Assembly Budget Subcommittee No 1 Health

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Assemblymember Bonta.

Assemblymember Schiavo. Assemblymember Solace.

We're gonna continue as a subcommittee. And so I wanna say good afternoon and welcome everyone to the Assembly Subcommittee number one on health. This hearing today is gonna cover the Department of Public Health across five different issues, including budget change proposals, program estimates, spring and spring finance adjustments. We're going to welcome Dr. Erica Pond, the CDPH director and state public health officer, who will join us today to provide the California 2026 state of the public health report, as well as an update from the administration on California's response to federal digression on public health. We have a couple housekeeping notes, as usual, before we begin. The agenda is available online on our committee's website, and physical copies are available in the hearing room. We also have supplemental materials, such as the State of Public Health Report, that are available. online. And we're going to ask panelists representing the Department of Finance and the LAO's office, if you'll sit on the edges of the dais like the last few times, to make room for other witnesses at the table. After we conclude each panel, we'll take questions from members, followed by public comment on that agenda item. And public comment is taken in person at the end of each issue. We will open for public comment for items not on the agenda at the very end of the hearing. And I'm going to ask again that when you do give public comment, its name, organization, your position on the issue that we're talking about, and that you take no more than 30 seconds, and Patrick will have his very friendly timer to help you remember. If you're unable to attend in person, you're welcome to submit written comments via email to asmbudget at asm.ca.gov. So we're going to start with issue number one, which is the California Department of Public Health budget overview estimates and budget change proposals. We have an overview of the budget, and you're welcome to come on up if you're presenting on this. We also have 19 non-IT budget change proposals, as well as the budget estimates for the program of WIC, or Women, Infants, and Children, and the Genetic Disease Screening Program, or GDSP. So you're welcome to introduce yourself and start when you're ready. Thank you.

requesting on a one-time basis from the Federal Health Facility Citation Penalties account to support various CMS-approved campaigns. Center for Infectious Disease is one of those areas that I'll kind of bypass because we're going to be talking about that in issue five related to IT proposals and issue four related to ADAP. We have one small proposal there that's in your agenda as well. Center for Healthy Communities has four proposals. It's primarily implementing a couple alleged proposals, including SB20 related to silicosis surveillance and AB1264, which is restricting ultra processed foods in schools. There is one larger proposal in this area, $7 million requested to fund tobacco and vaping prevention media campaigns and to award competitive grants targeting youth and priority populations. Then we have a few one-offs over in our Center for Health Statistics and Informatics. We have a proposal related to implementing SB 313 in Center for Preparedness and Response. We have one proposal that's related to a hospital bed capacity system, and it's to maintain a real-time automated dashboard tracking hospital bed capacity statewide. In our Center for Lab Sciences, finally, to round out the 19 different proposals, we have two proposals there. One at Governor's budget for Baby Big funding. We're requesting $3.6 million to cover manufacturing costs of Baby Big. And then finally, an April 1 proposal related to laboratory licensing resources, $3.8 million and nine positions to address expanding workload there. And then the last thing you asked was related to a couple of the different estimates in our Center for Family Health. Our genetic disease screening program is projecting no real major changes for the newborn screening or the prenatal screening programs. They remain relatively stable from last year. Specifically GDSP for 2627 is requesting a total of 175 million, which is a slight 0.3% increase from last year's budget act. And then newborn screening and prenatal screening program participation is projected to slightly decrease, a decrease of about 1% compared to last year. And we expect for the neural tube defects screenings, we anticipate a 2% decline from 25-26 and a further half percent decrease in 26-27. So relatively stable for that estimate. And then on the WIC estimate, we're projecting again no major changes in program expenditures and participation. It remains like GDSP relatively stable, although we do continue to monitor any changes in participation. Specifically, some of the changes were related to WIC food expenditures. The estimate there is 1.1 billion, which is a 6.4% increase from last year. And this is primarily driven by a food inflation rate of 2.8%. And then finally, program participation is stable. We're projecting that on average monthly participation will increase to about 1,006,000 participants, which is just a 0.1% increase over last year. So that's rapid fire as far as changes related to our budget. If there's any questions, we have some of our subject matter experts here, and I know Dr. Pan's gonna get into some of these as well. Thank you so much. First anything from a DRF or LAO Will owns with the Legislative Availance Office Nothing to add on these items but available for questions Great Thank you I just had a couple You mentioned a very, very slight decrease around infant funding. And just if that's, if there's anything of note on what's, why you need less money. It's the women, infants, and children. No. You mentioned something about infant program. Not women, infant, and children. Oh, sorry. On the screenings. The screening program. Yeah, primarily due to caseload. Caseload is primarily driven by births in California, and that's been seeing a slight downtrend. And so our estimate usually follows along that line. Okay. That's why I was wondering if it had to do with decreasing birth rates. Yet WIC is increasing. Very slightly, a 0.1% increase compared to last year. Okay. Okay. Is that probably primarily a little bit, maybe because of caseload, but probably the costs are primarily driven by the inflation rate. Yeah. Okay. And excuse me. And then on WIC, excuse me, WIC was affected by extended federal shutdown. Were there any lessons learned from the department around what to do, how to continue to help those most in need, women, infants and children? Yeah, we worked very closely. Fortunately, within the administration, even with the shutdown, we had sufficient reserves in the program to be able to continue to fund it. I think that's one of the areas that we would remain to kind of monitor our reserves as we go through in the instance of a federal shutdown, what's available to us to sustain the program ongoing. I'd see if our program staff have anything that they might want to add related to lessons learned from that. I think most importantly, we just it's the the feds have been so topsy turvy when it comes to the budget and so many problems between the shutdown, H.R.1, just they're being erratic. What we expect for women, infants and children moving forward and how you'll keep that stable. I think my other question is around did the shutdown affect the number of people that were coming to get help? Like, did they hear about the shutdown and just decide not to ask? And will you change any communication pieces should that happen again? Sure, yeah. Thank you for that question, Fareeha Chaudhary, WIC Division Director. So ensuring the continuity of WIC services remains a top priority. And one of our lessons learned from the 2025 shutdown is that we have to continue to work strengthening our preparedness. We were fortunate to be able to receive contingency funding from USDA and then also secure that general fund loan. So those strategies continue to remain in our pocket to respond as effectively as possible in the event of any future funding lapse. And also it's robust state fiscal forecasting that we conduct to ensure those reserves are available and then continued coordination with our state and local and federal partners. To your second question, we have seen a slight dip in enrollment since the federal government shutdown. And I think it is because people heard this news. Even though we continued social media, teletask messages, local partners that WIC is open, I think folks hear some things in the media and conclude otherwise. And then when the government is reopened, that message doesn't go through. So we hoping that again through that strengthening coordination with partners we can continue to make sure that people know WIC is open WIC continues to be opened in the event of any sort of federal funding lapse Great Thank you I think that the extent of my questions We going to you welcome to stay for public comment on this If there's any public comment on issue one. I see one person potentially coming up. Good afternoon, Chair, George Cruz on behalf of the California Behavioral Health Association. On issue one, we just wanted to touch on the Behavioral Health Service Fund that was identified in the report for $50 million in supporting the budget asked by Assemblymember Pellerin to use $30 million of that to fund the California Reducing Disparities Project for two additional years as one of the most successful equity-based programs the state has run in the past about eight, 10 years. Thank you so much. Hello, Sarah Diaz with the California WIC Association. We commend CDPH WIC as the near completion of implementing the new food package. This vital targeted short-term benefit supports about a million Californians each month and has proven positive outcomes with great impact, deserve our full support and investment. We remain deeply concerned about the many detrimental effects that HR1 will have on the program as 70 to 80% of WIC families rely on Medi-Cal and about half on CalFresh. Also, participants are adjunctively eligible for WIC if they participate in these programs, and if they're no longer enrolled, they'll have to provide income documentation to verify eligibility, creating additional administrative burden for both the workforce that's already stretched as well as the participants. Thank you. Good afternoon, Chair Addis. Lizzie Guansona here on behalf of the office of Kat Taylor and the American Heart Association in strong support of CDPH's BCP on AB 1264. We urge you to approve this funding so the department can develop these science-based regulations and provide schools with the technical assistance they need to serve healthier meals. Thank you for your leadership in protecting the health of California's kids. Good afternoon. My name is Clary Villacres. I work with the Clinica de la Raza in Oakland, which is primarily the Latinx community and is part of the California Reducing Disparities Project. I would like to request, please, the support of this program, which is essential to prevent the loss of life-saving services and to preserve the community-informed models that have been developed for the past 15 years in the area of mental health prevention and early intervention. There is not much hope that the counties will allocate Proposition 1 funds to continue these crucial services. So please consider these. Thank you. Just as a reminder, name, organization, and your position on the issue of the CDPH budget overview estimates and BCPs. Thank you very much. Vanessa Cajina on behalf of the Mosquito and Vector Control Association, much appreciation to CDPH for their submission of a BCP on the Vector-Borne Disease Program. These are very important public health certifications that our members need to ensure that they are applying pesticides correctly. We have a question, but we are having a good conversation with the department about it. Thank you very much. Good afternoon, Lupita Rodriguez. I represent the Health Education Council, which is part of the CRDP Latino-focused initiative. And I am here supporting the $30 million proposal out of the general fund to continue supporting the CRDP for the two additional years. Thank you. Good afternoon. My name is Vanessa Vasquez, and I'm representing Health Education Council. I'm a crisis counselor and I'm asking to support the 30 million because I see the impact that we have in the community and This is not just a need. It's a surviving for a lot of people. So I'm not talking about policy. I'm talking about people. So please support us. We need this money. Thank you. Nora Angeles with Children Now. The $1.8 million request for childhood lead poisoning prevention program reflects a growing caseload. More California children are meeting the CDC's definition of lead poisoning. This is a public health crisis requiring our full attention. We support First Five's request for additional flexibilities to allow them to access funding under the BHSA. And last, more than a million California children and mothers depend on WIC. Federal cuts under H.R. 1 threaten to increase administrative burdens and reduce access to lab work. Thank you. Madam Chair, Tim Madden representing the California Chapter of the American College of Emergency Physicians, and we're in support for the budget request under the Center for Preparedness and Response, specifically the Hospital Bed Capacity Registry. We believe this is an important tool for emergency physicians to understand what the capacity is, and if we need to transfer someone to a higher level of care, it'll allow us to do that more efficiently and quicker. Thank you. Good afternoon, Madam Chair. Ryan Spencer on behalf of the Environmental Working Group in support of funding for the implementation of AB 1264, the Real Food Healthy Kids Act. So appreciate that. Also, on behalf of the Environmental Work Group and the American College of OBGYNs, District 9, in support of SB646 implementation, which deals with test of heavy metals in prenatal vitamins. And finally, on behalf of the California Radiological Society, in support of the implementation of AB460, which would ensure that radiologists can supervise rad techs when they provide contrast for x-rays. Thank you. Good afternoon. Hi, my name is Navid Gyasi and I'm here on behalf of Mass Social Services Foundation, part of California Reducing Disparities Project. I hope this committee will support the request for $30 million for CRDP and CDPH. Thank you. My name is Abid Stranig and I'm here on behalf of Mass Social Services Foundation, part of CRDP project. I hope that this committee will support the request for $30 million to continue and save the California Reducing Disparities project. Thank you. Good afternoon. My name is Hosna Taslim and I'm here on behalf of Mass Social Services Foundation, part of the California Reducing Disparities project. I hope that this committee will support the request of $30 million to continue and save the California Reducing Disparities project. or CRDP, which would be under the debt of public health CDPH. With all attacks on all our communities coming from the federal government, the state needs to have our backs and provide protections for us. Continuing the funding of CRDP is one very effective way to do this. Thank you for your support. My name is Anthony Chen, and I represent Asian American Recovery Services, or ours in South San Francisco, which is part of HealthRite 360. Our work is funded by the California Reducing Disparity Project, or CRDP, within the Department of Public Health. I have traveled to Sacramento from the Bay Area today with my program manager and supervisor to urgently request continuation of the state million funding of the CRDP Thank you Good afternoon my name is Anastasia Flores I'm with Asian American Recovery Services, HealthRite 360, and also part of the California Reducing Disparities Project. We ask that the committee support the request for $30 million to continue and save the CDRP under CDPH. Thank you so much. Talofalava, Chair and members of the committee. My name is Lwani Mawasina and I'm with the Essence Amana program, also with Asian American Recovery Services Project. I humbly ask that you continue the funding for the CRDP because of these programs. Our communities are being heard and they're being served. It is 2026 and we're finally seeing solutions within the community. And so I please urge you to support our villages. Thank you. Madam Chair and members, I'm Tony Gonzalez. I'm here today on behalf of Networking California for Sickle Cell Care and the Sickle Cell Disease Foundation. We're incredibly grateful for the partnership with the California Department of Public Health and support the request by Senator Weber Pearson for continuing funding for the clinics for another five years to allow us to integrate into Medi-Cal. We serve roughly about 5,000 adults, and we've extended lives, and we've become a national model of care that I'd love to tell you more about someday. Thank you. Hi, my name is Matt Chinchule. I'm representing the Center for Inherited Blood Disorders and California Network for Sickle Cell Care. We were fortunate enough to establish 12 networks five years ago that are now caring for adults with sickle cell. Sickle cell in the state of California has a life expectancy of 43 years. The national average is 61. So our patients have not had a successful transition from pediatric to adult care. So we were able to establish these networks, and now we're starting to see a cost savings of close to $27 million a year because our patients are staying out of the hospital. And we'd like to continue this effort. Thank you. Good afternoon, Chair and members. My name is Courtney Armstrong with the First Five Association of California. I'm related to the Behavioral Health Services Act implementation. Despite past historic investments in children's behavioral health, the birth through H5 population remains underserved and is often underlooked. The sunsetting of the CYBHI community practice grants combined with changes due to BHSA implementation will widen that gap. For these reasons, First Five Association of California is requesting an additional $20 million for the new CDPH population-based prevention fund, specifically for the birth to five population. And we're also requesting some language changes designating 20% of the 51% you set aside for birth through five and allowing first fives to be eligible for that funding. Thank you. Thank you. Seeing no other public comment, we're going to move on to issue two, the state of public health report. that we welcome Dr. Erica Pond, the CDPH director and state public health director, to provide the statutory mandated state of public health report. So welcome, Dr. Pond. Good afternoon. Thank you so much, Chair Addis and subcommittee. I'm Dr. Erica Pond. I your honor to serve as your state public health officer and California Department of Public Health director Thank you to the legislature for the opportunity to share some highlights from the State of Public Health 2026 report in California and for your ongoing partnership to protect public health As your State Public Health Officer, I consider the whole state of California my patient. Today, I'm sharing some highlights on the health status and trends in California. The written highlight and full state of public health reports summarize more detailed information about California's population health status throughout the life course, identifies opportunities for population health improvement, highlights public health emergency responses, and shares strategies and programs that address these areas. Let's start with some highlights on major public health achievements and progress. We can be grateful that public health investments and other efforts have contributed to significant and measurable improvements in the health of Californians over the past 50-plus years. In 2024, all-cause mortality, cancer death rates, and cardiovascular death rates dropped to all-time lows, and life expectancy reached an all-time high. California currently has one of the lowest all-cause mortality rates, infant mortality rates, and highest life expectancy in the nation, thanks to the successes of public health, health care, and improved access to social drivers like education and healthy food that promote healthy people. I'm also very pleased to report we have finally turned the curve on overdose deaths, which decreased in 2024 for the first time in 14 years. Our collective efforts to increase access to naloxone, harm reduction services, substance use prevention and treatment, and culturally responsive community supports have all contributed, but we still have work to do. We have now also achieved a consistent decline in sexually transmitted infections, including congenital syphilis, since 2021, after dramatic increases since 2010. These decreases followed significant state and federal investments for public health to meet patients where they are and effectively test, treat, and prevent syphilis, along with updated screening and post-exposure medicine recommendations. While these numbers are finally improving, congenital syphilis rates in California are still three times higher than a decade ago, so we cannot let up on our efforts. California should also be very proud that we lead a nutrition policy through executive action and first-in-the-nation legislation in AB 1264 to define and limit the harms associated with ultra-processed foods and other harmful ingredients, phasing them out-of-school lunches by 2032. While we've made significant progress in these areas, there are concerning issues we must address. Behavioral and mental health conditions are the major and increasing contributors to years lived with disability, hospitalizations, and years of life lost. Earlier I mentioned decreasing death rates in many areas, yet we're seeing increasing death rates in adults aged 25 to 54 years of age, driven by overdoses. When we look at impacts based on years of life lost, road injury, homicide, and suicide are additional leading causes for this younger age group. Statewide initiatives like the Children and Youth Behavioral Initiative, 988 Suicide and Crisis Lifeline, suicide prevention, and substance abuse prevention programs are all important to address this concerning trend. And thankfully, through the Behavioral Health Services Act, California will dedicate prevention-specific funding for the first time to public health to lead a statewide population prevention approach where we can resource efforts earlier to promote social connection resilience and other prevention strategies While California infant and pregnancy mortality rates rang amongst the lowest in the U.S., severe maternal morbidity trends have increased between 2016 to 2023. And although pregnancy-related mortality has improved post-pandemic, it is still higher than it was a decade prior. specifically our ongoing unacceptable racial disparities and pregnancy related and infant mortality with black populations experiencing significantly worse outcomes must be addressed to turn these overall trends around cdph works with partners through programs like the perinatal equity initiative and our recently released black birth equity action plan to identify best practices and lays out a roadmap to close these gaps place matters we see concerning disparities by region and place for example death rates were higher and life expectancy lower in rural areas compared to urban and coastal areas even within counties we can also see a huge gap for example within la county the life expectancy in the redondo beach area is 88 compared to the life expectancy in compton area which is 73 A difference of 15 years, even though these communities are only 10 miles apart. Identifying these gaps in health outcomes allows us to explore what is driving health challenges and tailor prevention strategies and actions accordingly. I also must emphasize that we continue to see an increasing frequency and complexity of public health emergencies that we must stay prepared to respond to. Our emergency response center was activated for over 32 different and overlapping emergencies over the past five years. Given those overlaps, the cumulative days of activation added up to more than five years. We need a trained and resilient workforce and stable systems to support these public health emergency responses. Maintaining capacity to sustain health outcomes we've gained is hard enough in public health, But amidst increasing natural disasters and public health emergencies, federal threats, and the acceleration of technology at an exponential pace around us, it is more important than ever to both preserve the resources we can and think creatively to innovate. Thanks to the Future of Public Health initiative, California is better prepared to communicate, coordinate policies, advance equity and community engagement, and respond to public health emergencies, including federal actions. For example, the future of public health has allowed for a swift and coordinated H5N1 bird flu state and local response, with enhanced rapid disease detection and investigation, education and outreach, and strengthened multi-sector collaboration. After the devastating LA fires, the Eden Fire Shelter outbreak and infection control response and recovery was possible with future of public health staff. Other examples of specific impacts include a CDPHY 24-7 intelligence hub and expanded emergency response training, exercise, and evaluation. At the local level, the Future Public Health supports mobile health staff to better reach and serve residents in rural, underserved, and isolated areas, meet the health and social service needs of farm workers, and has supported effective management of a large hepatitis A outbreak among the homeless, to name just a few examples. support for sustainable and modernized data systems remains critical to help us track investigate and manage cases contacts and outbreaks manage vaccines and monitor and respond to these health trends to protect the public in closing public health can not do our job alone. As we navigate the volatility and challenge of this moment, we will continue our cross-sector collaboration, innovation, and communication. And we're grateful for our talented workforce and support from the legislature and the governor and the opportunities amidst other world-class leaders in our great state to forge ahead together to build a healthy California for all. Thank you for this opportunity to share California's health status. Thank you so much, Dr. Pond. Is there anything from LAO or DOF? Okay. Let me know if you have questions, Assemblymember. Happy to. Okay. I just had my main question really has to do around the effects of H.R.1 and knowing how difficult it's going to be to backfill everything that H.R.1 has taken from California and where you would suggest California put its limited dollars. Sure. For public health, the biggest impact of HR1 directly was to our SNAP-Ed funding, which affected our nutrition and physical activity branch. And, you know, while we had other support and are kind of highlighting our important work in nutrition and physical activity, that's sort of the biggest area where we've had direct impact. As you also heard, there's some other indirect concerns with the Women's Infant Children Program and other things. But thankfully, despite the roller coaster of threats, the discretionary budget from the federal government did not actually get cut. And then some of the threatened rescissions were actually stopped with legal injunctions. I was going to cover that a little bit in the next issue item as well. We are working, and I'll talk a little bit about this in the next issue as well, we are working on prioritizing, really thinking about our unique public health role at the state health department and how we better work with partners. Thank you. And a similar question around behavioral health and just the challenges, not necessarily around HR1, but you mentioned, you know, lots of decrease in certain deaths except for this 25 to 44 year old population where it looks like drug overdoses and perhaps combined with behavioral health issues and just sort of where you think we should be investing our limited dollars and what else could be done? Yeah, I think this is where I'm grateful that we have just recently sort of gotten this preventive public health, population health, statewide investment in behavioral mental health. So I do think that is a needed issue right now. Again, if you think about the leading years of life lost, some of the tables you'll see in here, I think I'll just flash on them to you because it's just so striking. And I forget which page it is in the actual report. But the leading causes of death based on years of life lost, drug overdose, is a far, you know, a far reaching biggest one. The other really impactful sort of graphic is when you look at causes of death by five-year age ranges, the blue areas are areas that are related to either drug overdoses, suicides, and then things like alcohol-related, road injury, homicides, other unintentional injuries. So all of those are really the biggest sea of blue in our age ranges from teenagers to even mid-40s to mid-50s. So I think I'm really, really grateful that we do have this resource to try to invest in the upstream areas around behavioral and mental health. Suicide stands out on that one. Yes yes And that definitely a key priority part of our work and our plan for the prevention strategies with the VHSA funding Thank you I just stunned actually by the number of age groups that suicide is showing up as one of the top issues And starting at age 11 and going all the way up through age 44. Thank you for that. And thank you for the very robust report. Really appreciate that. something useful is coming out of the legislature and the administration, right? That we can all take heart that we're producing useful information. Any questions, Assemblymember? Thank you so much for this. And I guess I'm like in between places. I don't know where I am. So, you know, I represent North L.A. County. L.A. County Department of Public Health has already closed some clinics and trying to keep the rest open. And so certainly we're seeing locally our public health infrastructure being weakened. And the statistics you talked about, Compton, and what was the other area? Redondo Beach. Redondo Beach, right? 15-year difference. Yeah. I mean, that's been the case for quite a while. Uh, and are you, and it's interesting to me that it's been the case, even though prior to HR one are, um, an insured population had gotten a lot, like very small, right? Single digits and percentages. And so do you have, is there anything that's kind of illuminated why we think that is, or if it's too many things to, I mean, there's so many factors, right, that can go into that, but why is there such a disparity? And what are things that public health can do to address that? Yes, I think there's increasing work and evaluation to look at what we call the social drivers or social determinants of health. And it really goes back to some of those basics to poverty and education and environment. So that's where I think from the public health perspective, we really look forward to partnering with all of you for health in all policies. And the more we can highlight with our data where we're seeing those impacts of those upstream efforts and how we can move the investments upstream. I think, you know, the other number I quote quite a bit, and I believe I said this in last year's State of Public Health Report, is that in health in general, we spend about 2 to 3 percent of the health dollars in prevention, and the rest of it goes to health care and after the fact. And we really, as a country, need to think about how do we invest upstream, because that really is the bottom line in a lot of those disparities. Yeah, I mean, and unfortunately, because of the cascading effects of H.R.1, poverty is just going to get worse in the near future. And, yeah. So I think, you know, I think this is important because what we try to bring into our policy discussions in the health committee is discussions around what an impact and what a cost savings it is for us to do preventative care and to focus on investing in policies that impact supporting preventative care. And it continues to be a challenge for us when dollars are put next to legislation and they only talk about what it costs to implement but they don talk about what it saves by implementing when you're preventing, you know, chronic disease or emergency room visits or all of the things that cost so much money and also, you know, harm people's health and lead to some of the tragic outcomes that we're talking about today. And so can you talk a little bit about some of those mental health investments? Because we know that's another crisis that we're facing and how those are being implemented. How are people in our community going to be seeing and feeling and experiencing the benefits of those mental health investments?

And lastly, I just want to highlight, you know, in Los Angeles, I feel like Department of Public Health has been getting it, but not has been, I mean, for a while has been involved in a number of more environmental hazard types issues, right? We've seen a lot of it coming out of the fires of last year, but also the Exide cleanup that's happened. We have a burning landfill in my district, which I often talk about because people are very, very sick from it. And Department of L.A. County Department of Public Health State agencies have been at the table on that. but don't seem to have, I feel like part of the inaction around protecting people's health has to do with the resources that are needed for it. And so I think that I just want to emphasize for future planning that as we expect to have hotter climates, more fires, floods, disasters you know floods in areas where there could be toxic things washing around right into communities that we really going to have to be thoughtful and intentional about making sure that there are there planning and resources behind funding needed to respond to these kinds of environmental disasters that are making communities sick And I know, you know, like you just said, and we've all been saying, we don't have enough money. We don't have enough money. It's being taken away by the federal government and, you know, and completely limiting our ability to deliver what we need to on health for our communities. so I know it's easier said than done but I think that it's really important as we see these environmental hazards making people sicker and sicker and and and the more and more prevalence of them that it's an area that we really really are going to have to be intentional around and make sure that we are able to act and protect people in the way that they deserve in our communities.

Thank you so much. We're going to move to public comment, which you're welcome to stay. I know you're in the next panel as well, but if you could state your name, your organization, your position on this issue in 30 seconds or less.

Good afternoon, Chair and members. I'm here for under issue number one. I'm sorry, Ms. The Q. I'm with Greenberg-Torrig on behalf of Triple P America. It's an evidence-based parenting and family strengthening program that is in 27 counties across the state. We strongly support First Five Association's $20 million budget proposal to sustain and expand prevention services for children and families across California. We respectfully urge the legislature to take a critical step further by redirecting a portion of the CDPH proposed $40 million statewide awareness campaign toward direct services. While awareness is important, families in our communities need access to tangible evidence-based interventions now. California is currently facing a significant gap in prevention funding, the transition from MHSAA to VHSAA combined with the sensing of CYBH dollars. Thank you.

bit over a year into my role as the state public health officer and director of public health. And as you just heard, I reported on the state of public health in California, which highlighted key health outcomes that we're following, but it doesn't actually capture the state of the field of public health. And the reality is in California and in our nation, our public health system is under attack. Our investments in prevention, protection, and improvements in health over the past few decades are all at risk due to federal actions. Our field has experienced cycles of boluses of resources during or after a public health threat, followed by dwindling and reduced support and funding, but I have never before witnessed such intentional and methodical attempts to dismantle the entire system. Specifically related to federal funding, it's important to reiterate again that about 80% of the CDC funding goes to state and local health departments. And as Mr. Nunez mentioned earlier, about two-thirds of our CDPH budget goes to local partners. Federal funding represents almost half, about 45% of our total department funding. And for many state and local health departments, that proportion is much higher. The federal administration has put us on an unpredictable and stormy course with multiple threats of funding cuts over the past year, some aimed specifically at a smaller number of states, including California. The initial presidential proposed budgets cut the CDC budget in half last year and currently proposes over a 40% reduction. Beginning last March and again in February of this year, the federal administration proposed rescissions of large and critical grants, adding up to hundreds of millions of dollars and funding hundreds of positions at the state and local level. Most recently, this was only cut in four states, including California. Both of those threats of rescissions were deemed unlawful by the courts that, in reversing those actions, repeatedly found the federal government exceeded its authority by inappropriately withholding federal funds. Yet this has caused a lot of chaos and uncertainty in our environment. In addition to that, the dramatic dismissal of experienced public health leaders and programs at the federal level have far-reaching impacts, including loss of technical assistance, reliable data, data privacy, and federal policies based on misleading information and unsupported claims. This has sowed confusion and public distrust in science, medicine, and public health. One of the most alarming areas is the devolving federal vaccine policy changes, which can impact vaccine access and uptake. While our strong immunization policies in California have kept our communities safe from large outbreaks, this success is at risk. We are seeing the highest levels of measles cases outbreaks hospitalizations and deaths in the U in 30 years driven by populations with low vaccination rates In California we already have over 40 cases to date in 2026 That's more cases than we had all of last year. And we've already had three outbreaks for the first time since early 2020. Almost half of those cases are from an ongoing outbreak right here in Sacramento and Placer counties. Ninety percent of these, 95 percent of these cases were not vaccinated. declines in vaccination rates can result in preventable missed school and work and a greater burden on the health care system. A study over a 29-year period estimated that childhood vaccinations have prevented over 60 million infections, 4 million hospitalizations, and 135,000 deaths. This is to the tune of $65 billion of health care costs averted and $324 billion in societal costs averted in California alone. California is fighting to sustain our hard-earned public health achievements of the past several decades and maintain our capacities gained added to the gaps in the public health system during the pandemic. Our department has also refreshed our strategic priorities to reimagine public health during this pivotal time. Reimagine includes prioritizing our most impactful efforts unique to our role and optimizing with a focus on efficiencies, partnerships, leveraging technology, and creativity. Last December, the administration launched the Public Health Network Information Exchange Initiative, partnering with national public health leaders to promote a more modernized and sustainable public health infrastructure. Phoenix strengthens public health innovation, collaboration, and communication across sectors and at the state, regional, national, and global level. So the first pillar to describe is innovation. We aim to launch a Phoenix Innovation Partnership to bring together public, private, academic, and philanthropic entities to develop advanced technology and funding frameworks that can deliver more stable funding. We aim to structure public health funding more broadly and have more of our partners participate. Phoenix Innovation intends to accelerate development and translation of technology innovations that address today's health challenges. Another huge area of progress and response has been collaboration. Over the past eight months, we've formed regional, national, and global partnerships, including the West Coast Health Alliance, the Governor's Public Health Alliance, and we joined the World Health Organization's Global Outbreak Alert and Response Network. Starting with the West Coast Health Alliance, a brief description. This is a partnership between California, Hawaii, Oregon, and Washington to ensure that public health recommendations are guided by safety, efficacy, transparency, access, and trust. The scope of our WCHA focuses on the following. evaluating and responding to threats to national public health policy and recommendations, reviewing the data, information, and reports from credible clinical and scientific professional organizations that use evidence-based methodologies and source materials to assess changes in public health policy, and develop unified public health position statements, policy recommendations, and guidance. And finally, I'll be reiterating this over and over about addressing communications needs and countering unsupported claims. The Governor's Public Health Alliance is a coalition of 15 governors working together to protect public health by helping states communicate across state lines, coordinate on pressing public health challenges, and support access to critical health care like vaccines. The World Health Organization's Global Outbreak Alert Response Network is a WHO-coordinated international network and brings together hundreds of public health institutions, national governments, academic centers, labs, and response organizations worldwide. Their mission is to rapidly detect, verify, assess, and respond to emerging public health threats, particularly those with cross-border or pandemic potential. Within California we created a cross public health for all Californians together or FACT coalition We partnered with Cover California and our agency and UCSF to develop this cross network of public health and clinical professionals health systems, health payers, academic and community partners to support public health. We're working with these partners to learn more about pediatric vaccine access and hesitancy by focusing on data, community partnerships, and communication strategies. Over 1,300 individuals representing over 290 organizations have joined to date, and since September of last year, we've had four webinars with 200 to 300 participants attending each. Finally, communication is more important now than ever. Thus, we're working with both the FACT Coalition and an organization called Your Local Epidemiologist to formalize a community messenger network and better listen and respond to Californians' health questions and concerns with Project Stethoscope. This uses expert-informed social media monitoring, community-driven insights, and targeted outreach and research to enhance and inform our communication tools. I am incredibly proud and thankful to be part of our California efforts to develop collaborations and innovation and to maintain these evidence-based vaccine policies and appreciate the partnership with the legislature to pass AB144 to ensure Californians have access to lifesaving vaccines and other preventive health services based on credible medical evidence.

So I'm James Watt. I'm the Deputy Director for Infectious Diseases at the California Department of Public Health. Following the adoption of AB 144, CDPH created a new Public Health for All website as a location for posting CDPH immunization and preventive service recommendations pursuant to Health and Safety Code 120164 and as a resource for the public and other stakeholders. We've developed a procedure for making changes to immunization and preventive services recommendations. First of all, our programs review guidelines from professional medical organizations or the federal government or significant new evidence that's come out. We consult with relevant national professional organizations like the American Academy of Pediatrics and the American Academy of Family Physicians and other partners to review scientific evidence. We consult on the impact of new recommendations with other state departments, and we coordinate with local health departments and other stakeholders to get input and align on communications. The FACT Coalition that Dr. Pond mentioned is an important avenue for our coordination with partners. We coordinate with the West Coast Health Alliance, as Dr. Pond mentioned, and then we finalize recommendation and post them on the Public Health For All website. We then draft regulations and submit those to the Office of Administrative Law. So far, we have made minor changes to the baseline immunization recommendations that were set out in the bill as of January 1st, 2025. So what we have done in September 2025, we posted recommendations for COVID, flu, and RSV vaccines in alignment with the AAP and the AAFP. In December 2025, we adopted updated recommendations from the AAFP for adult immunizations, and then in January of this year, we adopted the American Academy of Pediatrics regular annual recommendations for childhood and adolescent immunization We have also provided information to the public and stakeholders following changes in federal actions that we have not adopted And that been the biggest chunk of work that we done in this space We determined that the evidence prevented for these federal updates has been insufficient to warrant a change and that includes for example a federal recommendation to make hepatitis B vaccination at birth not routine. So we put out information about why we were not adopting that and tried to provide information to the public to reduce confusion that came out as a result of that federal action. We have also adopted several new recommendations for preventive services that have come out in 2025 from the U.S. Preventive Services Task Force. We reviewed these. We found that the updates were consistent with evidence-based health guidelines. So these are related to breastfeeding, screening for intimate partner violence, screening for osteoporosis, and screening for cephalosin pregnancy. So we reviewed those, adopted those, and posted those on the website as well. And that's a summary of our work in that space.

Well, look, I really appreciate all that's happened, and thank you both for explaining all of this to us. I guess one of the first questions I have is I heard you say, Dr. Pon, it sounds like measles are increasing and vaccines are decreasing. At the same time, we have a number of new initiatives around collaboration, communication, data sharing, publishing information. when do you expect the two to join such that vaccines will start to go back up and measles will start to go back down? Like when can we start to expect the effect? I am assuming these programs and collaborations are effective, but how long until it really shows in the population?

That covers most of it. I think that the key thing is that what we're seeing is spread, introduction, as Dr. Ponce said, from other places, and then spread in smaller communities that have lower immunization coverage. and that work that we're doing to identify trusted messengers in those communities that really needs to be a very tailored and culturally relevant communication is what's going to be most important for us here in California.

I can actually address that one. And we haven't actually, we're still assessing these more recent recommendations. So the Women's Prevention Services Initiative and HRSA did recently update in January some recommendations about cervical cancer screening for women between 21 to 65 years of age. There are some different committees that include the American Cancer Society, and then ACOG just came up with some recommendations as well. There's a lot of agreement about the updated recommendations, but not necessarily the frequency. I think there's still some, you know, some of the entities are saying every five years versus every three years. So we're still sort of assessing. And because these updated guidelines don't take effect for health insurance plans until January 2027, we're taking some time to really discuss both amongst subject matter experts. We're trying to consult with, you know, health insurers as well. We're talking amongst the West Coast Health Alliance because everyone's grappling with this issue. So we haven't actually made a recommendation. We haven't updated our website with that yet, but we're in active assessment right now and hope to come up with some recommendations very soon.

Thank you. Good afternoon, Chair Addis, members of the committee. My name is Joseph LaGrama. I am the branch chief of the ADAP branch within the Office of AIDS. For 2025 to 2026, the Office of AIDS estimates that the ADAP budget authority need will be $444 million, which is $42.7 million lower than reported in the 2025 Budget Act. The 8.8% decrease is driven primarily by lower medication and insurance premium expenditures than previously estimated due to decreased caseload projections and refinements to health trailer bill components that shifted from local assistance expenditures to state operations expenditures. For 2026-27, the Office of AIDS estimates the ADAP Budget Authority need will be $443.7 million, which is $43 million lower than reported in the 2025 Budget Act. The 8.8% decrease is driven primarily by the expiration of one-time investments. I'm happy to answer any questions.

I just, I know that the $900 million of ADAP funds was lent to the general fund. Do we know, is that on track to be paid back? What's happening with that?

And then do we anticipate use of any of the ADAP funds to backfill federal cuts? Yes, so the California budget did include AB 116.

Okay.

Good afternoon. Jonathan Froxweig on behalf of San Francisco AIDS Foundation, testifying in support of the End Epidemics Coalition's request for investment of ADAP rebate funds. The ADAP rebate fund, which is restricted for use on HIV-related purposes, will run a $203 million surplus next fiscal year. End the Epidemics is proposing that $143 million of that surplus actually be used to address HIV and related conditions by investing the dollars in effective but underfunded strategies like PrEP, low barrier testing, and rapid connection to care. We have the resources to end this epidemic. We urge the legislature to put them to use. Thank you.

Foundation and APLA Health and very supportive of the proposals for investment from the and the Epidemics Coalition. Good afternoon, Madam Chair.

Thank you. Kat DeBerg with the Health Officers Association of California, also here in support of the disease intervention specialists. Thank you.

Well, thank you so much. We're going to move on to our fifth and I believe our last issue on the agenda, which is the public health information technology systems. We're first going to ask CDPH to provide a general overview of all of the core public health systems. I know there's a number of them, including infection disease surveillance systems, as well as vaccine management and immunization data systems. Next, CDPH will provide an update on which of these systems are funded, which are lapsing. And then third, we'll hear from stakeholders on how these systems are used and how their loss may impact the state's public health function. So go ahead and introduce yourselves, whoever's first, and start when you're ready. Thank you very much.

whether they had been tested and what additional follow-up they might need. CalConnect also enables automated communications such as health instructions and symptom monitoring information to expose persons so that they know what to do to protect their health and avoid exposing other people. All of the data from CalReady and CalConnect flow into our departmental enterprise data management tools and including our departmental enterprise data lake. And that's used to move and process data and also route data to other places like our tuberculosis dashboard that's available to the public. Okay switching gears now, I'm going to switch over to the immunization systems and let's look at how that might come into play for somebody who receives a measles vaccine. So immunization information after a person is vaccinated is entered into an electronic health record, or it might be entered into the Miturn system if the vaccine is given as part of an outreach clinic, say if you're having a clinic to respond to an outbreak of measles. That information flows automatically from those systems into the care immunization registry. The registry creates individual immunization records. It matches that incoming dose to the record that is already there for a person, or if there's nothing there for the person, it'll create a new record. Care can determine which vaccines are missing and generate reminders. The data can be provided automatically to external systems like healthcare records so that healthcare providers have a complete immunization record. For example, if someone gets a vaccine in a pharmacy, that goes through care and then it can go back out to the electronic health record. Data and care can be queried by healthcare providers, schools, or individuals can get their own immunization records. Data can be analyzed to track our vaccination coverage in the state, so we can see how we're doing with that and also how well vaccines are working. And then, as with the other system, data are stored in our departmental enterprise system. Looking over at the vaccine management system, this includes three different functional areas. One is the MyTurn system that I've already mentioned that's used for outreach clinics, the MyCAVAC system, and then the digital vaccine record functionality. For the myCAVAC system, this is a system that carries out provider registration and data management, confirms provider eligibility to order vaccines, and tracks training and other requirements. This is the state system for ordering vaccines and tracking those vaccines and making sure that there's accountability for the vaccines that we distribute. This includes the vaccines under the Vaccines for Children program, which serves all Medi-Cal eligible children as well as uninsured children, any state purchased vaccines, and then federally purchased vaccines that support outbreak management, such as what we would use if we were responding to a measles outbreak. I've mentioned the MyTurn system that supports a clinic organization and provides the public access to making appointments to outreach clinics. And then the digital vaccine record enables people to access their own immunization information in an automated way from the immunization registry. And I will stop there, and I'm happy to take any questions about that. Anything from DOF earlier?

Can you talk about, or maybe DOF, either one, out of all the various programs, what's funded, what's being proposed to be funded, what's not being proposed to be funded?

Just to clarify, and then my apologies to our stakeholder who didn't get a chance to test by yet. Just Sapphire is funded?

And that's the only one?

CalReady and Cal...

Okay, so existing funding for CalReady, proposed funding for Sapphire, nothing for CalConnect, and nothing for care or the vaccine management system that we just heard are highly effective and helpful.

Okay, I'm going to go to our stakeholder from CHIAC, and then I have more questions. I'm assuming the rest of our panel, or the rest of our members may have questions as well, but my apologies. Jumped in without you and all my excitement.

Thank you so much. Really appreciate that. I just find this particular one totally confounding, because on the one hand, the administration has stood up something that really, in my opinion, is somewhat nation leading. We all lived through COVID and it was just complete mayhem. I guess I'll describe it that way from a public health perspective. It was total mayhem. And a lot of that was obviously because our systems had been ignored for so long. So on the one hand, the administration is investing in the you know all these partnerships and initiatives that we just heard on the last issue right The West Coast Health Alliance the Governor Public Health Alliance the Public Health for All Californians Together Coalition the Public Health Network Innovation Exchange, Project Stethoscope. And so there's this emphasis on communication at a high level. But the reason I asked the question on the last panel, when does this translate into more vaccines, less measles, is because that's where we need the real work. It's wonderful for us to collaborate across state lines and create these initiatives, but if we're not funding the things that then help us get more vaccines out the door, less measles, which is how a lot of these systems end up helping, what have we really done for the state of California? So I'm actually really confused by the lack of funding in the budget, given the talking points around how important public health is and what we see in the news and the various programs that have been presented to the public, it's confusing then to be presented with a Jan 10 budget that really is actually defunding the very things that are being touted as nation-leading.

And I mean, I think those numbers, I would agree those numbers are a good thing. I don't know that those numbers weren't just not funding a program, especially because when you stop funding technology, you stop using it, then it takes a lot to build it back up. So I'm a little confused about we have a system that's working. We don't need it as much as before. We're just not going to fund it. Let's let go of it. And then we're going to get back to this place where we're kind of in a world of hurt again. And if there's something better there and how long you're going to be studying this for, because it's true. We talked about this last year. That was my first year as the budget sub. chair, right? So we talked about this last year. It sounds like it was talked about the year before, like how long of a study do you need to decide if something's effective?

I would just suggest and then I'll turn it over to see if my colleagues have any questions, but I would just suggest if. If California is positioning as the answer to Trump's H.R. 1, the answer to Trump's attacks on public health. I just ran down and we heard on the last issue five or six different initiatives to improve public health while at the same time defunding important tools for public health. there's a mismatch there. And so I just think from an integrity perspective, it's important to see a proposal that matches the talking points. And so I don't know how much more time you need to study this, but May 10 is right around the corner. So I would assume you have some thinking that you've been studying, that there's some thinking. and I just would like to see something that matches the rhetoric, I guess is what I'm saying. I don't know if there's other questions from members.

Yeah, I appreciate those comments. And I would just say I don't doubt that the utilization is lower, but I think that's good. It means we're not in a global pandemic anymore. I would also say that the number of users are lower because we had all hands on deck. And remember, I had mentioned that during COVID, there was a lot of dollars invested. So we expanded our health department staff significantly. we're now shrinking back to pre-pandemic levels, which in itself is a challenge, right? We have already seen that that is important to keep public health staffed, but then to take these tools away because you're saying, hey, the number of utilizers are less and that the number of cases are less, I'd actually beg the question of what other types of cases are we seeing and how are we seeing utilization? Because I have not talked to a single health department that has said, hey, no worries, we're not using it anymore. Like it can go away. In fact, I think they're panicking because they're like, for example, I think you've talked about a health department that's shrinking already. Others are doing the same thing. And so they're trying to figure out what does this mean for them? And there hasn't even been a plan of what do we do to unwind these and what's next? And we hope to not have to have that conversation But if the administration is serious on not funding the systems we need to start planning for that And that shouldn happen in the same budget year that we talking about So these systems are imperative. They save tons of money. And I think that's the hard part about public health is that it's really hard to tell you that we have protected you from getting a disease because we went into contact tracing. So a disease never reached you. But these systems allow us to do that. It allows us to place vaccination into the community for the providers. It allows us to see who has immunity through vaccination. It allows us to see who we need to outreach to in the communities and where the exposures have happened. I think our folks for the recent measles exposures would be at a huge disadvantage to not have these systems in place. And I'll just say, you know, I think it's completely valid to do an assessment. I think that the assessment needs to happen in time for funding to happen for this program. And if it's not done, then it needs to be funded until the assessment is done. But it shouldn't be, you know, we're just going to cut the funding and do an assessment will come in someday because that's not really a plan. So I'll leave it at that. Thank you.

Good afternoon, Madam Chair and members. Jack Anderson on behalf of the California State Association of Counties in support of the CHIAC-COAC-SEIU request for the public health IT systems in the budget year. Thank you.

Madam Chair, Bruce Palmer with the California Association of Public Health Lab Directors, in line with HOAC and CHIAC and SEIU in support of investments for CDPH IT systems. Thank you. Thank you so much.