Senate Budget Sub3 — 2026-04-09

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Okay, but we're still doing it first. Great.

Thank you so much. and being such an incredible champion over the years for us. It means everything. My name is Michelle Marciniak with Let California Kids, and I'm a mom. For eight years, bipartisan efforts have received unanimous support, yet have been pulled back, blocked, vetoed, and the administration's program has not functioned as hoped. With the federal pathway no longer viable, we need a path forward for California's kids. You've heard from our doctors, but today I wanted you to hear from the kids.

Michelle, you don't have much time, okay?

you know it's time for California kids here you guys want to do it one more time ready I got that perfect thank you

yes so in previous years we included everyone including the kids in the exchange and And it's the reason why it was vetoed, because if you include the kids in the exchange, that triggers an $11 million defrayal cost, according to Chipper. So we're saying let's do large group market, get the majority of the kids across the finish line this year, and we will continue to work at the federal level on the exchange in the coming years.

We think it's somewhere between like 70% of the kids will move across. It's anywhere between 70% to 80%. We have asked the health committees for an updated chip burp report. I don't know if that has been requested, but the best we can guess is that it's 70%, 80% of the kids, we get them across the finish line.

It shifts every year. When we started, it was $10 million for the kids, $6 million for the vendor. It flipped where there more money for the vendor now and less for the kids And so basically the analysis that we done is there been 30 million and we have a chart we can share but there been 30 million allocated 23 million of that has gone to fixed administrative costs. The rest, about 7 million, was allocated for kids but went unspent. We were in a call with the Department of Health Care Services a few weeks ago, and at that time, 250 hearing aids have been dispensed. And that is evaluated through the TARS. So the TARS paid. So there has been 250 TARS paid as of a few weeks ago.

Thanks.

Hi, my name is Johanna Wunderlee. I've been following this issue since 2019. It's time to let California kids hear. Thank you.

Hi, my name is Casey Kane. I am a parent of a deaf and hard of hearing child. I'm an educational audiologist and I am the current board president for California Hands and Voices. We've been fighting this fight for eight years and it's time to let California kids hear. Thank you.

Hi, my name is Kapriza. My daughter Avery is up here and we've been coming here since 2019 and it's time to let California kids hear.

My name is Rhonda Ressfold. I'm the executive director of a local school for kids who are deaf and hard of hearing, wearing a little mini shirt because we see the little kids. They're in school right now. But I'm in support of this. I'm also a teacher of the deaf and hard of hearing from background. So for the last 20 years, I've seen the impact of kids getting hearing aids and kids not getting hearing aids.

Nora, Angela is with Children Now. We align ourselves with the testimony from Michelle and Let California Kids Hear. and we urge you policymakers to take strong action to address the persistent developmental emergency around access to sound.

Katie Van Dyne with Health Access California and strong support of ensuring there's timely access to hearing aids and services.

Good morning. I'm Paul Wonderly. Four of these kids are mine, all impacted by this, and so I'm in full support. Let California kids hear.

Pretty much.

We recently told her, Marie, I'm going to be like 80 years old, and I'm going to be like, it's our year, honey.

but we just we feel so touched by the strong leadership that we have had for the last eight years and with you for the last four years this is a bipartisan issue everyone has backed us You guys have always been with us and it means everything So thank you Thank you so much Thanks y Bye. Bye.

I did not.

Victoria Rapley, Department of Finance. As we begin today's hearing, which covers four departments and 26 issues, the administration would like to provide some introductory remarks to contextualize our discussions. As noted in previous hearings, both the administration and the legislature must address the broader issue of balancing the structural deficit so that we can sustain the state's vital programs that support millions of Californians. This means making difficult decisions to address the over $20 billion budget deficit that is projected throughout the multiyear. We understand and share concerns related to federal changes. However, any conversation around mitigating H.R.1 or federal policy more globally must balance addressing this deficit and limiting new costs so that we can responsibly support our core programs going forward. Furthermore, we would note that the hearing agenda includes numerous proposals for investment. To the extent these are legislative priorities, we can provide technical assistance on the proposals. Though no, any proposals will have to be considered as part of the overall budget framework, given the projected significant out-year deficits. We understand these discussions must take place and look forward to working with the legislature to develop a sustainable fiscal plan that serves all Californians.

No.

I apologize.

Second time. Okay, so I'm not there yet. Yes.

Good morning, Madam Chair. Good morning, Madam Chair. Elizabeth Landsberg, H-Chi, the Department of Health Care Access and Information, and that was a hard act to follow with those kids. I've been asked to provide a high-level overview of H-Chi's mission and programs. Our mission is to expand access to quality, equitable, affordable health care for all Californians by supporting high-value delivery systems, resilient health facilities and workforces, and actionable health information and strategies. We have five main program areas. We are a leader in collecting data and disseminating information about California's healthcare infrastructure and publishing information about healthcare outcomes. This work encompasses the Healthcare Payments Data Program, or HPD, the state's all-payer claims database, which we have a budget proposal to fund ongoing. HKIE is the building. Department for Hospitals and Skilled Nursing Facilities, monitoring the construction, renovation, and seismic safety of these facilities, which I'll talk more about. We also have Health Workforce Program, seeking to build a health care workforce to serve Medi-Cal members, to serve in medically underserved areas, and to reflect the Californians that it serves. You're familiar with our basic workforce programs. We also support programs that ensure Californians have access to reproductive health care, including abortion services. On the finance side, HKI has our Cal Mortgage Program, which offers loan insurance to nonprofit and public health facilities. We administer the Distressed Hospital Loan Program, as well as the Small and Rural Hospital Relief Program. We on the HCI has a number of programs aimed at improving health care affordability, including the Office of Health Care Affordability, the CalRx program and the hospital fair billing program. And most recently, last fall, we developed California's application for the rural health transformation program, which we'll discuss later in the agenda.

Question two asks for an update on the CalRx program. So I will start with our biosimilar insulin initiative. So CalRx has partnered with CivicaRx, a nonprofit pharmaceutical company, to develop both short and long-acting types of insulin. The 2022 budget included $50 million to support development of the insulin products. And under our contract, we have those max prices locked in. So $55 for the five-pack of pens and $30 for the 10-milliliter insulin. Uninsured Californians or those with high deductibles today commonly pay $300 per vial and $500 for a five-pack. This year, in January, we launched Calorex's first branded insulin glargine pen. That's a long-acting at the $55 for a five-pack. And this initiative introduces competition into a historically high-cost insulin market dominated by a few manufacturers. And so we are here to interrupt that very broken pharmaceutical market. So the Naloxone Access Initiative, two years ago in May of 2024, we contracted for the manufacture and distribution of Naloxone nasal spray, a medication that blocks the effects of opioids and can reverse an overdose. Our initial price was $24 for a twin pack, which was more than a 40% saving over the price the state was paying. We've now lowered that to $19 per twin pack. and we in April of 2025 Calirex announced that our naloxone is now available to all Californians at the same low price so we are doing direct to consumer we are also the primary supplier for Department of Health Care Services naloxone distribution program which supplies over two million boxes of naloxone per year free of charge to qualifying entities community-based organizations fire departments, hospitals, and the like. Since the NDP began in October of 2018, they've distributed over 8 million boxes, which have been used to reverse more than 224,000 overdoses. As of March of 2026, Calorex's Naloxone Access Initiative helped save the NDP almost $50 million. We are now working on the school albuterol initiative. So last year's budget included authority for up to 5 million to support Calorex partnerships with CDPH Office of School Health and we are planning to launch a centralized ordering system to provide California schools with two albuterol inhalers and 25 spacers so it can be used by multiple kids who are in respiratory distress and may not have their own inhalers

Yes, yes, K-12 schools. So we're collaborating with the school nurses on a training program, and that should start going out soon. I'll keep going. so we've been asked to provide an update on the reproductive health care grant program so proposition 35 health care act includes 90 million for reproductive health care services support so the first 90 million um in 2025 hci administered two contracts and all of those funds have been fully expended and we're currently working on the contract for the 90 million from prop 35 for 2026 it's confusing because they're all 90 million this legislature um in early The action did $90 million general fund to provide grants to reproductive health care provider Planned Parenthood affiliates, and we have executed that contract, and that provides funding for family planning services. Almost $62 million of that $90 million has been paid on the grant, and we are preparing to process a last payment for the remainder. And then last, we also executed a contract for $56 million from the Abortion Access Fund for abortion services to ensure access to abortion, and most of those funds have been expended of the $56 million, approximately $16 million remains. And I wasn't going to go through the 2020-23 programs.

Yes.

Next, I've been asked to provide an update on the Office of Healthcare Affordability. OCA was funded and created four years ago by the legislature in the budget and pleased to provide an update. It was established to slow the growth of health care spending while maintaining or we hope actually improving equity and quality and access. We have three core work streams, spending growth, high value system performance, and review of market consolidation. And so these three efforts have been shown. Research has been clear that these together can help support a more affordable and sustainable health care system. On the spending target side, the board did adopt in April of 2024 the first health care spending targets. Those apply to all health care entities, hospitals, health plans, physician organizations. The target chosen by the board was 3.5 percent this year, coming down to 3 percent by 2029. and a spending target sets a limit on how much health care spending should grow each year. Because we heard for many months from consumers who were unable to access health care services at the hospital or faced very high hospital bills in their area, we did a meeting in Monterey, California, and did months of analysis to try to understand hospital spending costs. We did identify seven high-cost hospitals who were charging prices at twice the average of other hospitals in California. And based on that, the Health Care Affordability Board did decide to establish hospitals as a sector and to have a lower spending target on those high-cost hospitals. So that target is 1.8% this year, coming down to 1.6% by 2029. So in order to understand the health care spending in California, we're collecting new data and publishing reports on that. And then we using that data also to measure the health plans against these spending growth targets So last June we released our first baseline report with health care spending trends from 2022 And this summer, we plan to publish a report with the 2024 spending data. OCA, as I mentioned, has a number of initiatives to improve the quality and value of California's health care system, including increasing investment in primary care and changing the way care is paid for to really emphasize quality. So we set standards and goals for alternative payment models. Those were approved by the board in June of 2024, and these are intended to support greater adoption of value approaches that promote equitable, high-quality, and cost-efficient care. We also developed benchmarks for primary care because when we spend more on primary and early intervention preventive care, we see improved health equity, improved health outcomes, and lower overall spending. So we developed a definition for primary care. The board set a benchmark, and that is a 10-year benchmark. And we're starting to collect data both on the APMs and on primary care. We also adopted equity and quality measures set so that we can measure equity and quality at the same time we're measuring cost. The third main component of OCA seeks to have oversight of market consolidation because we know market consolidation is one of the cost drivers throughout the country. And so we have new authority to review proposed mergers and acquisitions of health care entities. So two years ago, there's a requirement that before there is a merger acquisition involving a health care entity, they have to file a notice with us. We review those notices if we're concerned that there will be a negative impact to access or affordability. We can do a deeper cost-of-market impact review. So in two years of that program, we've reviewed 40 transactions and done two full cost-of-market impact reviews, one that was recently published and the other that is in flight. In November, we also published an investigative study of hospital market competition in Monterey County, finding that the exceptionally high hospital prices in the region are due primarily to their market power rather than high operating costs or superior quality of care. OCA is currently developing enforcement processes for entities who exceed the spending target with consideration for health system performance measures. So this year is the first enforceable year of the targets. So a lot of our board meetings have focused on discussing this 2026. So we'll be measuring the growth from 25 to 26. 25 was a baseline year, and 26 is the first enforceable year. So we're having a lot of conversations with the board and our public meetings about the enforcement process. There was a question specifically about the impact of H.R. 1 and how we're thinking about that. So OCA has publicly discussed the impacts of HR1 with the Healthcare Affordability Board, which has the decision-making authority over the targets. And the consensus from the board at this time was not to adjust the spending targets. We know that HR1 will impact healthcare entities differently depending on a range of factors, including payer mix. And if the spending targets were increased across the board, this could result in higher costs for commercial market consumers, undermining the goal of health care spending, the goal that health care spending should not grow faster than household income. Additionally, because OCA will report and enforce targets separately by market, this allows for evaluating the impacts of various factors such as state and federal policy decisions impacting spending trends So we have the ability to look by market and by entity at what the factors were if there were entities that exceeded the target, and really try to understand what those factors were. So that has been the discussion to date. And then last, Madam Chair, I was asked to provide an update on hospital compliance with the Alquist Act. So this framework has been in place starting in 1971 and really guided by lessons learned from past earthquakes, including the Sylmar earthquake, where a number of hospitals collapsed, the 94 earthquake in Northridge. So this overall framework has been in place for many decades. California has made substantial progress toward compliance, particularly in strengthening the structural safety of hospital facilities. So we think of the structural facilities, the bones of the building, and then the non-structural facilities like, you know, are these panels going to fall off the walls? Is the electrical system adequately braced? Are the pipes adequately braced to actually be able to provide health care? So we'll talk a little bit about both structural and non-structural. So there are a little over 410 general acute hospitals in California with 3,500 hospital buildings. About 80, more than 80% of these hospitals have fully complied with structural standards. So more than four in five hospitals in California are fully compliant with structural standards, meaning we believe that they are safe to provide care after the big earthquake comes in California. A total of 649 buildings remain in the SPC2 category, meaning that we do not believe they are at risk of collapse, but we don't think they would be able to provide services after the big earthquake, and 18 buildings remain in the highest risk category of SPC1. They are subject to a 2025 deadline due to collapse risk, and the state is actively working with these facilities to resolve the remaining high-risk buildings. In addition to the structural safety, hospitals must continue to upgrade non-structural systems that are essential to maintaining operations during and after an earthquake, including electrical systems, backup power, HVAC, and critical utilities. About half of hospital buildings remain in the lower performance categories for these systems, and there are some hospitals that are fully compliant with the 2030 seismic requirements. All hospitals are required to submit seismic compliance plans to HCI, and approximately 90% of hospitals have done so, so these plans identify whether hospital buildings will be retrofitted, replaced, or removed from service along with a timeline for completion. I also want to note that HKI administers the Small and Rural Hospital Relief Program. This legislature created that program a number of years ago. There are funds available for us to assist hospitals, small, rural, critical access, and distressed hospitals in helping them both design their approach to coming into compliance and actually funding construction. We have to date spent granted $16 million in grants, and we are ready and able and anxious to work with additional hospitals to get those dollars out and help them to comply. Compliance plans indicate that there are approximately 100 hospital facilities that don't expect to meet the 2030 deadline. These are about 40 or under review for AB 869 reviews. So under AB 869, small rural critical access hospitals have the ability to come in and ask for an extension, and we do a case-by-case basis. They submit a compliance plan with milestones that we review and work with them on, and we can grant extensions for that system. subset of hospitals. We do also have 60 hospitals who don't qualify for current statutory criteria. And at the same time, a significant number of hospitals are actively advancing projects to come into compliance with the 2030 requirements. I know that was a lot of information, Madam Chair.

Jason Concentoros, LEO. I just also wanted to note, if you're tracking initiatives at HKI, another initiative that could be worth tracking is the sort of diaper access initiative. This was adopted in last year's budget. There's another round of funding for it in this year's budget, as was agreed to as part of last year's multiyear. And so if you're trying to sort of do basic oversight, that's sort of another initiative. Thank you.

Absolutely, Madam Chair. Thank you for the question. So we do have a research data center at HCI that's looking at that data by geographic region, and that's really critically important to us. So we do determine which are HPSAs, which are the health performance. Profession. Health profession. See, I got to phone a friend. Health profession shortage areas, which are those MSAs, the medical shortage areas. And so we absolutely have that as a scoring criteria for all of our programs. Folks who get a loan repayment or scholarship have to agree to a service agreement to serve in a medically underserved area. Anytime we do something like the Songbrown residency or nursing training programs, we do look at geographic reach. We have full supply and demand models built out for the nursing workforce and behavioral health licensed workforces, as well as some work on the non-licensed side. We're working on primary care supply and demand models. We built ourselves the oral health and maternal health. So geographic region and profession is really important to us to use our state dollars. in as targeted a fashion as possible. So, yeah, so the research shows that we are being targeted and we have people in rural areas that have been awarded the support. Yes, there is still plenty of work to do. You know, I certainly don't want to suggest that we have met the needs of rural or other medically underserved areas, but it is an important criteria that we always look at with our programs. You'll hear more about the Rural Health Transformation Program and how we're focusing there as well.

Libby Abbott, our deputy director for health programs, I want to give her the opportunity to add. So it is an application criteria. It is something we score on.

But what do you want to add? Good morning. Elizabeth, oh, it's red. It's a lag. You covered that really well. So, yes, all the things that Director Landsberg said, we have a number of different tools for assessing geographic shortage and trying to prioritize the allocation of our awards. Really, the only thing I would add is we do our best to prioritize the allocation of funding to where there is the greatest need. But sometimes we don't get applications from the areas of greatest need. So yeah there is work ahead of us I think to continue to do promotion and outreach We also recently started a practice of every time we run a cycle looking at specifically the demographics and the geography of who was awarded be that organizational or individual and then trying to think about what that means for the way we run our next cycle. Do we need to do targeted outreach? Do we need to change our scoring criteria? So it's an active process, but very much top of mind.

or is there a separate thing under CYBHI? I didn't go into detail about kind of our four strategies, but pipeline and pathway is one of them. And under the CYBHI, we had eight different work streams, and one was about pipeline and pathway. So critically important if we're going to reach our equity goals that we have those pipeline and pathway programs.

Yeah, we have two or three kind of smaller programs for Pipeline and Pathway, and it looks like a mix of different things. We offer funding to organizations that hit one of several categories of Pipeline or Pathway programs. So, for example, we will fund internships. We will fund career fairs. We will fund summer exposure for high school or early college folks. So there's a couple of different categories by program. That said, we're actually in the process. we've contracted out an analysis of what is the best ROI in pipeline and pathway. What does the national evidence say? What can we learn from what we've funded? What are other states doing? That analysis is actually meant to inform what we do with our BHSA funding. We've identified the need to strengthen pipeline and early pathway programming as one of our priorities for BHSA. So we're going to take the outputs of that analysis, use it to set some design parameters, and try to fund what we think are the most high-impact pipeline and pathway programs.

I appreciate the input and I'll just quickly make the distinction. So when I talk about pipeline and pathway, we're actually usually talking about high school or early college level intervention. We do have work targeted to our master's folks and are proposing a bundled approach, which I was going to describe later, but I'll just preview for you now where we're going to fund education capacity expansion, but also fund the students who move through those master's programs, not just with scholarship, but with stipends for their for their internships and for their clinical time. and we want to support clinical placement. So we're really trying to attack it from all angles for the reasons you just described.

I am.

So has any investment been made in this program thus far Those funds were reverted so I let Dov Okay Speak to that I don have any information on that specific program in front of me right now but I can take that back The 2020 budget allocated $220 million to this program.

We do have a small amount of nursing funding. We have some Song Brown program funding that supports nursing education, and we do do some loan repayment and scholarship through our, we get a limited amount of funding through licensure renewals, but it's pretty limited.

Okay.

You're welcome to stay.

Our CalRx team has done some analysis of other drugs that we think could be high impact for the state, but we don't currently have additional funding for this.

Okay. EpiPens is one that's come to mind. We're certainly looking at GLP-1s.

Just as a high-need area. I don't remember all of them. We're happy to follow up if you're interested.

No, it hasn't. So the OCHA statute does define, as you note, a progressive enforcement approach. So for any entity that exceeds the target, our first step is to notify them of that, send them a letter.

So it's permissible, but it's not required?

Okay. And, you know, we, you know, the phrase for the past year is affordability. The word has been thrown around. It could mean a lot of different things. When we look at the work of OCA and the intent of the board, is it that it's not so much on decreasing costs and making it more affordable, but it's more on we don't want it to grow exponentially?

And, Director, you know, oftentimes the limelight has been on the hospitals. Premiums have been jumping two to three times in the past year that we're going to be looking at enforcement. Is there a different approach in looking at premium rates increase versus the hospital cost increase?

Okay, because now we're going to be enforcing.

Okay. When, I don't know if it's OCA that comes in, but when we're evaluating the targets, and targets have gone past 3% or 3.5%, what are the costs reducing strategies that will then be talked about with these entities to come back into compliance.

our relationship. We have a very open door policy and we continue to communicate. So this next question is a bit depleted if I already asked in our private conversations, but how do we take into consideration hospitals' investments in advanced technology, new medical treatment that they want to invest in and bargaining should, after bargaining with the unit, the increases supersede the 3.5 percent?

Okay, looking forward for as we move into the enforcement year to get to see what that looks like. And these are all living platforms, see how we can adjust moving forward. The last question in this space, not in this space, in your department overview is the diaper initiative. I actually am very interested in that. I had concerns last year, I think, around this being open to everybody, about just doing a hospital space. Not everyone has give birth there. So I'm wondering where we are in the program and any changes we're anticipating in its implementation.

And the diapers will be given to them at the hospital?

Okay, they'll walk out with them. They have the ability to say no?

We don't anticipate any leftover diapers at the end of each year?

And the partner or the vendor we contract with, they'll have experience and background in being able to distribute these kind of diapers at a hospital setting?

Okay. Thank you, Director.

I'm going to move into issue number two. Thank you, Madam.

Yeah, red is good.

A quick item, technical adjustments, VCP.

It seems like there's a history of not providing enough expenditure. This request is for this year and ongoing.

Okay. Great. We're going to hold that item open and move on to issue number three. H-Chi requests $8.8 million general fund and 2.36 health plan improvement data fund, pardon me, health plan improvement trust fund, ongoing in 16 positions to facilitate the transfer of the data exchange framework and the office of the patient advocate from the Center for Data Insight and Innovation to H-Chi.

All providers were supposed to execute contracts earlier this year, January 31st.

So wait until next year to get the list of those who haven't?

Is there anything you want to add?

Okay. All right. We're going to hold the item open and move on to issue number four. All right. Issue number four, the long-term care payment transparency staffing.

Jason, I forgot to turn to you on issue number three. Was there anything you wanted to add to the previous issue?

Okay, great. Thank you. We're going to hold the item open and move on to issue number five. Issue number five, Assembly Bill 1418, HKI requests $178,000 to fund one position in 2026,

Okay. Okay. Hold the item open. Move on to issue number six. Thank you very much.

Rebecca, are you going to be talking about the offset?

Okay. Yeah, so just again, speaking on the offset specifically, we think it raises kind of three key issues to consider. The first is that it's not quite clear to us that these savings are actually incorporated into the governor's budget, and that's because we worked with the department to track all of the general fund changes and were able to tie everything out without assuming $100 million in savings. So it's a little unclear to us whether this is sort of a signal into what we're looking at in May or if it's actually incorporated in the governor's budget. The second issue really gets at question number three. in your agenda that the staff raised, which is what are the eligible programs that would be supported by the funds. And I have to say here, we're not quite clear ourselves. H-Criot's general fund spending in 2627 is about $175 million. So this $100 million would be more than half of that amount. About 80 or so of that is for the BH Connect Workforce Initiative. but the administration has indicated that a lot of that funding already has sort of an offset in the Medi-Cal budget. The rest of that is really for things like the Song Brown program and the Office of Healthcare Affordability. These are things that don't have an obvious behavioral health connection. And because of that, it's not clear to us that the legislature would want to really get a better sense of what these programs are before it incorporates any sort of assumed savings from a fund transfer. And then the third and final point is that it's reasonable to be thinking about budget solutions, but really the core issue facing the legislature is the ongoing structural deficit in the out years. This appears to be a one-time solution. So the focus, we really recommend focusing more on the sort of ongoing structural changes rather than sort of one-time solutions. Jason, can you clarify?

170 of? Yeah, if you turn to page three of your agenda, that general fund amount in 2627 is about $175 million. Okay.

I'm saying that they're proposing to offset $100 million in general fund spending. Okay. That's more than half of their general fund amount. Got it. So that's a sizable amount, and we're not clear what – if there's really that much behavioral health workforce in that sort of appropriation to offset.

Very similar questions to what LAO has brought up. A couple things. The subcommittee is not the first time that we've heard proposals of supplanting funding of general funds when we voters have voted for something. I think it's very disingenuous for Californians. If we vote for something, it's to add value to our investments. And I've always been a huge fan of the behavioral workforce investments that we've made. And when this came about, I felt excited to add to this. I do recognize that we need to balance the budget. But it just seems that we're always balancing the budget with outward-facing services. And then I continue to see BCPs on growing our internal government exponentially. Actually, I'm wondering if when looking to balance the budget, then inwards we should look at ourselves first versus cutting outward services that we voted for with Prop 1. I don't know exactly the connection in terms of what programs will be funded exactly, so I would like more information. It is also frustrating that it's April and we don't have that information and we have to wait until May. I've shared and just systematically how that crunch time is really not conducive for a proper conversation to have back and forth. I wish I could have had more details on this earlier rather than later. I think May just is not good for this process. So that's my thoughts on the offset part. If 100 million is being requested to offset it leaves about million available for this purpose This is supposed to be implemented in July 2026 What are we going to be doing with the million

I've been calling you Rebecca. Correct me.

Sorry, Victoria.

But what's the actual plan?

And the plan from the five-year wet plan is supposed to come out in spring 2026?

to catch them up to the needs of today's clientele.

Got it. And then going back to the actual program details, some things I heard that are completely different to what exists now, the stipends for paid internships and then the placements part, those are new. But you also mentioned scholarships. Those already exist in the current programs right now. What is going to be the difference in these type of scholarships versus the workforce investments we have now?

Sorry, Deputy Director. I'm going to just, just because I'm looking at it, there's a lot. There's the Allied Healthcare Scholarship Program, the Advanced Practice Healthcare Scholarship Program, Associate Degree Nursing Scholarship Program, the Bachelor of Science Nursing Scholarship Program. So there's a lot of scholarship programs that currently exist. And they have minimal funding, and two of those will be winding down that include behavioral health providers.

But I'm wondering, nursing training for behavioral, really important. Are we going to be tapping into? In BH Connect nurses who work who serve in a medical setting and serve behavioral health clients are eligible for scholarship and loan repayment What about the Psychiatry Fellowship Scholarship Program Are we going to be adding more money into that or is that a fully funded program that does not need any more assistance

And then a lot of the focus sounds on the enhancement capacity for counties in terms of the employees that work on the county level, if I've understood correctly.

Perfect. A lot of that, sometimes what I hear anecdotally is we don't have enough employees to work in these spaces. The cases are so much. While we can prepare and get people ready for these jobs, are those positions going to be available? Will the counties have even the funding to hire them on? Is that a barrier to closing the gap here? Is that being looked at?

Okay. Victoria, my request would be if there's any details you can share with our office, with the committee members here, that give us a little bit more time to review, at least myself, give more time to review instead of waiting until the May revise, I would greatly appreciate more details on the offset and transferring programming.

We're going to hold the item open and we're going to move on to issue number seven. Great. Thank you, Madam Chair.

Really robust background. Appreciate it. Very interested in this. It was $50 billion total. For the nation. How did California fare in our allocation?

Some states have 2.8 million just living in the whole state.

And they might get the same amount of money.

Have we been told how much money we're going to be getting next year?

Yeah, it is critical.

Or if other states have left the worst because they cannot.

We'll be able to get maybe potentially a little bit more.

Okay.

Yeah.

It's October 30th.

Yeah, they shifted it one month off the middle.

You mentioned that you just got approved from the joint committee.

Yeah, correct.

That's correct.

Yeah, we're doing the design right now.

Are they responding quickly?

Okay.

And we have turned, you know, interesting, the public-facing materials are something that are reviewed.

are sensitive to the timing because we want to perform at a high level and pull down more

And it's not like we can use these dollars just to give to financially distressed hospitals

And again, in a professional way, but we've had serious conversations about how to use

And again, the original proposal, we tried to create some flexibility in the transformative

and we just had to revise it to be even more narrow and more specific to transformational efforts

So, yeah, it was quite a kind of a process.

Should we need more time to disperse?

They did not.

Is that provider payments to help them stay in those rural areas, to help draw providers to the area?

So the $35 million is going to be used?

Yes, we can give it to hospitals.

So it can be used.

That's not that.

That's why they cap it at 15%.

But what it gives, it does allow for, again, the idea you could buy some infrastructure, you could buy some equipment, but it's in the course of meeting the goals of the program.

I was like, why aren't we talking about labor and delivery? So there is ability to use some of these

Where does that fall under that could do the labor and delivery infrastructure?

The way we designed the three is actually I think in all three areas you could apply, for example.

So I think there's a set of opportunities.

But overall, we did highlight maternity care as where we want to move the needle through this investment.

It's never been brought up.

I don't know if in the short time we were able to connect with the stakeholders if that came up.

Tribes talked to me about it.

Well, two things.

It wouldn't be surprising.

Dialysis didn't necessarily come up.

But we can go back.

On career pathways grants, $7 million will go to rural region high schools.

I didn't know what it was.

I think that's also a big priority in these areas.

$23.6 million for a contractor.

We are putting this together.

Now, and, you know, to Deputy Director Abbott's point,

The thing that I think is important is that those are direct services to the grantees

No, no, no, yeah, of course.

And then all of this that you described, I mean, we submitted already to the CMS.

I mean, the details are being designed now.

Tell me on this workforce mapping to expansion.

This is one of my great areas of passion.

When you asked the question about how are we looking at geographic inequities and access to care,

So it is an analytical tool that helps us target our dollars.

Same approach here with maternal health and primary care.

if that's what we find has the most severe shortages.

Perfect.

Yeah, if they're serving the goals.

Perfect.

Did I turn to you already Jason Okay Great Perfect We going to hold the item open move on to issue number eight I mean thank you so much That it

You ready?

I think it's afternoon.

And with that, I'll turn it over to Dan to cover two of our BCPs, and then I'll be back.

Okay, so we're moving on to session number nine. Okay. Okay. Sorry. Yeah, go ahead.

Jason, anything to add? We're going to hold the item open, move on to a joint request on issue number 10. Okay. DHCS may be joining us, but I'll just move on. Okay. So the governor's January... Hi, Tyler's here. Hi, Tyler. All right. The governor's January budget included a proposal to increase access to treatment for the symptoms of perimenopause, menopause, and postmenopause through increased enrollee and provider awareness. The proposal specifies that health plans licensed by the DMHC, health insurers licensed by the California Department of Insurance, and Medi-Cal managed care plans must cover services for evaluation, FDA-approved treatment for menopause when medically necessary. In addition, health plans would be required to have a menopause program that includes a policy to provide an annual menopause assessment for enrollees age 40 and older during primary care and OBGYN appointments, A biannual notice to enrollees over age 40 that includes the definition of menopause and the services available to treat the symptoms of menopause. And also a biannual notification to primary care and OBGYN providers on best practices for care, including current clinical care guidelines for menopause care from nationally recognized professional associations or the Menopause Society. When making a determination about whether menopause care is medically necessary health plans are required to base their criteria on generally accepted standards of menopause care from nonprofit professional associations for the relevant specialty They also required to have a process to reimburse primary care providers and specialists for menopause care including care integrated into OBGYN or primary care visits Health plans are required to have a policy to contract with primary care at OBGYNs with certification and credentialing by a nationally recognized organization such as the Menopause Society. This should include a policy to incentivize providers to obtain and maintain their certification. There are also other business and profession code requirements related to continuing education to incentivize providers to complete coursework related to menopause. And finally, the proposal includes $3 million for the California Health and Human Services Agency to conduct an outreach campaign to increase awareness of menopause symptoms and about the menopause transition and how to access treatment and evaluation. To effectively implement and enforce these requirements, we will need to review plan filings, monitor health plan implementation, and verify continued compliance through our medical surveys. We're requesting two positions and 407,000 in 2627 and 391,000 ongoing to address these requirements. So you had a question about the difference in this proposal compared to AB 432, including the rationale for why the administration is making these changes. I will just note, I think the most significant difference is AB 432 would have limited utilization management for menopause-related services and would have required that one treatment option in each four categories of menopause symptoms be covered without utilization management when deemed medically necessary by the treating provider. The trailer bill proposal addresses the need for increased enrollee and provider education about the symptoms and latest clinical care guidelines for treating those symptoms while maintaining the health plan utilization management practices. The proposal specifies that health plans must cover FDA-approved treatments, and we believe the requirement to use the nonprofit criteria when making medical necessity decisions will address some of those concerns. I will just note, I think there are over 70. I read an article yesterday that there's been as 100 symptoms of menopause, so one of our concerns was removing the requirement for the plans to use utilization, manage your prior authorization for that many symptoms, knowing that half of the population will experience menopause at some point, has the potential to increase costs of the health care and also lead to unnecessary treatments because there's an easier pathway. So those were some of the greatest concerns. And I think I'll stop there and see if Tara, Tyler's anything to add? No.

Tyler Sadwith, State Medicaid Director. Very briefly, just with respect to the impact on Medi-Cal, the proposal exempts Medi-Cal managed care plans from changes to the health and safety and insurance code section of the statute, but it updates the welfare and institutions code to codify the existing comprehensive Medi-Cal coverage for menopause treatments, including screening, evaluation, and treatment. In effect, the proposal has the effect of bringing commercial payers up to alignment with current Medi-Cal benefits coverage.

Yeah, no, so plans can do utilization management today. I think AB 432 would have removed that requirement for treatment of certain symptoms. Symptoms was not defined, so I think the concern is could have been very broad. So plans can, under this proposal, would continue to be able to do utilization management, but they would need to apply the nonprofit criteria, which would give more visibility, but also would mean they are using the latest clinical guidelines. I think one of the things we hear over and over, and if this has showed up in your social media feed, I think the biggest concern is there was a 2002 study that linked hormone replacement therapy to breast cancer. and so there's been I think a lack of information for both enrollees as well as providers on what the latest clinical care guidelines are saying which have kind of disputed or we've kind of deviated from that that study and so the critical piece here is making sure that both health plan members and providers are up to date on the latest clinical guidelines and then also that the plans are applying those clinical care guidelines the most current ones when they're making those utilization management decisions.

So under the pieces, under the DMHC, the health plans will be required twice a year to send information to their members on what are the symptoms of menopause, what are your treatment options. Similarly, they will need to send information to their provider network about what the latest guidelines are from these menopause societies is really the go-to on this. Separately, through our California Health and Human Services Agency, there will be a public awareness campaign, really to make sure the general public has kind of the latest guidance on what are all of these symptoms of menopause, what can you do, who do you talk to. And, again, that's not under the DMHC. That will be under our Health and Human Services Agency.

Angel Alonso Coronet, Department of Finance. So with the public awareness campaign is still under development, and Health Immense Services Agency will be able to request a budget augmentation when ready to implement this campaign.

That is correct. Yes.

Correct.

We will provide updates as soon as it's available.

Thank you, Chair.

I'm Tyler Todd with State Medicaid Director, Department of Health Care Services. First, I'd like to provide information about CalAIM enhanced care management and community supports. Enhanced care management, or ECM, and community supports continue to expand and mature statewide with strong uptake among high-risk members, the population that these services are designed to reach. These are members who benefit most from whole-person, community-anchored care. Utilization is growing consistently across all counties. We have public reporting available on our website. And just to highlight some of the growth statistics for enhanced care management 205 unique members received ECM in the second quarter of 2025 This represents an increase of 61 percent over the prior year Since launching ECM more than 452,000 unique members have received this service. For community supports in the second quarter of 2025, 187,000 unique members received a community support, which represents a 51% increase over the prior year. Since launching community supports, more than 521,000 unique members have received a community support service, and in total, over 1.3 million community support services have been provided. Availability has grown significantly since launch. Although these are mostly optional for plans, every single Medi-Cal managed care plan in California offers community supports. Every county in California has at least eight community supports available to all Medi-Cal members no matter which plan that they're enrolled in. In 43 counties, representing 94% of Medi-Cal members, all members have access to at least 10 community supports, no matter which plan they're enrolled in. And in 24 counties, representing 75% of members, they have access to all 14 community supports. In terms of ECM, provider network growth has grown substantially. When we launched this service at the beginning of CalAIM, there were just 700 unique contracts. Today, there are over 4,000 unique contracts. Turning to the fiscal picture as requested, the governor's budget projects for ECM, $1.2 billion total funds in 25-26 and $1.4 billion total funds in budget year. For community supports, except for the newest community support of transitional rent, The budget projects $1.1 billion total funds in current year and $1.1 billion total funds in budget year. I want to note these estimates reflect only the distinct cost of providing community support services. These estimates do not reflect avoided costs of more costly services that otherwise would have been provided, such as emergency department visits, inpatient hospital admissions, and nursing facility stays. I'll talk more in a bit about our analysis of cost effectiveness of community support services. But in terms of the budget, if ECM and community supports were discontinued, we would project a significant increase in high-cost acute care spending due to higher levels of use of these intensive services. Per transitional rent, the final community support, we project $55 million total fund in current year and $225 million in budget year. In terms of cost effectiveness of community supports, this is sort of a complex area of analysis. In some cases, a member exiting a hospital might receive a community support like recuperative care in lieu of being admitted into a nursing facility, so we can capture that type of cost avoidance immediately. For some other scenarios and other community supports like asthma remediation services, which reduce the incidence of asthma exacerbations in care management, cost avoidance may be seen over a longer period of time including multiple months or even years In terms of community supports we published a report in April of last year describing a cost-effectiveness analysis of 12 of the 14 community supports. For members who received a community support, we compared the cost of delivering that service to the savings that we achieved from reducing and avoiding inpatient hospital use, emergency department use, and long-term care use, and other services in the six months before and after the intervention of the community support. So we have a fact sheet on our website. It shows that of the 12 community supports analyzed in this report, nine are already demonstrating cost-effectiveness, and the three remaining services are on track to be cost effective over a longer study period consistent with guidelines the federal government has for how to measure cost effectiveness for these types of interventions. Just a couple quick highlights. Respite services were associated with a 61 percent net cost reduction. Personal care and homemaker services are associated with a 58 percent net cost reduction. Housing deposits achieved a 32% net cost reduction, recuperative care associated with a 29% net cost reduction, and so forth. We are finalizing by the end of this month an updated report that analyzes more data over a longer study period, including new analytical methodologies. In terms of enhanced care management, a formal evaluation of cost savings has not been completed. However, there are independent evaluations of the programs that ECM is modeled on and based on. The whole person care and health home programs both demonstrated Medi-Cal cost savings by reducing avoidable acute care and emergency department use. The whole person care pilot showed annual Medi-Cal savings of about $383 per member and $581 per medically complex members. We are exploring the possibility of a formal evaluation of ECM outcomes and cost effectiveness. We have a formal independent evaluation underway. We are completing a full independent evaluation of community supports as required by our 1915 waiver special terms and conditions. UCLA and the RAND Corporation are completing this independent evaluation examining the program's cost effectiveness and health outcomes with results due in 2028. Turning to the question regarding provider capacity and transitioning community supports into the state plan, provider capacity for community supports continues to improve statewide managed care plans report steady increases in executed provider contracts and expanding network growth across these services as reflected in the submissions of their model of care that they that they send to us. We show on our website the number of provider contracts for community supports has increased from just 731 when we launched this program to over 3,000 as of about one year ago. In terms of the transition of community supports into a state plan benefit we are not pursuing that transition at this time Instead we are working to ensure continuity of community supports under the optimal federal authority for sustainability which is managed care authority as an in-lieu of service. In-lieu of services is a permanent option for state Medicaid programs enshrined in federal Medicaid managed care regulations, and it's memorialized in our approved managed care plan contracts. 12 of our community supports are covered under in lieu of services authority. As we described in our Section 1115 CalAIM waiver renewal, which we posted for public comment and had public hearings in February and March, we're planning to transition the federal authority for recuperative care and short-term post-hospitalization housing from the 1115 waiver into in lieu of services authority. This will allow us to incorporate those services and really ensure sustainability of these services into a consolidated service model. Given there is a very significant risk, CMS would not approve these upon the 1115 waiver renewal, and thus these services would no longer be covered effective January 1, 2027. Turning to the question regarding how the department ensures managed care plans leverage local vendors and community-based organizations, we work closely and actively with all plans to promote the use of community-embedded and community-rooted providers. We emphasize and have consistently emphasized contracting with local providers and CBOs that have deep ties to the communities they serve, understanding these CBOs understand local needs, cultures, and gaps. So in terms of oversight, we monitor the types of providers that our plans contract with to ensure they're engaging nonprofits and CBOs that reflect the cultural, geographic, and linguistic needs of members. We have regular monitoring meetings and additional oversight mechanisms to strengthen partnerships with these providers. To support these providers, the department has awarded over $1.6 billion in grant funding and in technical assistance resources to more than 2,200 CBOs through the PATH initiative, or Providing Access and Transforming Health. As part of the independent evaluation of CalAIM that UCLA and RAND are conducting that I mentioned, they developed an interim evaluation report that we submitted to CMS in December. And this focused on the impact that PATH has had on CBOs in participating in CalAIM. This report found that PATH is achieving its objectives of integrating CBOs that have historically not participated in Medi-Cal, bringing them into Medi-Cal for the first time for the purpose of delivering ECM and community supports. Among providers that receive PATH funding or technical assistance, the vast majority were CBOs, 91% and 93% respectively. This independent evaluation found PATH helped cover these providers' initial operational costs and supported a gradual ramp-up of their participation in CalAIM as intended. We are also working closely with the California Healthcare Foundation to support CBOs to participate in CalAIM, including through funding provided by the foundation and the development of technical assistance resources and toolkits in close collaboration with the department to really support managed care plans and CBOs to enter into as an option an arrangement through community care hubs. Community care hubs are a way to enable CBOs to focus on their core competency, service delivery, and reduce the administrative burden of data collection and reporting, claim submission, compliance requirement, contract negotiations, and so forth. So we have seen that these hubs really streamline these back office business functions for small grassroots CBOs and enable them to take advantage of CalAIM. We've heard from plans that a DHCS-endorsed resource explaining how these hubs can be operationalized consistent with federal and state requirements was really pivotal for them to expand these types of arrangements. Happy to answer any questions.

Yes. Will Owens with the LAO. So, on this item, last year our office published an update on the implementation of ECM and community supports benefits. So in general, we found that utilization of the benefits was growing over time but was somewhat lower than anticipated at the start of these programs. Additionally, we noted that more information was needed to determine whether these initiatives were meeting the goals outlined at the start, including reduction of costs and avoidance of higher cost services. So as mentioned by the department, there have been a few updates since that report. More information has come out. And I just wanted to highlight for the committee a few updated issues for consideration from our original report. So first, the most recent data released by DHCS does show the utilization of these benefits. Both ECM and community supports has continued to increase since we published our analysis last year. And as we discussed in a report, many of the barriers to increasing utilization of these benefits was mostly due to the fact that these were largely kind of provided by CBOs that were not as familiar with the Medi-Cal managed care plan kind of billing ecosystem and how that all worked is much different operating model to what they usually did. So we would expect that as CBOs, providers, managed care plans got kind of more used to this benefit and working with each other, that we would see utilization increase over time as things got streamlined. And that appears to be the case. However, we would still flag for the legislature that additional information may be requested from the department regarding provider adequacy, as well as barriers for both plans and providers and patients from accessing these services. These would be things that go beyond simply a number of provider contracts, but would be looking at things that are a little more closely related to things like timeliness of patients, accessing these benefits, reimbursement of timing of providers, things like that, that dig a little bit more deeper and try to understand these barriers. So second, as mentioned by the department, DHCS released an annual report to CMS last year detailing some of the cost effectiveness measures of community supports, and they have an upcoming evaluation as required by CMS that will be released later, kind of looking at CMS or the community supports as a whole over a longer time period. In general, most of the services were shown to reduce costs and, as the department said, reduce reliance on higher acuity care options such as inpatient and emergency department utilization. So this type of analysis really is critical for the legislature to assess the success of these programs kind of moving forward And kind of adding on to some of our recommendations last year we would suggest and the legislature may wish to work with the administration to determine how this type of analysis could be done on an ongoing and sustainable way to evaluate community supports as well as ECM As the department noted, ECM, the cost effectiveness is based on previous pilot programs that share some but not all components of the current ECM benefit. So given the kind of growing utilization and growing share of general fund spending on this that these benefits have shown over time, it's important for the legislature to understand how these cost savings are still being had moving forward. with that available to answer any questions.

Thank you, Madam Chair, for the question. I would say that the sort of resources that are allocated specifically towards the cost-effectiveness evaluations of community supports are prioritized in a way, in part because they are federally required across a few different areas, including our 1915B STCs, the federal regulations that govern in lieu of services authority, which we're using for most of these services. And then, in addition, the CalAIM 1115 STC is where an independent evaluator will review. So because CMS requires such sort of rigorous and prescriptive and ongoing cost effectiveness determinations for these, we're able to receive the resources to do that level of analysis. Generally speaking, we do try to take into account sort of, you know, cost effectiveness of health care services when, you know, designing, you know, benefits in general, but not to the level of this rigor, if that's helpful.

And with congregate health living facilities in particular, I mean, we are actively pursuing the opportunity to carve that into managed care to enable expanded access for that. Because we do believe that's definitely better for members as well as for the budget.

Well so I think some of the challenge here is in cases where the department is required to look at cost effectiveness sometimes their design works in a way where you can do that sort of evaluation A lot of other policies that have been enacted over time it can be much harder to sort of isolate those effects because they come in a package of many other sort of factors But generally, I would concur that it is a high priority to sort of evaluate new things. This has come up a lot. It's not just sort of new benefits, for example. like we're not aware still of an evaluation of how the Prop 56 rate increases sort of affected access. And that would be another sort of key policy question.

Yeah. The MCO tax maybe is because it still hasn't been implemented yet. That would be. But some of it comes down to sort of how it's designed. And sometimes you need to design it in a way that can contribute to the evaluation. The other thing I would just emphasize is that you sort of asked, is it just a money issue? And really, you know, the legislature has many priorities, and it isn't always just a fiscal consideration. Sometimes high-priority policy issues cost more money, but they're high-priority. They ensure access. They improve people's health outcomes. There can be other factors than just whether or not it saves money. So that would be an important consideration.

Yes, thank you. Thank you, Madam Chair. So we are preparing to navigate the expiration of the two federal waivers that we rely on for CalAIM. We have a 1915, what's called a 1915B waiver and what's called a Section 1115 waiver. Twelve of our 14 community supports are covered under in lieu of services authority, which is really established simply in managed care regulations. And states are typically able to cover services like our community supports as in lieu of services outside of any waiver. They're typically able to cover them in their plan contract, and they submit that to CMS for review and approval consistent with the regulations. In CalAIM, in our 1915B waiver, we do have a lot of specific standard terms and conditions about reporting on our in lieu of services because we were very comprehensive, And we kind of were innovative in addressing social determinants of health and health-related social needs. And so CMS, when they approved our CalAIM waiver, added a lot of extraordinary reporting requirements in our 1915B waiver. But fundamentally, the authority for them is in the regulations and not subject to a waiver renewal. Two of our 12 community support center CalAIM cannot be covered as an in lieu of service because they entail room and board. They pay for room and board. So recuperative care and short-term post-hospitalization housing, the only way to cover them is in what's called the Section 1115 waiver. That also expires at the end of this year. we believe it would be unlikely that CMS under this administration would renew our 1115 waiver with recuperative care and with short-term post-hosposition housing. And so if we just asked for that it likely they would deny it and these two services would fall off a cliff So we in the process and what we proposed through our public comment period for the 11 renewal we proposed to take those two services, really consolidate them into one because they're quite similar, and then move that new consolidated service into the in lieu of services authority so that it's similar to all of the other community supports. In doing so, we avoid the risk that CMS says, no, that's not approvable in the waiver. In doing so, though, we have to remove the room and board component because room and board cannot be covered under in lieu of services. That's why it was in the 1115 waiver. So we're modifying the service itself. We're also taking out room and board, but we are strengthening some clinical competencies, clinical staffing around it. So it's a little bit more of a medically monitored service. So sort of updating the service, if you will, and then covering it in lieu of services to avoid this renewal process.

So what we plan to do as we navigate the renewal process and transition across different federal authorities, we are aiming for a seamless patient and provider experience. So the providers that deliver recuperative care and short-term post-hospitalization today, we've been engaging them heavily on this approach. And our goal is to make sure that the majority, if not all of them, are poised in position to deliver the new recuperative care service covered under the in lieu of services authority. So they would still be able to continue operating. Patients would still be able to continue getting services there. The only fundamental difference is it's a different federal authority. And then technically speaking, we would no longer cover room and board. And technically speaking, RIM and Board would no longer be explicitly part of the payment rate development. But we are making other updates to the service, as I mentioned, to sort of strengthen some standards around it. We also are looking at the fact that we haven't updated these rates for inflation this entire time. And so just updating it for inflation would increase. So trying to make sure we're avoiding disruption for providers and patients as we do the transition.

Thank you, Madam Chair. So we have worked closely with Hedges, HealthNet with sole housing, both in Los Angeles as well as in Fresno County, where sole housing was also part of an interruption in their contract with the managed care plan to deliver recuperative care. Based on our understanding and our involvement in supporting members, these are unrelated issues. sole housing was it's all an individual case by case issue but in many cases sole housing was admitting people without prior authorization and expecting to be sort of paid and receive reimbursement without going through the typical and the required processes that Medi-Cal managed care plans use to administer these benefits and ensure the integrity of the program.

and with all the plans involved and with sole housing to help make sure that, above all, sort of the transitions were prioritized and making sure that there was individualized one-on-one case management to make sure people had a pathway to go to as the underlying, you know, business dispute was being adjudicated. So unique situation, nothing needs to be in place for guardrails, for other bigger picture issues on that. It was just this entity in specific. Like, we don't see that as a pattern. We don't see the experience that we observed with sole housing in several different locations. That is not a pattern across community supports.

You mentioned 4,000 unique contracts. Is that 4,000 unique vendors, nonprofits that clients have partnered with? Is that what you've alluded to?

And going a little bit more on one of the questions, I think it was the number three that you talked about, maximizing the benefits of local vendors. You know, there was reports that a lot of the contracts were out-of-state vendors. Do we have an update of has that percentage changed? There was a huge percent of them that were out-of-state. Have we focused more on in-state contracts?

Yes.

No, I'm not hitting on the no here, huh?

Okay, yeah. I've been trying to figure this out.

Okay. That was it on issue number 11. Thank you so much. Move on to issue number 12. Issue number 12 is the California Community Transitions Budget Change Proposal. The department is requesting limited-term resources equivalent to one position, an expenditure authority of $165,000 in federal funds in budget year to support the California Community Transitions Program operations, noting this is 100% federally funded and has no general fund impact. Through the California Community Transition Program, which operates under the federal Money Follows the Person initiative, eligible individuals with disabilities receive transition coordination services to help them move from institutional care to community-based living to receive long-term services and supports and home and community-based supports to maintain independence at home or in their community. This program also plays a pivotal role in the state's efforts to update operational infrastructure, including through the No Wrong Door system that is operated by the California Department of Aging. This position will help manage the administrative, operational, and monitoring workloads associated with these activities and comply with federal grant funding and reporting requirements. I'm going to hold the item open. Move on to issue number 13. Issue number 13 is a budget change proposal related to a final rule that CMS passed in 2024. The department is requesting one-year limited term resources equivalent to seven positions, four-year limited-term resources equivalent to 15 positions in expenditure authority of $7.275 million total funds, of which 1.788 is general fund in budget year. In addition, we are requesting four-year limited-term funding authority for 15 permanent positions that we received one-time funding for in last year's BCP. These resources will continue to support the department's ability to meet all federal and state requirements. As part of the 2024 final rule, the ensuring access to Medicaid services final rule, often known as the access rule. These resources are necessary to continue the planning, development, implementation, and ongoing administration, monitoring, and oversight for requirements starting to be effective this year. The rule imposes permanent operational and regulatory workloads, and complete implementation requires long-term staffing that far exceeds the limited-term positions previously approved. And just as context, in H.R. 1, Congress included a moratorium on several final rules that CMS had promulgated in 2024. However, Congress did not include a moratorium on the Medicaid access rule. So as a result ongoing resources are required to retain the initially approved positions and to achieve and sustain compliance and monitoring and stakeholder engagement in accordance with this rule No questions here? Hold the item open. Move on to issue number 14. This is a budget change proposal related to human resources plus modernization. The department is requesting three permanent positions and expenditure authority of $4,535,000 total funds in budget year to continue the planning, procurement, and project implementation costs to modernize our human resources and related fiscal systems and processes. The department recently finalized the procurement for a new system, and we are working on implementation planning. This system will result in streamlined human resources and fiscal reporting that are necessary to address current and ongoing federal concerns that CMS has raised in its financial reviews of our program regarding cost allocation documents in order to claim federal funds for administrative activities. This is necessary for DHCS to meet federal allowable claiming requirements and to not jeopardize significant federal funding and penalties and ongoing deferrals that we currently face as we administer a state-only health care program for Medi-Cal members with unsatisfactory immigration status. There are no cost savings directly associated with this request. However, the system investment will ensure federal funding that is claimed meets federal auditing standards, and thus it will result in cost avoidance due to avoiding federal disallowances. No questions for me. Hold the item open and move on to issue 15. Thank you. The department is proposing a technical cleanup in trailer bill language of the existing statute related to the breast cancer research accounts. The technical cleanup corrects State Department references from DHCS to the California Department of Public Health in the Revenue and Taxation Code, Specifically, the Revenue and Taxation Code, Section 30461.6, governs revenues that are allocated from cigarette and tobacco products surtax, which are deposited into the Breast Cancer Fund. This fund includes two accounts, the Breast Cancer Control Account and the Breast Cancer Research Account. Together, the revenue in these two accounts is used for our Every Woman Counts Program. DHCS is the designated State Department for the Breast Cancer Control Account. California Department of Public Health is the designated State Department for the Breast Cancer Research Account. This proposal is necessary to restore and correct State Department references to ensure appropriate designation of roles and responsibilities and ensure uninterrupted program operations, research, and public health services. Okay. Thank you so much. Thank you. Take care. Safe travels. Missed the flight, so I'm going on the next one. Department of Public Health. I do this myself. I'm the one asking questions, so. Now moving on to issue 16 That's this. Okay. All right. Not yet. Is the red on? I think it's off. I think it's off. The red light has to be. Thank you. There we go. All right. Can you hear me now? Yes. Okay. Hi.

How much do people pay for this now? For which? You said there was an increase of 5%. There's going to be an increase of 5%?

You said there was going to be a fee increase? Yeah. Roughly

newborn screening. So how much people pay now?

$226. Okay. And then now they're going to have to pay $20 more

And that's due to how labs work. Okay. So fixed costs

So there's an ongoing cost of 5.5 million for adding the Crave disease.

Is this the first time we're seeing back-to-back decreases in participation?

That's what I meant, yes.

because we lost the exclusivity. I don't see my generation changing their minds on this, so I'm anticipating more and more decline. So does that then equate higher and higher costs now moving forward with these programs if you explain that it goes the opposite direction?

Love the name crab, I guess. It's interesting how we name these things. But I guess I thought I heard that how lab works is the smaller the population.

And why are patients opting out? Of the P&S program?

What does that mean? Because if I say that, I feel like that means is our test not up to par to the private approach as to why people are opting out of ours?

Right, I heard.

Yeah. When did that switch over? When did we expand?

Okay. Okay. Yeah. Any, I'm going to hold that item open. Thank you so much. Issue 17. Thank you. Thank you. All right, good afternoon.

Do we have a timeline on the expected final rules?

Okay. No questions further? I'm open. Thank you. Issue number 18 please Okay Team please

Would you... Just on this part, and then we'll turn to you on the second part. Oh, okay. Yes, on the offset, yeah.

Yes, so Will owns with the LAO. So, yeah, this is obviously related to an earlier item you heard with HKI. So, yes, generally that understanding is that this estimate includes kind of current activities that the department is already doing that they believe would qualify under their new responsibilities under the BHSA for population-based prevention. So the administration has indicated that more information on the specific activities that would be funded by this new revenue would be available at May revision. So at this time, our office is waiting until that specific proposal is out with the specific programming to do a full analysis of that offset. But just echoing some of the comments from my colleague earlier, some of those same considerations apply, but available for questions. Yeah, definitely copy and paste my comments as well.

So the budget includes $184.5 million in projected Behavioral Health Service Act revenues that will be allocated to the Department of Public Health. If we take a look at that initial planning document, it estimates use of approximately $134.5 million in funding. So that $50 million is essentially the difference.

Yes. So the offset was assessed sort of within the context of the planning that has taken place so far I think the only thing I would emphasize is just that is sort of an initial planning document that has been put together by the department So to the extent that you know there any sort of specific proposals that come forth from that that will happen in a later timeline

Correct. So the offset proposal exists within the context and qualifications of Proposition 1. The funding will be utilized for existing behavioral health programming that meets the qualifications and requirements. We just don't know anything on that details yet.

Yeah, so the youth population is a priority population. Tobacco in particular is a separate center that will be, or office that will be absorbed and part of the complementary work at the Center for Social and Behavioral Health. So there will be some synergy, but in the final plan, tobacco I don't think is explicitly called out, but it will be.

Not under a different plan, but within the Center of Social and Behavioral Health. So it will be in tandem and in alignment with the rest of the work.

Yeah, absolutely. So I only answered the first question on the agenda there. So I'll kind of go into the second question. But absolutely, there's opportunity and priority to address emerging issues such as this. And there are many new emerging substances that we are tracking. So let me just go back to the second question here about funding structure. how is the funding structured between statewide entities and initiatives, and funding for local assistance for community-based organizations and other local entities.

We'll hold issue 18 open, move on to issue 19.

I have a curveball, but I don't know if you ladies are the right people to ask.

Just because you were here last time for the other regs. But I'm wondering if you're the right person for the hospice emergency regs.

That you can give me an update on that that was due in January.

So if we still have to submit it to another entity and still wait for their feedback, Once that feedback happens, do we have to go back to the stakeholders and get input on that revised?

So people have seen the regs. They kind of know what we're expecting from them so they can start ramping up to get ready for that. Is there anything we're doing systemically just to be able to get some of these rags out sooner? I mean, it's always like really, I was going to cuss. There's always a really weird situation. Like, there's always shitty situations that are occurring around the reg timeline. So how can we prevent so that we can have regs out in time before a situation occurs?

So we're looking at where there are high-risk areas that we need to prioritize.

Now, should I wait for the director? I'd love a little bit more feedback on what happened this week, particularly because it was in my district. I can wait to have the director if there is anything that you're able to share with me.

I definitely would be interested in the amount that were located in my district, in Van Nuys in particular. There was some viral attention to that area. I'd also love to see the connection of these regulations and from that how we can prevent some of these moving forward. And the breakdown of percentage versus state violations and federal violations, most recognizing that a lot of the payments come are Medicare payments, so that's the federal oversight, just to see the balance on that. And then the moratorium that exists right now, when does that expire?

Okay, so six months almost. Is there intent to extend that moratorium a little longer given this, you know, just recent incidents, or are we going to be lifting that up?

Okay, and I apologize. I don't know why I'm giving a little air to this question, but how many codes can you charge for in this hospice, in this billing world? Like, is it a laundry list of things you can charge for under hospice? Is it a short list?

Okay, I know it's a conjoined thing, sure.

Have we seen that there's a need to get more hospice up and running a license?

Okay. And the emergency recs, you know, I apologize. I haven't seen that the draft was posted, and I'll make sure to get a copy of it. But does it talk about, is it on how to get licensed, the requirements to get licensed,

So DHDS is more on the billing side. You're the licensing. Who's more on the enforcement side?

Okay. How do you flag that there's potentially fraud happening?

And have we been investigating? I mean, it's not like this week. We knew of these things just this week.

Okay. Are you able to share the awareness that the department had of certain facilities that were potentially committing fraud? How long the department knew or has been working on it?

Okay, thank you. I'm going to hold the item up and move on to issue number 20.

I haven't heard that general acute care hospitals, but I said GACs. Yeah. I was like, is that a thing? Oh, it is. No one's ever. There you go. Um, so that's the goal is to

You said assuming that all hospitals are onboarded is there potential that they won all be onboarded No the goal is to have them all onboarded but we in the process of a competitive solicitation for a vendor Okay, anything to add on this? Okay, no questions further? Hold the item open, move on to issue 21. Thank you.

Dr. Seuss, here at the right hand. It is, like a Lorax. All sorts of interesting acronyms in CDPH. Would you like us to?

Oh, really?

Do you want us to dive into the next item? Yes, please.

I have no questions on this issue. We're going to hold the item open and move on to issue number 22.

And then the other one, I see a list of programs that have been funded in the past. Does the money go to further continue those programs, or is it for new programs?

What kind of programs exist under this funding?

Okay. All right. Okay. No other questions? Okay. Next item.

Issue number 23.

No questions on this, but can you also give me an update on the, I know there's a pause in the psych regs for implementation. When does that go into effect officially past the pause?

Yeah, it was a staffing part. All right, thank you. Can we hold the item open and move on to issue number 24?

Would you like me to go straight into the question? Regarding the question on current licensing fee structure and what it's going to look like in the future,

On how much would be the increase? Like, what does 20.3 mean?

I did. I actually wanted to know how much do they pay right now?

It's because you said there was a lot of different ones, right?

Would you like a couple more? But no one's gotten an increase since 2017?

I don't know if you know this answer, but that's nine years.

Is this common for other licenses, or have they been able to escape an increase?

I got an email recently in my office, not on this profession but a different profession, that their annual fee increase had just jumped up dramatically. And I was like, let me investigate. Who did that? And I voted for it. So I was like, me. That was my fault. But I'm wondering, because his questions were like, why did it increase and so forth? When these happen, are they notified for the reasoning as to the increase?

Exactly. Okay. Okay. And how long do you think the fund will be stabilized with this 20.3% increase?

Okay. Yeah, I just want to know if we're entering a period where we're going to have to do more ongoing increases.

Okay, so with this fee increase, it leaves a little bit of room for flexibility? Okay.

What do you mean? They're practicing without being licensed?

So are they practicing without our license? Sorry?

Not that we know of.

I guess I don't understand how there's – what do you mean they're slipping through the cracks? What are they doing?

Correct. So there is more accounts receivables we want to help also. That will help us increase the revenues as well because we will be able to stay more on top of those past payments But it not enough to cover what is needed You still need we still have to chase the people to actually pay and also do an increase Right. Okay. Correct. Anything else? No? Okay. Thank you so much. Hold the item open. Move on to issue 25.

Okay. I know what I've asked the department to do, but the only one I just need clarity is on the one to review medical records to confirm the cases. If these are cases that are diagnosed in the hospital and it's on their records, why do we need to double confirm that it is, in fact, silicosis? I'll turn it over to my colleague.

Got it. Okay. We can move on to the next bill.

Sorry, I lied. I have another question. I was looking at... the report that CDPH had come out with. And as we're doing this, I just want to make sure the mindset of CDPH isn't that this is a hopeless thing. The reason why I got that is because in the report from CDPH, it talks controlling exposures to levels low enough to prevent disease is technically challenging and costly, thus rarely feasible. I look at that as we won't be able to accomplish much in this space, that leaves room for what is the incentive if CDPH feels like it's really not feasible to really do anything in this space. So I just want to make sure as we're looking at this, there isn't a mindset of like we're not going to be successful anyways.

Okay. I just wanted to make sure. Yeah, no. Reassurance in that space. Okay.

The next one is the next group. Okay, thank you.

Okay, that clarified a lot because I was like, wait, I can give you my intern to cut and paste this word somewhere else. Because I was like, why do we need so much money to literally cut and paste somewhere else? But $95,000 is to just modernize the whole system as well.

Okay, I still think we don't need an extra person. I just felt like this, unless I'm missing something, I'm literally just moving stuff around.

Okay, so a little bit more than it.

Do you have anything to add to this?

Okay, great, perfect. I want to turn to you. Next one. Oh, okay. Who's doing six for six?

For the next remaining, I don't have any questions, so we can go as fast as you want.

Sounds like a plan.

The next one. For the next one, you could just talk about what the position would do. You don't have to explain the bill.

Okay, you don't have the last one? Okay.

Thank you. Thank you.

Got to be quicker than that.

Okay. No questions? Leave the item open. Thank you so much. That's it on department issues. We're going to go back to proposals for investment, issue 26, and we have a couple for presentation. The first one is going to be on the cost relief trailer bill language to prevent community-based adult services closures. Each presentation has three minutes. Great.

Thank you. Has anyone assessed a cost to this?

Department of Finance, if you can assess a cost to this stakeholder proposal and get back to me. I know you don't have it now.

I want to emphasize to the extent that we can provide technical assistance.

If you're able to put a cost to it, I'd love to.

Okay.

Okay. But as to assessing, you know.

Yeah. Is anyone here from DHCS?

Tsk, tsk.

We welcome technical assistance on the language. It was a first stab and intended to be as low-key as possible while also moving the issue forward. THDS, you left too early. You always stayed for public comment. Okay.

Thanks for the opportunity, Madam Chair.

All right. Next presentation. Nurse midwifery education programs funding.

Thank you. I'm glad that you mentioned, because I was going to ask you if you had conversations with the H.

Yep. In your conversations, did they share that one of those parts you could be eligible to?

And so ideally, we would love to get some funding from the RHTP program.

And this is something that I will tell you is an urgent need now. And so we're what about on the funding for the rural areas? I don't know if you were here for that presentation as well.

And as you heard from folks just now talking about 669 from last year, that really is for rural communities as well.

I'd love if HCAI can get back to us as well to see if this is something that would be eligible under the rural program as well. DOF, if you could share that with them. Thank you. All right.

Thank you so much. Really appreciate it. Our last for presentation. is utilizing community health workers promotoras to keep Californians covered.

Thank you. Is this to bring on more CHWs or to continue the ones that are currently working?

Okay. Do we know when they're no longer going to be?

be able to work or it's just we need more funding it's not enough funding i know but you need more funding but it's not to bring more chws you said it's to continue the ones that already exist so i'm wondering or is their contract ending and then they need the money to that's where i'm having it

Right now, the HKIs infrastructure, health navigation is a piece of that.

Yeah, okay, thank you. Thanks. We're going to move into public comment now.

Appreciate your consideration. Thank you. Thank you, Mark. You know, like two hours ago, I looked on, and I was like, oh, it's not a lot of people. It won't be a lot of public comments. Silly me. People come towards the end.

them better as well as helping their caregivers provide better service. Thank you. Thank you. Good afternoon. Kelly LaRue here on behalf of Alignment Health Plan, who serves over 200,000 of California seniors with about 70,000 who are eligible for both Medi-Cal and Medicare. Just this week, CMS finalized a 2.48% increase in Medicare Advantage payments for 2027. Reinforcing the role these plans can play in supporting providers and patients during periods of financial strain and ensuring that California optimizes Medicare funding in this challenging fiscal environment. High-performing, highly-rated Medicare Advantage plans, like alignment, improve outcomes while also providing more predictable funding to providers and the broader health care ecosystem, in addition to delivering richer benefits for dual eligibles. As CalAIM continues to evolve, we urge the subcommittee to support policies that preserve access to high-quality MA plans and allow them to continue serving duels while advancing the state's coordination goals. Also wanted to flag for you for the California Urgent Care Association. We're putting together some information about providers who began taking Medi-Cal under the TRI payments, and so we can get that cost savings and increased access numbers to you guys Thank you Kelly Brooks here this afternoon on behalf of the University of California Health to comment on two items First on the Rural Health Transformation Program UC Health serves patients from 99 of California zip codes and is committed to expanding rural access to specialty and inpatient care. UC Health also supports building a sustainable rural health workforce to address care gaps in underserved areas. UC Health looks forward to continued collaboration with HKIA as they begin to roll out the grant funding application. On issue 26, UC Health supports CDA's request to reject the plan elimination of $311 million in general fund support for propositions of 56 dental rates. UC's dental schools at UCSF and UCLA are key Medi-Cal safety net providers serving children, older adults, people with disabilities, medically complex patients, and underserved families. These cuts would impact critical services including pediatrics, hospital dentistry, oral surgery, orthodontics, endodontics, and special needs care. Thank you. Thanks, Kelly. Good morning. Angela Pontus on behalf of Planned Parenthood Affiliates of California, representing the seven Planned Parenthood affiliates that operate over 100 community health centers and our providers in the uncompensated care grant program offering abortion and contraception care. The program is currently in its last round of funding and therefore will not continue without an appropriation. Planned Parenthood is in strong support of the $30 million request to continue the program for three more years at $10 million per year as Planned Parenthood providers and the other providers in the program need that funding to continue offering services for those that do not qualify for Medi-Cal programs or otherwise have coverage. Thank you. Thank you. Good afternoon, Madam Chair. Connie Delgado on behalf of the District Hospital Leadership Forum. These are the 33 district and municipal hospitals in the state. Excuse me. We appreciate HKI's presentation on the RHTP. As outlined in today's materials, this program represents a significant and timely investment to strengthen access, workforce, and innovation in rural communities. For the hospitals DHLF represents, many of which serve as the backbone of care in rural and underserved areas, this program is critically important. The focus on transformative care models, including hub-and-spoke networks, will help stabilize essential hospitals and improve coordination of care. The workforce investments will directly address persistent staffing shortages, especially in these hard-to-recruit regions. You've heard some conversations about that and you yourself mentioned. As the technology and infrastructure funding, including telehealth and EHR modernization, will help close longstanding gaps in access and connectivity. We look forward to continuing to partner with HKIE and the legislature to ensure these resources are deployed and effectively reach the communities most in need. And also we would like to offer support for the CHA-sponsored $300 million for the distressed hospital loan program. As you know, district hospitals received over half the pot. Thank you. Lena Workman with the California WIC Association, representing the 83 local WIC agencies that provide the WIC program. We would like to commend CDPH WIC as they are currently undertaking the Herculean task of implementing the new food package. This vital targeted short-term benefit supports 1 million Californians each month, and its proven positive outcomes with great impact deserve our full support and investment. We strongly support their efforts to implement WIC online shopping. The long-sought-after flexibility by WIC families will facilitate equitable access to healthy foods by reducing barriers such as transportation in both urban and rural communities, easier shopping for WIC-approved foods, mitigating ongoing immigration threats, and the stigma for utilizing public benefits. Thank you. Thank you. Good afternoon. Lizzie Guansona here. I'm going to comment on two items today. First on behalf of the Office of Kat Taylor on item 25 in support of the BCP to implement AB 1264 we urge the legislature to approve this funding so the department can develop these rigorous science regulations and provide schools with the technical assistance they need to serve healthier meals. Also here on behalf of the California Medical Association, on item 10, CMA applauds efforts to improve access to quality menopausal care and wants to ensure requirements placed on plans are contemplating the implementation impacts on providers. To that end, CMA and ACOG are working with other impacted providers to provide feedback on the language and look forward to continuing conversations. Thank you. Thanks. Good afternoon, Madam Chair. Nico Molina on behalf of Bayer. Bayer supports the governor's budget proposal and the related budget trailer bill on prescription drug coverage for menopause treatments. While Bayer fully supports the TBL and funding proposal, we urge the legislature to consider revising the language to ensure that women experienced in menopause have access to the full range of treatment options, including innovative new treatments that might not otherwise be covered by insurance. Thank you. Thank you. Good afternoon, Chairman Javar. My name is Courtney Armstrong with the First Five Association. I'm here to speak on item 18 under CDPH's BHSA Population-Based Prevention Fund. Despite past historic investments in children's behavioral health, the birth through age 5 population remains underserved and often overlooked. The sunsetting of the CYBHI community practice grants at the end of 2026, combined with the changes due to BHSA implementation, are going to widen that gap. For these reasons, First Five Association of California is requesting an additional $20 million for the new CDPH population-based prevention fund, specifically for the birth to five population. And we're also proposing two technical fixes for that fund. So first is designate 20% of the 51% youth set aside for the birth to five population. And the second is to clarify the statute to ensure that county first fives are eligible applicants for those funds as local early childhood experts with deep community knowledge. Thank you. Thank you. Good afternoon, Madam Chair. Jack Anderson with CHIAC, representing our local health departments throughout the state. Under issue 26, CHIAC respectfully requests the legislature and administration provide $97.6 million for four key public health IT systems used in communicable disease and vaccination programs. These systems include MyCAVACS, CalConnect, the California Immunization Registry, and the Future Disease Surveillance System. The governor's January budget does not propose resources for these systems, and without funding, these systems are slated to shut down on June 30th, with no contingency plans communicated to local health departments, health care providers, or other users. The loss of these systems would force local health departments back to pre-pandemic, less efficient and administratively burdensome workflows and processes to prevent and control infectious diseases. And these practices would include manual spreadsheets, faxing, emailing reports, cold calling, emailing electronic data files, and manual labor to establish new workflows. These systems have saved countless hours of state and local health department staff time and have enabled more timely and actionable public health interventions statewide. California cannot afford to... Thank you so much. Thank you. Thank you. Chair, Kathy Mossberg on behalf of Essential Access Health. I want to comment on one of the items for reinvestment on the uncompensated care program to the point made by my colleague from Planned Parenthood. These funds have now been expended after this last grant cycle. This has been a true lifeline for the providers and for those we serve. This was something put in place post-Rowe. Now with H.R. 1, we're even in a worse situation. We're going to see more uncompensated care, and we need this program even more. So I want to just urge your support for the $30 million dollars. the request, spend the money over three years, $10 million a year. We also have some additional outside of general fund that we could use and the abortion fund that was created last year and some of those insurance dollars. So there's ways to offset some of the general fund requests. So we urge your support when the time is appropriate. Thank you. Good afternoon, Ryan Souza. On behalf of Ceres Community Project, lead organization in the CBO Medi-Cal Coalition. Our coalition represents over 700 community-based organizations, and we serve all community supports and all populations of enhanced care management. We just want to highlight the conversation around CalAIM, ECM, and community supports today. Our CBOs are local and doing the work from moving people from long-term skilled nursing facilities to successfully living in affordable housing, to helping keep people's diabetes in check with medically nutritious meals. And we just want to say that DHCS was clear today. We are hearing from our organizations and individuals. These are innovative programs that are cost savings and that are working. And so we just want to support and keep this, you know, CalAIM, ECM, NCS as a priority, both in policy and funding as the conversations move forward. We also have a brief here today I'm going to leave, which is in partnership with Center for Care Innovations. And it really describes kind of the nature of the organizations doing the work and what's happening in the field right now. Thank you. Thank you so much. Good afternoon. Michelle Gibbons with CHIAC, representing local health departments as well. I just wanted to comment on issue 18, BHCA population prevention. The local health departments that are in the plan are receiving $12 million, but we're being asked to create suicide prevention plans and then convene all the folks that CDPH then provides funding to locally and making sure we're all rowing in the same direction. $12 million across 61 local health jurisdictions is not going to go very far and is not enough to complete that work. The challenge that we see is that the state is using a lot of those dollars for programs that they already pay for and leaving us with $12 million and not really expanding that to anything more. So we would love to continue that dialogue with the department but also with the legislature to try to get a little bit more funding for local health departments so we could actually maximize the opportunity and show that public health can add value into this prevention space. Thank you. Thank you. Chris Kahn representing the ALS Network. I'm here in continued support for the ALS Wraparound System of Care program outlined as part of item 26. This proven program allows ALS patients and their families to access clinics throughout the state, taking a huge burden off our health care system. Thanks for your consideration, and I hope there's a third flight. Thank you, Chris. I know. Seriously. Good afternoon, Chair. George Cruz on behalf of the California Behavioral Health Association. We appreciate the state's commitment to behavioral health through CalAIM and want to highlight two areas where targeted investment is needed. First, on BHSA population health funding, we urge this legislature to support the budget request championed by Assemblymember Pellerin that allocates $30 million from the Behavioral Health Fund to fund the California Reducing Disparities Project. CRDP's approved and prevention model that reaches communities not served by traditional system, and the state has already made significant investments in building that infrastructure. For every $1 invested, the state's seen roughly $5 in return. and CRDP's funding is set to expire in June of 2026. Second, the enhanced care management and community health support. Community-based providers are responsible for providing these services, but current rates and infrastructures do not accurately reflect the true cost of care. Providers lack access to the same level of technical assistance as counties, which create uneven implementation and limits access. Thank you so much. Thank you. I have to stop public comment at 3 I have to So I get 30 seconds y each person Good afternoon Madam Chair Jessica Moran with Capital Advocacy On behalf of Big Smiles Children's Choice Dental Care, the Association for Dental Support Organizations, and Golden Age Dental Care, all in support of the Prop 56 reinstatement of dollars, you know, representing providers who treat children all the way to the end of life, who treat patients in school dental offices and school nursing facilities. This funding is critical to maintain the dental network and make sure that we don't hinder access to care for a vulnerable population. Thank you. Hi, good afternoon, Madam Chair and staff. My name is Julie Sherman. I'm here on behalf of the Arc of California. We represent people with intellectual and developmental disabilities. I'll be quick. We are just here again to urge the committee to reinstate the funding for Medi-Cal Dental. This is something that is very important to the special needs community. Thank you so much. Thank you. Sarah Nosedo on behalf of the California Chronic Care Coalition. We are here in support of our partners at the Alzheimer's Association's Budget Act request for $5.4 million over three years for the Dementia Care Aware program. Thank you. Thank you. Hi, Kat DeBerg with the Health Officers Association of California in support of the stakeholder proposal for $97 million for state IT systems so that we don't fight 21st century diseases with 20th century technology. Thank you. Thank you. Madam Chair, Bruce Palmer with the California Association of Public Health Lab Directors who represent 28 local public health labs serving as part of the first line of defense against public health threats in our community. We are in support in alignment with CHIAC, HOAC, and SEIU for this $97.6 million for CDPH IT systems. Thank you. Thank you. Good afternoon, Madam Chair. Trevor Nelson with the California Alliance of Child and Family Services in support of funding for the CalAIM enhanced care management and community supports. These programs are essential to meeting the needs of our most vulnerable residents and they are delivering results. I'd also like to speak in support of the $20 million allocation for the population-based prevention fund for children ages 0 to 5. Thank you very much. Thank you. Good afternoon, Madam Chair, members. Raymond Contreras with Lighthouse Public Affairs on behalf of Fullwell and the continued support for CalAIM. Since the launch of CalAIM, specifically the medically tailored meals and medically supportive food have connected with over 220 patients across the state. We want to continue prioritizing equity across California. Thank you. Thank you. Thank you, Madam Chair. West Saver HealthRide 360. I want to stress the importance of preserving the California Reducing Disparities Project through our Essence of Mana program. We operate the only CRDP program specifically serving Pacific Islander communities. And without the continued funding for CRDP, we risk losing effective programs, a trusted workforce, and behavioral health infrastructure. I also want to uplift the End Epidemics Coalition requests and the California Hunger Action Coalition's requests. Thank you. Thank you. Melissa Cortez on behalf of Homestyle Direct. Homestyle Direct provides medically tailored meals within the CalAIM program. We do want to offer continued support for that program. But I also want to note that we did provide some recommendations to the department, copied this committee on ways that we believe you can see additional cost savings within that program by standardizing eligibility and streamlining documentation required. Thank you. Thank you. Thank you Madam Chair Eric Dowdy with the California Dental Association here to support the reinstatement of the Prop 56 supplemental payment cuts for Medi Dental We see it as existential for the survival of the program and access, so we appreciate your support for that. Thank you. Good afternoon, Chair. Beth Malnowski with SEA California. I want to align my comments to those of CHIAC and HOAC in supporting the public health IT investments of roughly $97 million. I want to additionally support some of the investments outlined earlier on the HCI budget, in particular ongoing investments to the data exchange framework, the HPD, and the Office of Healthcare Affordability. Additionally, support their work implementing AB 1418. And lastly, appreciate their focus of workforce on centering the Rural Health Transformation Program and the Workforce Needs of Rural California. Lastly, on the Department of Public Health Budget, want to support the investments in the Center for Healthcare Quality Field Operations Strike Team. Thank you. Thank you. Nora Angeles with Children Now. We are in support of the following. CHIAC's public health IT funding request. the $26 million request for gender-affirming care support, CDA's proposal to cover Prop 56 incentive payments, the $4 million investment in CHWs and immigrant health care, and we support the additional funds in trailer bill language for first fives. Thank you. Thank you. Good afternoon, Chair. Diane Aluna with the County Behavioral Health Directors Association. We just want to express our gratitude to H-Chi for their partnership and collaboration on the HSA Workforce Initiative development. While we appreciate the partnership, we do want to raise one concern that we have with the draft WET plan, which proposes evaluating the impact of the BH Connect Recruitment and Retention Program prior to making additional investments. While the BH Connect Program has made meaningful progress, gaps remain in its scope, so we would really urge the reconsideration of this approach. Thank you. Thank you so much. Jennifer Tannehill for the California Dental Hygienists Association. We want to echo the comments of the Dental Association and also just that we would like to make sure that we support the preservation of Prop 56 Funds for Dental. It really impacts the alternative practice hygienists and their patients who are in nursing homes and those homebound elderly and disabled patients. Thank you. Nicole Wardleman on behalf of the Children's Partnership in support of two stakeholder proposals, the community health workers $4 million, as well as the $20 million for zero through five mental health through first five commissions. Thank you. Thank you, Madam Chair. Andrew Mendoza on behalf of the Alzheimer's Association, we are sponsoring the budget request for the Dementia Care Aware. It is $5.4 million to sustain a dynamic training program for three years. They have already trained more than 7,450 people reaching professionals in every California county, and they offer free CEUs and CMEs in exchange for that training. And we do believe that this has led to better detection and diagnoses of dementia, which can reduce necessary hospitalizations and emergency room visits and can save costs to our shared health care system, which will help mitigate the impact of implementing HR1. Thank you. Thank you. Good afternoon. ask of $30 million to Visione Compromiso to support the Alianza, which is 14 CBOs working to support this and million to Visione Compromiso Thank you Hi Romelu Antoine with the Sacramento LGBT Community Center and a coalition of LGBT centers across the state here in strong support of the million LGBTQ plus community center fund and $25 million for gender affirming care. Centers such as ours provide critical care such as mental health, housing support, HIV services, affirming care for youth, etc. Right now with federal talks, it's time for California to be a backstop for our youth in our community. Thank you. Thank you. Daniela Zimmerman, Ally Mom of an LGBT Kiddo and Board Chair of the new Placer LGBTQ Plus Center. Just wanted to underscore the importance of providing these services in rural areas throughout California so that individuals have access to supportive medical professionals and services, legal help, safe gathering spaces employment opportunities, all of the above which benefits mental health. Thank you for including funding for LGBT centers in the state budget going forward. Thank you. Good afternoon, Chair. Matt Veles with the Latino Coalition for Healthy California in support of the $4 million asked to HCAI to support community health worker CBO infrastructure. And additionally, we urge the HCS to provide utilization data of the CHWPR benefit. and support the $750,000 asked to support this report. Thank you. Thank you. Afternoon. EJ Agua. I'll be fast. I have a few. On behalf of Ochin, we appreciate Senator Dahle's championing of $20 million to reauthorize and scale H-Cai's proven health IT and AI workforce program. On behalf of CAFP, we appreciate the dedication to and protection of Song Brown. Also on behalf of CAFP, we appreciate the administration's engagement on improving access to menopausal care. Look forward to continuing discussion on amendments to the proposed trailer bill language. Almost lastly, on behalf of CalPACE in support of the CADS budget request geared to prevent community-based adult service closures. Lastly, on behalf of Vision y Compromiso in support of the $4 million investment. Hello, Uthman Ahmad with Roots Community Health Center. We strongly wanted to ask for two investments. Investments, the first is $750,000 asked to require to report on who's accessing the CHW benefit and where those gaps are. And second, the formula asked to expand CHW capacity through HK's existing infrastructure. This investment would deepen and broaden that reach for our health center. Thank you. Thank you. Hi there. Lily Dorn with the Children's Partnership. I'm here to echo the comments of my colleagues at CPEN to urge the legislature to invest at least $4 million one-time funding to build on existing HCa infrastructure to support CHWPRs and CBOs in helping California's children and families stay enrolled in Medi-Cal, mitigate HR1 harm, and access care. We also strongly support a one-time allocation of $750,000 for DHCS to publish data on utilization so advocates can better work with the state to improve this critically important benefit within Medi-Cal. Thank you so much. Thank you. Good afternoon, Madam Chair. Doreena Wong from Asian Resources, Inc., to comment on item 26. We also support the $4 million allocation to H-Chi to support CHWs. We've seen firsthand the importance and critical need for these CHWs to provide culturally and linguistically competent care. We also support the $750,000 to make for the report to ensure the CHW benefit is effective. Thank you. Thank you. Good afternoon, Whitney Francis with the Western Center on Law and Poverty. We appreciate that the TBL implements coverage requirements but have concerns that the language treats Medi-Cal patients differently by not requiring annual provider assessment or patient notification. We urge low-income Californians not be treated differently than those with commercial coverage. We're also pleased to see the Department's commitment to CalAIM and to ensure the long-term success of vital community supports. We recommend movement to make these services Medi-Cal benefits. And we align our comments with previous colleagues supporting the two CHW asks and support the $26 million request to protect transgender health care. And finally, we continue to urge the legislature to pursue progressive revenue solutions to protect health care for all Californians. Thank you. Thank you. Just flagging that this subcommittee has not received a formal request for the $750,000 from CHW. So if you want to turn in a workshop, a worksheet that has to be formally submitted. Good afternoon. My name is Prosperity, and I'm here on behalf of the Coren Organization of San Diego serving refugees from Burma. Our community languages, including Karen and Karenian others, are rarely represented. So we are here to urge legislature to invest at least $4 million to support community health workers and community organizations in helping all Californians stay enrolled in Medi-Cal, navigate changes, and access the care they need. Thank you. My name is Muey and I a community health worker with the Karen Organization of San Diego also serving Korean Kareni and other Burmese speaking ethnic groups in Burma In my five plus years working in this role I have seen firsthand how important it is to have trusted messengers The formula investment will fund trauma-informed outreach and education done by community health workers like myself. Thank you. Thank you. Hello, Madam Chair. I'm Anna Chodos. I'm a geriatrician and internist at UCSF and professor of medicine and executive director of Dementia Care, where I want to just put in my support for the budget request for that. You heard we've talked to thousands of people and trained them. We're just getting started. There's tens of thousands more people to train in how to do dementia care while the population is doubling before 2040. So thank you so much. We do not have any other state support to continue this program after this cycle. Thank you so much. Thank you. Madam Chair, Monica Miller, on behalf of Alzheimer's San Diego, Orange County, and Los Angeles, We're in support of the CADS request as well as the Alzheimer's Association request related to Dementia Care Aware. Thank you. Thank you. Good afternoon. Katie Van Dyne with Health Access California. On H.I. Issue 1, we support strong implementation of the Office of Healthcare Affordability. Consumers will bear the brunt of the impacts of H.R. 1, and we can't protect household and state budgets without addressing the drivers of high healthcare costs. HCI issue three we support the BCP to transfer the data exchange framework over to HCI and strong implementation of the program including an independent governing boarding and enforcement HCI Issue 5 we support the BCP for AP 1418 DMHC Issue 9 we support the BCP for SB 41 and SB 306 And for Issue 26, we support CPN's ask for the $4 million document. Thank you. Thank you.

Thank you.

Thank you.

Thank you. Thank you for your patience.

We urge you to cut it off. Thank you so much. That will conclude public comment. Budget subcommittee number three on health and human services has adjourned. Thank you.