Senate Select Committee on Select Committee on Older LGBTQ+ Californians

I'll call the select committee on older LGBT Californians to order. And, our first panel, as you move to the table, I'm gonna make some introductory comments and invite any of my colleagues who are here. First, let me apologize for the fact that we are an hour late in the hearing, but the Senate floor session went an hour longer than we expected and that is the reason that that we are late today.

We there's a couple of other hearings going on and things and we expect some members to come in and out. And and so I am joined now by Senator Christopher Cabaldon and we expect others to come during the day.

And I wanna thank all the state departments that are here today and for their participation in the various panels. But I also wanna thank in particular the amazing coalition of advocates. California is home to hundreds of thousands of older LGBTQ adults and it's a generation that has lived through discrimination, transformation, an epidemic, and and much progress. And and so many in our community have given so much to get to some of the progress that brings it today.

But when I look back on the seventies and eighties, I have no doubt that our youth have more resources, more support, more representation than any other time in history.

And yet there are still gaps, gaps of service and things that we'll talk about. But the the all the progress is not by accident. It has been said and repeated many times. Martin Luther King has said the arc of the moral universe is long but it bends toward justice. And there's times like the current ones where that principle is stressed but it is up to us to continue to make sure that it bends toward justice.

And I think the the hearing today is about older Californians and I I would mention two older LGBT Californians. I'd mentioned two things. And first, I was sort of floored. It had not occurred to me completely when I first came back into the legislature to hear about out LGBT Californians going into nursing homes and feeling vulnerable and at risk with everybody else and feeling like they had to go back in the closet to do it.

And and a few years ago, when I did Senate bill two fifty eight that prioritized just special status within the Older Americans Act for HIV and aging Californians with HIV.

As somebody that ran an AIDS service agency at the height of the epidemic in the early nineteen nineties before the drug cocktail, It was our dream that people would live to old age. And now over fifty percent of Californians with HIV are over the age of 50. So today what we wanna do is hear from people in state departments, various experts, various people with lived experience about what some of those situations are.

And lastly, we're we're gonna go through different subjects and lastly we'll hear about the work being done to support our transgender and gender nonconforming and intersex seniors. And I look forward to the discussion.

I would just mention that we have three panels. We had originally targeted this hearing in its entirety be to two hours. We'll see how that goes. And if we have time, we will open for public testimony at the end of the three panels in case there are people that wish to talk about that. And as we go through each individual panel, we're gonna let each presenter present.

We've asked them to speak for up to five minutes. And then we will hold the questions from the committee until we're after completely done with the panel and and allow all four to be able to speak. With that, before we go to panel one, let's we have also been joined by Senator Steve Padilla. Let me ask if any of my colleagues have any comments they'd like to make now at the start of the hearing. Senator Padilla.

Thank you, mister chair. Appreciate your leadership in this space, your long leadership in this building, and working to convene the select committee on this topic, one that is more than timely. I'm honored to join some esteemed colleagues here, honored to be hearing from the panelists, and I think, you know, all good intentions produce good results, but some of them unanticipated. So we have wonderful advances in technology and medical care, and we have aging populations that at one point sadly were not expected to age.

And so as a community, we have in part a scenario that we wished for but have not been prepared for.

So it is a joyous burden in some ways. Dialogue here to to be thinking about ways that as a matter of policy and other priorities, we can address the needs in the community. And again, I thank the chair.

Thanks again for being here. Senator Cabaldon?

Yeah. Thank you so much. And I I also am, I I just wanna express immense gratitude, certainly, to all the panelists and particularly to the chair who is, you know, at every stage of his own career in life has has been taking on these challenges. If there was a select committee on middle aged LGBTQ Californians, he would have been leading that. Young ones as well.

A while ago.

And, you know, in preparation for the hearing, I was reading a couple of of, sort of, inter intergenerational studies by academics in the field and about sort of the the the even older generations than we've talked about today and the comparisons sort of the generation before, what you might call the silenced generation and the invisible generation before even before that from the twenties on.

And what what really struck me was that these are generations with far that that, enjoyed far fewer, if any, rights, at all, recognition, safety, security, much of what we increasingly take for granted as the chair noted. But that this generation, what in which in these studies are referred to as the pride generation, the sixties and and seventies and eighties, with with more of those rights and safety and and supports, but but more challenged mental health outcomes, more challenged challenged physical health outcomes despite that.

And and so this is it isn't the the the for me, the the hearing is not just about how do we how do we say thank you to folks who who blazed a trail and but folks who have paid a a better price in terms of even more intense trauma and struggle that has led to the progress that the chair has outlined that that they that they continue to grapple with.

And then into some extent, and the nursing home example is the greatest one of these, is that where they are in in many cases, they we are are are still in some sense living in the seventies or the eighties, or the sixties even despite the changes in laws and programs and what have you.

And so this this hearing could not be more timely and more profound and I really wanna, as I say, salute the chair for his for your work in fighting so hard to assure that this committee and this that it was foreign that the spotlight is shined.

Thank you. I really appreciate the comments of both both my colleagues. And I would just acknowledge Jacob Fraker from the caucus and Natalia from the caucus are both here and and have worked really hard to put this together. We're gonna move to our first panel and the agenda sort of states what each will do, but let me just say it's really the healthcare and support landscape for older LGBT adults. And we have Denny Chan from the Justice in Aging.

We have Brian Kaplan from the California Health and Human Services Agency. We have Sarah Steenhausen from the Department of Agency where she's the Deputy Director of Policy Research and Engagement. And we have Jax Cali, the Founder and CEO of Aging and HIV Institute. And so, each of you is going to make comments and we'll go in the order that I introduced you. So welcome, to the committee.

Good afternoon, Chair Laird and select committee members. Denny Chan on behalf of Justice in Aging. We're a national legal advocacy organization dedicated to strengthening the rights of low income older adults including LGBTQ older adults. Thank you for conducting today's inaugural hearing on health and supports for LGBTQ older Californians. Across the state, somewhere between a 120,000 to 400,000 older Californians identify as LGBTQ plus, and these numbers continue to grow.

As they age, they face significant inequities and discrimination in many areas. In California's first ever survey of LGBTQIA plus older adults from 2024, twenty seven percent of respondents reported being treated unfairly with less respect than others or discriminated against in just the past twelve months. And keep in mind that was from 2024. So that may have even changed or increased today. In the same survey, almost one in four reported incomes of less than $400,000.

LGBTQ older Californians experience significant challenges with respect to health and healthcare coverage. As they age and their health needs grow, they need more help. Nearly a quarter of respondents describe their physical health as fair or poor, and notably, and I'll get back to this point in just a minute, notably, almost one in ten reported difficulty doing errands alone and it was even higher for respondents of color and transgender individuals.

Given these health needs and their economic insecurity, the Medi Cal program is an important lifeline for LGBTQ older adults here in California. Across the country, LGBTQ adults are twice as likely as their non LGBTQ counterparts to have Medicaid as their primary source of health care coverage.

This is particularly important for LGBTQ older older adults who are not yet Medicare eligible like people between 50 and 64 because they have no other source of coverage. Medi Cal enables LGBTQ older adults to have access to essential health and long term care to age with dignity. While many of them may also qualify for Medicare, the Medicare program alone is inadequate to meet their needs. Medi Cal helps pay for Medicare premiums and cost sharing.

Medi Cal is the primary funder for home and community based services ranging from personal care aids who help older adults with their daily activities like our IHSS program, to home modifications that help them move around in their homes independently.

Medi Cal also pays for other optional services like vision, hearing, and dental. This is particularly important for LGBTQ older adults because they disproportionately rely on medical funded home and community based services. They're less likely to have traditional sources of unpaid care from family. LGBTQ older adults are twice as likely to be single and four times less likely to have children. Those are the people who would provide unpaid care.

So medical home and community based services can fill that gap. Unfortunately, as a result of the passage of HR 1 from last year, cuts to Medicaid will have a significant impact on older adults, especially LGBTQ older adults in California. Cuts to Medi Cal lead to reduced state budgets and ultimately cuts to critical programs like home and community based services.

Senator Laird, this goes back to your point because this would increase the likelihood of LGBTQ older adults being institutionalized where they face unique discrimination and can be forced to go back in the closet. These cuts will also result in reduced provider reimbursement further limiting the number of providers who can provide culturally competent care to LGBTQ older adults in the state.

The fallout from HR 1 collides with the Trump administration's ongoing assault of LGBTQ communities across the country. From executive order to agency action, the federal administration has used all of its tools to make life more difficult for LGBTQ older people, rolling back policies that target LGBTQ communities, attacking gender affirming care for minors, and erasing data for transgender individuals, all in the name of reversing diversity, equity, and inclusion efforts.

Back home here in California, the state government has been unfortunately slow to respond to the erosion of rights at a federal level. For example, in the 2025 to 2026 California master plan on aging initiatives, of the 81 initiatives, only two mention LGBTQ older people. One of which is to conduct outreach and focus groups to improve access and build upon the state survey.

These actions are inadequate given the threats to LGBTQ older adults. Now is the time for state departments like the California Department of Aging and the Department of Healthcare Services to use all of its tools and double down on their commitment to LGBTQ older people and ensure that through policy and action, they can age with dignity and justice. Thank you for this opportunity and happy to answer questions at the appropriate time.

Thank you very much. You are right on the time. You must have timed that out. So we'll move on to the California Health and Human Services agents.

Thank you. Good afternoon, Chair Laird and members of the Select Committee. My name is Brian Kaplan and I serve as the Deputy Secretary for Policy and Strategic Planning at the California Health and Human Services Agency. Thank you for the opportunity to address the Select Committee about our work to support LGBTQ plus older Californians.

It is my distinct privilege to provide an overview of CalHHS and our departments as well as the efforts underway to support these older adults who are a significant focus for the administration and for our programs.

California is leading the way in creating a future where every older adult including those who are LGBTQ plus is valued, respected and supported. Despite federal threats to the LGBTQ plus community and the impact of federal actions such as HR 1 on the healthcare system and social safety net, California continues to lead the way and fight for the health and well-being of its communities including LGBTQ plus older adults.

You will soon hear from three of our departments, aging, public health and social services each speaking to their work in this area. I will also share a few points on behalf of the department of healthcare services which is unable to participate in today's hearing. CalHHS is composed of 12 departments and four offices dedicated to improving the health and well-being of all Californians through the administration and oversight of a number of health, behavioral health, and social services programs.

Our mission is to work together with counties, cities, and communities, as well as our public, private faith, and educational partners to make California a healthy, vibrant, inclusive place to live, play, work, and learn. Central to that mission is ensuring that our older adults are supported in every community and every setting of care. By 2030, just a few years from now, nearly 10,000,000 Californians will be six years of age or older, representing almost 25% of the state's population.

Between five and ten percent of these individuals identify as LGBTQ plus. In January 2021, the Newsom administration released the master plan for aging, a comprehensive commitment to California's older adults, people with disabilities, and caregivers.

The MPA is a ten year blueprint for public and private partners to plan for the state's shifting demographics and to ensure that this community is represented and served appropriately. As part of the MPA, the state conducted the first ever statewide survey about the current and future health and well-being of LGBTQ plus midlife and older adults.

While eighty six percent of survey respondents reported overall positive well-being with quality of life rated as good or very good, there are key indicators in the data about subgroup health disparities, social isolation, and discrimination that are critically important to address. In the LGBTQ plus community, ensuring that we address belonging and isolation for older adults as well as stigma and discrimination is vitally important. You'll hear more from the department of aging in this hearing on the MPA and on the survey results.

These critical findings provide a foundation for meaningful change, guiding our advancement of the MPA and ensuring that all older Californians feel recognized and included. You'll also hear from CDSS on supporting older adults in our social services programs, one of the key ways we're effectuating the NPA. And finally, you'll hear from the Department of Aging and the Department of Public Health on their work to support older adults living with HIV, including through the area agency agencies on aging and a number of CDPH administered programs.

Supporting the needs of older adults living with HIV is of particular importance as the chair noted according to the centers for disease and disease control and prevention more than half of people living with HIV are over the age 50 with a unique set of health and equity challenges to address. First and foremost, CalHHS and its departments are committed to supporting and honoring the dignity of our LGBTQ plus community members including older adults.

California state law prevents discrimination on the basis of sexual orientation and gender identity and we are dedicated to ensuring that older Californians can thrive and access the care they need free from discrimination. In particular, DHCS supports and ensures access to medically necessary evidence based gender affirming care as a covered benefit for medical members. In alignment with state law and our mission to promote the health and well-being of all Californians.

Gender affirming care refers to services provided to address incongruence between a Medi Cal Member's sex assigned at birth and their gender identity. Services must be rendered by provider specially trained and experienced in providing culturally competent gender affirming care services.

Medi Cal managed care plans may not deny or limit care based on a member's gender identity. Coverage decisions must solely rely on medical necessity consistent with clinical guidelines. DHCS has also issued various all plan letters to manage care plans in the last few years to reinforce these policies. You will hear more about federal impacts in the coming panels but recent federal actions attempting to restrict access to gender affirming care disregard established, peer reviewed research showing this care is effective, medically necessary, and improves health outcomes.

These proposed federal actions do not yet carry the force of law and California law protecting access to gender affirming care remains fully in effect.

I will now share a little bit about a few selected programs and services that DHS administers to support older Californians. The program for all inclusive care for the elderly or PACE integrates Medicare and medical benefits to keep eligible older adults living safely in the community rather than institutions. PACE participants get all Medicare and medical covered services through one organization coordinated by interdisciplinary team or IDT and anchored by a PACE center.

This integrated care managed through the IDT reduces fragmentation and improves continuity, especially important for LGBTQ plus older adults who may experience discrimination or inconsistent care. The IDT tailors each base participants care plan to their identity, goals, and social context which is essential for LGBTQ plus older adults who may have unique health histories and care preferences.

Of note, in September 2024, DHCS implemented the gender affirming care policy letter which is tied to Senator Wiener's Senate bill two nine twenty three. This letter directs space organizations and directed entities to require staff to complete evidence based cultural competency training for the purpose of providing inclusive healthcare to individuals who identify as transgender, gender diverse or intersex. In addition, older adult medical members have access to a wide range of care management services directly through MCPs.

These services include an initial needs assessment with linkage to appropriate long term services and supports and to care management programs such as enhanced care management and transitional care services. Medi Cal MCP members also have access to community supports such as medically tailored meals and housing navigation services to help them thrive while maintaining independence living in the community.

Many LGBTQ plus older adults may not have family to care for them, so it is incumbent on our programs to support them comprehensively in every setting of care. Thank you again for the opportunity to address this committee on our work to support LGBTQ plus older Californians. As we face an uncertain federal landscape, California's commitment to this community has never been more important. We look forward to continued engagement and partnership with you to ensure that California remains a place where every older adult can thrive. Thank you.

Thank you very much for your comments. Now, we're gonna move to the Department of Aging.

Wonderful. Thank you so much. Good afternoon, Chair Laird and members of the Senate Select Committee. My name is Sarah Steenhausen, and I serve as, Deputy Director of the Department of Aging's Division of Policy, Research, and Engagement. And I really appreciate the work that you have done to uplift this issue and this population through this committee.

From Harvey Milk to the AIDS crisis to marriage equality, older LGBTQIA adults didn't just witness history, they made it. Older LGBTQIA adults are not just a legacy, but they are the leaders, the mentors, and the advocates whose lived experience helps shape policy today. But this appreciation must come with responsibility as too many LGBTQIA older adults face isolation, housing insecurity, and and barriers to affirming health care.

So what I'm going to do today is provide an overview of the findings of our first statewide study on older adults, you've heard referenced earlier, but also an update on the implementation of our master plan for aging. So as you know, Governor Newsom launched the master plan for aging in 2021.

So now we are in year six of implementation and in partnership with our state and public and private partners, we continue to advance the MPA's five bold goals, including one, housing for all ages and stages, two, health reimagined, three, inclusion and equity, not isolation, four, caregiving networks, and five, affording aging. I wanna note that the plan intentionally uplifts equity across all five bold goals, and in particular, the population of LGBTQIA older adults and those living with HIV continues to be a priority.

And despite the devastating impacts of H. R. One and the continued federal threats to our most vulnerable communities, we continue to uphold California values and priority populations in alignment with the master plan for aging.

I will now discuss the impetus for and provide an overview of the first statewide study on LGBTQIA older adults. It's been said that by 2030, nearly ten million Californians will be 60 years of age or older, And researchers cite that approximately five percent to 10% of this population are part of the LGBTQIA community. Yet we know relatively little about the health and well-being of this community.

So to begin filling these gaps, the Department of Aging spearheaded the first statewide survey of midlife and older LGBTQIA adults to better understand the health and well-being and to inform implementation of the master plan for aging. We view this as a baseline survey that can be built upon in future years.

As part of this effort, the department worked with subject matter experts and academic partners in the survey design, data collection, and issues impacting this community. Additionally, a community advisory committee provided input on the overall survey design and dissemination. To support language access, the survey was translated into Spanish, Chinese and Tagalog. We received over 4,000 survey respondents, including responses from every census region in the state, representing a range of sexual orientations and gender identities, as well as diverse racial and ethnic groups.

In the final analysis, survey respondents generally skewed more white, higher income, more educated, and more urban.

So it's important to note that. Additionally, a series of focus groups discussions were held across the state to provide individual perspectives and more depth to the survey's findings. 23 focus groups were held with over 200 underrepresented LGBTQIA older adults who are the hardest to reach and often excluded from these types of surveys. Focus groups participants included low income, marginalized, and geographically isolated individuals. I'm now going to walk through the key findings, of which there are five that I want to highlight.

Key finding one is strong resilience but unequal outcomes. Many survey respondents report overall positive well-being with 86% rating quality of life as good or very good. However, significant disparities exist for certain subpopulations. For example, there were worse outcomes reported for transgender older adults and older adults of color. And in the focus groups, participants consistently described lifelong resilience in the face of discrimination.

The second key finding is centers on health care access and trust barriers. Both the survey respondents and the focus group's findings show that many LGBTQIA older adults have experienced significant lifetime trauma and discrimination, including in family, employment, housing, and health care settings, with nearly half of survey respondents having experienced a traumatic event in their lifetime. Additionally, concerns about discrimination in care settings persist into older age.

In the focus groups, participants described avoiding or delaying care due to fear of mistreatment with a strong emphasis on needing to explain identity repeatedly in clinical settings. The third key finding centers on economic security challenges.

Over a quarter of respondents reported current and future financial concerns, including income stability, housing security, and benefits navigation. Focus Group participants described the difficulty experienced in making ends meet and in navigating complex systems of care. This economic strain directly affects the ability to age and place and access care with dignity. The fourth key finding centers on social isolation. Survey respondents listed social support as one of the top five service categories with the most unmet need.

One in five respondents rated their mental health as fair or poor, and eleven percent reported experiencing serious thoughts of suicide within the past year. These challenges are more pronounced among transgender and gender expansive respondents, with the highest rates reported among transgender women at eighteen percent. Many of the respondents live alone and lack traditional caregiving structures, as my colleague, Denny Chan, was speaking to.

Therefore, individuals who live alone are at higher risk of social isolation compared to the general population, and there's many issues that stem from social isolation. And finally, the fifth key finding is on discrimination.

Across both survey and focus groups, discrimination continues to shape access, trust, and engagement with aging and health systems. Respondents reported discrimination related to sexual orientation, gender identity, as well as other aspects of identity, including age, race, and ethnicity, disability status, money and income, and others. Nearly one in five reported experienced an abusive or threatening situation in the last year, but the majority, almost eighty percent, did not report these incidents to authorities.

The survey respondents reported widespread reluctance to report safety and discrimination issues to authorities, as well as discomfort disclosing their gender identity and sexual orientation to professionals who should be sources of help and support. Many of the focus group participants also noted that they're often unsure where to go for, affirming support.

So in conclusion, the study elevated the importance of strengthening culturally responsive and affirming care across systems, improving access through navigation and outreach, and addressing gaps where services exist but are not visible or trusted by LGBTQIA older adults. Additionally, the findings point to the importance of supporting alternative structures to traditional caregiving structures, including chosen family as caregivers.

Finally, improving data collection and standardizing collection of identifiers in aging, health, and social service systems can help ensure that we understand the population needs, the gaps, and the opportunity for service improvements. Thank you for the opportunity to be here and I'm happy to answer any questions when it's

I appreciate that very much. And we're going to move on to our fourth panelist, the founder and CEO of Aging and HIV Institute. And just before you start talking, let me just thank you because when I did Senate bill two fifty eight, you were just one of the foremost advocates all the way. And I just want to acknowledge it in public and thank you for it because that really makes a difference for elevating the status of people with HIV in the senior programs.

I appreciate that very much. And we're going to move on to our fourth panelist, the founder and CEO of Aging and HIV Institute. And just before you start talking, let me just thank you because when I did Senate bill two fifty eight, you were just one of the foremost advocates all the way. And I just want to acknowledge it in public and thank you for it because that really makes a difference for elevating the status of people with HIV in the senior programs.

So welcome to the committee.

Thank you. Thank you, mister chair and members of the committee. My name is David Jax Kelly. I'm the founder, president, and CEO of Aging and HIV Institute, and I'm a person aging with HIV. I'm here in an advocate role to frame what we are seeing at a systems level.

Not just what people experience, but how system design produces these experiences. What I want to focus first on is fragmentation. People often experience this as difficulty navigating care, but what sits underneath that is that aging services, HIV care, and broader health care are structured as separate health systems. They are funded separately, designed separately, and held accountable separately. There is no built in expectation that these systems coordinate with each other.

No shared responsibility for the whole person. So what happens in practice is that individuals become the point of coordination. They carry the burden of navigating across systems that were never designed to work together. What people experience are gaps, delays, repetition, having to tell their story over and over again in different places. But the pattern is consistent.

When systems are fragmented, coordination becomes optional. And when coordination is optional, it often does not happen. This is not an individual failure. This is a system design outcome. And it has real out consequences.

It affects continuity of care. It affects adherence. It affects whether people stay engaged at all. This is especially pronounced for older adults living with HIV who are interacting not just with one system, but with multiple systems at once. Aging services, HIV care, primary care, behavioral health.

Without integration, there is no single place where the full picture is held. That is the first issue. The second is invisibility. Fragmentation describes how systems are structured. Invisibility describes what happens when populations are not recognized within those structures.

If a population is not explicitly named in planning documents, in data systems, and in policy frameworks. It is not systematically included in how services are designed or just delivered. We have seen this in the California state plan on aging and the master plan for aging. Historically, older adults have been treated as a general category without consistent attention to how aging intersects with HIV or LGBTQ plus identity. When that happens, needs are assumed rather than defined.

Data is incomplete. Data systems are incomplete and not consistently designed to capture the populations that are they are meant to serve. Outreach is not targeted. Services are not designed with those populations in mind. And the result is that people who do not see themselves reflected in the systems that are meant to serve them.

This is where visibility with purpose becomes important. Visibility is not about language alone. It is about whether systems are designed to recognize and respond to specific populations. The HIV and Aging Act is a clear example of this principle. When people aging with HIV were explicitly named as a population of greatest social need, It created a basis for inclusion, for data collection, and for accountability.

Naming changes outcomes. Without naming, systems default to generalization, and generalization often leads to exclusion. So fragmentation and invisible and invisibility are connected. One describes a structure, the other describes a consequence. I want to briefly ground this in lived experience.

When I was first navigating care as a person living with HIV, I found myself moving between different providers and systems that were not connected to each other. I was managing my HIV care in one place, aging related concerns in another, and broader health care needs somewhere else. At that point, I was responsible for connecting the dots. This experience is not unique. What it reflects is a pattern, and that pattern reflects how these systems are designed.

When there is no integrated structure, individuals become the integration point, and that is not a sustainable or equitable model of care. It depends on a person's ability to navigate to advocate and to persist, which means the system works best for those with the most capacity and least well for those with the least. That is a design issue. There are additional issues that follow from this. Workforce readiness is one.

Providers are not consistently trained to understand the intersection of aging, HIV, and LGBTQ plus identity. Access and continuity is another. People experience disruptions as they move between systems that are not aligned. What is happening at the federal level will either reinforce or undermine these system challenges. Many of the services older adults rely on are supported through federal programs.

The Older Americans Act, Medicaid, Ryan White, and housing supports like HOPWA. When those programs face funding instability, policy shifts, or lack of coordination at the federal level, the impact shows up locally as gaps in access, disruptions in care, and reduced capacity for coordination. And for populations that are not explicitly named within these frameworks, those impacts are often felt first and most severely. So when we talk about fragmentation and invisibility, those are not just state level issues.

They are shaped by how federal policy defines funds and prioritizes the systems themselves.

I do want to make one broader point. Healthcare access does not exist in isolation. For older adults, including those aging with HIV, factors like housing, food, transportation, and economic stability are fundamental determinants of health. But even these factors depend on whether systems are designed to recognize and to respond to the populations they are meant to serve. What this points to is not the need for more isolated solutions, but for systems that are intentionally designed to coordinate.

That includes how populations are named, how data is collected, how programs align across aging, HIV, and health care systems, and how accountability is structured across those systems. This is the work ahead, not just improving access with ex with existing structures, but examining how those structures are designed in the first place. So I will close with this. What we are seeing at the individual level is not random. It is not patterned.

And those patterns reflect system design. If systems are fragmented, people will experience gaps. If populations are not visible, they will not be served. The opportunity here is to design systems that are structured to coordinate and intentional about who they include. We exist.

We age. We deserve to be named within the systems that are meant to serve us. Thank you.

Thank you. I appreciate your comments. I appreciate the comments from the entire panel. And I'm gonna ask a few questions and then give my my colleagues an opportunity. And I want to start with the Department of Aging because actually one of the reasons we were originally moving to form this select committee was to study that you had done.

And and we were hoping for a chance to to sort of air it out. But let me just ask to start because I think members of the public or stakeholders always wanna know how you're gonna take what's in the study and translate it to specific actions and integrated into programs. So how have you done that since the study came out?

Yeah. No. That's a wonderful question. Thank you, Senator Laird. I would say a few things.

One thing is that we recognize that we need to continually embed lived experience into how we, advance the master plan for aging. So, hearing more about, you know, people's personal experiences and their experiences in the system has been really critical. So we did convene our first aging and disability lived lived experience advisory board that includes representatives from the LGBTQIA community. And, you know, we feel that what we're learning from there, it it really it's underscoring a lot of the issues that we've heard.

And what we do from then is we're going to be building in, you know, additional recommendations as we iterate and update the next plan for the master plan for aging.

So, you know, we could think of specific areas I could highlight. But at this point, I I can't think of, you know, any particular initiative that's standing out that responds to the survey since it was just released.

Well, I want to acknowledge Senator Wiener for the work that he did on sort of the bill of rights for for nursing home residents. It took a while for every section to be upheld by the court, but it moved ahead and I had to I talked to him because I visited a a center in in Monterey County.

And when I walked in, they had a big nondiscrimination policy that included LGBTQ right at the door and I had to ask him if that was up every day or if it was up just because I was there that day. Yeah. And it was up every day and so I thought that is a good thing.

And and one of the things that you mentioned when you mentioned the the tabs for who participated in the survey is there was limited response from people in rural or underserved areas. So have you compensated for that somehow in what you're doing?

So a couple of things with that. The focus groups that were held following the survey, we made a big focus on ensuring that we did hear from those underrepresented groups. But I would also say in terms of our program development, it's been really important for us to ensure that, in implementation of a different bill, Senate Bill twelve forty nine, that is kind of modernizing our structure of the area agency on aging network.

That includes an update to the interstate funding formula that essentially lays out how to distribute the funding from the Older Americans Act across the network. And, I will say that in we have factored into that people who live in the rural regions to ensure that the rural regions are compensated for, you know, the the additional resources it often takes to serve people living in those areas.

So that's one example of how we're using the findings of people who are hard harder to serve, through our funding formula.

And I know SB 1249, which was a Senator Roth bill

Yes. Correct.

Was upgrading the Mello Gremlin Act of 1996. And so in sort of doing that and modernizing it, do you feel like there is more of a focus on underserved areas or rural areas because of the way that's been done?

Well, and, you know, I will what I can say about twelve forty nine is that it is updating the way that we, for in this example, our interstate funding formula. So that has not been touched since the eighties. So, yes, the idea was that we could update the funding formula to account for underrepresented areas. You know, our population has changed so much since the eighties when that funding formula became in place. So we knew that Yes.

I was young.

As was I. So we knew that we had to look at our state's current population and how it's shifted since that time to account for, you know, the underrepresented populations that are served. And it includes HIV status, in that as well.

And then one difficult question. The plan that you submitted to the Federal Government did not have references to LGBTQ or HIV in it. Could you speak to that?

Well, we actually did include in the front forward, you know, part of the the revised plan. We did include reference to that. But, you know, it was it was we're balancing a lot of different competing, you know, authorities that review the plan. So we remain committed, steadfast in the work we do to uplifting the needs of this population.

And in fact, when we speak to the implementation of SB 258, what's really exciting and what's most important is that our local partners are uplifting these populations and it's impacting how they're planning for and funding services at the local level to meet the needs of LGBTQI older adults.

And obviously, we disagree with so much stuff that's going on at the Federal Government right now. And and I was gonna ask Denny Chan because you talked about the response to HR 1. And and I think you said it was the state was slow to respond to federal pullbacks of rights and services. It's it's what do you see as things that we should be doing that we are not doing as a state in responding?

Yeah. This is on? Oh, it's on. Okay. So, you know, I think that comment was specifically in light of everything that we know is happening federally.

The state government has been slow to respond. And the reason I said that is because if you look at all the work that our friends in state government have talked about DHCS, CDA, they're not putting in additional resources to make sure that people have the services they need. So if you think about for example the survey that CDA did, that result those results were from 2024. And I understand that there's a need to do more outreach and listen to people with lived experience.

But there were a number of community partners who were involved in the creation of that survey.

And what we hear from the people that we work with is that people don't know these services exist. So when I was talking about the importance of, medical funded home and community based services and why they're so important for LGBTQ older people, There's a lot more outreach and education that has to happen before people even know that those things, that they are available and they're eligible for them.

So what we would wanna see is some concrete policies and actions and steps to make sure that people know about these programs and services. In addition to, you know, because that's going to ultimately be one way that we can fight back during these cuts.

And and I'd make one comment cause unfortunately I am the budget chair. And the, you know, we have a proposal to backfill $23,000,000,000 of higher education research and some of that is very important clinical trials. It is not unrelated to some of the things that we're talking about.

But we do not have $23,000,000,000 and so you can be partners with us in figuring I mean when it's food, you know, CalFresh is being cut, Snap is being cut, different things from the federal level and so we are compensating by expanding our funding to food banks because they could fill the gaps where they don't have different requirements that now are being placed by the Federal Government.

And you can help us in a time where we don't have the money to backfill everything, But we do have the commitment to triage and, you know, the Senate plan just tried to we proposed putting a few $100,000,000 to counties so that they can hire more workers so that with the new requirements, they can work to keep everybody on. That it's gonna take that extra effort and and that's an investment we can afford.

So happy to get advice as that goes on and you might and and others might be more right there on the ground to do that. Let me add I'm sorry. Go ahead.

I was just gonna add that I think a number of the community partners that worked with the department on the survey would be really interested in in furthering outreach and making sure that those outreach efforts.

And are you aware of maybe how other states are responding or you see a response from another state that you think we should be doing?

Not on this specific topic. No.

If you do figure that out, you know how to reach us.

Yes. Thank you.

Yeah. And and let me ask mister Kelly because one of the things you said is that you were responsible for connecting the dots between your service the the the health care that you get and and various services. If you were to lobby the people that are sitting next to you to make sure that the system made those integrations and connect the dots and affect the the gaps rather than you. What advice would you give them to do that?

Yeah. Well, I'm very systems focused. Right? So I'm gonna start with the macro level. And I would kind of look at where we are now with the MPA and say because of one of the things that I like the most about the MPA is it's the idea that we're going to cut across different sectors of the government to provide solutions for individuals like myself.

So in this particular time of of scarcity in the Federal Government, and what's going to be happening with your budgets and how you're going to find ways to to do things. I think, since we're still are all employed in our jobs at this point, maybe we could actually have some cross communication about how we're affecting individuals and where those opportunities might be. I go back my experience goes back to, really HIV efficacy.

And one of the things that, was really impressive to me in the forty years that we've been fighting HIV is the fact that we've always gone back to community for solutions. And one of the things that we've done is we've actually engaged community more regularly, in the kind of decision making.

And I remember a few years ago when we were talking about Obamacare, and as an HIV community, we were saying, oh, this is wonderful because Ryan White has such limitations. Nobody's really increasing the funding for Ryan White. But yet, we have the eligibility under expanded medical to actually transfer a good portion of our population over there. And we're seeing that same kind of a transfer now as people are aging with HIV and are becoming eligible for Medicare.

So that there's maybe in the long run, maybe we won't have that same system problem in terms of the health care on the Ryan White side as we've had in the past, but we we're still seeing new infections.

So, you know, population of aging, HIV positive people moves on, it's gonna take a while before the next generation is is Medicare eligible. So we're we're always kind of moving the monies, I suppose. But we could still be having these conversations, not just within the Department of Health where most of the Ryan White where all of the Ryan White funding is.

But to, you know, talk to our friends over in aging or in health and human services to say, what are the opportunities to what are the opportunities to make sure that our population of people who are aging with HIV, are still being served given all of what's going on in Washington?

Thank you. And he he that tees up a question. And by the way, I had a meeting this morning with Doctor Pan, the health director apologized for useless for not being able to be at this hearing because she has to appear in front of the Assembly Budget Committee. So I see where her priorities are. But let me ask a question to follow-up on that of you and and so we've heard from the Department of Aging about the the study and what they do.

But as you said in your opening comments, you're the one this is actually overall the departments that has to implement or has to actually do this. So how do you coordinate with the Department of Aging so when they say services should be more integrating of these things, you then reflect into your departments just to try to make that happen.