Senate Budget Sub3 — 2026-03-26

Thank you. Thank you.

Good morning, Chair. Michelle Boss, Director of the Department of Health Care Services. I'll first start with an overview of the department and its budget. The governor's budget proposes $229.1 billion total funds and 4,745 positions to support the department's programs in the budget year. Of this, about $1.3 billion is for state operations, and the remaining $227 billion supports local assistance. In terms of the funding split, we have $49.5 billion in general fund, $138.5 billion in federal funds, $35.3 billion in special funds, and about $6.5 billion in reimbursements. With regard to the Medi-Cal caseload, in the current year, we estimate about 14.5 million individuals enrolled in Medi-Cal, and then in the budget year, about $14 million. This reflects, the reduction reflects the continued Medi-Cal redeterminations under the no longer having the public health emergency flexibilities, the freeze on enrollment for undocumented adults, and reinstatement of the asset. test. When we, the next two items on the local assistance and family health estimates, I'll go through some of the big changes in those areas. Happy to answer any questions.

So the 2025 Budget Act eliminated the general fund-supported Prop 56 supplemental payments for dental services effective July 1, 2026. So again, these are supplemental payments using general fund on top of the base rates for these services. The estimated savings in the budget year are $331.8 million general fund. We have engaged with stakeholders through various meetings, the statewide stakeholder group, the Los Angeles stakeholder meeting, our Medi-Cal dental advisory committee, various meetings with the California Dental Association and the California Dental Hygienist Association. In preparation for this change that is effective July 1, 2026, we have been releasing monthly provider bulletins starting in February, and those bulletins will run through June. We released an all-plan letter for our dental managed care plans at the end of October 2025 and continue to have ongoing discussions with our dental managed care plans. The department, since these are a reduction in supplemental payments, is required to do a rate reduction restructuring analysis as we submit this information to CMS. We're required to do this by the end of September, by the last day of the quarter in which the change goes into effect. This analysis must review public feedback, historical trends, provider participation, utilization of these services. And so that's what we're in the process of completing.

We don't have that analysis completed yet. We'll learn more through that process. And I've been hearing from stakeholders that the average is bringing back to the rates to, like, the early 1990s. I don't know if that's the perspective, the view of the department as well.

So these were implemented to address the budget challenges as part of the 2025 Budget Act. And so these were supplemental payments that were first supported by the tobacco tax. And as those revenues have gone down, were backfilled by general funds. And so as a means to balance the state budget last year, this was implemented.

That's what we will learn as part of this access study.

We do not.

And, you know, data does show that increased rates does often lead to increased provider participation. We don't have any specific data points on this. And I know the California Dental Association has done a survey, but the administration has not completed any survey in that regard.

I can't remember if you've produced a report on this. Jason Constantero, I'm not aware of a report we've done specifically in the dental area, but the questions you raise are really the key questions before the legislature. The legislature took many of these budget solutions to help sort of control spending growth in Medi and also address sort of the state fiscal challenging fiscal situation And so if this is an area where the legislature would sort of like to revisit it it does sort of you know raise the trade of what else needs to happen in the state budget to sort of balance the budget and address the long-term deficit. But I'm not aware of any

They are just information to providers about this change that would go into effect. So it's really kind of the education about the changes that are coming starting July 1, 2026.

Not yet. We would be required to submit the public notice by the end of the fiscal year and then the final SPA and kind of the rate access by the last day of the quarter in which the change goes into effect.

We will be required to submit a rate reduction and restructuring analysis, yes.

It would include public feedback, a review of the feedback that we've received, historical trends, provider participation rates, and service utilization. So this is what we have to submit to CMS as part of the kind of approval to eliminate the supplemental payment.

I believe we take in the public feedback and include it as part of the report, but in terms of reviewing the public report, I would defer.

No, that's accurate. And then providers also have an opportunity to submit comments to CMS directly as well after it is publicly available.

I mean, we are happy to provide it earlier. I just don't have a date for when we will have this done.

Medicare cost growth, including ongoing growth in just the Medicare population and the higher premiums that we pay for that population, that's about $640 million. State-only claiming adjustments. We've made additional adjustments related to our state-only claiming for members with unsatisfactory immigration status, and this includes about $819 million. general fund. Higher benefit deferrals from the federal centers for Medicare and Medicaid services and some additional quarters from the state administrative deferrals. And then changes related to our 2025 budget solutions, a change in the timing of the pharmacy rebate aggregator collection. We spoke about this last hearing, just the timing of only being able to score one quarter's worth of savings. And then in terms of offsetting savings so changes where we actually have less general fund spend we have lower utilization of fee pharmacy benefits and inpatient services and then some changes in our managed care. Compared to the current year, compared to the budget year, again, some of the changes in that space relate to our managed care tax. Managed care base rate growth increases both in enrollment and just the rate increases, just base managed care rates, $2.7 billion general fund. The changes that we've discussed related to H.R.1, the federal policies related to the change in the unsatisfactory immigration FMAP percentage that we can claim, and some of the changes related to the work and community engagement requirements and the semi-annual redeterminations. Increases in the rate of fee-for-service pharmacy spend, the cost per claim amount of about $900 million general fund. And then again, also increases in our Medicare cost growth, the higher premiums in the higher populations. As I mentioned, we do anticipate a reduction in caseload from current year to budget year to reflect the full implementation of kind of the normal operations with no longer having the federal flexibilities related to the public health emergency, the asset limit reinstatement, and again, the enrollment freeze. Those are the key significant changes related to the Medi-Cal estimate, and happy to answer any questions.

I would just say generally the cost of health care is growing, and Medi-Cal is not immune to that. So a lot of these costs reflect those just general increases in health care costs. Some of the Medicare, the cost premiums that go up as a result, and our managed care base rate increases similarly, just to reflect the base cost of health care in California and nationwide. And like I mentioned, the decrease right now sits at like 2.1%, 2.4%.

So I will say up until the last year or so, the Medi-Cal trend was going up, particularly when we held enrollment and weren't doing the redeterminations. And so we had a peak of over 15 million enrolled in Medi-Cal as we were not processing redetermination. So individuals maintained eligibility for close to three years. So we were, you know, before the pandemic, we were probably close to, I can find it right here. We were closer to about 13 million enrolled in Medi-Cal. And then we've grown since then in reflecting a height of about 15.3 million in 22, 23, and 23, 24, and then have started to go down starting in 24, 25, reflecting no longer having the kind of the freeze and redeterminations and then the various changes in expansions.

Correct.

Sure. That was part of the trailer bill that we implemented in the 2025 Budget Act. Prior to the trailer bill, the state and managed care plans were prohibited from doing any type of utilization, management, or prior authorization. So any kind of parameters by which to approve or not approve hospice care. And as a result of this new trailer bill language that goes into effect July 1, 2026, anticipated cost savings based on potentially, you know, abuse of these services or just kind of inappropriate use of hospice services as managed care plans and the state can provide some more utilization management parameters for these services.

So emergency services, dental emergency services would still be covered under emergency services. So those would still be covered if an individual shows up in an ER for something related to dental procedures. So those are still covered.

I know when the dental benefit was eliminated back in the, so that was a different process, and I don't think we have any data to show as rates have been cut or rates are cut, you know, the impact on provider participation in any history that I've seen. Jason.

Okay. Thank you so much, Jason, for that. Okay, issue number three, please.

Do you have anything? Okay, yeah, I have a couple questions on the CCS program. I know we've talked, I think a couple years ago, we've talked about making the website a little more user-friendly. And, you know, I've visited recently, I have a couple of constituents that, you know, they're doing their due diligence and continue to reach out to my office regarding, you know, they had the unfortunate situation with their daughter and they were participants of this case. But it's still, it's not super user friendly and being able to apply for this benefit. You have to submit through your local social worker and you contact them. I'm still wondering, I'm still hoping that we can still look at that website to make it a little bit user friendly so that people can benefit from this program. So I'd love if we can get a follow-up on just elements that we can implement to improve accessibility. And then also, there was a bill that passed, AB 847, the SOFIAs Act, that was looking to address a potential funding gap. And I'd love it, Director, if you can help me, because is it safe to assume once you age out of the CCS, you go into the GHPP program?

So what happens once you're 22 and you're not eligible for Medi-Cal and you can't afford these services? What do real-life scenarios there look like? What are options?

And so if you can't afford that, there's no option?

Okay. So someone's been on CCS, like, the majority of their life, once they're 22. The services stop?

Jason. Sorry about that. I just wanted to emphasize that in the CCS program, you know, about 90% of beneficiaries are on Medi-Cal, too. And so the income thresholds for Medi are higher for kids than they are for adults So some people when they become adults they lose Medi coverage But for those who stay in the Medi program they still have access to those services through Medi-Cal. So it's the people who are affected are those who don't have sort of Medi-Cal coverage. But most of the people in CCS have Medi-Cal coverage.

No, there have been ongoing discussions related to county, particularly the public health departments, the local health jurisdictions, the funding levels, and are they appropriate to support the work associated with CCS. This has been a topic for many years.

My understanding is about $100 million request. I would defer to the counties, but I think that's about the range.

I believe so.

It's difficult to, you know, with kind of.

No, yeah, I mean, difficult to maintain kind of the timelines, the number of staffing that are required to serve this population and the families. It's challenging for the counties.

Oh, it's decreased. The trends right now are that the CCS population is decreasing. But over time, I think, you know, these things become more expensive and the budget may not have adjusted appropriately.

I will say earlier this year we did clarify in guidance that the CCS, there was a maintenance and operation kind of M&O funding that was really supposed to be available for kind of the revised or kind of amplified M&O activities that were new over the last couple of years. we have clarified that those dollars can be used kind of for a broader purpose to address kind of the concerns that we've heard. Recognize it's not complete.

Great. And there a couple of BCPs on being able to address that Okay And then on the Women Counts program we made great strides to decrease the caseload in this Are we worried, given all the changes to Medi-Cal, that now we're going to have more people utilizing the Every Woman Counts program? And that's going to increase our...

Is this something that regardless of how many people are in the program, the general fund will cover those cases?

Okay, and is it a requirement that regardless of how many people are in the program, we have to fund it? Or is this something that, I'm not saying the department is looking to cut, but is it eligible for cuts down the line?

Okay.

Okay, moving on to issue number four. Good afternoon, Chair.

Okay.

You were going to provide the numbers of how much we could potentially get?

What's the 2025 one that's been submitted?

Jason, anything to add?

Thank you, Jason. Yeah, very technical. I was coming into this hearing trying to make sure I memorized all these numbers, and I think I have a little bit of a hold on it kind of. I'll start with the MCO tax and kind of what Jason alluded to with the constraints on both the federal rules and Prop 35. If we were to move forward with a new MCO plan, with both adhering to both those things, how much revenue would we bring in?

And we can't change the federal. Maybe we can change Prop 35.

Did I say that right?

Thank you.

It's three-fourths.

Okay, okay.

So three-fourths each house.

The other option, again, is to go to voters and have the voters amend it. And add to the 500 propositions we'll be voting on in November. That would be in addition to anything else on the ballot. Has the department explored the former option in terms of the legislature?

Okay, great.

And outside of those two options, addressing or tweaking Prop 35 and bringing it back to us to vote on, Are there other creative ways the department is looking at for a new version of MCO or are those two the only options I think I would just say broadly we looking at kind of what are health care provider taxes and kind of the governing rules in that space and what are ways we can think about generating

And I think I asked this question maybe last year. I've always wondered if we've gotten some analysis of what the impact were of providing the increase to provider rates, if, in fact, we're seeing a distribution across California in terms of them actually going to serve in the areas that are most needed. Like the impact of that, I think that I'm just wondering if we've ever analyzed the MCO tax with that section of its impact.

Exactly. Okay. Okay. And so the provider rates of $2.6 billion for 26, 27, those are still going to be able to go out?

Correct. Okay. On the HCOF, I know that we've submitted the 2025 for approximately $6 billion and so forth,

How does the impact, are we going to see potentially in May revise a change in addressing those dollars coming in?

Got it. Thank you so much. I forgot another question on the $2.6 billion for provider rates. As compared to... Okay, so I'm seeing $2.6 billion for provider rates for $26.27. How much do they get in this budget year right now? for 25-26. What were the provider rates set aside?

Yeah.

And my understanding is that a lot of these funds are still sort of to be released. And so there's a bit of a delay if you look in terms of the actual governor's budget numbers. But in terms of what the measure provides, it's $2.7 billion each year in 2025 and in 2020. So the Prop 35 is in calendar year, and then we budget, obviously, in budget year. So to Jason's point, it's just sometimes the lag or when things go into effect. But overall, the result eventually gets them to those numbers.

No, H-QOF is not broad-based and uniform. I think it's the intermediate care facility for the developmentally disabled quality assurance that is broad-based and uniform.

I'm sorry, the ground emergency medical transportation also is broad-based.

Yes, provided CMS is consistent with the technical assistance that they've provided to us. What they've indicated is that we do qualify for that transition period, and if we keep it to the 2024 levels, it should be approvable. this is not written down in guidance this is based on some verbal conversation and technical assistance and so that is the best understanding that we have at this time.

So in effect, this simply represents less net benefit to private hospitals compared to what they were anticipating in the 2025 fee before HR1 passed.

Some of those rural or distressed hospitals might be private.

And I will say, they didn't get these dollars. These were anticipated. They've never gotten it. They've never. So these are dollars that we were trying to get for 2025. We applied to the federal government. H.R. 1, it was never approved. H.R. 1 came and said you can't do that, so we had to revise our 2025 proposal. But they actually never received that increased amount.

Yeah, well, no, DHCS just made the exact point I wanted to really emphasize, which is when we're talking about both the MCO tax and the HCOF in terms of what's going to providers, you know, this really will look more like an opportunity to cost to them. This hadn't been sort of the normal course of business for providers because the MCO tax had only recently been notably increased and only recently had been used for provider rate increases. And then the H-QOF had only been sort of recently proposed to be increased. So in some cases in the MCO tax, it will probably look like more of a one-time boost in 25 and 26. But it really isn it really more of an opportunity cost I think that a helpful way to think about it AND A bigger impact on the general fund because we scored a lot of savings from it And a bigger impact on the general fund I think that a fair statement The other thing I would also emphasize is we're taught, you know, there's actually a couple of different policies. It's laid out. I know your agenda lays it out. I know there's a lot of moving parts. But we're really talking about the uniform requirement is really the most immediate effect. There could be some other impacts long term that could affect things too. The revenue limit under federal law is also scheduled to go down over time. So even if we sort of adjust formity, we may have to think about that limit, too. There's lots of rules at play, so a lot of it depends. But it's just important to keep in mind that this will be a conversation the legislature may be having over multiple years. Thank you.

No, those continue. We had one in January to kind of go through some of these HR1 changes to present that if we had certainty through the end of the calendar year, we would be moving forward with the 2026 domains as outlined in Prop 35. If we only had six months, which is what we had certainty of in January, what we would do. So we continue those as required under Prop 35.

I think it's just going to be a matter of Prop 35 is still in effect.

So issue number five is a budget change proposal for implementation related to the managed care final rule. We are requesting one-year limited-term resources equivalent to six positions, four-year limited-term resources equivalent to 33 positions, and expenditure authority of $12,310,000 total funds in budget year to support implementation and ongoing operations of new federal requirements from their 2024 rule that really overhauls a lot of managed care requirements. And as part of this BCP, we are requesting four-year limited-term funding for 25 positions for which we received one year funding in last year's BCP. So this new final rule adds a lot of new requirements to Medicaid managed care delivery systems, really focused on heightened standards around access, quality, transparency, and oversight. This includes new standards for appointment wait times, new secret shopper audits to validate compliance with those new appointment wait time standards, new website transparency requirements, lots of increased reporting of financial data, including medical loss ratio and in lieu of services or community supports, and a publicly facing quality rating system to publicly rate the performance of Medi-Cal managed care plans. Jason?

Okay. Great. Department of Finance, last week I had some requests on BCPs, and I was told that CalHR doesn't like to do one or two-year limited terms, but this BCP is asking for one-year limited terms. I just want to flag that discrepancy of what I was told last week. So if we can do it here, that means we can do it in other BCPs. Isabella Elliott, Department of Finance.

Yeah, but the excuse I was given is that CalHR doesn't like to do it. It wasn't on the type of work. So it seems like CalHR can do it.

Okay. And then I had a question on, like, for example, the capitated rate development division are asking for three positions, four-year limited, and they're going to be conducting, so three analysts, two positions, they're going to be conducting continuous and comprehensive monitoring, but what happens after four years? There's no longer needed to continue monitoring.

When I was reading all the descriptions of these jobs, it just seemed like these are jobs that seem ongoing. Like it's hard to, it seems like you have to collaborate for more than four years or analyze for more than four years.

Okay. 58 positions is a ton. That's a ton. I'm on the state side, so I have allegiance to the state, but we have the capacity. We're asking for the capacity to be able to increase our workforce to address these issues. And then I have the counties coming to me and saying, And you're being able to do that, and you're not giving us the opportunity to do it as well. Just sharing the messenger here of some of those concerns that we're asking for 58 just on this BCP. And we're meeting the moment, and we're asking the counties to meet the moment without the increased workload. Same question on, you know, one information technology is the lead product manager. And after that, I guess they don't have a lead product manager after they're done with their one year. They're only going to lead the project for one year.

Thank you for that. I have no other questions here or statements. We're going to leave that item open. Move on to issue number six.

Any comment on this?

Outside of, you know, there's some things that Issue 6 is doing, you know, CYBHI, behavioral, but Issue 5 is asking for positions to kind of do the same exact thing on transparency, quality, oversight of providers, I'm just, what's, like, with the 58 positions you're getting in issue five, it seems like a lot of them are going to be doing similar work in this.

So would they stop that long-term care work moving into?

Okay, they'll continue that work and they'll add this to the workload. Okay, we're going to hold that item open and move on to issue number seven.

Happy to go there, unless you have questions.

So just for some examples, if you're interested in some of the amounts, for designated public hospitals,

Correct.

When did that start?

Oh, sorry.

So I just wanted to provide that context about in just the past two years alone, the extent to which we've increased hospital reimbursements in Medi-Cal managed care.

Happy to move in. Last question? Yeah. Yeah, you can move into the last. The HR1 interaction, yeah.

Okay. Anything to add?

Thank you. I appreciate it. You shared some examples on increasing the payments and then the payment lag. but can you share a little bit about how you're doing that? For example, can you start with you've decreased the payment line, you said, down to 15 months, and then you're going to do it to quarterly payments.

Okay. Would that be the same for the increases in payment? In terms of how are we increasing the payment?

So we're just submitting in a way that brings down additional dollars?

So these increases that you shared are not going to be ongoing.

and they approach, as Elia mentioned, the average commercial rate. And that was done in tandem with sort of CMS technical assistance and learning about that as a possibility. That was also memorialized in the 2024 final managed care rule where they set average commercial reimbursement as the limit for state-directed payments. So we were moving in that direction.

Okay. And then you mentioned we don't want to de-incentivize outpatient care, right, and so forth, with a value-based strategy. But how do we put that into practice given hospitals having to now well they going to right seeing a lot of more at their emergencies and uninsured care How are we taking that into consideration Yeah absolutely And so right now our rates are higher on average for inpatient care than they are for emergency department care and outpatient care

Yeah. Okay.

Okay. Thank you. We're going to hold the item open. Moving on to issue number eight.

Does LAO want to comment?

Okay. I'll start with the most recent comment on the third question that you answered. In my four years here, I've heard about child care rate reform, developmental disabilities, the true consequences. of child care, foster rate, true cause, and now this is another form of a rate reform. And in all those, we have not seen success yet. I have no confidence that we're going to get another financial proposal and it be implemented and provide some reprieve or some light at the end of the tunnel that we're going to be addressing and increasing the rates according to the true cause and so forth. It keeps getting pushed back and back, all these rate reforms that I've seen so far on sub three. I also don't know if you two are going to be here next year. I don't know who's going to be leading this administration and giving these polls. I don't know. Scary. Sorry. So I'm wondering and hoping that we can do a one-year kind of safety net or safety for the SNFs, given the uncertainties of next year with the new administration, new goals, what have you. But also we're batting zero here with rate reforms in sub three. I know not under DHCS, just under HHS as a whole, that it's really hard for me to be confident that, hey, we're doing this, so hold off. This is why we need to eliminate the WQIP or we haven't renegotiated a new contract because we have a plan in place for this new financing proposal. So I don't have a lot of hope in that. Department of Finance, how much would it cost to do a one-year extension of the WQIP? I don't think we have that.

So that would be the same then if that's a savings?

Safe to say if that's a savings, then that would be the cost?

And then, I want to know if I'm understanding this, so if this is correct, as I was reading, have SNFs been accustomed to a coif for over 20 years?

The SNFs have had a coif,

So we don't have sanctions and so forth. Have we ever sanctioned any of them?

So we haven't sanctioned anyone in the past four years?

Don't tell the public that. Sorry. That's disappointing. Okay. Okay. I am interested in this space to, you know, if the goal is to do the 2027-28 plan, and it sounds what I'm assuming I'm taking this, because you're doing that, let's hold off on anything until this comes live. I don't know if that's the department's position as to the extension of the of the not renegotiating?

Why are we so late in getting that going if we could have started this last year?

Okay, so we got the funding in July 1st, but we haven't started any of the work.

I mean, as you're going through this process, why can't we just bring back the WQIP for one year? I know it's not a question for you. I get it. But I'm interested in finding out, Department of Finance, if we're going through this process. You need more time to go through this process. During that time, they're not getting a renegotiation of a contract that expires at the end of this year. And they're also being asked to take on an additional year of the elimination of the WQIP. because the department needs more time to go through this process. I am interested in seeing if we can look at bringing back the WQIP just for a year while we go through this process. In the greater scheme of things, $149 million. It's a lot. I know it's a lot. Sometimes it's not, though. But I am interested in that, and I wanted to flag that and put that on the record. but I also would like to know what was stopping us. When would we have started the negotiation for the contract? What's the regular timeline, knowing that it expires at the end of this year? So it would have been part of the governor's budget or May revise of this year? So negotiations would have started this year?

Okay, and we're not because of this financial proposal? Financing proposal?

Okay. Director, you mentioned, did you say regardless of any of this, they're still getting increases?

When was that, the last one?

Every fiscal year they get that?

And it's fiscal or budget year?

Sorry, it's one budget, huh?

Okay.

Okay. Okay. LAO, anything else you want to add to this, to our finance?

Okay. Moving on to. We're going to hold that animal open and move on to issue number nine. Issue nine is a budget change proposal related to the long-term care payment transparency final rule. The department requests ongoing expenditure authority of $2,537,000 total fund with the non-federal share coming from the long-term care quality assurance fund to support the implementation of new data reporting requirements under this federal rule. Last year, the department received eight permanent positions with only one year funding through BCP. This request provides ongoing funding for those eight positions and additional contract resources. These are necessary to continue implementing the Medicaid institutional payment transparency requirements, which must be implemented no later than June 21, 2028. This is a federal requirement, and there is a question about if, you know, the minimum staffing standards of the federal rule are unenforceable until 2034 due to sort of a pause from H.R. 1. Why is this requested?

It remains a requirement.

And so last year, this department and the Department of Health Care Access and Information requested one-year limited term resources given uncertainty with how H.R. 1 or the administration would change their implementation of this rule.

I don't have any questions on this one. We're going to hold that and I'm open and move on to issue number 10.

I don't like that member. You don't have to explain the bill. I know the bill very well I know the bill very well Just my only question is that doing a probe the HGS didn have any costs associated to this bill Just came out of, missed that last year?

Since most of the work, I thought all the work was going to be moved to HKI, what's going to be DHCS's role?

So HCI won't develop, even though I moved to HCI, they won't develop the plan?

I mean, they would, you know, moving this to HCI, they largely own it,

Okay. Okay. Before I move on, I know you have other presentations in this BCP. For your bill, it's one permanent position, expenditure authority of $178,000 total fund.

Yes, please.

For Senate Bill 246, the department requests one permanent position, and expenditure authority of $165,000 total fund, the non-federal share from reimbursements, to implement a graduate medical education program for district and municipal public hospitals and their affiliated entities. So this is necessary to operate GME payments to the district hospitals.

For Assembly Bill 543, The department requests four permanent positions and expenditure authority of $698,000 total fund to monitor compliance with provisions of the bill, including preparing and conducting audits, reviewing payments, ensuring compliance, monitoring drug use, checking provider records, and supporting Medi-Cal managed care plans. On this one, because we talked about it, I think, in the first hearing around, you know, HR1, homelessness, how would these positions in particular intersect with the coverage and homelessness? So I know that for this bill, part of the sort of discrepancy between the BCP here and some of the fiscal analysis coming out of appropriations is that we did provide technical assistance into this bill that aligned the definition of homelessness with current departmental policies.

I might have to get back to you on the particular detail

Yes, I would. There's overlap in terms of the individuals experiencing homelessness being perhaps at highest risk of potential disenrollment as it relates to the work requirements.

supporting those providers to also assist members with getting... Seems like an organic fit there.

Okay. Any comment? Okay. We're going to hold that item open and move on to issue number 11. So issue 11 is a BCP requesting three-year limited term positions, three-year limited term resources equivalent to 18 positions and expenditure authority of $3,479,000 total funds to plan and implement the CMS, the second final rule CMS has implemented regarding interoperability. So this is specifically the advancing interoperability and improving prior authorization processes, final rule in 2024. Just as context, several years prior to that, there was a patient access-focused interoperability rule for which the department received some resources. This final rule is different. It requires implementation of standardized data exchange, including payer-to-payer and payer-to-provider data exchange, using secure standards-based application programming interfaces, or APIs. The rule also requires enhancements to prior authorization. The resources requested in this proposal will work to develop policy guidance and then contract language, develop a strategy and enforce compliance across impacted payers and entities. And as with all federal requirements, we do face the risk of loss of federal financial participation from CMS if we're noncompliant. And of course, successful implementation of this final rule would really improve data exchange, enabling greater care coordination and outcomes for members. No questions for me. We're going to hold the item open. Thank you for joining us.

We're now going to be moving into the California Health Benefit Exchange, Cover California. Thank you Good afternoon Madam Chair

Okay. Question three is an update on the implementation of gender-affirming care program pursuant to AB 144.

Angel Alonso Coroner, Department of Finance. For question four the total loans issued from the Healthcare Affordability Reserve Fund to the General Fund amount to million The timeline for general fund repayments to the healthcare affordability reserve fund includes 200 million in budget year 2627, 262 million in 2027-28, and 309 million in 2028-29. Okay, moving on to question five, providing an update on the status of the federal consideration and approval of the California's Essential Health Benefits Benchmark Plan. On February 9th, 2026, the U.S. Department of Health and Human Services issued the Notice of Benefit and Payment Parameters, which sets the standards for health insurance exchanges for the next plan year and impacts ongoing implementation of the Affordable Care Act. The notice as drafted would eliminate a state's ability to revise their benchmark plan to add new benefits to the individual and small group markets. The notice also states that HHS has paused review of new benchmark plans as they consider revising the regulations related to essential health benefits consistent within the letter that the Department of Managed Health Care had received in December 2025. As such, it is unlikely that California will be able to adopt a new benchmark plan for the 2027 plan year. On March 13, 2026, the Department of Managed Health Care submitted a comment letter to HHS regarding this 2027 notice.

Based on the content of the information received from CMS, it is unclear on what timeline. They've basically noted, as my colleague mentioned, And they're pausing review at this time as they conduct a comprehensive review of the ACA and its charge. And they're actively considering future rulemaking. So I don't know that we have clear guidance on the timeline.

The governor's budget still proposes $190 million for next plan year for Cover California for 2027.

So we would plan to design a program for 2027 with $190 million, unless the legislature were to increase that funding amount.

So the governor's budget is maintaining the $190 million from the Health Care Affordability Reserve Fund to provide the premium subsidies to eligible covered California enrollees up in the year. to 165% of the federal poverty level. The governor's budget does not include any new significant proposals and already reflects continuation on previous investments. As the administration is developing the 2026 budget, we are also taking into account a holistic approach as of trying to mitigate the impacts of H.R. 1. The state is not in a position to fully backfill the loss of the federal and hence premium subsidies.

Oh, that is correct.

Yeah, so if we were to take two and count.

The Health Care Affordability Reserve Fund. It is $369.4 million.

With it.

That's right.

at this moment we cannot really figure out the out-year projections and what the fund will be holding. So the federal policies, I don't see any federal policies impacting this.

So heading into the May revision, we'll have an opportunity to provide an update on the revenue and at that time could revisit potential legislative priorities to the impact of federal policies. So I'm hoping if Covered California could speak a little bit more to that,

That's the individual's shared responsibility.

Well, so it is a state penalty that is required under law. There are specific exemptions, and as we get more data on who would be paying into this in the future, who would be exempt, There is just a lot of uncertainty about the revenue and how the fund balance will look in the next year.

But if you want to add to that.

They tend to do the penalty revenues. I think on the Covered California side, part of the flux is as we implement some of the

Okay. And can you remind me, I know there was a lot of federal coming back, what actually got implemented, but DACA recipients, did they fall off of Covered California?

Okay. Okay. And then can you talk to me a little bit more about the bronze plan? So you've mentioned higher intake on the bronze plan. It's the lowest amount of what consumers have to pay, but it's the lowest coverage.

What is a bronze plan?

you only pay if you use it kind of thing? Because what if I don't go? That's what most people are trying to choose this plan? That's right.

So they'll still pay their monthly premium, and then they'll have to decide if I need services, can I afford that $60 primary care? Can I afford to fill the script? if I have a high cost of coverage and I wind up approaching that deductible or that maximum out-of-pocket, how am I going to afford that? And then what are we doing? What is our response to the fact that Latinos saw a drop in 39% in enrollment and our black and African community saw a 34% drop in enrollment?

Yeah. We are working with those communities. We've redesigned our marketing with a culture-first approach, So we are trying to reach communities, sign them up, and then we're trying to emphasize the value of coverage as they're enrolled, how they can use free preventive services, how they can access primary care, make a relationship with their doctor. So we're trying to make the value proposition very clear for all of our enrollees and for our communities who are impacted more strongly. I think the other thing that we did very intentionally as we looked at targeting that $190 million in state dollars, we looked at a variety of different options our board did for implementing a premium subsidy program. One of the key metrics we looked at is how will any particular program design impact equity? And our modeling showed that when we targeted the lowest income enrollees, we would have the greatest retention among our black, African-American, and Latino communities. So it is baked into the program that we're offering this year to try to support those communities. We're trying to do more in the way of outreach and marketing.

Oh I would be happy to follow up with that I don have those details in my fingertips I be very interested in you know we throw out the word culturally competent approach campaigns but what does that exactly look like Have we tapped into our community health workers

We'll follow up.

Maybe the Department of Finance has the answer to that one.

No, that's right.

Okay, if then they revise if we get a little bit more of what was used, because I guess my question stems from this. we put money aside, but a lot of providers are no longer providing this care. So is the money there and there's no providers? And is it actually getting utilized?

Okay. Thank you.

Thanks so much. Thanks for having me today. I've got some slides that can hopefully be shown overhead, and I'll go ahead and introduce myself while we work on that. As I said, my name is Miranda Dietz. I'm director of the health care program at the UC Berkeley Labor Center, and we focus on issues that matter to working families in California, including health insurance and Medi-Cal, which covers a large number of low-wage workers in our state. So our health insurance system is primarily a job based system. Most people under age 65 get their coverage through their job or family members job. And workers usually contribute to the cost of premiums and employers usually pay a substantial portion of the premium cost. So on average employers are contributing more than for single coverage and more than for family coverage But that not true for everyone If we look at where workers get their health insurance, the dark blue here on this slide are the folks who are getting coverage through their own employer. And you can see that workers who work in low-wage jobs, that's folks who were paid less than about $20 an hour in 2022, and that's about a third of California workers, they're much less likely to get coverage through their own jobs. And they're more likely to be covered by Medi-Cal, that's the share in orange, or to be uninsured, the folks in gray. So why are some workers left out of job-based coverage? There's three basic reasons. First is that their work just doesn't offer coverage. So they might be self-employed or work at a firm that doesn't offer coverage to anyone. These are usually smaller firms with under 10 people. About a third, 35% of firms with 50 or fewer employees offer coverage to at least some of their workers. And if you have 50 or more full-time employees, the ACA says you have to offer coverage to at least full-time workers. So the second reason is that folks might not be eligible. So part-time workers are often not eligible, and there can be waiting periods for new workers to become eligible for health insurance coverage. And then the third reason is that coverage might just not be affordable. So the worker portion of the premium cost, on average $1,300 for single coverage and more than $7,000 for family coverage in California. these are usually the same costs for the CEO and for an admin assistant. But whether that cost is affordable is going to feel very different for the CEO versus the administrative assistant. So when we look nationally at the issues of offer and eligibility, we can see that lower income workers, folks who are making 200% of the federal poverty line or less, these folks are less likely to work at a firm that offers coverage to anyone. That's the dark blue bar here, about 60%. And they're less likely to be eligible for that coverage at just about 50%. And when we think about affordability, for a worker with really low income, say at the poverty line, right, the average cost of job-based coverage can just feel completely out of reach. So for a family of four with earnings at the poverty line, that's about $32,000 a year, they'd have to pay 23% of their income for the average family plan through their job in California. And chances are that plan would come with a more than $3,000 deductible. Even a single person with earnings at the poverty line, coverage for just themselves would be 8% of income. And that would also probably come with a large deductible. And given the cost of living for folks living at or near the poverty line when money is so tight, $100 a month for health insurance premiums alone can feel completely out of reach. So even though we have this job-based system, just under 60% of workers have coverage through their own job. And there are differences in who gets health insurance from their job across race and ethnicity. So the blue lines here, you can see that Latino workers are the least likely to have this kind of coverage. And non-citizens are also less likely to be covered by job-based coverage. And note that this category is quite broad and includes all non-citizen workers. The rate for undocumented workers would be lower still. Okay. The lack of job-based coverage for low-wage workers has state budget impacts. Many workers, I was pointing the right direction one time, not right, sorry. So there are lots of workers on Medi-Cal, 3.6 million, excluding those who are self-employed. And given DHCS's projected costs, the state will spend $36 billion in both state and federal dollars on Medi-Cal for these workers. Another way of looking at this is to look at who's actually enrolled in Medi-Cal. Of the enrollees who are 19 to 64, most of them are working, about two-thirds, which you can see kind of in the blue and green on this chart. And most of the folks who are working are working full-time. This right is newly relevant because of H.R. 1 work requirements, which we know from experience in other states are not going to increase the number of people working, but will cause people who are already working or should be exempt to lose their coverage and become uninsured. If we look a little bit more at who are the workers enrolled in Medi-Cal, we can see the industries that these Medi-Cal enrollees are working in. This analysis includes self-employed folks, and it shows us the industries where there's a higher than average share of workers who are on Medi-Cal. Close to the top there, we can see restaurants, bars, food services at 35%. So that's about one in three workers in this industry are enrolled in Medi-Cal. Some of my colleagues at the UC Berkeley Labor Center have done research focused on this slice of the industry, and specifically fast food industry in L.A. They found in 2019, prior to the fast food minimum wage, that about half of the fast food workers in Los Angeles County either were enrolled in Medi-Cal or had an adult in their family enrolled in Medi-Cal at a public cost of $700 million a year in 2019. And that's just related to fast food in L.A. They also projected a substantial reduction in workers enrolling in Medi-Cal as a result of the fast food minimum wage. Because when wages are improved through the statewide minimum wage, the $25 health care minimum wage, or the $20 fast food minimum wage, state expenditures on Medi-Cal are reduced. focusing on one other industry here on construction 21 percent of workers are in medi-cal and my colleagues analysis of the construction industry in california found that almost half of families of construction workers in the state are enrolled in a safety net program like medi-cal snap earned income tax credit at an annual cost of over three billion dollars there are higher wage high-road employers in construction who offer health insurance to their workers, but the low-wage, low-road employment practices in some of these industries have real public costs. Beyond looking at industry, we can also look at firm size of workers enrolled in Medi-Cal. Some are in those really small firms that usually don't offer coverage, But about half are in firms of 50 or more, and more than a quarter are at firms with 1,000 or more employees. Now in some other states like New Jersey and Washington the states are collecting and reporting on data on which firms employ people who are enrolled in Medi And, you know, there's some large employers that we've all heard of at the top of those lists. And as other states think about who has responsibility in our current health system, some are considering requiring contributions from employers who have workers on public coverage. Vermont has done this for years, and Massachusetts, New Jersey, and Washington are considering it, as is Colorado. Oregon has set up an advisory group to suggest how to fund Medicaid. This idea of making sure that employers are contributing is not new. We have this largely job-based system for health insurance, but we know it leaves some people out. Medi-Cal plays a really critical role in covering many of these folks and their family members. And funding Medi-Cal and making sure it's an option for Californians who need it is vital to maintaining our progress toward universal access to coverage. Thank you.

Good afternoon. My name is Jesus Barrios Fierro. I have 64 years old and I'm a proud husband and father of two daughters. My daughter is currently cursing a career in biology at the university. During 25 years I worked as a janitor in the supermarkets Lucky in Livermore. Thanks to our contract with SEAUSWW, my colleagues and I could make sure just salaries and benefits. especially a family insurance that protects the health and stability of our families. Although I worked in the LACI, my employee was King Janitorial Equipment, a company of cleaning cleaning. In February, we informed that the supermarkets would not pay for the standards of benefits required by the syndical contract and we were all left. Poco después, un nuevo contratista, Mr. Clean, una empresa sin sindicato, comenzó a operar en las tiendas y ofreció recontratar a algunos de nosotros, solo con salario mínimo y sin seguro médico, pensión ni vacaciones pagadas. My colleagues and I, we were forced to take a difficult decision, to work for this new contract with minimum salary and without health benefits or to seek employment in another place. I've been with diabetes for 14 years. When I lost my employment, my biggest concern was how I would continue to pay the insulin necesito para mantenerme con vida y poder seguir trabajando. Afortunadamente, nuestro sindicato decidió apoyar a los trabajadores despedidos, cubriendo dos meses adicionales de nuestro seguro médico con fondos acumulados. Sin embargo, esa cobertura termina en abril. Actualmente tengo un temporal como investigador de campo en MCTF y existe la posibilidad de que pronto obtenga un seguro m b pero la incertidumbre sigue siendo abrumadora La realidad es que con el alto costo de vida en California muchas familias trabajadoras apenas podemos cubrir cada mes nuestros gastos The reality is that with the high cost of life in California many workers families can only cover every month our basic expenses A medical emergency can mean to pay me or to have to depend on public programs like medical. I have colleagues who can't find employment and others who work daily two jobs without benefits, only to survive. It is very difficult to find employment according to our abilities that offer medical insurance. This means that my colleagues who are now in Mr. Clean recurran a medical y aquellos que consigan trabajo en otras empresas de limpieza o que estén trabajando en dos empleos, también recurrirán a medical. Por eso estoy aquí hoy. California necesita una fuerza laboral saludable, estable y protegida. Creo firmemente que los empleadores deben asumir la responsabilidad de garantizar que las personas que sostienen in their business, have access and medical attention and a conditions of work. If the employees don't provide medical attention to their employees, then they must pay their part just to ensure that the medical is available to provide the attention that our labor force and their families need and deserve. Thank you.

Good afternoon. Diana Douglas with Health Access California. Thank you, Madam Chair, for convening this hearing and including this conversation on employer coverage. We cannot talk about employer coverage without also talking about affordability, our Covered California marketplace, and our Medi-Cal safety net, as we've heard today. More Californians overall have had coverage in recent years. However, the percent with employer coverage is decreasing. This means our safety net programs, Medi-Cal and Covered California, are taking on more responsibility while employers do less. At the same time, both Medi-Cal and Covered California have faced the significant cuts we've been hearing about due to the Trump administration. While the ACA includes an employer mandate to ensure that employers are doing their share to keep covered, the mandate is unfortunately not proving to be an effective tool, as we can see by the rising numbers of employed Californians who are relying on Medi-Cal. The employer mandate only requires that coverage is offered, not that employees must actually enroll. and the coverage must meet the federal definition of affordable, but that only ensures premiums are no more than 9.5% of salary, which does not meet the definition of affordable for many regular people's actual budgets. Meanwhile, deductibles and other out-of-pocket costs have been skyrocketing. It's no surprise that many potential enrollees may see a health plan that costs almost 10% of their salary, comes with a deductible and the thousands of dollars, plus significant co-pays to simply not be worth it. and many other employees don't have the option of this expensive employer-sponsored coverage. The ACA employer mandate has numerous exemptions for part-time employees, businesses with fewer than 50 employees, and seasonal workers. The high premiums, escalating cost-sharing, and employee mandate exemptions have resulted in a system where employers are off the hook while workers struggle to afford coverage, rely on Medi-Cal, or go without. Consumers with employer-based coverage are being left behind, finding that even though they're working full-time, have employer-based coverage, the premiums eat away 10% of their earnings. If they have a more serious health issue, they could be on the hook for deductibles of $4,000 or $5,000 or may skip getting care altogether. Our medical system is also being left behind, facing both federal tax and being taken advantage of by employers paying such low wages that workers remain in poverty and dependent upon the safety net. Meanwhile, the cuts that are decimating our state's health care funding are being used for tax breaks, largely going to the same corporate employers who are failing to provide affordable coverage for their workers. Health Access supports the coverage mandate, which, if properly enforced, could help employees have better access to coverage, even if still expensive. Health Access is also strongly supportive of efforts to reduce the overall cost of health care, specifically California's Office of Health Care Affordability, which will keep premiums from outpacing wages helping both employers and their workers Finally, Health Access sees revenue solutions based on employer responsibility for workers on Medi-Cal as key to rebalancing our safety net. For too long, employers have enjoyed federal tax breaks, now more than ever thanks to Trump, while still leaving their workers to depend upon the state for coverage. To ensure employers are doing their fair share in keeping the workers covered and healthy, Health Access would support a revenue model that would, for example, require employers to pay a fee to support health coverage. A successful revenue model would need to be well thought through and maintain the goals of our accessible, quality health care system. It would first need to prioritize keeping Californians covered and healthy, revenue going to folks in Medi-Cal and public services. Second, it would need to be long-term and impactful. We seek sustainable solutions so we can get out of the cycle of these conversations year after year. It would need to be targeted and progressive, really cracking down on those who are most abusive of the system of tax breaks and not taking care of workers. And it would need to be non-discriminatory, not allowing workplaces to discriminate against Medi-Cal enrollees or take that into consideration in their hiring. With a well thought through revenue solution, we could help ensure the full vision of the ACA and California's vision for universal coverage could finally come to fruition in a sustainable and long term way. Thank you.

I believe that folks who are working multiple jobs that adds up to full time would count in the full time section there. So it's about the individual and the hours that they're working.

Exactly.

9.5.

Is there another number? In the Affordable Care Act, the amount that a family has to contribute to premiums varies by income. So it's graduated, so lower-income families are paying a smaller percentage of their income toward the premium, which is progressive and makes sense because sort of the space in your budget. that 9% might make sense for someone in a more middle-income category.

Not that I'm aware of.

which reduced the contributions to premiums through the exchanges the maximum was I believe 8 of income So that at least a maximum that been out there

My colleagues did some projections for fast food workers who would no longer be enrolled in Medi-Cal as a result of getting higher wages.

Yeah, that was projecting.

I believe to date it's just been a projection.

So in Vermont, they're collecting a fee, the employer health care fund contribution, which is around $300 per quarter for workers who aren't covered. So an employer in Vermont, they have an employee,

Yes, that's my understanding of how that works in Vermont.

I think Massachusetts also has their employer medical assistance contribution, which is up to $750 per employee who's on public coverage.

Okay.

I'd probably have to take that back to our team that worked on the report. They did look at a number of metrics, and they selected the tax options that they felt sort of met those metrics the best. But I'd have to turn to them for more specifics. I would also say that it's my understanding that every tax consideration has tradeoffs that need to be weighed. It's my understanding there's some research that, you know, these sorts of employer-based taxes can result in sort of employment effects. And to the extent that that is an effect, that might need to be, you know, considered as part of the effect. But, again, I'd have to circle back to what I was.

Probably a little out of my depth. Probably should consult with our economists on that. But yeah happy to circle back with the committee Okay thank you And is Katie Ravel still Yes And I so sorry I missed your title Deputy Director

Covered California didn't look at that.

It could be you're ineligible, declined coverage, or covered by another plan.

So we have a little bit of national data looking at the importance of the offer and eligibility part, right, that lower income workers are less likely to be at a firm that offers and less likely to be eligible for that offer. so it's playing a bigger role for lower-wage workers than for higher-wage workers in the folks that don't have coverage. I don't have the disaggregated exactly how many are because of which reason.

Are they, you know, 1099ers mostly? Is it? We have a mix. We have a mix of self-employed folks who are working full-time, and I'm happy to provide that for you.

Yes, we'll follow up with that. Another large group for us are early retirees as well, so we'll send that data.

is like, while employer coverage has declined, caseloads in Medi-Cal have increased. I think one of you said that. Yes, I believe I had said that in my talking points. Okay. Is there a starting point when that happened as to when we started to see a decline in employer coverage? I don't know the timeline trajectory, but I believe we have that and can provide it. I wonder if there was something at a point in time, a policy change that happened as to why that started seeing an opposite impact or effect. I'm not sure that there was a single point in time policy change, but I think it was the effects of how many employees are offered coverage and also the cost of coverage. Okay. Jesus puedo preguntar una pregunta Maybe I should do it in English S claro In English Usted me dijo que sus amigos est trabajando m de un trabajo Sí, efectivamente. ¿Por qué lo hacen? Porque las compañías solamente ofrecen un part-time, cuatro horas, cinco horas, y con el salario mínimo que están pagando, Aunque sea una compañía que esté pagando 20 dólares, por decirlo así, arriba del salario mínimo, no es suficiente para vivir en California para pagar una renta, para cubrir todos los servicios básicos o para comprar los servicios básicos que necesitamos. La canasta básica es cara ahorita, la gasolina. Al incrementar la gasolina, todo sube. La renta es carísima en el área de la bahía. So I asked, you know, because he shared that his friends do a couple of jobs, and I was like, why is the need for the two jobs? So he just said that a lot of employers are offering part-time hours, so you have to get two jobs, if I heard correctly. I'm sorry, I thought you were going to add to that. And my second question is, are you hearing in your conversations or your experience is that you want to work full time, but sometimes in transition of management, they come in and don't offer full time hours? es correcto que como en su experiencia estaba trabajando full time usted y después vinieron en cambio de management y ya no le estaban ofreciendo las misas horarias y así bajó sus beneficios si efectivamente la compañía nueva que entró solamente está dando medio tiempo pero es el mismo trabajo la misma cantidad de trabajo and only offers the minimum salary, which is $16.90, after earning $21.47, and only the days of illness, which are law in California, 40 hours of illness, and nothing more. If we want a week of vacation, we give a week of vacation, but without a week of vacation. No plan de pensión, no holidays, no nada, nada más lo que le acabo de decir, el salario mínimo y las 40 horas de enfermedad que ofrece la ley de California. And are you seeing when that happens, when you reduce the hours, you've had benefits before and now you don't, are you seeing you and your colleagues, your peers, now going to Medi-Cal to find that benefit, or are you just saying, I'm not going to sign up for any insurance? La pregunta para usted también es, cuando eso pasa y ya no tienen acceso a beneficios, vea usted o sus compañeros que dicen, okay, ahora me voy a apuntar con Medi-Cal, or for a while I'm not going to have a security? Well, for the moment, we're not going to have a security until we get a job or decide to continue working with Mr. Clean. And if we work in any other job, we're only going to qualify for medical. There are many workers who work for a few hours and have a part-time, or have two jobs of part-time, están utilizando medicamentos and, well, they've been threatened to remove or disappear. And they're worried, where are we going to go now? Who told you that? In the news, they tell you that situation. So they're working part-time, several jobs, and then, so they signed up for Medi-Cal, but now they're seeing on the news that Medi-Cal is going to be taken away from them, given the new rules. So they feel like they're stuck. Okay. Thank you. To you two here, what do you think is needed in California if we wanted to implement something like this? If we wanted to do something similar to Vermont? I know you shared some of that. Yes. I mean, if we want to implement something like that, I think we need to carefully work through what would be the best solution for California. what would be the best solution to ensure that we are generating enough revenue to go into the system and bring sustainability, access, and coverage that we need and to uphold the values of California. I think we would need to work through how to make sure that it was targeted at the employers and folks who are most abusive of the system, reaping the most rewards from taxes while keeping the most of their employees on Medi-Cal or gaming the system in the form of not providing the hours and wages and everything needed. And we would need to work together in broad-based coalitions here with the legislature, advocates, labor partners, the consumers who are out there in the front lines of not having coverage, to agree on a solution and move forward with it. You mentioned something as well. My last question is health insurance is offered and then the employee denies it. They don't deny it because their spouse has it, but they deny it. Do you think that should be changed, that the mandate should go beyond just offering, that the employee must take it? Or anyone have thoughts on that? I don't know that I can say right here exactly how that should be approached because I think it's a balance of affordability also. We understand when employees see an offer of coverage, but the premiums are going to take up nearly 10% of their salary, and then they see how big the deductible is and how much they'll have to pay out of pocket to even make use of that coverage that they're paying for. We understand that people are making difficult choices between coverage and food on the table or rent. I would just add my understanding of the Vermont fee is that it is on workers who don't take up their employer's offer, who are either on public coverage or uninsured. So if they do take up a spousal offer, fine. They don't pay for their employee. Sorry? Yeah, yeah. So they won't pay for their employees. Is that what you're saying? That the fee is not just for employers who have workers on Medicaid. It's also for employers who have workers on the equivalent of Covered California or who have workers who are uninsured. Okay So it a more broad based fee But it sort of the other side of not forcing the workers to take it but recognizing that maybe there an affordability challenge with what you are offering More of your – got it. Yeah. Okay. Thank you so much. I appreciate it. We have a lot of proposals for investment, but only one of them are going to be for presentation. So for the level of care nursing staff for programs for all-inclusive care for the elderly can step forward. Ma'am, you will have three minutes for your presentation. I don't think it's on. You can get it closer to you, too, if you can. Is it on now? There you go. Good afternoon, Madam Chair and members of the subcommittee. Thank you for this opportunity to speak to you today on behalf of the CalPACE Association. My name is Julie Erdman, and I'm here today representing ONLOC, the founder of PACE. PACE allows for frail, older individuals who qualify for a nursing home level of care to remain safely in their homes and communities while receiving fully integrated and coordinated medical and social services. PACE is interdisciplinary with an 11-plus member team that not only cares for the participant, but also supports their caregivers, family members, and recognizes that successful care extends beyond the individual. It's a proven model that works, and the demand for it continues to grow. For a little background, every individual who chooses to enroll in PACE must be evaluated by DHCS and determined to meet a nursing facility level of care. This determination is a regulatory and programmatic requirement and serves as the gateway to enroll in PACE. PACE organizations submit a level of care form to DHCS on a monthly basis, and each form is manually reviewed and individually evaluated by a nurse evaluator too. These are not administrative transactions. They are clinical determinations that directly affect whether a frail older adult can assess comprehensive community-based care through PACE. We want to start by... Sorry, Tyler. I'm going to ask you a question here if you can stay for a minute. Sorry. Almost. He was almost gone. But we want to start by acknowledging that DHCS, we recognize that DHCS staff are working hard to manage a significant and growing workload. Each month, the department is reviewing 1,500 to 1,800 level of care determinations, an essential step in the PACE enrollment process. And we appreciate the continued commitment to this program. At the same time, the strain on the department's capacity is having real consequences to access to care. To manage workload DHCS has recently begun implementing earlier internal dates for the level of care submission around the middle of the month Previously it had been five calendar days to the end of the month What this does is we understand the intent behind the change, but it's an impact significantly. The earlier deadline effectively shortens the enrollment window, making it harder for eligible seniors to access PACE in a timely manner. to introduce delays into the process that is already time-sensitive for frail older adults. Delays in enrollment mean delays in care. These individuals who often have complex medical and social needs, generally when a referral comes to a PACE program, these are people that have already had a change in condition. Somebody has noticed that something's changed and they're reaching out for help. So it's really time-sensitive that we get that care to them as quickly as we can. When access to coordinated care is postponed, it can increase the likelihood of emergency department visits, hospitalizations, or even premature institutionalization, overcoming outcomes that we all are working to avoid. I mean, that's really the goal of our program. Keep people at home and in the community out of the hospital and out of the nursing home. This is not a question of effort. It's really a question of capacity. So our ask today, CalPACE is respectively requesting funding for four additional state nurse positions dedicated to reviewing level of care determinations. This is a targeted short-term solution that would help the department keep PACE with current demand, reduce delays, and restore more timely access to care for eligible seniors. At the same time, we want to be clear that we see this as part of a broader conversation. CalPACE is committed to working in partnership with DHCS and the legislature to identify longer-term efficiencies and process improvement that can support the continued growth of PACE. Thank you. I just wanted to see if you're able to address if you also are witnessing or agree there's a backlog in processing these. Thank you, Senator. I believe we received a copy of this request, I think, this morning, so I haven't had time to fully digest it. So I can't speak to sort of the status or the extent of the backlog or the specific workload associated with processing a level of care determinations. But taking a step back, I think the broader context is sort of the two-year moratorium on new PACE applications due to, A, the department's ability to administratively process the significant growth in new PACE requests. Right, there is. coupled with needing to develop sort of a strategic policy about sustainable pace growth that supports appropriate access. So while that two-year moratorium is in place, we really needed to stabilize our internal resources to sort of handle that application backlog. But this specific request about the level of care determinations, I'd have to follow up. When does the moratorium end? We have proposed a sort of not for applications that had been submitted. We committed to processing those those in sort of Q1 But for new applications we had proposed a two moratorium of no less than two years Okay. Yeah, I'd like to hear if you can get back to me, if the department does determine that there is a backlog here. I know this is a new request, so I'm not looking to see where department finance is on this, but just want to know if you're accurately, if you're on the same page, at least on the delays, if that is an issue. We'd be happy to. Okay. Thank you so much. Would you like me to stay for other... You are good now. Okay. I just... You are fine. I even asked my team. That was it. Thank you, Senator. Thank you so much. Thank you for your presentation. Thank you. We are now moving into public comment. Step on up, everyone. Madam Chair, Terry McHale with Aaron Reed and Associates, representing the California Optometric Association. First of all, thank you for your endurance and your willingness to be here all afternoon. Madam Chair, the California optometrists are primary care providers giving over 80% of the Medi-Cal treatment to Californians, yet they have not had an increase in their fees since you were in junior high. It has been 26 years since they've had an increase. They get $47 for the patients that come in. Not even junior high. Not even junior high. That's how long it's been. Not how long. I better be careful on this age bid here. But they get $47 for each treatment that they do. It does not, in some instances, pay the cost of the rent. It does not pay the cost of their employees. It does not pay the cost of their equipment. 26 years. What we are asking for, Madam Chair, is $30 million, $15 million from the state, $15 million from the federal government. That puts us close to what ophthalmologists get as they pay their PAs and their nursing assistants 87.5% of the Medicare reimbursement. It's critical. What we are seeing throughout California is that optometrists cannot afford to provide these services. Thank you, Terry. We don't need to get rich, Madam Chair, but we do need to be able to pay our bills. Thank you. Thank you. Madam Chair, Sarah Nocedo on behalf of the California Chronic Care Coalition. We respectfully urge consideration for restoring obesity medication coverage consistent with the balance model and federal requirements. The obesity landscape has changed significantly since California enacted the cuts in last year's budget, providing the legislature a new opportunity to restore coverage with a considerably lower fiscal impact than a year ago. Obesity is a chronic multifactorial disease affecting nearly 30% of California adults, and aside from causing numerous other diseases, untreated obesity adds billions in avoidable costs to Medi-Cal. Cutting off evidence-based treatment does not eliminate those costs. It just delays them until patients are much sicker and much more expensive. We asked this committee to direct DHCS to fully analyze the cost of obesity medication coverage, especially in light of the new balance model pricing, and including the long-term offsets from preventing diseases and related complications. Low-income Californians should not be forced to get sicker in order to qualify for the same medicines that they could have used to prevent the disease. Thank you. Thank you. Madam Chair, Tim Madden representing the California Chapter for the American College of Emergency Physicians. We appreciate the inclusion of our budget request in the proposals for investment in the packet. We are asking for $100 million, which is a continuation of funding that's occurred over the past three budgets. This funding goes to the budget. towards increasing reimbursement for emergency physicians, treating Medi-Cal enrollees, and the importance there is staffing levels. This allows us to staff emergency departments at higher levels with more emergency physicians, so this would be a continuation of that. And just one point of clarification on the request, with the clarification that the MCO tax is good through the end of 2026, So that covers this for the first half of this budget year. The budget request would actually be $50 million, which would be for the first half of 27, where there is no MCO tax. So are you adjusting it to $50 million because the MCO tax is going all the way to 731? To the point that the department submits the SPAS to allow us to receive that reimbursement, which they haven't done yet, but they have indicated that they will, then it would be adjusted to $50 million. Okay. than it would just be for the first half of 27. But if by some miracle there's an MCO tax that comes together for 27 moving forward, that would include those funds, then that's kind of how it's worked the past three years. It's been an MCO tax fill the whole way through. Thank you. Thank you. Good afternoon, Chair and Staff. Kelly LaRue here on behalf of Eli Lilly. We appreciate the opportunity to comment as you consider the path forward for Medi-Cal. Obesity is a chronic disease with significant health and economic impacts in California. GLP-1 medications are effective tools that can help reduce long-term disease burden. The impact of these tools can be even greater when access is not tied to income. Under new federal pricing guidance, there are lower-cost pathways that California can leverage to expand access while managing the fiscal impact. Increased access will help address disparities in obesity burden. California's Medi-Cal population is disproportionately black, Latino, and rural. A Medi-Cal coverage policy for chronic weight management that balances clinical rigor with equitable access supports improved health outcomes and long-term savings for the state. Lilly supports reopening the conversation about GLP-1 coverage for chronic weight management in Medi-Cal. We recognize California faces serious budget pressures, which is why we're excited about the opportunity for cost savings presented by the balance model. Thank you. Thanks, Kelly. I just want to say I really like your boots. Do you? Really nice. I thought you might, Madam Chair, just for you today. Tiffany Whiten with SEIU California on behalf of the California Labor Management Coalition for Quality Care, a coalition of over 20,000 skilled nursing facility workers represented by SEIU 2015, which you have in the room with you here today, and 21 reasonable California SNF operators covering over 500 facilities or more than half of all SNFs in the state. We are opposed to the DHCS trailer bill related to SNF financing reform unless it is included the restoration of the WQIP. We appreciate the discussion on the item today and just want to clarify that the 3% that you guys were talking about does not go to the workforce. The beauty of the WQIP is that it directly and many times and oftentimes it goes directly to the workforce, which we all know is the backbone of the facilities and it's the true way to ensure quality care and facilities. Thank you. Thank you. Thank you, Madam Chair. Eduardo Martinez here on a couple of items. First, on behalf of Altamed PACE, we support the item for investment that was referenced earlier around nurse evaluators. That's one of the biggest barriers to getting seniors who are frail, keeping them in their homes and getting them enrolled in our program. Also on behalf of Altamed we support the request from CPCA to restore or delay the cuts to the PPS rate for the UAS population which of course we think is going to be critical as some of the changes around H 1 and state budget cuts maybe go into effect We need to be there to be able to provide for this population. Lastly, on behalf of Western Dental, which is the largest provider of Medi-Cal Dental Services in California, here to speak in support of a restoration of cuts to Proposition 56 dental payments, which is a critical tool to maintain access to care in ManiCal. Before Prop 56, it was widely considered a failure. There were too few providers and too many patients going without care. Prop 56 really helped turn that around and expanded provider participation and access throughout the state. We believe that eliminating these payments would reverse that progress. and it won't reduce costs. It will just shift them. According to a recent study by HKI, when patients lose access to preventive dental care, they end up in emergency rooms with higher costs and worse outcomes. Thank you. So thank you very much. Thank you. Hello. Thank you. I'm Deborah Payne. I'm past chair of the Medi-Cal Dental Advisory Committee. We have been meeting since 2012. We were put into existence through the legislature. and I'm also a consultant for First Five Sacramento on oral health issues. And the answer, you know, we have about 100 people at our meetings, not only Sacramento County but through the state. They come in on Zoom. And we have heard because of Prop 56, about half of the Medi-Cal dentals will go away. We know this will impact emergency rooms. That is not the place to go for dental care, of course. You only get antibiotics and pain medications. It still doesn't fix the issues. Emergency rooms are already overrun. We'll go back to pre-Prop 56 when it was so difficult to get an appointment. We help families. We help children. You know, children can't arrive at school ready to learn if they have a swollen cheek because of mouth pain. So we really, really would like to see Prop 56 stay. and so that we, for all the work that we've done over time to increase the number of providers because of Prop 56, that that stays. Thank you so much. Good afternoon, Madam Chair. Eric Dowdy with the California Dental Association. CDA, along with its 100-plus members of our Save Our Dental Coalition, urged the subcommittee to protect the Prop 56 supplemental payments from Medi-Cal Dental. This $311 million cut would leave $517 million in federal funds on the table, decimate the provider network, and severely curtail patient access and place additional strain on our already overburdened emergency rooms. We have heard from our members who have been close to this issue. We'll have to close clinics in their communities where a few other alternatives exist. They'd have to shutter plans to build specialty clinics for special health care needs populations and cut off access for regional center clients. In CDA's survey of 1,500 dentists, we found that over half would disenroll from Medi-Cal dental program if these cuts were allowed to go into effect, and another one-third would see fewer Medi-Cal patients. Further, as the LAO notes, this cut would have to be subject to federal review by CMS to ensure access to services would remain sufficient even after reducing rates. We believe that based on our survey results access would be significantly reduced and may fail this federal review So we respectfully urge your support in protecting Medi Dental Thank you Madam Chair, Gary Cooper representing the California Academy of General Dentists. They specifically represent the General Dentists in the state of California. And of utmost importance to CAGD is the Medi-Cal cuts for the dental program. As has been noted many times, one-third of the California population is on Medi-Cal, and this would be very detrimental to the communities, to the oral health of the communities. And so basically we, like other dental groups, are asking you to reject the Medi-Cal dental cuts when it comes before the committee. Thank you, Madam Chair. Thank you. Good afternoon, Madam Chair. Cleo Bluthenthal with the California Community Foundation here in partnership with the Fight for Our Health Coalition. Our state's most vulnerable are relying on us to find sustainable long-term revenue solutions to fund Medi-Cal for all Californians. Because of H.R. 1, health care for millions of California's working people and vulnerable families are in jeopardy. They'll be forced to choose between paying for rent, food, and going to the doctor. Meanwhile, corporations are set to reap record windfalls. Many Californians who stand to lose their health care coverage from HR1 are working for the same corporations that will benefit from Trump tax breaks to the tune of $900 billion over the next decade, funded by the biggest cuts to health care in a generation. Rather than continuing to allow corporations to shift their responsibility onto everyday workers in the state, we urge you to hold corporations accountable and identify long-term revenue solutions that are needed to keep Californians covered. Thank you. Good afternoon. Madam Chair, Mandy Isaacsley here on behalf of the California Primary Care Association, the statewide organization representing our community health clinics. I want to thank the committee for including our proposal to delay the PPS cuts to the state-only Medi-Cal populations, including those in the UIS. I don't need to explain to you how devastating this cut will be, Madam Chair. I think you well understand it. But just as a point of reference, one of our member clinics in L.A. County informed us that this cut represents a 40% hit on their operating budget. I don't need to explain to you guys reduction in hours, staff reductions, potential closures will ensue if this moves forward. So we very much appreciate the inclusion of this in the proposals for investment and look forward to future conversations. Thank you, Mandy. Good afternoon, Mr. Chair and staff. I'm Antonio Pabros. I work 20 years as restorative nursing assistant in one of the facilities in Marin County. As a direct contact to the patient, I really want to reinstate the funding for WKIP for not to impact the quality of work. Thank you very much. Thank you.

Megan Subers on behalf of the California Professional Firefighters and would like to urge your support for the investment proposal listed to provide $1 million to DHCS to implement the provisions of SB 1180 by Senator Ashby. This would provide for Medi-Cal reimbursement for community paramedicine, triage, alternate destination, and mobile integrated health programs on the Medi-Cal side, which is already required on the private pay side. This resource allocation would allow for DHCS to seek the federal approval that is required under the statute and really think those programs have shown value and would urge your support And on behalf of the Los Angeles LGBT Center also would like to see a delay in the proposed PPS cuts for the UIS population Thank you

Correct, on the Medi-Cal side. So the provisions of the bill were automatically effective as of July last year on the private pay side. But for the Medi-Cal side, that portion was contingent upon appropriation to get federal approval.

Hi. My name is Kristen Mozak. I have been a CNA for 23 years, currently work at the Pines of Placerville Healthcare with PACS, third company I have worked since 2003. I oppose the governor's nursing home rate reform proposal unless it fully restores the WQIC. I believe the WQIC needs to be reinstated. It benefits the residents and operators and workers based on the quality care in nursing homes. Without this funding, I believe the quality care will decline. Thank you.

Good afternoon, Madam Chair.

My name is Carol Ruiz Driver. I work in the activities department for 19 years at a nursing home in Santa Clara. Please restore the WQIP. It benefits the residents and the workers. And thank you for your work in helping us today.

Good afternoon, Madam Chair. Yvonne Chung, representing the California Association of Health Facilities and our over 900 skilled nursing providers, as well as the Support Skilled Nursing Patients Coalition, a coalition of over 20 organizations. We're here today to oppose the reauthorization of the SNF funding methodology unless the funding for the WQIP is restored. As you've heard today, this is a critical program to support staff and the workforce so that they can continue to provide high-quality care for the most vulnerable and disabled residents in California. And we appreciate your comments today in support of that.

Good morning, Madam. My name is Verna White. I'm a CNA. I've been working at a facility for 15 years. I ask that you guys keep the WQIP in the program because it is an incentive for us. We look forward to that bonus at the end of the year because we are the essential workers that's directly giving hands-on care to the patient in order to pass that survey. That's what we look forward to.

Oh, I hope I can reach you.

My name is Carol Silva. I've been working over 30 years as a CNA for Sacramento County, and I want for a WQIP.

Yes, the WQIP.

I can't even pronounce it. So for you to keep it because we need it, And also, I'm asking for, you know, like they help. So we need more staffing and for give better care to the patients. And that's it.

Good afternoon, Chair and staff. My name is Austin Bradley. I'm the Director of Nursing at Merced Behavioral Center and Educational Chair for CAF's Progress Valley Chapter representing skilled nursing facilities in Merced, Tuolumne, and Staslaus County. But most importantly, I'm a mental health advocate with nearly 20 years of experience I, like many others, you will hear today oppose the current budget trailer bill unless it is amended to restore WQIP's funding. In California SNFs and healthcare facilities, we've already seen patient occupancy rates return to pre-COVID levels, but we are still short roughly 22,000 healthcare workers compared to the same time period. At the same time, throughout SNFs and healthcare facilities, we are seeing an increase in patient acuity, including more individuals with complex mental health needs. WQIP is critical in helping facilities rebuild the workforce and provide and support behavioral health education, which is essential for the safety and caring of these patients. So as a result, I respectfully urge restoration of this funding.

Hi. My name is Veronica Chavez. I work for 20 years as a restorative nurse assistant in the San Joaquin County. I want you to help us to restate the WQIP that we need to support the welfare of the residents and staff.

Good afternoon, Chair Katie Rodriguez with the California Association of Public Hospitals. here in support of the $500 million ask for public hospital systems. To supplement low medical base rates that are not currently covering the cost of care, public hospital systems put up non-federal share in place of the state to draw down federal funding through supplemental payments like the state-directed payments, which I know was discussed earlier. In total, public hospital systems are now putting up $4 billion annually in non-federal share to draw down federal funding. As mentioned earlier, H.R. 1 will significantly reduce state-directed payments. In total, public hospital systems are facing a loss of $3.4 billion annually from H.R. 1. As you heard last week, public hospital systems are doing everything they can to maintain access to care, but they cannot absorb the scale of cuts, and we are facing losses in services, likely facility closures, and layoffs. Public hospital systems also put up the non-federal share for inpatient fee-for-service rates. The $500 million appropriated for public hospital systems would address a structural inequity and an important first step towards stability for public hospitals. We urge your support. Also, we urge the support of the restoration of the PPS rates for FQHCs for the UIS population. Public hospitals have 100 FQHCs across the membership and are facing millions in dollars in cuts from that as well. And that combined with H.R. 1 is going to be very challenging to navigate.

That's correct.

Good afternoon, Madam Chair. Andrew Guillo, UC Davis Health, Government Relations. I'm here in support of CAPH's request for $500 million general fund as the region's safety net hospital and public hospital for the capital. We're in strong support of that.

Kelly Brooks I'm here on behalf of two clients first on behalf of the Center for Elders Independence which is a PACE site in Alameda and Contra Costa counties we're here in support of the CalPACE proposal when level of care nursing determinations are delayed due to staff constraints there are real consequences to patients including health deterioration or institutionalization Second on behalf of Lifelong Medical Care a community health center that serves over 50 patients annually in Alameda and Contra Costa counties We support the CPCA proposal to delay the billion in cuts to the PPS system for the UIS population. The PPS cuts would have significant impact on our mission to provide high quality

Good afternoon, Madam Chair and staff. First of all, thank you for your close attention to these very complex and difficult issues. My name is Jennifer Moore Ballantyne. I am CEO of the Coalition for Compassionate Care of California. We are a cross-sector coalition working to improve care for people with serious illness across the state, many of whom reside in or are cared for in skilled nursing facilities. On behalf of our board of directors and our nearly 100 organizational members, I oppose the current budget trailer bill language unless it is amended to restore the W-Equip

clients today for two different issues. On behalf of Point Click Care, we're here in opposition unless amended to restore the funding for the WQIP. On behalf of the District Hospital Leadership Forum, these are the 33 district and municipal hospitals. We want to thank you for the discussion on the various hospital financing mechanisms. These programs are critical to the survival of district and municipal hospitals. As a reminder, these hospitals are located in some of the most rural communities in this state. We know that the impact under H.R. 1 is going to be significant for these hospitals, and they are often the only providers of care in their community. With respect to item 7 on the value-based program, we do have concerns that it could add additional risks and we would like to partner with DHCS and all stakeholders to ensure that the voice of district hospitals are heard. And lastly, we want to thank you for the support and of the BCP in implementing SB246. This was graduate medical education at district hospitals. Thank you.

Good afternoon, Madam Chair and committee. My name is Jeff Jamison. I'm a regional vice president with PACS Healthcare, we have 136 facilities throughout the state of California with about 40,000 employees. We take care of about 16,000 patients. And like many others, I oppose the current budget trailer bill language unless it is amended to include a restoration of funding for the WQIP program. WQIP doesn't just give money to the facilities. It's a program that has to be achieved and earned. it aligns that funding with measurable improvements with staffing and with patient care.

Good afternoon, Madam Chair. George Cruz on behalf of the California Behavioral Health Association. We just want to highlight two urgent concerns. First, the loss of the MCO tax will continue to strain the behavioral health system. Providers are already concerned about reduced capacity, increased workforce strains, and longer wait times for individuals seeking care as funding becomes more uncertain. Second, we're deeply concerned about the coverage losses for undocumented populations. This population already faces significant barriers to care and are more likely to experience serious mental health needs, substance use challenges, and housing stability, and the loss of coverage will delay care, worsen health outcomes, and increase the likelihood of crisis. We also support CPCA's efforts to address the strain placed on clinics due to the federal challenges as the impacts are being felt across the safety net. We urge the legislature to prioritize protecting access to care, preserving coverage, and

Good afternoon Madam Chair and staff My name is Emily Shields I the Director of Nursing from Pine Creek Care Center in Roseville I oppose the current budget trailer bill language unless it is amended to include a restoration of funding for the Workforce and Quality Incentive Program Thank you

Good afternoon, Mark Farouk on behalf of the California Hospital Association. CHA is allied with the other comments to support the restoration of the age quit program. I would also add a comment related to the discussion related to Prop 35, the MCO tax. We are concerned that there may be an effort by the administration to sweep the remaining funds in that program rather than dedicate those funds to providers.

Thank you, Madam Chair and staff. I appreciate your comments earlier in regards to the WQIP program. My name is Casey Calloway from Folsom Care Center. We are a family-owned and operated facility with more than 140 employees and care for 99 residents and 70% of them being Medi-Cal patients. And we want to strongly oppose the current budget trailer bill and the language amended and hope for the restoration of the WQIP program. And, again, I appreciate your comments earlier today.

Nasset Short on behalf of Loma Linda University Health, here to support the PACE budget request. This proposal will improve access to community-based care for our medically fragile elderly patients in our communities, which not only has proven to help and support their well-being, but it will also improve access to the rest of our health care delivery system and this really critical time for our safety net. Loma Linda also wants to align our comments with the other stakeholders who have concerns and oppose the cuts to the DENICAL program.

Good afternoon, Madam Chair. Jackie Anderson with CHIAC, representing our local health departments throughout the state commenting on issue number three under DHCS related to the family health estimates. Thank you for your questions about county funding for the California Children's Services Program, serving the most medically complex and vulnerable children and youth in the state. We did want to clarify that counties are not asking for a funding augmentation because of increased county costs. Instead, counties are asking the state to pay counties what they are owed based on DHCS's own existing staffing standards and caseload. Just a quick, simple example to illustrate the issue. DHCS staffing standards indicate that counties should receive $200 for the caseload that they serve. But DHCS has this information, but instead only provides counties $100. And not because the staffing standard is wrong and not because the funding is not needed, but because the administration simply will not include the full dollar amount in the budget proposal. Because of this issue in the current year, DHCS allocations are $109 million below what counties should receive. budget year allocations will similarly be less than what is needed due to this issue. This underfunding contributes to delays in county eligibility determinations and annual redeterminations, service authorizations, medical therapy services, and ultimately access to lifesaving specialty medical services for CCS children. CHIAC respectfully requests the legislature to provide sufficient funding to county CCS programs in alignment with CCS caseload and

I'm a registered dietitian representing the California Academy of Nutrition and Dietetics. We have over 3,000 members in the state of California and there's over 11,000 dietitians in the state of California that work in health care. We are here to also oppose the current budget trailer bill language unless amended to include restoration of workforce funding registered dietitians and NDTRs are a critical part of nutrition staff and services and also included within those workforce challenges

Hello, Chair. My name is Laura Marcus, and I serve as CEO of Dientes Community Dental Care, serving Santa Cruz County, where we see 18,000 patients each year, the majority of them Medi-Cal. This is actually my first Senate Budget Subcommittee hearing. It's been quite an education despite being in my role for 20 years. I've been busy doing the work on the ground at home, and now I'm excited to get more engaged at the state level. I'm here to respectfully urge you to prevent the elimination of full-scope adult dental benefits and Medi-Cal for the UIS population. I'm actually disappointed I haven't heard more of our audience speak to this. While the cuts to PPS reimbursements and Prop 56 dental provider rate funding will also impact us, it's the benefits for UIS population that it's just not logical. I was leading Dianthes when California eliminated adult dental benefits for Medi-Cal adults in 2009, and I saw firsthand the impacts on our patients. But it also didn't save the state money. A 2025 policy analysis from the American Dental Association estimates that eliminating adult dental benefits for the UIS population alone would cost California roughly $400 million over five years. And that's due to increased emergency department visits, higher medical costs associated with untreated oral disease, etc. This practically eliminates the budget's planned savings. I have to believe the state can find $40 million to save this important benefit. Dental services for low-income people are getting cut from so many directions. Please protect Medi-Cal dental benefits for UIS populations, but also maintain Proposition 56 provider funding and look at that PPS reimbursement for health centers as we will be failing across the system if we don't do all three. It was talked about last week's session, that's why.

Okay, I've got to pay closer attention to the agenda.

Jean Hurst here today on behalf of the University of California. First, we want to share our strong support for the public hospital budget request of $500 million. Second, regarding provider taxes, UC Health would like to express appreciation for the $75 million in MCO tax funding for graduate medical education that was released to UC in 2025. These funds are supporting 200 medical resident and fellowship positions in 162 different GME programs across the state, as well as direct technical assistance to MGE native health systems. Support for GME will only become more critical as H.R. 1 student loan caps begin to exacerbate the physician workforce shortage. UCHealth also supports the administration's MCO tax spending plan for 2025 and 26. Finally, regarding Prop 56 dental, UCHealth supports CDA's request to reject the planned elimination of Prop 56 dental payment rates. UC School of Dentistry located at UCSF and UCLA are key providers in California's Medi-Cal dental safety net serving children, older adults, people with disabilities, medically complex patients, and underserved families. The elimination of the Prop 56 rates would impact critical services including pediatrics, hospital dentistry, oral surgery, orthodontics, endodontics, and special needs care.

Good afternoon. hospitals, including the three mentioned, providing access to essential services for Medi-Cal and uninsured patients. With the changes in HR1 public hospital systems, which include county hospitals, estimate $3.4 billion in total annual losses from HR1 when fully implemented. Without investments from the state, California's county hospital system will be unable to sustain current care levels. The consequences will include reduced access to services, increased wait times, staff layoffs, and possibly even facility closures, which we are already seeing. The CAPH proposal will bring parity to the financing mechanism for Medi-Cal patients, fee-for-service, and is a down payment to help public hospitals sustain their essential work in the health care delivery system. Lastly, counties will also need resources to restart indigent programs, the eligibility work, and behavioral health to help blunt the HR1 impacts.

Madam Chair, I'm Erin Evans on behalf of the County of Santa Clara. We appreciate the attention this committee has paid to the needs of public hospitals and our residents as we all grapple with the impacts of HR1. The county operates the second largest public hospital system in the state with four public hospitals and 15 health centers. We also operate trauma, burn, and rehabilitation centers that serve residents regionally. Once all the changes within HR1 are implemented, our county anticipates a billion-dollar loss. We're doing all we can locally. We have passed a local sales tax measure. Our community, our board of supervisors, excuse me, implemented $200 million of mid-year cuts to the health care system, but we just can't do it alone. So we're here seeking partnership with the state. As my colleague before me mentioned, we very strongly support the $500 million request from the California public hospital systems as sort of one of the down payments to help mitigate the impacts of H.R.1.

Good afternoon and happy almost spring break. I'm Darby Kernan on behalf of LeadingAge California. We represent nonprofit providers of care services and housing for older adults. including SNFs. We are requesting you to restore the WQIP for SNFs and associate our comments with everyone else that presented earlier.

Hi, Madam Chair. Kendra Matthews with Flagstone Healthcare. We have 93 skilled nursing facilities we support in California, and we're so grateful that you're taking the time on our industry, so thank you. So we are here in support of reinstating WQIP. Though it's a $150 million savings to California, it's federally matched, so we're losing $300 million overall. And this money really does go straight to our employees and our staff to help recruit them, retrain them, and just that all adds to the improved quality of care.

Hello there. My name is Frances. I am the marketing director with Flagstone Healthcare. And I want to keep it short and sweet. I oppose current budget trailer bill language unless it is amended to include a restoration of funding for the workforce and quality incentive program. Everybody deserves quality care. This is why it matters to me and my communities. I love my patients. They deserve the best.

Good afternoon, Madam Chair and Staffer. Thanks for the opportunity to speak with you today. My name is Eric. I an administrator for Flagstone Healthcare I one of the 1 administrators in California that would be in deep trouble without the WQIP program I use that money to pay for many of the CNAs that you saw come up front. If I didn't have that money, I'd have fewer staff. Without that staff, we'd have more patients going back to the hospital and costing the state untold amount of money to do that.

Good afternoon, Madam Chair. Jessica Moran with Capital Advocacy. I have a few items to comment on. So on issue number eight, on behalf of the California Association for Nurse Practitioners and the Occupational Therapy Association of California, we would support an amendment to the department's trailer bill language related to the skilled nursing facility financing that restores the W-QIP. These payments are necessary to support important therapy and nursing services that are happening in skilled nursing facilities. On issue number 11, on behalf of WellBeHealth, we support the proposal that was presented here today, the staffing request for critical nursing evaluators who are evaluating applications for older Californians who are enrolling in PACE. And lastly, on behalf of the Association of Dental Service Organizations and Golden Age Dental Care, urging the legislature to reject the plan elimination of Prop 56 dental funding, appreciate your comments at the beginning this morning, Chair. And thank you, looking forward to working with the legislature.

My name is Christine Smith with Health Access California. Just appreciate the opportunity for my boss to be on one of the panels today and did want to note that our state's most vulnerable are relying on us to find sustainable long-term revenue solutions to fund Medi-Cal for all Californians. I know you know about the impacts of H.R.1, but people will be forced to choose between rent, food, and going to the doctor. Meanwhile, corporations are set to reap record windfalls. Rather than continuing to allow corporations to shift their responsibility onto everyday workers in the state, we urge you to hold corporations accountable and identify long-term revenue solutions needed to keep Californians covered. We also appreciate your attention to the Healthcare Affordability Reserve Fund loan that is being repaid and how it could help people afford care.

Madam Chair, Kathy Mossberg with APLA Health. Want to align ourselves with our colleagues in support of the restoration of the PPS reimbursement to health centers that serve all people regardless of immigration status. Without this PPS rate, we are certainly not going to be able to sustain our current level of service. As an L.A.-based provider, cutting PPS to UIS population will further tear the safety net further than what we're already seeing happen with H.R. 1. We hope this committee will restore this when the time is appropriate.

Good afternoon. Katie Layton on behalf of the Children's Specialty Care Coalition. Here to comment on how changes to Medicaid financing will impact pediatric specialists who care for children and youth with complex health care needs. There's a looming workforce crisis within pediatric specialty care, in large part due to high Medi-Cal volume, upwards of 70% at some of the largest children's hospitals in the state, and chronically low Medi-Cal rates. These physicians undergo years of additional training, yet earn markedly less than their adult counterparts and a number of pediatric specialty fellowship slots are either at or below 50% filled and this is causing delays in accessing care. Programs like loan repayment under Prop 56 have served as a lifeline to support this pipeline of physicians and Prop 35 provided a pathway to finally bring Medi-Cal specialty care rates closer to parity with Medicare However changes to Medicaid financing under H 1 will harm this network To date specialty care rate increases for 2025 have not materialized We ask at minimum that the state protect current Medi rates and we appreciate DHCS's commitment to thinking creatively around maximizing future MCO tax revenue to the extent possible. And lastly, just wanted to align our comments with those

Good afternoon, Madam Chair and staff. My name is Vilma Bocanegra. I work for a nonprofit organization called Hijas del Campo, where we service our hardworking field workers. And I'm here in partnership with Fight for Our Health Coalition. Our states more vulnerable are relying for the state to fund long-term revenue resolutions to fund Medi-Cal for all Californians. Due to the passing of H.R. 1, millions of Californians, working people and vulnerable families are in jeopardy, while many of them will have to be forced to choose between rent, food, or doctor visits. while corporations are benefiting from the tax cuts that were in place by the current president. Many Californians are working for these corporations as well, and we are urging that you hold them accountable. Along with this urge is also to stop any additional cuts to Medi-Cal dental coverage as oral health is physical health. It should not only be funded for emergencies when it is too late when preventative care can be given.

Good afternoon, Madam Chair. Omar Altamimi with the California Pan-Ethnic Health Network. As we know, H.R. 1 state cuts have really impacted our most vulnerable communities. The legislature voted last year to eliminate adult dental benefits for 2.1 million immigrants, including undocumented immigrants as well as lawfully present immigrants, starting in July 2026. California has done this before. In 2008, the California legislature voted to eliminate adult dental benefits, and it spent nearly a decade to restore them. During that time, many people were forced to stop seeking oral health care, which allowed preventable conditions to worsen and pushed people into more costly emergency situations. This time is no different. You know, people will delay seeking care until it becomes an emergency, which leads to worse oral health outcomes for our most vulnerable communities. Following the 2008 elimination of adult dental benefits in 2009, the average cost for dental-related emergency department visits increased by 68%. In recent years, costs for emergency department-related dental visits have increased from $3 billion in 2020 to $3.9 billion in 2022. We know that the elimination of adult dental benefits will further exacerbate the unaffordability crisis we're experiencing in our state. As we're considering investments in Medi-Cal, we should prioritize maintaining access to essential benefits for patients, joining calls to raise revenue as well in a way that truly reflects California's values by raising revenues from corporations and the wealthy rather than squeezing dollars from our most vulnerable communities. Thank you.

Kathy Sunderling-McDonald here for two clients today. First for Habitat Health, a PACE organization with sites in Sacramento and Los Angeles counties. We support the CalPACE Nursing Evaluator funding request and believe it will be a helpful resource for the department, both during the moratorium and beyond. Every delay in a level of care determination represents an elder Medi-Cal recipient with high-level needs who has both elected that care and is not currently getting the coordinated and comprehensive care they need. Thank you for your consideration of this.

For the California Pan-Ethnic Health Network, specifically related to the California Health Benefit Exchange, Californians are feeling the impact of the GOP's failure to extend the enhanced premium subsidies. We see that with the impacts on new enrollment which is down 32 with Latino and Black or African American individuals most impacted But we see that while new enrollment is down the majority of enrollments held steady particularly for those below 200 of the FPL This is a direct result of last year's H-CAR funds, which allowed Cover California to provide state-funded tax credits to individuals earning up to 165% of the federal poverty level. It's more urgent than ever that these funds be preserved and maintained so we can continue to mitigate current and future coverage losses. And finally, we strongly support annual funding so qualified health plans can continue to provide gender-affirming care to their enrollees. Thank you.

Good afternoon, Madam Chair. My name is Meena Ramachandran. I'm an operating leader at Scene Health PACE in beautiful San Gabriel Valley, close to nowhere you hail from. I'm here to support CalPACE's budget request for additional nursing support. Much has been said by my colleagues around the impact of delays in pace enrollment on seniors, but I also wanted to highlight the delay impact on caregivers. It's often family members who will step up and bear the additional stress when their seniors and loved ones are in crisis and have delays in enrollment. And so we want to highlight that addressing this need will not only benefit seniors, but the entire system and ensure families are able to provide the care that they need for their loved ones. Thank you very much for your time. Good afternoon, Madam Chair. Megan Allred on behalf of San Diego PACE, St. Paul's PACE, and CalOptima Health in support of the level of care nursing staff for PACE and passing along our gratitude to Senator Grove for sponsoring the Senate proposal and also on behalf of San Ysidro Health to support the proposal to delay cuts to the prospective payment system for UIS populations. Thank you.

Good afternoon, Madam Chair and Assembly. My name is Rob Mathuni. I run a dental services company, statewide California. We primarily serve Medi-Cal Dental patients in long-term care facilities, specifically SNFs, and I want to give voice to the segment of the population I think might be a little bit overlooked, which is the frail elderly residing in these SNFs. We talk about the alternative to not bringing the services, not having the providers as the patients going to ERs. It's not really an available option in a lot of cases to the SNF patients. We go on-site, treat them bedside, and a question was raised about the availability of dentists. I can assure you that they'll fall off the cliff. It was a problem, a large problem before Prop 56 came into effect. and just think about the explosion of costs since 2018, 2017 to today with standard of living. And I can tell you I can't pay my doctors what they demand today for compensation, so these patients will not be served, and that will lead to serious compounding health risks and dignity, quality of your life, if nothing else. Thank you, sir.

Madam Chair, Rand Martin, and this is not my first sub-three hearing, but I still do learn a lot. I'm here on behalf of Aviana Healthcare as well as Maxim Healthcare and Prime Home Health in support of the 40% Medi-Cal rate increase for private duty nursing. I want to point out two things that remain the same over the four years since we first went down this path. Number one is that the ask has remained exactly the same. It's about a $62 million request over a full year. the second thing is that there are hundreds of kids who are still being authorized for these services, but are not receiving them because there's just not enough people out there. There is one thing that has changed over the four years, and that is that hospital costs continue to rise. Just last year, 7.5%, according to the American Hospital Association. Our costs remain the same. So the savings to the state, pegged three years ago at $175 million, is much, much larger now. So we really hope that you will support it, and we appreciate your longstanding help on this issue. Thank you. Good afternoon. My name is Pat Hornbecker. I'm president of the Arc of California, representing 500,000 people with developmental disabilities in California. I'm also a retired dental hygienist, and I worked for 35 years in San Francisco, and I have to echo the comments on Denical and the fact that I worked for my father and my brother in dentistry. I can only echo how much they did not find their inability to serve Medi-Cal patients under the system as it exists. But they did do a lot of pro bono work. We did it just because it's the only way to get around the system and to actually make it worth their time and energy to do. My son is a kid with severe disabilities and recently had a four-year wait for services, four years for the UOP to be able to operate on him. He lost nine teeth, had eight fillings in gum surgery. This is not the way we should run our businesses, and it's not the way we want to run our practices. and these proposed cuts are going to reduce access.

Thank you for the time, Madam Chair. My name is Aaron Elder, and I'm the CEO of Sola Kids Dental. We're a three-location dental practice serving primarily 90% of our patients are on Medicaid in South L.A. We serve 7,500 patients a year, and I just wanted to tell a little bit of our story because I think it's really representative of the vast majority of dental coverage for patients on Medi-Cal. especially kids. We have about 15% net income margins or EBITDA margins before debt service, and Prop 56 funding represents 27% of our reimbursement. So a 27% reduction to price would flow through to having basically negative 10 to 12% net income at the end of the year. We can't sustain a business that way, and we would just have to close, and we don't really have anywhere to squeeze. We have 30 employees that serve those 7,500 patients, and I think there's nothing really unique about our cost structure or financials, and I think a lot of other practices are in that same position. So I just wanted to share those numbers and hopefully help as you and the rest of the Senate and Assembly think through funding. Thank you for your time. Good afternoon, Madam Chair. My name is Sama Gonzalez with the California Hispanic Chambers of Commerce, and we respectfully ask the committee to restore Medi-Cal dental services for the state's most vulnerable population or children. While we understand the need for fiscal discipline, these cuts jeopardize hundreds of millions in federal matching funds. Not only do those that need the services the most lose out, but the state also loses considerable federal funding. We hope you reconsider these cuts. Thank you. Thank you. Good afternoon, Madam Chair and staff. My name is Estella Kessler. I'm a school board member, representing the Central Valley Latino mayors and elected officials And here to tell you that a toothache is one of the leading causes of preventable school absences And where I come from, the Central Valley, children are underserved and are more likely to delay care until problems become severe because access is limited. Preventative care keeps children healthy in school and able to focus on learning. So let's restore the dental. Thank you for children. Good afternoon, Madam Chair. My name is Doug Kessler. I represent two groups, the Central Valley and Northern Yemenese Society and Cisepoide Fresno-Telare Kings in Kern Counties. We work in very, very rural areas where the kids have just recently been going to dentists for the first time. And the loss of this isn't at the 30 miles that they go to the dentist or the 40 miles to go to the dentist. They're just not going to go at all. So we ask you please to reinstate the dental. Thank you. Madam Chair, Nick Luizos on behalf of the California Association of Health Plans. As discussed earlier, the future of provider taxes in California is at a crossroads due to H.R. 1 and recent federal guidance. CAP, the R Association, has historically supported an MCO tax, but that support was rooted in three key principles. Number one, that the tax be affordable to purchasers of health care in the individual and employer markets. Number two, that the revenue generated from the tax be used to enhance the Medi-Cal program and not just serve as a general fund backfill. And number three, that the tax is fair, equitable, and stable amongst the taxpayers. So in light of that, we ask that if there are discussions around the MCO tax, a cap is an integral part of those discussions, that the legislature be thoughtful and deliberate, and that affordability be a key consideration in any discussions. Thank you.

Madam Chair, thank you very much. Chris Scroggins with Capital Advocacy on behalf of Big Smiles and Children's Choice Dental Care. I just want to echo the comments of past speakers on the importance of the restoration of the Proposition 56 funding for Medi-Cal Dental. Since the passage of Prop 56, we've seen a tremendous increase in the number of providers accepting Medi-Cal Dental patients and meeting the needs of this critical population. And with these cuts, we run the risk of losing all that progress. So we urge the legislature to restore those cuts. Thank you. Good afternoon. Alexis Rodriguez with the California Chamber of Commerce. I want to begin by thanking you for today's discussion. While the goal of expanding access to health care is one, we all share imposing penalties on employers for having employees enrolled in Medi-Cal may have unintended consequences on California's businesses. As mentioned today, businesses with 50 employees and more are already required to provide health care coverage for their full-time employees. and California's employers are proud to provide health care coverage for their employees and we do our best to make it affordable. Penalizing California's business community may discourage hiring and push employers to limit growth. Rather than imposing these measures, we'd like to focus on collaborative solutions that support employers in offering affordable coverage. Thank you.

Good afternoon, Madam Chair and staff. My name is Sean Yen. I with California Coverage and Health Initiatives and I here to support the creation of sustainable long revenue solutions for Medi especially those which hold corporations accountable as they receive billions of dollars in tax cuts which would have gone to assist Medi-Cal recipients to begin with. Thank you very much. Thank you. Good afternoon, Madam Chair and members. My name is Diana Ordaz-Charrington, and I'm here on behalf of Southern California Healthcare Advocacy Coalition. I'm urging you to reconsider the proposed cuts to Medi-Cal dental services at a time when families are already stretched by rising costs. Eliminating dental benefits will only deepen health disparities and drive higher medical costs down the line as preventable oral health issues go untreated. These cuts also come with a significant fiscal consequence. California would forfeit hundreds of millions of dollars in matching funds, dollars that help stabilize access to care in the communities that need it the most. I respectfully ask for you to restore Medi-Cal dental benefits and protect access to essential preventative care for our most vulnerable residents. Thank you for your time and consideration. Good afternoon, Madam Chair. My name is Roberto Arnold, representing the California Multicultural Business Alliance. We represent over 3,500 small businesses that are minority-owned, women, LGBTQ, and veteran-owned. Um, cuts to the medical dental coverage will turn an already difficult healthcare situation into a crisis for many families. We understand tough choices that will be made for the state's budget, but we should not balance the budget by cutting children's dental service. Dental care is not optional. It's preventative. Healthcare that keeps small issues from becoming serious, costly emergencies. For a small business owner perspective, this isn't just a healthcare issue. It's a workforce and economic stability issue. When children are in pain or facing untreated infections, parents miss work, productivity drops, and families fall further behind. That impact shows up in our shops, offices, and job sites across California, especially communities already carrying the heaviest burden. If one thing should be spared in this budget, it's funding for our children's health care, Starting with the basic services that protect their health, school attendance, and long-term being. Thank you.

Good afternoon, Madam Chair and staff. I'm Naomi Padron. On behalf of Innovage, we'd like to echo the comments made by previous speakers in support of the budget request for $700,000 for four nurse positions within the Department of Health Care Services. Thank you.

Good afternoon, Madam Manjabar and staff member. My name is Nora Canetti. On behalf of the Latino Business Association, we ask that the committee restore the Medi-Cal dental budget and so we protect our children's health always. Thank you and have a great evening.

Good afternoon. Nora Angelis with Children Now. The budget projects significant Medi-Cal caseload reductions, more than 500,000 fewer enrollees by 26-27, driven by policy changes like stricter eligibility and redetermination requirements. For children, even short gaps in coverage can mean missed check-ups, delayed diagnoses, and worsening health outcomes. Families may struggle to enroll or stay enrolled even when eligible because these federal provisions were designed to churn people off coverage and reduce revenues supporting Medi-Cal services. We strongly urge you to protect Medi-Cal for children youth and their families And we would like to associate ourselves with the comments of CDA on Prop 56 Thank you Thanks Good afternoon Beth Monalski with SEA California on behalf of our 750 members and our Fight for Health Coalition. Really want to appreciate the thoughtful panel today on the intersection between employment, coverage, and Medi-Cal. As was noted on the panel, we cannot ignore this intersection and the importance that we are placing on guaranteeing that all workers, especially low-wage workers, have access to coverage. And if that's happening through Medi-Cal, making sure we're holding accountable the employers that are leading to those workers being on Medi-Cal. So really encourage your continued deliberations in this space with your fellow members of your Senate. Additionally, want to align myself with the comments made by the urban counties and the public hospitals and the need for a $500 million really down payment to reinvest in our public hospitals and health systems. Additionally, want to acknowledge the comments made earlier by my colleague from CHIAC on CCS and appreciated the conversation on that earlier today. And lastly, as was noted by the UCC, as we talk about what does the future of Medi-Cal look like, who will and will not have coverage, we can't ignore the state of our indigent care programs and encourage further deliberations on the need to invest in those programs as well. Thank you.

Good afternoon, Chair. Sarah Brennan with the Weidman Group. On behalf of our client, DenteQuest, we urge the committee to reverse the proposed Prop 56 cuts to DenteCal providers. These supplemental payments are the difference between providers staying in Medi-Cal and leaving it. California spent years rebuilding its dental network after prior underpayment clasp provider participation. These cuts risk triggering that clasp again. And millions of Medi-Cal beneficiaries who finally gained real access to dental care will be the ones who pay the price. Please restore the funding. Thank you.

Good afternoon, Madam Chair. Chris Bollinger on behalf of the California Asian Chamber of Commerce and our 700,000 API-owned businesses throughout the state. Here to speak to the employer-based health care coverage item, we just want to align our position and comments with the California Chamber of Commerce. Thank you so much. Thank you. Hi, good afternoon, Madam Chair and staff. My name is Julie Sherman. I'm Director of Public Policy for the ARC of California. We represent half a million people with developmental disabilities in this state. We are here today to urge you to restore the funding for Medi-Cal Dental. Right now it looks as though there is going to be up to a billion dollar hole in the budget and for a three billion dollar budget that is extremely significant. I want to talk about how difficult it is for people with intellectual and developmental disabilities to see a doctor. Right now, it can take up to two years to see a specialized doctor that can help with the specific needs of people with intellectual and developmental disabilities who have sensory issues and find it difficult to go to a dentist. That is only going to get much worse. In a recent survey, 50% of dentists said that they would no longer accept Medi-Cal Dental or would much-reduce services if these cuts go ahead. Thank you.

Thank you, Madam Chair, for a great hearing. Anderman does on behalf of the Alzheimer's Association. On Issue 8, we are concerned with the elimination of the Workforce Quality Incentive Program. We do know that this program supports the delivery of quality care to people that are living with Alzheimer's and dementia in these settings. The vast majority do want to age in place and live at home. But as the disease progresses and the symptoms become more complicated for fulfilling the activities of daily living, they're definitely needed. So in this setting, we would like to see that restored and appreciate your inquiry approach. if the program could be extended during these uncertain times, and we support that exploration. So thank you so much. And then we do also appreciate the department speaking about the collaborative efforts on this issue, and we stand ready to provide additional perspectives. Thank you.

Good afternoon. Michael Melantine. I'm a first-time public commenter, and you've run a great meeting, and I appreciate all that you do. So I was rather shocked when you had the direct question of what's going to happen to access with the Prop 56 cuts for the dental payments, and they couldn't give a clear answer. I'm going to give you a clear answer that it's going to be devastatingly cut dramatically, at least 50%, I would think. But I'm an anesthesiologist. Me and my dental partner own a dental center in San Jose. We see children. I put them to sleep. These are kids with autism, developmental delay, Down syndrome et cetera the most vulnerable of the medical population I would think And if these Prop 56 cuts come through that a 43 reduction in Medi revenue 95% of what we do is Medi-Cal. We can't sustain a business that way. We would have to go away. We get so many reviews on our website. How wonderful, you know, they have access to us. It's going to go away. Thank you, sir.

Good afternoon. Esther Flores with the California Farmworker Foundation. The Central Valley is home to some of the highest concentrations of Medi-Cal-enrolled children in California. Many families we serve are farmworker families and low-income households who depend on Medi-Cal solely as their only option for dental care. Reducing funding will widen existing health disparities in already underserved communities. We respectfully ask the legislature to restore funding for medical dental services. Thank you so much for your time.

Yesenia Rubancho with End Child Poverty California I just want to say thank you to Jesus at SCIU We urge you to unrig the system and properly tax wealthy corporations who just benefited from $1 trillion in tax credits from the federal government, paid for by cuts to Medi-Cal, and these corporations still expect California to foot the health care bill for their unpaid workers. That's a shame. We also urge you to oppose any additional inhumane cuts to Medi-Cal, and there is still time to revert the cuts to dental coverage, as folks have said, and we must undo the erases, exclusions, and freezes from last year. Thank you.

Good afternoon, Madam Chair.

Raymond Contreras with Lighthouse Public Affairs on behalf of Fullwell regarding CalAIM. under CalAIM community supports have been an instrumental in expanding access to care for patients across California and the continued implementation of community supports and Louv services is critical for maintaining patient entered care and saving health care dollars Too many patients across the state are living with preventable chronic diseases and access to nutritious foods to help prevent, treat, and reverse these health conditions. Since CalAIMS launched, the community supports known as Medically Tailored Meals food has connected to over 220,000 patients with food interventions that have helped them achieve dramatic health improvements and avoid a more intensive level of care. Without ongoing prioritization of community supports, we risk wasting the billions of dollars that California has invested in establishing these services across the state over the last four years and patients not seeing the positive health outcomes they deserve. Thank you.