Assembly Budget Subcommittee No. 1 on Health

Good afternoon, and thank you for your patience. We're gonna call this hearing to order. And if you'll please call the roll.

[Roll Call]

We're gonna continue as a subcommittee. And so I wanna say good afternoon and welcome everyone to the assembly subcommittee number one on health. This hearing today is gonna cover the Department of Public Health across five different issues,

including budget change proposals, program estimates, spring and spring finance adjustments.

We're gonna welcome doctor Erica Pahn, the CDPH director and state public health officer who will join us today to provide, the California 2026 state of the public health report as well as an update from the administration on California's response to federal digression on public health.

We have a couple housekeeping notes as usual before we begin. The agenda is available online on our committee's website, and physical copies are available in the hearing room. We also have supplemental materials such as the state of public health report that are available online.

And we're gonna ask panelists representing the Department of Finance and the LAO's office if you'll sit on the edges of the dais like the last few times to make room for other witnesses at the table.

After we conclude each panel, we'll take questions from members followed by public comment on that agenda item, and public comment is taken in person at the end of each issue. We will open for public cod comment for items not on the agenda at the very end of the hearing.

And I'm gonna ask again that when you do give public comment, its name, organization, your position on the issue that we're talking about, and that you take no more than thirty seconds, and Patrick will have his very friendly timer to help you remember.

If you're unable to attend in person, you're welcome to submit written comments via email to [email protected]. So we're gonna start with issue number one, which is the California Department of Public Health budget overview, estimates, and budget change proposals.

We have an overview of the budget, and you're welcome to come on up if you're presenting on this. We also have 19 non IT budget change proposals as well as the budget estimates for the program of WIC or Women, Infants and Children

and the Genetic Disease Screening Program or GDSP. So you're welcome to introduce yourself and start when you're ready. Thank you.

Sure. Thank you. My name is Brandon Nunez. I'm the chief deputy for operations at the Department of Public Health, and I'll provide the overview for the department's budget.

CDPH operates a budget of 5.1 billion to support all of our programs that reflects a 2.1 increase from last year's budget act.

The 5.1 billion includes 1.8 billion for state operations and 3.3 billion for local assistance. And our budget funding wise is broken down by 45% of the funding or 2.3 billion is from federal funds, 2.2 billion is from special funds, and 625 million is from general funds.

As you mentioned, we have a number of different BCPs to present, and your, your agenda there does a great job of outline it. So I'll kinda go relatively quickly through them. In the first area for Center for Environmental Health, we have four BCPs.

Of the four, three of these are related to ledge proposals that are passed in last session related to food and beverage labels, enforcing standards for radiologic tech supervisors, and prenatal multivitamins.

We have a larger request of 4.6 million in center for environmental health to cover, some rising operational costs for inspecting x-ray facilities and certifying medical prevention, which will help prevent delays in diagnostic patient care.

Over in our center for health care care quality rather, we have six different BCPs of the 19 you mentioned.

These are ranging from a new team in our central applications branch to process provider applications and enrollment, implementation of SB 669 related to a perinatal services pilot, and funding for a rapid response team to address emergent public safety threats.

There are a few larger proposals in this area, such as funding request from a quality improvement account of 5,900,000, which will help us transition manual facility application process into a streamline online licensing system.

We have a $5,000,000 request for nursing home residents resident projects rather. This is expenditure authority to award federal penalty funds to CMS approved local projects that directly improve the quality of life for nursing home residents.

And then there's an April 1 proposal in here for nursing home staff recruitment. There's 7,400,000 that we're requesting on an on on a one time basis from the federal health facility citation penalties account to support various CMS approved campaigns.

Center for infectious disease is one of those areas that I'll kind of bypass because we're gonna be talking about that in issue five related to IT proposals and issue four related to ADAP.

We have one small proposal there that's in your agenda as well. Center for Healthy Communities has four proposals. It's primarily implementing a couple alleged proposals including SB 20 related to silicosis surveillance and AB 1264,

which is restricting ultra processed foods in schools. There is one larger proposal in this area, $7,000,000 requested to fund tobacco and vaping prevention media campaigns and to award competitive grants targeting youth and priority populations.

Then we have a few one offs over in our center center for health statistics and informatics. We have, a proposal related to implementing SB 313, in center for preparedness and response.

We have one proposal that's related to a hospital bed capacity system, and it's to maintain a real time automated dashboard tracking hospital bed capacity statewide.

In our Center for Lab Sciences, finally, to round out the 19 different proposals, We have two proposals there, one at governor's budget for baby big funding. We're requesting 3,600,000 to to cover manufacturing costs of baby big.

And then finally, an April 1 proposal related to, laboratory licensing resources, 3,800,000 in nine positions to address expanding workload there.

And then the last thing you asked was related to a couple of the different estimates in our center for family health. Our genetic disease screening program is projecting no real major changes for the newborn screening or the prenatal screening programs.

They remain relatively stable from last year. Specifically, GDSP for 2627 is requesting a total of a 175,000,000, which is a slight point 3% increase from last year's budget act.

And then newborn screening and prenatal screening program participation is projected to slightly decrease, a decrease of about one percent compared to last year.

And we expect for the neural tube defect screenings, we anticipate a two percent decline from 25-26, and a further half percent decrease in 26-27. So relatively stable for that estimate.

And then on the WIC estimate, we're projecting again no major changes in program expenditures and participation. It remains, like GDSP, relatively stable, although we do continue to monitor any changes in participation.

Specifically, some of the changes were related to WIC food expenditures. The estimate there is 1.1 billion, which is a 6.4% increase from last year, and this is primarily driven by a food inflation rate of 2.8%.

And then finally, program participation is stable. We're projecting that on average, monthly participation will increase to about 1,006,000 participants, which is just a point 1% increase over last year. So that's rapid fire as far as changes related to our budget.

If there's any questions, we have some of our subject matter experts here, and I know Dr. Pan's gonna get into some of some of these as well.

Thank you so much. First, anything from a DIA for LAO?

Will Owens with the Legislative Analyst Office. I'm nothing to add on these items, but available for questions.

Great. Thank you. I just had a couple you mentioned that a very, very slight decrease around infant funding and just if that's if there's anything of note on what's why you need less money.

It's the women, infants, and children.

No. You mentioned something about infant program. Not women, infant, and children.

Oh, sorry.

On the screenings.

The screening program? Yeah. Primarily due to caseload. Caseload is primarily driven by, births in California, and that's been seen a slight downtrend. And so our estimate usually follows along that line.

Okay. That's why I was wondering if it had to do with decreasing birth rates, yet WIC is increasing.

Very slightly, a a point 1% increase Okay. Compared to last year.

Okay. Is that

Probably primarily a little bit maybe because of caseload, but probably the costs are primarily driven by the inflation rate.

Yeah. Okay. And excuse me. And then on WIC, because excuse me. WIC was affected by extended federal shutdown.

Were there any lessons learned, from the department around what to do, how to continue to help those most in need, women, infants, and children?

Yeah. We worked, very closely. And fortunately, within the administration, even with the shutdown, we had sufficient reserves in the program to be able to continue to fund it.

I think that's one of the areas that we would remain to kind of monitor our reserves as we go through in the instance of a federal shutdown, what's available to us to sustain the program ongoing.

I'd see if our program staff have anything that they might want to add related to lessons learned from from that.

I think most importantly, we just it's the the feds have been so topsy-turvy when it comes to the one just they're, you know, being erratic. What we expect for women, infants, and children moving forward and how you'll keep that stable.

I think my other question is around, did the shutdown affect the number of people that were coming to get help? Like, did they hear about the shutdown and just decide not to ask, and will you change any communication pieces should that happen again?

Sure. Yeah. Thank you for that question, Fariha Chowdhury, WIC division director. So ensuring the continuity of WIC services remains a top priority. And, one of our lessons learned from the 2025 shutdown is that we have to continue to work strengthening our preparedness.

We were fortunate to be able to receive contingency funding from USDA and then also secure that general fund loan. So those strategies continue to remain in our, pocket to respond as effectively as possible in the event of any future funding lapse.

And also, it's robust state fiscal forecasting that we conduct to ensure those reserves are available and then continued coordination with our state and local and federal partners.

To your second question, we have seen a slight dip in enrollment since the Federal Government shutdown, and I think it is because people heard this news.

Even though we continued social media, tele task messages, local partners that WIC is open, I think folks hear some things in the media and conclude otherwise.

And then when the government is reopened, that message doesn't go through. So we're hoping that, again, through that strengthening coordination with partners, we can continue to make sure that people know WIC is open,

WIC continues to be opened in the event of any sort of federal funding lapse.

Great. Thank you. I think that's the extent of my questions. We're gonna you're welcome to stay for public comment on on this, if there's any public comment on issue one. I see one person potentially coming up.

Good afternoon, Chair. George Cruz on behalf of the California Behavioral Health Association. On issue one, we just wanted to touch on the behavioral health service fund that was identified in the report for 50,000,000 in supporting the budget asked by

Assemblymember Pellerin to use 30,000,000 of that to fund the California reducing disparities project for two additional years as one of the most successful equity based programs the state has run-in the past about eight, ten years. Thank you so much.

Hello. Sarah Diaz with the California WIC Association. We commend CDPH WIC as they near completion of implementing the new food package.

This vital targeted short term benefit supports about a million Californians each month and proven positive outcomes with great impact, deserve our full support and investment.

We remain deeply concerned about the many detrimental effects that HR1 will have on the program as seventy to 80% of WIC families rely on Medi Cal and about half on CalFresh. Also, participants are adjunctively eligible for WIC if they participate in these programs.

And if they're no longer enrolled, they'll have to provide income documentation to verify eligibility, creating additional administrative burden for both a workforce that's already stretched as well as the participants. Thank you.

Good afternoon, Chair Addis. Lizzie Cootsona here on behalf of the office of Kat Taylor and the American Heart Association in strong support of CDPH's BCP on AB 1264.

We urge you to approve this funding so the department can develop these science based regulations and provide schools with the technical assistance they need to serve healthier meals. Thank you for your leadership in protecting the health of California's kids.

Good afternoon. My name is Claire Villacres. I work with the Clinica de LA Rosa in Oakland, which is primarily the Latinx community and is part of the California Reducing Disparities project.

I would like to request, please, the support of this program, which is essential to prevent the loss of saving life saving services and to preserve the community informed models that have been developed for the past 15 years in the area of mental health prevention

and neurointervention. There is so much hope that the counties will allocate proposition one funds to continue these crucial services. Yes. Thank you.

Thank you. Just as a reminder, name, organization, and your position on the issue of the CDPH budget overview estimates and BCPs.

Thank you very much. Vanessa Cajina on behalf of the Mosquito and Vector Control Association. Much appreciation to CDPH for their submission of a BCP on the vector borne disease program.

These are very important public health certifications that our members need to ensure that they are applying pesticides correctly. We have a question, but we are having a good conversation with the department about it. Thank you very much.

Good afternoon. Lupita Rodriguez. I represent the Health Education Council, which is part of the CRDP Latino focused initiative. And I am here, supporting the 30,000,000 proposal out of the general fund to continue supporting the CRDP for the two additional years. Thank you.

Good afternoon. My name is Vanessa Vasquez, and I'm representing Health Education Council. I'm a crisis counselor, and I'm asking to support the $30,000,000.

Because I see the impact that we're having in the community and and we this is not just a need, it's a surviving for a lot of people. So I'm not talking about policy.

I'm talking about people. So please support us. We need this money. Thank you.

Nora Angeles with Children Now. The $1,800,000 request for childhood lead poisoning prevention program reflects a growing caseload. More California children are meeting the CDC's definition of lead poisoning.

This is a public health crisis requiring our full attention. We support first five's request for additional flexibilities to allow them to access funding under the BHSA.

And last, more than a million California children and mothers depend on WIC. Federal cuts under HR 1 threatened to increase administrative burdens and reduce access to lab work. Thank you.

Madam Chair, Tim Madden representing the California chapter of the American College of Emergency Physicians, and we're in support for the budget request under the center for preparedness and response, specifically the hospital bed capacity registry.

We believe this is an important tool for emergency physicians to understand what the capacity is and if we need to transfer someone to a higher level of care and allow us to do that more efficiently and quicker. Thank you.

Good afternoon, ma'am Chair. Ryan Spencer on behalf of the Environmental Working Group in support of funding for the implementation of AB 1264, the real food healthy kids act. So appreciate that.

Also, on behalf of the Environmental Work Group and the American College OBGYN's District 9 in support of SB 646 implementation which deals with tested head metals in prenatal vitamins.

And finally, on behalf of the California Radiological Society in support of the implementation AB 460, which would ensure that radiologists can supervise rad techs when they when they remote contract when they provide contrast for x rays. Thank you.

Good afternoon. Hi. My name is Nawid Gheyasi, and I'm here on behalf of Mass Social Services Foundation, part of California reducing the spreadsheets project. I hope this committee will support the request for $30,000,000 for CRDP and CDPH. Thank you.

My name is Abit Stanikzai, and I'm here on behalf of MAS MAS Social Services Foundation, part of the CRDP project. I hope that this committee will support the request for $30,000,000 to continue and save the California Reducing Disparities project. Thank you.

Good afternoon. My name is Hosna Taslim, and I'm here on behalf of MAS Social Services Foundation, part of the California Reducing Disparities project.

I hope that this committee will support the request of $30,000,000 to continue and save the California Reducing Dispertise Project or CRDP, which would be under the depth of public health CDPH.

With all attacks on all our communities coming from the Federal Government, the state needs to have our backs and provide protections for us. Continuing the funding of CRDP is one very effective way to do this. Thank you for your support.

My name is Anthony Chen, and I represent Asian American Recovery Services or AARS in South South San Francisco, which is part of HealthRite 360. Our work is funded by the California Reducing Disparity Project or CRDP within the Department of Public Health.

I have traveled to Sacramento from the Bay Area today with my program manager and supervisor to urgently request continuation of the state $30,000,000 funding of the CRDP. Thank you.

Good afternoon. My name is Anastacio Flores. I'm with Asian American Recovery Services HealthRight 360, and also part of the California Reducing Disparities project.

We ask that the committee support the request for $30,000,000 to continue and save the CDRP under CDPH. Thank you so much.

Tala Falava, Chair and Members of the committee. My name is Lueni Masina, and I'm with the Essence of Mana program, also with Asian American Recovery Services Project. I humbly ask that you continue the funding for the CRDP because of these programs.

Our communities are being heard and they're being served. It is 2026, and we're finally seeing solutions within the community. And so I please urge you to support our villages. Thank you.

Madam Chair and Members, I'm Tony Gonzalez. I'm here today on behalf of Networking California for Sickle Cell Care and the Sickle Cell Disease Foundation.

We're incredibly grateful for the partnership with the California Department of Public Health and support the request by Senator Weber Pierson for continuing funding for the clinics for another five years to allow us to integrate into Medi Cal.

We serve roughly about 5,000 adults, and we've extended lives, and we've become a national model of care that I'd love to tell you more about someday. Thank you.

Hi. My name is Matt Chincholi. I'm representing the Center for Inherited Blood Disorders and California Network for Sickle Cell Care. We were fortunate enough to establish 12 networks five years ago that are now caring for adults with sickle cell.

Sickle cell in the state of California has a life expectancy of forty three years. The national average is 61. So our patients have been have not had a successful transition from pediatric to adult care.

So we were able to establish these networks, and now we're starting to see a cost savings of close to $27,000,000 a year because our patients are staying out of the hospital. And, we'd like to continue this effort. Thank you.

Good afternoon, Chair and Members. My name is Courtney Armstrong with the First Five Association of California, related to the Behavioral Health Services Act implementation.

Despite past historic investments in children's behavioral health, the birth through age five population remains underserved and is often underlooked. The sunsetting of the CYBHI community practice grants combined with changes due to BHSA implementation will widen that gap.

For these reasons, First Life Association of California is requesting an additional $20,000,000 for the new CDPH population based prevention funds specifically for the birth to five population.

And we're also requesting some language changes, designating 20% of the 51% you set aside for birth through five and allowing first fives to be eligible for that funding.

Thank you. Thank you. Seeing no other public comment, we're going to move on to issue two, the state of public health report.

We welcome Dr. Ericka Pan, the CDPH Director and State Public Health Director to provide statutory mandated state of to provide the statutory mandated state of public health report. So welcome, Dr. Pan.

Good afternoon. Thank you so much. Chair Addis and Subcommittee. I'm Dr. Erica Pan. I'm your honor to serve as your state public health officer and California Department of Public Health Director.

Thank you to the legislature for the opportunity to share some highlights from the state of public health 2026 report in California, and for your ongoing partnership to protect public health. As your state public health officer, I consider the whole state of California my patient.

Today, I'm sharing some highlights on the health status and trends in California. The written highlight and full state of public health reports summarize more detailed information about California's population health status throughout the life course.

Identifies opportunities for population health improvement, highlights public health emergency responses, and shares strategies and programs that address these areas.

Let's start with some highlights on major public health achievements and progress. We can be grateful that public health investments and other efforts have contributed to significant and measurable improvements in the health of Californians over the past fifty plus years.

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

California currently has one of the lowest all cause mortality rates, infant mortality rates, and highest life expectancy in the nation thanks to the successes of public health, health care, and improved access to social drivers like education and healthy food that promote healthy people.

I'm also very pleased to report we have finally turned the curve on overdose deaths, which decreased in 2024 for the first time in fourteen years.

Our collective efforts to increase access to naloxone, harm reduction services, substance use prevention and treatment, and culturally responsive community supports have all contributed, but we still have work to do.

We have now also achieved a consistent decline in sexually transmitted infections, including congenital syphilis since 2021 after dramatic increases since 2010.

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

While these numbers are finally improving, congenital syphilis rates in California are still three times higher than a decade ago, so we cannot let up on our efforts.

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

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

Earlier, I mentioned decreasing death rates in many areas, yet we're seeing increasing death rates in adults aged 25 to 54 years of age, driven by overdoses.

When we look at impacts based on years of life lost, road injury, homicide, and suicide are additional leading causes for this younger age group.

Statewide initiatives like the Children and Youth Behavioral Initiative, nine eight eight suicide and crisis lifeline, suicide prevention, and substance abuse prevention programs are all important to address this concerning trend.

And thankfully, through the behavioral health services act, California will dedicate prevention specific funding for the first time to public health to lead a statewide population based prevention approach, where we can resource efforts earlier to promote social connection,

resilience, and other prevention strategies. While California's infant and pregnancy related mortality rates rank amongst the lowest in The US, severe maternal morbidity trends have increased between 2016 and 23.

And although pregnancy related mortality has improved post pandemic, it is still higher than it was a decade prior.

Specifically, our ongoing unacceptable racial disparities in pregnancy related and infant mortality with black populations experiencing significantly worse outcomes must be addressed to turn these overall trends around.

CPH works with partners through programs like the perinatal equity initiative and our recently released black birth equity action plan to identify best practices and lays out a road map to close these gaps.

Place matters. We see concerning disparities by region and place. For example, death rates were higher and life expectancy lower in rural areas compared to urban and coastal areas. Even within counties, we can also see a huge gap.

For example, within LA County, expectancy in the Redondo Beach area is 88 compared to the life expectancy in Compton area, which is 73, a difference of fifteen years even though these communities are only 10 miles apart.

Identifying these gaps in health outcomes allows us to explore what is driving health challenges and tailor prevention strategies and actions accordingly.

I also must emphasize that we continue to see an increasing frequency and complexity of public health emergencies that we must stay prepared to respond to. Our emergency response center was activated for over 32 different and overlapping emergencies over the past five years.

Given those overlaps, the cumulative days of activation added up to more than five years. We need a trained and resilient workforce and stable systems to support these public health emergency responses.

Maintaining capacity to sustain health outcomes we've gained is hard enough in public health, but amidst increasing natural disasters and public health emergencies, federal threats, and the acceleration of technology at an exponential place around us,

it is more important than ever to both preserve the resources we can and think creatively to innovate. Thanks to the Future of Public Health Initiative, California is better prepared to communicate, coordinate policies, advance equity and community engagement,

and respond to public health emergencies, including federal actions.

For example, the future of public health has allowed for a swift and coordinated H5N1 bird flu state and local response with enhanced rapid disease detection and investigation, education and outreach, and strengthened multisector collaboration.

After the devastating LA fires, the Eden Fire shelter outbreak and infection control response and recovery was possible with future of public health staff.

Other examples of specific impacts include a CDPH wide 24/7 intelligence hub and expanded emergency response training, exercise, and evaluation.

At the local level, the future of public health supports mobile health staff to better reach and serve residents in rural, underserved, and isolated areas, meet the health and social service needs of farm workers, and has supported effective management of a large hepatitis A outbreak

among the homeless, to name just a few examples. Support for sustainable and modernized data systems remains critical to help us track, investigate, and manage cases, contacts, and outbreaks, manage vaccines,

and monitor and respond to these health trends to protect the public. In closing, public health cannot do our job alone. As we navigate the volatility and challenge of this moment, we will continue our cross sector collaboration, innovation, and communication,

and we're grateful for our talented workforce and support from the legislature and the governor and the opportunities amidst other world class leaders in our great state to forge ahead together to build a healthy California for all.

Thank you for this opportunity to share California's health status.

Thank you so much, Dr. Pan. Is there anything from LAO or DOF? Okay. I and let me know if you have questions, Assembly Member. Happy to okay.

I just had a my main question really has to do around the effects of HR 1 and knowing, how difficult it's gonna be to backfill everything that HR 1 has taken from California and where you would suggest California put its its limited dollars?

Sure. For public health, the the biggest impact of HR 1 directly was to our SNAP Ed t funding, which affected our nutrition and physical activity branch.

And while we had other support and and are kind of highlighting our important work in nutrition and physical activity, that's sort of the biggest area where we've had direct impact.

As you also heard, there's some other indirect concerns, with the women's infants and children's program and other things.

But, thankfully, despite the roller coaster of threats, you know, we, the discretionary budget from the Federal Government did not actually, get cut, and then some of the threatened rescissions were actually stopped with legal injunctions.

I was gonna cover that a little bit in the next issue item as well. We are working, and I'll talk a little bit about this in the next issue as well, we are working on prioritizing, really thinking about our unique public health role at the

State Health Department and how we better work with partners.

I think you're in a similar question around behavioral health and just the challenges, not necessarily around HR 1, but you mentioned, you know, lots of decrease in in certain deaths except for this 25 to 44 year old population where it looks like drug overdoses and perhaps

combined combined with behavioral health issues and just sort of where you where you think we should be investing our limited dollars and what else could be done.

Yeah. I think this is where I'm grateful that we have just recently sort of gotten this preventive public health population health statewide investment in behavioral mental health. So I do think that is a needed issue right now.

Again, if you think about the leading years of life lost, some of the tables you'll see in here, I think I'll just flash on them to you because it's just so striking. And I forget which page it is in the actual report.

But the the leading causes of death based on years of life loss, drug overdose is a far reaching sort of biggest one.

The other really impactful sort of graphic is when you look at causes of death by five year age ranges, the blue areas are areas that are related to either drug overdoses, suicides, and then things like alcohol related road injury, homicides, other unintentional injuries.

So all of those are really the biggest sea of blue in our age ranges from teenagers to even, mid forties to mid fifties. So I think I'm really, really grateful that we do have this this resource to try to invest in the upstream areas around behavioral and mental health.

Suicides stands out on that one. Yeah.

Yes. Yes. And that's definitely a key priority, part of our work and, and our plan for the prevention strategies with the VHSA funding.

Thank you. I'm I'm just stunned, actually, by the number of age groups that suicide is showing up Yes. As one of the top as one of the top, issues and, starting at age 11 and going all the way up through age 44. Thank you for that, and thank you for the, very robust report.

Really appreciate that, something useful is coming out of the legislature and the administration, right, that we can all take heart that we're producing useful information.

Any questions, Assemblymember?

Thank you so much for this. And, I guess I'm, like, in between places. I don't know where I am. So, you know, in I represent North LA County. LA County Department of Public Health has already closed some clinics in trying to keep the rest open.

And so so, certainly, we're seeing locally our public health infrastructure being weakened. And it's the the statistics you talked about, Compton and what was the other area? Redondo Beach. Redondo Beach. Right.

15 year difference.

Yeah. Though I mean, that's been the case for quite a while. And are you and it's interesting to me that it's been the case even though prior to HR 1, our uninsured population had gotten a lot, like, very small, right, single digits and percentages.

And so do you have is there anything that's kind of illuminated why we think that is or if it's too many things to to I mean, there's so many factors, right, that can go into that.

But why is there such a disparity, and what are things that public health can do to address that?

Yes. I think there's increasing work and evaluation to look at what we call the social drivers or social determinants of health, and it really goes back to some of those basics, to poverty and education and environment.

So that's where I think from the public health perspective, we really look forward to partnering with all of you for health and all policies, and the more we can highlight with our data where we're seeing those impacts of those upstream efforts and how we can move the investments up stream.

I think the other number I quote quite a bit, and I believe I said this in last year's state of public health report, is that in health in general, we spend about two to 3% of the health dollars in prevention, and the rest of it goes to health care and after the fact.

And we really, as a country, need to think about how do we invest upstream, because that really is the bottom line and a lot of those disparities.

Yeah. I mean, and, unfortunately, because of the cascading effects of HR 1, poverty is just gonna get worse in the near future. And yeah. So I think this is important because what we try to bring into our policy discussions in the health committee too is is discussions around what

an impact and what a cost savings it is for us to do preventative care and to focus on investing in policies that impact supporting preventative care.

And continues to be a challenge for us when dollars are put next to legislation, and they only talk about what it costs to implement, but they don't talk about what it saves by implementing when you're preventing chronic disease or emergency room visits or

all of the things that cost so much money, and also harm people's health and lead to some of the tragic outcomes that we're talking about today.

And so can you talk a little bit about some of those mental health investments, because we know that's another crisis that we're facing, and how those are being implemented.

Like, how are people in our community going to be seeing and feeling and experiencing the benefits of those mental health investments?

Yes. I wanna recognize it's gonna take us a bit. We're sort of just getting this investment starting July 1, and we're really we've looked closely after a year, actually two years, of a lot of stakeholder input.

We've looked at a lot of the sort of different community based practices that do seem to be, you know, the most impactful, and it's still gonna be challenging just acknowledging as you guys are both asking that there are less dollars to go around.

But I think really working with how do we come up with measurable outcomes really, you know, this behavioral health transformation as an agency trying to look at the whole spectrum and having shared goals and shared measurable outcomes and then being able to balance how

we have those statewide strategies with investments at the local level as well. So I do think there's a lot of amazing progress in those intersections at the state level and at the local level as we work across the sort of different public health perspectives,

behavioral health perspective, health care perspectives, because they're all, of course, very intertwined, and they've been very siloed historically. So I think a lot of that is happening, and it's gonna take some time.

And I think, you know, as as shown, we have made some we we turned the dial on overdoses.

You know, we wanna continue that investment in the office of suicide prevention and working again with partners. So those are some examples of where we have made a difference.

We wanna continue to have those impacts and and also, again, work upstream on social connection and resilience and well-being because a lot of that really can impact again earlier than some of these other, you know the sea of blue I was pointing out again too.

And lastly, I just wanna highlight, you know, in Los Angeles, I feel like Department of Public Health has been getting not has been, but I mean for a while, has been involved in a number of more environmental hazard types issues.

Right? We've seen a lot of it coming out of the fires of last year, but also the Exide cleanup that's happened.

We have a burning landfill in my district, which I often talk about because people are very, very sick from it, and department of LA County Department of Public Health state agencies have been at the table on that,

but don't seem to have I feel like part of the inaction around protecting people's health has to do with the resources that are needed for it.

And so I think that I just wanna emphasize for future planning that as we expect to have hotter climates, more fires, floods, disasters, you know, floods in areas where there could be toxic things washing around, right, into communities,

that we're really gonna have to be thoughtful and intentional about making sure that there are there's planning and resources behind funding needed to respond to these kinds of environmental disasters that are making communities sick.

And and I know, you know, like you just said, and we've all been saying, we don't have enough money. We don't have enough money.

It's being taken away by the Federal Government and completely limiting our ability to deliver what we need to on health for our communities.

So I know it's easier said than done, but I think that it's really important as we see these environmental hazards making people sicker and sicker and and and the more and more prevalence of them.

That is an area that we really, really are going to have to be intentional around, and make sure that we are able to act and protect people in the way that they deserve, in our communities.

Yes. Hear you, and I think, what I would wanna emphasize too is this is where things like, a flexible future public health initiative that allows us to be adaptable to the emerging threats is really important.

I think we're increasingly learning and seeing that the issues change, and on one hand, we wanna plan ahead as much as possible, and we need to be adaptable for the moment.

The other one health approach that I actually also some smaller investments from the future public health has started, and that's just a broader approach at all levels of of public health, really thinking about to your point, not only human health,

but how does environmental health impact, and then animal health. You know, we saw that with bird flu. That was really important to be thinking about all three of those things, and, I've heard some other colleagues, talk about planet health. Right?

We really need to think about that more coherently, and it's another area, I think, where in a cross sector way, we can improve some of that thinking as well, and getting more, sort of partners to the table to think about it, but absolutely hear you.

Thank you so much. We're gonna move to public comment, which you're welcome to stay. I know you're in the next panel as well. But, if you could state your name, your organization, your, position on this issue in thirty seconds or less.

Yeah. Good afternoon. Michelle Gibbons with TEAC representing local health departments. Just wanna add a piece that local health departments are core partners in administering public health. Appreciate your line of questioning because it does get to the heart of the issue.

There are a lot of federal funds that are being decimated and grants that are terminating all right now. The state invested in Future Public Health Dollars, the only funding source that we could use flexibly across programs.

It has been working, and I can share with your offices excerpts on how for each of your counties. The problem is is that a couple years ago, those were decreased. They have not been built back up.

And with every federal funding source declining, we will need to bring up more funding for public health so we can tackle what seems to be a myriad of challenges that are coming to our communities and that public health can be successful in helping. Thank you.

Good afternoon, Chair and Members. I'm here for under issue number one. I'm sorry. I missed the queue. I'm with Greenberg, Torreg on behalf of Triple P America.

It's an evidence based parenting and family strengthening program that is in 27 counties across the state. We strongly support First Five Associations $20,000,000 budget proposal to sustain and expand prevention services for children and families across California.

We respectfully urge the legislature to take a critical step further by redirecting a portion of the CDPH proposed $40,000,000 statewide awareness campaign toward direct services.

While awareness is important, families in our communities need access to tangible evidence based interventions now. California is currently facing a significant gap in prevention funding.

The transition from MHSA to BHSA combined with the sense setting of CYBH dollars. Thank you.

Thank you. Alright. Dr. Pan, thank you for staying with us for issue number three. We're gonna talk about public health partnerships and initiatives, and have an update on California's response to federal digression on public health,

and then specifically hear about CDPH's new responsibility to modify and supplement federal recommendations for immunizations, items, and services as established through the budget last year as well as the administration's various public health initiatives and partnerships,

and you're welcome to start when you're ready.

Great. Thank you. So, I'm now a little bit over a year into my role as the state public health officer and director of public health.

And as you just heard, I reported on the state of public health in California, which highlighted key health outcomes that we're following, but it doesn't actually capture the state of the field of public health.

And the reality is in California and in our nation, our public health system is under attack. Our investments in prevention, protection, and improvements in health over the past few decades are all at risk due to federal actions.

Our field has experienced silent cycles of boluses of resources during or after a public health threat followed by dwindling and reduced support and funding, but I have never before witnessed such intentional and methodical attempts to dismantle the entire system.

Specifically related to federal funding, it's important to reiterate again that about 80 of the CDC funding goes to state and local health departments. And as mister Nunez mentioned earlier, about two thirds of our CDPH budget goes to local partners.

Federal funding represents almost half, about 45% of our total department funding. And for many state and local health departments, that proportion is much higher.

The federal administration has put us on a predict unpredictable and stormy course with multiple threats of funding cuts over the past year, some aimed specifically at a smaller number of states, including California.

The initial presidential proposed budgets cut the CDC budget in half last year and currently proposes over a 40% reduction.

Beginning last March and again in February, the federal administration proposed rescissions of large and critical grants adding up to hundreds of millions of dollars and funding hundreds of positions at the state and local level. Most recently, this is only cut in four states, including California.

Both of those threats rescissions were deemed unlawful by the courts that in reversing those actions repeatedly found the Federal Government exceeded its authority by inappropriately withholding federal funds. Yet this has caused a lot of chaos and uncertainty in our environment.

In addition to that, the dramatic dismissal of experienced public health leaders and programs at the federal level have far reaching impacts, including loss of technical assistance, reliable data, data privacy, and federal policies based on misleading information and unsupported

claims. This has sowed confusion and public distrust in science, medicine, and public health. One of the most alarming areas is the devolving federal vaccine policy changes, which can impact vaccine access and uptake.

While our strong immunization policies in California have kept our communities safe from large outbreaks, this success is at risk. We are seeing the highest levels of measles cases, outbreaks, hospitalizations, and deaths in The US in thirty years,

driven by population with low vaccination rates. In California, we already have over forty cases to date in 2026. That's more cases than we had all of last year, and we've already had three outbreaks for the first time since early 2020.

Almost half of those cases are from an ongoing outbreak right here in Sacramento and Placer Counties. 90% of these 95% of these cases were not vaccinated.

Declines in vaccination rates can result in preventable missed school and work and a greater burden on the health care system.

A study over a 29 year period estimated that childhood vaccinations have prevented over 60 million infections, 4 million hospitalizations, and a 135,000 deaths.

This is to the tune of $65 billion of health care costs averted and $324 billion in societal costs averted in California alone.

California is fighting to sustain our hard earned public health achievements of the past several decades and maintain our capacities gained to added to the gaps in the public health system during the pandemic.

Our department has also refreshed our strategic priorities to reimagine public health during this pivotal time. Reimagine includes prioritizing our most impactful efforts unique to our role and optimizing with a focus on efficiencies, partnerships, leveraging technology, and creativity.

Last December, the administration launched the public health network information exchange initiative, partnering with national public health leaders to promote a more modernized and sustainable public health infrastructure.

Phoenix strengthens public health, innovation, collaboration, and communication across sectors and at the state, regional, national, and global level. So the first pillar to describe is innovation.

We aim to launch a Phoenix innovation partnership to bring together public, private, academic, and philanthropic entities to develop advanced technology and funding frameworks that can deliver more stable funding.

We aim to structure public health funding more broadly and have more of our partners participate. Phoenix Innovation intends to accelerate development and translation of technology innovations that address today's health challenges.

Another huge area of progress and response has been collaboration. Over the past eight months, we've formed regional, national, and global partnerships, including the West Coast Health Alliance, the Governor's Public Health Alliance,

and we joined the World Health Organization's Global Outbreak Alert and Response Network. Starting with the West Coast Health Alliance, a brief description.

This is a partnership between California, Hawaii, Oregon, and Washington to ensure that public health recommendations are guided by safety, efficacy, transparency, access, and trust.

The scope of our WCHA focuses on the following, evaluating and responding to threats to national public health policy and recommendations, reviewing the data information and reports from credible clinical and scientific professional organizations that use

evidence based methodologies and source materials to assess changes in public health policy, and develop unified public health position statements, policy recommendations, and guidance.

And finally, I'll be reiterating this over and over about addressing communications needs and countering unsupported claims.

The governor's public health alliance is a coalition of 15 governors working together to protect public health by helping states communicate across state lines, coordinate on pressing public health challenges, and support access to critical health care like vaccines.

The World Health Organization's Global Outbreak Alert Response Network is a WHO coordinated international network and brings together hundreds of public health institutions, national governments, academic centers, labs, and response organizations worldwide.

Their mission is to rapidly detect, verify, assess, and respond to emerging public health threats, particularly those with cross border or pandemic potential.

Within California, we've created a cross sector public health for all Californians together or FACT coalition. We've partnered with Cover California and our agency and UCSF to develop this cross sector network of public health and clinical professionals, health systems,

health payers, academic and community partners to support public health. We're working with these partners to learn more about pediatric vaccine access and hesitancy by focusing on data, community partnerships, and communication strategies.

Over 1,300 individuals representing over 290 organizations have joined to date. And since September, we've had four webinars with two to 300 participants attending each.

Finally, communication is more important now than ever. Thus, we're working with both the FACT Coalition and an organization called Your Local Epidemiologist to formalize a community messenger network and better listen and respond to Californian's health questions and

concerns with Project Stethoscope. This uses expert informed social media monitoring, community driven insights, and targeted outreach and research to enhance and form our communication tools.

I am incredibly proud and thankful to be part of our California efforts to develop collaborations and innovation and to maintain these evidence based vaccine policies and appreciate the partnership with the legislature to pass AB 144 to ensure Californians have access to life

saving vaccines and other preventive health services based on credible medical evidence. I'm gonna turn it over to Dr. Watt to talk more about the implementation of AB 144.

Thank you, Dr. Pan. So I'm James Watt. I'm the Deputy Director for Infectious Diseases at the California Department of Public Health.

Following the adoption of AB 144, CDPH created a new public health for all website as a location for posting CDPH recommend immunization and preventive service recommendations pursuant to health and safety code 120164,

and as a resource for the public and other stakeholders. We've developed a procedure for making changes to immunization and preventive services recommendations.

First of all, our programs review guidelines from professional medical organizations or the Federal Government or significant new evidence that's come out.

We consult with relevant national professional organizations like the American Academy Pediatrics and the American Academy of Family Physicians and other partners to review scientific evidence.

We consult on the impact of new recommendations with other state departments and we coordinate with local health departments and other stakeholders to get input and align on communications. Pond mentioned is an important avenue for our coordination with partners.

We coordinate with the West Coast Health Alliance as doctor Pond mentioned, and then we finalize recommendation and post them on the public health for all website.

We then draft regulations and submit those to the office of administrative law. So far, we have made minor changes to the baseline immunization recommendations that were set out in the in the bill as of January 1, 2025.

So what we have done in September 2025, we posted recommendations for Covid flu and RSB vaccines in alignment with the AAP and the AFP. In December 2025, we adopted update updated recommendations from the, AAFP for adult immunizations.

And then in January, we adopted the, American Academy of Pediatrics regular annual recommendations for childhood and adolescent immunization.

We have also provided information to the public and stakeholders following changes in federal actions that we have not adopted, and that's been the biggest chunk of work that we've done in this space.

We've determined that the evidence prevented for these federal updates has been insufficient to warrant a change. And that includes, for example, a federal, recommendation to make, hepatitis B vaccination at birth not routine.

So, we put out information about why we were not adopting that and try to provide information to the public to reduce confusion that came out as a result of that federal action.

We have also adopted several, new recommendations for preventive services that have come out in 2025 from the US Preventive Services Task Force.

We reviewed these. We found that the updates were, consistent with evidence based health guidelines. So these are related to breastfeeding, screening for intimate partner violence, screening for osteoporosis, and screening for syphilis in pregnancy.

So we reviewed those, adopted those, and posted those on the website as well. And that's a summary of our work in that space.

Great. Thank you. Anything from DOF or LAO? Any questions, Assemblymember? Well, look, I really appreciate all that's happened, and thank you both for explaining all of this to us.

I guess one of the one of the first questions I have is I heard you say, Dr. Pan, sounds like measles are increasing and vaccines are decreasing.

At the same time, we have a number of new initiatives around collaboration, communication, data sharing, publishing information. When do you expect the two to join such that vaccinate vaccines will start to go back up and measles will go will start to go back down?

Like, when can we start to expect the I am assuming these programs and collaborations are effective, but how long till it really shows in the population?

Sure. I'm gonna start and then certainly Dr. Watt might have other things to add, but I think they do go hand in hand and a lot of the focus on a lot of these initiatives have been about how to maintain or improve confidence in vaccines.

And we do have, again, strong overall statewide rates of vaccination and stronger than many states. And like other states, we have pockets of unvaccinated individuals, and often that's focused in individual communities.

And that's where we work really closely with local health departments or across jurisdictions when there's a multi jurisdiction outbreak, for example.

Or, of course, there are many times when you might have a case in one county and a contact in another, things like that. So that's a lot of our role.

I do hope and think that, you know, we are not seeing anything here like what we've seen in some of the states with the really, really large outbreaks because of our strong requirements here in the state of California in high risk settings like schools and day cares.

So we do think and hope you know, and some of the examples of just getting a little more nitty gritty is with our health care assistance partners in the FACT Coalition, really starting to drill down and look at geography of where are they seeing those lower either pockets or

geography and doing some more outreach. So we did a combined effort in the rural North recently.

We're looking at some listening sessions in the Central Valley and other places like that. So our hope is to do our best to stay ahead of it.

I would say, and Dr. Watt may have the numbers more handy most of the cases have still been associated with travel to somewhere outside of California, whether it's another country or another state that's having a large outbreak.

But then we've had these you know, again, we hadn't had any measles outbreak since 2020, and now we've had these three. Two of them were much smaller, but this this current one is is looking bigger.

I don't know if you wanna add anything else.

That covers most of it. I think that the key thing is that what we're seeing is spread introduction, as Dr. Pan said, from other places and then spread in smaller communities that have lower immunization coverage.

And that work that we're doing to identify trusted messengers in those communities that really needs to be a very tailored, and commute, culturally relevant communication is what's going to be, most important for us here in California.

I asked the question because I think vaccinations is one area where you can see things are working or they're not working. Right? So much of what we do is a little bit it becomes opaque for the public and really they want results from government.

And I do think this is one area where if we say we're doing a lot of things but we don't see vaccination rates go up and disease go down, We're in a tricky you know, puts us in a tricky position.

You mentioned, doctor, that some of the recommendations from the Federal Government you're not, you don't take.

And it looks like they are moving to approve new services such as and this one just seems so strange to me, but I'm gonna ask about it anyway. Such as self collected HPV testing that and California is not following suit. So can you kinda walk us through?

I can actually address that one. And we haven't actually we're we're still assessing these 1%, recommendations.

So the Women's Prevention Services Initiative in HRSA did recently update in January some recommendations about cervical cancer screening for women between 21 to 65 years of age.

There are some different committees that include the American Cancer Society, and then ACOG just came up with some recommendations as well. There's a lot of agreement about the updated recommendations, but not necessarily the frequency.

I think there's still some some of the entities are saying every five years versus every three years. So we're still sort of assessing, and because these updated guidelines don't take effect for health insurance plans till January 2027,

we're taking some time to really discuss both amongst, subject matter experts. We're trying to consult with health insurers as well. We're talking amongst the West Coast Health Alliance because everyone's grappling with this issue.

So we haven't actually made a recommendation. We haven't updated our website with that yet, but we're in active assessment right now and hope to come up with some recommendations very soon.

Great. Thank you. We're gonna, move to public comment now then. You're welcome to stay up at the table if you'd like to. So, again, name or organization and your position on this issue or input on this issue.

Seems like there may not be public comment, but I think the sergeant might be checking. So give him a minute. Staff is gonna just check briefly outside before we move on.

Okay. No public comment for issue three.

So thank you so much. Really appreciate you being here. We're gonna move on to issue four AIDS drug assistance program for the 2026, 2027 estimate.

We are gonna receive CDPH's ADAP estimate for 2627. And then if there's additional comments from Department of Finance or LAO, we'll hear those and then turn to member questions and then public comment.

Welcome. Okay.

Thank you. Good afternoon, Chair Addis, Members of the committee. My name is Joseph LaGrama. I'm the branch chief of the ADAP branch within the Office of AIDS.

For 2025 to 2026, the Office of AIDS estimates that the ADAP budget authority need will be $444,000,000 which is $42,700,000 lower than reported in the 2025 budget act.

The 8.8% decrease is driven primarily by lower medication and insurance premium expenditures than previously estimated due to decreased caseload projections and refinements to health trailer bill components that shifted from local assistance expenditures to state operations expenditures.

For 2026-27, the office of aids estimates the ADAP budget authority need will be $443,700,000, which is $43,000,000 lower than reported in the 2025 budget act. The 8.8% decrease is driven primarily by the expiration of one time investments. I'm happy to answer any questions.

Thank you so much. Anything from DOF to LAO? No. Member questions? I just I know that the 900,000,000 of ADAP funds was lent to the general fund. Do we know is that on track to be paid back? What's happening with that?

The $400,000,000 is anticipated to be paid in 27-28 and the 500 in fiscal year 28-29.

Okay. And then do we anticipate use of any of the ADAP funds to backfill federal cuts?

Yes. So the, ADAP or the CaliforniA Budget did include AB 116 that includes, funding for, backfilling pets to, HIV prevention, and disease intervention in these disease intervention specialists or investigation specialists.

Got it. Got it. Okay. Thank you and appreciate your rapid testimony very much. We're gonna turn to public comment for issue four on the AIDS Drug Assistance Program, otherwise known as ADAP.

And if you could share your name, organization, position on this issue in under in thirty seconds or less.

Good afternoon. Jonathan Froxweig on behalf of San Francisco AIDS Foundation testifying in support of the End Epidemics Coalition's request for investment of ADAP rebate funds.

The ADAP rebate fund, which is restricted for use on HIV related purposes, will run a $203,000,000 surplus next fiscal year. And the epidemics is proposing that a 143,000,000 of that surplus actually be used to address HIV and related conditions by investing the dollars in

effective but underfunded strategies like prep, low barrier testing, and rapid connection to care. We have the resources to end this epidemic. We urge the legislature to put them to use. Thank you.

Hi. Good afternoon. Chair Addis and committee Members, Soa San Perez, APLA Health. Echoing the comments that my colleague, Jonathan, just made.

Specifically wanna mention the expansions to PrEP and PEP navigation, routine opt out testing in emergency departments, and late and enabling CDPH to authorize ADA rebate fund to backfill HIV syndemic contracts disrupted by federal action.

These investments will patch up HIV syndemic care and prevention services despite HR 1's efforts to tear the safety net. So thank you very much. We look forward to to working with you as the budget unfolds. Thanks.

Good afternoon. Craig Pulsipher on behalf of Equality California. Just wanna align my comments with San Francisco AIDS Foundation and APLA Health and very supportive of the proposals for investment from the in the epidemics coalition.

Good afternoon, Madam Chair. Jack Anderson with CHIAC representing our local health departments. CHIAC respectfully requests 18,600,000 in ADAP rebate funds to support the disease intervention specialist workforce and local health departments.

Without this funding, we stand to lose over a 150 personnel supporting HIV, STI, and HCV work. Thank you.

Thank you. Kat DeBurgh with the Health Officers Association of California, also here in support of the disease intervention specialist. Thank you.

Good afternoon. Glenn Backus for Drug Policy Alliance, a member of the Ending the Epidemics Coalition. We support ETE's call for reinvestment of ADAP funding.

We'd like to call out the investment and the good work of CDPH in reducing the overdose rate and recommend the continued support of the California overdose prevention and harm reduction initiative funded by opioid settlement funds, not general funds.

By continuing funding, we can prevent layoffs and prevent a rebound in drug overdose. Thank you.

We will thank you so much. We're gonna move on to our fifth, and I believe our last issue on the agenda, which is the public health information technology systems. We're first gonna ask CDPH to provide a general overview of all of the core public health systems.

I know there's a number of them, including infection disease surveillance systems, as well as vaccine management and immunization data systems. Next, CDPH will provide an update on which of these systems are funded, which are lapsing.

And then third, we'll hear from stakeholders on how these systems are used and how their loss may impact the state's public health function. So go ahead and introduce yourselves, whoever's first, and start when you're ready.

Thank you very much. I think I'll be leading off again. I'm, James Watt, the Deputy Director for Infectious Disease at CDPH. And I'm gonna just start with the overview of the systems. I think you might have some diagrams.

I hope that those are helpful as I go through these. My comments will generally mirror what is in those figures. I think it's helpful to think of these systems that we'll be talking about as two related ecosystems.

First of all, there's a disease monitoring ecosystem that includes Sapphire, CalReady, and CalConnect. And then there's also an immunization ecosystem, which includes the care immunization registry and the vaccine management system or VMS.

I'm gonna start out first with the disease monitoring and control system. And just to for illustration purposes, let's imagine that we're talking about someone who has tuberculosis and how do they how does the information about that case work its three way through the system.

So the patient may be diagnosed based on a laboratory test or a provider evaluation, and data about the patient are sent automatically from a laboratory system or a health care data system to SAFIRE.

SAFIRE receives the information and does initial data checking and cleaning. It automatically blocks duplicate records that are coming in.

It checks and corrects formatting, and then it sends con confirmatory messages back to the submitter. SAFIRE then routes data to CalReady. The key function of CalReady is to create and manage a disease incident. CalReady receives the incoming data.

It looks to see if it's related to a case that's already been reported.

If it if that's the case, it connects that new information to an existing record. Or if not, then it creates a new record. For TB, CalReady then moves that new incident information into a local health department workspace.

And that's within the CalReady system so that local health department staff can evaluate the case and enter additional information. For some high volume conditions like flu, CalReady just automatically processes the data and sends it on to the data warehouse.

Data on tuberculosis also flow between CalReady and CalConnect. And CalConnect is a suite of tools that support contact tracing and case investigation work for those conditions that are more complicated and require more complex local health department work.

For example, bird flu, tuberculosis, sexually transmitted infections, and HIV. CalConnect tools increase the efficiency of local health department work.

They have tools for workflow management to help local health departments prioritize cases for investigation and also case investigation tools like automated lookup of vaccination status or translation services for interviews.

CalConnect enables data collection on persons who are also exposed to a disease. So CalReady is all about disease incidents. The CalConnect enables contact tracing, so it collects data on people who have been exposed and does that in a systematic and organized way.

For example, we recently had a tuberculosis outbreak at a school in San Francisco. There were hundreds of exposed students and staff.

And using CalConnect, local health department could gather information about all of those folks, send them follow-up information, track whether they had been tested, and what additional follow-up they might need.

CalConnect also enables automated communications such as health instructions and symptom monitoring information to expose persons so that they know what to do to protect their health and avoid exposing other people.

All of the data from CalReady and CalConnect flow into our departmental enterprise data management tools and including our departmental enterprise data lake.

And that's used to move and process data and also route data to other places like our, tuberculosis dashboard that's available to the public. Okay.

Switching gears now, I'm gonna switch over to the, immunization systems, and let's look at how that might come into play for somebody who receives a measles vaccine.

So immunization information after a person is vaccinated is entered into an electronic health record, or it might be entered into the MyTurn system if the vaccine is given as part of an outreach clinic, say, if you're having a clinic to respond to an outbreak of measles.

That information flows automatically from those systems into the care immunization registry.

The registry creates individual immunization records. It matches that incoming dose to the record that's that is already there for a person or if there's nothing there for the person, it'll create a new record.

Care can determine which vaccines are missing and generate reminders. The data can be provided automatically to external systems like health care records so that health care providers have a complete immunization record.

For example, if someone gets a vaccine in a pharmacy that goes through care, and then it can go back out to the, electronic health record. Data and care can be queried by health care providers, schools, or individuals can get their own, immunization records.

Data can be analyzed to track our vaccination coverage in The States so we can see how we're doing with that and also how well vaccines are working.

And then as with the other system data are stored in our, departmental enterprise system. Looking over at the vaccine management system, this includes three different functional areas.

One is the, MyTurn system that I've already mentioned that's used for, outreach clinics, the myCAVAC system, and then the digital vaccine record functionality.

For the myCAVAC system, this is a system that carries out provider registration and data management, convert confirms provider eligibility to order vaccines and tracks training and other requirements.

This is the state system for ordering vaccines and tracking those vaccines and making sure that there's accountability for the vaccines that we distribute.

This includes the vaccines under the vaccines for children program, which serves all medical eligible children as well as uninsured children, any state purchased vaccines, and then federally purchased vaccines that support outbreak management,

such as what we would use if we are responding to a measles outbreak. I've mentioned the MyTurn system that supports clinic organization and provides the public access to making appointments to outreach clinics.

And then the digital vaccine record enables people to access their own immunization information in an automated way from the immunization registry. And I will stop there, and I'm happy to take any questions about that data.

Anything from DOF or LAO? No? Can you talk about or maybe DOF, either one, out of all the various programs, what's funded? What's being proposed to be funded? What's not being proposed to be funded?

Riley Thompson, Department of Finance. So included within the governor's budget is funding for the SAFIRE system as it's been noted. With regards to the remainder of the systems, the administration has been in the process of performing an evaluation of these systems.

As has been noted throughout this discussion, the state is facing a significant budget deficit, and it is important and prudent that we, analyze these systems within the context of that deficit.

As has been noted, these systems were partially supported by federal funding that has since lapsed, and the state in general is not in a position to backfill all of the federal funding that has been lost over the past few years.

So we've been conducting this analysis to try and determine how we can be most efficient with our resources within the context of the state budget picture as a whole.

Just to clarify it, and then my apologies to our stakeholder who didn't get a chance to testify yet. Just SAFIRE is funded?

Included within the governor's budget proposal, there's funding for SAFIRE. That's correct.

And that's the only one? That is correct. CalReady and Cal. There is existing funding, sorry, for CalReady as well. So CalReady and Sapphire are are funded within the governor's budget. Okay.

So existing funding for Cal Ready, proposed funding for SAFIRE, nothing for CalConnect, and nothing for care or the vaccine management system that we just heard are highly effective and helpful.

That is correct. Again, I would emphasize that the the purpose of of performing this assessment with regards to the system as a whole is to try and understand again how we can be most efficient with these resources within the context of the budget picture that we're facing.

We understand and acknowledge the utility of these systems and what they provide for the state, but it is important even within that context to be looking out for the budget picture ongoing.

So in general, our our assessment is trying to understand, again, how we can be most efficient with our resources within how these systems are utilized in this current moment compared to when they were initially either established or enhanced at the beginning of the pandemic.

Okay. I'm gonna go to our stakeholder Herb from CHIAC, and then I have more questions. I'm assuming the rest of our panel or the rest of our members may have questions as well. But my apologies.

Jumped in without you and all my excitement.

No worries at all. I appreciate the excitement. My name is Michelle Gibbons. I'm with CHEAC representing local health departments and really appreciate the opportunity to spend some time with you here today on these issues.

This is the third year in a row that I have been here trying to protect a critical information technology system for public health.

I just wanna debunk a couple of things. Lower utilization is great because these systems were stood up during Covid. So that means that we have less disease spread, but it's probably because a lot of these systems are in action and we're able to address critical issues.

I also wanna debunk the fact that or not debunk, but clarify that as you evaluate the utilization or the utility of these systems, you have to also think about the time saved for the workforce.

As you're thinking about federal funds declining, that actually means our workforce is shrinking, and then you're also taking out a tool that the workforce needs to do their their jobs as effectively as possible.

And I think that's a a huge concern. And then the last thing I would just remind folks is the the billions of dollars spent on responding to a pandemic. And why would we eliminate the tools that allow us to get ahead of that?

I will just remind you that two years ago, the administration didn't include any funding for CalConnect. Last year, they didn't include any funding from ICAVAX.

This year, they decided to choose multiple systems. And I'm just really grateful to say that the legislature has led the way in to say that the legislature has led the way in championing these systems year after year. Without them, the work does not stop for local health departments.

It just gets manual and more tedious and slower.

I just wanna describe a few impacts, you know, and just think about it in the context of these measles outbreaks, Avian flu threats that we had seen earlier this year, hepatitis, and I'm probably not even naming all the diseases, tuberculosis, all the diseases that come our way that

Californians day in and day out may not know that we're protecting them from, but we're utilizing these various systems to do that work.

For CalConnect, I would just mention that disease investigators can't conduct outreach and education through automated processes, which means that they will call you, try to gather some information about you and who what contacts you've been around.

They'll probably type it into a spreadsheet or write it on a piece of paper and then ask for their phone numbers and then call those folks again or the next set of folks. And so exponentially, your workload has increased really quickly.

I also wanna just say that that just means that our ability to get to people is really slow, right, compared to what these systems through automation have been able to do.

For care, the immunization registry, providers and local health departments won't be able to input their vaccinations into a statewide system, which means they also lose the ability to query the system in real time to verify whether an individual has had a certain vaccination prior to administering it.

And you'd be surprised, especially with people who just don't frequent their same provider all the time, but maybe getting a vaccination at a pharmacy, at their doctor's office, at the local health department, how important it is to know that they've already had that vaccine or not.

So that becomes a much more it's a hurt we lose that ability.

In an outbreak, we would no longer be able at the Health Department level to have a quick way to know who has been vaccinated and so knowing who has some immunity.

And so what this might mean for the public is that you could potentially quarantine folks or or try to have them, you know, isolate themselves so that they avoid exposing other people. But if you already knew that they had a vaccination, that could also avoid some of those circumstances.

I wanna share some storytelling during Covid, and that was around myCAVAX, that vaccine management system.

So before that existed, the State Department of Public Health, they would actually send a spreadsheet that says here how here's how many Covid doses that you have for your jurisdiction. The health department would then have to call all the providers and say, hey.

How many doses can you handle? How many can you store? And then when new rounds of vaccine became available, local health departments then had to call providers and say, hey. How many did you use? How many more can you handle?

And make sure that that's the real time updating via spreadsheets and phone calls that was happening. That's why that system was built.

It was built to allow more visibility visibility on vaccine administration throughout our state, and it was highly effective, and it still is. And vaccination is a huge source of protecting our public's health.

I also just wanna mention that CARE and myCAVAX work together to ensure the access to digital vaccine records. If you're like me and you may have carried multiple immunization cards or lost a few of them, that access to digital records is really important for families in the community for school.

I would also note that schools have access to, I believe, the care registry so that they could actually look up in real time whether students have been vaccinated, which is really important for school outbreaks as well.

So I just I say all of this to say that public health information technology, it's not a nice to have. It's a must have. We are the home of the Silicon Valley, so it feels wrong to have invested billions of dollars into these systems or millions of dollars into these systems to pull them now.

The systems need sustained ongoing funding, not something that I mean, while I'm happy to come before you every year if you allow me, I don't want to keep fighting for these systems.

They should be in the budget as a ongoing piece.

And when they're not, we fail to protect our our the health of our communities. And it just puts us back into a really poor cycle for funding public health. And the New York Times article from many years ago, put it the best.

And it says that the cycle of funding public health is neglect, panic, repeat. So I'm just asking that we not make the same mistake here.

CHEAC, HOAC, and SEIU California respectfully request funding for these systems in the state budget and appreciates your leadership in this area. Thank you.

Thank you so much. Really appreciate that. I just find this particular one totally confounding, because on the one hand, the administration has has stood up something that really, in my opinion, is somewhat nation leading. We all lived through Covid, and it was just complete mayhem.

I guess I'll describe it that way from a public health perspective. It was total mayhem, and a lot of that was obviously because our systems had been ignored for so long.

So on the one hand, the administration is investing in the, you know, the all these partnerships and initiatives that we just heard on the last issue. Right?

The West Coast West Coast Health Alliance, the Governor's Public Health Alliance, the Public Health for All Californians Together Coalition, the Public Health Network Innovation Exchange, Project Stethoscope. And so there's this emphasis on communication at a high level.

But the reason I asked the question on the last panel, when does this translate into more vaccines less measles, is because that's where we need the real work. It's wonderful for us to collaborate across state lines and and create these initiatives.

But if we're not funding the things that then help us get more vaccines out the door, less measles, which is how a lot of these systems end up helping, what have we really done for the state of California?

So I'm actually really confused by the lack of funding in the budget given the talking points around how important public health is and what we see in the news and the various programs that have been presented to the public.

It's confusing then to be presented with a gen 10 budget that that really is actually defunding the very things that are being touted as nation leading.

So if I can provide a little bit of a response and some context as to kind of where we were versus where we're at now. When we look at the utilization rates of these systems, if we take CalConnect as an example, we've seen that the CalConnect records since beginning of the pandemic

through 25-26 have decreased for over 90%. So from 2.5 million to 250,000. And we've seen user rates decrease from 13,000 to 900. We see similar decreasing usage rates within VMS.

So as an example, the number of active clinics in my turn has decreased from 83% from 48,000 in 2021-22 to approximately 8,000 in 25-26. There's additional data I'm happy to provide as needed, but I think what that highlights is a need to, again,

take a look at these systems in the current moment that we're at now and see in which ways the cost associated with these systems might be reflective of their output and their usage within this current moment.

And that is the rationale behind taking some additional time to assess these systems is looking at how these systems exist in our current moment compared to where they were when they were initially propped up.

And I mean, I think those numbers I would agree those numbers are a good thing. I don't know that those numbers weren't just not funding a program, especially because when you stop funding technology, you stop using it, then it takes a lot to build it back up.

So I'm just I'm a little confused about we have a system that's working. We don't need it as much as before. We're just not gonna fund it. Let's let go of it. And then we're gonna get back to this place where we're kinda in a a world of hurt again.

And if there's something better there and how long you're gonna be studying this for because it's true. We talked about this last year. That was my first year as the budget sub chair. Right? So we talked about this last year.

It sounds like it was talked about the year before. Like, how long of a study do you need to decide if something's effective?

So the administration over the past couple of months has been performing this analysis of these systems. I don't at this time have a specific end date to the extent that there's, you know, any proposals that come forth with regards to the remainder of the systems that will occur during May revise.

I think the only other thing that I would add is, like, the administration has those concerns with regards to the utility that the systems provide the state, and here's the concerns that have been expressed by the panel with regards to the possibility that any lack of funding for these

systems might result in returning to data tracking and ingestion processes that we had prior to the pandemic.

I think the only other thing that I would note and emphasize here is there are ways to achieve efficiencies with these systems. So as an example, we've seen some elements of these systems become more complex prior to their pre pandemic predecessors,

which maybe doesn't align with these usage rates that we've articulated. Additionally, there are some functionalities within these systems that are now being performed by other public health entities throughout the states. There might be some existing duplicities within these systems.

And, additionally, with regards to some of these activities, they were performed by local health entities prior to the pandemic and prior to the development of these systems.

So, you know, just emphasize that we do hear those concerns, and our, part of this analysis, again, is to figure out a way that we can address the public health needs of the state, but center that within the significant budget deficit that we're facing within the context of these costly systems.

I would just suggest, and then I'll turn it over to see if my colleagues have any questions, but I would just suggest if California is positioning as the answer to Trump's HR 1, the answer to Trump's attacks on public health,

I just ran down and we heard on the last issue five or six different initiatives to improve public health while at the same time defunding important tools for public health. There's a mismatch there.

And so I just think from an integrity perspective, it's important to see a proposal that matches the talking points. And and so I don't know how much more time you need to study this, but May 10 is right around the corner.

So, you know, I would assume you have some thinking that you've been studying, that there's some thinking, and and I just would like to see something that matches the rhetoric, I guess, is what I'm saying. I don't know if there's other questions from Members.

Yeah. I mean, I wanna echo the Chair's comments and concerns. I think, you know, last year, I remember talking about this and we're talking about if this disappears, we're going back to spreadsheets and, you know, like, manually doing this.

And I think there's again, you know, the conversation we had earlier about the the prevention piece, investing in this is going to, how I see it, also save money because you're not gonna need additional staff.

We're gonna have to do all of these investigations and laborious, tasks to be able to try to track this information that can be, you know, that that we've already, as was stated, invested millions of dollars standing up, creating, and supporting.

You know, I understand the point about it it's being used less. Hopefully, it's definitely being used less than a global pandemic.

But, you know, so I don't know what that means in terms of the level of funding that is needed, and I don't know if you have kind of a response to some of the comments that were made today around that.

But it it to just let it dissolve and disappear completely is such a waste of taxpayer dollars that have been invested in creating this system and standing it up and benefiting public health. And so I really need to be able to figure out a way to sustain this, I think. And

Yeah. I appreciate those comments. And I would just say I don't doubt that the utilization is lower, but I think that's good. It means we're not in a global pandemic anymore. I would also say that the number of users are lower because we had all hands on deck.

And remember, I had mentioned that Covid during Covid, there was a lot of dollars invested, so we expanded our health department staff significantly. We're now shrinking back to pre pandemic levels, which in itself is a challenge. Right?

We have already seen that that is important to keep public health staffed. But then to take these tools away because you're saying, hey.

The number of user utilizers are less and that the number of cases are less. I'd actually beg the question of what other types of cases are we seeing and how are we seeing utilization?

Because I have not talked to a single health department that has said, hey. No worries. We're not using it anymore.

Like, it can go away. In fact, I think they're panicking because they're, like, are are for example, I think you've talked about a health department that's shrinking already. Others are doing the same thing, and so they're trying to figure out what does this mean for them.

And there hasn't even been a plan of what do we do to unwind these and what's next. And we hope to not have to have that conversation.

But if the administration is serious on not funding the systems, we need to start planning for that. And that shouldn't happen in the same budget year that we're we're talking about. So these systems are imperative.

They save tons of money, and I think that's the hard part about public health is that it's really hard to tell you that we have protected you from getting a disease because we went and did contact tracing so a disease never reached you. But these systems allow us to do that.

It allows us to place vaccination into the community yet for the providers. It allows us to see who has immunity through vaccination. It allows us to see who we need to outreach to in the communities and where the exposures have happened.

I think our folks for the recent measles exposures would be at a huge disadvantage to not have these systems in place.

And I'll just say, you know, if the I think it's completely valid to do an assessment. I think that the assessment needs to happen in time for funding to happen for this program. And so and if it's not done, then it needs to be funded until the assessment is done.

But it shouldn't be we're gonna, we're just gonna cut the funding and do and any assessment will come in someday because that's that's not really a plan. So I'll leave it at that.

Thank you. Anything else for Assembly Member? I'll just reiterate this.

I just find this situation to be one of the stranger things that has been presented to us to have so much in the public sphere about how important public health is and then to have this lack of funding and to have a study that there's no parameters on that we're not sure when this

study is gonna be done and how we're gonna use this study to assess if the funding's effective to have zero proposals about unwinding. This just seems to me, the whole thing just feels really odd.

So I'm hoping what we see in gen 10 actually makes sense. And that feels like, you know, it's been thought out. There is a plan. You have finished your study. You have data to present.

You know why you're making the decisions that you're presenting to the legislature so that we can make sound decisions instead of just presenting us kind of nebulous thinking around something that you suspect based on utilization rates that there's controversy around,

the benefit of those utilization rates going down. So I just hope it's more thought out when it comes to us for May revise. So with that, we'll turn to public comment. You're welcome to stay at the table to hear the public comment.

If you could share your name, position on the issue, and if you can keep it thirty seconds or less.

Good afternoon, Madam Chair and Members. Jack Anderson on behalf of the California State Association of Counties in support of the CHIAC COAC SEIU request for the public health IT systems in the budget year. Thank you.

Thank you. Kat DeBurgh with the Health Officers Association of California, cosponsor of the IT budget ask, and also a board member of the California Immunization Coalition that also supports. Thank you.

Madam Chair, Bruce Palmer with California Association of Public Health Lab Directors in line with POAC and CHEAC and SEIU in support of investments for CDPH IT systems. Thank you.

Thank you so much. And seeing no other public for this, public comment for this item, we're gonna go to public comment for items not on the agenda.

Okay. Seeing no other public comment for items not on the agenda, we're gonna adjourn our hearing and thank you so much. Thank you to DOF and LAO for joining us as well.

The hearing is adjourned.