cost of premiums at a time when we need to make sure that we are doing so to be able to ensure that everybody has the ability to pay for the health care that we deserve.

On the other hand, at some point, your cumulative arguments starts to lose all sense of anything that makes sense when you are talking about legislation that would provide an opportunity for people to have critical care when we are talking about .001 cent.

So I would encourage you all to perhaps refresh your talking points and consider whether or not there might be some ability for us to have a manageable conversation around the cost of health care that includes the ability to consider these kinds of mandate bills.

With that, seeing no other comment, assembly member, would you like to close? Please press the button.

Thank you so much, madam chair. This was really important for us to really double down on this just the negligible impact on premiums and really appreciate you helping with that given that it really does cure ninety five percent of cases. And we respectfully ask your Ibook.

Moved by Aguiar-Curry. I will second the bill for now. With that, thank you. We will be able to conserve the vote when we have a quorum. We're gonna move on now to item number 20.

Oh, apologies, Elhawary. Yes. Go ahead. Which is item number 22 AB 2247 by El Hawari. And I think you need to press the button.

I was like, I'm just loud, but not that loud. Interesting. Good afternoon again. First, I wanna start by saying that I accept the committee amendments. Today, I'm presenting AB 2247, the trauma healing and resilience investment for victimized and exposed youth act or thrive act.

This bill creates a state program that funds mental health services for people 25 and under impacted by gun violence, including victims and witnesses. When trauma goes untreated, it can lead to long term harm and cycles of continued violence. But when young people have access to care early, it can change the trajectory of their lives. AB 2247 is about making sure you don't have to fight the system to get help.

It connects them directly to mental health providers or peer support in their communities and ensures that they are not required to pay out of pocket or wait for reinvest reimbursement to get care.

This bill is about meeting our young people in the moment they need help and making sure the system responds. With me here today is Gabriel Garcia, who's the policy and advocacy director of Youth Alive, and Raya Corson Higgs, who is a mental health counselor with them as well.

Thank you, Assemblymember. Good afternoon, chair members. My name is Gabriel Garcia. I'm the policy and advocacy director for Youth Alive. We're a community based organization in Oakland that focuses on addressing gun violence in three different ways, prevention, intervention, and healing.

Now that prevention work is working with young people. It's upstream youth leadership development. The intervention work is focused on active conflicts, the people that are most likely to be shot or pull a trigger in the next couple months. The healing work is what I wanna talk about today, and that is serving victims, survivors of gun violence, specifically many mothers who lose their children to gun violence in our city as well as providing mental health counseling to any individual for free.

Now AB 2247, as we talked about, provides California much needed direction on how we can better serve victims and survivors, especially young people who are impacted by gun violence.

What is so critical, about this work is that it helps alleviate the barriers that many folks already experience, which are many. Individuals may not even know that these services exist, that lack of awareness. There may be bureaucracy and paperwork that young people are expected to navigate just to receive basic care, or it may be that the, mental health services that are available to them that are in network are not adequately designed for the specific experiences of folks who have survived a gunshot.

And that is why AB 2247 is critical because it removes one of the barriers that we have control over, which is cost. So today, grateful to be joined by my colleague, Rhea, who is a mental health counselor who can talk about why this work is so critical, especially for the young people that we serve, but young people all around California that are impacted by gun violence.

Thank you.

Thanks so much, Gabe. Good afternoon. My name is Rea Corson Higgs, and I serve as a mental health counselor at Youth Alive. I work with young people and adults who are impacted by community violence. Everyone impacted by violence should have access to free and effective care. But young people whose brains are still developing are particularly vulnerable to long term negative consequences. Studies show how, for children and adolescents, trauma exposure alters brain development, emotional regulation, social functioning, and physical health.

That's why effective therapy and healing can make a huge difference in young people's life outcomes. For my youth clients, therapy with me is often the very first time they're vulnerable about the toll that violence and trauma have on their lives. It's a space where they do not feel ashamed or alone in what they've been through. Traditional mental health care is often inaccessible and ineffective due to the realities that young people impacted by violence are often facing. They do not feel safe leaving home.

They do not have support to travel to an office setting, and they do not have a safe and confidential space to access telehealth services. Youth Alive's counseling accounts for all of this. I meet young people where they feel most safe, comfortable, and supported, whether that's at their home, school, or elsewhere in the community. Beyond talk therapy, I bring clients into nature. I get them meals.

I help them connect to other services so that their basic needs are met. This work is all about minimizing barriers to healing. I served a young man who had been shot in the leg shortly after his eighteenth birthday. He was unable to walk and was suffering from severe PTSD and anxiety, making him scared to leave his home and felt like he would need to carry a gun himself anytime he did.

I met with this young man in his home for as long as he needed until he felt safe and ready both physically and mentally to be back outside and in the community.

I brought him to get food, to take short short walks, and he began to heal not only his physical wounds, but the deep impacts of trauma on his body, mind, and spirit. Thank you.

We're gonna move on now to, those in the hearing room who would like to offer a position of support.

Good afternoon. Capri Walker with California for Safety and Justice, proud cosponsor and support, also on behalf of Drug Policy Alliance and support.

Good afternoon, chair and members. Rebecca Marcus representing the Brady campaign and the California Public Defender's Association in support. Thank you.

Good afternoon, chair and members. I'm doctor Jasmine Smith. I'm the director of capacity building for the California chapter of the National Association of Social Workers in full support.

Good afternoon. My name is Sofia Coburn. And in honor of my nephew, Nicholas Joshua Martinez, who was murdered in a home invasion, with gun violence in front of his two little brothers, I strongly support this. Thank you.

Good afternoon. My name is Nithya Avari and founder of seven Euro, and I'm strongly in support. Thank you.

We're gonna move now into any primary witnesses in opposition to this measure or those in the hearing room who would like to offer a me too in opposition? Seeing none, I will bring it back to the committee for any comments or questions. Thank you, Assemblymember Elhawary. I wanna thank you for bringing my hometown amazing organization, Youth Alive, that does phenomenal work for our youth in particular within the context of growing gun violence in our city or I should say, persistent gun violence in our city.

And, know that, we've had opportunity to try to declare gun violence a public health crisis in the past in this legislature to be able to ensure that we are proactively providing all of the resources necessary to be able to support our communities.

I've been the biggest advocate and supporter of that and taking the leadership of organizations like Youth Alive to be able to do that.

Would love to be considered as a co author on this measure and and really appreciate your personal leadership in this space to ensure that we are not only addressing gun violence from you know, a public safety perspective, but also recognizing that shared safety includes making sure that we have the ability to have our survivors and our communities recover from level of gun violence that they shouldn't have to. So thank you for your leadership.

Through the chair. I would also like to be added on as a coauthor.

Thank you. Would you like to close?

Thank you both so much. We welcome, the addition of both of you as co authors and really appreciate the work that you all do every day and respectfully ask for your aye vote.

Thank you. Does not move moved by Aguiar Curry, and we will consider that when we have the quorum. Thank you. We're gonna move on now to Maggie Krell. Item number 20AB2138.

Good afternoon, chair and members. Thanks for having me today. I'm presenting Assembly Bill two one three eight. I wanna begin by, thanking committee staff for their work on this bill. I'll be accepting the amendments, and I think that also removes, the concerns, not opposition, opposition, but concerns.

So appreciate everyone's work on this. AB 2138 strengthens Californians California's behavioral health workforce by expanding access to peer support specialists for those who need them most. Certified peer support specialists have lived experience with mental illness or substance use disorders, and it makes them uniquely positioned to really help other people navigate their own recovery. Peers improve engagement in treatment, help people nav navigate the complex systems they need to navigate, and also it just supports their long term stability.

Access still to peer support still remains uneven.

Oftentimes, peers are not part of the enhanced care management teams serving the behavioral health patients who would benefit from them the most. And so this bill takes two steps that would help with that. One is it requires enhanced care management providers who meet certain criteria to take specific steps to ensure that patients with serious mental illness or substance use disorder have access to a peer to support them.

And then it also ends the automatic employment disqualifications based solely on criminal background checks while still maintaining federal requirements and exclusions when it comes to, you know, serious and and and child related offenses. With me here to testify are Rachelle Chambers, the executive director of Painted Brain, and also Alan Richards, the vice president of Enhanced Care Management for the Amity Foundation.

And at the appropriate time, I'll respectfully ask for your aye vote.

Thank you. Please go ahead. You'll have two minutes.

Good afternoon, chair and members. I am Rachelle Chambers, the founder and executive director of Pain It Brain. I am a person living with lived experience of a serious mental health condition, and I'm a peer support specialist and have trained over 900 individuals in California in the peer support specialist training. We provide enhanced care management services in Los Angeles and Alameda County and other counties across the state. And I am here in strong support of AB 2138.

ECM not only only works if people are engaged. And engagement is not just offering services. It's building trust and relationships over time. And that is where the peer support is essential. Peers are not add ons.

They are central to how ECM work. They reach individuals not responding to traditional care. They build trust with people who who the system has failed. We help members navigate appointments and services, and we show up along to ensure them that there's follow through in their appointments. These services are core to ECM.

Peers are trained to use our lived experience as structured engagement tools, especially for individuals who are distrustful and ambivalent to care. This is not anything new. Peer support is is a evidence based practice, Medicaid reimbursable, and recognized in California through SB 803. From our experience, peers are often the diff the difference between engagement and disconnection. AB 2138 reflects what's already working and ensures that ECM reaches the peoples it's designed to serve.

We respectfully urge your yes vote on this.

Thank you. Go ahead.

Good afternoon, chair and members. My name is Alan Richards. I'm the vice president of Enhanced Care Management Services for Amity Foundation here in support of AB 2138. Amity Foundation is a teaching and therapeutic community that focuses on creating successful reentry pathways for citizens returning to our communities. Amity has been at the forefront of developing, implementing, and enhancing approaches to provide holistic services that foster community building, healing, and sustainability.

Amity's modality includes peer to peer support, coaching, mentoring, concepts, and designs, which contribute to the successful reintegration reintegration of many individuals who have come through our doors. Having been a direct recipient of these individualized services, and in my current role at Amity, I continue to pay it forward by teaching and demonstrating to others how to do the same. Thus, paving additional pathways for them to follow. This is exactly what Amity does. Each one teach one.

I fully support AB 2138 and the reasoning behind its importance. Peer support specialists continue to be utilized in many programmatic areas today, providing a beneficial and supportive landscape for men and women returning to our communities from various institutional settings. This plays a vital role in individuals being willing to accept help from people they deem trustworthy. Connecting men and women to services such as housing, health and behavioral care, employment, and educational services is essential to successful reintegration.

Who better to help these individuals navigate these sometimes complex areas than those who have already trodden the path.

The link that binds these supportive relationships together is the underlining factor that credible messengers possess

Thank you.

An effective way of building community.

Thank you so much. We're gonna move now in to those who are in support of this measure, who are in the hearing room. Please come forward to state your name, affiliation, and position on the bill.

Grace Gallagher, advocacy manager with Painted Brain, and I strongly support this bill.

Claudia Gonzalez on behalf of Vera California, proud cosponsor of AB 1231 by Assemblymember Corral, and strong support.

Marona Goneifer with Call Voices, also on behalf of Mental Health America of California and strong support.

Hi. Karen Chiu, The National Alliance for Mental Health or Mental Illness, be strong support.

Hi, Nithira Virey, also on behalf of National Alliance Mental Illness, and I'm strongly in support.

Bindu Akamala with the National Association of Social Workers, California chapter in strong support.

You're Dylan Elliot on behalf of the California State Association of Psychiatrists in support.

Can I give one from up here? Tara Gimbo-Eastman with the Steinberg Institute in support.

Thank you. Are there any primary witnesses in opposition who would like to offer testimony? Seeing none, I are there any who would like to offer me twos in the hearing room?

Good afternoon. Trent Murray with the California Association of Alcohol and Drug Program Executives. We support the bill and concept. We've been working with the sponsor and the author's office related to our concerns with the bill, which we submitted to committee.

Thank you, sir. That's so we've had two support witnesses, and we are at the point where we're offering me too's, which is name, affiliation, and position on the bill.

Okay. We had submitted concerns and we are working with the author's office and they the first look at the

Thank you so much.

Just wanted to record on the record, me too in support by the Steinberg Institute which is a sponsor of this bill.

Thank you. Alright. We will bring it back to the committee for any questions or comments. Moved by Johnson, seconded by Agi or Curry. Thank you.

Assembly member, I wanted to thank you for working with our committee to address some of the concerns that we had.

I I fully recognize the critical nature of our of our peers to be able to support enhanced care management and know that even in this legislative cycle, you've have a a package of legislation that is really focused on being able to provide care, baby health care in particular, on the street closest to those people who need it by people who are able to provide that care and really wanna appreciate your leadership in that in that space as well. With that, would you like to close?

Thank you so much, madam chair. I wanna thank my witnesses for their work and for their testimony today and respectfully ask for your aye vote.

Thank you. And we have a motion and a second. And when we have full quorum, we will be able to consider that. We're gonna move on now to item number 11 oh, sorry. Item number six by Hart AB 1682.

Thank you, Madam Chair and members. I'm pleased to present AB 1682, a bill to ensure patients undergoing chemotherapy have access to scalp cooling, a treatment that helps reduce chemotherapy-induced hair loss. California Cancer Registry reports each year that nearly two hundred thousand Californians are diagnosed with cancer, with breast cancer being among the most common, accounting for over thirty thousand new cases annually. Chemotherapy is a critical tool in fighting cancer because it targets rapidly dividing cancer cells.

However, it also affects other fast-growing healthy cells in the body, including hair follicles, which often leads to significant hair loss during treatment.

Hair loss is one of the most visible and emotionally distressing side effects of chemotherapy. It can impact a patient's mental health, confidence, and sense of privacy. This removes the patient's control over when and how they share their diagnosis. Scalp cooling is an evidence-based treatment that helps address hair loss by cooling the scalp before, during, and after chemotherapy to reduce the amount of medication that reaches hair follicles. Despite its effectiveness, access to scalp cooling depends largely on whether a patient can afford it.

Coverage remains inconsistent across private insurance and Medi-Cal. Patients are often required to pay out of pocket, with cost ranging from $4,000 to $5,000 for a full course of treatment, putting it out of the reach of many. This year, Medicare began covering scalp cooling, recognized its importance as part of a comprehensive cancer care. However, that same level of access is not guaranteed for many Californians.

AB 1682 addresses this gap by requiring health plans and insurers to cover FDA-cleared scalp cooling devices when prescribed by a provider.

This bill ensures that cost sharing is no more restrictive than other oncology supportive services and expands access to an evidence based treatment that can reduce one of the most challenging side effects of cancer care. Speaking in support today are Dr. Frederick Kass, Assistant Clinical Professor of Medicine at UCLA Health, and Dr. Susan Salcido, Santa Barbara County Superintendent of Schools.

Thank you so much.

Thank you, Madam Chair and members of the committee. It's a privilege to speak here today. I'm an Assistant Clinical Professor of Medicine at UCLA, but I speak on behalf of my colleagues at Santa Barbara, and I don't represent the university. This is my fortieth year in cancer medicine. Eight years ago, I led a team that brought scalp cooling to our practices in Santa Barbara.

That changed dramatically a toxicity of therapy that we had all learned to accept and live with. For patients, needless to say, hair loss is not minor. It's the most visible and emotionally distressing of the side effects that our treatments cause. I've seen the impact of scalp cooling in so many of my patients who are now empowered to maintain some degree of normalcy in their professional lives, in their personal lives, in their caring for their children.

As Assemblymember Hart emphasized, the coverage is inconsistent.

Without insurance coverage, the cost puts this intervention out of reach for most of our patients. Some of our patients have coverage. Some of them don't. In oncology, we routinely cover interventions to ameliorate the toxicities of treatment, nausea, vomiting, allergic reactions, seizures. These interventions are essential, not optional.

Scalp cooling, in our view, is no different. Three states, New York, Maryland, and Louisiana, have already enacted coverage laws similar to this legislation. The legislation under consideration.

Thank you.

It is pending in 9 states, as well as California.

Thank you so much.

Thank you.

Go ahead.

Good afternoon, Chair and members. I'm Susan Salcido, and I serve as the elected Santa Barbara County Superintendent of Schools. Just about 2-years ago, this summer, while dropping off our daughter to the University of Hawaii for her freshman year, I got an unfortunate, fortunate sunburn. I found myself scratching at the peeling skin, and I found a lump. What followed was a rapid education about breast cancer, and learned that there are many types of breast cancer and many types of treatments.

Mine required chemotherapy, surgery, and radiation. I began chemotherapy in December of that year, and on Christmas Eve, I lost all of my hair. I had prepared to lose my hair. I had a wig. I had scarves.

I had a beanie. What I wasn't prepared for was how emotional and painful it felt to have it all fall out strand by strand and then handful by handful and then clump by clump. Everything else about cancer felt private, but losing a full head of long hair in about two weeks while continuing to work full-time in the public felt quite public, visible, and vulnerable.

During my chemo treatment, I had access to a Paxman cold cap through my clinic at no cost to me due to an anonymous donation for all women who wanted to use it. Therefore, the decision I had was not whether or not I could afford the cold cap.

It was simply whether I wanted to use it, and I did. I am now cancer-free. My hair is growing back at a surprisingly rapid pace. I'm grateful for my health, and I'm very grateful to be here to support this bill so that others might have access to the same care without a financial barrier. Thank you.

I move the bill.

Moved by Aguiar-Curry, seconded by Schiavo. We will now take any positions of me too, that would like to offer support. Please come forward.

Hello. My name is Annika Manley from Oakland. I am a cancer survivor. I cold-capped last year, and I'm here also on behalf of hundreds of other survivors who are not able to be here, but whose signatures you have.

Thank you.

Hi. I'm Inez Manley, and I'm the daughter of a cancer survivor. I strongly support this bill.

Hi. My name is Etienne Manley, and I'm the son of a cancer survivor, and I also support this bill

My name is Sofia Cobrin. I'm a cancer survivor, and I strongly support this bill.

My name is Cyndi Wheeler. I am a cancer patient in treatment and a former cold-cap user, and I strongly support this bill.

My name is Amy Morgan. I'm a former cancer survivor, and I also cold-capped, and I'm in strong support of this bill. Thank you.

My name is Linda Lichtenberger, and I am a cancer survivor, and I strongly support this bill.

Good afternoon, Madam Chair and members. I'm Obed Franco here on behalf of CenCal Health, in support.

Christine Smith, Health Access California, in support.

Christina Perriman, Folsom, California. Cancer survivor, successfully cold-capped, and I am strongly in support of this bill.

Chair and committee members, [inaudible] here on behalf of Biocom, in support.

Hi. Melissa Bourestom with Paxman. We're the manufacturer of the technology used at 55 locations in California, and strongly in support of the bill. Thank you.

Rebecca Pearson, State Employee, cancer survivor, 3 years cancer-free from using the DigniCap, and hair is back fuller and thicker than ever. My insurance was denied from the state.

Thank you.

Kevin Guzman with the California Medical Association, in support.

Good afternoon, Chair and members. My name is Dr. Jasmine Smith. I am the Director of Capacity Building with the National Association of Social Workers California Chapter, and I am the daughter of a cancer survivor who didn't have the opportunity to cold cap. So we both shaved our heads off, and I fully support this bill.

Cher Gonzalez, representing the Association of Northern California Oncologists and the Medical Oncology Association of Southern California. Our apologies to the author and to the committee for not getting our support in on time; that will be forthcoming. Thank you.

Thank you. We're gonna move now to any primary witnesses in opposition.

Thank you, Chair. We're not gonna sit on every mandate bill today, but we are opposed to this one. Respect the author's intent, and the intent behind the legislation. But due to the impact on premiums, 4 million for this and over 500 million total, we have to oppose it. Thank you.

Good afternoon, Chair and members. Matt Akin, on behalf of the Association of California Life and Health Insurance Companies. Also respectfully in opposition to the bill, I would just like to align my comments with my colleague. Thank you.

Thank you. Any others in opposition in the hearing room who would like to offer a me too? Seeing none, I will bring you back to the committee for any comments or questions. Assemblymember Schiavo.

As the daughter of someone who is just starting treatment for breast cancer, I am very happy you're bringing this forward. Thank you.

Thank you.

Thank you, Assemblymember, for bringing forward this measure. And I wanna just thank Inez and Etienne, especially for bringing their voices into the room and supporting their mother in this moment. And, Assemblymember, you have been working on this for quite a while. I know that this is an area of great concern and passion for you. I wanna thank you for bringing forward this very thoughtful measure. With that, would you like to close?

Yes. Thank you. I just wanna say that, really, no patient should have to endure unnecessary emotional distress on top of what is already a very difficult diagnosis. This bill helps preserve not just physical health, but also mental well-being and dignity at a very modest 1.5-2.7 cents per patient cost. Thank you.

And I just wanna acknowledge and thank the witnesses for testifying. Superintendent for bringing your personal story into the room as well.

Thank you.

Thank you. With that, we have a motion and a second. We don't have quorum yet, so we will consider this bill when we do.

Thank you so much. We're gonna move on now to Item Number 11, AB1879 by Dixon.

Good afternoon. Thank you, madam chair, chair, and colleagues. I want to thank the chair and their staff for working with myself and my team on amendments to refine and improve this bill. I am pleased to accept the committee's amendments. AB 1879 is a straightforward bill that provides consistency on how alcohol or other drug recovery or treatment licensed facilities and certified programs report data to the California Department of Healthcare Services, DHCS.

Under current law, treatment programs and facilities receiving public funds and narcotic treatment programs, regardless of funding source, must report to the county data on clients, outcomes, and treatment availability through two existing systems, the California Outcomes Measurement System treatment and the Drug and Alcohol Treatment Access Report. However, if a facility or program does not receive public funds, it is not required to report this data except for, previously mentioned narcotic treatment programs. This inconsistency is report in reporting creates a significant gap in data.

Every year, we pass laws regulating alcohol or drug recovery and treatment. However, we lack the necessary data to see if what we are doing in Sacramento is actually helping people.

I want people to get better and receive the treatment they need in a safe environment. Therefore, AB 1879 would apply the same reporting standards of those programs and facilities that receive public funds to those that do not. This bill builds upon existing precedent and regulations and will provide us with the necessary data to ensure that the decisions we make in Sacramento are actually working. With me today, I have Devin Waite on behalf of the California Alliance for Behavioral Health and Addiction Treatment, CBAT.

CBAT?

CBAT.

CBAT. And oh, not the other one. Here here here. Once again, I want I want to thank the chair for your help, and I'll request an aye vote. But thank you very much for working this bill through.

Thank you.

Thank you. Chair Mia bonta, members of the committee. My name is Devin Waite, and I am a person in long term recovery, a behavioral health advocate for over twenty three years in the field. And I'm here today with the California as the chair of the California Alliance for Behavioral Health and Addiction Treatment. We strongly support AB 1879.

California has thousands of licensed and certified substance use disorder treatment providers. Right now, we have no consistent statewide picture of what's working, what's available, and who's being served. That's a serious problem when we're trying to invest public dollars wisely, close gaps in access, and actually move the needle in recovery outcomes. AB 1879 changes that.

It brings non Medi Cal, Non County contracted providers into a unified data reporting structure using a framework that already exists, using the two data platform systems, otherwise known as Cal OMS and Datar.

This is not new bureaucracy. It's smart, long overdue alignment. But I want to say something broader because this bill points to something in the field that is needed to be reckoned with for a long time. Private treatment providers have long operated under different sets of expectations for their public as opposed to their public counterparts, And that gap has real consequences. Public programs are required to contribute data that informs treatment efficacy, need, adequacy, and funding decisions.

Private providers largely are not. This means the statewide picture we're building is incomplete. And the analysis we rely on to understand what treatment is work what treatment is working, where the gaps exist, and where future resources should flow is built on partial information. AB 1879 begins to close that gap. When private providers contribute to the same data infrastructure, policymakers get a fuller picture of treatment effectiveness across the entire continuum, not just the public funded side.

That matters for needed adequacy need adequacy assessments. It matters for funding monitoring, and it matters for every Californian trained to find care.

We can Thank you. Thank

you.

Are there any others in the hearing room who would like to offer support for this measure? AB 1879. Please come forward with your name, affiliation, and position on the bill.

My name is Pete Nielsen with the California Consortium of Addiction Programs Professionals and strong support.

I'm doctor Brandy Jordan with the California Coalition of Addiction Recovery Advocates in strong support.

Nelson Case, Central Valley Recovery Services, and I support this.

Michelle Pinos, Central Valley Recovery Services in strong support.

Lori Newman, executive director to Community Social Model Advocates Inc in strong support.

Anthony Fry, the Ranch Recovery Center's Desert Hot Springs, we support.

Certified counselor for CCAP for sixteen years, Kelly Couch, strong support.

Elena Wolf. I am a Delance Street graduate, four year, eighteen year, SUD counselor in a jail. I'm not gonna say which one. And I strongly support. Thank you.

Graham Sargent, CEO of American River Wellness, and strong support.

Hello. My name is Donald Rivers. Humboldt Recovery Center, strongly support.

Stacy Smith with Waterfront Recovery Services and I strongly support.

Shirley Pardo with the with the California Consortium of Addiction Professionals and Programs, and I'm in strong support of this.

Jamaica Barts, executive director of Waterfront Recovery Services, am strongly support.

Nisha Watts, Humboldt Recovery Center substance use counselor, also CCAP member, strong support.

Luis Lererra, SUD Counselor, Madera County, strong support.

Thank you. We will move on now to any primary witnesses in opposition.

Good afternoon. Trent Murphy

You'll have two minutes.

Trent Murphy with the California Association of Alcohol and Drug Program Executives. We had submitted an opposition letter alongside comp, to a previous version of the bill. This new version of the bill looks like it alleviates our concerns related to duplicative data reporting. So appreciate the author's office for the new version. Thank you.

Thank you.

Good afternoon. I'm Jennifer Alley with the California Opioid Maintenance Providers. We appreciate the hard work of the author's office and the committee staff, and we are removing our opposition. Thank you.

Thank you. Any others in the hearing room who would like to offer a Me Too in opposition? Seeing none, I will bring it back to the committee for any comments or questions. Seeing none, Assemblymember Dixon, I know that this is an area of of incredible, leadership and interest on on your behalf. And I know that you are incredibly passionate to make sure that we have a robust set of of data.

And I really appreciate you taking the time to be able to make sure that it's, that our policies can be data informed. And I think, with the committee's amendments and support, you've identified a potential reporting gap that, we will, be able to close as a result of this legislation.

I do wanna just note that, it seems like there will need to be some further technical assistance, from DHCS, the Department of Healthcare Services, in order to be able to make sure that we are adequately closing that reporting gap. So I encourage you to continue working with the department to be able to make sure that we can strengthen this bill as is. With that, would you like to close?

Well, I just wanna thank you. It was both of our staffs that really brought this together with your support. I'm very grateful. And I think we can help a lot of people when we have the facts and the data to do it right. So thank you, and I respectfully ask for your support.

Thank you.

Thank you. Can we have a motion and a second? Moved by Rogers, seconded by Johnson. The chair's recommendation is an eye, and when we have a full quorum, we will be able to move forward with this bill. Thank you.

And now we are going to yeah. We are going to move to members of the committee, and we will hear Assemblymember Aguiar Curry's second bill, item number 14 AB 1906.

Good afternoon. Thank you, madam chair and members. I'm pleased to present AB 1906, a bill to ensure all Californians have access to at home cervical cancer screening kits. AB 1906 requires coverage of these tests for private health plans and Medi Cal patients without cost sharing. Cervical cancer is one of the most preventable cancers when detected early, but screening for it can be invasive and inconvenient.

Research shows that rural women are more likely to die from cervical cancer, and black and native American women experience far higher mortality rates. Allowing patients to test in their home expands access for rural and working Californians, increasing preventative screening levels and reduces strain on our health care system. Research from the CDC shows that increased screening has reduced cervical cancer incidence and deaths by seventy percent since the nineteen fifties.

AB 1906 promotes early detection and works to reduce health disparities and strengthen preventative care across the state. With me today, I have Angela Pontes on behalf of Planned Parenthood and Christine Smith on behalf of Health Access.

Thank you, chair and members. Angela Pontes on behalf of Planned Parenthood Affiliates of California in support of AB 1906. The 109 Planned Parenthood health centers collectively provide one point three million patient visits each year. This includes nearly 100,000 cancer screenings and two point six million STI tests. HPV is the most common STI in The United States with an estimated thirteen million new cases each year, and it is responsible for nearly all cervical cancers.

Up to ninety percent of HPV infections are asymptomatic. Routine cervical cancer screenings can detect high risk HPV and precancers, which has proven to be a critical preventive measure against cervical cancer. Unfortunately, timely screenings remain a challenge with studies suggesting that approximately twenty five percent of US women are under screened. AB 1906 would require coverage without cost sharing for at home cervical cancer screening kits, which were recently FDA approved.

This change will expand access to critical preventive care, especially for rural and working Californians that face barriers to in person screening. We ask for your aye vote.

Thank you.

Good afternoon, chair and members. My name is Christine Smith with Health Access, the statewide health care consumer advocacy coalition, and here in strong support of AP nineteen o six. At Health Access, we work to ensure all Californians can get the care they need when they need it at a price they can afford. This is this bill is a strong step toward that goal. Cervical cancer is one of the most prevent preventable cancers when detected early.

When caught early, the survival rate is about ninety one percent, but that drops to about twenty percent when diagnosed at a later stage. The difference is access to screening. Yet too many Californians face barriers to in clinic screening, including cost, lack of time off work, transportation challenges, and provider shortages, especially as named in rural communities. At home screening tests can help remove those barriers and make it easier for people to get screened on their own time and in their own homes.

This is especially important for low income Californians and medical enrollees who are more likely to face obstacles to in person care.

From a consumer perspective, no one should miss out on life saving preventive care because it is not covered or is this inaccessible. This bill ensures that both privately insured Californians and medical enrollees can access these tests without out of pocket costs. It also promotes a smarter health care system by investing in prevention, helping avoid more serious and costly health issues down the line. This bill and expanded access to screening will improve early detection, reduce disparities, and save lives.

Ultimately, this bill is about making our health system more equitable, more affordable, and more responsive to patients' needs. We urge your aye vote.

Thank you. Are there any others in the hearing room who would like to offer support of this measure? Please come forward with your name, affiliation, and position on the bill.

Sandra Poole, Western Center on Law and Poverty in support.

Good afternoon, chair and members. .... CPAN, the California Pan Ethnic Health Network here in support.

With California Life Sciences in support.

With California Commission on Status of Women and Girls in support.

Kevin Guzman with the California Medical Association in support.

Doctor Jasmine Smith with the California chapter of the National Association of Social Workers in support.

Gilbert Lara here on behalf of Biocom in support.

Thank you. We are going to establish quorum, majority leader.

[Roll Call]

We have a quorum. With that, are there any primary witnesses in opposition who would like to offer testimony?

Madam chair and members, Olga Shiloh here on behalf of the California Association of Health Plans. In the interest of time, I would like to align my comments with our, previous testimony on mandates and their impact to health care affordability. For these reasons, we are in opposition to AB 196. Thank you.

Good afternoon. Matt Akin on behalf of the Association of California Life and Health Insurance Companies, also respectfully in opposition to Assembly Bill 1906, and we just like to align our comments with our colleague at Kat. Thank you.

Thank you. Are there any others in the hearing room who would like to offer opposition? Me too. Hearing none, I will bring it back to the committee for any comments or questions. Assembly member, I just also wanna note that, the Federal Government has already moved to ensure that the the mandate to coverage of self collected HPV testing without cost sharing is in place.

And the reason why you are bringing for this measure is because it is it is currently unclear, that the state of California will take, a similar position. I wanna thank you for bringing for this bill. My 20 year old self who experienced cervical cancer very much appreciates this measure as well.

And I'm glad that with this, many people will be able to get self screen at home and get the care that they deceive early die receive, deserve, and the early diagnosis that they will keep them healthy. So thank you for bringing forward this measure. With that, would you like to close?

Right now, we are fighting for Californians to keep access to health care. AB 1906 gives us an opportunity to not only stabilize health care access for Californians, but to expect it. Making sure Californians can screen for highly preventable cancer helps us reduce strain on our health care system and tailors health care solutions to working in rural Californians. My bill makes sure that the federal guidance that requires coverage of cervical cancer screens is adopted by California. With that, I respectfully ask for your aye vote.

Like to move the bill. Moved by Patel, seconded by Johnson. We have a quorum. So secretary, please call the roll.

[Roll Call]

That bill is out. Thank you so much, majority leader. We're gonna move on now to item number 2, AB 1556 by Haney.

Thank you, Madam Chair and members. I'm proud to present AB 1556, which will strengthen and clarify California's approach to drug-free recovery housing. This is my fourth year in a row in front of this committee on this particular issue, and we're hoping that four times is the charm here to make sure that we can have access to recovery housing for those who need it in our state.

Recovery housing is an evidence-based model that provides stable, supportive environments for individuals working to maintain sobriety and rebuild their lives. But under current law, recovery housing providers are navigating conflicting guidance between California's Housing First policy and administrative rules on maintaining drug-free environments.

That lack of clarity makes it difficult for providers to protect the safety and stability of their residents while remaining compliant with state requirements. For residents, this gap has real consequences. Not every person's recovery journey looks the same, and for many, a drug-free living environment is essential to maintaining stability. But today, individuals seeking sober living environments often face limited options and may instead end up in housing that does not support their recovery needs. AB 1556 will provide a balanced, common-sense solution.

It will create a clear statutory framework that allows for recovery housing and also allows recovery housing providers to maintain drug-free environments while ensuring that individuals who return to use aren't pushed back into homelessness. It will require recovery residences to adopt a written return-to-use policy ensuring transparency, consistency, and support for residents, and these policies must include access to treatment providers, recovery support, and non-punitive approaches that prioritize connection to services.

Importantly, AB 1556 will ensure that individuals are offered a warm handoff to alternative housing or services before any discharge related to substance use. Here with me today to testify are Emily Cohen from the office of San Francisco Mayor Daniel Lurie, and Amber Richmond, a San Francisco resident and individual with lived experience battling homelessness and addiction.

Thanks so much. You'll each have two minutes. Make sure to press the button so that we can hear you.

Thanks. Good afternoon, honorable chair and members of the committee. My name is Amber Richmond, and I am from San Francisco. I started using drugs my junior year of high school. It began with OxyContin, then whatever pills I could find.

I swore I would never touch heroin. My father died from it when I was 12, but that's exactly what happened. I could list everything heroin cost me, but we don't have the time for that. I will say this: few people survive two open-heart surgeries from injecting drugs.

I did. After those surgeries, I went right back to using because I was homeless. Later, I spent six months in a San Francisco navigation center before receiving Section 8 housing in 2020. I have not only lived in the system, I have worked in it as an assistant supportive housing manager in multiple HSH-funded buildings. I have seen what works and what does not.

I have seen buildings where very few people were using, and the difference was clear. People were more stable, safer, and more hopeful. And I have seen the opposite. I have watched people who are not struggling with addiction barricade themselves in their rooms out of fear. I have watched people trying to get clean lose that battle, not because they lacked the desire to recover, but because the environment they were placed in did not support recovery and instead normalized chaos and drug use.

I have lost far too many people in those buildings. Just as I was preparing to move into an SRO in supportive housing, I reached the top of the Section 8 wait list. That changed everything. I had the privilege of living in a sober, stable environment surrounded by everyday working people, and it pushed me to want more for myself. But that was not something I earned, and it was not something most people receive.

It was luck. I still ask myself, if I had moved into that SRO, would I be here today? Not everyone gets lucky like I did. That is why this bill matters. This bill creates the kind of environment I needed, but it makes it intentional, not accidental.

It supports sober, drug-free housing with services, including medication-assisted treatment. Because of Sublocade, I was able to stop using heroin after fifteen years. AB 1556 helps local governments create and expand more sober living environments where recovery is possible for those who choose it.

Thank you. Thank you so much. Yeah.

Good afternoon, chair and members of the committee. Thank you very much for the opportunity to speak in support of AB 1556. My name is Emily Cohen, and I'm the deputy director of the San Francisco Department of Homelessness and Supportive Housing. I'm happy to be here to talk about the choices and the options that we need to infuse into our homelessness response system so that people can get the type of housing that will best support them in their goals.

Over the past decade, our state has faced a devastating addiction crisis that has taken thousands of lives and deeply impacted communities across the state.

In San Francisco, we are seeing more people experiencing homelessness who also struggle with substance use disorder and are seeking recovery-oriented services. We need a full continuum of options to meet people where they are, including recovery-focused housing for folks actively seeking sobriety and recovery. AB 1556 is important because it would clarify that local governments can use state funding to support recovery residences, and that flexibility matters. We know that this model can make a difference, and we know that it is already showing promise.

In San Francisco, we recently opened two new recovery-focused transitional housing sites, and both filled very quickly, demonstrating a real demand for this type of housing.

And the ability to move that into a long-term housing setting is incredibly important, and we need the funding in order to achieve that. AB 1556 is a practical step that would help us save lives, support recovery, and give local governments another important tool to respond to the overlapping crises of homelessness and substance use disorder. Thank you very much for your consideration.

Thank you. Are there any others in the hearing room who would like to offer support on AB 1556?

Yes. Good afternoon, chair. Adrian Covert with the Bay Area Council, proud cosponsor of AB 1556. Thank you.

Devin Waite with the California Alliance for Behavioral Health and Addiction Treatment, and strongly support.

Dr. Brandi Jordan with Addiction Recovery Communities of California and strong support.

Pete Nielsen with the California Consortium of Addiction Programs and Professionals, in strong support.

Eileen Mariano on behalf of bill sponsor Mayor Daniel Lurie, in support.

Isela Bravo with Cruz Strategies on behalf of the City of San Jose, in support.

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

You'll each have two minutes.

Good afternoon, Chair Bonta and members of the committee. My name is Lewis Brown. I represent the Corporation for Supportive Housing. We are taking an oppose unless amended position on this bill. We very much appreciate AB 1556's goal of ensuring abstinence-based housing is available to unhoused individuals.

However, we are concerned this bill would allow recovery residences to evict formerly homeless individuals back into the streets solely because of relapse, even though relapse is a normal part of recovery. We are also concerned that the bill fails to include sufficient protections that would ensure individuals who are placed into the eviction process aren't forced back into homelessness, which would only worsen their physical and mental health conditions and increase the likelihood of substance use.

Under AB 1556, recovery residences would be required to adopt a return-to-use policy that would permit evictions when tenants relapse and reject the warm handoff to supportive housing or shelter. Unfortunately, the bill does not establish a clear, detailed process that will facilitate a tenant's transition to more suitable housing or ensure that this tenant can remain safely housed until a transition can take place.

The bill does state that recovery residences would be required to provide a warm handoff, but it does not define what warm handoff means.

And so it's not possible, as the bill is drafted, to understand what would be required of recovery residences. The bill's issues could be fixed by reincorporating elements of AB 255, which was a bill that was introduced last year by Assemblymember Haney and passed by the legislature. That bill included specific protections to ensure that people who relapsed were provided support and also to ensure that those individuals weren't returned to homelessness.

We've had very productive and open conversations with the member's office, and I look forward to continued conversations. Thank you for your consideration.

Thank you. You have two minutes.

Good afternoon, chair and members. Purva Bhattacharjee with Housing California. Similar to my colleague, Housing California is opposed unless amended on this bill as well. We believe AB 1556 can offer choice in past recovery while embracing proven Housing First principles. However, the current version of this bill is inconsistent with Housing First laws and guidance in multiple ways.

Firstly, the current bill language allows for state funding for temporary housing for these recovery residences, which can include transitional housing options. This is inconsistent with Housing First, which promotes permanent housing. HUD's Family Options Study has shown that transitional housing that evicted people for failure to follow abstinence or a program prescribed to them resulted in high returns to homelessness. People placed in this model of housing were just as likely to end up homeless as a control group receiving no intervention.

This bill also requires that all prospective residents agree to the residence's return-to-use policy as a condition of residency.

This is not consistent with Housing First either. Under Housing First, tenants may only be evicted for noncompliance with the lease, such as for nonpayment of rent, disruption of other tenants' abilities to peacefully enjoy the premises, or damage to the apartment. Evictions for reasons unrelated to compliance with typical lease terms result in people returning to homelessness.

We look forward to continued conversations to address our concerns with Assemblymember Haney's staff. And we greatly appreciate the author's work to champion affordable housing and defend homelessness funding in the budget as well. Thank you.

Thank you. Are there any others in the room who would like to offer a position of opposition? Seeing none, I will bring it back to the committee for any comments or questions. Assemblymember Schiavo.

Can you talk a little bit more, responding to the opposition's concerns that are being raised and how those conversations are going to address those concerns? Because I'm a huge believer in Housing First. I cofounded an organization doing homeless outreach in my community that reached 500 people every weekend. But I've also helped some of those folks that I've met through that outreach get into housing, and I've seen people who are sober struggle when there are folks in their housing who are using.

And it's I can't imagine how hard it is for them.

And I think it's so important that we have spaces where you can have clean housing where people have that supportive environment. And so I think it's really important that we figure out striking this balance, and I appreciate the author's diligence in trying to work this out. I don't want to undermine Housing First, but I think that it's really, really important that people who are working so hard to stay clean are supported in doing that and not kind of dragged down by people around them.

And that those folks have options too, that they get support, that they get housing. But I do think it's reasonable that there needs to be housing where people know that folks are being clean, want to be clean, and are working on being clean, and they're going to respect that.

And so, you know, I'm just curious how all of this is playing out in the discussions that you're having to address the technical concerns.

I appreciate that. I appreciate the comments and your sentiment and your work in this area. You know, I could not agree more with what you said. I do believe that the goal always has to be to get people into housing, to get them to a place of stability, to get them the support that they need, and to keep them in housing.

And for people who are seeking an environment where they need to recover and are wanting a community of accountability and support for recovery, we should be providing that option to them.

And for many folks, that is actually a barrier to housing. If they don't have access to one of those environments, they know if they went into an environment where drug use may be open and allowed, or they're not supported in that, that may be a very dangerous place for them.

So this is about ensuring that for people who want to go on that path of drug-free recovery, they have those options and that we're supporting it. And right now, there's a real lack of clarity in the law as to whether we can fund those types of environments and what the rules are within them. So we try to strike that balance here.

The federal government under President Obama already said that these types of recovery residences can meet the definition of Housing First, and we want to clarify that, first of all. The guidance that the Newsom administration put out is largely what is reflected in our bill, but there needed to be further clarification in order to ensure that these recovery residences can actually be a community of accountability and support.

If you have an individual who is no longer committed to that journey of sobriety and it's not working and is becoming disruptive to the other folks there, we have to be able to have another placement for them. And so this bill is very clear. The policy must first include access to treatment providers, recovery support, and a non-punitive approach.

Nobody believes that this is a straight line for folks. There will be people who relapse and should stay in their housing and should continue on that journey. But if it does reach a point that that individual is disrupting the recovery journey of others, they have to be offered a warm handoff to alternative housing or services before any discharge can happen. And we're committed to continuing to work with the administration and the opposition to refine those definitions.

The goal is to help people on their journey, not to evict them even if they relapse.

But at the same time, this is a community of accountability and mutual support where everyone has to be committed to that for it to work.

I appreciate that and really appreciate what you're doing with the bill. I'm going to support it, and I hope that the conversations lead to some resolution. The only concern that I have really is that I don't want this to turn into a revolving door of transitional housing. And I think that's the point that the opposition is talking about, and I don't think anyone wants that.

And at the same time, the reality is we don't have enough permanent housing.

And so, you know, sometimes we don't have the options that we want or need. But I think if there's a way to kind of orient it towards a permanent housing situation, that should be kind of first choice, something to help prioritize permanent housing even if people are having to be exited from their current housing. And I appreciate you being here and sharing your story today. Thank you.

Thank you. Assemblymember Ahrens, did you want to make a comment? No. All right.

Thank you so much, Assemblymember Ahrens. And fourth time, hopefully, will be what makes a difference. And it sounds clearly that there is some work that needs to be done with the administration so that this bill is consistent with the guidance that's been provided by the California Interagency Council on Homelessness. And I know that you will continue to work with the opposition to make sure that there's alignment with the Housing First model as well.

With that, because I know that you want this signed this time, I'm sure that you will continue to work with the opposition to make sure that this bill hits the governor's desk fully formed. Yes.

With that, do we have a motion and a second? Moved by Aguiar-Curry, seconded by Johnson. Assemblymember, do you accept the amendments that the committee has offered?

Yes. We accept the amendments and appreciate the work on the bill.

And any other close

No. Again, we will continue to work with opposition. We are working very closely with the administration. A lot of what is in this bill reflects that guidance, and it will be further refined to address all of the issues that have been raised. And I appreciate the engagement on it for a fourth year in a row and respectfully ask for an aye vote.

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

[Roll Call]

That measure is out. You're on a roll. Thank you so much. We are going to move now to item number 32, AB 2613 by Sharp-Collins. Thank you, assembly member, whenever you are ready.

Good afternoon, chair and members. I would like to begin by thanking the committee for working with my staff on this bill, and I will be accepting the committee amendments. Today, I'm here to present Assembly Bill 2613, a bill that requires health plans to provide consumer notification through electronic and telephonic communication. Under current law, health plans are required to notify consumers of these changes, but in practice, these notifications are often sent by paper mail alone.

We all know what what that means. Right? I mean, a lot of us do it. It's either, we don't open up the mail, or the letters arrive late, you know, or they get lost or whichever. And so patients are left too often

in the dark. The consequences of that action is actually real. People show up for appointments only to be turned away. They face unexpected out-of-network charges. Ongoing treatment plans are also disrupted.

And in some cases, care is actually delayed when timing matters the most. At the same time, nearly every other part of our health care system has gone digital. Patients schedule appointments online. They receive test results through their portals, and also communicate with providers by phone and email. But when it comes to critical coverage changes, we are still relying on a system that has too often failed to reach people. Assembly Bill 2613 brings our notification practices into the present time.

This bill allows health plans to to contact patients through email, phone, or other modern communication methods when when appropriate, rather than relying exclusively on paper mail. It ensures that patients receive timely, accessible information about changes that could directly impact their care. This is about preventing avoidable, I mean, yeah, avoidable disruptions. It is also about giving patients a fair chance to understand their actual coverage and make informed decisions before they are standing at the door of a doctor's office and have either been turned away.

Assembly Bill 2613 does not create new burdens to our patients.

It simply ensures that the information we already require plans to send is actually received. With me to testify, this is amazing, in support of of of my bill is my chief of staff, Mister Michael Lucien.

Thank you, sir. You will have two minutes.

Thank you, chair and members. Before I begin, I'd like to thank the assembly member who definitely kept her commitment to her constituents that everyone has a seat at the table under her leadership. To that end, when I approached the member with an issue that I personally experienced, she's more than willing to listen, and now we have the bill that's before you today.

I, like many staff throughout the building, experienced an upheaval in my health care coverage last year when a provider and a health plan were struggling to renew their contract with each other. I hope that none of you find yourselves in that position, but if you do, be prepared for a mountain of letters to head your way.

The Department of Managed Health Care and the Department of Insurance govern communication between health providers, health plans, and their respective clients. Existing law requires that those communications must be in writing, specifically postal mail delivered to the client. You can imagine the volume of mail coming your way when you're getting frequent updates about the status of the contract negotiations and information about your continued coverage.

I personally felt that I was under a mountain of mail, much of which I ended up not opening after I found the early mail to be very repetitive. What I did not realize was that letters that looked identical would contain very important information, including information about me being transferred out of my provider group and losing my primary care physician.

I didn't understand this until I tried to schedule another appointment and was informed that I was no longer a member of my provider group. AB 2613 asks a simple question: how should health care information be delivered in 2026? This bill requires additional electronic communication, either by email or text message.

In my case, I most certainly should have read my mail regardless of how tedious a task. But for many others, the existing law is simply dangerous. How does a person with housing insecurity stay up to date with their medical information when everything's coming via mail? What about a person with disabilities for whom a trip to the mailbox is a much more involved process? And all of this is to say nothing about any of the complications from federal cuts to the United States Postal Service.

So I respectfully ask that you join Assemblymember Sharp-Collins in stepping into the 21st century and allowing for modern communication of health care updates. Thank you.

Thank you. Are there any others in the hearing room that would like to offer a position of support? Please come forward to state your name, affiliation, and position on the bill.

Kevin Guzman with the California Medical Association in support.

Christine Smith, Health Access California, in support.

Bindu Makamala with the National Association of Social Workers, California Chapter, in strong support.

Thank you. Are there any primary witnesses in opposition?

Madam chair and members, Steffanie Watkins on behalf of the Association of California Life and Health Insurance Companies. First and foremost, we'd like to thank the author as well as the committee and their staff for the leadership in this on this issue. We appreciate the amendments that were taken today. We're reviewing those with our membership and look forward to continued engagement on the bill. That said, for today, unfortunately, we are currently opposed to the bill on print.

Thank you. Cassidy Heckman on behalf of the California Association of Health Plans. Again, wanna echo the comments of my colleague. We appreciate the communication, the committee amendments, and we look forward to reviewing them with our membership.

Are there any others in the hearing room that would like to offer a me too in opposition? Seeing none, I will bring it back to the committee for comment or question. Assemblymember Addis.

Thank you so much, Madam Chair. And thank you, assembly member, and to your staff for bringing this bill forward. I'd be happy to move the bill, and I would love to be added as a coauthor. And, just wanna uplift an issue that I've talked about quite a bit in this committee and elsewhere, which is, I know my communities have really suffered when there's been a transition in health plans.

And what a number of my constituents have gone gone through is that they had a provider under one health plan. The health plan then changed. They didn't have choice in that. And then all of a sudden, they didn't have that provider anymore. That provider wasn't taking that insurance anymore, and so they got caught up in this situation. And so I just wanna appreciate your work in this area and the network transitions that are happening. And I think anything we can do to make movement when there's a transition is gonna be helpful for all of our constituents.

Thank you so much. Assemblymember Johnson.

Thank you. I also wanna thank the author for her work. I think you reverse engineered this, and I I'm really pleased that, and the problem of communication, which is literally the root cause of all our problems, that you have evolved. And so I just wanna say thank you, and I will happily be your second.

That is that is the truest statement ever shared, Assemblymember Johnson. We have a motion and a second. Assemblymember, would you like to close?

Yes. Thank you. Assembly Bill 2613, once again, simply ensures that that these notices are delivered in ways that people actually receive them and that they're able to respond to. And it it's just my goal just to make sure that we get an actual modern fix that puts patients first and then help, you know, obviously prevent some things that that could be, obviously, avoidable, meaning avoidable harm.

So with that, I would like to thank you, chair and members, and I respectfully ask for your aye vote.

Thank you. Motion by Addis, seconded by Johnson. Please call the roll.

[Roll Call]

That bill's out. Thank you so much, assembly member. We're gonna move now to item number 13, AB 1887 by Zbur. Whenever you're ready, assembly member.

Thank you, madam chair and members. I just wanna thank the chair and the committee for working with us, especially over the course of yesterday evening and this morning. We will be accepting amendments, which I will describe in part. We just—we got some language of just a few minutes ago.

We haven't been able to look at it because it was fairly technical, but I will actually go through in the presentation what I think the chair and I agreed to today, and we will be accepting, those in accordance with the agreement that we made.

So, I just wanna thank you and thank, thank your staff. I'm proud today to present AB 1887, a targeted bill to remove unnecessary insurance barriers that delay or interrupt access to life saving and life altering treatments for Californians living with rare diseases. I'm very proud to chair the California Rare Disease Caucus, and this bill is a direct result of a rare disease patient roundtable that we convened in December so—that several of you attended.

When we asked patients what single change at the state level would be, would most improve their lives, the answer was strikingly consistent. After years of fighting for diagnosis, they face a second battle getting their health plan to authorize the medication that their specialist prescribes.

A rare disease is defined in federal law as a condition affecting fewer than two hundred thousand people in The United States, not just in California, the whole country. There are roughly eight thousand to ten thousand recognized rare diseases, and only about five percent have any FDA approved treatment. Many rare diseases are genetic, progressive, and life threatening with early onset and rapid progression, which is why half of rare disease patients are children and so many do not reach adulthood.

For these families, navigating the health system is not a straight line. It is a maze.

Studies show the average time to receive an accurate rare disease diagnosis is around four to six years, often involving 10 to to 17 different providers, multiple misdiagnoses, and inappropriate treatments before anyone even considers a rare condition. During that diagnostic odyssey, families are draining savings, taking second jobs, and choosing between a rent payment and a child's test or travel to a distant specialty center.

And even after all of that, when a patient is finally diagnosed and there's an FDA approved treatment, they too often run into prior authorization and step therapy fail-first protocols that delay or deny the only medication that has been shown to work for their disease. Prior authorization and step therapy were designed as cost control tools in areas where there are multiple adequate alternatives. This is not the reality in rare disease.

For 95% of rare diseases, there's no FDA approved treatment at all. And when the treatment does exist, there's, there's very often only one option. That data—the data shows that the, these utilization management tools do not function as a meaningful gatekeeping at, at, in this space. They function as a delay tactic. A national physician survey found that over 90% of providers report prior authorization delays care, over 90% say it harms clinical outcomes, and over 80% of denials are then appealed or eventually overturned.

Research shows that when prior authorization is required, treatment can be delayed by a month or more, and when it is initially denied and later approved, delays can reach fifty days or longer. For rare disease patients, especially children with rapidly progressive conditions, those weeks and months are not benign.

They mean avoidable ER—they mean avoidable ER visits and hospitalizations, irreversible disease progression, and in some cases, whether a child can walk, can breathe independently, or survive to school age. We also know from national economic studies that nearly half of the direct medical costs in rare diseases come from inpatient and outpatient care, hospitalizations, surgeries, emergency visits, while prescription drugs account for less than one fifth of the direct cost.

One landmark analysis of 379 rare diseases found a total annual economic burden of about 1 trillion with hospital care as the main driver and prescription medications representing roughly 18% of the direct medical cost share. The everyday life foundation and other analyses show that avoidable costs from delayed diagnosis and treatment interruptions can range from roughly $86,000 to over half $1,000,000 per patient over the years of delay, and that lack of treatment is associated with more than 20—with a more than 20% increase in annual cost per patient.

If we save money by denying or delaying the one FDA approved treatment, but then drive patients into hospital beds, operating rooms, and intensive care units, we've not reduced cost. We have shifted them onto families and onto the rest of the system. The CHBRP analysis estimates that AB 1887 would increase total premiums by about 148 million per year, which they equate to roughly point 0.08% premium impact, less than $1 per member per month across all markets.

What CHBRP does not fully quantify are the offsetting savings from reduced hospitalizations, emergency visits, catastrophic progression, and administrative burden, factors that data indicate will offset the majority of the drug spending increases when treatment delays are removed. 18—AB 1887 is deliberately narrow and targeted. First, it eliminates prior authorization, and we're gonna be amending this in a minute. I'll go through this in just a second.

The initial bill eliminates prior authorization, step therapy, and similar utilization review only for FDA approved drugs used to treat rare diseases and only when prescribed by an appropriate specialist based on medical necessity.

Second, it applies only where there's no generic biosimilar or interchangeable biological alternative, preserving the use of biosimilars and generics and leaving utilization management fully in place where true therapeutic alternatives exist. Third, it leaves intact other safeguards. Plans can still enforce medical necessity standards, formulary rules, dose limits, and coverage policies for non-rare disease uses. What they cannot do is hold up the FDA approval of the FDA approved rare disease treatment behind redundant paperwork.

So, let me be clear about what AB 1887 does not do.

We are not mandating coverage of new drugs. We are not second guessing the FDA scientific review of the physician's clinical judgment. We are not touching situations where there is a generic or biosimilar and real therapeutic choice. All we are doing is removing insurance driven delays for rare disease patients to receive treatments that they're already entitled to under their existing benefit, treatments that their plans ultimately approve in nearly every case, often after weeks or months of avoidable delay.

This bill will simply put medical decision making back where it belongs in the hands of doctors and their patients, especially when there's only one FDA-approved option on the table.

You will hear the argument that 1887 will significantly increase premiums because it reduces these barriers. I struggle with that argument for two reasons. First, as I've noted, the bill does not expand coverage. These are treatments the patient's plan already covers once the family survives the appeals process. Essentially, opponents are saying that the delay itself, the months in which a patient goes without treatment, financial—financially benefits the insurance company even though the patient has been paying premiums for that coverage for the entire time.

I don't believe that this is a defensible financing strategy for such a small and fragile population. Second, the premium impact that CHBRP identifies, which is under $1 per member per month, must be weighed against what we know about the downstream cost and human outcomes.