August 12, 2026 · Budget Sub3 · 45,530 words · 11 speakers · 422 segments
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're trying to be as 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 going to be going over two big programs. One is going to be the Be Home Soon program, since it's a brand new proposal, get more details flushed out. And the second is going to 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 going to be for presentation. They're just a review that those are things that are also needed are still are needing to be landed before we leave in 1918 days. OK, 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 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 going to start with Kate Myers. Go on.
If it's red, yeah. Good morning, and thanks to Senator Menjivar for the invitation to speak today. My name is Kate Myers, and I'm a senior program officer at the California Healthcare 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 10.3 million Californians age 60 or older, and this will be an increase of over 3.3 million people in just a decade. Second, across our healthcare 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, etc. 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 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. So while we have a lot of programs, we don't necessarily always have reliable access. briefly why is medical 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 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. Many of these programs result in having waitlists because they are capped. Specifically today, the Home and Community Based Alternatives Waiver and the Assisted Living Waiver both maintain significant waitlists. 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, etc. 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 of 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 Medi-Cal enrollees or expected Medi-Cal 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 that, 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 Healthcare 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 preferences align with the state's fiscal interests Most older adults want to age at home not in institutions In fact 75 of adults age 50 and older want to remain in their homes as they age and 73 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 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 a 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 has largely ignored his own health because he is 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 garabars, and 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 discharged to a Medi-Cal-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. 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 Medi-Cal, 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 Soon 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 to reduce fall risks and prevent avoidable hospitalizations. Under the proposal of share of cost reforms, John would not have to spend $1,600 a month before receiving Medi-Cal 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 default 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. We'll go on to our next speaker.
Thank you, Madam Chair and members. Amber King with Leading Age 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 in pairing 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 Medi-Cal 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 HealthNet recent decision to discontinue CalAIM living highlights the ability and the instability for older adults and providers when their access depends on plan year decisions We would encourage the legislature to consider establishing assisted living as a mandatory statewide benefit We would 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. LeadingAge 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 90 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 90 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 services interact together, we can stabilize people at home faster. Thank you.
Thank you, Bea.
Thank you, Madam Chair and members. I'm Kate Ladish, 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 wrote an 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 15 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. We're people, not just patients. The community also benefits when it is kept whole. Barriers to or 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 are 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 also concerned that we may attempt to shoehorn people into IHSS for whom it 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 pay 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 Medi-Cal 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 Medi-Cal asset limit that targets the very people Be Home Soon is aiming to help are two keys to this valuable program's success. Thank you for this opportunity, and thanks also to the nearly 30 people who shared ideas and 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 Advantage 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 balance the budget in the budget year, but we're still facing 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 commitments would challenge that balanced budget structure. Thanks.
Okay. And then if I can have the department come up. You could shimmy on over to your right.
Good morning, Chair. My name is Tyler Sedwith. 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 longstanding 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 million 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 lists, The department estimates $434 million 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 1915C waivers into a Section 1915I 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 1915C waivers require an individual to meet nursing facility level of care need to enroll. The 1915I does not require individuals to meet a nursing facility level of care need. And so 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 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 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 payments cost neutrality impacts on managed care reimbursement rates and the potential for some components to have the unintended consequence of 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 length of time is about four to five months for the under 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 11 to 12 months. For the adult protective services long-term care ombudsman referral population it's three to four months and for the community enrollment population it's three years. 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 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 enrollments onto the waiver. For example, we added 7,000 slots to the assisted living waiver during the COVID pandemic using enhanced federal funding We included annual slot increases of 1 per year within the current five waiver terms of each waiver The HCBA waiver ends at the end of 2027 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 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 to 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.
There's so many. That was a lot of information. I appreciate it. um okay sorry i have like a billion questions i'm trying to gather my thoughts here um let me start with uh 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 i want to bring out a c i'd like to hear feedback cal aim was used as hey there's an investment um and it the point of cal aim is to address some of the issues that y'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 is the difference, you would say, CalAIM and then the P-HOME program? How does this go above that and what we currently have?
Justice and aging, I think 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 3,500 people losing their housing at the end of the year. So I think while the aim is great, making this an in-lieu of service and having no state plan benefit 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 an institutional population is a population of focus, we're not really seeing delivery 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 your remarks you talked about in that potential story, you talked about a care coordinator not being there to share resources. Why aren't there care coordinators there to share 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 you need more staff on the more of the agencies that really go out. go out. Thank you. That's your organization. Sorry. 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 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 folks. It's very difficult for people in a nursing facility to figure out the resources that they need in order to make these transitions, and we need 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 intended to replicate California community transitions and the package provided there with home 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 agree that even those social services are medical treatments, I would say. Yeah, I think 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 judge, 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 there 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 to program incentive right 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 continuity of care issue um the deputy director talked about potential bottleneck is 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 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 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, speaking to that, East Banovations 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 process-y 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 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 are 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 capacity constraints.
And Juwan, LAO, I would love to see if I can get some assistance on the proposed savings is $625 million. dollars the total is like 1.2 but that's part of the federal um there seems to be still unanswered of at what point that can be achieved um 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 maybe from both of like what exactly you quickly went over them but some some of those tech challenges that we can address and making this successful if possible. Can I get 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 just to be clear, we have a high flow 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 1,000 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 are you seeing more being added?
Yes, 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 is it that you mentioned some like the month is it the dollars Like we can if for some reason we like we get approval and more providers are added to the list and it not a staffing capacity issue is it that, would that be the only thing that would 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 Bea mentioned, 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 counties covered by the assisted living waiver. We have over 40 care coordinators.
And they said they're at capacity, don't give me any more slots?
Yes, we have an issue currently with care coordination agencies being able to process the number of slot releases that they receive on a monthly basis. So what's the 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 way in further, but I think that it would be sort of a 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 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, the social workers, the RNs.
So what's the magic ball in our RN 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 so for example ebi is in the waitlist their own waitlist 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 track more and we can ship but if there are people that are ready providers are ready to go right now what magic bullet is needed um 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 have 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 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 resources to process the workload That hard It hard That hard I can grow a 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, with the backlogs, the other provider shortages, aren't there provider shortages. There's 900 RCFEs waiting to enroll in the assisted 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 Soon, the power of Be Home Soon is it's really focused on the consumer and the consumer experience. And 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 facility and receive services while 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 those steps could take up to six months while the person has already received their slot. By the time the DHCS is done with all of their processes, that individual has already lost their RCFE spot, and they've lost that bed because the RCFE 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 in the Department of Finance, ma'am, if you could come back up. And, you know, when is the savings going to kick in versus its upfront cost? How do we approach when we know it's, what, 10 times more institution versus at-home care, the savings that it creates?
when do we look at we we will see this the medical 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 there's i don't know who else we're going to kick out but y'all get creative so we'll see next year um we we need to address um and do investments in preventative care everything else is about preventative everything else is primary care here it's we need to do that why aren't we
looking at this as investing in in 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 Griswell, 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 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 the 2026 budget act is balanced in the budget year and budget year plus one. And I think at this point when we looking at this proposal what we 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 balanced budgets for the past couple years and every single year the year after so far that I been here we 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 dhds come into this subcommittee of like the growth has increased this the cost is 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 10 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. Is there a lever you're looking at to say, now is the time to do the investment?
I think I would say that while there's no one specific time that we can be having those conversations, I think that that's 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, it's here. It's ready here. I think that's one of the largest growing demographics in the Medi-Cal program here is the aging population and the complex needs surrounding that. And if we continue to see proposals to cut the in-home or community services, we're going to not see Medi-Cal 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, but like a serious conversation of like, we need to make this happen, because if not, we're going to be in a worse situation. 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 structural deficits we're looking at for the out years, this is just something that because of the current general fund costs, I think it would help. 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 months ago. When is Department of Finance going to do that analysis?
I think it's something that we're continuing to look into.
Look into deciding if you're going to do the analysis?
I think we're looking at the proposal.
We're looking at these conversations. So you've been looking at it for a couple months now. Are you going to do an actual analysis on your look at when the savings would kick in?
I think that we are just still looking at the proposal. And what we're seeing is that there would be costs in the immediate future.
So you can't say there's cause because you have done an analysis. So 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, 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 would be great to have an analysis so that we can actually see your stance, Department of Finance stands on if you think this would create outgoing savings and when it 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 are on the verge of closing?
I know that's one of the issues. I actually have that data, but I don't remember it offhand. No. 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 SEBA center openings having to do most likely with population density. And so as the SEBA centers close, they do tend to impact already underserved communities.
Right. Okay. Okay. And can you share on 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 Alice Joda weigh in. I think generally speaking, these home and community-based services, federal authorities historically, 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 1915C waivers into a 1915I 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 1915I. Thank you, Tyler. And I apologize for not introducing myself earlier, Joseph Billingsley with Department of Health Care Services. So, yes, difficulties with implementing a 1915I are less so with the actual 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 1959 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 a difficult process to go through in checking all the boxes that are required from a federal standpoint for 1915I and being able to implement in a way that works with in our existing systems. Actually I think 1915I doesn have cost neutrality because you not serving a nursing facility population So you don have to yeah So actually from that perspective I think it easier since you don have to show cost neutrality It solves one of the biggest problems that I think from a federal perspective DHCS has with expanding 1915C, 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 structure a 1915I based on the needs criteria. So you could look at, for example, IHSS. We're now serving 900,000 people in IHSS. Half of that population is at nursing facility level of care. Half the population is at needs criteria. So looking at the IHSS needs criteria, you could essentially match that to the 1915 I and 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 Medi-Cal population, it's not like all of a sudden the entire Medi-Cal 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, is kind of make sure that you're not opening the doors, just anyone who feels like it. I mean, I don't know who would do that, but 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 going to presume to understand some of the different codes that were just happening here from the consumer perspective. I'm working on it too.
Then we're all in it together. I believe it is.
It's 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 20 years. I've lost count of the number of neighbors 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 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 going to dislocate joints when I do my laundry. And so I think that might tie in with what you're doing.
Yeah, I think IHSS 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 24-hour supervision side, IHSS isn't going to do it for you. And the only other option for you as a person with Alzheimer's or dementia is to go into an 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 have Alzheimer you can wait three years on the community wait list So you are going to end up in an institution because there is no actual service can meet that need If you have a holistic sort of one 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 IHSS, 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 take from the department 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 your slot. We know they're going to 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 process for us 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. have been taking services away.
You've encountered that.
Yes. I mean, we have individuals that come in for waiver enrollment that are denied. I mean, the 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 1915c 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 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 states at the risk of staying 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 many, many 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 can we do today that will help prepare us for where we need to be in 10 years or where we need to be in 15 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 other final thoughts from anyone else?
I'll be glad to jump in. One thing that we haven't talked about is who's providing the care within IHSS. 70% of the providers in the program are providing care to family members. 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 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 provider. It's easier for me to come in here and testify in a Senate hearing than to find a new provider so it's it's not easy and I and doesn't that also help to close the gap
in rural areas the like these kind of opening these yeah yeah yeah and in
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 these programs and proposals from a consumer perspective like Hagar said that one of the beauties of be home soon is that it's it's considering the consumers much more and the amount of paperwork that is required to be disabled and poor is tremendous so my 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 cal fresh 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 the way that University of California went to, if there's an application, you press, you know, check the box.
There's the core problem with government.
Anything, any program, paperwork.
Exactly.
And people stop living in the community because they can't do it. And so if we have somebody who can assist with that, if we're not able to fix the paperwork problem, I think that that really has to be a big part 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. And it's not, again, like Kate 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 taking a big picture view of this and really trying to redo the system so that it works for consumers and centers the consumer first and 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 is in the details. these are ambitious proposals that require thought and debate on how to best implement and I'm open to continuing that discussion with the department but to dismiss it offhand as this is too difficult and too expensive I think is a mistake.
I agree. Bea?
I just wanted to add, emphasize the caregiver shortage. Often that's the reason why clients go back to the hospital 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 timesheets and the other one is the contract mode and a lot of counties don't want to 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 that really great point, is that what I've heard from counties is that they want to make sure that there isn't an unfunded mandate that comes to them to carry out Be Home Soon 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 at what time one of the hearings here, I 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, this is a little personal for me, and I don't want dialysis access to only happen in ERs and hospitals. I think it 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 share the concerns about the new restriction on covering outpatient and routine dialysis as emergency Medicaid for Medi 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 Medi-Cal 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 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 costs, 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 were the department to cover outpatient and routine dialysis as a state-only benefit for people who have restricted scope Medi-Cal today, who are only eligibles for emergency Medi-Cal today, what would that cost be? So we are looking into that.
How many members do we know?
How many lives?
I apologize, Senator. I don't have that offhand. I'm really interested in investing in this topic. I think last time I asked about if an impact analysis was ever run in this space,
the director mentioned that she was going to look back and see if we can get something like that.
I don't think I've received anything since. I love an impact. 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. I recognize there are 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 topic I wanted to bring up is this never landed in the budget regarding 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 with the assumption that 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 entity, what are the opportunities to use those funds to go back to the skilled nursing facilities, given that now it's going to 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 Medi-Cal program, the Department of Healthcare Services, they're going to 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 aspects of the Medi-Cal program within the current fiscal year and then also the upcoming fiscal year. and so if at this kind of updated estimate at the May revision, 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 Medi-Cal program and for the state overall, decreases and increases across kind of all of those programs that we're looking at for Medi-Cal and across the state budget, kind of given the large impact of Medi-Cal 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? It seems like every single year there are savings. They don't use the full allocated amount.
Where does that go?
Broadly, I think they're just going to the overall Medi-Cal program generally.
Okay.
What, if any, consideration can be given to, because we've not addressed or have not, There's going to be no negotiation for, I forgot, 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 Medi-Cal program? If those orders are already allocated for that specific entity, 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 Medi-Cal in the state budget. This isn't – we typically – like we're not – the funds for this are not typically budgeted sort of in those – we're looking at this for the overall Medi-Cal picture, so that's what I think. So in effect, the concept of sweeping any surplus relative to actual expenditures that come in beneath projections related to SNF, provider weight growth, would in effect be a dedicated new appropriation?
How? If we appropriated for them already.
So from sort of a budget estimate perspective it not sort of a direct dedicated appropriation for that item It 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, caseload, acuity, and so forth, largely driven by managed
care plan rates, which are... But isn't the balance budgeted on that projected amount? on a projected amount um but you know in in reality if there is a in 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, etc. So just like 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 the past 3-4 years, give me a historical recap of what has happened. Have we gone under or over this allocation or projected allocation in first-scale nursing facilities? I'd love to see if there's been a historical pattern that they've exceeded our projected amount or it's been a pattern of just under the allocated amount. Thank you. Issue 2. Thank you. Okay, we're moving on to the CARES system. We have a lot of individuals here. I will have LAO kick it off.
Thank you, Madam Chair, and good morning. My name is Zin 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 CWIS. 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 2020 final rule governing the 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 million 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 $1.7 billion, 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 October 26, 2026, about two and a half 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 systems 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, and guiding 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 frontline 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 June 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 27 to 39 months, and a delay of this magnitude would carry significant fiscal and operational consequences. We estimate the actual cost exposure could range from $558 million in general fund to $1.2 billion, 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 for another 6 to 8 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 26th 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 am 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 meets 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 with the counties tribes CWDA and frontline 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 CARES 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 GoLive. 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 30 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 October 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 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 GoLive. County training, onboarding, and feedback loops are progressing, and that input is driving improvements to the system. In regards to the feedback 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 is 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 workarounds. 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 workaround 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 Finding Summary View. We acknowledge that there is important work still happening, and the overall project trajectory is positive, sustainable, and supported by a strong interagency commitment. 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, hundreds of millions of dollars, and increased 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 the remaining questions in the agenda when it is his turn to present.
I'll have you go now. It just makes sense. Okay, thank you.
Good morning, Madam Chair. 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 12 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 changes to the projects that have occurred within the past 12 months. In late July 2025, ACF informed the project that they did not support a small county pilot as we had planned due to the costs 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 to improve the statewide readiness. This did require a redesign of our implementation plan and timeline. So in March of 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 re-procure our vendor in only three weeks, which helped minimize the delays, and we implemented a new training plan in coordination with the new vendor so that 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 noncompliance 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, streamlined look and feel for easier navigation, navigation, enhanced safety alert banners, search, print view enhancements with approved workarounds such as safe measures. A highlight right now that has been discussed in the CWDA letter is hotline. Some of the changes that we've made to hotline have been referenced, but to reiterate, we are providing a one-page reference guide to provide clearly identified only mandatory fields that hotline screeners must complete in V1 to submit a screening and promote it to a referral. This guide will help staff focus on required data entry, clearly distinguishes required fields from optional fields, and separately identifies the required initial ICWA inquiry fields. And again, on average, the folks on the project are able to complete this in 30 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 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 I go on to question three The project plan and timeline for delivering converted data resolving defects and training system users prior to go live on 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 30 years of data, over two billion records. that 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 2. It is the largest data set that we have provided to date for validation. And we are on schedule for what we are calling Mock 3. 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 3 cycle. And in order to ensure the most up-to-date data from CMS is in CARES, on September 29th, if there is a go decision, the project will start what we call a micro-conversion process that will capture all data changes in CMS that have occurred since Mach 3 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 June 30, 2026. The biggest shift in our training approach was based on feedback that was that we offer the in-person instructor-led training as close to go live as possible. It did start on August 3rd and will continue all the way through October. And lastly, for GoLive support, counties will receive up to 30 days of on-site support and 60 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 26th, GoLive. Please describe the project's approach to addressing and identified risks of child safety. Provide concrete examples of the functionality that have been identified as essential and how it will be addressed.
You don't have to read the whole question. Okay, just want to make sure.
Okay, again, child safety is our highest priority. 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 what the essential part is that it was determined was needed for GoLive We committed to fixing or developing short 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 reiterate 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 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, 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 120 days prior to go live, 90, 60, and 30, each of which can inform if there should be a decision to delay. And the formal go live decision currently set for September 29, 2026 will be informed by these checkpoints and a more formal checklist. We will also, after September 29th, follow weekly progress updates that could also inform if there is need to change a decision from the go 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, 90 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 back 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 29th decision. That concludes the answers to the agenda questions.
Thank you. CWDA.
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 system's functionality in real time, and from county child welfare leadership we 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 current performance while child welfare 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. 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 actively 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 15 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, CARES 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 lifesaving 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 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 the feasibility of our proposal, and the offering that a window of up to 59 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 59-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 Javar. 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 definition and measures of success and the necessary support model and escalation paths to enable planned and or just 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 30-year-old CWS CMS with a modern CARES 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 little. That's right here. Thank you. Good morning, Madam Chair. My name is Alan Sheldon, and I am 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 want to 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 10 1⁄2 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 March 1, 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 March 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 GoLive 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 GoLive. 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 GoLive and gives them an opportunity to practice. Should workarounds be needed, we reduce their risk through quick reference job aids. Furthermore, our GoLive 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 GoLive, close collaboration across the integrated project team is key to addressing 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 want to 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 thank you for your remarks. Let's dive into it. um i'll start with um chief deputy director so we for the for months for years um 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 going to be on track october 26th how do you that kind of um presentation i would assume doesn trigger a the building is burning kind of response from CWDA What the disconnect You have one side is saying everything okay You have another side is kids are going to 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 okay. We have read in our milestone reporting, We report monthly 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 burndown 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 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. Are behind schedule.
So, Assistant Deputy Director, you mentioned 10 milestones in the red. What are the differences between those milestones and those schedules?
I think I can start. So, again, what I was citing was in our 120 and our 90-day, 60-day, 30-day checkpoints, we have 90 readiness activities that we report out on. And this is part of these reports. And of those, 21 are behind and are being actively managed, such as the volume of defects on both product and data conversion. And we're working those down in the backlog. We're behind schedule on the volume identified on quality. It also is about the defects and being able 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 in production simulation. So we are working directly with our platform as a service vendor 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 6, 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 meet the scope within SPR 6 and deliver go live, not counting the essential stories, the 300 or 313 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 3 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.
Okay. 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 kept repeating, go live, we're ready for go live. Is it that on October 26th, that's the day you're ready to switch?
Is it a day before?
Okay.
As the plan is right now, we have our checkpoints, 190, 60. These are informative checkpoints that will inform a decision culminating on September 29th. That is the first official go-no-go decision, and that starts a cascading of events that from September 29th to October 26th must occur, including data conversion, moving code into production, preparing ancillary systems 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 microconversion, as I mentioned, the incremental conversion of new data in CMS. And we will 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 29th. Post-September 29th. 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 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 kind of 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 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 going to be deployed, and then throughout that in parallel we're updating the training materials to reflect the new things that are coming online so that that can be available for the users so that they can get up-to-date as real-time as possible, right, training materials that reflect what's in the system.
And just to 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 lifecycle, 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 3rd was mentioned as the start of the live training That about three months before the go live Is that a common pace or a head time to trying individuals on a new system
It is. We would look to actually have the training done as close to go live as possible. When it's close to being done. Exactly. Right. Right. So with a user base as large as this and a system as complex, that's a time where we are able to account for all of the train-the-trainer requirements as well as all of the instructor-led training as well. So some folks are going to get trained earlier, right, and then be able to practice. Some folks are going to be practicing first and getting trained a little bit later, but it all fits within the timeframe between now and go live.
And how are you addressing some of the concerns I'm hearing that some of 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 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 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 going to be fixed, So let's jump to the next part of the process. And that can be very frustrating for users. And so we have proper talking points and training of the trainers to minimize the frustration as much as possible.
You mentioned the post-go live day. You have trained trainers. So that means, if I understand correctly, that post-go live, KPMG is leaving. you're leaving the trainers that you've trained that would then take on any further TA needed?
So our contract will continue post-go live specifically to provide the post-go live support 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 from the county workers that the trainers that they feel that are not adequately providing the training is being addressed and are able to move forward with, yeah, addressing that.
Well, first, I have a good deal of sympathy for our state partners and for our vendor partners when Chief Deputy Director Hansard described the challenge of converting 2 billion records collected over 30 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 been a part of testing the system for years through extended user testing They do know and have conversants 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 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 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 in my comments our willingness to entertain a 59-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 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.
Correct.
Eight years after this was kicked off, initiated four years after it was supposed to be completed, supposed to be completed in 2017. So you inherited already just a bad luck 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 approximately 313 stories, which I'm taking as design flaws that haven't been fixed are still in this phase where we are about three months away from go live and it's major needs of tweaks. but I also like to hear from CWDA in this question because if I'm not mistaken CWDA not you particularly but there 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
included in the v1 solution is approximately 4,000 so from my 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 v1 what's happening is there's about 300 additional user stories that have been identified. I think that'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 100 of those are being included in the V1 release. So those are scheduled and on track to be supported in V1. approximately 100 of those need workarounds associated with those, or the remaining 200 will be done at a future stage. Of those 200, approximately 100 of them need workarounds, and the additional 100 can just be deferred until a later release date.
So right now your priority is 100 of them?
Correct.
For the V1. For the workarounds, is that the pen and paper process?
No, no. At this stage, as Alan had mentioned. 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 V2, not the V1.
Not necessarily V2. 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 February, and one in April.
And the three, 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 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 great question that we've been trying to solve for for 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 6 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 6. 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 not prioritized for V1, I think that is ultimately the question that 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. for. 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. A subset of them, 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 workaround. 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 going to happen on October 15th 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 15 days to go and there are functional defects available through those fixes, that we actually have a remediation pathway.
I had a question on that. It's a two-part question, I think, to both you. is, are we successful October 26th because it's completely 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 20th, or is that too late to allow room for training?
I'll start. First and foremost, we have no plan to be releasing in October 15th, October 20th new code. There would be no time for testing, quality assurance, state acceptance, let alone production simulation awareness to the user community and training. So we are finalizing, as Carlos had mentioned, we are burning the midnight oil. And I appreciate the time that everyone is spending on this to try to solve 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 play out. But 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 acknowledge these 313. 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 tracked to. What we have now are these 313. We're not going to lose sight of these 313. We are going to track them. We want to be able to report out on them to show the progress that we are making and how we dispositioned these so that we can show what is going in for Go Live And as alluded to by Deloitte that we have these post Live releases and we continue to report on the post Live releases 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, Mr. Kelly. Mr. Kelly.
Okay. Based on the schedule that we've put forward, we have something that we call a freeze date. And what a 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 925. Okay, which gives you four days for your September 29.
Correct.
Okay.
Carlos, is it safe now? It sounds like CWDA, I don't know if you've taken a position, it sounds though you're switching your ask to the six-month delay to now, whatever can be done within the 59 days.
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 noncompliance 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 59 more days, we should do the responsible thing and maximize those 59 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 of 2026 and then I do want to 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 59 days there that still I sorry within the 59 days yeah I think I think it important to be clear as the Assistant Deputy Director was highlighting that we don't currently have federal approval to go beyond the go-live of October 26th. So 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 60 days that we've all been referring to are really 59 days, is because at the 60-day mark, we 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 we see a delineation that is a heightened risk because we then have to sort of start over in those conversations with the federal government. So that is the window that we're referring to as 60-day. It gets triggered at 60, so 59 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.
And to the ED's question of codifying, is there a 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 60-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, Mr. Marquez mentioned a couple of instances.
One that I quickly wrote down was around the medical history, just because I myself and the allergy kid as well, or was. Those items that are on your radar, you're tracking, and those are going to be fixed.
Yes. They are deemed as an essential story.
I want to make sure, checking my list here real quick. Essential to be delivered by GoLive, yes. I want to ask some other specific ones because those stood out to me in the CWDA's 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. Yes. 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, that note not being placed. And so.
Safety alert. Thank you. Okay. Safety alert. Had to get the right terminology. I didn't know. 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 be across case and referral screens. and we are working right now to test in QA. It's being tested in QA by the end of this month for a planned release September 24th into production. I'm sorry, September 14th into production simulation.
Okay And Assistant Deputy Director you mentioned the translation because that was another pointer they brought up That 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 anomalies? Well, so we evaluate every reported instance of issues with any single training class. And we evaluate what the issue was, and we try to, of course, we're not in every class, right? So 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 styles across 200 people, different styles of conveying that to users, and so what we've been doing to rectify that is to make sure that we're updating talking points to 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 the system currently as well as when they can expect to see fixes.
And OTSI, Chief Deputy, how are you holding the vendor accountable when 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, in which we are addressing issues, concerns as they are being raised. working to mitigate them. Also, if there's an issue that requires a change in personnel or approach, we will push for that and 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 work done. these are the contractual levers that we are also using. I will say we have had, I know, specific incidents where we have met with the vendor, discussed, made a change in personnel. But 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 at this time they don't have that same perception. Yeah.
I definitely don't want to hear that you're just hearing this now.
Well, 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 will 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 30 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 the legacy system. That's table stakes. We're not talking about being able to even achieve the lofty aims of the system when it is fully functional. We're talking about parity. And I think I would just add, we do have some concerns with the project's governance. I think CDT noted in their recent report to the legislature that the evaluation of the project's governance was trending down. So, I mean, I think if we're going to 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 want to 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 want to 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 what is the emergency lever? What are those points, September 29th, that you're looking at your checklist? Like is it a long checklist?
It is a long and growing checklist. It's growing. Yes. That doesn't get paid that way. 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 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 reporting areas. We're going through and making sure we have every technical, every piece of data points that we can to inform us going into that final checklist.
If I were to read you my notes I read on all my briefings that I got, it's a bunch of WTFs, and it's been 13 years. A kid went to graduate 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 there's 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 going to reach this? Are you able to share some of those on the checklist? I don't 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 met we cannot move forward Yeah I be glad to share some of the higher roll that again have many very task or yes questions
But, again, product readiness, so the core product being developed, performance, ADA compliance, quality readiness. from an implementation services standpoint, confirming access to the environments, making sure that all of our roles and responsibilities in the security profiles are set up correctly, from training, ensuring that all training activities have been completed, from the command center, making sure that we are stood up, ready to support the activities from September 29th through post-go live from a 24-7 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, Secris, other interface partners that we rely on to deliver this comprehensive system are ready, tested, deploying the 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 of the checks have been made there. And 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 have shown that objective.
One of the first ones or the first three, you said something about core responsibilities program, something, I think you said core responsibilities on the first ones. 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 go life have to go through the full SDLC and be accepted into production. So that would be part of the criteria. What if maybe I don't know if Department of Finance or like the carrying or like the carrying the carrying cost of like needing to address. What if there's another 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 they are not or 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 came in as a story and is later identified as a defect. The other essential stories, we don't believe there will be more new essential stories for V1. And again, V1 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 appropriate release post-V1 go live. And we expect continual releases all the way until V2 and even post-V2. We never will be done. and it will be continual and iterative.
One of my final questions. Mr. Sheldon, 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 So we have refresher training planned for starting October 8th just looking
at the schedule here, October 8th to run through GoLive, and that's incremental training and refresher training needs based on what the final training materials look like. So all of the trainers in all the counties will have materials. They'll have our workforce of training professionals working with the training coordinators in the county to provide additional and any refresher training that's needed from any of the counties.
And your other question on total timing? Yeah. So we'll be training all the way up until then. So with the code freeze on September 25th, we'll be updating
all the training between the 25th and the 8th. For one individual, like how long does that individual... I'm sorry. So one individual goes through 8 to 12 hours of training in total.
Okay. Mr. Marquez, final question for you. What is an outstanding question that you have not been able to get an answer throughout this process that you'd like to share here, if there's any?
Well, it really isn't intended to be a rhetorical question. I think we really would like to understand in fulsome terms what a plan B would look like if a plan B is actually being explored. It's certainly we are a partner in the project. We are in the governance in the project, and I'm not aware of a plan B. So, again, how objective can our criteria terms be if we don't have a plan B? And I really would – I think it's in everyone's interest to understand that as soon as possible, given the waning days that the legislature is in session because we felt compelled to sound the alarm. In our view, the system is not ready, and certainly we're worried about our ability to hold up our mandate to keep vulnerable children safe. So this is our best effort to get the legislature involved. We recognize that this is an incredibly tough tradeoff, and we have to weigh the equities. But we certainly will live with the system that we have, and we will continue to exhaust every remediation pathway possible before go live. But our position is clear. We do not believe we're ready.
It doesn't seem like we have a plan or can have a plan B. It seems like the current system, we get penalized monthly for utilizing the current system. We're not allowed to use it past the calendar year. It seems like we could be at risk of upwards of $850 million of losing funds. I don't know if a plan B actually exists. I think the plan B is 59 days. I think that's plan A through Z right there. I mean, Director, any last words or Chief Deputy Director of like that bodes confidence of like this is where, but it sounds like where you have to get it done with a child safety.
Child safety and again going through our governance and our processes that are built into the project to have our go no go decisions have that objective criteria. Again we are not going to go live with a system.
I was about to ask you that just please tell me on record that you will not go live. Not go live if we feel there is that critical flaw in the system based on that objective criteria that we have to say no go The opportunities are there in the process in the governance to do a no We would then have to deal with the ramifications of the schedule slippage what does that mean
for the planned activities, all the way down to training. Everything then starts a domino effect of what do we do then and if it was no-go, then what are we planning for the new go decision.
Okay. That's all. Thank you so much on this issue. Moving on to the Department of Social Services with issue number three.
Good afternoon, Chair and members. Claire Ramsey, Chief Deputy Director with the Department of Social Services. I'm here to speak on the first open item, the Child Care Age Groupings and Inclusion Policy Framework. The Department was asked to provide an overview of two of the 26-27 May revised trailer bill language proposals related to the age groupings and inclusion policy framework for the single rate structure or SRS. And additionally, we were asked to respond to a few additional questions. So I'll start by walking through your questions. The first question is to provide an overview of the proposals. The first one related to the age groupings would codify the definition of an infant, toddler, preschooler, and school age rate with specific age cutoffs, and these are described accurately in the agenda. The second is to create an enhanced rate for children with special needs and to outline the eligibility criteria for this enhanced rate. How that rate would be administered on a per-child basis, and the documentation needed are also included in the language of the trailer bill. These two policy proposals will move us closer to a single-rate structure implementation because they are two of the necessary components for a single-rate structure. These are part of the policy decisions that we do need to make before other activities, including implementation, excuse me, automation can be completed. Moving on to your next question about whether we can have a date certain for completing automation. Unfortunately, as shared in previous hearings, we are not able to guarantee an automation date. And the way that we are thinking about this is that we need the full blueprint for the house before we can build the house. And similarly, for automation, we need the blueprint for the single rate structure before we can automate it. We would highlight a couple of activities that need to happen before automation can begin. There are additional policy decisions that need to be made, which I will highlight in the next slide. in a moment to one of your other questions. We would then basically have to map over all of our current rates into the new single rate structure. For the RMR, that will be reasonably straightforward. There's a sort of relationship. For the SR, it is a totally different structure. So we will need to map all those rates. Local contractors will also need to do an automation crosswalk to determine what changes are needed to their payment systems. We do think that the department can provide technical assistance on how any proposed changes to the TBL can better support the timely completion of non-automation milestones that need to occur before automation systems can be changed. Moving to your next question about what other policy decisions are necessary. Besides the age groupings and enhanced inclusion, we would need to decide proration for the part-time rate, the enhanced rate for night and weekend care, or also sometimes referred to as non-standard hours of care, and we would need the funding structure for the administrative and indirect costs. Additionally, we would flag that there could be other decisions as part of a policy framework that came up in our November 2025 Joint Labor Management Committee, which included adopting guidelines for how rates would be set under an SRS, such as, in examples, prioritizing rate increases for rate categories furthest away from the cost of care. And we think this will help us provide more of a framework to work within for the single rate structure as we move over to rate setting. We do think the mechanism for these policy decisions could be trailer bill language considered through the budget process, which reflects how we have moved forward with the age groupings and enhanced inclusion policies today. To your final question, the department is happy to provide technical assistance to the legislature on what information can be provided on how the existing child care rate structures could be simplified, and if and how rate increases could bring the state closer to a single rate structure that includes the cost of care. We don't have any proposals on that at this time, but we are happy to continue conversations. We realize this is a complex undertaking and we're committed to continued partnership. I'm happy to answer any questions.
Anything from LAO?
Dylan Oxlutso with the Legislative Analyst Office. We don't have any comments at this time, but we're here for questions.
Okay. Okay. Nothing? Great. Is, you know, we had, you were responding to milestones, provide TAM, milestones to get to automation, but were those the ones that you answered for question number two?
So, yes, those go together.
That's right. Those few that I highlighted, those three are connected to those milestones.
Those are the milestones that need to be accomplished before you can start automation? Right, at minimum. Before we can basically have a framework that could move toward automation. I don't want to skip over the steps, though, related to the mapping over and things like that, because we do need to know what to change within our automation systems to account for the single rate structure.
So, you know, this is maybe too simple, right, of a question. So you can't, we don't have the numbers.
Again, we don't have the numbers. But you can't start the work on the system of automation to just then plug in the numbers? Right because think of it like this Right now the system tells us that a family child care provider in San Mateo County serving an infant would receive this rate We need to understand what happens within the single rate structure. So are they still defined the same way as an infant? Are they what rate category does a family child care provider sit in? What region we're going from counties to regions within the single rate structure? or what region is San Mateo County in so that it maps into the new rate. So it's just an example. And so we need all those frameworks there before we could automate that.
I hope that's terrifying.
Yes. But the TBO will lock in the categories, the age groups, at minimum, that part.
Right.
And then on top of that will give us a framework for the inclusion rates.
Is Jackie nodding her head? Oh, good. Then I know I'm doing okay. So then you've mentioned a couple of milestones to get to there. A couple of things that need to happen to get to there. What is then the deadline for each of those things? I think that is something that we understand is something that the legislature and the administration could work out together.
We do have a framework to look to because we did have the JLMC at the end of last year, which put out proposals on each of these items. As you know, not every item had an agreed upon sort of definition. But we do have a framework for how to move forward. And so we think we're well positioned to continue to move these pieces forward in the coming year.
I don't know if you heard the entire previous conversation, but there's a lack of trust of getting these through. And we seem to, with any kind of program in the sub three, always not meeting the deadline, whether it's anything. This foster what like there's always uncertainty. It is so important to put some kind of deadlines on these milestones, these project milestones to convey that we are doing what we were told that we were asked to do. I understand there's a lot of things to be done before the full automation. But what I continue to see is that we'll pass something and it's ready to go. But then we're told automation is not ready. So we're trying to reverse that and say, OK, then let's do the automation. So once that's ready, we can go forward. And that's also a no. So we need something in the middle. And I know continuing conversations.
I think I'll just say we both really respect what you are trying to get to here related to continuing to move this forward. This is something that we're very committed to as well. And I think we're very open to deadlines for the project for those milestones, because we do think that is like a necessary step before automation. And we do want to continue to move the pieces forward. Okay.
I appreciate you sharing that. We'd love to see that maybe if we can land on some, at least for one of the things so that we know we're working towards that. One milestone was accomplished. And 10 years, the next one. And so forth. But I just, we need something. So I appreciate at least considering that compromise. And I think that was it for you.
Yes, I had nothing else unless you had any other questions.
I do, but that's other stuff. I mean, okay, I still have the outstanding of why infant is two and under. And that's will forever be a question for me if they're walking.
Do you want a short answer? I would love some Yeah I mean I think it just to be clear we can define infants for rates differently than for licensing So that is a possibility It does add potentially complexity to the system. That exists now. There's one that gets it already. Right, the single rate, SRR, does define it as 0 to 18 months, and licensing is 0 to 24 months. So we already have a separation already. We do have some separation.
That's right.
It is a policy decision. There is a way in which having a broader definition actually benefits people on the rate side, right? Because if you're caring for a child who's 19 months old, if the definition of infants for rates is 18 months and under, you flip into a toddler rate at that point. So if it stayed till 24 months, you would continue to get the infant rate all the way through two years. I do understand people are concerned with caring for more children. And that's, you know, a whole separate question of like, can how much can somebody handle kids of those younger ages safely and healthily?
I just the fear that I had was just locking this in. We saw what happened with universal TK. Then the bottleneck is in that infant slots. We don't have enough infant slots locking this in. I feel like we're not being able to address what happened with TK. and these providers, they need more slots on the TK, on the infant side than they do on the toddler and so forth because those are leaving.
I would just say that that is a distinct issue from rates because, again, the rates could pay on a different definition than the licensing. The reason why I say that is because even though it currently exists, the separation, that's still being used as a reason why we can't do it Because if we lock in the rates here, it makes it difficult to pay rates different when the ratio is different. I would just say I do think it's worth thinking the way we simplify or make the system more complex with these types of choices. So that is part of it. But I do want to say there, I think, is a whole conversation to be had about health and safety within licensed care. If we move the definition downward, that is sort of separate and apart from the rate conversation. Just want to acknowledge that it's sort of two components that interplay with each other but are not the same.
Okay. Thank you.
Thank you.
And I know there's a second item in this issue.
Yes, good afternoon, Madam Chair. Eliana Kamot's Office of Equity Director with the Department. I'm here to provide an overview of the Department's proposal to conduct to modify our current statutory authority to allow for the hiring of an independent consultant to develop a service framework for the youth immigration legal services and the TURP program. Our proposal really seeks to develop a framework that's tailored to the needs of children and youth in this program and create a standardized, evidence-informed model for how services are delivered statewide, establishing shared strategies, metrics, and outcome measures to evaluate effectiveness, identify gaps and ensure consistent quality of care and immigration legal support. After several years of funding these services for children and youth, and with the recent addition of social services in the statute, this effort will inform a framework for funding to serve the best interests of children who face multiple challenges navigating multiple systems, not just the immigration system, but also the child welfare system, the probate and family court, new school environments, complex healthcare needs, among many other challenges that have drastically expanded under the current federal administration's enforcement policies. Currently our CDSS programs are developed with legal service providers without a neutral external evaluator Our nonprofits use various different local models different case management approaches and have different legal advocacy capacities and different resources in specific regions. This sometimes results in inconsistent access and different quality of services across the state. The proposed framework introduces an integrated model built with child welfare, legal, and includes our nonprofit providers and health experts to support statewide quality of care for youth and maximize outcomes for these programs. There was a question in the agenda about which funds we're planning to use. We're planning to use our existing immigration services funding allocations to support this third-party evaluation. The exact cost is still being determined. We have initial informal estimates from potential providers ranging from $250,000 per year to $500,000 per year. depending on travel, convenings, and staffing needs. This is not something we can complete internally, partly because developing a comprehensive statewide framework requires specialized expertise in evaluation design, analytics, cross-system research, and best practices standards in child welfare and immigration legal services. There's not a lot of folks that have those overlapping expertise. And we do not currently have the technical research staff to produce an evidence-based model within the required timelines. In addition, the program integrity piece of it would require an independent third-party evaluator, and our initial feedback from some of our advocates highlighted the need for a neutral external contractor to ensure an objective assessment uninfluenced by a single perspective or historical program practices. And I'm happy to take any other questions.
Anything from LAO or DeBern Finance?
Juwan Trotter, LAO. We have no additional comments.
so one of the last things you've mentioned you said within the required timelines whose timelines like who's putting this timeline it's our own timeline just for improving the services they
have been ongoing for several years we're again hoping to expand we've been using social workers in the program for a while but I think it's good to evaluate the effectiveness effectiveness and have some standards across the board for all of these programs, for youth legal services as well
as for the CHIR program. I agree that we should be auditing any and all government program that we fund. That's always beneficial. Transparency is really, really great. I'm wondering, Department of Finance, if this is a request of the department, why additional funding that's not being allocated for this, and instead the funding's being taken away from funding that we gave for actual services.
Chris Cook, Department of Finance. I think the request is viewed from our perspective similar to how we would fund other existing administration of these type of funds, where they're just carved out of the appropriations.
Well, the discussions we had in the past six months in the subcommittee regarding this was the need for increasing actual services. There was never a discussion that these funds were going to be used to pay a third vendor that could amount to between $250,000 to $500,000 for the services.
So there was never a conversation on that.
So I don't know if that's a perspective that is maybe singular in view because we did not have that perspective at all. The proposal is to take away funding from actual services. Given the increase, the need here, it just seems a little bad timing. if we don't have the funding for that I've been told or our request then we can't fund that right now we don't have the funding for this so I would return your words and say we can't fund this right now because it's coming out of services and Director, have we heard concerns from the field about these programs?
I think at different times they've been hard to implement. Not all immigration legal service providers know how to work with social workers, and I think for us defining some standards to make sure that we can monitor and audit the same quality of standard across the board is important. These services become more complicated as the needs of the children become complicated, but we have we have done our own site visits and seen seen the variation but
no we have not heard any can you clarify there are two programs that were called out the the youth legal services and trip and trip but in the past historically we have asked the youth legal services to be more like trip because trip was like the model services why are we then now grouping them as well as potentially them not meeting well if you recall we recently changed the statute so that the
youth legal services could be similar to CHIRP sure that's a best practice so it
is they will be similar but there's no standard across the board for what type
of quality of service all of these all of these programs are implementing because we haven't created that type of framework so that's really what we're looking to do but so even though it's not just an evaluation okay it's it's
more to create kind of a standard of best practices that we can say this is you know what we see as the quality of standard across the board. Okay it's been in a lot of our
programs it's hard to do that because each county or each service they might not have that specific kind of service and then we create a list that they must might must reach and what doesn't that service doesn't even exist in that county or around that area how do you work around that?
The number of providers that work in the youth immigration legal services space is actually relatively small. Okay.
The expertise within immigration legal services. So it feels like creating a standard or guidance for that group would be something that's feasible.
It's a standard for the services provided. I mean, it is true that not all of the youth in different regions wouldn't necessarily have access to the same supports
because they are different across each region. But, you know, kind of the way that each immigration legal service provider would approach the work hopefully would be similar.
so then it's safe to say if this proposal is coming forward we haven't allocated or started to allocate some of that funding already have we held back some of the funding knowing that we need to use some of that to pay for the third-party vendor no we're still i mean we we're still in
conversations about all of the immigration legal services funding and how to implement it so exactly where it would come from is still you know a conversation where we're looking to have amongst the different programs, but we're not holding back funding. This is not delaying the
implementation of the funding. How does it not delay if you have to settle? You don't know how much. It's going to come from the one pot and the one pot pot pot. It comes from that pot, right? The pot that is given out to the vendors or the service providers. It's not necessarily coming from the
CHIRP pot. We also have supplemented the immigration, sorry, the youth legal services program with ISF funds in the past. So we're still trying to identify exactly those are our existing funds, our $45 million allocation that we have every year. We often set aside some funding for capacity projects or things that are, you know, that creep up in the immigration legal services space. So potentially that's a place where we could pull some funding and set it aside for this. It wouldn't necessarily have to come from the CHIRP allocation. Department of Finance,
feedback on it still unknown where the money going to come from It still unknown how much it going to cost for the vendor This trailer bill is being asked with about 19 days left in the session
versus this being in the January proposal to actually flush it out and have the full details. Wondering what is the harm if we don't do this right now versus this being proposed in the January budget to actually have more details to present to the legislature?
Well, I think you said it earlier. not identifying the amount or where it's coming from would potentially hold up the allocations for these services in the coming year. So unless you're referring to us coming back to the legislature and asking for this for future funds, that is an option definitely. But what we're requesting for is of all the money that's been allocated specifically in 26-27, that we start doing that study and contract in the current year. and that way if we do it now, we don't have those delays in the out years.
But then maybe I'll come back because then I misunderstood then. So we've allocated funding for these programs. Yes. And my question was if we've allocated those funding, those monies,
since we don't know how much it's going to cost for this, is that delaying what vendors we choose to give the money out because we need to save some for this potential vendor.
We are still in negotiations with a lot of our awardees
about kind of what amounts of funding they can take. So there's a lot of fluidity in terms of how much capacity people have, what their final award will be. And so it's possible for us to carve out some of that and set that aside and still continue the conversation with the awardees about how much my funding they can take.
So I think both we can set aside the funding and kind of work with the remaining funds
to have those conversations with awardees. Or the conversations are still ongoing right now.
It's not an automatic process. Every year, the capacity of the field is different.
So we're still within time right now to carve out that funding for this year.
And what's the impact on services that are going to look like? Did we over allocate? Or if we set aside some of this funding, everyone's going to get what is needed? All the needs are going to be met? I don't know that we have that full picture quite yet.
And, Chair, I would just also add that this last year in the 26-27 budget, we did add quite a bit of money to the program. And so although my colleague mentioned that those conversations are continuing with those organizations, the additional money would – it would be helpful to kind of incorporate this now and allow for that study to help inform future allocations.
But Mr. Cook, right?
Yes. Mr. Cook, but the reason why we added more funding is because the need was much greater. We also added dollars for capacity building. That was part of the administration's proposal for, I believe, we added, we proposed $20 million that was included into the budget.
Yeah, I remember.
And then there was also additional funds added on top of that. Because the need is great. The need is really, really, really great during this time. So that's why I'm particularly interested as to during a time where right now service providers are like up to their neck with cases. Again representing the number one targeted place in all of California which is my district I see this every single day I recognize transparency is very important but given the time where service providers are so busy trying to meet the needs right now providing a review of it during a time that is so heightened also may not produce the results we're looking for because it could be an anomaly versus a more regular period. And I just want to clarify that the idea is not necessarily for this to be like an audit. Oh, you did say that. It's really just to bring an expert to think of like what best practice guidance could be for the field. And I appreciate that there is an incredible need for services out in the field. And I think we also try to take great pride in the high quality of service. And so for us to be able to create some standards is always important in our programs. And that's where that's coming from. A hundred 100% agree, but I think adding additional funds to meet this request, I would have preferred that. I say that and what are we going to cut? It's the end of the budget. I get that. But the ask is to remove from what we've allocated already that are direct services, capacity building because we need more services, and instead pay a third vendor to come and address the needs, the gaps that exist during a time that we all know gaps exist right now. And maybe the best practices aren't happening right now because we're in crisis mode and we're doing what we can right now to just meet the need of an individual at the moment and whatever best way we can. Just seems at a very particular, peculiar, peculiar time to do this. Personally, not a huge fan of the timing of this, of this proposal. I am worried about taking away funds for services. A quarter of a million to half a million dollars goes a long way. If there's a small amount of providers already that only exist, that can go a long way with them. You're asking a chair, well, I continue seeing kids crying about their parents taking away. I'm like, I need more services for them. Not tell me how, you know, that's just where I am right now. but it's above my pay grade on these conversations at this point. So, all right, I appreciate your presentation. I don't appreciate it. I don't like it. So I won't say I appreciate it. I don't like it. But thank you.
Thank you, Chair, and happy anniversary.
Ah, thanks. Thanks. Issue number four, DHCS. You may begin. The row of 988, yes.
Good afternoon. Paula Wilhelm, Deputy Director for Behavioral Health at the Department of Healthcare Services, and I have with me my colleague Ivan Bardwaj, who will assist with questions. Your first prompt or question from the committee was just to please provide a brief overview of the current version of our 988 trailer bill. And so would share that the core policy proposed within the administration current 988 trailer bill that is specifically administered by DHCS is the authority for DHCS to establish a new statewide designation process for California 988 suicide and crisis lifeline centers And the key goal of the proposed designation process is to establish a new statewide designation process for California 988 suicide and crisis lifeline centers And the key goal of the proposed designation process is to create a pathway to add new 988 centers, thus improving our 988 response capacity in light of increasing call text and chat volume, while also specifying standards that all of our centers must meet to assure quality services and receive 988 funding. The Trailer Bill also defines what qualifies as a designated 988 center going forward, describes what is meant by a mobile crisis team, clarifies how funds from the 988 Suicide and Behavioral Health Crisis Services Fund will be allocated, and requires DHCS to publish certain information about designated 988 centers on the department's website. So the components that I just mentioned were included in the original version of the TBL and discussed in our previous testimony to this committee. The 988 TBL was subsequently revised on May 18th of this year to add new provisions. And the substantive provisions that were added primarily involve the Emergency Medical Services Authority, EMSA, and the Department of Public Health, or CDPH. So we are not going to go into detail on those proposals and would defer to our colleagues and those agencies to address questions. The updated language does also include requirements for some of our sister state agencies to consult DHCS as they carry out their 988 responsibilities. So there's new consultation language included in relation to activities carried out by EMSA, CDPH, the California Health and Human Services Agency, or Cal HHS, and the Governor's Office of Emergency Services, or Cal OES. If I may share a couple of additional points about the designation process proposed in the TBL, the statewide standards and designation process that DHCS will seek to develop if the trailer bill is enacted is really meant to support service quality at our designated 988 centers by addressing staffing requirements, training, clinical and triage protocols, performance measures, counselor service expectations, and processes for oversight. and monitoring by the state of the centers. And that new designation process is proposed to be implemented no sooner than October 1st of 2027. All of our existing California 988 centers will continue to receive funds from the 988 fund through December 31st, 2029. And after December of 2029, all centers will need to have obtained DHCS designation to receive 988 funds. The trailer bill really offers a high-level framework for the center designation process. So DHCS is planning to work with our 988 centers and other stakeholders prior to October of 2027 to fill in the framework and establish the full details of the designation process and center standards. And we look forward to supporting and collaborating directly with our existing centers to fill in that framework and set up that process if the legislation is enacted. Thank you. Shall I keep going with second question?
Yes, absolutely. Don't break in any time.
The second question was about how we are currently utilizing 988 fund revenue to support the 988 crisis centers. So for fiscal year 26-27, in the recently enacted budget, DHCS received a total of $31,998. 61,000 from the 988 fund to support operations across our 11 988 crisis centers. And the 988 fund supports our crisis centers by providing direct operating funding to deliver 24-7 call, text, and chat services statewide. Funding also helps centers that may not offer 24-7 text and chat capacity yet to establish and grow that part of the service. A couple of core examples of the way the 988 funds are used includes just underwriting basic staffing that the centers need to make progress toward meeting the Substance Abuse and Mental Health Administration's key performance indicators, including the goal of a 90% answer rate across all 988 contacts. And then they would also use the funding to support crisis counselor participation in required trainings, technical assistance, and reporting activities that strengthen service quality. And we'll mention required trainings in a moment when we talk about services for the LGBTQ plus population. So, in addition to addressing that question about how the centers are using 988 funds, we also wanted to take this opportunity to highlight and share an update on potentially available federal funding that is new since we last testified before the committee and, in fact, since the budget was enacted. SAMHSA has now released an additional three-year grant opportunity to strengthen states' capacity for 988 services. DHCS had applied for and received funding under a previous three-year grant cycle from SAMHSA, and we have now applied for this new opportunity. That application was submitted in July. The upcoming grant cycle, if we are awarded, will run from September 30th of 2026 through September 29th of 2029, and we hope to know if we are receiving the award by early September of this year. If awarded, California will receive a little bit over $20 million in additional SAMHSA funds annually, and that is comparable to prior allocations from the previous three-year grant cycle. And so, if we do receive the grant, additional funding will be allocated directly to the 988 Crisis Centers to expand capacity, strengthen performance, and continue working toward those key performance indicators. We anticipate that they would receive about $14 to $15 million annually of the $20 million that is available. And then funding from that award would also be used to support newly required grant activities for the state and the centers and ongoing reporting and evaluation activities with SAMHSA. So last sort of note on this is the SAMHSA grants do include non-supplantation terms. funds obviously must supplement but cannot supplant existing state investments in 988 I just saw that as a question to think yes thank you we we have always treated these federal funds in California as additive to right and not duplicative of or interchangeable with state 988 funds appropriated in the budget and if we receive these additional federal 988 funds the total amount available to the 988 centers and for state administration in this coming year including both state 988 funds this new SAMHSA grant and then a relatively smaller amount of federal mental health block grant funds that we are able to allocate through the 988 centers. Taken all together, this is about $57.4 million, and that represents a marginal increase from prior year funding so we think it would be an increase of about five percent over what the centers have operated with previously so hopefully those data points are helpful and we're happy to answer additional questions and then the last prompt is about resources available for LGBTQ plus individuals calling 988 following the elimination of the federal press 3 option and how California can help address this so thank you for the question and DHCS very much shares the legislature's interest in ensuring that lgp LGBTQ plus Californians can access effective and responsive support through 988 callers to 988 today receive help from 988 Center staff that have received required training to provide competent and equitable support to LGBTQ plus in individuals so you may be aware that after the federal decision to end the national press 3 option in July 2025 the California Health and Human Services Agency partnered with the Trevor project which was the primary organization that had previously helped respond as part of the national press 3 option and Cal HHS partnered with the Trevor Project to develop and provide LGBTQ plus competency trainings for our California centers, including a four-part equitable care series. DHCS actively worked on that effort and helped promote and reinforce the Trevor Project's training opportunities. So those live trainings have concluded now, but the Trevor Project did develop a public-facing website and resource, and so we can still use those trainings for new and current 988 crisis counselors. I mentioned previously that DHCS does require 988 crisis counselors to complete specialized training to serve our LGBTQ plus population, and required trainings over the last fiscal year included topics like transgender youth and compassionate care in the 988 crisis continuum and supporting our LGBTQIA plus youth in digital crisis. So DHCS is very committed to partnering with all of the centers to ensure we continue to prioritize and focus on serving this population. We also note that SAMHSA did recently release a request for proposals to establish a 988 Lifeline LGBTQ plus youth voice, text and chat subnetwork. I'm quoting that name from the RFP, and we think this is intended to be similar to a Press 3 option. As we understand it, the purpose of the RFP is to select qualified crisis centers to operate as an LGBTQ plus youth subnetwork, and they would provide specialized services to help seekers, not just callers, also texters and chatters who choose LGBTQ plus youth voice text or chat options. So SAMHSA work to develop a new dedicated subnetwork does indicate some progress at the national level toward improving or assuring access for this population DHCS will continue to monitor any developments federally or with SAMHSA and also are certainly available to collaborate on state-level efforts to improve our services in this area. Thank you.
Anything to add, Will?
Will Owens with the LAO. Nothing to add on this item, but available for questions.
Okay, I did that. Okay. Excited about the potential of getting, so $60 million, it would be 20 annually, right, for three years?
We were projecting a total, oh, for the federal grant, yes, about $20 million for each of three years, correct.
Are those funds eligible to fund mobile crisis units?
No, they are eligible for activities specified in the grant opportunity and its core support for existing 988 centers. And then there are certain expanded activities that are included in this three-year grant cycle. And one example of that is an emphasis on improving 911 and 988 connectivity and protocols for transferring contacts between the two lines. And there are some other new requirements as well attached to that funding.
Okay. And the potential 5% increase that you mentioned for the centers, would that allow, because last time I remember they said they wanted to bring in more people,
or like the capacity, do you think will allow them to increase their capacity? We have understood or thought that the incremental increases we've been able to offer with state and federal funding will allow them to incrementally increase their capacity and make some progress on improving center performance. We're definitely aware that they have also calculated a greater need and put that proposal forward. And we have been meeting and working really collaboratively with the centers on a new methodology to better project funding needs and sort of calculate exactly how much might be needed for them to improve performance in certain ways. So we are looking at using that methodology in the next budget cycle when we put forward a new request for funds.
Yeah, and we'll hopefully continue. I think, you know, I'm glad we were able to save the mobile crisis for one more year. I think, you know, it's pretty important to the continuum of care. So we'll see you next year to continue that conversation on what that looks like. But I don't have anything else. I know those conversations on this specific item are almost landing. So excited about that. Thank you. Thank you. We'll move on to issue number five.
Good afternoon, Madam Chair. Tyler Sadwith, Chief Deputy Director at DHCS and California's Medicaid Director. The Department proposes targeted statutory changes to modernize and strengthen Medi-Cal provider oversight These updates reinforce the Department ability to act swiftly when program integrity risks arise they enhance transparency and they support consistent risk enrollment actions The proposals provide clearer authority, cleaner business standards, and improved alignment with longstanding federal risk-based provider enrollment and screening frameworks. The updates also clarify the Department's authority to impose temporary suspensions and payment suspensions when credible allegations of fraud or other program integrity risks are identified, and strengthened statutory tools used to deny, suspend, or terminate enrollment when concerning affiliations or investigations arise. Just as quick background and additional context, in January of this year, CMS requested California develop a comprehensive program integrity plan. In developing that plan, the department found that further clarification in state statute regarding provider enrollment, payment suspension, and provider termination authorities would strengthen our ability to uphold the integrity of Medi-Cal in alignment with federal guidelines. CMS also recently issued a directive requiring states to revalidate all high-risk Medicaid providers within two years. and this accelerated timeline creates new program integrity pressures and risks with respect to provider enrollment, and the proposed bill seeks to mitigate those risks. We're engaging with stakeholders closely on this, including several provider associations. We're listening to their feedback and their assessments of the trailer bill, and we are evaluating their recommendations.
Can you expand a little bit? I know one of the concerns is around guardrails. I know if you can share, I'm a provider. I'm the one that I triggered potential fraud. fraud. Is it everybody with my title is now stopping payments or is it just I'm being targeted
as an individual provider? Generally it would just be the individual provider. There is one component of the proposed trailer bill that would enable the department to propose a targeted and temporary moratorium on new provider enrollments within a specific benefit category or provider type. That would enable the department to act swiftly when there are seriously concerning trends of high risk fraudulent.
So like hospice?
Exactly.
So we would do what we did with hospice with providers, these kind, other kind?
Yeah, the trailer bill proposes to grant the department the authority to sort of impose new targeted provider enrollment freezes when something like hospice emerges.
Are you able to share any of the potential guardrails that you're looking at that you're hearing from stakeholders in terms of concerns?
Sure. So I think with respect to that one, the stakeholders have asked for a little bit more sort of transparency to make sure the department uses its discretion appropriately. So to that end, the department is sort of actively considering what what options in terms of sort of, for example, legislature notification would be appropriate before acting to impose a new targeted moratorium. So these are reactions to their feedback that we are still proving.
processing internally. Okay. And post our letter that we send to CMS in January, with new proposals
like this to address this kind of issues, are we sending updates to CMS? Are we required to send
updates? Generally speaking, no, we're not required to send updates, and we wouldn't plan on
necessarily proactively saying, hey, look what we're doing. That said, I did mention a new national directive that CMS is imposing on all states to conduct a off-cycle revalidation of high-risk providers within a two-year period, which exceeds federal regulations, which is a five-year period. So we have responded to that, and we have submitted, just like every other state, a plan describing how we plan to conduct sort of a risk-based framework for doing that enrollment. they have they are requesting quarterly reports on that and they're I mean they're digging into it they sent follow-up questions to us that we that we had to respond to and like every other state
so what I would say with respect to your specific question is there's a possibility depending on the
content that CMS requires in their quarterly reports pursuant to this two-year provider
revalidation plan we might reference this if it's relevant and material okay
thank you it looks like you're enjoying that process no comment it's not your
administration you're allowed to speak about it thank you so much no further questions on to the next department department of Developmental Services.
Good afternoon. There we go. Better. Good afternoon, Chair and members. My name is Angela Munoz with the Department of Developmental Services. Thank you.
Have I seen you here?
A couple years ago.
Oh, okay, okay, okay.
Blocked it out.
No worries.
Thank you for the opportunity to speak today on the Department's Community Placement Plan and Community Resource Development Plan merge proposal. This proposal combines the Community Placement Plan and the Community Resource Development Plan into one unified program. The Community Placement Plan was historically created to develop residential supports and services for the individuals transitioning from the developmental centers to the community. With the closures of the developmental centers behind us, the original purpose of the Community Placement Plan has been completed. The Community Resource Development Plan develops community resources to support services and needs for those individuals in the community while also prioritizing the development of resources for individuals residing in restrictive settings or with complex needs. The Community Placement Plan has always served this purpose. Instead of maintaining two separate programs, we are proposing one program with one name and one set of requirements that serves the same purpose. Thank you Any questions
Sorry, I was trying to gather my... I know the Assembly dove into this. Just wanted, at least on the Senate side, if you can answer some of the similar questions, obviously. Or wait, are you looking at me confused?
We have a couple of proposals.
Did I miss something?
We have three proposals that we're bringing forward today that remain open.
Yes, three trailer bill proposals.
Correct.
We just did the first one.
Correct. Thank you.
I apologize.
No worries.
Good afternoon, Chair Christine Bagley, Department of Developmental Services. So I'm going to speak on the second proposed trailer bill, which is the state-operated transitional rehabilitative services proposal. So this would establish clear timelines, 24 months to transition individuals, yes, from Canyon Springs and individuals that are residing at Porterville Developmental Center under 6,500 commitments into the community in community-based settings consistent with the Lanterman Act. You know, the absence of time limits has led the developmental service system to rely heavily on the use of both Canyon Springs and Porterville as long-term residential placements rather than prioritizing transitions to the community. As a result, we have individuals that are remaining in these highly restrictive settings for far too long, way beyond what's necessary for their rehabilitation. You know, this current version of the trailer bill, we want to thank our community partners as well as the Senate for thoughtful feedback and input. Specifically, this proposal includes a 12-month provisional placement to the community with the right of return to both Canyon Springs and Porterville. It has a built-in 60-day extension to the 24-month time limit when specific criteria are met. It includes clear timelines and transition planning notification to counsel and clients' rights advocate, which really increases the collaboration and support for those transitions. It includes an initial implementation plan that would be developed in partnership with the community and with their engagement. We also included in this proposal quarterly legislative briefings with written updates that would be posted publicly for transparency and sharing of the progress that's made. And then it includes a variety of repeals for obsolete language, specifically for old acute crisis admissions that no longer are permissible. And then lastly, I think there is thoughtful timelines that allows a kind of planning ramp for those transitions and staggered transitions. And so with that, I appreciate the opportunity to speak. And, you know, again, I would just name you remain committed to engaging with all of our partners to ensure that we're, you know, accomplishing safe transitions for individuals. and we really feel that this proposal allows us to do it more intentionally, quicker, with consistency, and in alignment with the values of the Lanterman Act. Thanks.
I'll ask some questions on this one. Yeah. Is there anyone opposed to this trailer bill Stakeholders outside of the three So in terms of like our community stakeholders I would say like no
I would say I think there was concerns raised by the district attorneys.
Yeah, but no official opposition or anything like that?
We're not aware of anything in writing.
Okay. Okay. Would you say any of the district attorney's concerns hold any water?
I think the department, you know, recognizes, you know, the need to be responsive to public safety. And, you know, the department is or the administration is aware of some proposed amendments from advocates that I think do address some of the public safety concerns. So, again, the administration remains open and committed to any sort of amendments that would strengthen this proposal.
Can you share it? Because I'm not aware. Are you able to share some of those proposed amendments you're looking to consider?
Yeah, I would say, well, so this is proposed by some of our advocate communities, and at a high level, those amendments include kind of the ability for individuals with specific kind of histories to move through kind of a second review process that allows kind of a backstop. So if those individuals do remain a concern for public safety, then the department would, there would be a process including, you know, clinical review as well as court review processes that would potentially allow an extension past the two years. So it really creates a backstop.
Got it. Okay. I mean, even though the trailer bill you're proposing already provides
a very comprehensive assessment, you're just, okay.
Because I believe this trailer bill is – I felt like you had already addressed all those kind of potential missing factors. I felt like the proposal was very robust, that had enough backstops necessary.
And I think if I remember, they were able to come back.
Yes, that's right of return.
So, yes, that's correct.
Yeah, okay. So no other questions on that one? We could go to the third proposal.
Hello, and thank you for this opportunity to provide an overview. I'm Michi Gates, Chief Deputy Director of Program Services at the Department of Developmental Services. This is the third proposal. This one is the equitable access to intake and services. Last time we spoke on this, it had a different title, and then we discovered there was a lot of confusion created by that title and some of the ways that this was written, so we've clarified that. The goal of this proposal, which contains two parts, is really to further address and try to improve upon equity and consistency and fairness in the regional center system. It is responsive to the concerns that we have heard many, many times over and over from our community, from people in the system, that they find processes that regional centers follow confusing, that they vary quite a bit from regional center to regional center, and that there is a lack of transparency and fairness in some of those processes. So this proposal addresses all of those concerns in two parts. One for those who are applying for regional center services and being assessed for eligibility The second process is for identifying the needs of people who are in the regional center system have been found eligible, and are having their needs assessed for services and supports. So the first part of this proposal would create one way for regional centers to assess individuals for eligibility using the current definitions in law. So this does not in any way change the definition of what makes a person eligible for regional center services. It is not meant to narrow who can become eligible for regional center services in any way. This is not meant to be a way to slow down growth or anything like that in the regional center system. Rather, as the department has worked on SB 138, standardizing the intake process for regional centers, what we have heard consistently from the many stakeholder groups that we have met with is that a major part of the concern in the intake process is how regional centers determine eligibility itself. So while we were under SB 138 planning to standardize the process overall, what's the first day of intake, what are the application forms, what information is required, et cetera, what we're really finding is that if that is what all we do and we don't address this eligibility assessment part, that we are still not going to have a process that is satisfactory to individuals applying for services. So, this would propose that we would establish a valid and reliable and consistent way that regional centers would assess individuals applying for services for the presence of a developmental disability and then the second part of eligibility is, is it substantially disabling? So that's what the first part of this proposal would do. The second part of the proposal focuses on those who are regional center eligible and receiving services and supports. That part strives to improve the identification of individual needs. So another common concern expressed by our community is that individuals' needs go unnoticed, unmet despite the planning process, despite the planning team, despite person-centered planning and thinking. And so what we are proposing to do, and we have changed these proposals also as a feedback from the May hearings so that they are simply, both of these parts are simply proposals to you study to go out there, explore what are the options, and through that process, gathering robust community feedback and input, and then making a recommendation to the legislature. Neither of these can be implemented without legislative approval. So with the second part, what we're proposing to do is replace the current instrument that regional centers use, the CDER client development evaluation report. Replace it with a modern tool that actually speaks to our current society. The CEDAR was developed in the 70s. It is not consistently used by regional centers as a needs assessment tool because it is very outdated. So we are proposing to, again, explore, research, study, gather community input, and then come back to legislature with a recommendation on what an improved tool could do. This again is not meant to be a cost cutting measure. It is not meant to have people do this needs evaluation and then it's going to map to particular services, to particular amounts of services. It will not do any of that. It is simply meant to provide another way to make sure that planning teams identify all of the needs of a person, and not even just limited to their developmental disability needs, but all of their needs. And hopefully that this would help planning teams to make sure that they have talked about as many things as they possibly can, and that planning team meetings can be difficult. They can be stressful for individuals and families, and sometimes things don't come up that should have come up. So this, we propose, would be a help for that and be more likely to bring people up who perhaps currently are not getting the services and supports they need, to have those needs identified, spoken about clearly in a planning team meeting. So it does not replace the planning team. It does not replace the IPP process. Those are very central to our system. So those are the two proposals. And, again, it would require legislative approval to implement anything new.
Leo? Yes, good afternoon, Madam Chair. Mark Newton with the Legislative Analyst Office. Just a few quick comments to add to the Department's comments on this issue. The origins of much of what we're talking about today are sort of data findings from a few years back that were submitted to the legislature where it was found that spending on developmental services disaggregated by race and ethnicity and depending on where you lived in the state showed disparities. And the legislature enacted SB 138, which provided legislative intent and policy direction. This is noted sort of in the agenda as well to provide just sort of more statewide uniformity and consistency in the assessment of eligibility by regional centers of their consumers as well as in the provision of services or so. So this trailer bill is pursuant, or much of the trailer bill is pursuant to SB 138 as sort of the first step. As the administration sort of mentioned, a key change that has been made to the trailer bill is to make the new processes subject to legislative approval in both components of the trailer bill. While generally consistent with legislature policy direction these are fundamental potential changes to the program and giving the legislature the opportunity to see whether the proposed changes with stakeholder input sort of align with the legislature priorities So that I think goes a good way to address a number of concerns that have been expressed thus far in the process.
I believe so, too. Thank you. Department of Finance, anything to add?
One more sentence. Department of Finance, nothing further to add.
Okay. You answered most of the questions I had for you, so I appreciate that. I think I just have one or two left. If I am receiving services at our regional center currently right now, will this proposal require me to be re-evaluated? No, no. And it would not require a reevaluation. The needs evaluation, which has nothing to do with intake because that was a major source of confusion, that that would be determining substantial disability, will not do that. It will simply be a needs evaluation that will be done with each IPP. Some regional centers do that annually, some every three years. It would be done at that time, but also if a person's needs change significantly, a planning team could be called and the needs evaluation could be done again. Thank you. And you did answer that the CEDAR is not even widely used across regional centers. Is it even a validated assessment tool? It is not validated for its current form. It has not been substantially updated for many, many years. Many of the updates have been more clinical regarding diagnosis. It is primarily, regional centers are required to use it, but it is primarily used for administrative purposes, for diagnostics. But as far as actually being used as a practical tool for identifying needs, not so much. Thank you. And I think, I just don't want to repeat all of it, but I think that was a key point. We'll be back whenever the proposal is done and reevaluate if it aligns with what the stakeholders, what everyone's looking to make sure we all accomplish. And I think that's a really good approach to it so that it just doesn't get implemented without their approval. Nothing further? That concludes our items for presentation. As I said earlier, issues 7 and 8 are not for presentation, but they're in agenda. Line on up. Here we go. Oh, boy. That's it. We're in the middle of the budget. don't start my clock Carmen yes that's right happy anniversary kick us off so the median life expectancy for Californians living with sickle cell is 54 years and that's recently up from 43 and these are lives that have never enjoyed equitable care and they are literally on the line thankfully we know what it takes to keep warriors alive and thriving in addition to clinical care they need and deserve. The same services that are available to CalAIM populations are focused, but only one in four warriors are eligible for enhanced care management. The federal administration has canceled sickle cell research as unlawful DEI and chose not to renew a decades-long program that funded coordinated comprehensive care for warriors. I'm here today to advocate for continued state investment in coordinated care, free transportation and mental health therapy, and the other critical supports that get warriors to their infusions and lab appointments that improve housing stability that reduce pain crisis reduce expensive ER visits and avoidable hospitalizations for the 8 Medi and CHIP members in California I am distressed to report there is no dedicated funding despite the undeniable need Thank you. I think I should say Carmen Cox, my client is Cayenne Wellness Center, just for everything. Thank you. Thank you. Buenas tardes. Buenas tardes. Hola. Buenas tardes. My name is Ana Valentino, I'm a provider of care infant for 27 years. I'm a member of CCPU, I participate in the committee, with other providers elected from the state. I was the third committee of this type. We're in the last four years to bring us to the adoption of a unique structure. We have discussed issues that are important for us, as a fair salary for the providers of better tariffers, that allow us to help families who work for the afternoon or the weekend, that require services, transport to children with special needs. How does it mean to continue with the results of the last discussions of the committee that has been prolonged during many years? The CICPU solicit that they will be presented in the legislation for the coordination of the laws. These solicitudes will continue the next phase del Desarrollo de la Prologia Alternativa. Gracias, Senadora. Gracias. Cuídense. Good afternoon. Kim Rothschild, the California Association of Public Authorities for IHSS. I want to thank you for the discussion on the Be Home Soon proposal, and also thank you for championing the Backup Provider Program. That is the exact type of program that we discussed today that helps people transition safely from facilities to their home. So again, wanted to just make sure that that remained top of mind and so that we invest in programs that are in place to do the proposal that was discussed this morning. Thank you so much. Thanks. Thank you, Chair and members. My name is Adriel. I'm here on behalf of United Way California Capital Region, and I'm here in support of a $300,000 district investment for Communities Against Sexual Harm, or CASH, to help convert a donated property into a permanent, trauma-informed support center for women and girls, including sexual exploitation and trafficking. United Way is also contributing $100,000 to this project. CASH already serves survivors in Sacramento and connects them to medical, mental health, housing, and other supportive services. This investment would turn a donated community asset into a permanent infrastructure where survivors can access coordinated care in a safe, trauma-informed environment. This is a relatively small state investment with a lasting community benefit, and I respectfully ask for your support. We appreciate the members, particularly Assemblymember CREL, for submitting the request and standing with United Way in CASH. Thank you. Thank you. Hi, Chair, and to the committee, Monica Kirkland with Senior Services Coalition of Alameda County. I'm here to just voice our support for the Be Home Soon initiative because we understand that older adults deserve the opportunity to remain safely and successfully in their homes and communities. And investing in home supports really promotes dignity stability and independence while helping prevent unnecessary displacement and institutionalization So we just urge you to continue to support policies that help older Californians remain in their homes and connected and thriving Thank you. Thank you, Madam Chair. Brendan McCarthy with the California State Association of Counties. We appreciate the discussion of the CWS CARE system. We share the concerns outlined by CWDA about the risk to child safety with problems with implementation. And so we urge the committee to delay implementation and set the milestones that my colleague outlined. With regard to H.R. 1, we're pleased with the funding in the budget for public hospitals and county-eligible workforce. There's no funding for indigent care with work requirements starting in 2027. There will be demand for those existing county programs. So we're requesting $100 million in the current year for Article 13 in public hospital counties to meet their state mandate. We're also requesting technical cleanup to the AB85 language to keep the intent of AB85 that realignment redirections shift with the level of expenditure by counties and not freeze the reallocations at the lowest level of demand. Thank you very much. Thank you. Good afternoon. Jennifer Snyder on behalf of the California Association of Health Facilities. We appreciate the chair raising the issue of WQIP funding for skilled nursing facilities. CAF was disappointed that the Workforce and Quality Incentive Program was not restored in the 26-27 state budget, but we believe that a viable option is to partially fund the WQIP program by utilizing unspent funds that have already been allocated in this budget in the 2026-27 budget for nursing facility rate reimbursement. We believe these previously allocated funds, while much more limited than the full WQIP program, will still be impactful and incentivize workforce and quality investments in skilled nursing facility care. Thanks. Thank you. Hello, my name is Sherry Sinwelski, and I oversee the 988 Center at D.D. Hirsch. I'm also speaking on behalf of the California 988 Consortium, whose leadership could not be here today. During the 988 agenda item, there was a question about the needs of the 988 Centers. I'd like to supplement the answers that were provided. We do not believe that the 5% increase comes close to meeting the needs of the Centers. A 5% increase for centers would be equal to about $70,000 total across the network, or less than $6,500 a month if divided by 11 centers. 988 volume is up 40% over the last six months, and that is on top of increases in previous years, where funding was already insufficient. DHCS projects 21% increase in contacts in the upcoming year. When you add these increases to the fact that the centers were already facing capacity challenges, a 5% increase is nothing. 65% of chats and texts are going out of state, meaning that those 988 help seekers will rely on non-California centers to help them navigate resources like mobile crisis. California falls way behind other states like Washington, Oregon, Nevada, Utah. Appreciate it. Thank you for your time. In their investments in 988. Thank you so much. Sub 3 needs to take a 5-minute recess. Sub 3 will reconvene. Can I just... Subcommittee on the Lausanne rail corridor is moving to room 2100. Okay, sub three can reconvene. Thank you, Madam Chair, and not members, but thank you, Madam Chair, Sarah Bridge, on behalf of the Association of California. health care districts here to direct the budget committee's attention to a remaining unresolved issue related to the distressed hospital loan program. We greatly appreciate the legislature's significant investment in new financial stabilization grants. However, fixes are needed for those remaining hospitals that received the loan under the original program in 2023. Without the clarity needed, districts will continue to struggle to stabilize issue bonds for critical funding needs and find meaningful partnerships to keep care in their communities. We ask that the legislature address these issues through the budget as a vehicle in which the original program was enacted and now as it is timely and needed for continued stability. Thank you. Thank you. Good afternoon, Madam Chair. Connie Delgado on behalf of the 33 District and Municipal Hospitals at the District Hospital Leadership Forum. In the interest of time, we also are here in support of some clarity on the Distressed Hospital Loan Program. on behalf of Point Click Care, also here in support of restoration for the WQIP. Thank you. Thank you. Clifton Wilson, on behalf of the Board of Supervisors for the counties of Kern, Fresno, Napa, San Joaquin, Tulare, Nevada, and Humboldt, all requesting a six- to eight-month delay of the implementation of the CWS CARES system and in support of CWDA's proposed trailer bill and budget bill language, and then also more generally on behalf of all of our firm's county clients that are Article 13 counties and or public hospital counties in support of the additional $100 million for indigent care to help offset the H.R. 1 impacts and align our comments with CSAC and other statewide organizations. Thank you. Angela Hill with the California Medical Association. We are opposed to the proposed Department of Health Care Services provider oversight, TBL, unless our amendments are accepted to address implementation concerns. We do worry that the language as drafted will have unintended consequences, including limiting a provider's ability to maintain enrollment in the Medi-Cal program. And we do think that the enforcement authority is brought in in ways not requested or necessary for addressing concerns from CMS. And also, while not an open item, CMA continues to pursue important implementation amendments for the previously adopted menopause TBL language. We are in active conversations with all stakeholders, including in the Assembly, and we look forward to continuing those conversations and are really hopeful to have a resolution before the end of session. Thank you so much. Thank you. Good afternoon. Angela Pontus on behalf of Planned Parenthood Affiliates of California, aligning our comments regarding opposition to the Provider Oversight TBL with CMA, particularly for unintended consequences potentially related to sensitive services providers, and that the language may be in conflict with SB 487. Also urging the legislature regarding CMS rule issued yesterday that will prohibit federal funding for minors receiving gender-affirming care, urging action to ensure that those patients can maintain access to care and providers can maintain their reimbursement. Thank you. It's ongoing, always. Thank you. Thank you. Good afternoon. My name is Dan Okunfuss with the California Foundation for Independent Living Centers, representing the state's independent living network. CFILC, we strongly support the goals of Be Home Soon California and greater investment in home and community-based services. We particularly support efforts to eliminate waiver caps and wait lists, strengthen transitions out of hospitals and nursing facilities, and removing barriers that too often leave people waiting for services until they are forced into institutional care We urge the legislature to move Be Home Soon forward next year and make a sustained investment in HCBS. Thank you so much. Thank you. Good afternoon, Madam Chair. Jonathan Clay. Two issues really brief, echoing the comments of my colleagues on the Distressed Hospital Loan Program on behalf of the Imperial Valley Healthcare District. We're one of those districts that's trying to go out to bond and need some clarity in order to be able to effectuate this. And then secondarily, aligning our comments with Planned Parenthood on behalf of Trans Family Support Services and the Alliance for Trans Youth in urging some sort of solution on a California-only option for those gender-affirming care. Thank you very much. Thank you. Hi there, Michael Henning, California Alliance of Child and Family Services, representing over 200 nonprofit organizations in our state. We are concerned about the liability insurance crisis that is impacting foster family agencies, supporting one in five foster youth statewide. Many of these youth rely on stable, well-supported placements. Without adequate funding, FFAs will continue to close and disrupt these placements. We would also like to echo the concerns brought up by CWDA regarding the impact of the Cal-SAUS interface for eligibility as well as readiness of cares for implementation. Also, we applaud the funding for mobile crisis services in the 2026 budget. Funding to the centers must be increased and the additional 20 million previously supported by the legislature must be reinserted into the budget. 988 centers are leaders in the field. Some have been answering our state calls for over 20 years back when 988 was known as the the lifeline and they know their funding needs, we align our concerns with the previous laid out by Dee Dee Hirsch. We support the additional funding for the state's 11988 call centers, as well as the press the option for LGBTQ plus suicide prevention. Thank you. Thank you. Hello, Madam Chair Gail Gronert with the Behavioral Health Directors Association. Happy anniversary. Thank you for your work to support mobile crisis and the 988 call centers. We support full funding for both. We also support the administration's trailer bill language for call center designation, and we look forward to future work ahead to develop funding for both call centers and mobile crisis. Thank you. Thank you. Sarah Ducat, on behalf of the rural county representatives of California, we're here to urge you to take action on trailer bill language we need for AB85 fixes. We have counties that receive freeze notices where the state's taking the maximum amount of realignment, which would typically go to indigent care if we had those those needs that is based on data from 23 22 23 and we need to really keep the status quo so we can continue reporting data and at least be able to draw down some realignment to help us with those costs we also have counties that are currently a 60 40 that need to transition to a formula unfortunately when that statute was changed back in 2019 some code references got messed up and now we need to restore it so we can make sure that petition happens also want to say we have concerns along with CWDA around the CARES system and that we're concerned it might not be ready by October. Thank you. Thank you. Good afternoon. Thank you for listening. I'm Farrah McDade Ting with the County Health Executives Association of California and I want to align myself with with my colleagues from CSAC and RCRC. The need for the AB 85 technical fixes is great in these waning few weeks of session. We also just want to reiterate our support for a hundred million dollar bridge funding for counties to serve the indigent folks who will be coming back for those services and then we look forward to partnering on a future solution whether it a state emergency services solution or funding for counties to provide the services or a partnership between the two. We look forward to working on that. Thank you. Thanks. Thank you, Madam Chair. Kathy Sunderland, Catbird Strategies. I'm here for three organizations. First, for Public Health Advocates, which runs the All Children Thrive Program under the Department of Public Health. We're requesting no-cost budget bill language similar to the reappropriation language that's in issue 7 for a different program under DPH to reappropriate unspent funds to the end of the fiscal year. The program has been extremely successful since the legislature created it eight years ago, and it is in jeopardy of not being able to continue if we don't get this language. Thank you for your consideration. Second, for the California Association for Adult Day Services, we appreciate the inclusion of the CBAS trailer bill language in the Be Home Soon discussion, which was fantastic and really appreciated by us as well as the entire field. As you know, CBAS is the second largest HCBS program for our entire long-term care services. It's critical to help us survive locally while we continue to work with you and the department on long-term rate reform. Finally, I've been asked to say a Me Too in support of Be Home Soon on behalf of CalPACE. And thank you for your time and happy anniversary. Thank you. Good afternoon, Madam Chair. Lourdes Perez with Public Health Advocates directing All Children Thrive California. We focus on upstream prevention efforts such as policy and systems change to create positive environments for children to thrive. We have been hugely successful with 31 communities being funded, coached, and technical assistance provided for policy solutions that are community-driven. And we have had a rate of return of over $35 million with a $25 million investment from the California legislature. I know that you continue to be invested in supporting vulnerable children, and we ask that you approve the no-cost extension so that we can continue to support an additional 14 projects through 2027 and for them to pass ballot measures, tax measures that will provide local tax dollars and jurisdictional dollars for these children and families to thrive. Thank you very much. Thank you. Good afternoon. My name is Manuel Serrato. I currently oversee youth development at Public Health Advocates within the All Children Thrive Initiative. In this role, I've had the chance to work alongside youth age 14 through 24 from a variety of communities across California. With support from the initiative, these young people have taken on leadership roles in local policy change with opportunities to speak to decision makers, collect data, tell their stories, support outreach in their communities, and work toward achieving policy wins. I've watched young people in our program grow as advocates and leaders in their communities. We hope to continue this important work and ask that you please support our no-cost budget bill language for All Children Thrive. Thank you so much for your time. Thank you. Peace and love chair, Crystal Harding with Public Health Advocates, leading the All Children Thrive statewide initiative. I have the privilege to serve As a coach, a champion, and celebrate community-led policy campaigns, we empower young people, residents, community organizations in partnership with elected bodies, turn lived experience and expertise, data, research, and advocacy into a policy that lasts, that mitigates adverse childhood experiences, and strengthen protective factors. In my four years serving eight projects across California that approach has delivered In Sacramento All Children Thrive assisted SAC Kids First Coalition pass Measure L for a youth and children fund securing to $10 million ongoing. Working with United Way Santa Cruz County, the team received a unanimous council vote and approval for a youth liaison position so young people have a real seat at the table. And in Oakland Havens Court neighborhood, our Safe Homes Initiative, youth-led education about lead exposure and conditions in their neighborhoods with the city and county to make their homes healthier and safer. We're creating opportunities for local jurisdictions to collaboratively change. Thank you. I appreciate it. Please support no-cost budget but bill language for all children thrive. Thank you. Thank you. Good afternoon. Linda Way with Western Center on Law and Poverty in full support of the Be Home Soon proposal. As part of that proposal, I want to highlight the share of cost reform, which is critical in ensuring that older adults and people with disabilities stay in the community rather than the current law that requires them to spend down and live off of $600 a month, which is just not sustainable. In addition, look forward to working with the legislature and administration on cleanup language as well as urge your support in anti-hunger budget ask. Thank you. Thanks. Ryan Spencer, back at the American College of OBGYNs. I'd like to put our support behind the comments made by my colleague at the California Medical Association, particularly those comments related to the menopause trailer bill. We, along with the California Academy of Family Physicians, have been in active discussions with all stakeholders with the administration since spring, and even recently with the Assembly and the Senate. We are hopeful we'll come to a resolution and get it fixed before the end of session. Thank you for your time. Thank you. Good afternoon, Josh Gogger. First, on behalf of the urban counties of California, the California Association of Public Hospitals and Health Systems, and the counties of Ventura, Santa Barbara, and Santa Cruz, we support resources and trailer bill language for indigent care. There is an urgent need for the trailer bill language because DHCS has notified counties of their intent to freeze allocations under AB 85. This is not the time to freeze allocations as the number of uninsured and people seeking indigent care is about to increase exponentially. The 60-40 technical fix is also important to counties like Santa Barbara. Finally, on behalf of the urban counties of California and the chief probation officers of California and the Riverside County Board of Supervisors, we are concerned about the CARES implementation and align with CWDA's request. Thank you. Thanks. Good afternoon. Christina Rico with 211 California. Thank you, Madam Chair, for your commitment to public health, health, and your very thoughtful questions through the committee hearing. We respectfully ask for your support of $20 million to 211 California, a significant investment but important. This request has significant support, 20-plus legislators and multiple local government officials signed Assemblymember Pellerin's Behavioral Health Prevention Letter, and 160 organizations plus have joined Assemblymember Ransom's effort to strengthen 211. 211 is a critical part of California's health and behavioral health safety net. By screening needs early and connecting people to food, housing, health care screening, HR1 work requirements, guidance, behavioral health services, and other supports, 211 helps prevent problems from becoming crises at the beginning instead of putting pressure on 988 or 911. Thank you. Thank you very much. Appreciate it. Thanks. Good afternoon. Chair, my name is Danielle Bautista with United Ways of California, the state association of 27 local United Ways throughout the state. United Ways operates or funds about half of the 211s in the state to support Californians in accessing housing, food supports, and state-run programs. We expect demand to increase in 2026 and beyond due to H.R. 1 implementation and cuts to public services at the federal, county, and local governments. We humbly request the $20 million one time for critical 2-1-1 infrastructure. Thank you. Thanks. Hi. Good afternoon, Chair. Jenny Aguilar here on behalf of Sacramento County in support of the proposed AB85 trailer bill language reflected in the letter from the urban counties of California. These targeted technical fixes will ensure counties are not locked into outdated funding methodologies that no longer reflect current health care realities and will allow counties like Sacramento to better align. AB 85 today's indigent care cost as HR 1 is implemented. Additionally, on another issue, Sacramento County supports modernizing California's child welfare case management system, but it is critical that the transition occur only when the system is fully tested and ready. Based on frontline testing, counties continue to identify significant operational issues that could impact child safety and case management. We respectfully support a delayed but timely implementation coupled with enhanced oversight and accountability to ensure the system is fully prepared before it goes live. Thank you. Happy anniversary. Thanks. Good afternoon, Madam Chair. I appreciate the moment. I would like to say that my name is Alvin Robinson. I'm a parent partner with Parents Anonymous. We're asking to invite you to continue funding the California Parent and Youth Helpline. This helpline has catastrophically helped me as I'm in Service Area 1, Supervisor District Number 5, and being able to ruminate thoughts with my kids and my children, being able to support them, my children's father was in a blended family model father of six where I was able to be supported by the helpline for my children when their father was in a motorcycle accident and I just want to be able to say continue to funnel the helpline for the California Parenting Youth Helpline. Thank you very much and happy anniversary. Thanks. Hi my name is Adriana Recoy and I'm a parent leader with Parents Anonymous also advocating for the helpline. I have seven and a half years clean and sober and coming home I was still hiding because I had to tell my parents that I was gay so they've helped me a lot navigate through all those feelings supporting me I'm a caregiver for my parents today I go to school I go to work and that's also stressful and overwhelming so I'm grateful for them they've been a really big help to me offering me emotional support whenever I call not just for me but for my son in the community because I make sure that I pass those cards thank you for sharing space and happy anniversary thank you it won't be happy if I'm not out of here by now or I've got to pick her up from the airport, y'all. Okay, okay. I'll talk fast. Thank you, Chairwoman and committee members. I'm Dr. Lisa Pyrenver, the president of Parents Anonymous, Inc. During the pandemic, we launched in partnership with the governor and the Department of Social Services, the California Parent and Youth Helpline. It's the only evidence-based helpline in this entire country. Research shows that 85% of the parents who call feel more hopeful, feel solution focus at the end of the call. This is published research, peer-reviewed. Also, we just affirmed that all the evidence-based strategies used, non-blame, non-shame, and real support is affirmed, and that's published in research. So we want to know that we've made an impact. We reached nearly 150 California residents and parents who feel isolated know that they can go online find us quickly call us text us and live chat Our request is million We have a budget request in that Assemblywoman Pellerin led with 211 and other partners and we had many senators who made a request. What we're saying is don't dismantle what works and is not expensive and has a great return because kids today feel totally isolated. The immigration impact during the fires, during the Boyle Heights. We just did an article about what's going on in the Boyle Heights. community. Thank you. Good afternoon, Madam Chair. Dr. Gloria Carroll from County of Santa Cruz Human Services, Assistant Deputy Director. I am just reaching out to please urge you to consider the 59-day delay that CWDA brought forward and put child safety back in the center of this issue. A lot of work has gone into the CARES system, both with the purveyors and also the state, but we're just not there yet. And we need to remember that this is about child safety. It's not about the politics. It's not just about the money. We do understand that there are fiscal penalties, but training has been so challenging that several counties have considered pulling their staff out, both of the training for trainers and also the instructor-led training. It's one thing to say that, oh, we're fixing all the glitches, but when you can't finish the scenarios because there's so many glitches and everything is, okay, we'll pass and move on. people are sitting in training that they're not getting much out of. And we feel like we'll do a better job if we do it ourselves. And so I just really need to put child safety back in the center of it. We're just asking you to strongly consider that. And happy anniversary. Thank you, ma'am.
Nicole Wardleman on behalf of the Orange County Board of Supervisors, also in strong support of the county coalition request around indigent care funding and AB 85 trailer bill language. Orange County also received a notice last week around a pause in their realignment funding, and they are looking at an increase of individuals eligible for indigent care by about 70,000 people. Thank you. Good afternoon, Madam Chair. Michelle Huelcava with Nielsen Merckxler on behalf of the County of San Diego, also here in support of proposed trailblazer language to AB85. This technical adjustment would provide a focused time-sensitive solution, enabling counties to continue delivering essential indigent care services while ensuring that AB85 operates as originally intended and aligns with today's health care landscape.
That's it. So you can get to the airport.
Good afternoon, Madam Chair. Norlin Asperich with Axiom Advisors. here on behalf of Prime Home Health, a provider of PDN services. We commend your leadership and the support of the subcommittee and staff of the Home Soon package. We appreciate the inclusion of PDN funding in the package, which will help many medically fragile children awaiting care and will help bring them home. This critical investment will help improve the lives of children and their families, while also saving the state funding in the Medi-Cal program. I'm also here on behalf of PACS requesting the restoration of the WQIP. Thank you.
Thanks.
Good afternoon, Madam Chair. I'm Lisa Cajarino. I'm President and CEO of the United Way of the Wine Country and the Administrator for 211 Sonoma and for 211 Mendocino. Thank you for spending your anniversary with us. I'm here today to respectfully request the $20 million infrastructure investment in California 211 Network and to expressly connect the dots between what we heard in the morning testimony about be whom be home soon California and the work that the 211 network does across the state 1 million people are served by 211 across the state annually and one in four Sonoma County residents reaches out to 211 every day. What we know about where we are right now is that infrastructure serves, is that that infrastructure serves the safety net and broadly helps to reinforce the safety net so that people don't fall into more expensive crises. We respectfully ask for the investment in the 211 network and for the rest of the safety net that's part of Assemblymember Pellerin's bill. Thanks for your time.
Thank you.
Good afternoon, Madam Chair. My name is Claire Margusen. I'm with United Way Bay Area, where we oversee the 211 program in six of the Bay Area counties. Annually, we connect over 50,000 residents to behavioral health services, housing services, food. We help people navigate the changes in their benefits and make sure they don't lose CalFresh or Medi-Cal. We are so grateful to the state for all of the investment in our behavioral health systems and our crisis response systems. And those systems rely on an open front door that is easy to access, and that is truly what 211 is. As local funding becomes less certain, 2-on-1s are increasingly at risk. In the Bay Area, we've had to reduce staffing at our call center because of funding cuts. We no longer have two-way texting capabilities because of funding cuts, and we are at risk of more cuts. I respectfully ask you to include the 2-on-1 California $20 million budget request. Thank you so much.
Thank you.
Good afternoon, Madam Chair. Timothy Burr on behalf of Maxim Healthcare. We want to hear in strong support of the Be Home Soon Package. Maxim provides private duty nursing services to over 21,000 patients throughout the state. This Be Home Soon investment and the inclusion of PDN in that investment will ultimately save the state money, but most importantly, there are over 1,000 kids on the wait list right now in California. This Be Home Soon Package will help bring them home. Thank you so much to the staff and to the subcommittee for your leadership. Thank you.
Thank you.
Good afternoon, Madam Chair. My name is Robert Morton here on behalf of United Way of Northern California. Now, I ran the numbers and it turns out helping people is the budget-friendly option. Who knew? In the North State, we know struggle like we know fire season. We don't need pity. We need relief. And relief has a number, 211. 211 helps campfire survivors rebuild and connects Hmong families and black residents in Chico and Reading to real help. Every call it answers is one that 911 doesn't have to. Please keep the $20 million allocation in the final budget. The North state is calling. Someone needs to pick up.
At last. I felt like you were reading a poem, you know, it was so beautiful. Oh man, I got a follow up. I know. Jeez.
Tiffany Whiten with SEIU California, Madam Chair. Related to the Be Home Soon, we appreciate the discussion and the thoughtfulness of the proposal representing both IHSS providers and skilled nursing facility workers. We encourage coordination and partnership with the workforce as they will be key to successful implementation. We also continue to seek restoration of the WQIP for skilled nursing facilities for one year to continue the effort to increase quality of care to residents. The WQIP benefits employers, workers, residents, all proving that a successful program and we continue to ask for your support. Related to CARES we want to echo the concerns for the proposal and that even with the delay rolling out a system that is not ready will have impacts to workers potentially devastating impacts to our children Workers already face shortages burnout and workarounds and inadequate training will only exacerbate those challenges that the workers in the counties face We want to make sure that we do everything we can to get this right as possible. So we continue to support alternatives like those that CWDA presented that are viable, support the workforce, and protect our children. Thank you so much.
Thank you.
Good afternoon, Chairman Javar, committee staff, Edgar Guerra with SEIU California. Two quick things on health care. We want to align our comments with urban and rural counties and calling for urgent action on indigent care. On child care, we want to thank the Senate. Thank you and Senate leadership for championing child care in the budget, specifically in securing slots for working families. With that, thank you and happy anniversary.
Thanks.
Hi, Chair. Yesenia Jimenez, or Robancho with N Child Poverty California, here to speak on the cruel cuts designed by the Trump administration that has already led to thousands of Californians and nearly a million Californians will follow in losing assistance to CalFresh. But this budget, unfortunately, does not do enough to prevent this hunger crisis. We come to you urging to protect humanitarian immigrants and our kids. As a child who lived through the welfare reforms of the 1990s, I witnessed my parents not be able to eat. I entered the labor workforce at the age of nine to support my family to keep food on the table and keep a roof over our heads. And that is a scenario that our children are finding themselves in. We still have time. We still have time to protect our children. Please stand with them. Thank you.
Thank you.
Good afternoon. On behalf of Darby Kernan, on behalf of Nourish California, and a member of the Food for All Coalition, we want to associate ourselves with the comments from our colleagues and creating a path for access food for those impacted by H.R.1. Also on behalf of LeadingAge California, we associate our comments with CAF and SEIU, who commented on the WQIP earlier. Thank you.
Thank you.
Good afternoon, Madam Chair. My name is Jasmine Amons, and I'm the Senior Development and Grants Manager at John Byrne Advocates for Youth. We are grateful for California's June investments made in response to H.R. 1 that will support our most vulnerable households. We must build on this commitment and prevent children, youth, and families from going hungry by addressing the needs of foster youth, people experiencing homelessness, and those receiving in-home supportive services in-state data, investing in the California Food Assistance program to extend state food aid to humanitarian immigrants and funding a one-time family food supplement to stabilize nutrition for families with children. Youth cannot recover from the instability of homelessness or begin to reach their dreams if they do not have their basic needs met.
Thank you. Good afternoon. Amy Wessling from the Association of Regional Center Agencies,
representing all 21 of the state's regional centers. Really appreciate the clarification from DDS about the needs assessment proposal and particularly around its role in influencing rather than driving the IPP process so that we have a clear sense of people's needs as well as their strengths, and that can help inform consistent planning around the state. Second, really appreciate the robust discussion around the planned time limits for individuals in state-operated facilities and appreciate the willingness of the department to recognize the need to develop services. additional models of care and to consider whether the proposed timelines are flexible enough to enable us to stand up those new models in time for the people who are currently served. So really appreciate the conversations throughout the budget process and happy anniversary.
Thanks.
Good afternoon, Chair and members. Really appreciate your service. My name is Yvette and I'm here representing the Family Resource Center's Network of California and the 47 FRCs serving families experiencing disabilities and delays. I'm also a clinical psychologist, and I'm a mother who has spent over 40 years in the developmental services system. FRC and CA does support the DDS proposals before you today. We support that modernization in the first two proposals because we do want to strengthen a transition out of restrictive settings in the community. But my primary comments are to the equitable access and intake services proposal. We strongly support the goal of standardizing intake where a person lives should not determine that equitable access. But I want to share why this matters to me personally. My wife and I have to correct three children, but I'm only going to talk about two. I'm so sorry. It's too late. I will send the rest to you. Thank you. Madam Chair, Rand Martin here on behalf of Aviana Healthcare. Not surprising, but certainly disappointing to hear both the Department of Finance and Department of Healthcare Services talk about looking only at the fiscal impact of the budget year and maybe sometimes budget year plus one when we really need to look at the long-term impact of some of the changes that the Be Home Soon California proposal anticipates. We think that the decision, thank you, for the rate increase for private duty nursing will help provide the state and us, all of us, some information that will help justify some of the things that are in the Be Home Soon proposal. We stand ready to work with you to provide that information to help convince people that doing it in other rate codes would also be beneficial for the state of California. Thank you.
Thank you.
Hello. My name is Adriana Bautista. I'm here today with fellow Eaton Fire survivors. We've been talking about the CARE Fund, which Senator Perez has introduced to provide disaster relief, but we've realized that there's also the potential for our community members to lose food access as well. And I want to request that the California Food Assistance Program also be extended. We know that families have increasingly relied on food assistance CalFresh programs due to loss of their homes, of work, and increased financial instability. And I believe that families should not be criminalized or put at risk of losing access to basic necessities due to struggling with poverty and disaster-related circumstances. So please extend and do everything you can to support this Thank you Buenas tardes Mi nombre es María Salinas y soy víctima de los fuegos en Altadena, California. Y estamos acá para apoyar a las personas que no pueden hablar. Y estamos acá representando a las personas que van a perder Carfresh. Por favor, apóyenos ahora más que nunca. Perdimos nuestras casas. Estamos empezando de nuevo y este apoyo ayuda a muchísimas familias. Necesitamos más que nunca ahora que ustedes nos apoyen. Gracias y congratulations.
Linda, gracias.
Good afternoon. Here today with Dina Rise Up for Altadena, but also here for En Child Poverty. And we're asking for you to invest in the California Food Assistance Program. School starts on Monday. And I know my kids, whoo, they're going through a hard time through the disaster and struggling to leave school and to think about food sometimes is one of their highest priorities of what their parents who have three or four jobs or don't have jobs because ICE is trolling around now. And so one of the parents has to stay home to be safe. So please invest in this program. Thank you.
Thank you.
Hello, good afternoon. My name is Jose Madera. I'm director of the Pasadena Community Job Center, which is part of the National Day Labor Organizing Network. As my neighbors and colleagues mentioned, we just have gone through a disaster with the Eaton Fire. And we know fires are happening in different parts in California. and we know that the immigrant community are vital to the recovery, the cleanup, and the reconstruction of these communities. And now in Alcadena, we have many workers who are rebuilding Alcadena, but now many of them are in danger of losing the basic needs of food for themselves, for their children. And again, like I mentioned, fires, floods, earthquakes that are going to affect a lot of California. again the migrant community is vital to the reconstruction and the recovery of these disasters and again now they're going to lose some food and again these basic necessities so again we're asking here to support and extend this food assistance to the 34,000 humanitarian immigrants that are going to lose the support so thank you thank you good afternoon chair and committee staff Gabriela Chavez with United Domestic Workers representing IHSS care workers, which are a cornerstone of California's HCBS system, in strong support of the Be Home Soon Californian proposal. As this proposal moves forward, we urge policymakers to center the voices and experience of the caregivers and providers who will support these individuals every day. It is also critical that any savings achieved through reduced institutional care be reinvested into the program that makes this transition possible. Those savings should strengthen support that help people remain safely at home rather than being absorbed to the general fund at discretionary savings. And we look forward to working with you.
Thank you. Thank you.
Thank you, Chair. My name is Zadalia King with UDW here on behalf of CCPU. Again, I want to share our appreciation for the Senate prioritizing child care and slots. And also uplifting the conversation today around the alternative methodology something we been actively working and supporting along the way So it great to see your partnership in this aspect as well because as our members have shared with you and they were here yesterday about 200 folks and they were sharing their stories of the fact that, like, they cannot continue to provide this care at a loss. And this is a political climate or just the climate in general. And then the cost of care is just absolute mandatory that we address this directly. So look forward to continued conversations and partnership. Thank you.
What is education doing here?
Good afternoon, Madam Chair. Tristan Brown, Federation of Teachers. Here to echo the comments of CWDA about the CWS CARES implementation. As you know, all of our members are mandated reporters. They take that duty very seriously. We don't have the time and resources to become involved in a system that has been implemented before it's actually ready. We hear of a lot of bugs in the system. We simply don't have time in the day to navigate something that's not ready for prime time. So we hope that the implementation of the upgrade meet efficacy standards rather than arbitrary timelines. And so with that, we echo the CWDA's comments and hope that it is implemented when it's ready. Thank you. Hi, Chairman Mendovar. I'm Gabby Davidson with California Food Banks. First, just want to thank you for your anti-hunger investments in food banks, CalFresh Outreach in our counties in June. and here today to ask you to stand with advocates in our community and go further this budget cycle to support those impacted by H.R. 1, specifically by providing food through CFAP for humanitarian immigrants. States like Maine and Washington have already done this, and we need to stand and do this too, and also by funding one-time food benefits for families with children impacted by the H.R. 1 time limits, and by passing trailer bill language to maximize food support for Californians. Families need to eat today. They cannot wait until next budget cycle. Thank you.
Thank you.
Good afternoon, Chairman Javar and staff. I'm Keely O'Brien with the Western Center on Law and Poverty, also here to advocate for August's actions on anti-hunger. Very grateful for the June investments, but we have more work to do. Every day since April 1st, 100 more humanitarian immigrants in California lost CalFresh, and it continues to go on. August budget action is our last chance to protect California's refugee children, survivors of sex trafficking, and elderly asylees from suffering the pain and indignity of hunger. Even as we face this hunger crisis, California's food assistance program, CFAP, the budget was reduced by over $30 million this year. If we just keep that money in CFAP, we can prevent hunger for over 15,000 children, seniors, and adults with disabilities who are asylees, refugees, or victims of trafficking. If we can't sit back and let elderly refugees and children who are survivors of trafficking go hungry, but if we don't act now, that is exactly what will happen. We know California is a powerful, wealthy state, and with great power comes great responsibility. So if we don't use this power to stop this hunger crisis, the consequences will be our responsibility. Hunger, deep hardship, and avoidable suffering for thousands of our neighbors, including our babies. Thank you.
Thank you.
Thank you Madam Chair. Andrew Shane on behalf of the County Welfare Directors Association. We are a proud member of the coalition asking for continued action on the humanitarian immigrant inclusion for CFAP. So associate myself with our colleagues. On Be Home Soon, we continue to be in strong support of the proposal and urge that its end to end success which includes addressing DSS acknowledges the program is underfunded by about $125 million. We're still spending, we're using the 2018-19 rate, I believe, to pay our social workers. Several of the panelists brought that up, and so we need to address that, as well as the CIFCO penalties. I know that that issue was not agreed to this year, but we should look fresh at it, because we're actually going to exacerbate the impact of that, because counties are going to have to focus only on that population. And if we increase just as we should right then we going to have those timeliness challenges So thank you for that comprehensive look Thank you Good afternoon Madam Chair Josh Wright with Equality California We are grateful for the $26 million investment in support of provider stabilization and capacity grants, but want to align our comments with Planned Parenthood and trans family support services about yesterday's CMS Medicaid and CHIP final rule. We urge immediate action to provide a pathway in funding to ensure continuity of health care for transgender youth and their families. And we also continue to request funding for the Press 3 option for 988 calls that was discussed today. Thank you so much.
Thank you.
Hello, and thank you, Chair. I'm Sam Wilkinson with the Prosper California Coalition. Our coalition advocates for the cash and resources necessary for all families to thrive in California, and protecting food benefits for Californians is central to that vision. Our coalition is in strong support of expanding California's food assistance program so that Californians cruelly cut from H.R.1 won't go hungry. Specifically, we'd like to second the investments to expand CFAP uplifted by the California Association of Food Banks and the Western Center on Law and Poverty and the fourth largest economy in the world. We cannot allow our children, our seniors, and humanitarian immigrants to go without food. Please take action in this budget. Thank you.
Thanks.
Hi, Madam Chair and staff. I'm Koyse Tern, legislative advocate with the Coalition of California Welfare Rights Organizations. I'm also here for the August anti-hunger budget request. Thank you for everything that you have done in June for the budget, but we do need more. Include the humanitarian immigrants for CFAP and fund the one-time food benefits for the 49,000 families of the children impacted by the time limits. And also pass the trailer bills for our foster youth and individuals experiencing homelessness. As a first-generation California-born daughter of refugees, my parents, grandparents, fled Laos to go to Thailand to the refugee camps because of a conflict that our government had created. They fled persecution by opposing factions, saying they were American slaves. So they did not feel safe in their country. Our government brought us over here for safety. Because of the welfare reforms in the 90s, California had created CFAP to help our people. We want that promise. Thank you.
Completed today. Thank you. Thank you.
Good afternoon. My name is Nadia Manroy, the 211 Program Supervisor, and I'm here on behalf of 211 San Joaquin, operated by the Family Resource Center. We respectfully request $20 million for 2-on-1 California to preserve a critical part of California's behavioral health prevention infrastructure. In our region, 2-on-1 is the central hub connecting individuals and families to needed resources. It's the call a parent makes when they can't make rent, when food runs out, when they're fleeing domestic violence, or when they don't know where to turn to for mental health support. Every one of those calls is prevention. Connecting them to those resources helps keep a family stable and significantly reduces their need to dial 988 or 911 instead. San Joaquin has kept our 2-1-1 running on local and philanthropic dollars alone. California still provides no dedicated state funding for this system. Statewide, this $20 million investment would protect services that are critically at risk in 25 counties and shore up access to 2-1-1 for every Californian. Please include this funding in the final budget agreement so Californians can get the help they need before it becomes a crisis. Thank you. Good afternoon. My name is Benny Minchao with the California Grant Policy Center. We're a co-sponsor of the Food for All campaign. Before the session ends, we are continuing to urge you to restore food benefits for the 34,000 refugees, asylees, and other humanitarian immigrants cruelly cut off by H.R.1. We're asking you to fund the system's readiness and lost food benefits before it's too late so that we can ensure thousands of Californians abandoned by the federal government can still access their most basic need, which is food. Several other states have done this already. Maine, Minnesota, New Mexico, Washington, and even Washington, D.C. Why can't we? Thank you. Good afternoon. Krista Ramos with the California Imgrim Policy Center. CIPC is here today in support of additional anti-hunger measures to protect children and families who are being impacted by H.R.1. We're supporting funding for one-time food benefits for 49,000 families with children who are being impacted by time limits because their parents are out of work or have not been able to get enough hours at work. We're also supporting trailer bill language that would maximize food assistance for Californians, including foster youth and individuals experiencing homelessness. We believe that these measures are important to make sure that children and families continue to have access to the food and support that they need. Thank you. Thank you, Madam Chair. Andrew Mendoza on behalf of the Alzheimer's Association, I be brief to expedite your celebration We are in support of the Be Home Soon proposal and we would align our comments with the California Association of Adult Day Services on CBAS centers Thank you Thank you Good afternoon Jackie Gonzalez here to comment on the trailer bill related to immigrant youth. As of July 31, 2026, the federal government has awarded a new contract to allegedly serve unaccompanied children to a nonprofit founded by a former ICE agent. The contract that served unaccompanied children in California expired on July 31st. The impact is immediate. It means that since the state passed its budget, California has lost $20 million. CHIRP and YLS are supplemental income for the very small field of legal service providers that do this work. So to the question about whether dollars can be absorbed and whether there is capacity to take money by the state of California, absolutely, because we have lost $20 million in the last week. This morning, New York announced a $7 million investment for unaccompanied youth. And we spent the morning in California discussing a tone-deaf trailer bill to answer a question that we answered in 2021 about the best way to serve children. And we got the answer. It was CHIRP. And we've been funding that thanks to the legislature for the last several years. So I would say we need to spend our time figuring out how to fill that gap. We're better than that. Thank you.
Good afternoon Chair and staff Nice to see you all Mackenzie Richardson with Thriving Families California Foundation We respectfully request a six transition period before new restrictions on the use of the million for community child care contractors take effect
Without this flexibility, this retroactive change will result in layoffs across California and unintentionally jeopardize services for families and child care providers. While this decision acknowledges that hardships will occur across the state, contractors agree that this six-month transition will allow agencies time to implement the changes moving forward rather than retroactively to July without increasing costs to the state. Thank you.
Thank you.
Good afternoon, Madam Chair. Trent Murphy with the California Association of Alcohol and Drug Program Executives, also known as CADPE. we represent providers who serve clients in all of the state's 58 counties I'd like to align my comments with the California consortium and the 98 call centers like DD Hirsch mental health services and I'll just add that another angle from the 98 system and bolstering call centers here in the state is the ability for warm handoffs not just to the mental health field but also the substance use disorder treatment field thank you Good afternoon Madam Chair and members of the committee. Sanjita Nahar here on behalf of WellSpace and 988 California a statewide consortium representing California 11 Crisis Centers speaking on item four Thank you for including 988 funding in the state budget However demand continues to outpace funding, with contacts increasing 40% statewide since January. Currently, 65% of 988 texts are routed out of state away from local resources. We respectfully ask the legislature to restore $20 million supported by both the Assembly and Senate. While this is only half of what is needed, it would help ensure more California contacts are answered here in California. Thank you for your consideration.
Thank you.
Good afternoon. Monica Madrid with the Coalition for Human Immigrant Rights, CHIRLA. We urge the legislature to ensure that humanitarian immigrants who have been excluded from CalFresh benefits can now have access to the CFAP program. These are Californians who should not be left without access to critical food assistance because of changes at the federal level. California has long led the nation in ensuring that immigrant families can access basic necessities regardless of immigration status, and we urge the legislature to continue on that commitment. Thank you. Thank you.
Thanks for everyone coming back in August to give your stakeholder input. with that budget, Subcommittee of Nutrition Health and Human Services has adjourned.