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

Good morning. Thought you got rid of me. We're back. So today, doing something kind of new for this year. We still have outstanding issues that usually during this time are negotiated behind closed doors.

So we are trying to be as trans more transparent as possible and talk about those outstanding budget issues that were not squared away when we voted for the budget. So we're gonna be going over two big programs. One is gonna be the Be Home Soon program since it's a brand new proposal, get more details flushed out. And the second is gonna be a review of the wonderful IT project called the Cares program.

And after that go over just outstanding health and human services issues that like I mentioned are still not fully flushed.

At the end of the agenda you'll see some issues also that are not gonna be for presentation, they're just a review that those are the things that are also needed are needing to be landed before we leave in nineteen, eighteen days. Okay, so we'll begin with the first on Be Home Soon proposal. If I can have the panelists come join me, please. Where would you like to be? We can I think I think we'll have you use that microphone, and she can use that other one? There we go.

Perfect. I'll have each of you introduce yourselves and we're gonna start with Kate Meyers.

Good morning and thanks to Senator Menjivar for the invitation to speak today. My name is Kate Meyers, and I'm a Senior Program Officer at the California Health Care Foundation. And I'm happy to be here today to provide a brief overview of Medi-Cal Home and Community-Based Services or HCBS to set the stage for the rest of the conversation.

Let's see if we can get these slides to advance. There we go. As we get started, I wanted to just describe and highlight a little bit of context and challenges that make today's topic and conversation especially important. California's population is aging rapidly. It's expected that by 2030 we'll have 10,300,000 Californians age 60 or older, and this will be an increase of over 3,300,000 people in just a decade.

Second, across our health care delivery system from both a cost and quality perspective, we see bottleneck problems. Too often, people get stuck in nursing facilities or even hospitals when they could live safely in home and community settings with the right supports. And third, we see that people living at home without the right supports can experience more rapid declines in health.

That can often result in emergency department visits, hospitalizations and nursing facility stays that could have been avoided if only they had the support they needed at home. So what are Medi Cal HCBS and how can they help to address these challenges?

Broadly speaking, HCBS are practical, everyday supports that help older adults and people with disabilities to remain independent, healthy, and safe in their own homes and communities where most people would like to reside. Some of the common types of HCBS are listed here on this slide. Other specific, programs may have more specialized services. But largely speaking, these are the kinds of things people need to get through their life day to day.

Things like, help with bathing, eating and dressing, which are commonly known as activities of daily living or ADLs, as well as some more complex tasks like transportation or making medical appointments, etcetera.

The Medi Cal approach to delivering HCBS is across a number of different programs that range widely in size that are administered by different agencies across the state and that manage, the approach to enrollment differently, some maintaining wait lists and others not, and some of these programs being available statewide, while others are limited to specific counties. So you can see a wide array of programs with a wide variation in the ways in which they are delivered across the state.

So while we have a lot of programs in California, many Californians do face challenges in getting HCBS, and this can be due to challenges around access and availability. Specifically around access, given all the programs that I just showed on the previous slide and the different ways in which they're administered, This delivery system as a whole is complex and it's fairly fragmented. It can be very hard for individuals and their families to navigate.

So people who need these services may not be aware what's available in their counties, what they might be eligible for and how to access those services. And we know that the different approaches to eligibility and enrollment processes across different programs can make it confusing for people to know exactly how to access services. In terms of availability, we know that in different parts of the state we face issues related to provider capacity or workforce shortages for these services.

Different programs maintain wait lists in different ways, and people don't always know exactly how to approach managing, their space on a wait list. And we know that rural parts of the state have more limited access to home and community based services overall, and many of those counties are some of the fastest growing in terms of the older adult population.

This slide is meant to be illustrative, not comprehensive of all Medi-Cal home and community-based services. But what I want to convey here is that a number of these programs provide similar sets of services, things like adult daycare or personal care services or assisted living services.

So from an individual's perspective who might know that they need help with a certain, set of issues, they may have really no idea which program to go to for these services and which ones are available in their county because of this overlap and repetition between programs. And again, across this array, we see a number of different administering entities across the state. While we have a lot of programs, we don't necessarily always have reliable access.

Briefly, why is Medi-Cal HCBS so complex? A few reasons are indicated here. One is that while institutional nursing facility care is a required Medicaid benefit, home and community-based services are not. They are optional. And so California has built its HCBS set of services over time, one program at a time, one authority at a time, all with the intention to expand services to more and more people, but the result is a patchwork of different programs rather than a single unified system.

As noted earlier, there's a variation in whether programs are provided as state plan benefits available to anyone who is eligible for them, such as the In Home Supportive Services Program or IHSS, or if they're provided through waivers which have different rules related to CAPS, and enrollment populations and approaches. And many of these programs result in having wait lists because they are capped. Specifically today, the home and community-based alternatives waiver and the assisted living waiver both maintain significant wait lists.

And finally, as I've noted before, coverage varies by county. This can make it very difficult and complicated for people to know what's available where.

And because the administration for these programs is split across so many different state agencies, we see differences in the approaches to the programs in terms of assessment processes, enrollment processes, and, importantly, different approaches to their data systems. So it's difficult for the state as a whole to have a really comprehensive look at what programs are available to whom, what unmet need looks like, etcetera.

I wanted to highlight before I close just a few different aspects that have been highlighted by the State's own gap analysis on home and community-based services. They released a report back in January 2025 that has a wealth of data and information, but a few things to highlight. One, again, in rural counties where home and community-based services coverage is more limited, we do see people using these types of services at, on average, half the rate as in urban counties.

So we can imagine significant unmet need, especially in rural counties. We also see some demographic differences in who's enrolled in what programs. There's, not one pattern here, but we do see over or under representation among specific racial and ethnic groups, in specific HCBS programs compared to the overall population receiving those services. And lastly, the report notes, of course, that we're expecting the future needs for these programs to only grow as this population grows.

The data here is related to California adults who are medical enrollees or expected medical enrollees who would have any limitation in activity of daily living.

So that eating, bathing, dressing, sorts of activities. In 2020, it was about 1.3 million, and by 2040 it's expected to be over 1.9 million people with those needs. And lastly, to summarize, the state's gap analysis again highlighted a number of the key needs that I've mentioned here today. Again, the population aging rapidly, the need for more providers for these services, that our fragmented system with different eligibility requirements and enrollment processes makes access challenging.

The highly decentralized set of systems and programs makes monitoring access and unmet need and quality difficult, and as the report notes, filling these gaps will require substantial and sustained investment.

I've also included in the slides for the committee's resources, a few resources produced by the California Health Care Foundation in recent months. And with that, I thank you for your time and look forward to the rest of the discussion.

Thank you so much. We'll move on to you. Thank you.

Good morning Madam Chair. My name is Hagar Dickman of Justice and Aging. When it comes to long term services and supports, California and preferences align with the state's fiscal interests. Most older adults want to age at home, not in institutions. In fact, seventy five percent of adults age 50 and older want to remain in their homes as they age and seventy three percent want to stay in their communities.

At the same time California faces recurring budget pressures making home based care the fiscally responsible option for the state. Yet our long term care system continues to steer people towards the most expensive setting of care nursing facilities. This isn't because nursing homes are what people want or need. It is because of decades, decades of policy decisions have built barriers to home and community based services while protecting institutional care.

The result is a fragmented system that makes it difficult to access lower cost preferred alternatives and leaves older adults vulnerable to avoidable institutionalization.

To understand the problem, let's follow one Californian through the system we have today. John is 70 years old. He spent his career working as a mechanic for manufacturing company. Today he lives on $2,200 a month in social security retirement income while paying 1,500 a month in rent. Over the last several years, John has developed increasing weakness and joint pain.

He's largely ignored his own health because he's caring for his mother who has dementia. As his mother's needs increase, John can no longer manage alone. He helps her apply for a Medi Cal HCBS waiver program that he heard about from a friend with an aging parent that may help her receive the intensive home care that she needs. But the wait list is at least three years long. Adult day health services through the CBAS program are unavailable in their county.

His mother receives limited IHSS services. Her neighbor is her provider but four hours per day still requires John to provide intensive care and supervision for the rest of the day. He requested additional hours on her behalf but the assessment is delayed because of County backlogs. Meanwhile John's own health worsens. One day he falls at home and breaks his hip.

After surgery and rehabilitation he's discharged home with instructions to install safety modifications including to obtain help with dressing, meal preparation and other daily activities. While he is in rehabilitation his mother's increasing care needs go unmet. She's hospitalized due to a UTI and discharge to a medical covered nursing home where she spends her remaining years. John also needs IHSS but he learns that qualifying for services would require him to pay a $1,600 monthly share of cost before medical assistance begins.

That would leave him with only $700 a month to live on not enough to pay for rent.

Unable to survive on that amount John declines the care he needs. He hears there may be other programs available but navigating them is confusing. He doesn't know which programs to apply for where to start or whether he could afford them even if he is approved. He also cannot afford the recommended home modifications. A few months later he falls again and this time the consequences are worse.

After a lengthy rehabilitation stay Medicare notifies John that continued coverage in the facility is no longer medically necessary but he is unable to safely return home. He needs assistance bathing, dressing and moving around. He enrolls in medical which covers his nursing facility stay costing roughly $10,000 per month for the state. As required by current rules nearly all of his income goes towards the facility leaving him with just $35 per month for personal needs. Because he can no longer pay his rent he loses his apartment.

Now he's both institutionalized and unhoused. He could apply for the assisted living waiver but the current wait list would require him to wait a year at least and with a waiver at near full capacity it may take even longer. That doesn't matter though. He doesn't know about the assisted living waiver and there's no care coordinator who comes by to let him know his options.

He remains stuck in the nursing facility at an annual cost to the state of approximately $130,000 not because that is the setting he prefers but because the alternatives are unavailable and unattainable.

John's story is fictional but every barrier he encounters is real. Justice in aging has heard these stories too many older adults and people with disabilities who are eligible for HCBS but cannot access it. Be Home Sweet California is designed to address each of these barriers before they push people into hospitals nursing homes and homelessness.

Rather than forcing people to navigate a maze of disconnected programs, Be Home Soon creates a more coordinated accessible and affordable system that delivers services when people need them not when bureaucracy finally catches up. Under be home soon, John's mother would not wait years for the services she needs.

She could enroll in a unified home and community based services program and receive a comprehensive set of services such as personal care, adult day health and caregiver supports without waiting for every administrative step to be completed before services begin. John could also access home modifications that reduce fall risks and prevent avoidable hospitalizations. Under the proposal share of cost reforms John would not have to spend $1,600 a month before receiving medical support.

Instead he could receive services while still retaining enough income to maintain housing and basic financial stability. If John required a short term nursing facility stay after surgery he would be able to keep enough income to continue paying rent and preserve his housing.

And if he later needed assisted living he would transition without spending months or years waiting in a far more expensive institutional setting. Would be home soon, John and his mother would live at home where they want to be saving the state thousands of dollars. California has built a long term care system that too often waits until people are in crisis then pays the highest possible cost to serve them. Be Home Soon proposes something different. Remove the barriers that keep people from getting help early.

Invest in the infrastructure that supports community living and make aging at home the defaults instead of the exception. That is what Californians want. It is what many older adults need and it is a smarter way for the state to invest its resources. Thank you.

No thank you for that. Move on to our next speaker.

Thank you, Madam Chair, members. Amber King with LeadingAge California, representing nonprofit providers of care services and housing for older adults. Happy to be here today to share the provider perspective. Our members serve low-income older adults through the assisted living waiver, assisted living community supports, adult day, and PACE programs, and are focused on providing the highest quality of care in the most integrated community setting possible. Increasing housing costs continue to be a major barrier to keeping older adults in the community.

Without pairing services with truly affordable housing, many older adults have no practical pathway to home and community based care. Our CBO members often report difficulties impairing the housing benefits with the HCBS benefits. On the provider side, lengthy state level administrative processes, including delays in provider enrollment, certification, and program approvals, slow providers' ability to open or expand services and participate in medical programs in a timely way. For example, assisted living providers have waited more than two years for the department's approval.

Providers continue to experience inconsistencies with CalAIM implementation by each managed care plan, including variations in authorization practices, contracting requirements, reimbursement approaches, and program implementation, which creates confusion for providers and can delay or prevent placement for eligible residents.

Continuity of care is also at risk when plans choose to discontinue benefits, displacing older adults and disrupting their care. Not to mention this disincentivizes providers from participating in these programs. For example, Health Net's recent decision to discontinue CaliM assisted living highlights the ability and the instability for older adults and providers when, they're facing when their access depends on plan by plan, year by year decisions. We would encourage the legislature to consider establishing assisted living as a mandatory statewide benefit.

We'd also encourage you to consider how rate structures can be rebalanced to ensure plans and providers are incentivized to support transitions to the least restrictive setting appropriate for each individual.

We are encouraged to see the presumptive eligibility included in the Be Home Soon proposal as it's vital to reducing barriers to eligibility, which can be lengthy on its own. However, coupled with the delays in state needs assessments, which can take up to six months, those can be devastating for older adults in need of urgent services. And then, as you know, PACE, provides a critical role in allowing medically frail older adults to remain safely in their homes and communities.

As demand for PACE grows, investments are needed to ensure timely access and timely level of care determinations by DHCS, which is required to enroll in PACE and can take three months or longer. Improving timeliness and efficiencies of this process is one of the most important and meaningful ways to increase HCBS access.

Leading Edge California appreciates your leadership on these critical issues and is pleased to support the policy changes included in the Be Home Soon proposal. These reforms will strengthen California's long term care continuum and expand access to the services that are much needed to allow older adults to remain safely in the community. Thank you.

Thank you. I know I skipped you so I'll go back to you.

Hi. My name is Bea Saki. I'm the director of policy at East Bay Innovations. East Bay Innovations is a nonprofit agency located in Alameda County, supporting adults with disabilities since 1995. With over a decade of nursing facility transitions experience through programs like California Community Transitions and CalAIM, we guide clients through complex discharges by establishing thorough transition plans. We help them get housing document ready, like obtaining an ID, social security card, income, and applying for affordable housing.

We support them with budget planning so they can manage their expenses and ensure they're connected to primary care doctors and pharmacy in the community before transitioning. We connect them with resources and services that they need to live safely at home. We ensure they have IHSS and WPCS caregivers hired and trained prior to transition. For clients whose needs exceed the approved IHSS hours, the WPCS provides an additional number of hours to ensure their personal care needs are met at home.

We ensure home accessibility through programs like CCT and CalAIM. There's funding for ramps, grab bars, handheld shower heads for home access. CCT and the HCBA waiver fund personal emergency response systems. For someone living alone who is at fall risk, these devices automate a call to their emergency contact for help, preventing unnecessary 911 calls. Before these resources can be in place, the client needs to be approved for housing. Their clients face three main barriers when transitioning.

First, limited affordable housing options. According to HUD, someone who has been in a nursing facility for more than ninety days no longer considered homeless, even if they were homeless before or if they would be exiting to homelessness. At this time, Section 811 is the only rental assistance program that prioritizes people exiting nursing facilities. And for someone in a nursing facility, their SSI is reduced to $62 a month for personal needs allowance, which makes it impossible to qualify for housing that is not deeply affordable.

Second, clients face delays due to complex processes for basic services like IHSS.

They face delays in IHSS approvals up to three months or more, difficulty recruiting IHSS caregivers, and HCBA waiver delays over ninety days for transitioning population. And for someone in the community, that can be over three years. Lastly, in CalAIM, clients face denials for transition services from the managed care plan because they don't have safe housing to return to. The bottom line is that people with disabilities shouldn't need to wait for these services to come together.

By eliminating the waiver wait list, improving IHSS caregiver models, and access to transition services, clients will be more successful in preparing for a safe transition and post transition stabilization.

We encourage two things in the Be Home Soon model, investing in caregiver models that can be in place immediately so that people can transition from nursing facilities and receive integrated care at home on day one and implement rate restructuring. Rates for CCT and HCBA waiver habilitation services have not changed since implementation in 2007. So by improving how these surfaces interact together we can stabilize people at home faster. Thank you.

Thank you, Bea.

Thank you Madam Chair and members. I'm Kate Ladysh, president of the California IHSS Consumer Alliance and Chair of the Yolo County IHSS Advisory Committee and an IHSS Consumer. When I was 35 a diagnostic spinal tap resulted in me leaking cerebral spinal fluid for over a year adding significant problems to existing conditions. It also landed me in the hospital where the neurologist written order for me to be sent to a long term care facility saying that he just didn't know what else to do with me.

And I cannot overstate the terror that I felt at the prospect of being warehoused of losing my freedom.

I couldn't speak in complete sentences, but mustard won't go and I didn't. But it was rocky largely because I was discharged without assistance in place. Fast forward fifteen years when I was discharged from a hospital after life saving surgery and nearly three weeks of care, I already had IHSS in this case. This time I could transition home safely. So yes, I very much support the goal of the Be Home Soon California proposal.

Having IHSS and other HCBS allows older adults and people with disabilities to live safely at home in our community of choice. We can maintain relationships with family and friends, volunteer, perhaps go to school or work. It helps our physical, mental and emotional health where people not just patients. The community also benefits when it is kept whole.

Barriers to where delays in accessing HCBS can postpone or prevent return home or make the return unsafe resulting in chronically or acutely dangerous conditions, family crises, ER visits or facility placement.

Effects include stress, injury, unsanitary living conditions, missed work by family members and even unnecessary deaths. The barriers to accessing IHSS and HCBS when transitioning home can make people feel like they're banging their head against a wall where there should be a door. The paperwork for all the different programs is daunting to the point of undoable, especially for people coming out of a health crisis. Programs and departments don't coordinate, introducing needless delays.

IHSS consumers may no longer have access to their previous provider and the chronic provider shortage makes it hard to find a new one.

Some people may lose their housing or miss HCBS recertification deadlines while in care. The HCBS learning curve is steep and most facilities don't have knowledgeable staff. This is especially true of IHSS. I am a big fan of the IHSS consumer centric model. This is the nothing about us without us philosophy just put directly into practice and I love that the be home soon proposal highlights the importance of IHSS.

But I'm also concerned that we may attempt to shoehorn people into IHSS for whom it's not a not a good fit. Managing IHSS is a heavy lift and not everyone can do it, especially when transitioning home. People with resources can do private pay with a company that matches you with a care provider and has little paperwork. People without money use IHSS. People who are unable to manage their IHSS can be more likely to end up in care facilities than their wealthier peers.

This makes Olmstead's right to community living dependent on wealth. But true rights aren't paid to play. So how can we provide in home care for people who could live safely at home with assistance but who cannot manage IHSS as a consumer supervisor? Do we need a different track within IHSS or an additional program? Let's not dismantle the existing and very successful program but let's do think about how to address more needs.

And two quick budget related thoughts, the backup provider system is crucial in transitions but having to spend six months of the year fighting for it in the budget robs the opportunity to strengthen it. Similarly, the yo yoing medical asset limit affecting IHSS consumers introduces tremendous uncertainty and instability and affects people's ability to return home and stay there.

Committed support for BUPS and the rest of IHSS and the abolishment of the medical asset limit that targets the very people be home soon is aiming to help are two keys to this valuable program success. Thank you for this opportunity and thanks also to the nearly 30 people who shared ideas experiences with me in the last few days.

I appreciate it. Thank you so much. Before we bring up the department and try to squeeze everyone in here, we turn to LAO and Department of Finance for comments.

Juwan Trotter, Legislative Analyst Office. We have no further comments at this time but as you continue to evaluate this proposal, we're, available to provide technical assistance as necessary. Okay.

Natalie Griswold, Department of Finance. Notwithstanding the merits of this proposal, we note that the administration and legislature worked hard to budget, balance the budget in the budget year, but we're still facing some sort, some types of deficits in some of the out years. So we appreciate hearing from these stakeholders but we note that any new ongoing general fund, any new ongoing general fund commitments would challenge, that balanced budget structure. Thanks.

Okay. And then if I can have the department come up. Okay shimmy on over to your right.

Good morning, Chair. My name is Tyler Sadwith. I'm the State Medicaid Director and the Chief Deputy Director at the Department of Health Care Services. The department is aligned on values, on principles, and on policy objectives, with the Be Home Soon California proposal.

The department is taking significant steps to continue achieving progress on our long standing goal of rebalancing long term services and supports so that care provided to members with disabilities and frailty continues to trend away from institutional settings and towards home and residential settings integrated into the community.

The department is implementing policies and strategies to achieve this goal through initiatives like CalAIM, by restructuring managed care plan capitation rates, by developing a skilled nursing facility value strategy, and by supporting and promoting sustainable growth in the assisted living waiver and the home and community based alternatives waiver. I can share more about this work later on in my remarks. For now, I want to address the questions included in the agenda.

While the department supports, many aspects of the proposal in principle, it is, necessary to note that we project substantial upfront general fund costs to carry out the proposal before any potential savings can be realized. The Be Home Soon proposal estimates, annual savings of 625,000,000 general fund when fully implemented.

However, it is unclear as to the timeline when those savings are expected to be realized, and it is unclear what assumptions were used to project those savings. For example, to expand the home and community based alternatives or HCBA waiver and fully eliminate the wait list, the department estimates $434,000,000 in general fund cost. So this would entail clearing the wait list of approximately 6,000 people, about 95% of whom are currently residing in the community, not in institutions.

And so what this simply means just from a budget perspective is that savings associated with expanded HCBA enrollment would be hypothetical at an indeterminate, point in the future rather than immediate actual cost avoidance that can be assumed and budgeted. Other components of the proposal include transitioning several section nineteen fifteen c waivers into a section nineteen fifteen I state plan option with the goal of eliminating enrollment caps.

This would require the department to lower eligibility criteria for these programs. So currently, the nineteen fifteen c waivers require a an individual to meet nursing facility level of care need to enroll. The nineteen fifteen I requires sort of a does not require individuals to meet a nursing facility level of care need.

And so what what this would mean is that in addition to expanding total enrollment, which is the goal, the compounding effect, from a budget perspective is the programs would no longer represent lower cost alternatives to institutional care given the lower acuity population. Even if we were able to expand enrollment in a budget neutral way, expanding enrollment through slots does not automatically need to expand that access on the ground for enrolled participants.

Today, currently, HCBA waiver agencies and assistant assisted living waiver care coordination agencies struggle to manage the volume of slots they're allotted to enroll every month. So these agencies would not be able to expand their capacity for new enrollments without more investments such as provider payment rate increases, including for registered nurses and social workers in a highly competitive market.

So these are just several examples for illustrative purposes of how, just the first component in the Be Home Soon, California proposal may may result in significant general fund increases rather than yielding cost savings that can be scored in the budget.

There are several other components in the proposal, that while the department is aligned on principle and on values and on policy objectives, there would be complexities, or technical challenges that we would have to further assess to see what the impact would be or even the possibility of it would be.

These include federal rules regarding presumptive eligibility, room and board, spend down and share of costs, state directed payments, cost neutrality, impacts on managed care reimbursement rates, and the potential for some components to have the unintended consequence of incentive incentivizing plans to opt out of covering community supports which are voluntary under the federal in lieu of services authority.

The agenda asks for wait lists and length of time for each waiver program. There are two HCBS waiver programs that currently have wait lists at the state level. So the information is as follows. For current enrollment statistics for our HCBA waiver, there are 11,254 enrollees. For the assisted living waiver, there are 14,495.

The wait list for the HCBA waiver is 6,674. The wait list for, the ALW, the assisted living waiver is 17,886. The length of time from wait list placement to enrollment, broken down by waiver population is as follows. For the HCBA waiver, for the institutional transition population, the the length of time is about four to five months. For the 21 or the institutional deeming population, it's about three to four months.

And for the community enrollment population, it's about two years. For the ALW waiver by waiver population, the average length to enrollment for the institutional transition population is eleven to twelve months. For the adult protective services, long term care ombudsman referral population, it's three to four months.

The department has sought to maximize the use and the growth of these two waivers sort of in tandem with aligning program growth with program capacity at all levels, including at the state level, at the capacity of waiver agencies, and at the capacity of direct care service providers. So at the state level, the department cannot simply eliminate, wait lists with an immediate increase of slots on paper.

To ensure members enrolled in a waiver program have timely access and are able to receive services in compliance with federal requirements, Additional capacity is needed, for the department to administer the increased workload, increased operational and policy support, and increased monitoring, oversight, and program integrity responsibilities. The ability to rapidly expand waiver enrollment and to ensure meaningful on the ground access for enrollees is currently constrained by the lack of sufficient provider infrastructure and capacity for waiver agencies, care coordination agencies, and direct care workers.

There are provider shortages today in these waiver programs. A steep and sharp growth in slots without significant investments in workforce will exacerbate an access issue. However, the department is committed to continuing our successful track record of rebalancing long term services and supports towards home and community based services.

We continue to promote, continuous growth in these two waivers in a sustainable manner. This includes prioritizing access and expansions in light of the growing older adult population through steady annual slot increases to each waiver that align with the existing capacity of waiver agencies. This allows us to, successfully manage the flow of enrollment onto the waiver. For example, we added 7,000 slots to the assisted living waiver during, the COVID, pandemic using enhanced federal funding.

We've included annual slot increases of 1,800 per year within the current five year waiver terms of each waiver.

The c b the HCBA waiver ends at the, end of twenty twenty seven, and we plan to continue annual slot increases in the next waiver term. I would highlight we increased reimbursement rates for IHSS workers, consistent with the recommendation from the California state auditor that it's necessary to increase the rates, to grow the IHSS workforce, to meet the growing demands of California's aging population. And we've updated the sort of the incentive structure within managed care plan capitation rates.

Last year, we started blending rates of the seniors and persons with disabilities category of aid and the long term care category of aid, which incentivizes plans to divert members from entering institutional care and incentivizes plans to transition members out of institutional care. And we've also worked to expand member access similar services through CalAIM, including through enhanced care management, which has a specific population of focus, serving adults residing in a nursing facility transitioning out, as well as several community supports that are similar to HCBS services.

And finally, we're strengthening internal operations with process improvements to create new efficiencies in both the HCBA waiver and the ALW waiver and these process improvements have increased the rate of waiver personal care service request authorizations and in the enrollment of waiver providers. So I'll pause here and happy to answer any questions.

So many, that was a lot of information. I appreciate it. Okay. Sorry I have like a billion questions so I'm trying to gather my thoughts here. Let me start with you mentioned some of the investments and we've heard those investments for the past couple years.

One in particular I want to point out I want to bring out as he I'd like to hear feedback. CalAIM was used as, hey, this is an investment and it, the point of Cal AIM is to address some of the issues that you all have brought up, right? Like have a coordinated care, let you know the resources and so forth. So, I'm wondering from the five women here is, what, what is the difference you would say Cal AIM and then BHOME, pro the P home program?

How does this go above that in what we currently have?

Justice and Aging, I think the that CalAIM held a lot of promise to fill the gaps and the biggest issue with the services provided by CalAIM is that they're not mandatory and they're not standardized. So what we're seeing is that accessing for example assisted living through a waiver provides consumers more rights and stability. And when they are receiving services through CalAIM they are constantly at risk of losing those services.

For example there's a plan that just announced that they're going to be terminating the service and it's going to lead to thirty five hundred people losing their housing at the end of the year. So I think while the the aim is great making this an in lieu of service and having no state plan benefit to that is mandatory for the plans to actually deliver makes these services quite unstable.

And then on enhanced care management I think we're also seeing that although it's true that institutional population is a population of focus. We're not really seeing delivery on the on that front of really plans going out and identifying consumers in nursing facilities and then assisting them in transitioning to an appropriate setting.

And so I think if the state wanted or the legislature wanted to look at ECM specifically and bolster that service, one of the things that could be looked at is how does that standard work, how does that identification of consumers work. And I think that there is a within Be Home soon there is a proposal here to really force the question of you know force that issue of identifying eligible consumers or eligible members and then offering them transitional services.

And in in your in your remarks you talked about in that potential store in that story, you talked about a care coordinator not being there to share resources. Why aren't there care coordinators that are shared resources to individuals?

I think partially I think an EBI can maybe talk about this. There's just not that many EBIs out there so we can need more staff on the Yeah, more of the agencies that really go out. Oh, EBIs. Yeah, your.

Thank you that's your...

The organization sorry the I think there needs to be additional agencies but there needs to be also more facilitation from the nursing facilities, more active facilitation and identifying residents that want to transition and are ready to transition. I think the of the facilities themselves are supposed to be doing that work. They're supposed to be identifying folks. People in nursing homes are generally isolated.

They're not in contact with with folks that it's very difficult for people in a nursing facility to to figure out the resources that they need in order to make these transitions and we need more active more active care coordination that shows up at the facility that offers services that gives people a holistic strategy for coming out of a nursing facility in a safe and stable manner.

And I think that having both I think like you had mentioned the stable housing and the services that come together and are offered to the individual as a stable package is really important.

Anything you'd like to add to that?

Yeah. I can just speak a little bit to like CalAIM access and the idea behind it is great. It replicates it's an it's intended to replicate California community transitions and the package provided there with whole modifications transition services. But I think the way that the managed care plan delivers it is very, like, through a medical lens where these services that we're providing are really social.

We're supporting clients to access housing and to stabilize in their homes through resources and services that are home based and with the managed care plan But

I would say that's a medical treatment. I would I would agree that that even though social services are medical treatments, I would say.

Yeah. I think that the access to the caregiver resources, I think, are very siloed and the managed care plans are having the authority to review these services and deny are basically denying access to transition services under CalAIM.

Okay. The Deputy oh, please, Ms. King.

I was just going to add that I think there's also, we need to look at the rate structure as well because the plans are not necessarily incentivized to move into the ALFT. They're, getting a straight pass through for skilled nursing facilities at least that's our understanding. But for the assisted living, that's kind of a money loser for them. And so they're losing a lot of money, which is why I think we're starting

Which is why the program is an incentive. It's a proposal.

And I think that's why we're starting to see plans like health plan drop that as a benefit because it's, they're losing money and and then that causes the kind of continuity of care issue.

The Deputy Director talked about potential bottleneck as we can open up all these thoughts and so forth, but the staffing capacity at these providers won't be able to meet the needs to even clear the additional thoughts. Can you ,can anyone address that point?

Well, I would say for the assisted living waiver and for some of our assisted living provider members, there's a significant delay in those that are willing those providers that are willing to participate in the program. Some of them are it's taking up to two years for the department for them to get that department approval. So I think that's part of the issue. I think maybe some of the rate conversation is also part of the solution as well. Yeah.

I would say, to speaking to that, East Innovations has been waiting, to hear back from the department on our care coordination agency approval. And so, I mean, I think that there's providers out there that are willing to do the work and are ready to engage but we are faced with a processy delays to getting approval to become a provider.

Ping pong back to you on that constraint.

We fully acknowledge that there are lengthy delays in processing sort of provider enrollment waiver applications. We have taken steps, I mentioned them briefly to actually bring in outside resources to do a little bit of a forensic analysis on our processes and identify root cause blockers and identify new ways of doing business so we can be more efficient. So we are putting that into place. We have we are bending bending the curve so to speak with respect to the backlog.

So it's early promising results on being more efficient with processing this.

And again, there are, yeah, capacity constraints.

And Juwan, LAO, I would love to see if I can get some assistance on the six the proposed savings is $625,000,000 The total is like 1.2 but that's part of the federal. There seems to be still unanswered of at what point that can be achieved. If you could help with that in the timeline And then I'd love to see you mentioned some technical challenges as well.

I'd love to get a little bit more expansion and maybe from both of like what exactly you quickly went over them, but some of those tech challenges that we can address in making this successful if possible.

Can I get, like, on the AWL, the wait list, is it that it's so long because there's no placements for them?

Not so much that there's no placements. I mean, we do have a large number of facility providers. But and and and just to be clear, we have a high flow of of slots being released from the wait list on a regular monthly basis. So the wait list is very large. We mentioned 17 over 17,000.

We release at least a thousand slots a month. So there's a constant influx of new slots onto the list. Of those slots that are released, we have about a 50% enrollment rate.

Compared to how many people get added? Correct. What is the comparison to how many people get added? Sure. You're releasing 1,000 but you're seeing more being added?

Yes. It's it's it's it's it's slightly more that are added each month because our wait list has been steadily growing.

One step forward, three steps back every month? Yes. And it's is it that the you mentioned some like the month is it that the dollars like we can't if for some reason we're like we get approval and more providers are added to the list and it's not stopping capacity issue, is it that would that be the only thing that'd be needed to get more offline?

Increasing care coordination agency capacity to actually process these enrollments is a necessary step for further expansion of the waiver. As B mentioned, you know, their their organization has been waiting to enroll onto the waiver as a care coordination agency, but we do have a significant number of care coordination agency providers across the the counties covered by the assisted living waiver. We have over 40 care coordination.

And they said they're at capacity. Don't give me any more slots?

Yes. We we we we have an issue currently with care coordination agencies being able to process the number of of, slot releases that they receive, on a monthly basis.

So what's the bat and magic bullet to add more?

I mean

To add more providers to help with this? What's the magic bullet? What is

It's a joke and weigh in further but I think that it would be sort of workforce growth policy portfolio which could include a combination of increased provider rates on a targeted basis. I think the care coordination agencies specifically have registered nurses and social workers, there's a shortage so they need more of those. How do you attract them to work for the sort of, you know, county based, care coordination agency?

But those are the ones that haven't applied yet. The ones that apply are accepting the current rate. Right? If they've ever applied, they're accepting and that means they have the capacity of social workers to our end. So what's the magic bullet on our end for the people that are ready or ready to go and they're still waiting to be approved?

Those entities that are already providers and already operating struggle of capacity to expand their ability

to provide services. So for example, EBI is in the wait list. They're on wait list to be approved. It doesn't seem it seems like for right now, the rates or whatever the rates are is okay for them right now. I know we need to attract more and we could ship but if there are people that are ready, providers are ready to go right now, what magic bullet is needed to get them approved and not be waiting how long so far?

Almost three years. Three years.

So the process the problem is that we we are at capacity, we need more providers. We have providers ready to go. We can worry about the providers that don't want to even be in the system because the rates aren't great but we have some that are ready to go. What's the magic bullet to approve those? Three years is ridiculous.

So on the DHCS side, right, we have taken steps within the resources that we have to improve the flow, the throughput here. We reassigned staff from across the department to address this backlog and to address this delay. Again, we brought in sort of external consultants to help develop an entire sort of work strategy to tackle this. We've identified technology improvements.

But to the magic bullet, Chair would be additional resources at the department for both sort of technology and tools to help us work in a more efficient manner and and resources to process the workload.

That's hard. It's hard. That's hard. I can't grow bureaucracy to help bureaucracy. That's hard.

That's a hard sell for me.

You know we've been talking about this with DHCS for a couple of years now the backlogs the other provider shortages aren't their provider shortages there's 900 RCFEs waiting to enroll the living waiver. So that's a lot of capacity there. We're hearing from agencies that they have no place to place folks because all of these people are waiting to enroll.

And I think what it comes down to and what be home the power of be home soon is it's really focused on the consumer and the consumer experience. And even we know that there is a bureaucracy and that processes need to be improved and things need to be moved faster but at least let's make sure that when a consumer needs a service, they can get a service paid for while the rest of those processes are taking place.

So if you're applying for assisted living waiver and your slot comes up, there's zero reason why you can't move into the assisted living waiver and into the living waiver and into the facility and receive services while the all of the paperwork is getting done and maybe your waiver agency needs more time. They don't have enough staff, so they need more time to finalize all that paperwork and send it into DHCS so they could do their nursing level of care assessment and certification.

All that all those steps take could take up to six months while the person has already received their slot. By the time that DHCS is done with all of their processes, that individual has already lost their RCA fees Spot and they've lost that bed because the RCA has moved on. So at least at a minimum, put in place policies that help people get those services while the bureaucracy does what the bureaucracy does.

Right. And then this is a question Department of Finance. Ma'am, if you could come back up. I'm and you know, when is the savings gonna kick in versus it's upfront cost? How do we approach when we know it's what 10 times more institution versus at home care, the savings that it caused it creates.

When do we look at, we will see this, the Medi Cal program continue to grow. It's happening regardless. We can't stop. I don't think we can kick more people out of this program to create more savings. I don't know who else we're gonna kick out.

But you all get creative so we'll see you next year. We need to address and do investments in preventative care. Everything else is about preventative. Everything else is primary care here, we need to do that. Why aren't we looking at this as investing in primary care as I'm looking at this versus wasting so much dollars when it gets so serious?

How do you, how does DOF look at that? Like you say, we can't invest in this because it's going to cost us money but it's costing us so much more money because we're not investing in one time investments.

Natalie Griswold, Department of Finance. So when we're looking at the estimate for the whole Medi Cal program, I think we're looking at this holistically. We know that there there are obviously costs associated with long term care. I think that one of the things that we're looking at in terms of this budget act, the 2026 budget act, is that we've like, the 2026 budget act is balanced in the budget year and budget year plus one.

And I think at this point when we're looking at this proposal, what we're seeing is that that would kind of challenge the fact that that budget is balanced in budget year and budget year plus one.

Yeah. So I think we've balanced budgets for the past couple years and every single year the year after so far that I've been here we've not been balanced. I just, we always are in a deficit the following year so, I don't know if that's a good enough answer.

If the whole goal is to make sure we trim down the cost for Medi Cal, if each year we say, well we can't do it because we need to be balanced right now, we're going to be every single year DHCS come into this subcommittee of like the growth has increased this, the cost has increased here and we're still not going to invest so we're going to be in this loop forever of what if we would have invested ten years ago by now we would have seen some savings.

Like at what point does Department of Finance look at this is like we need to bite the bullet.

Yes, it's going to cost us some dollars but we're going to see a return on investment in the next couple of years. Like is there like a lever you're all looking at to say like now is the time to do the investment?

I think I would say that while there's not a, there's no one specific time that we can be having those conversations, I think that, that's like why we're here having these hearings now is to hear these conversations and kind of think about these types of things.

Right. Right. This silver tsunami, I mean, we keep it's here. It's already here. I think that's one of the largest growing demographics in the MediCal program here is the aging population and the needs surrounding the complex needs surrounding that.

And if we continue to see proposals to cut the in-home or community services, we're gonna not, see MediCal go down. I just, I guess I know we've heard a lot of challenges and so forth but is it the political will to take on these challenges, take this really seriously and say like we really need to look at this program.

Maybe it's not a perfect presentation of but like a serious conversation of like we need to make this happen because if not, we're gonna be in a worse situation. Is it are you allowed to say if there's a political will there?

I think I would more go back to the fact that we know that this probably would have general fund costs in the budget year and given the whole the on the structural deficits for like, you're looking at for the out years. Like, this is just something that because of the current general fund cost, why don't, I think it would be

In the out years, this would be good. In the out years, this would help us.

I don't know if we've done that analysis either. I'm just saying that right now, what we're looking at would be costs in the present.

So this proposal started a couple of months ago. When is Department of Finance gonna do that analysis?

I think it's something that we're continuing to look into.

Look into deciding if you're gonna do the analysis?

I think we're looking at the proposal. We're looking at these conversations but

So you've been looking at it for a couple months now. Is there are you gonna do an actual analysis on your, on your look at what when the savings would kick in?

I think that we are just still looking at the proposal and what we're seeing in the immediate few that is that there would be cost in the immediate future.

So you can't say there's cost because you have not done an analysis. So you would I, it would be beneficial to your stance if there's an actual analysis you can show us. I've asked LAO. I hope to get some kind of analysis there. I would love Department of Finance your counter analysis to because that shows there's no political will if you haven't done an analysis.

I think for me that's the answer that you haven't seriously taken this proposal seriously because you haven't done your own analysis. I think it'd be great to have an analysis so that we can actually see your stance, Department of Finance's stance on if you think this would create outgoing savings and when it would create outgoing savings to have a more real life conversation on that. Okay, thank you.

Can anyone of the five panelists tell me how many CBASs have closed or on the verge of closing?

I know that's one of the

I actually have that data but I don't remember it offhand. I can tell you that there's been a shift in CBAS since it's moved into Managed Care. There's been closures in rural counties and in the North and a preference for Southern California open CBAS center openings having to do most likely with population density. And so the as the CBAS centers close they do tend to impact already underserved communities.

Right. Okay. And can you share on the '19 the transition from C to I of the 1915? We still need federal approval for that. Can you tell me an insight of the chances that it could be rejected or approved?

Historically, what have we seen here?

So I'll let [inaudible] to weigh in. I think generally speaking, these Hellman Community Based services, federal authorities historically are they're less sort of sensitive from a policy perspective. So it's less about the administration that's in the White House at the time and whether they support it. Usually, it's more about can the state demonstrate compliance with the applicable regulations and program requirements.

One program requirement that stands out, I think, as a challenge to shift the three 1915 waivers into a 1915 as proposed is the cost neutrality requirements.

But I'll ask Joe to further weigh in on his thoughts on moving these three into the 1915.

Thank you, Tyler. And I apologize for not introducing myself earlier. Joseph Billingsley with Department of Healthcare Services. So, yes, difficulties with implementing a 1915 I or less so with with the actual federal, likelihood of federal approval and more so with the details and how that is implemented. Tyler mentioned cost neutrality.

In addition, CMS, you know, there's strict rules around 1915 I from a standpoint of how we define the eligible populations and then also from a standpoint of how it is set up and meeting conflict of interest requirements within the 1915 I which are stricter even than within the 1915 C waivers. And so being able to set it up in a way that meets federal requirements while also meeting the goals of the state and falling within the budgeted goals for that program.

So it is you know, a difficult process, to go through in checking all the boxes that are required, from a federal standpoint for 1915 I, and being able to implement, in a way that works within our existing systems.

Actually I think 1959 doesn't have cost neutrality because you're not serving a nursing facility population. So you don't have to. Yeah. So actually from that perspective, I think it's easier since you don't have to show cost neutrality. It solves one of the biggest problems that I think from a federal perspective DHCS has with expanding 1915 C which you have to show cost neutrality and so you're serving less of the preventative care population and more of the nursing facility.

I think from the state's perspective the financial challenge can be mitigated. It's true that you can't use the nursing facility level of care which is the highest level of care requirement but you could use you could structure a 1915 I based on the needs criteria. So you could look at, for example, IHSS. We're now serving a 900,000 people in IHSS. Half of the population is at nursing facility level of care.

Half population is at needs criteria. So looking at the IHSS needs criteria, you could essentially match that to the 1959 I, have an individual get IHSS when that's no longer enough, you can move into the I. And that would limit the population and it's you know when you're thinking about the entire medical population it's not like all of a sudden the entire medical population is going to apply for the 1915 I.

So you could structure your program in a way that people with the functional needs that would be satisfied by that program are the ones that are receiving it. That would be the way to do budget control for the state.

Just kind of make sure that you're not opening the doors just you know anyone who feels like I mean I don't know who would do that but you know you can structure it based on people's needs and again kind of looking at the IHSS population and limiting access for the fraction of the IHSS population that needs more than those personal care services are able to deliver.

Were those kind of the guard rows you were talking about?

I'm not gonna presume to understand some of the different codes that were just happening here from the consumer perspective.

I'm working on it too. So yeah.

Then we're all in it together. It's I believe it is. It's I would just as an example so I live in a subsidized apartment building that's for seniors and people with disabilities. I've been there for twenty years. I've lost count of the number of neighbors who just who have IHSS.

So we're in the 900,000 who have IHSS hours but so many people just can't manage it. Like don't have the executive functioning or as dementia increases. So they're just not in a position where they can supervise it. And so I think that would tie into it. But I think there's also that I think specifically what what Hagar was talking about gets to for example, a friend who lives here in Sacramento County who relies on a ventilator.

And he has very different IHSS needs than I do where I'm gonna dislocate joints when I do my laundry. And so and so that I think that might tie in with what you're doing.

Yeah. I think you know, IHS provides a maximum of 283 hours a month. And so if you're a person where you need 283 hours a month that works for you and that's great. And if you're a person who needs less than that but can't direct your care, you have Alzheimer's and dementia and you need really more on the on the 24 hour supervision side. IHSS isn't gonna do it for you.

And the only other option for you is as a person with Alzheimer's or dementia is to go on into institution or get WPCS hours through the HCBA. You might not need the private duty nursing under HCBA but you need those personal care services and so you can't wait if you're if you have Alzheimer's you can't wait three years on the community waitlist. So you are going to end up in an institution because there's no actual service can meet that need.

If you have a holistic sort of one stop shop program that says, okay, well, you don't need private duty nursing, so we're not going to give you that, but we'll give you 24 hours of care, then now you've solved that problem for the individual. That individual doesn't need it meets the requirement for IHS, but they can't really access it.

So you've offered a solution that steps in. It's just not the entire package and you're not holding taking up slots based on, you know, only one fraction of the one service within that waiver.

And that kind of triggered something we talked about presumptive eligibility. I'd like to hear from the department of the barriers to implementing a procedure like that. Where the you know, the approval or the process to review it takes so long they might lose their slot. We know they're gonna be eligible. What's the barrier or what is the whole bag to implementing that kind of approach?

So I think working through the federal approval process, it's not something that we've done for any of our HCBS waivers. So that's an unknown, you know, process first from that standpoint. And then also just understanding that with presumptive eligibility, while expected that most individuals would qualify for the services. We also run into the risk of individuals that are presumed eligible, receiving services, and then determined ineligible and having to go through process of then taking services away.

You've encountered, you've encountered that?

Yes. I mean, we have individuals that come in for waiver enrollment that are denied. I mean, majority are enrolled, but not every individual that is submitted for enrollment into our various waiver programs is found eligible and approved.

Okay. And what is the need for caps on enrollment?

So 1915 C waivers do allow for states to or actually they require states to identify how many individuals are going to be served in each waiver year. And so this does allow for states to cap the number of individuals that can be served. From a waiver perspective. Historically, one, it's useful when a waiver is initiated in terms of piloting that waiver and ensuring that it's working correctly.

And then also allows states the ability to grow that waiver responsibly within bounds of state budgetary constraints as well as capacity of the program to effectively and timely provide access to services.

Okay. I'll use this opportunity for final thoughts from everyone on this.

Kate Myers from CHCF. I wanted to just provide one other piece of context that as we're talking about the gaps within programs or difficulties for people to access programs and that the end result of that is that often people decondition and wind up having to go into a nursing facility. We also have a limited number of nursing facility beds available in the state at the risk of stating the obvious.

It's not an infinite number, and we know today that a lot of nursing facilities, may not accept someone who is enrolled in Medi Cal as they wait for a Medicare patient, for example. And so

They want Medi Medi?

Could be. And or private pay.

And as our population growth continues at this pace that it's at, our older adult population growth, I think the notion of thinking about this sort of from a more holistic standpoint and from a systems level of what what can we do today that will help prepare us for where we need to be in ten years or where we need to be in fifteen years given where we are with the number of nursing facility beds today and the constraints there and the difficulty people have even accessing those from a hospital setting and so forth.

So I just wanted to keep that in mind as we're talking about these issues.

Any final, other final thoughts from anyone else?

So I'll be glad to jump in. One thing that we haven't talked about is who's doing the providing the care within IHSS. 70% of the providers in the program are providing care to family members.

Right.

And so that's I think it's really important to keep that in mind that that's also a way that families are remaining financially viable as well as keeping, keeping people with disabilities out of care. And I think that the dynamic if you're getting care from a family member or from a friend or neighbor or somebody that you've found can be different than if you're trying to hire somebody off of the registry.

And it just it can be difficult to find a it's easier for me to come in here and testify in the Senate hearing than to find a new provider. So it's not easy. And

Doesn't that also help to close the gap in rural areas? Like this kind of opening this.

Yeah, anything that we can do. Yeah, yeah and definitely closing the gap in rural areas would be tremendous.

One of the things that I think is really important to consider is to consider these programs and proposals from a consumer perspective. Like Hagar said that one of the beauties of Be Home Soon is that it's considering the consumers much more.

And the amount of paperwork that is required to be disabled and poor is tremendous. So my subsidized housing and we get federal and then two state programs. Every year my recertification file is more than two inches thick.

And that's just one of my programs. And so that's not also counting everything you have to deal with with Medicare, Medi Cal, two different social security programs. If you're doing CalFresh, IHSS and all of these have different forms. You have to get different information. Sometimes it's similar information but needs to be presented a different way.

If there could be a way to unify these forms so that people can just fill it out. And you know, the way that University of California went to if there's an application you press, you know, press the button.

Or problem with government. Anything, any program, paperwork.

Exactly. And people, people stop living in the community because they can't do it. And so if we have somebody who can assist with that, if if we're not able to fix the paperwork problem, I think that that really has to be a big part of it because otherwise people just they go someplace else.

Thank you.

I just want to leave you with just I think that the department's experience with assisted living waiver and managing that wait list is really a cautionary tale for what we're going to be seeing across the board in the coming years. If you're adding, if you're doing only incremental steps, you're adding a few slots maybe 1,800 slots a year but your enrollment is skyrocketing. Those incremental steps are just not going to cut it.

And we're going to be seeing an increased number of people who are not getting served and who are putting pressures that it's not again like it said there's not enough beds in nursing facilities so it's putting pressure not just on nursing facilities but also on hospitals, also on family members, also on housing providers.

And so I think without looking taking a big picture view of this and really trying to redo the system so that it works for provide for consumers and centers the consumer first in the consumer experience and making sure that people can actually access services before they go into nursing homes.

Things are going to get really expensive. And very very difficult for Californians. So I think that you know the devil's in the details these these are ambitious proposals that require thought and debate on how to best implement and I'm open to continue that discussion with the department but to dismiss it off hand is you know this is too difficult and too expensive I think is a mistake. I agree. B?

Yeah I just wanted to to to add emphasize the caregiver shortage. You know often that's

the reason why clients go back to the hospital or the nursing

facilities because they lost their evening or the nursing facilities because they lost their evening or weekend caregiver. IHSS has two pathways. One is the IHSS self directed where the consumer is the person hiring and approving time sheets, and the other one is the contract mode. And a lot of counties don't wanna do contract mode because it is more expensive.

It requires an entity to manage and train caregivers, which for clients who can't manage their care and having the continuity of an entity, like sending caregivers to your home and then or sending caregivers when you come out of the hospital and they're there for you where you don't have to manage them but you need care, that could be a caregiver model to support a lot of people who are destabilizing in the community.

I think if I may add on to really quickly. Really great point is that what I've heard from counties is that they want to make sure that there's an unfunded mandate that comes to them to carry out Be Home Sweet California with that.

Of course they do.

Thank you so much, I appreciate participating in this panel. I still have questions for the department on two separate topics so if you can stay up here please. Appreciate it.

Thank you. And it's so exciting to come speak in favor of something. Thank you so much.

There are two topics I wanted to bring up. A couple, I don't know what time one of the hearings here I've asked about the emergency dialysis situation and the administration decision to remove that. I wanted to know if there's additional information you could share with me because it appears like we're the only state doing it. So I just wanted to a little this is a little personal for me and I wanna I don't want dialysis access to only happen in ERs in hospitals.

That would be devastating.

I just want to know if the department has just stopped looking into this. Like what are our options here to not be the only option?

Thank you. Thank you, Chair. And frankly we shared the concerns about the new restriction on covering outpatient and routine dialysis as emergency MedicAid for MediCal members with unsatisfactory immigration status. So that again, just to sort of provide the context that I provided, that was not a decision made by the department. That was direction given to the department by CMS during their review of our claim for federal funding for emergency MedicAid.

We have been, under sort of an ongoing and open review of how we operate our state only program where we expanded medical coverage to individuals who don't qualify for federally funded Medi Cal because of their immigration status. Of course, we draw down federal financial participation, FFP, wherever we can under federal rules, allowing that for emergency MedicAid. We have always claimed outpatient and routine dialysis as emergency MedicAid.

And late last year, CMS, as part of their open and intensive review of our claiming procedures related to the UIS population directed us to change our benefits coverage policy and to stop drawing down federal funding for outpatient and routine dialysis under the emergency MedicAid policy.

Were we the only state that was drawing those funds?

So based on my understanding, which is not an exhaustive and complete scan of the nation, I am aware of other states that have, you know, historically covered it the way we had covered it. And, up until recently, I was not aware of CMS directing any other state in the way that they directed us. But just in the past several weeks, I have heard that CMS has reached out to several other states regarding this topic specifically.

And is it a cost then to I can imagine it cost to switch over to state only?

So that is something that the LAO has reached out to the department on and we're engaging with the LAO to identify sort of where the department to cover outpatient and routine dialysis as a state only benefit for people who have restricted scope MediCal today, who are only eligibles for emergency MediCal today, what would that cost be? So we're looking into that.

How many members do we know? How many lives?

I apologize, Senator. I don't have it off hand.

I'm really interested in investing in this topic. I think last time I asked about if an analysis, impact analysis was ever run-in this space. The Director mentioned that she was gonna look back and see if we can get something like that. I don't think I've received anything since.

I love an impact and I need an impact analysis on this. I need to see what the cost would be to go over to the state and how many lives this is covering. If I recognize there's still outstanding budget issues that we need to work on but this is really important for me I'd like to get a response on that.

Understood. Would you prefer that via the LAO or directly?

As soon as you have something you're sending to LAO, I'd love to receive it at the same time.

Okay.

Yeah. And the next the next topic I wanted to bring up is this never landed in the budget regarding this the skilled nursing facilities, the reimbursement and the WQIP. Yes, WQIP. The WQIP. I recognized last year we decided to do a one year because they were going to come back and renegotiate but that year was now extended.

It's come to my attention that we allocate, Department of Finance, we allocate funding that with the assumption that every skill is every single facility is going to utilize the full 5% COLA. Some don't and there's additional funding that is left over from what we already allocated to them. That as I'm understanding just goes back into the general fund.

But if we've allocated those dollars already for that, those that entity, what are the opportunities to use those funds to go back to the skilled nursing facilities given that now it's gonna be two years that we're not giving them the WQIP. Does that make sense?

So looking more broadly. So when we're budgeting for the medical program, the Department of Healthcare Services, they're gonna publish their estimate twice a year at the release of the Governor's budget in January and then at the release of the May revision in May.

So at these two points in time, sort of broadly, the estimated costs, they're going to be revised based on the updated actual information and then various, like, aspects of the MediCal program within the current fiscal year and then also the upcoming fiscal year.

And so if at this kind of updated estimate, the May revision, we don't we wouldn't score savings specifically for a specific program if they weren't all used. I mean rather, like, we would instead kind of look at the larger budget picture for the MediCal program and for the state overall, decreases and increases across kind of all of those programs that we're looking at for MediCal and across the state budget, kind of given the large impact of MediCal on the state budget.

Okay. I feel like I just got like a recap of how the budget works. I don't need that. It's where do the savings go from that allocation? I mean It seems like every single year there are savings.

They don't use the full allocated amount. Where did where does that go?

Broadly I think they're just going to the overall MediCal program generally.

Okay. What, if any, consideration can be given to because we've not addressed, or have not there's gonna be no negotiation for I forgot the but there's no renegotiation for like every three years and there's no WQIP either. What consideration can be given if there's savings at the end of the '26-'27 budget to stay within that program and not just go into the MediCal program. If that those are already allocated for that specific entity or entities, can we look at just keeping it there?

Have we even considered that?

I mean I think broadly we again point to looking at the overall picture of MediCal in the state budget. This isn't that's we typically like we're not the funds for this are not typically budgeted sort of in those like silo. We're looking at this for the overall medical picture. So that's I think.

So in effect that the concept of sort of sweeping any surplus relative to sort of actual expenditures that come in beneath sort of projections related to SNF provider rate growth, would it in effect be a dedicated new appropriation?

How? If we appropriated for them already?

So from sort of a budget estimate perspective, it's not sort of a direct dedicated appropriation for that item. It's rather the skilled nursing facility provider rate growth item is a projection in the budget comprised of a complex mix of factors including sort of facility and service mix, federal funding splits, case load acuity and so forth. Largely driven by managed care plan rates which are

This is the balance budgeted on that projected amount?

It on a projected amount. But you know, in reality, if there is a in any given budget year, right? if the actual expenditures exceed the projected amount, we don't cap it. We don't say that's the appropriation. Rather, the budget absorbs that deficit and it either can make up for it or there are deficiencies that have to be addressed through sort of new appropriations or general fund loans, etcetera.

So just like there's no, there's no actual ceiling, there's also no floor if that makes sense.

Sure. Maybe LAO and Department of Finance if you can maybe for like the past three four years give me a historical recap of what has happened. Have we gone under or over this allocation or projected allocation and for skilled nursing facilities. I love to see if there's been historical pattern that they've exceeded a projected amount and or it's been a pattern of just under the allocated amount. Thank you.

Issue two.

Okay. We're moving on to the CARES system. We have a lot of individuals here. I will we'll have LAO kick it off.

Thank you, Madam Chair, and good morning. My name is Xin Ma with the Legislative Analyst Office. Today, I will be providing a brief overview of the CWS CARES project. CWS CARES is the state's IT project to replace the legacy child welfare case management system, CWS CMS, which has been in operation for nearly three decades. The legacy system is aging and it has limitations in meeting the state's current child welfare information needs.

It also does not meet current federal requirements for a comprehensive child welfare information system or CCWIS. These limitations have contributed to the state's challenges in meeting certain federal reporting requirements. For example, California is not currently in compliance with the twenty twenty final rule governing the adoption and federal, excuse me, adoption and foster care analysis and reporting system or AFCARS. And the state has been assessed financial penalties related to that non compliance.

And so to address these challenges, CWS CARES is intended to replace the legacy system with a modern federally compliant system that supports current state policies, streamlines case management activities, and improve how child welfare information is collected, shared, and managed across the state.

This project was initially approved in 2013 with a baseline cost of approximately $400,000,000 and a completion date of September 2017. Since then, the project has undergone multiple revisions to its scope, cost, schedule and implementation approach. And under the project's current approved baseline, the total project cost is approximately $1,700,000,000 approximately half of which is from the General Fund. And under the project's current plan, CWS CARES will be delivered through two major releases or versions.

The first version V1 is scheduled for statewide implementation on 10/26/2026, about two point five months away.

This version is intended to replace the core functionality of the legacy system and support new policies and programs. The second version, V2, will build upon V1 and is planned for implementation in April 2028. At which point, the system is expected to achieve full CCWIS compliance. With the upcoming release of V1, the project is at a critical point as the state completes development and testing and prepares counties and other users for this transition. This will be the project's first major statewide implementation milestone.

And that concludes my presentation. Thank you.

Thank you. We'll go over to the director.

Good morning Madam Chair and staff. Jennifer Troia on behalf of the Department of Social Services. Thank you for the opportunity to share more about the child welfare services California Automated Response and Engagement System or CWS CARES. As you've just heard, CARES is designed to modernize our statewide child welfare information system and to replace a very outdated legacy child welfare system, the CWS CMS system.

CARES is designed to be a more stable, a more modern system that's easier for workers to use and that helps them get information more quickly and accurately.

It is intended to support work in the field, reduce duplicate data entry and give the workers, the counties and the state clearer insight into what children and families need. Launching CWS Cares on time is essential to maintaining federal funding, avoiding major penalties, keeping our system stable and children safe, and ensuring that counties have the tools they need to support children and families. CWS CARES is governed through a shared state county governance structure.

The Department of Social Services and the Office of Technology and Solutions Integration oversee the project, while counties also play a central role in shaping requirements, testing features, implementation through formal advisory groups, governance committees, including our executive leadership team and our board of directors. The partnership is designed to ensure that the system reflects the front line needs and supports consistency statewide.

We understand that the counties and county welfare directors association have raised concerns around going live in October and whether the system will be ready. As your agenda outlines, CWDA is more specifically requesting a delay in CARES launch by what they estimate to be about six to eight months to no later than 06/30/2027.

Before I speak to our analysis of the proposal and answer the questions in the agenda, I want to emphasize what I think we all agree on, which is that child safety and the smooth reliable operations of our county child protective services systems are our highest priorities. I appreciate that we have differing perspectives that we will offer you today coming all from that same commitment to protecting children and families and supporting the workers who serve them.

So with that in mind from the administration's perspective I think it's important to share that CDSS, OTSI and the administration have carefully evaluated CWDA's proposal and we believe that it would result in a substantially longer delay than the six to eight months projected.

Our initial analysis indicates the delay would more likely range from twenty seven to thirty nine months And a delay of this magnitude would carry significant fiscal and operational consequences. We estimate the actual cost exposure could range from $558,000,000 in general fund to 1,200,000,000 which represents the combined cost for the delay and the carrying costs for the two systems for that extended period. Importantly, we also believe such an extended delay would pose a serious risk to child safety.

We cannot rely on the current CWS CMS system to remain viable really for another six to eight months, let alone significantly longer. For these reasons and because we believe that CWS Cares will be ready to perform essential functions needed in time, The administration does not recommend delaying the launch of CWS Cares.

We're committed to achieving necessary system readiness by the October 26 go live date and to doing so in close partnership with our county child welfare and probation colleagues and with other stakeholders. I will turn it over to Assistant Deputy Director Diana Wagner to answer some of the questions in your agenda and the remaining questions in the agenda for the administration's part will be answered by Chief Deputy Director Hansard from OTSI when it's his turn.

Good morning. My name is Diana Wagner and I'm the Assistant Deputy Director over CDSS Children and Family Services Division. I will be happy to address the question in the agenda, but before talking about the health and progress of CWS Cares project, it is important to add some additional details about the health of the current CWS CMS system.

CWS CMS is currently functioning on obsolete technology and counties are doing critical work every day in an environment that cannot get security patches or defect fixes And that creates real risk. We must transition to a long term option that supports safety, daily operations, and meet state and federal reporting requirements.

The CWS CARES project is in an intensive phase of final development, and several project health indicators are currently marked red. While we are candid about the red indicators, we also believe they reflect the pace and complexity of the work rather than the systemic failure. Items that are incomplete remain red even where the issue is identified and a fix is in progress. As we will discuss, critical issues are well understood and actively being addressed today. The CWS CARES governance structure includes CWDA, CDSS, and OTSI.

This unique governance has provided an opportunity for a co creation with the counties, tribes, CWDA, and front line users. No other statewide automation effort has involved this level of co creation. Counties have shaped the design, functionality, testing, training, and the rollout approach. The project currently has 14 county consultants that participate as full time employees on the project, and more than 95 core county participants that have supported the design and development of CWS care system.

And I will add that this engagement model was developed in partnership by the state and CWDA.

Through this collaborative structure, measurable progress is occurring every day to stabilize the system, resolving critical and high impact defects, validating data conversion, and complete performance, scalability, and security testing. Recent releases have delivered clearer, more reliable workflows for county users, demonstrated that the system continues to be strengthened as we approach go live. The collaboration between CDSS, OTSI, and county partners is productive and focused, accelerating issue resolution and readiness preparation. We understand that there are changes in the system that look, feel, and flow differently than before.

And in the intake process this will take time to learn.

I will add that team members on the CARES team are able to complete the mandated screening fields within approximately thirty minutes, and one of our experts is able to complete it in much less time. We recognize the criticality of this functionality and have responded to county feedback and are continuing to partner with the counties to ensure the hotline process is effective. Based on the current trajectory, we believe the system will be ready for the planned end of October go live within the approved budget.

There are 36 milestones that the project must meet, and as of today, we have met 26 of them. The remaining 10 milestones are on track to be completed prior to the 10/26/2026 go live.

All critical and high defects and a prioritized list of essential stories are on track to be completed before go live. These updates and fixes are delivered to the project, to the production simulation environment every week and become available for county validation. All remaining critical work is assigned and tracked through daily governance mechanisms. The state team, counties, and our vendors start and finish every day together, tracking the critical items for go live.

County training, on boarding, and feedback loops are progressing, and that input is driving improvements to the system.

In regards to the feedback highlighted from the counties, highlighted to the committee from the counties, child safety remains our highest priority. And we continue to work with counties to identify and address related issues prior to go live. Specifically, this reference is to the essential stories, which are short, simple descriptions of a software feature that optimizes county workflow written from the end user point of view. We are committed to fixing and developing workarounds for those essential stories where there are potential safety risks. Examples of essential functionality.

The project has added safety alert banners across case and referral screenings to highlight safety concerns. Things such as a dangerous animal in the house, or even if there's a history of DV in the family. There are search refinement updates to ensure eligibility workers can receive placement information, so resource families can receive payments which support child stability.

Also, a language spoken field is prioritized for inclusion in go live to ensure that when a social worker shows up to a family's home, they can clearly communicate the purpose of the investigation to the family. Examples of non essential functionality with work arounds.

There's a print view of a person, which really gives a summary view of a person in the system. There is an enhanced version that will be delivered after go live. In the interim, a work around utilizing a feature available in safe measures will allow the user to click on the person record and get an easy to use print view. This is something that counties use today. The CARES system has the functionality to sort, compile and print contacts and delivered service logs.

Post go live enhancements will be added allowing for additional filters for search results and for specialized reports view, such as family findings summary view. We acknowledge that there is important work still happening and the overall project trajectory is positive, sustainable, and supported by a strong inter agency commitments. We remain fully focused on delivering a modern system that fully replaces the current CWS CMS system used today, and that will improve outcomes for children and families.

We believe that the proposed delay to implement would unnecessarily delay the project by years, cost hundreds of millions of dollars, and increase risk to child safety due to the fragileness of the existing system. We appreciate the legislature's ongoing oversight and support, and we are committed to maintaining transparency as we move through the final phases of readiness.

With that I will defer to OTSI Chief Deputy Director Brandon Hansard to respond to the remaining questions in the agenda when it's sent his turn to present.

I'm Hugo now. Just makes sense.

Okay. Thank you. Good good morning madam Chair. My my name is Brandon Hansard. I'm Chief Deputy Director at the Office of Technology and Solutions Integration.

I'll address the remaining questions in your agenda starting with question two. You asked to summarize key design decisions and changes to the project that have occurred within the past twelve months and how these changes have affected the project plan and implementation including the plan and schedule for training system users. In terms of key design decisions, I'm going to highlight some of the largest. Changes to projects that have occurred within the past twelve months.

In July 2025, ACF informed the project that they did not support a small county pilot as we had planned.

Due to the cost and because it was not focused on organizational change management across the state, the project then evaluated and determined that a production simulation environment would allow all counties to test mock CWS CARES system using current system data, test the system interfaces with external systems, and allow for the project to conduct performance testing with actual users to determine how the system reacts. This expanded approach increased hands on practice for all county users and improve the state to improve the statewide readiness.

This did require a redesign of our implementation plan and timeline. So in March 2026, the project made a decision to change our implementation services vendor to provide the county's additional support for in person training and in person on-site support go live. The project is delivering train the trainer and instructor led training, utilizing the production simulation environment for practice, and training was redesigned to reduce time in classroom for the trainers and users based on county feedback.

In navigating federal approvals and transitioning to a new implementation services vendor, we did have some slippage on training activities in the schedule. But we were able to reprocure our our vendor in only three weeks, helped minimize the delays and we implemented a new training plan in coordination with the new vendor. So the in person training options would be provided which was a top priority for counties. ACF has been briefed on all these changes and is supportive of the current approach of the project.

Failure to meet the agreed upon timeline puts the state at risk of non compliance with our existing advanced planning document.

We have also made targeted adjustments to system functionality to address possible safety concerns such as redesigning resource management functionality, streamline look and feel for easier navigation, enhance safety alert banners, search print view enhancements with approved workarounds such as safe measures. A highlight right now that that has been discussed in in the CWD letter is hotline.

Some of the changes that we've made to hotline have been referenced but to reiterate we we are providing a one page reference guide to provide clearly identified only mandatory fields that hotline screeners must complete in v one to submit a screening and promote it to a referral. Required data entry, clearly distinguishes required fields from optional fields, and separately identifies the required initial inquiry field.

And again, on average, the folks on the project are able to complete this in thirty minutes with having more hands on experience with the new system.

We expect as it continues to roll out in production simulation that other users will also have the same experience. We also took one other action on hotline, which was the intake approval process. We are updating to allow Screener Hotline workers to promote a screening to a referral immediately after submitting it, without waiting for supervisor to complete the approval. This option will be made available when invest when the investigative referral pathway is selected.

And once promoted, the screening will remain in a pending approval status, allowing the hotline worker or supervisor to continue updating the screening details until the supervisor approves it.

The screening details until the supervisor approves it. I'll go on to question three. The project's plan and timeline for delivering converted data, resolving defects, and training system users prior to go live in October 26. So again, a product defect is a failure in the software to perform a function as specified in our requirements. Defects are evaluated based on technical criteria and business impact such as is there a work stoppage, is there a reasonable program approved workaround.

And then we bucket those into into severities, low, medium, high, and critical. And we are required the project is required to fix all critical and high severity defects prior to go live, and we are on track to meet that requirement. For data conversion, child welfare, CWS, CMS has over thirty years of data, over 2,000,000,000 records must be extracted and translated into the care system.

This data is important to convert to ensure child safety and continuity of case management, as well as to meet the federal and state reporting in support of children and families. Counties are validating our eighth cycle of data conversion.

It's called mock two. It is the the largest data set that we have provided to date for validation. And we are on schedule for what we are calling mock three. Again, the full data set at a point in time to be validated in multiple environments including production simulation. Data conversion defect resolution is occurring right now on a weekly basis prior to our next Mach three cycle.

And in order to ensure the most up to date data from CMS is in CARES, on September 29, if there is a Go decision, the project will start what we call micro conversion process that will capture all data changes in CMS that have occurred since Mach three until go live. For training to prepare the users for the new system, currently we are in train the trainer and instructor led courses are underway in our dedicated training environment.

In addition, over 25,000 county staff have been given full access to production simulation for hands on practice. Counties have dedicated environment to develop and test their county forms and reports and gain familiarity with this functionality. The project provides support and office hours for each of these environments and workflows.

And programs and lessons were made available to all users in production simulation on 06/30/2026. The biggest shift in our training approach was based on feedback that it was that we offer the in person instructor led training as close to go live as possible. It did start on August 3 and will continue all the way through October. And lastly, for go live support, counties will receive up to thirty days of on-site support and sixty days of virtual support by the project vendor during launch.

For question four, again the counties have stated a myriad of design flaws that pose direct risk to child safety are not scheduled to be fixed by October 26.

Please describe the project's approach addressing the identified risk child safety, provide concrete examples of the functionality that have been identified as essential and how it will be addressed. And functionality

You don't have to read the whole question.

Okay. Just wanna make sure. Okay. Again, child safety is our highest priority. It's everyone here at the table is putting that first and foremost.

We continue to work with counties to identify and address safety related issues and address them prior to go live. Specifically, this refers to what we've been calling essential stories. They're the short simple descriptions of the software that optimize the workflow and and what the essential part is that it was determined was needed for go live. We committed to fixing or developing short term workarounds for those critical essential stories where there are potential safety concerns.

And again, my colleague has already highlighted some of the, ones that were identified as essential versus non essential.

Be glad to to reiterate if if need be. But the commitment is there to make sure that we have those essential stories delivered at go live or shortly after with approved workarounds. And then for question five, again, how do we know that the project's ready for go live in the coming months, and what criteria will it be based on? Our readiness will be decided using clear, measurable, objective criteria across 24 critical readiness areas monitored through checkpoint processes.

Criteria includes closure of all critical and high defects, validation and reconciliation of data conversion, successful performance, scalability, and security testing, complete completion of readiness milestones, county readiness reports on tasks completed submitted by counties and reviewed in biweekly meetings with implementation managers, operational command center preparedness for go live.

And we are monitoring this through our governance and through formal readiness checkpoints at a hundred and twenty days prior to go live, ninety, sixty, and 30, each of which can inform if there should be a decision to delay. And the formal go live decision currently set for 09/29/2026 will be informed by these checkpoints and a more formal checklist.

We will also, after September 29, follow weekly progress updates that could also inform if there is need to to change a decision from the go go to or no go decision. And then lastly, the administration's plan to achieve county readiness by training users prior to go live and how does that criteria of go live factor in training? So the county readiness is supported through train the trainer, instructor led training.

Again, this full access that we've given to production simulation, monthly county organizational readiness checkpoints, local and statewide support to stand up command centers, ninety days of post launch support with 30 on-site and 60 virtual. And currently we are monitoring these readiness activities. And as of last report, of the 90 readiness activities, 18 are complete, 51 are on schedule, and 21 are being actively managed because they are behind schedule. But we are managing and monitoring to make sure that they are brought.

Brought back, income into the schedule. And then last, training progress is measured through readiness checkpoints. County readiness tasks is a factor in the go live criteria and will be reviewed at each checkpoint leading up to that September 29, decision. That concludes the answers to the in agenda questions.

Thank you. CWD.

Good morning. Madam Chair, Carlos Marquez on behalf of the County Welfare Directors Association. Thank you for the opportunity to discuss our risk assessment of CWS CARES and our request for an urgent delay to the planned system launch. Based on robust system user feedback from social workers who are actively testing the systems functionality in real time And from county child child welfare leadership, we've reached the conclusion that the cares go live date as currently planned is incompatible with our mandate to keep vulnerable children safe.

Guaranteeing the protection of child safety and worker safety must be a necessary precondition of any launch.

Based on the system's current performance, while child welfare has been, workers have been testing and training in production simulation over the last seven weeks as well as previous cycles of extended user feedback. The system as it exists today cannot guarantee these protections and remains too unstable for release into a live child welfare environment where the safety of children, hangs in the balance.

The system's current limitations are shaking the confidence of frontline workers and have given us no other option but to seek legislative intervention for a delay. And while we continue to make steady progress with our state partners, in remediating major functional defects, We simply don't have any time left to validate whether those fixes are adequate. And our concerns remain high that a major system failure is still probable.

Examples of major safety risks that counties have identified to date are and that the state is actively working with us to remediate include the following. A substantial increase in the time it takes to process a hotline call from a mandated reporter like a teacher or a doctor who is calling to report allegations of child abuse or neglect. Cares hotline documentation can take up to two hours to complete for a call that takes fifteen minutes now.

When there is an immediate safety concern, such as severe physical abuse or a sexual perpetrator in the home, delays in reporting and response can leave the child vulnerable to being harmed again. In order to protect themselves and the children that they are charged to protect, it's vital that social workers have access to as much existing child welfare history as possible before interacting with a family.

Information that can typically be accessed through contact notes, logs, and safety alerts. Currently, CARE safety alerts are not populating properly, leaving emergency response social workers blind to the risks both children in the home and they themselves may be exposed to when being dispatched to a home visit or investigation like firearms or aggressive animals in the home.

Access to child welfare history is also essential for the social worker to conduct accurate safety assessments and to develop case plans that are responsive to the needs and the strengths of children and their families. To prevent unnecessary family separation, to connect families with the services they need to stay together and to reunite as soon as is safely possible and to ultimately minimize unwarranted involvement of the child welfare system in the lives of children and families.

The process in CARES for accessing this information is incredibly complex and time consuming, which we worry may also impact discovery for dependency hearings and civil litigation.

If a child must be removed from the home, locating placement options for children who require immediate placement takes substantially longer and timely and accurate payments to resource families once those placements have been made are currently a challenge in cares. This lack of essential functionality risks prolonged stays in foster care and placement disruptions.

Once the child is placed with a caregiver, the accurate and timely transfer of certain records to the caregiver such as a child's known allergies, their vaccine status, chronic health conditions like diabetes, or the need for psychotropic medications can be life saving. Today, due to data conversion issues and cares, this information is not populating accurately or is not even intelligible.

Our county users are also facing roadblocks in training, including the quality of training delivery, rendering rendering counties unable to update their local policies and procedures to align with the new system functionality since the system itself in our view is unfinished.

I wish I could convey with confidence that these examples represent the full balance of unresolved system gaps and that once fixed we will be ready for go live. However, the more issues we discover as the system is stress tested in production simulation, the less confident we feel that an October launch date is responsible and why we believe our exposure to federal noncompliance increases should we choose to launch as planned with an incomplete system.

In closing, recognizing the administration's response to CWDA's six to eight month delay proposal, their view of our of the feasibility of our proposal, and though, offering that a window of up to fifty nine days may exist before new federal approvals are triggered.

CWDA requests that the state and the legislature work with us to exhaust all delay options within that fifty nine day window that may adequately mitigate risks to both child safety and federal noncompliance and to codify the terms of such a delay before the legislature adjourns this year.

While our risk assessment hasn't changed in recognition of the progress that is being made with the project and vendors, we look forward to finalizing an alternative path forward with the legislature and the administration that protects the safety of children and workers and ushers our child welfare system into the future.

Thank you. Now we'll turn over to our two contractors. We'll start with Deloitte.

Good morning Chairman Najjar. My name is Kevin Kelly. I'm a principal with Deloitte and I lead our work with the California government. I appreciate the opportunity to be here today to discuss our role in supporting

Don't lie. It's okay.

I appreciate that more. With the state's efforts to modernize the child welfare and case management system, Your commitment to supporting vulnerable children and families across California is clear. I want to underscore that Deloitte shares the seriousness and responsibility of this work. Deloitte's professionals have been working alongside OTSI, Department of Social Services, CWDA, the counties, tribes, and vendor partners to help bring the CWS CARES system online.

Deloitte's role is focused on building and testing the CARES application and preparing the technology with other vendor support for the state's planned October go live.

For launch to be successful readiness needs to be evaluated within a broader operating ecosystem which includes supporting child and worker safety. Those items include system functionality and quality, aligned policies and procedures, clear implementation steps and coordination across the ecosystem, trained and supported workers who understand and can execute against the new business processes, shared escalation paths to enable planned and or just in time communication or decisions. Project implementations are a defined process.

We are working in accordance with the established and agreed to plan and progressing towards October. Implementation of CARES V1 is not the end, but instead a start of something new, something that will continue to evolve and be enhanced based on policy, business practice and functional changes into the future.

Replacing the thirty year old CWS CMS with a modern care system that spans 58 counties, the state, tribes and resource families while maintaining and meeting regulatory compliance requirements in a single statewide implementation is a significant undertaking. As the leader of Deloitte's work in California government I can attest firsthand to the dedication and care our team has brought to this effort. Deloitte remains committed to supporting the vision for a modern child welfare system and supporting the wellness of children and the people who support them.

I'm happy to discuss our role and the portions that Deloitte oversees and answer any questions that may pertain to that. Thank you.

With that I turn it to Alan.

Good morning madam Chair.

If you can put the mic a loop. Yeah. That's for you. Thank you.

Good morning madam Chair. My name is Alan Sheldon and I'm a principal with KPMG's advisory practice responsible for our work with the state of California. Thank you for the opportunity in all seriousness to discuss the CARES project. Per your instructions, I will address the specific questions provided in advance. First, I wanna recognize the importance of the state's investment in modernizing its child welfare system for the betterment of children, families, caregivers, and the county professionals who rely on it daily.

CARES is a project ten and a half weeks from go live with strong state leadership who have shepherded what many in the industry consider to be the largest, most complex child welfare modernization and transformation in the nation. At the same time, we acknowledge the risks and areas that CWDA identified and that the project must continue to track and mitigate to achieve a successful implementation. For the first question regarding our role, KPMG has been a contractor on this project since 03/01/2021, serving two main functions.

First, as the product value services vendor, we were responsible for researching business requirements, facilitating stakeholder sessions, and collecting user feedback. Currently, we provide real time system support as users test functionality in what is called production simulation.

On 03/24/2026, our role expanded to include the scope of the implementation services vendor. This involves developing a training program for 25,000 users, leading change management efforts, assisting with go live readiness, and planning for post launch support. Note as a contractor, we do not establish policy, determine funding or set deployment dates. Our responsibility is to provide objective advice, transparent reporting and delivery support to help California make informed decisions and achieve a successful implementation.

To that end and in response to the second question regarding key risks and challenges, we have observed three major focus areas as we approach go live.

The first is maintaining a shared vision of stable functionality for all users. For this, Deloitte is responsible for technical readiness and resolving defects while we support users as new functionality is deployed to the production simulation and training environments. The second area is achieving technical readiness and stabilizing the system which is Deloitte's focus. The third is implementing an accelerated training plan which is KPMG's focus. Our shared objective is to minimize disruption by identifying issues early, resolving them quickly, and providing intensive post go live support.

For the third question regarding manual workarounds, the project's goal is to minimize them and to date no major pen and paper processes have been identified. It is not uncommon for implementations of this scale to have some workarounds initially. It is prudent to phase the deployment to reduce risks associated with complex functionality that is not critical on day one. State leadership is confirming a plan that distinguishes which features will be implemented at go live versus those scheduled for later deployment.

This strategy allows for a stable initial launch while providing a clear path for future functionality.

KPMG supports this by updating training materials to reflect decisions as they are made. We also proactively communicate known workarounds which allows trainers to inform users of the exact steps needed at go live and gives them an opportunity to practice. Should workarounds be needed, we reduce their risk through quick reference job aids. Furthermore, our go live support includes one month of on-site over the shoulder assistance and three months of virtual support.

For the fourth question regarding training needs after the system stabilizes, we expect those to be limited.

The train the trainer and instructor led training already underway are supported by materials that will be updated as new functionality is deployed. CARES also benefits from the extended use of production simulation and dynamic training before go live, giving users time to practice in a realistic environment. Finally, you asked how KPMG works with the state to address high risk issues. In these final weeks before go live, close collaboration across the integrated project team is key to addressing high risk high risk issues efficiently.

The project holds twice daily calls with leadership from the state, CWDA, and vendors to escalate triage and resolve risks.

Daily operational reporting provides insight into ongoing challenges and details specific risks and mitigation plans. We also maintain continuous county engagement through direct and frequent interactions allowing us to capture readiness input, monitor progress, and address concerns as they arise. In closing, I wanna stress KPMG's continued commitment to standing shoulder to shoulder with the state and counties throughout this transformation.

Our dedicated professionals are mission driven and believe strongly in providing a better experience for end users and by extension a better way to protect and serve the children and families of California. Thank you.

Does Department of Finance have anything to add?

Chris Cook, Department of Finance. Nothing additional.

Okay. So let's thank you for your remarks. Let's dive into it. I'll start with Chief Deputy Director. So we for the for months, for years, we've kept hearing everything's okay, everything's okay.

I think you yourself have been here, everything's on track, everything's okay. And today your presentation is like everything's okay, we're gonna be on track, October 26. How do you that kind of, presentation I would assume doesn't, trigger a the building is burning kind of response or MCWDA. What's the disconnect? You have one side is saying everything's okay.

You have another side is kids are gonna get hurt. That's a very different perspective of it.

It is. And again, I am not going to sugarcoat and say that everything is is okay. We have read in our milestone reporting. We report monthly to the to the LAO, to our project oversight. We are behind on certain activities.

We are in a compressed schedule to get to October, but we do have mitigations in place. We are actively managing, and we do believe that we are on track based on the metrics that we are seeing in such cases such as defect burn down or the essential stories that we have now replanned that shows that we can get to October.

So while there are indicators that are red because they are behind schedule, we do believe that we have the active management and we have the resources to get to a a the go live date successfully.

I think you mentioned, I wrote it somewhere, 21 are behind schedule. I think that's the number you gave.

Yes, 21.

Or behind schedule. Assistant deputy director, you mentioned 10 milestones in the red. What are the difference between those milestones and those schedules or those behind?

I I think I can start. So again, what I was citing was in our 120 and our ninety day, sixty day, thirty day checkpoints. We have 90 readiness activities that we report out on. And this is this is part of these reports. And of those, 21 are behind and are being actively managed such as the volume of defects, and data on both product and data conversion, and we're working those down in the backlog.

We're behind schedule on the volume identified of yeah. On quality, it also is about the defects and being able to to complete those before. So again, we've closed over 1,400 defects in the past two months, but we still have active defects that I can give you quotes on, that we are working through. System performance, it was noted about, concerns about scalability and latency and production simulation. So we are working directly with our platform as a service vendor to to identify the root cause and remediations.

And then certain activities that are not primary to production but must be in place for us to go live such as our disaster recovery activities and making sure that we have those in place before we go live. In terms of the 10 milestones, so separately in the legislative report tied to SPR six, there were originally 37, now there are 36 milestones being tracked. We have closed 26 of those milestones.

There are 10 milestones that must be completed in order to SPR six and and deliver go live, not counting the essential stories, the 300 or three thirteen, that that we can talk about separately. Of those milestones, five of those 10 are above 86% complete.

There are others that do not show that percentage of completion, but because they have dependencies on either interface or data that we are awaiting on either Mach three or an interface connection that we can then finalize the testing. All the design development work is done. We are in the QA and acceptance testing on those 10 last milestones.

And those milestones aren't the ones that you categorize as critical or high severity that need to be addressed or that's just a whole separate thing?

Whole separate thing. Got it.

Okay. And you, you know, you kept repeating go live, we're ready for go live. Is it that on October 26? You're that's the day you're ready to switch? Is it a day before?

Is it Okay. As the plan is right now, we we have our checkpoints. 19060. These are informative checkpoints that will inform a decision culminating on September 29. That is the first official go no go decision, and that starts a cascading of events that from September 29 to October 26 must occur including data conversion, you know, moving code into production, preparing, ancillary systems for for, the go live, our interface partners.

So that is why there's that lead time. So we will inform up to that go, no go decision. At that go, no go decision starts processes such as micro conversion, as I mentioned, the incremental conversion of new data in CMS. And we'll be monitoring and reporting and frankly the governance will be meeting on a weekly basis to determine are we still on track as those activities occur.

Post September 29.

Post September 29. So it's not a one and done but it does start a very complex, a very intense period of time where the activities must occur.

Okay. Thank you I'll come back to you. I'd like to turn to the vendors. One of you is in charge of providing the training, one of you is in charge of the design and fixing whatever is feedback. How do you then collaborate if the designer and the fixer of the program is not providing the training?

So how do you work together to understand KPMG, what the fix was and how you then translate that in your ever changing training.

Well it's it's a it's a very collaborative team. Right? So it's not like the Deloitte team sits in one box and the KPMG sits in another box and we kinda don't talk to each other. So there's constant communication between the teams.

It's really an integrated team and so as things are being fixed, we're tracking what needs to be fixed because in the training materials, we have provided and created the training materials to train on the system to as much as as is currently available knowing that some things are coming in later.

And so as those things come in later, we're working with the Deloitte team to understand the timing, working with the QA team to understand, okay, now that it's in place, is it fixed and ready to go, working with the release team, when is it gonna be deployed? And then throughout that in parallel, we're updating the training materials to reflect the new things that is better coming online.

So that that can be available for the users so that they can get up to up to date as real time as possible. Right? Training materials that reflect what's in the system.

And just add, Senator, it's not uncommon in industry to have one vendor building the solution and another vendor training on the solution. So there are some standardized processes that are in place but as Alan mentioned, it is a collaborative effort that through the entire process of what we refer to as the systems development life cycle. We play actively together to make sure that what we are doing is understood by the training team and what the training team is understood by the development team.

Okay. And and KPMG, August 3 was mentioned as the start of the live training. It's about three months before the go live. Is that a common pace or ahead time to train individuals on a new system?

It is. We we would look to actually have the training done as close to go live as possible.

When it is close to being done?

Exactly. Yeah. Right. So with with a user base as large as this and a system is complex that that's a a time that where we are able to account for all of the train the train the trainer requirements as well as all of the instructor led led training as well. So some folks are gonna get trained earlier, right?

And then be able to practice, some folks are gonna be practicing first and get getting trained a little bit later but it all fits within the time frame between now and go live.

And how are you addressing some of the concerns I'm hearing that some of the your selected trainers? I don't understand the system that is being used and some of the county workers are struggling to get trained adequately because the trainer doesn't know the system.

When we hear that we we assess at every instance and recognizing that we have 200 trainers now. Right? And so those we're seeing as more isolated instances and in many cases there's lots of reasons. Right? Whether the trainer knows the system or not it's it's what what we're finding as we dig into that it's more of what's ready in the system and what are the users expecting to see and there might be a gap in a process.

Right? And so the trainer gets to a point and is showing things in the system and saying, okay, where we are right now there's a defect here it's gonna be fixed so let's jump to the next part of the process. And that can be very frustrating for users and so you know we we have have proper talking points and and and training of the trainers to minimize the frustration as much as possible.

You mentioned the post go live date You have trained trainers. So that means if I'm understand correctly that post to go live KPMG is leaving, you've you're leaving the trainers that you've trained that would then take on any further TA needed?

So the so our our contract will continue post go live specifically to provide the post go live support and and absolutely we will utilize the people who have been training with the counties to provide the over the shoulder support afterward as well. So we keep the continuity of both knowledge and people and personalities as well.

Okay.

Relationships.

Just on this topic Carlos, just on the trainer and the because we'll come back to other topics. Can you expand, you know, I've heard if you can share how quickly are you hearing that the, from the county workers that the trainers that they feel that are not adequately providing training is being addressed and are able to move forward with.

Yeah. Yeah.

Well, first, I have a good deal of sympathy for our state partners and for our our vendor partners. When chief deputy director Hansard described the challenge of converting 2,000,000,000 records collected over thirty years, you get the magnitude of the challenge. So I will say this because it is the responsible thing to do to convey how our counties are experiencing production simulation today, but to not offend anyone at the table. There we believe the feedback around the quality of training is systemic. It's not incidental.

And the first round of feedback that we have is based on train the trainer, instruction. These are our super users who've been a part of testing the system for years through extended user testing. They do know and have conversions with the system, better than most anyone, but they were told that the instructors, through the vendor would be superior in terms of being able to manage the system, and that's not what we're experiencing today.

I say I have sympathy for the vendor because the system from our view is incomplete. So traditionally, you have a a solid stabilization period, after which data has been fully converted and validated, and the system functionality has been complete in which counties or the end user can actually prepare and train in the most, lookalike environment possible to real life.

We do not have the benefit of a true stabilization period right now because what we've done given the compression of the timeline and the slipping of milestones is stacking every phase that goes into, a an effective, go live, conversion. We are stacking development on top of data conversion, on top of testing and validation, on top of county readiness, rather than having each of those phases, take its sequential course.

And so even when I shared at the in my comments our willingness to entertain a fifty nine day delay because what we're being told is that that's the only safe harbor we might have before we might incur federal penalties. Just understand, we're still negotiating away that core stabilization period that we believe is the true mitigating step to preventing maximum harm.

And we'll we'll come back to that. I think this is a good segue because I'd like to turn to you now is you came on board 2021. Eight years after this was in kicked off initiated four years after it was supposed to be completed. It was supposed to be completed in twenty twenty seventeen. So you inherited already just a bad luck of a of a timeline with this.

I'd like to hear more about the compression that we continue to hear of the design. I'd like to hear your perspective on why three approximately 313 stories or which I'm taking as like design flaws or not that haven't been fixed or still in this phase where we are about three months away from go live and it's major major needs of tweaks.

But I also like to hear from CWD in this question because if I'm not mistaken, CWD, not you particularly but they were county workers part of the design as well and if they were part of the design, why is it so behind in being more a robust complete program if we had experts also with you or you're the experts but like why are we at this compression period?

The number of user stories that are included in the v one solution is approximately 4,000. So from a scoping lens perspective, those 4,000 user stories have been defined from the 2021 up until probably the range of about 2024, 2025 when that definition was taking place. While that was happening, we were running what was referred to as an agile like or agile light process that would then take those stories, do development, turn it back around.

Those stories had been evaluated over the course of time and there was a population team of county, state, and others involved in that population of what those user stories were. That was defined to be the scope of what we would go live with on v one.

What's happening is there's about 300 additional user stories that have been identified. I think that's what's what has been called out as approximately 300. In that 300, through the course of communication and working with the counties and the state, I think of it in a simplistic term of about a 100 of those are being included in the v one release. So those are scheduled and on track to be supported in v one.

Approximately a 100 of those, need workarounds associated with those or the 200 the remaining 200 will be done at a future stage.

Of those 200, approximately a 100 of them need workarounds and the additional 100 can just be deferred until later release date.

So right now you're only their priority is a 100 of them?

Correct.

For the v one. For the workarounds, is that the pen and paper process?

No. No. At this stage as Alan had made

None are identified? None

are identified.

Okay. So workarounds is just like a longer process of how to do that?

Or a different way to do it than what has been initially intended to be.

But all those 200 need to be finalized in the v two not the v one?

Not necessarily v two. We are putting together a plan with the state to identify incremental releases that will be done subsequent to the go live. One is currently, if I'm remembering correctly, there's a small one in December, one in January, and one in or one in February, and one in April.

And the three over a little over 300, that was outside of the 4,000 goal?

In addition to. Yes.

Okay. CWDA, how if we had some workers who who know the system very well or the process very well, how did we just so late in the game identify those additional 300?

I think it's a it's a great question that we've been trying to solve for for the last the last few months. What I can say is that when we look at the way that the project tracks its performance particularly for the purpose of the legislature, it is looking at the SPR six milestones. It's important to note that the 300 plus essential stories are not within the scope of review for the legislative briefings that staff see on a monthly basis. They're not within the SPR six.

So in essence, they are invisible to, be able to evaluate the performance of the project for those who are outside of it.

In terms of how those essential stories were were not prioritized for v one. I think that is ultimately the the question that we're we're trying to understand. I think, what I understand is that there was a plan to revisit those 300 plus stories into the future after they had been defined as essential in 2024. And around the middle of May of this year, we were informed that a subset of those essential stories would move forward through the established governance process of the project.

That's 100? Uh-huh.

A subset of them like like like 40 something of them for green lighting for development. And so it begged the question for us, what is the opportunity cost? Does that mean that with approving the subset of those 300 that we are essentially agreeing to no longer prioritize the remaining balance of those 300 stories before go live? And through additional discussion, understood that the project, the vendor, and counties had a different view as to what was essential, any longer, since how they were defined two years ago.

But essentially, essential means that the end user can't complete, a business process and that there is no existing work around.

We've been our teams have been working, burning the midnight oil for the last several weeks trying to refine a consensus around what must happen within V1. But to be clear, we're really worried about being jammed when are we getting some of these essential functionality fixes released into production simulation? Is it gonna happen on October 15?

If we have no opportunity to validate and test those fixes, are we then going to have to live with a dysfunctional system in all of the areas of criticality that I discussed today? That's what hangs in the balance and we don't have confidence necessarily that if we have fifteen days to go and there are functional defects available through those fixes, that we actually have a remediation pathway.

That's a I have a I had a question on that. It's a two part question. I think to both you is are we successful October 26 because it's complete designed, it's ready to go and we're not calculating the need for training that doesn't include our definition of success. And the second part is at what point do you need to stop the design to leave time for KPMG to do the training?

To his point is if you're like okay the final design is October 20 or is that too late to allow room for training?

I I'll start. First and foremost, we we have no plan to be releasing in, like, October 15, October 20 new new code. There would be no time for testing, quality assurance, state acceptance, let alone production simulation, awareness to to the user community and training. So we we are finalizing as Carlos had mentioned, we are burning the midnight oil. And I appreciate the the time that everyone is spending on this to try to solve for for these essential stories.

In doing so, we are getting back together this week to go over the plans as we have worked through them with our technical partners on a release schedule and how that will will play out. But we are we are working that schedule so that while compressed, we do not shortchange the SDLC especially on the quality assurance, state acceptance, and training part of it. But it is compressed.

I also want to to acknowledge these three thirteen, this is an iterative project and in doing so decisions evolve, scope changes as you learn more about the system, how it functions. A story may be created or a story may become obsolete.

From whatever reasons back from 2021 through 2024, something may have been decided not to be part of the milestones that we track to. What we have now are these three thirteen. We're not going to lose sight of these three thirteen. We are going to track them. We wanna be able to report out on them to show the progress that we are making and how we disposition these so that we can show what is going in for go live.

And as as alluded to by by Deloitte that we have these post go live releases and we continue to report on the post go live releases. So so we show completeness of this effort.

Okay. And Mr. Sheldon what is the final date that you have that you can do a final fix? So we've been. Sorry.

No. Mister Kelly. For Mister Kelly. Okay.

Based on the schedule that we've put forward, we have something that we call a freeze date. And what freeze date is is the date by which all code is supposed to be defined frozen for lack of a better word. So no additional changes and then from that point forward it's an emergency change to make a change. That date currently in the schedule is 09/25.

Okay. Which gives you four days for your September 29

to Correct.

Okay. Carlos, is it safe now? It sounds like CWDA I don't know if you've a position, it sounds though you're switching your ask to the six month delay to now whatever that can be done within the fifty nine days?

I I don't wanna be like I don't want to be too simplistic about it but the reality is we are in harm reduction mode. We've been able to demonstrate that by both going to the legislature and making a request for some sort of intervention for delay while also exhausting a remediation pathway with the project with our partners at the state and with vendors. So we've always been we've never left the table. We have been consistently in remediation mode. We are in harm reduction mode.

That extends to what we're trying to achieve in the legislature as well. If it's true that the legislature is chiefly concerned with potential risks of federal non compliance and that the administration's analysis holds up. They're the ones who are in the room talking with our federal partners at ACF. We cannot substitute our judgment for theirs in that regard. Then we are hearing the limitations that they're laying out for us.

And we're saying, okay, if we have fifty nine more days, we should do the responsible thing and maximize those fifty nine days. And because we've had so much slippage in the timeline and deliverable of the project, we think that the terms of that delay should be codified by the legislature.

Okay. Director or assistant deputy director. Would we lose federal funding if we go past October 26 to not exceed the calendar year?

So I think that it's what has been shared with us is that the expectation is that we go live in October 2026. And then I do wanna share that ACF has found failure of three systems under this administration. One was New York City. Their eligibility program lost 100% of their funding for their system. North Carolina was deemed to failure in regards to building their system and lost their funding.

And Pennsylvania also lost funding for failure to show approval processes for procurement prior to approval. So the actions of the Federal Government has been that they have taken away federal funding on projects.

So even with the fifty nine days there's that still? I'm sorry within the fifty nine days. Yeah. There's still that risk.

I think it's important to be clear as the deputy as the assistant deputy director was highlighting that we don't currently have federal approval to go beyond the go live of October 26. So we we cannot say there is no risk to going beyond that date in terms of conversations with our federal partners and those risks can be very serious.

The sixty days that we've all been referring to are really fifty nine days is because at the sixty day mark, need to submit a new proposal to the Federal Government, a new advanced planning document. So we would be past the window in which our current advanced planning document applies. So that is a key milestone or marker where there where we see a delineation that is a a heightened risk because we then have to sort of start over in those conversations with the Federal Government.

So that is the window like that we're referring to a sixty day. It gets triggered at sixty, so fifty nine is one day less and that's why people are referring 59. But we don't have approval from them to do something necessarily within those 59. It would be a conversation we would need to have with them to figure out whether or not we could gain their continued support.

Into the ED's question of codifying, is there potential of calling attention to us of codifying something that goes beyond what they have asked us to do?

I mean I think it's fair to say that that could add to the risk. It is the case already that in our governance processes as, the chief deputy director of OTSI referenced, we have go no go decisions built in and we are certainly aware that the sixty day mark is where we would need to submit a new APD. We're also in very regular communication with our federal partners who are watching this project very closely.

And Chief Deputy Director, you know, Mr. Marquez mentioned a couple of instances, you know, one that I quickly wrote down was around the medical history just because I myself in that allergy kit as well or was. Those items that are on your radar, you're tracking and those are gonna be fixed. Yes.

They they're deemed as an essential story and I wanna make sure checking my list here real quick. Essential to be delivered by go go live, yes.

I wanna ask some other specific ones because those stood out to me Okay. In the CWDAs letter. The child protective services creating delays in intake that one seemed like a pretty serious scenario. The hotline? Is that the hotline?

Yes. Well, that's the one you talked about. Okay. The other one was around and I think I think director, I'm not sorry, someone brought it up around potentially not knowing of a relative that the case shouldn't be placed with? Like information like that flagging.

I

don't know if I have a specific

So CWDAs in their letter talked about a scenario where a behavior of a family not that note not being placed and so Safety alert.

Thank you. Okay. Safety alert. Had to get the right terminology.

I had to phone a friend on that one. But yes. So it is one of the essential stories that we've been working through, and safety alert banners will will be across case and referral screens. And we'll be we are working right now to test in q is being tested in QA by the end of this month for planned release September 24 into production. So Okay.

I didn't know that.

I'm sorry. September 14 into production simulation.

Okay. And assistant deputy director, you mentioned the translation because that was another pointer they brought up that's also on track?

Yes. That is currently on track. Okay.

And then back to Mr. Sheldon. I'd like to have a more expanded response regarding what CWDA is saying a systemic potential problem in the training and how you're evaluating you had a different perspective. You're calling it the anomalies.

Well, so we we evaluate every every reported instance of of issues with any single training class. And we evaluate what the issue was and we try to we try to of course we're not in every class right? So we we try to understand exactly what happened and start to see if there are patterns right? And most of the patterns we are seeing is frustration from the users of not being able to see the full workflow in the system.

The trainers have different different styles across 200 people, Different styles of of conveying that to to users and so what we've what we've been doing to rectify that is to make sure that we're updating talking points to all of the all of the trainers so that they know exactly what to say and give a consistent message on both what they're seeing in gaps in this in the system currently as well as when they can expect to see fixes.

And OTSI, deputy, chief deputy, like how are you holding the vendor accountable? Like, we we continue to hear feedback on that.

Yeah. So we have engaged with our vendor and we engage with all of our vendors in kind of two ways. Active vendor management, which we are addressing issues, concerns as they're being raised, working to mitigate them. Also, if there's an issue that requires a change in personnel or approach, we will we push for that and we we see that through.

In addition, through contract management, leveraging the contractual terms and conditions, service level agreements, you know, not paying invoices unless we have accepted a deliverable or accepted, the the work done.

These are the contractual levers that we are also using. I will say we have had I know specifically specific incidents where we have met with the vendor, discussed, made a change in personnel. But in in the case of the more systemic that I'm hearing today, again, noted going back to research to find out if I have those indicators, but I at this time, they don't have that same same perception.

Yeah. I definitely don't wanna hear that you're just hearing this now. That's

Well, we've we've heard specific instances in specific counties and have made specific changes including changing trainers and assignments. So yes, we have addressed that.

And Mr. Sheldon, Mr. Kelly is it common to be both training simultaneously and redesigning and fixing design? Is this a common approach to projects like this?

It's a very common approach to have enhancements and changes that are continuing to be made to the solution. And the training material get updated as that's being rolled out. So it's very common and it's done traditionally in almost every implementation I've been doing for the last thirty years to have incremental enhancements done both just before go live and shortly thereafter go live.

I mean, I I'm not I don't think we're in the enhancement realm right now. We're talking about core functionality. We're talking about parity with this legacy system. That's that's table stakes. We're not talking about being able to even achieve the lofty aims of the of the system when it is fully functional.

It's not even meeting the basic

We're talking about parity. And I think I would just add we do have some concerns with the project's governance. I think the CDT noted in their recent report to the legislature that the evaluation of the project's governance was trending down. So I mean, I I think if we're gonna rely on the go, no go decision at the end of September, and by the way, that is absolutely outside of the grasps at that point of the legislature.

I think we would wanna know a lot more about what happens if based on an independent objective read of those criteria in that readiness checklist, it's determined that we actually aren't ready.

Because I haven't heard, and I'm not sure we've heard anything in good detail about a plan b. All we've heard is we have an objective set of criteria, but by the way, we can never go past our planned go live date because of the feds. It's one or the other. The level of objectivity that we can rely on the criteria to provide for us is only as objective is how much we've actually thought through a plan B if we're not ready.

So I think we would really wanna hear more about that.

And Director, I actually asked this question. I think I even said I was supposed to ask that question. If you can share what I asked, I think what I had asked is like what is the emergency lever? Like what are those points September 29 that you're looking at your checklist? Like, is it a is it a long checklist?

It is a long and growing checklist.

That's growing?

Yes. That doesn't get but that's a good thing. That is that we are identifying the most critical items that must be done binary. Yes, no questions of of are we prepared to go live and ensuring that we don't miss anything. So all of our teams, again, are looking back.

We have our 90 readiness, right, reporting areas. We're going through and making sure we have every technical, every piece of of data points that we can to inform us going into that final checklist.

If I could if I were to read you my notes, I write, on all my briefings that I got. It's a bunch of WTFs and it's been thirteen years, a kid went to graduated high school and is in their first year of college. It's a lot of curse words on my notes. Today is my nine year wedding anniversary and I'm full of love today which is maybe why I've taken a different tone to this. But I think Mr.

Marquez like I appreciate the, it's a lot of positivity of like we're so confident in reaching this but they're still very outstanding or lack of faith or lack of, I don't know, given California's history with high speed rail and all these IT programs, that are we gonna reach this? Are you able to share some of those on the checklist?

I know it's a long list, I don't need you to read them all off but like just to show some confidence like we internally know that if these aren't met we cannot move forward.

Yeah. I'll be glad to share some of the high higher roll ups that Sure. That again have many very task driven or yes, no questions. But again, product readiness. So the core product being developed.

Performance, ADA compliance, quality readiness, from an implementation serve services standpoint, confirming access to to the environments, making sure that all of our our roles and responsibilities in the security profiles are set up correctly. From training, ensuring that all training activities have have been completed. From the command center, making sure that we are stood up ready to support the activities from September 29 through post go live from a twenty four seven, you know, monitoring and compliance standpoint.

Ensuring we have the service desk stood up ready and manned appropriately to field phone calls, help desk, any inquiries. Making sure our external partners such as Calsaws, CCRIPS, other interface partners that that we rely on to deliver this comprehensive system are ready, tested, deploying the same same schedule.

Making sure that we have the dedicated support, at the county and tribe level. Ensuring all of our security and infrastructure have met all the certifications, making sure our disaster recovery and external systems, all the check checks have been made there, and it it can continue on and on. So again, very comprehensive but ensuring that we meet every component of when we say this is ready to go. We we we have shown that objective.

One of the first ones or the first three said something about core responsibilities program something. I think you said core responsibilities one of the first ones. Are are we talking about like those part of ensuring those like safety ones that we those are part of that? Okay.

Yeah. So those essential stories that that will be there for GoLife have to go through the full SDLC and it be accepted into production. So that would be part of the criteria.

What if maybe I don't know if department finance or like the carrying cost of like needing to address what if there's another a 100 new stories that come up post October 26? How do we handle that?

So through the course at this time, new stories are being created out of production simulation. Now again, evaluated right now to determine if essential most are not or or they are not or they're they're defined as a defect. If they're a defect, they are prioritized critical, high, medium, or low. We are ensuring critical and high defects are put in even if it's came in as a story and it's later identified as a defect.

The other essential stories, we don't believe there will be more new essential stories for v one.

And again, v one is the first iteration of a continually again, iterative project with iterative product development. So we will continue to evaluate, prioritize all stories that are being created to make sure they're put in the the appropriate release post go post v1 go live. And we expect continual releases all the way until v2 and even post v2. We never will be done. It will be continue on iterative.

One of my final questions. Mister Sheldon, is it once new fixes are coming in from Deloitte, you've already trained those people, you're bringing them back to retrain them on the new fix? And then how long does just regular training take?