Assembly Budget Subcommittee No. 1 on Health , Monday, March 9, 2026
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Assembly Budget Subcommittee No. 1 on Health California State Assembly
Follow its sittingsSpeaker 1
So again, more federal red tape. So when we look at these two pieces together, we're really looking at about 1,800,000 Californians losing Medi Cal coverage, which is detrimental in a state that covers about 15,000,000, with Medi Cal. And studies have shown from other states that work requirements really don't, do anything. They don't meaningfully increase employment. They don't meaningfully increase access to health care.
In fact, they just create new barriers and complicated administrative steps and more paperwork and more challenges with getting health care. So California has never, implemented requirements like these, and I do believe that we owe it to our constituents to understand how this is gonna unfold, what California is gonna do about it, how we are planning into it so that the least number of people lose care due to this kind of red tape. And then our last topic, we'll examine how HR one and related federal actions affect immigrant communities' access to care. So under HR one and various other federal actions, we know that the federal government is eliminating health coverage for entire categories of people who are lawfully present in this country. So for those that may have not, dug into the details on this, this includes refugees and asylees who were granted protection by the US government after fleeing persecution.
These folks will no longer be eligible. Victims of sex and labor trafficking who are granted visas because they cooperated with federal law enforcement to prosecute those crimes will no longer be eligible. Afghan parolees who assisted with US military operations will no longer be eligible. And in all of those instances, the federal government did grant these individuals their immigrated immigration status, their lawful immigration status, but is now taking away, health care coverage. So today's hearing is not just about policy mechanics of the changes, but really to understand the human consequences that will unfold because of what the federal government is doing under HR one.
So we will do a couple of house housekeeping items. As you heard, we're gonna start as a subcommittee, or if I didn't say that before, we're obviously starting as a subcommittee. And, we will have public comment in person at the end of each issue and would like for your comments. It looks like a number of people are here today, so ask that your comments, be restrained to one minute to allow everyone to make their public comment and to please direct your comments to the specific issue at hand. If you're unable to be here in person today, you can submit written public comment via ASM budget at asm.ca.gov.
And at the end, we will open to public comment for items that are not on the agenda. That'll be at the end of the hearing. So we are gonna jump into issue one, which is the impacts of HR one and federal actions on the covered California marketplace. And we'll start with our first issue covering the covering that topic. For this panel, I'd like to welcome to the witness table representatives from Covered California, the Department of Finance, as well as the LAO.
We we have a lot of big teams today, so we moved hearing rooms and tried to get more chairs and appreciate everyone who, is able to be with us. So we're gonna start with Covered California to provide an overview of the HR one marketplace provisions, the new CMS federal regulations, the impact of the expiration of the enhanced federal premium subsidies, an update on the 2026 California premium subsidy program, as well as an update on this year's open enrollment period. And if you can just introduce yourselves before beginning your testimony. After that, we will go to Department of Finance to provide any additional context on the state's HCARF projections on the 2627 budget, posture for the special fund. And then finally, we'll go to LAO to see if there's any additional, comments.
So I'll start with you covered California and then let each of you introduce yourselves as you present. Thank you for being here.
Speaker 3
Thank you for having us, chair. Good afternoon, chair and members. My name is Jess Galtman, the executive director of Covered California. I am joined today by Katie Ravill, our director of policy eligibility and research, who will assist with any questions that you may have following my remarks. I wanna thank you for the opportunity to be here today and for hosting this important public hearing.
As you know, there is a lot to cover when it comes to cover California and federal policy changes from h r one and regulations that we've seen. As a marketplace under the Affordable Care Act, covered California is subject to federal law and rules. HR one and new federal marketplace rules will have sweeping impacts and along with the expiration of the enhanced tax credits are expected to lead to a substantial decline in marketplace enrollment and a rise in the number of insured by imposing policies that will limit enrollment opportunities, add new administrative burden on consumers, limit eligibility, and increase consumer costs. To give just a few examples, Covered California will see its 2027 open enrollment period, our next open enrollment period shortened from twelve weeks to nine weeks, giving people less time to enroll. Gender affirming care is now no longer considered an essential health benefit by the federal government.
HR one removes tax credit repayment caps, potentially subjecting consumers to much higher tax bills when they file their taxes. In future years, consumers will face stricter enrollment verifications and lose automatic renewal, potentially losing coverage simply due to new and unnecessary red tape. We are also analyzing a new federal proposed rule, the notice of benefit and payment parameters that would implement elements of h r one and federal rules by codifying restrictive eligibility policies and reducing meaningful state marketplace flexibility. One thing HR one did not do was extend enhanced premium tax credits. The enhanced premium tax credits accounted for 2 and a half billion dollars of premium assistance for Californians each year, and they have now expired as of December 31, and consumers are experiencing higher premium costs in 2026 as a result.
We estimated the 2026 monthly consumer premium costs would on average nearly double, an increase of 97% in monthly payments. Middle income consumers no longer eligible for any tax credits, particularly those who are older or live in high cost areas, are seeing more extreme increases. And in total, as many as 400,000 Californians were estimated to potentially drop marketplace coverage over time due to this loss of affordability. To give an update of where we are as of today, open enrollment ended on January 31, and after doing everything possible to support consumers through these changes, we are closely tracking 2026 enrollment trends. Over 1,900,000 Californians did sign up for coverage this open enrollment representing a 3% decline in enrollment from the same time last year.
But there is more to this complicated story. New enrollment is down 32% and at its lowest level in years, about a 110,000 fewer new sign ups compared to last year during this open enrollment. New enrollment among middle income Californians above 400% of the federal poverty level, about $62,000 a year for an individual, declined 59% after their tax credits were entirely taken away. More consumers opted for lower level bronze coverage, which has a lower monthly premium that then comes with higher deductibles and out of pocket costs and associated outcomes from those affordability burdens. And it is still too early really to see the full effects on enrollment for our renewing consumers, but we are seeing some trends emerge.
Over 70% of renewing enrollees who switched their plan tier moved to bronze coverage compared to just 28% last year in 2025, a similar trend to new consumers opting for bronze plans. Termination rates among middle income consumers are nearly double that from last year, 22% compared to 11%. And we really are continuing to track enrollment outcomes for our renewing population very closely, and that will continue in the coming weeks and months. Given planned billing cycles and grace periods that allow people to keep coverage when they have not paid their bills for a limited period of time, it will take time to see a fuller picture on overall impact. We may also see higher cancellation rates throughout the year as consumers who want to stay covered find that in the end they cannot afford their monthly payments.
Unfortunately, we have also seen disproportionate declines in new enrollment among Latino and black African American Californians. When enhanced premium tax credits were available, we saw the largest increases among these same communities, and so we anticipated that we might see this disproportionate enrollment impact with the expiration of enhanced premium tax credits, and unfortunately, that is coming to bear. We work to reach and connect with communities of color through cultural first marketing, outreach, communications, our in person assistance through navigators and partnering with community based organizations and communicated much earlier than usual through notices and communications to inform them about changes in 2026 and give them time to plan. We will continue to invest and connect with and support these communities to promote coverage and access to care and try and counteract these disparate outcomes. While these numbers are stark, we are seeing less severe coverage declines than the rest of the country.
For example, we are down 3% in California. Healthcare.gov states are down 8% in enrollment as of today, and we want to highlight the meaningful impact of California's continued leadership to keep coverage affordable. This legislature appropriated a $190,000,000 from the health care affordability reserve fund, which I will call HCARF, to covered California to provide financial help in 2026. Currently, these state funds provide premium assistance for our lowest income enrollees with incomes up to a 165% of the February party federal poverty level or about 26,000 annually. While the $190,000,000,000 cannot backfill the 2 and a half billion dollar loss in enhanced premium tax credits, the program is making a meaningful difference.
Nearly 390,000 enrollees are benefiting from these funds. Renewal rates among lower income consumers receiving state funded premium support are consistent with last year, unlike the significantly higher cancellation rates at higher income levels. In closing, I also want to make sure to cover the remaining questions outlined in the committee agenda.
Speaker 3
comes to potential modeling for HCAR funds, we have not yet modeled other uses of HCARF resources. However, we could do that quite quickly if needed. We can also share our previous modeling scenarios and discuss the other income based scenarios presented in the agenda with you and your staff. With regard to models that may support immigration statuses, and I know this is one we'll talk a lot more on the third panel, we do want to note that under h r one, approximately a 120,000 lawfully present immigrants currently enrolled in Covered California will no longer be eligible for federal tax credits beginning in 2027, and their tax credits are valued at approximately $600,000,000 each year. Regarding HR one and federal rule implementation, we are very actively planning for eligibility changes for lawful present immigrants as well as the shorter open enrollment period, both of which take effect for 2027 coverage.
These changes will each require thoughtful and comprehensive communication and engagement strategies with consumers and the public at large, and our planning is very well underway. Other federal enrollment and verification policies are not taking effect until 2028, but we are already developing implementation strategies that will do whatever can be done to mitigate consumer impact and enrollment barriers. With that, thank you again for having me, and we're happy to take any questions.
Speaker 1
Briefly, I'll just end on so we have established quorum, and then we're hearing that the audio is not getting picked up. So if you can, move the mic closer to you when you when you speak into the mic. I'll defer to the who's next. I know we have covered California and then we have Department of Finance and then we have LAO.
Speaker 5
Angel Alonso Coronel, Department of Finance. No further questions. Happy to answer any questions you have.
Speaker 1
Okay. I'll turn it to my colleagues just to see if anybody had any opening statements that they wanted to make. I have a number of questions that I'll jump into unless I see someone telling me they wanted to make an opening statement. Alright. Well, number one, I wanna say thank you for the, work that you've done, and I know this is a particularly challenging hearing because the effects of HR one are so incredibly detrimental.
I heard you say that you have yet to do the modeling, is that what you said, for the the on how to use the HCARF resources. Is that correct? You have past modeling yet to do future modeling.
Speaker 3
That's correct. And and part of that is so in the past, we've modeled different versions. Obviously, we've now seen the governor's budget that puts forth a $190,000,000, and we can produce really any modeling through technical assistance that would be helpful looking at either mitigating further the loss of the enhanced premium tax credits or mitigating the future loss of lawful present impact, but would look for guidance from this body in terms of what would be most helpful, in in producing that modeling. And I'll let Katie add anything she'd like.
Speaker 6
No. I'd say that's exactly right. And if the appropriation stays at a 190,000,000, our process would be to rerun
Speaker 6
we can still afford the program we have today into the next year at that same funding level. But, again, with any enhancements, we can model what that would do.
Speaker 1
Got it. For the administration, it looks like we're projecting closer to $370,000,369.4 to be more exact of unobligated HCARF balance for 2627. Does the administration intend to propose any kind of updated numbers for the state subsidy program for 2027? And if so, what could that what could that look like given the information that we've heard about the drastic increase in disenrollment and decrease in new enrollments. What could it look like to help more people into the marketplace?
Speaker 5
Yeah. So the governor's budget maintains 190,000,000, from the health care affordability reserve fund to provide subsidies to low income covered California enrollees up into 165% of the federal poverty level. The governor's budget does not, propose any new significant proposals and will is is is working on continuation of previous investments at this time.
Speaker 1
Is is there a perspective on how to help the middle class folks given that there's 369,000,000 projected?
Speaker 8
Yeah. Joseph Donaldson, apartment of finance. So as my colleague noted, you know, obviously, the governor's budget is maintaining the previous investment of 190,000,000 for the state subsidy program. Right now, I think just how we've talked as a whole about building the 2026 budget of when we're having discussions of trying to mitigating those impacts of H. One, we really need to kind of take it holistically of, you know, the state is not in a position to backfill all loss federal funding while also acknowledging that we do have out year structural deficits.
So as of now, the governor's budget maintains that current investment, but to the extent that that is a priority of legislature, we can continue to have those conversations.
Speaker 3
I was just gonna add since you asked specifically about the middle income group, it might be helpful to know that last year, we did model what it would cost to replace the premium subsidy that California established prior to the enhanced premium tax credits that did provide some assistance to that middle income group at 400% of federal poverty and above, and that modeling came out at $454,000,000 to replace the program design that was previously implemented. Obviously, we could update that if helpful.
Speaker 1
And you could do less than 400, but less than 400% above, but more than a 150% above. I'm assuming are somewhere in the somewhere in there that we could find a way to help people?
Speaker 3
We can either model a result and give you a a dollar amount, or if you give us a dollar amount, we can give you options. So we can do any of the above.
Speaker 1
Great. Great. Thank you. And then I know you mentioned a couple of strategies for addressing various specific communities. Can you elaborate a little bit knowing that the drop off was highest among Latino consumers, then black and African American consumers also very high if we solely look at income and not, not background?
So we are I I would
Speaker 3
just start by saying we are incredibly proud of the investments that we've made in recent years and the fact that empowered by the increased affordability under the enhanced premium tax credits, we were able to make disproportionate gains among our Latino and African American communities that have historically lagged when it comes to rates of coverage and take up. And so we are, I think, similar to to this committee devastated to see as the federal government pulls back on affordability that those same disproportionate impacts are are being reversed. We really leaned in in thinking about how are we communicating changes. I will also tell you when we brought different options for the use of the $190,000,000 to our board last year, we shared impact across race and ethnicity, which is not the same when you look across income levels, and so that was a factor that was considered in determining how to spend the funds. This year, we leaned into culture first messaging.
We expanded our translations into more languages even than we've used in the past, which were significant, and really, tried to show up in community with trusted community partners to deliver the truth of messaging. I also want to highlight, right, what we'll talk about on panel three, which is the overlay of the fear and concern among our immigrant communities, which while it's hard to tease out in the data, we also believe is having a dampening impact on coverage and enrollment, particularly among our Latino communities.
Speaker 1
Thank you for that. I'll turn to my colleagues and see if there's any questions from any of our community member or, excuse me, committee members for this first panel that's really focused on covered California and assembly member Banda. Thank you, chair.
Speaker 6
I wanted to just pick up on this last thread around the modeling. So you said you can give give you a number to back up into or give you a population to back up into for the modeling?
Speaker 3
Right. So you could say we have 250,000,000 and we can say here are four things you could do with that, or you can say we wanna backfill all of the loss of lawful present tax credits for this subset of lawfully present immigrants and we can also produce that number. So really, I think the question is is there are we starting with a dollar amount or are we starting with a policy goal? And we can model any of the above.
Speaker 6
Okay. I think I think it would be helpful then for us to be able to get clear on what that policy goal might be Because I think another potential thing to consider is the profile of the consumer that is going to be the most impacted. Our lower income consumers, higher income consumers, And certainly, can you share what will happen for legally present immigrants under HR one right now in terms of their coverage?
Speaker 3
In 2027, as we'll cover in detail on panel three, large groups of lawfully present immigrants, a 120,000 of our current enrollees will lose all of their, federal affordability assistance in 2027. And what will that
Speaker 3
Generally speaking, they are not on Medi Cal because their income is too high for them to be eligible for medical, so no. So, basically, they will
Speaker 6
I think that one of the considerations that we have to make is just the potentially disparate impact on different types of consumers based on the overall overarching realities of HR one that we are dealing with and just a recognition that there will be whole swathes of community members, 120,000 is your estimated number, who will not be able to have any kind of an option of any kind of health care.
Speaker 3
And I'll just reshare because I think it was before you arrived that we value the tax credits that group of people will lose at $600,000,000 annually, to give you one number to start with.
Speaker 6
Thank you. I appreciate that. And then I just have another question around how ultimately the authority around making prioritization decisions are made. So who has the authority to design the HCARF dollars right now?
Speaker 3
So his well, have been, different versions of this. The last time with the $190,000,000, this body approved an amount of funding and then allowed the covered California board to review options and to make a determination about how those funds were best spent. I would say my understanding of that is is that was largely because so much was uncertain. We didn't know if the enhanced tax credits would be extended or not, and that gave us the flexibility to have we had two very programs at the ready depending on what the federal government did and didn't do. But certainly the legislature could define how those funds would be used through the through the budget process and the legislative process.
Speaker 6
Right. Because absent policy directive from the legislature, then the Covered California Board is essentially left to its discretion to make that decision.
Speaker 3
With public comment and a clear outlining of options as well as trade offs across different measures. Yes.
Speaker 6
I think to the chair or through the chair, I certainly would hope that the chair of the budget subcommittee and this legislature, given the incredible dynamic nature of these funds and how HR1 will get involved would have a very defined role in the allocation of those HCRF dollars, just for your consideration.
Speaker 1
Thank you, Assembly Member Bonta. And we'll move to Assembly Member Stephanie.
Speaker 9
Thank you, chair. So many egregious new rules and provisions to review. And on page four of the materials, there was one that I noted about allowing issuers to require payment of past due premiums. And the keyword that I saw was permits. And it doesn't require, in my reading of that, inch the issuers to actually require payment of past due premiums.
And I'm wondering whether or not a health plan then could choose to waive or not enforce this requirement. Do you think that would be allowable?
Speaker 3
If it's okay, I'd like to take that one back and come back to you once I've consulted with legal counsel to make sure I give you a correct answer.
Speaker 9
Okay. Because I I am wondering if HR one does not mandate that insurers actually require that people pay these past due premiums before they enroll, if we have any leverage over the health plans to make sure that they don't enforce this new egregious rule?
Speaker 3
I'll just say, generally speaking, to the extent the federal government gives Covered California flexibility to make decisions that minimize red tape, minimize consumers being shut out, and make this process of getting health care simply easier, we always take advantage of those flexibilities. Thank
Speaker 1
you. Any other questions? Okay. If not, we will move to public comments. So specifically for our first panel on Covered California, if you have public comment, you're welcome to give that now.
And as a gentle reminder, even if not that many people come to the mic, we'll still ask you to keep your comments to one minute.
Speaker 10
Good afternoon. Michelle Johnston with the National Multiple Sclerosis Society. I'm here on behalf of, almost sixty eight thousand Californians living with multiple sclerosis. Delays or gaps in necessary diagnostic tests or treatment can worsen the prognosis for an individual living with MS and may lead to serious long term and irreversible consequences. Without adequate medical and prescription drug coverage, managing this disease becomes financially impossible for many.
The average annual cost of living with MS is over $88,000 a year. The median annual cost of brand disease modifying treatments was over $113,000 as of July. As you work around covered California, we encourage you to maximize the funding for the California premium subsidy program in 2027 and beyond to help individuals continue to maintain their coverage. Thank you.
Speaker 11
I'm Christine Smith with Health Access California. I just wanted to thank the the inclusion of the $190,000,000 that was secured in last year's budget to continue on to this year's budget, for the subsidies and then also, for Covered California stuffs. Just incredible work on modeling every possible scenario. So just really do appreciate them. Thank you.
Speaker 1
Seeing no other public comment, we're gonna move to our second issue which is the impacts of HR one on medical enrollment and the state's implementation framework. We're going to invite to the witness table a number of people representatives from the Department of Health Care Services, the Sacramento Native American Health Center, the Department of Finance, and the Legislative Analyst Office. We're going to begin with DHCS who will provide an overview of the work and community engagement requirements as well as six month renewal provisions DHCS's estimates of coverage losses and the department's implementation plan and then we'll move on to a few other people. I think okay. Because space is tight, if, LAO wouldn't mind trading with doctor Hadini.
I apologize if I'm saying your name wrong from Chief Clinical Officer at the Sacramento Native American Health Center. When it's your turn, Doctor. Hadini is going to offer his perspective on how these changes are affecting patients and safety net providers on the ground. Then we will invite LAO back up in case LAO has any additional comments. So we're gonna start with DHCS, and, please go ahead and introduce yourself and start when you're ready, and then we will, move to doctor Hadi Niyi.
I should have practiced your name before getting up here, but you'll tell us how to say it.
Speaker 4
Good afternoon, madam chair members. Michelle Boss, director of the Department of Health Care Services. HR one enacted 07/04/2025 mandates new eligibility and enrollment requirements for Medicaid programs nationwide. California must comply with these federal changes, which include work and community engagement requirements for certain adults, changes to eligibility criteria for groups of noncitizens, six months renewal requirements for specific groups, and cost sharing provisions. These requirements are significant and make devastating changes to the Medi Cal program.
Under HR one, the work and community engagement provision, which requires adults eligible as part of the new adult age adult group or part of the Affordable Care Act optional expansion to demonstrate work or community engagement participation. It's estimated to lead to two hundred and thirty three thousand Medi Cal members losing coverage by 06/01/2027, rising to 1,400,000 by 06/01/2028. The six month eligibility redeterminations, which require the state to conduct eligibility redeterminations every six months rather than annually for the new adult group members will lead to an estimated two hundred and eighty nine thousand Medi Cal members losing coverage in by June 2027, ultimately rising to 400,000 members. As we work to implement the provisions of HR one, we are guided by the following principles to mitigate the harms imposed by these new federal requirements. We will automate to protect coverage, use state, federal, and other data sources to verify eligibility whenever possible, reduce paperwork, and prevent coverage loss due to administrative issues, communicate with clarity and connection, deliver clear plain language information in all required languages, ensuring messages are culturally appropriate and easy for members, families, and caregivers to understand, simplify the renewal experience, streamline our Medi Cal renewal process with clearer forms, and simplified six month renewal steps to help members stay enrolled, educate and train those who serve Medi Cal members, provide our counties, our coverage ambassadors, and other community partners, with information to help our members navigate coverage.
This includes training, practical tools, and ongoing support to assist our members. And then finally, provide timely and transparent communication to our members, sharing updates through multiple channels so members have sufficient time to prepare for and comply with the new requirements. Our goal is to make this transition as smooth as possible by providing clear information, reducing burdens, and working closely with our members, counties, health plans, and community partners. At the January, we released our HR one implementation plan, which outlines our strategy for implementing these program requirements pursuant to HR one. No other state has released such a plan.
We are a leader in ensuring that our changes are transparent and clear to so many individuals impacted by these provisions. The implementation plan provides detailed guidance on how DHCS will implement these changes while working to minimize disruption. To familiarize our partners with this plan, we've hosted a few, all comer webinars with thousands of people joining to learn about these, plans and our our implementation. Additionally, we are committed to educating our, those who serve our Medi Cal members. This includes our county partners through comprehensive training, monthly work groups, and additional implementation provisions.
As we will speak to in a minute also, we have multiple areas where we are working on our outreach to our members. We have a budget change proposal requesting 17,500,000.0 for an outreach and engagement plan. We have 4,000,000 for clinic navigators proposed in the governor's budget. Also, additional actions related to our enhanced care managers, street medicine, and our community health workers. I will now turn it over to, Tyler Sadwith, our chief deputy director and state Medicaid director to answer some of the questions in the agenda.
Speaker 12
Good afternoon, madam chair and committee members. My name is Tyler Sadwith. I'm the state Medicaid director for California. As director Boss mentioned, one of our guiding principles is to, automate data and use data matching to the maximum extent possible to, minimize disenrollments in Medi Cal. One of the questions in the agenda materials about the 50% disenrollment rate that reflects the assumption used for those individuals subject to work requirements who cannot be automatically determined exempt or compliant.
So I'd like to provide a little bit of information about that assumption. DHCS reviewed literature developed by the Urban Institute related to the several states, Arkansas and New Hampshire, that have implemented work requirements in Medicaid and specifically reviewed the disenrollment rates associated with individuals who were subject to manual reporting and verification. Based on the literature, both states experienced high procedural disenrollment rates for individuals requiring manual verification across the two states, the average disenrollment rate was seventy seven percent. However, in California, we are proposing several measures to mitigate the impact of disenrollments on individuals that we cannot exempt or deem compliant on an ex parte basis. We are proposing, as Director Boss mentioned, dollars 4,000,000 for clinic navigators in the governor's budget to guide Medi Cal members through work requirements at application and renewal.
We are proposing in the governor's budget $17,500,000 for an outreach campaign to develop a tactical outreach strategy to raise awareness, to develop social media toolkits for various groups such as tribal partners, coverage ambassadors, providers, Medi Cal managed care plans, and more. This outreach strategy includes earned media, paid media, and other dissemination in all 19 Medi Cal threshold languages. In addition, we have a strong network of coverage ambassadors who are people that help people in their community find, better understand, and keep their health care coverage. The department provides toolkits and information such as flyers, informational documents, and social media to equip coverage ambassadors to talk to their community in a way they understand. We have over 7,000 individuals across the state signed up to be coverage ambassadors, and this was a successful initiative launched during the public health emergency unwinding process.
We have enhanced care management providers who are positioned to help Medi Cal members navigate the eligibility process, gather needed documentation, and help maintain continuity of coverage. Another key benefit is community health workers who serve as trusted messengers in the community and can help people navigate the Medi Cal eligibility and work requirements process, including manual verification. Another benefit that is relevant is street medicine, which is covered under Medi Cal and which includes care coordinators who can help members complete Medi Cal applications and assist with gathering documentations. Neither Arkansas nor New Hampshire implemented such an array of services and supports to help individuals who cannot be determined on an ex parte basis. And based on these mitigation measures, we reduced the disenrollment rate assumed for those individuals subject to manual reporting from seventy seven percent to fifty percent.
There's another question in the agenda materials regarding the estimated share of projected coverage losses that will be procedural, meaning the member is eligible but fails to complete the red tape or the paperwork versus substantive, meaning the member does not genuinely meet the work requirements. At this time, the department does not have such an estimate as this is a new policy for Medi Cal, neither is there a robust information from the other states that have implemented this or in the literature. We do know at a very high level from self reported survey data that sixty two percent of non disabled Medi Cal members aged 19 to 64 report working either full time or time. And of the same population, we know that fourteen percent report being a caretaker, nine percent report having an illness or a disability, and six report going to school. This is an analysis performed by the UC Berkeley Labor Center based on American Community Survey data from 2023.
So this analysis suggests most individuals in this population would appear to either be exempt from the work requirements or satisfy the work requirements. However, there are limitations. First, this is self reported data. Further, based on the limited information, it is not possible to determine that all of these individuals would meet the official exemption criteria or the official work requirements criteria established in either HR one or in federal guidance, which is still forthcoming and which we are still waiting for. However, even though we cannot project this estimate at this time, the department understands the importance of capturing this information once the policy is implemented.
We are planning for this in our implementation design. We plan to display refined data related to members, not retained subject to work requirements and being disenrolled on our monthly eligibility dashboard. And we plan to distinguish members in several different ways to help illuminate this point. We plan to be able to track and distinguish members who could not be determined on an ex parte basis and were requested to submit, manually submit information, members who did not respond at all, members who responded with the renewal packet but did not provide enough information regarding work requirements to enable a determination either way, and members who responded and included information but substantively did not meet the requirements. At this time, I will turn it over to Ying je to round out the questions from the subcommittee.
Speaker 7
Good afternoon, chair and committee members. Ying Zhou Huang, the deputy director for health care benefits and eligibility at Department of Health Care Services. Wanting
Speaker 7
little bit on the questions regarding outreach and the system and the department's kind of current collaboration with our county partners and lastly, sharing a bit more on the budget trailer bill and the current status of the federal guidance. So you asked a little bit in terms of what our current assessment of our county administrative readiness is and I think in general sharing that the approach that the department is taking is a very structured support. We are utilizing a lot of the lessons that we learned during the Medi Cal continuous coverage unwinding. So in the DHCS HR1 implementation plan that was released in January '26, we discussed in a very fine detail matter the various work groups that we are currently, that we have started with the counties since the 2025, and these meetings take place on a bi weekly basis where we provide technical assistance to our county's regular county requested trainings and it's important to understand that there's currently very little federal guidance on this policy but it's important because we've learned through the unwinding there's a lot of a change in the county workforce. So I think through this time we've been kind of hosting quite a few of county refreshers on various kind of salient areas as it relates to Medi Cal eligibility determinations and providing technical assistance of very specific eligibility scenarios which we know serving a population of this size there's just so many different types of scenarios that can present itself at the county.
And also, as the federal government is releasing guidance, we are committed to providing timely federal interpretations of the federal guidance in the form of an all county letter to our counties and we know this is super important as we are planning on implementing this on 01/01/2027. Through these work groups, the counties have an ability to provide feedback to the department in terms of the various deliverables. They also have an opportunity to provide comments on policy letters, kind of adding to the richness of the policy letters that we provide for them so it's actually off the ground level that they can actually implement and actually have conversations with members or applicants that present themselves at the county lobbies. To also facilitate county and system readiness, the all county letter that I referenced, the department published a preliminary guidance in December 2025, and that is well before any federal guidance because we know concrete policy guidance is of the most critical importance to actually starting the work given the rigor of the various federal provisions within HR1. In understanding the administrative pressures on the counties, DHCS is maximizing the use of data sources as Tyler was sharing through the form of ex parte which is really a no touch process where we're able to gather many of the data sources in the background so that we're not burdening the applicant or the Medi Cal member at kind of their normal scheduled renewal.
And one thing of note is with HR1, it really pushes a lot of state Medicaid agencies to look at very creative ways to pull in information that's not normally known to the eligibility systems. So we'll talk a little bit more about that in a little bit, but wanting to really kind of push the piece on the automation and maximizing the possibilities of looking at different sources that could allow for an actual exemption to work and community engagement or allow us to check for work and community engagement compliance quickly without asking for additional information. And at this time, we are still working with the County Welfare Directors Association and learning a lot more about what the impacts are with the counties in terms of their workload. I think just generally to say we recognize there is a change in kind of the workflows for counties with additional kind of provisions in policy. We are deeply committed working with the counties closely and in collaboration on next steps.
You also asked about our outreach strategy for HR1. In our implementation plan, we detailed a two phased approach to how we are thinking about outreach in general. And the two phase approach sounds quite familiar. The department did use this during the continuous coverage unwinding where we were able to retain lots of individuals in coverage because at that time we were afraid with the passing of the pandemic, we will lose, there will be a significant loss in coverage. So we took a lot of those lessons learned from that approach and in the implementation plan, we spelled out phase one where it is preparation and awareness and that process is currently underway and we anticipate that process to be ongoing until about September but more than likely, it will still be kind of in the shadows as we start phase two.
Phase two shifts the tone of phase one in terms of phase two kind of pushing for a call to action and we're anticipating that phase to begin sometime in September, October timeframe. And the difference between the two is with phase one, it's really preparing the individuals that will be impacted by the significant changes under the federal HR1 provisions. So already in February, we have started outreach to individuals that are starting the renewal process in January 2027, February 2027, because these individuals will be kind of the first groups that will be up for a potential work requirements assessment. So, we're doing it in cohorts because we want to minimize the confusion given that, you know, there's quite a few of quite some concerns in the community about just texting in general but we know text messaging is the most popular modality. We've learned that through the unwinding outreach campaign and continuing to leverage that.
In the summer of this year, to kind of continue with the phase one approach of PrEP and awareness, we will be sending a general outreach notice translated in all 19 Medi Cal threshold languages to all impacted individuals, the new adult group, which is approximately 4,600,000 individuals, and with FAQs, etcetera. And the tone of the text message that will complement this will change as we're gearing up for phase two where it's really starting to say, hey, start paying attention to the things that may be coming to you in the mail. There's changes to the Medi Cal program and you need to pay attention. And we also include links to a page on the DHCS website that's called What Members Need to Know. And I think in general, really trying to make it as consumer friendly as possible in an effort to mitigate the potential loss of coverage.
In the governor's proposed budget, we requested $17,500,000 for outreach and through the requested outreach dollars, it will be complementing kind of the phase one and two approach that I've just described and we are looking to work with the vendors through the requested outreach dollars and really using some of the tactics that we've learned through the unwinding specifically things like demographic targeting, looking at census data, household data that aligns with the income threshold for Medi Cal eligibility. So we have an ability to target certain areas, tailor messages to certain areas in language targeting. So for example, if there is a population that resides in Los Angeles County that may be largely Spanish, you know, we will have an ability to use kind of the data through the census, pairing that up with medical information, and certain languages over the others so our individuals could see it in ethnic grocery stores, bus stops, etcetera. So those are very successful strategies that we use and looking at geographic targeting as well. So looking at placing digital ads in counties by looking at various zip codes where more Medi Cal members reside.
And through the vendor, through the outreach dollars you're requesting, we are looking to create social media toolkits and newsletters and Medi Cal threshold languages, video placements where again we were able to put together a thirty second, sixty second videos in all Medi Cal threshold languages. It's downloadable on the DHCS website and has targeted audiences whether it be for Medi Cal providers, our tribal partners, managed care plans, and it's free for them to disseminate into the community. And partnering with ethnic media, we found this to be very helpful where we went on various, had interviews with various ethnic media. We partnered with Univision, Telemundo, when we were doing the continuous coverage unwinding where we had digital placements on the radio, on TV, on Hulu, on YouTube, and recorded lots of different versions of the kind of the messaging that was critical for this effort so folks could hear it within their drive to work, for example. And we know that the mixture of digital platforms is probably the most important and we need to target those kind of platforms where our members actually use.
And in terms of the metrics that DHCS will look to measure. So, as part of the kind of the standard vendor kind of capturing of how many impressions which is like how many ads we've placed across the state. We also look at clicks to certain websites because we will be creating like a devoted website for this process and how many times the website's embedded in various areas like video completions and more importantly, what we learned quite a bit is how many times somebody actually clicks on the text message and we have an ability to measure that and how effective that is so they actually go to the page and go through the process. And of course, most importantly, like Tyler was sharing,
Speaker 7
And to, the most importantly, in terms of a metric for us to put on the Medi Cal eligibility dashboard in terms of measuring disenrollments, and we will have an ability to look at what that looks like. So lastly, in closing, wanting to share the trailer bill language is already posted on the Department of Finance's website. We did receive updated guidance from CMS just on Friday on six month redetermination, so the department is reviewing that closely, and we will look to capture as much as possible and pivot as needed, but currently at this time, the budget trailer bill that's posted on the website captures all the eligibility provisions that go into effect prior to 2028. Thank you.
Speaker 1
Thank you so much, and I'll turn to the esteemed doctor, chief clinical officer at the Sacramento Native American Health Center and I'll let you introduce yourself. Thank you.
Speaker 16
Thank you. Thank you chair and members of the committee. Thank you for the opportunity to speak today. I'm Doctor Hakeem Admi Junior. Most people call me Doctor Hakeem and I serve as the Chief Clinical Officer at Sacramento Native American Health Center, which is a FQHC, a federal qualified health center that serves Native American populations as well as other underserved and priority communities in Sacramento County.
I also am a family and community medicine physician who sees patients regularly. So given that, that gives me a direct view of these policies and how these policy decisions will have an impact on our patients, provide us in a safety net health care. So with that said, community health centers are the backbone of primary care access in California and currently across the state health centers operate around 2,300 clinics serving around 6,000,000 people per year and including about one third of all medical lives in California. Like many health centers in the state, Sacramento Native American Health Center provides integrated medical, dental, behavioral health and vision services. And our organization was founded to address the healthcare disparities that many have faced, but including our American Indian and Alaskan native populations, but we also serve everyone regardless of income, insurance status and background.
That approach really reflects our core values as being a native American health center where we're caring for the entire community. Today I'd like to highlight three areas of concern related to the current policy environment. First over the destabilization the destabilization of the health care safety net. Community health centers serve about one third of all Californians on medical yet we make up more than half of all primary care visits for that same population. One reason we're able to do that is because of the Medi Cal prospective payment system or PPS, which ensures safety net clinics are reimbursed based on a true cost of delivering comprehensive care.
This support continued efforts to provide medical, behavioral health, dental and enabling services to those in need. Recent state budget actions would eliminate PPS reimbursement for state only medical populations, primarily patients with unsatisfactory immigration status beginning in July 2026. Looking at that from the statewide perspective, this represents roughly a 1,000,000,000 annual reduction in funding for community health centers. Here in Assembly District 6, Health centers would lose more than 7,500,000 each year in revenue tied to providing care for these patients. At the same time, federal federal policy changes are expected to push millions of people out of medical in the coming years.
Combined these changes significantly weakened the financial stability of very of the very clinics that serve as the foundation of the safety net. Leading to losses of at least 1,600,000,000.0 in the coming fiscal year and growing exponentially thereafter. And the reality is simple. There's no parallel system ready to absorb these patients. When primary care access becomes unstable, we see predictable system impacts.
More emergency department visits, more uncompensated hospital care and greater strain on the county public health system. The costs do not disappear. They just simply move elsewhere and usually at a much higher cost. Second is the operational impact on community health centers. Health centers are already navigating significant pressures, which include rising operational costs, workforce shortages across the health care sector and growing demand for services.
If reimbursement declines while more patients lose coverage, clinics will be asked to do more with even less resources. In practical terms that could mean slowing the hiring process of physicians, nurses and behavioral health providers, delaying the expansion of services or reducing clinic hours and programs. These are not decisions any health center wants to make, but without stable reimbursement, they may become unavoidable. Third is the impact on patient care. While immigrant communities will experience the most immediate consequences policies that effectively defund clinics for serving these patients ultimately affect all patients in the system.
When access primary care becomes unstable, patient delays occur. And when care is delayed, physicians see the consequences. And I see this regularly inside my class and inside my clinics. I think about Mr. Gonzalez, a patient with diabetes who was finally able to get his medications and receive regular monitoring and without care, he instead presents with a foot infection that leads to an amputation.
I think about Mrs. Tran, who has high blood pressure and high cholesterol, who whose conditions are well controlled on appropriate medications, who now instead present after having a heart attack or stroke. And I think about Elder Tittman, a well respected community member living with heart failure who now presents after a lengthy hospitalization with a pacemaker. These aren't rare cases. They are an extreme.
They are predictable consequences when patients lose access to consistent primary care. It results in higher costs and much worse health outcomes. In closing, the health care safety net is already carrying a significant share of California's health care burden. If reimbursement declines while workforce shortages and coverage losses increase, the system will struggle to meet patient demand. Strategic investment in primary care is one of the most effective ways to protect both patient access and long term health care affordability.
California has already has already recognized this through the creation of the Office of Healthcare Affordability, which has set a goal of increasing primary care investment from 7% to 15% of total health care spending over the next decade. Policies that weaken the financial stability of primary care clinics. Move us in the opposite direction. As you consider the state budget, I respectfully urged the Legislature to protect the prospective payment system or PPS that supports community health centers invest in primary care workforce and ensure reimbursement reflects the true cost of delivering care. Strengthening strengthening primary care is not only the right thing to do for our patients.
It's also the most effective way to maintain a stable health care system. With that said, thank you very much for your time and for your continued commitment to protect California's health care safety net.
Speaker 1
Okay. LAOs, did you have presentation? Okay. Please. Thank you so much.
We may ask you back up, doctor Hakim, if there's questions from members.
Speaker 2
Thank you, madam chair and members of the the committee. Min Lee with the LEO. We would like to offer a few comments on the disenrollment and workload associated with the community engagement requirements and six month renewals. Our office recently released Medi Cal reports that discussed these issues in greater detail. We developed an independent forecast of the disenrollment using administrative and survey data, as well as existing literature.
Our estimate of total coverage loss is slightly higher than the administration's. We estimate that about 2,100,000 fewer people would be enrolled in Medi Cal by June 2028 compared to the administration's estimate of about 1,800,000. That said, we think the administration's estimate is reasonable given the considerable uncertainty that lies ahead. Key uncertainties will include how burdensome people find the new reporting and documentation requirements, the extent to which administrative data can allow eligible beneficiaries to stay enrolled without additional paperwork, and the readiness of county eligibility systems. We think county readiness is important for at least two reasons.
First, it will help ensure smooth implementation of the community engagement requirements and six month renewals, including mitigation of people losing coverage for administrative reasons. But secondly, it may also affect the risk of fiscal penalties in the future. Starting in late twenty twenty nine, HR one tightened certain rules related to reducing payment errors in Medicaid, so the performance of county eligibility systems will be important to comply with these rules. For these reasons, we recommend that the legislature review the May revision proposal to assess whether the budget appropriately reflects the county administrative workload under HR one. As we noted in a recent report, the methodology used in recent years to budget county administration of Medi Cal has lacked a clear link to workload changes.
Accordingly, the legislature may wish to monitor the administration's efforts to address the limitations of this methodology. Thank you.
Speaker 1
Thank you. Maybe I'll turn it over to member questions first. I have a couple, but if anybody else has any, assembly member it looks like everybody. So we'll go down the line. I'll start with assembly member Patterson and come around the horseshoe here.
Speaker 17
Great. Thank you. Well, I think, you know, the first comment that I would like to make is and I don't think anybody disagrees with thisbut I think it's, you know, our responsibility to make sure those who are eligible and need the coverage, you know, get the coverage. I heard about the efforts that are being made already. You know, and this isn't gonna be the the first time you hear this from me.
Sorry to my colleagues. But, you know, it's it's really hard for me to you know, we have so many priorities in this state, you know, getting people the services that we need to get, you know, cutting cost of programs, you know, helping people get Medi Cal, you know. Yeah, we're spending $19,000,000 on an RFP to, you know, help clean up California's image on the national level, and I think that's reprehensible. But, you know, you'd mentioned differences in people who fail to complete paperwork versus actual qualification issues. And I think you have some estimates around that.
Is there going to be what kind of efforts? I think we talked a little bit about that, but can you help me understand a little bit more what kind of efforts in terms of, you know, failing to complete the paperwork, you know, helping those people? What is the department looking at?
Speaker 4
I'll say we have a few efforts underway in that space. So the clinic navigators, the budget includes 4,000,000, and these are individuals who at at community health centers can help individuals with the paperwork or understanding what the requirements will be, and so really kinda using that base and that place where people go to get their services to assist in that space. We also have the coverage ambassadors, which is about 7,000 individuals who really will be armed with toolkits and information to help their community understand what these rules are and when to, you know, take action and the time frames for those things. I'll turn it over. I think there's there's a few areas that we're also thinking about in terms of other places where individuals touch our members.
Speaker 12
Several several other ways that are designed to principally support individuals who can't be matched from the administrative data that we have include the community health workers. So these are trusted messengers in the community, sometimes known as promotoras or community health representatives, who are able to really help these individuals understand the information that the department needs to help them keep their Medi Cal and then help them with developing that paperwork and reporting it or submitting it. And that is a covered Medi Cal service that can assist with that. Another Medi Cal benefit where people with a trusted relationship with a lead care manager under enhanced care management will also have that one to one relationship with someone who can help them navigate the step by step process with reporting that information. And again, for individuals experiencing homelessness, street medicine providers also there positioned in the community where those members are who were not able to match with administrative data, and they can help them that way.
In addition to those covered Medi Cal providers and services, and in addition to the 7,000 volunteer coverage ambassadors that the director Boss mentioned, we do have the proposal for a $17,500,000 outreach strategy, which again will leverage paid media, earned media, and community linguistically and culturally centered communication to reach people where they are in their community to help them understand the information to help them keep their Medi Cal.
Speaker 17
You know, it might be helpful, I think, for us is, you know, when I was helping my parents and in laws and stuff try to get, you know, Medicare and Social Security, and I consider myself, you know, maybe average intelligence or so, but it was, like, hard for me to figure out, you know? And I'm assuming this could be similar. But what would be interesting is some kinda presentation or something for us, you know, to understand what a person might have to go through in that process to obtain coverage under the new HR one. And then if you see policy changes, not so much in HR one, but especially in the guidance, I think there's an opportunity. I mean, I'm sure there'll be plenty of times where there are opinions on that, on what that guidance looks like.
But in terms of changes, policy changes, I mean, you know, some of us can get involved in that, you know, I think in a bipartisan basis, you know, especially when it comes to guidance. Because I think there's a little bit more flexibility there. And, you know, one other thing I kind of wanted to ask about is, you know, because I look, I think at the end of the day, you know, we're all concerned about people losing coverage. I don't know I I think maybe there are populations that we've heard political debates on that should or shouldn't have coverage in as time of limited funds. But I think, you know, if a person's eligible or interested in getting them help, I think we need to be that needs to be demonstrated.
But my understanding is and I know that this isn't exactly this letter wasn't written to you, but, you know, it was written to the secretary in terms of three chairs of congressional committees wrote a letter a few days ago about, you know, waste fraud and abuse programs that California might be you know, ask California to answer some questions. And I know this is recent, but are you aware of whether, there will be responses to those questions?
Speaker 4
Yes. We said we did receive this letter. I believe it was last week, and we we will be responding to the congressional committee. And I would also note, the federal government, CMS, sent a letter, to the state as well in a similar vein on program integrity, and we sent a robust response to CMS. It's about 60 pages, and if you do not have it, we would be happy to share that response with you outlining all of the different ways we kind of think about program integrity in the Medicaid space to really kind of demonstrate how we think it is a critical component of our responsibility as the administrators of the Medi Cal program.
Speaker 17
Okay. I consider legislator threshold language to be audiobooks, to go over the 60 pages. But, you know, in the letter, it is pretty interesting because there are I think, you know, they they do name examples of fraud. I mean, look, I think any there are plenty of fraud in federal programs and state programs that have gone on forever. I mean, this is not like, you know, the question is is what can we do to address those issues and multi million dollar issues?
And I think what the federal government is pointing out is that some of the programs, which I'm not saying, you know, we shouldn't have, like, one example, in home support services. They're they're not saying we shouldn't have them. They're saying those are more prone to potential fraud and abuse, hospice being another one. And I have personally seen examples of hospice fraud that and I think there's gonna be a lot more coming to light on that. And it is it's very scary.
Millions and millions and millions and millions of dollars that make the $19,000,000 the governor spent on RFP look like a drop in the bucket. So so I'm really interested in the responses about, you know, the actions that we're taking. I mean, because we're not talking small sums of money, we're talking about, you know and I'm obviously I know the state isn't interested in having waste, fraud, or abuse, you know, in any of the programs. But if we're going to be limiting have a more limited pot of money, I have an interest in making sure that obviously that what the what the federal government's asking for to ensure that this isn't happening. I'm definitely interested in the answers to those questions about our programs and, and especially if there are some changes that we need to make or if there maybe there's some things that the legislature needs to do to ensure that maybe there's no regulatory approval for that, maybe you need legislative changes or whatnot.
Because I think, you know, things like hospice and in home support services are are very important, obviously. But if they're more prone to fraudulent items, I mean, what can we do about that? You know? So I'll definitely be interested in the answers. Do you have any idea when a response would come on this letter?
Again, I know it wasn't written to you, so but you happen to be in charge of the Medi Cal program.
Speaker 4
We're working to meet the kind of the requested timeline. I'm working with committee staff as well, the federal committee staff to to go through the process. But we're, in the meantime, happy to share our other response that has a lot of the there's a lot of overlap in the information.
Speaker 17
Okay. Great. Yeah. If I can get a copy of that, that'd be terrific. So thank you very much.
Speaker 1
And I have an app that you can use to listen to that report. Oh, yeah. If you need a recommendation. If you need a recommendation. Perfect.
Speaker 6
you for answering that question and for providing us the information about the 60 page report that you all have already put together to address, the congressional letter, which, in my estimation, kind of goes right up there with creating a war and trying to not be responsive to the Epstein files in terms of this challenge or this indictment around waste, fraud, and abuse. I know that, the state of California has done a significant amount of work and has multiple agencies both at the city, county, and state level to ensure, that there is not the level of fraud that, that congressional letter in indicates there might be, and, certainly was on display in terms of the g o p GOP's actions as it related to Minnesota. Wasn't my question. I'm gonna not fall down the rabbit hole that was just offered around that. I did want to get to some of the questions around your disenrollment estimates and assumptions.
So if I were to kind of crosswalk what you offered and what is in the analysis today, so 70 there was 77% disenrollment rate in Arkansas and New Hampshire, you indicated.
Speaker 6
your assumptions are kind of the governor's budget proposal indicates that there's gonna be about a 50% disenrollment rate. Is the lower relatively lower disenrollment rate from 77 for those other states to 50% for us based on the assumptions that you are going to be able to effectively employ the strategies of the outreach, the coverage ambassadors, the community health workers, and the lead care managers?
Speaker 12
Yes, assembly member, with one minor clarification. The 77% disenrollment rate from the two other states and our 50% disenrollment rate does not apply to the entire population subject to work requirements. Rather, it's individuals who are subject to work requirements that we cannot adjudicate using automated data matching.
Speaker 12
Yes. Yes. The about the 60%. Yes. Remit who who have to manually report information.
So that's the the population that the other states, 77% of those folks lost Medicaid. And in California, because we are taking comprehensive steps through the navigators, through the media, etcetera, as you referenced, we aim to bring that DES enrollment rate down to fifty percent.
Speaker 6
And the and the strategies are primarily, as you've indicated, I wanted to just touch upon the strategy related to community health workers, in particular, given the fact that we've difficulty in making sure that community health workers are able to fully bill and recognize, and have managed care plans and medical providers, fully avail themselves of the ability to have those community health worker service benefits reimbursed. Are you all is DHCS planning on issuing any guidance to be able to ensure that folks like doctor Hakim here and other FQHC and community health care providers actually have more of a likelihood of being able to recoup those investments?
Speaker 12
Yes. We're looking at developing resources, technical assistance, guidance to help our Medi Cal managed care plans, provider associations, and in collaboration with the State Department of Health Care Access and Information to really lift up the value of community health workers and ensure they're able to deliver the services, including navigating Medi Cal eligibility and be able to receive reimbursement for those services. So yes, we do plan to issue guidance.
Speaker 6
Great. And then are you anticipating adding any additional resources or provision of funds to the community health workers or the lead care managers or the coverage ambassadors, which I think you said 7,000 volunteer, which I'm very curious about the word volunteer there, or are you relying on the same number of individuals who are doing that work right now to produce the the fact that only 50% of people will be disenrolled who are eligible?
Speaker 12
We are proposing $4,000,000 in the budget for a new net increase of resources for clinic navigators to support this work. But at this time, governor's budget does not propose any new resources for enhanced care management or community health workers specifically for HR1.
Speaker 6
Okay. So you're with just the addition of some clinic navigators in the tune of $4,000,000 and the $17,500,000 for an outreach campaign, you're making assumptions on the input side of relatively the same amount of people to produce the lowered number of disenrollment. I just note that community health worker is a benefit in in the medical program,
Speaker 4
and so based on utilization, that spend or those dollars will go up. So we don't have a kind of a direct assumption in terms of how much more community health worker spending would result in, you know, these activities, but it is as a benefit. That is just how it will get financed, on the natural. Okay.
Speaker 6
Can doctor Hakim, can you speak to the, just on the from a practitioner's standpoint, the extent to which, you have been able to or your understanding of how FQHCs have been able to avail themselves of fully realizing that reimbursement for that benefit?
Speaker 16
So it it depends on the FQHC. Where I've worked previously, we had promotores. We had cultural brokers that were able to help our patients with limited health literacy assume and receive care that they otherwise wouldn't have. Generally speaking, during the during our clinic visits, half of our time is trying to navigate systems and making sure our patients are able to get access to the care that they deserve. So it's a clear and huge benefit to have the community health workers be part of that process.
Otherwise, it's we're unable to do a number of things within our health care visits.
Speaker 6
Right. My understanding in talking to both community health clinics and FQHC providers is that they have not been able to fully maximize the community health worker role and the health navigator role. So I'm appreciative that you all are planning to provide additional guidance around that.
Speaker 4
I would also note though that kind of the distinction between FQHCs and community health depends worker on if it's part of their PPS or not, and so there is a distinction. It's a little bit different.
Speaker 6
Yeah. Understood. I'd like to move now over to couple of questions around the federal flexibilities. So well, just a very, very random aside. I think as you were describing, the the outreach program, you said that there was going to be a plan to send two text messages out?
Speaker 7
It will be an iterative renewal process. So is it gonna be multiple text messages kind of throughout the year? Yeah. But we've already started this in February.
Speaker 7
So every What is it? So every month, depending on the individuals that are up for the renewal, say for we started in February for the January 2027 people that have a January due date. So I it's about 400,000 text messages that we do send out, so it's member base.
Speaker 6
How many text messages will an individual who has the opportunity to re enroll receive?
Speaker 7
They will get probably two from the department. And as they're getting close to their renewal date, the county also send a reminder text messaging to them as well. So there's going be multiple. I don't actually have this information, but be happy to follow-up.
Speaker 6
That would be appreciated. Our outreach protocol or kind of best practice indicates that an individual needs to receive a message 33 times before they actually take action on that. So receiving two text messages to the tune of $17,500,000 seems like we are not going to be hitting that mark in terms of the number of people who we would be able to get to stay on if we are able to do that. I wanted to move a little bit more towards the idea of making sure that we're maximizing retention of coverage for eligible Medi Cal members. That is kind of a stated position and goal of the administration.
A lot of the kind of this new program around outreach is certainly laudable. There were, though, some federal flexibilities that DHCS had in place coming out of the public health emergency, and there was a move to end those federal flexibilities. Those were proven to be very effective strategies for keeping people enrolled and online. Has there been any thought to how we ensure
Speaker 4
that those federal flexibilities actually get reinstated? So at this point, we're not considering reinstating those federal flexibilities. In many cases, they would require federal review and approval, and we don't think, given the federal climate, that the federal government would approve these flexibilities. Additionally, just given the context of program integrity and ensuring that, we do evaluate individuals to ensure that they continue to meet eligibility requirements, really, some of those federal flexibilities looked at income that was a few years old, and so we wanna maintain kind of the ability to ensure that our Medi Cal members are eligible as part of kind of just maintaining the fiscal stewardship of the program.
Speaker 6
So it's the position of the administration right now that there's no intention to really look at the income and asset verification streamlining that assuredly kept people enrolled
Speaker 6
Yeah. I also think that that is a missed opportunity. It's was a tried and true strategy to ensure that people could may be maintain themselves on coverage, and we are buying into the narrative that set me off on an unfortunate tangent here by my colleague with not even considering whether or not that's something that we might be able to do here in the state of California. So I hope that we might be able to think through that one a little bit more. And I will just end my my last question is really around the provision of or just the reality.
So even though they don't have coverage, people will still get sick. Our clinics will be largely, having to deal with the fact that they are getting care in more urgent moments as well as our hospitals. That is going to result in significant costs around uncompensated care for both our clinics and our hospitals. From the clinic's perspective, have you all done any modeling or planning around the costs related to uncompensated care that you will now have to carry given that you have a mandate to provide care regardless of a person's ability to pay?
Speaker 16
So we for our health center, we are estimating at least ten percent of our patient population potentially is going to fall into this category of losing coverage. So as a result, we're having to reconsider how we provide services. And with them losing coverage, having to reconsider how we're providing their medications. So it is a huge concern for us. As we've looked at expanding our clinical care teams to provide wraparound services, we're having to, stop that process right now.
So as a family physician, I provide care directly to patients and I have a number of people that support my team to provide the care, but more of that's gonna fall on my shoulders, which I'm a bit concerned about for the rest of my colleagues.
Speaker 6
And certainly, that's going to be even further exacerbated with the changes that we made around PPS.
Speaker 16
Yeah. Many of the people that go into community health have bleeding hearts and wanna do the work. It's been harder and harder to recruit additional staff that wanna do this work, and this is just going to make it worse. Primary care has always been the backbone, but it also has been shown to have a lack of additional people coming into the practice. So I don't anticipate that making it easier, knowing that patients need the care, you know, the evidence based care, but not being able to provide it to them because they don't have the insurance to cover it.
I think that's gonna be pretty disheartening for a number of people.
Speaker 20
Just to pick up a little bit on the point that Assembly Member Banto is making, it's I feel like I mean, there's this premise that suddenly we're gonna save a bunch of money by kicking people off health care, And that is not going to happen. I mean, we're going to have a ton of people getting an uncovered care, you know, an uninsured folks who are going to clinics, going to emergency rooms where it's much more expensive. And that is going to either cost us because now we have to reimburse the care in those clinics, or if they're going to hospital ERs, then those, you know, those costs are going to end up going into all of our insurance premiums. And insurance premiums are, you know, we're already seeing them go up. So, you know, just it's so frustrating because the whole kind of what feels like is the premise behind HR one and really going after poor people's health care who are poor, and they're going to be poor in six months, and they're going to be poor in a year probably.
And as we heard, most of them are already working. I mean, it's systemic failure where people are working and they are poor. These are working poor people who still need health care and are going to be faced with trying to avoid it until it's really serious, and then it's gonna be much more expensive to be able to to help them. So it's just well, my dad would use different words, but it's very backwards. It's very backwards.
And and I you know, so it's like the whole premise is ridiculous. And we've seen that this has made life changing difference for people, having care when they need it and being able to get the medicine they need when they need it. So, you know, we are on the precipice of seeing people die literally from this policy. And, you know, and there already is verification that happens. And and so, you know, the the the burden of the paperwork and, you know, for I just think about in my life, if I had to go through the process of verifying to get my insurance, I can barely sign up for stuff that we have to sign up for every year as a single mom.
And I know, you know, I'm not working two jobs like other people are trying to survive. So it's incredibly frustrating. I know there's shared frustration in this room, but, you know, I think the navigators are going to be really, really critical in eligibility eligibility workers. I I, you know, authored a budget request for $230,000,000 for eligibility workers, and a number of colleagues are supporting that as well. I'm a little concerned that there's more going into the outreach campaign and the budget that is going into navigators.
And, you know, I believe in this situation that face to face contact and that individual personal connection is really, really critical. And I, you know, appreciate a digital campaign like the next person, but and I think that the you know, we have to hit kind of people where they're at in lots of different areas. But I think that the investment around the navigators needs to be much, much more. And, you know, and I'm concerned about the capacity of counties since there's doesn't sound like any there's nothing in the budget to help bolster counties' ability to really be the front line of of this in our communities that there needs to be, you know, funding for the counties to be able to to be able to do that both navigation piece and whatever is kind of the technology and and and technical side of the the upgrades and the improvements and the processes that you're talking about today. What do you have an assessment of where counties are kind of at on being able to implement all the changes that you're talking about to streamline and remove.
And I I appreciate all of the streamlining and, you know, and the thought clearly that you all have put into to figuring out how to make this remove as many barriers as possible, which I know is the goal. But what's our understanding of how counties are going to be able to implement this on the local level?
Speaker 1
Sorry to interrupt. Before you answer, I'm just going to ask both our committee members as well as panelists, to tighten up our questions and comments. We still have a third panel that I know is going to, have a lot of interest in it, and so, just ask all of us to tighten it up slightly.
Speaker 4
So we acknowledge in our budget, our governor's budget documents that we are working with counties to go through this assessment. And as we refine our numbers in terms of how many kind of automatic data matches we can do as we continue to get federal guidance, That's what we'll be working with them on to kind of assess readiness, assess what it might take, recognizing that this is new workload for them. So we don't have a number in governor's budget, but did acknowledge that this is important work we need to do together.
Speaker 20
So it's something a number will be coming? We're working towards that. Okay. Okay. Great.
And what about what is kind of the estimate on the side of the clinics and FQHCs who are going to be bearing more of the burden around reimbursing cost of care and how we can be prepared to support the incredible demand that they're going be experiencing?
Speaker 4
We don't have estimates for kind of the health the overall health care industry impact. I think we have acknowledged from the beginning that we're not going to be able to backfill the loss in federal dollars as a result of HR one. It's tens of billions of dollars that just given the state's fiscal situation, we're not gonna be able to completely address. And so recognizing that and thinking about mitigation and kind of the how we can think about things differently, but just we don't have particular estimates for for these types of situations.
Speaker 20
I mean, there's there's already multiple county clinics in LA that have closed just in this last week, I think. So, I mean, that's basically what we're facing is that some clinics are just gonna be closed. They're not gonna be able to keep their doors open because there's not gonna be reimbursement for this care, and you won't be able to afford to do it. Hopefully, not you, but Yeah. Like you.
Speaker 16
Yeah. So one of the other estimates we looked at in terms of our insurance premiums just for our employees, it went up 20% in the past year. So with that said, we did a great job of not putting that on our employees, but we have to make the difference up somewhere. We can't charge our patients more.
Speaker 20
Yeah. On both sides of the issue. Yeah. Okay. In in the interest of time, I will end there, but thank you.
Thank you.
Speaker 1
Thank you, Assembly Member Schibel, Assembly Member Stephanie. Any question? Any okay. On this side of the dais, any questions? Yep.
Oh. Our our budget vice chair has decided to join the today. So welcome.
Speaker 21
Thank you and thank you for letting me join you. And I I I do have some quick questions that I wanted to touch on. On the MCO tax, I know that California has done some additional changes with the MCO tax, but with the big beautiful bill, HR one
Speaker 21
I'm I'm gonna ask how HR one affects the reimbursements in their federal funding for Medi Cal. Okay.
Speaker 4
So it significantly constrains the state's ability to, generate revenue via the the provider tax. We do know that our current MCO is valid through the end of calendar year 2026. And for for context, the changes with regards to h r one and the the federal final rule in this space really limit our ability to make a differential between our tax on Medi Cal managed care plans and commercial plans. So in conjunction with proposition 35 and the new federal requirements, today, the MCO brings the the Medi Cal program 7,000,000,000 net general fund to support the Medi Cal program under the new federal requirements and proposition 35 that is reduced to $6,000,000. So we go from 7,000,000,000 to 6,000,000.
So really significantly limits the ability of the state to, really, use this vital fine financing mechanism.
Speaker 21
Well and that's mainly because California decided to increase the MCO tax just to gain match funding. Correct?
Speaker 4
We followed all rules, and it was federally approved. So, we did, use, the provider tax policy to, generate revenue for the Medi Cal program.
Speaker 21
And so and for me, I understand. You know, I'm an advocate for the state of California, and I understand that change is scary. But the big thing is, it's truly is how is DHS making changes to how they prioritize funding programs to to ensure that we are going to have to live within our means. I understand HR one is changing the rules. They are closing loopholes.
And what priority steps are we taking to make sure that our counties, and I I represent a lot of the rural counties, can implement and work within this new framework?
Speaker 4
Well, that is part of the governor's budget proposals to live within the the budget forecast that the Department of Finance has has acknowledged. And, you know, as we think about out years, what other future changes might be necessary to maintain, meeting, the obligation to have a balanced budget.
Speaker 21
Do you have any recommendations for the legislature where we could provide either new resources or state resources personally to our local counties to make sure that they can implement these changes?
Speaker 4
I I would leave it to the legislature to identify with other revenue sources. We don't have anything in the governor's budget, for counties.
Speaker 21
Well and and I'm only asking just so you know, again, we can get together and say that we understand that HR1 is making these changes, but we don't control Congress in that sense. But what we can do is look at solutions here at the local level. And I'm simply just asking from your professional stance if there were recommendations, maybe suggestions that you would see that could benefit some of our local counties to make sure that we're working for them.
Speaker 4
I I think it's it's a matter of of what the legislature prioritizes in terms of the dollars that are available in terms of spending.
Speaker 21
Okay. Thank you. The other question that I had, shifts have been making changes to eligibility for Medi Cal and Medicaid. The work requirements for that, can you go into depth for how many able-bodied individuals and the changes that we are specifically gonna see for the work requirements here? Because I remember I believe I heard from the LAO earlier that 2,400,000 people will be removed or affected.
Speaker 4
So we estimate that as a result of of the work and community engagement requirements, 233,000 Medi Cal members may lose coverage in the budget year, and that grows to 1,400,000 in 2028.
Speaker 4
It it it is a matter of that they were not able to either meet work work requirements or demonstrate that they met those requirements. Some of it may be procedural disenrollment because they were not able to complete the paperwork. We we don't have a distinction.
Speaker 1
Remember before you arrived, we had a very in-depth conversation on this.
Speaker 1
So so we've covered that. Do you have another question? We've already covered that question, I guess, is what I'm trying to say.
Speaker 1
No. Actually, in testimony and then with member questions, that was already answered.
Speaker 1
The. Both in the testimony and member questions. But do you have another question?
Speaker 21
The yes. Thank you. The biggest thing that I wanna make sure, and I these are just will be general comments, is, again, we are seeing some of the largest changes in the reformations in HR one for what it's gonna do to our medical program here. What I wanna make sure is that I'm prioritizing the citizens of California and understanding that HR one is here regardless on how we feel about that. We know that prior to HR one, over 70 hospitals are on the verge of collapse.
We know that most of these hospitals that are on the verge of collapse are because they are in areas that have seen extreme expansions of Medi Cal that reimburse at less than 70% of the cost. So what I wanna make sure that we are prioritizing is getting the services to the people who need it most. I have multiple hospitals in my district that are on the verge of collapse because they have such high enrollments in Medi Cal without the reimbursements. And we here in the state of California have expanded a broken program that the changes in HR one hopefully give us the fuel to make sure that we're prioritizing the citizens of California over anyone else. Thank you.
Speaker 1
Thank you, assembly member. Any other questions? I'm sure a lot of people have a lot of things to say, but any other questions from the dais? If not, we're gonna go to public comment. Alright.
So we will move to public comment for our panel two on the impacts of HR one and medical enrollment and the state's implementation framework. And as a reminder, since there's a number of people in public comment, if you can keep your comments to under a minute, we are actually gonna set a timer just to give you a gentle reminder. And we do wanna hear, from everybody that took the time to come here. So it's just a matter of respect for your other colleagues in the audience. So please, begin.
Speaker 13
Nothing is more important than freedom. California collects the genetic DNA of babies, millions of babies born after 1983, their blood taken without parental consent, scamming Medi Cal and insurance for newborn screening tests, inflating the actual cost to siphon millions to the biobank. It's budget trickery to fund genetics research, selling to the military and private labs just like Texas, and it's illegal to high heavens. The governor knows it. Epstein was into genetics too.
I will bring California and trader Trump to heal. Babies can't fight back? I can. I'm the firstborn daughter of a United States marine and a former trial lawyer. My name is professor Julie Elizabeth Muma.
In sum, steal our baby's genetic material, taxes for the privilege of it, a whopping 100 and
Speaker 1
But, 44 ma'am, we're talking about the impacts of HR one on medical enrollment and the state's implementation framework. So, if you don't have a comment on that, you're welcome to make public comment for items not on the agenda at the end of the hearing. So, we're going to move to the next My
Speaker 1
So, we're gonna move to the next to the next member of the public. I'll remind everyone that you are welcome to come at the end to make public comment for items not on the agenda.
Speaker 24
Afternoon. Linda Way with Western Center on Law and Poverty. We appreciate the department's implementation principles to automate to protect coverage and proactive outreach, including text message campaign. We recommend the department translate the application into threshold languages more quickly, ensure notices and other materials are used to test it, funding to trusted partners, including the health consumer alliance to help people get and keep coverage, and data dashboard to measure HR1 harm. Finally, we urge the state to reinstate key Medi Cal renewal strategies or flexibilities to keep their Medi Cal, ensuring that eligible people keep their Medi Cal and are not cut off due to paperwork reasons.
As acknowledged by the department, manual renewal processing will result in higher disenrollment rates due to administrative burdens for the county as well as Medi Cal members. Thank you.
Speaker 23
Good afternoon. Yasmeen Pellet on behalf of Justice in Aging. We thank DHCS for their work thus far in implementing these new requirements. However, we encourage DHCS to continue to the maximum extent possible implement policies that mitigate the loss of coverage, including the adoption of all federally allowable exemptions and exceptions. We also encourage DHCS to track the effects of HR1 and all disenrollments in a data dashboard, as well as appropriately user testing all notices and outreach material.
We also encourage the legislature to consider additional funding to the Health Consumer Alliance in order to provide legal assistance to individuals struggling with their enrollment or renewals due to the implementation of these policies. Thank you.
Speaker 25
Thank you for holding this important hearing. I'm Talar Alexanian, manager of legislative and advocacy affairs for AltaMed Health Services, the nation's largest federally qualified health center. We serve more than 600,000 patients annually across Southern California, many of which rely on Medi Cal or Covered California for access to care. So we're deeply concerned about the new work verification requirements and six month eligibility renewals. These new requirements risk significant coverage loss among individuals who remain eligible but cannot navigate complex paperwork.
Community health centers are trusted partners in helping patients enroll and stay covered, but doing that work effectively requires meaningful investment in enrollment navigators, multilingual outreach, and on the ground assistance to help patients complete these new requirements. We also agree with the FQHC representative from the Sacramento Native American Health Center. The 2025 budget act eliminates the prospective payment system reimbursement for services provided to medical patients with unsatisfactory immigration status and replacing it with much lower fee for service rates. This change threatens the financial stability of community clinics, resulting in at least a $1,600,000,000 loss in FY twenty six-twenty seven alone and could significantly undermine access to primary care and data privacy for some of our state's most vulnerable populations. We look forward to working with you all and trying to address that and many of the other impacts.
Thank you.
Speaker 26
Kelly Brooks on behalf of the California Association of Public Hospitals and Health Systems. We represent public 17 public health care systems serving 3,700,000 patients annually. We know from Arkansas that a quarter of enrollees lost coverage not because they were ineligible, but because of the paperwork. At California scale, this is a crisis. People who lose coverage don't stop needing care.
They delay it. They skip medications, miss follow-up appointments, and show up at our emergency room sicker and in crisis. That means longer stays, worse outcomes, and higher costs borne by public hospital systems. We urge the legislature to minimize procedural disenrollments and invest in the safety net systems that will absorb this impact. Finally, on behalf of the urban counties of California and the boards of supervisors of Ventura and Riverside, we similarly urge you to invest in medical eligibility in public hospitals.
Thank you.
Speaker 11
Christine Smith with Health Access California. I just wanted to appreciate the comments of many folks on the panel, but also the legislators that spoke, specifically Assembly Member Schiavo. Without health insurance, people will live sicker and die younger, so there will be huge losses throughout the state. We do appreciate the department for all their work in, coordinating, but also all their work to get stakeholder input on so many of these areas. We do urge the legislature to minimize further loss of coverage, and also utilize resources to track populations losing health care.
Thank
Speaker 27
Good afternoon. I'm Erin Evans on behalf of the county of Santa Clara. As the state and counties work together to mitigate the impacts of HR one, our community members are at risk. In Santa Clara County alone, approximately 400,000 Medi Cal enrollees will be affected by the eligibility and work requirements, and we have approximately 80,000 covered California enrollees. The county seeks to preserve eligibility for all residents, which will require new and increased eligibility work.
We operate the second largest public hospital system in the state that offers comprehensive care locally as well as critical trauma, burn, and rehabilitation center that serves up serves our region of the state. Once all changes are implemented, HR one is estimated to cost the county $1,000,000,000, and so, therefore, we seek partnership with the state. Even with the passage recent passage of measure a within our county, we have a daunting $700,000,000 budget gap. And so we seek partnership to provide the $500,000,000 referenced by the California Association of Public Hospitals excuse me. Preserve Medi Cal enrollment as proposed by assembly member Schiavo and the county welfare directors association.
We support the enrollment systems and technology upgrades that were referenced by the department. And finally, we urge the legislature to allocate significant new resources to counties to serve an expected increase in the uninsured populations. Thank you.
Speaker 10
Thank you. Michelle Johnston, National Multiple Sclerosis Society. I wanna thank everyone in front, everyone in the back in this room who are trying to do their best to mitigate the harms of HR one. Almost a quarter of Californian sixty eight thousand people living with multiple sclerosis are on Medi Cal, and this allows them to have early diagnosis and consistent treatment of their disease. As you work through a series of difficult decisions, we urge you to use every flexibility possible to minimize the harm in California.
We recommend that you broadly define health related exemptions for parents and care partners, maximize the use of self attestation for exemptions, and put simple, accessible processes in place for those required to demonstrate compliance. Over half of people living with MS experience cognitive symptoms such as brain fog, which places them at greater risk of losing coverage due to administrative paperwork issues. Please adopt the lowest permissible cost sharing amounts and prevent providers from reducing services due to nonpayment. Provide sufficient support for administration costs to ensure there are enough trained staff in every county to provide robust, accessible consumer assistance support, protect patient privacy and prioritize transparency of reporting on the outcomes of these changes. Thank you very much.
Speaker 28
Good afternoon, chair and members. Karen Stout here on behalf of the California Nurse Midwives Association or CNMA. I'm here to express our deep concerns with HR one's impact on community health, particularly in. Cal. We are deeply concerned that both the federal changes and the governor's proposed budget aligning with those federal directives will significantly impact California's most vulnerable populations.
D d DHCS estimates that one point eight million people will lose coverage, further exacerbating our existing health care access and maternity access crisis. Certified nurse midwives attend fourteen percent of births here in California and often fill the gap, in OB GYN deserts. Medi Cal is essential to both our patients and providers, creating a critical and necessary avenue for Californians regardless of immigration status to seek critical care. As reproductive health and re abortion care providers, current Medi Cal rates are also critical to sustaining the midwifery workforce. Cuts to rates pose an existential threat to our ability to continue to attend hospital births and operating birthing centers, which are often people's only access point for maternal health care, especially as we see labor and delivery and other maternity wards close across the state.
We also want to express our concerns with the PPS cuts that the panelists mentioned earlier, which will also impact pregnant people and providers across the board. We urge you to continue to oppose these dangerous cuts, and we appreciate you convening this hearing as well as the series of hearings today. Thank you.
Speaker 29
Good afternoon, madam chair members. Dylan Elliott here today on behalf of the county Of San Joaquin as well as the county medical services program. With respect to San Joaquin County, the county estimates that due to the ending federal subsidies and increased eligibility requirements, they'll need roughly $72,300,000 ongoing to address the costs associated with providing care to the significantly increased number of medically indigent adults. This includes the operation of their continuum care in their public county hospital. With respect to the county medical services program, which for those who don't know, serves 35 rural counties in the state by providing coverage to those who do not qualify for Medi Cal using pre affordable care act data, the county medical services program projects that roughly 41,000 low income adults will seek CMSP services representing roughly a third of those that would otherwise be eligible.
The cost to provide care for those individuals is $311,000,000 per year. If all 100% or 140, excuse me, 124,000 individuals were to seek those services, the cost would be $943,000,000 per year to CMSP. As such, and trying to use the one third estimate, as I mentioned, consistent with pre ACA data, CMSP is seeking $300,000,000 to be appropriated in fiscal year twenty seven, twenty eight. We appreciate your consideration in this matter. Thank you.
Speaker 30
Good afternoon. Thank you, chair and committee members. My name is doctor Cecilia Aquino, executive director of the Latino Coalition for a Healthy California. Latinos make up 40% of the population in California, and half of all Medi Cal enrollees are Latino. These budget discussions directly impact current and future Latino health.
California must prioritize restoring full scope Medi access to all California taxpayers regardless of immigration status, including eliminating the freeze, preventing some Californians from enrolling into Medi Cal. Additionally, we ask that the state rejects subjecting state funded populations to new burdensome federal eligibility requirements like work requirements and provide health access to humanitarian populations set to lose care on October 1. Thank you.
Speaker 31
Good afternoon, chair and members. Olga Shiloh on behalf of the California Association of Health Plans. On behalf of our 41 member plans and the 28,000,000 Californians that they collectively represent, we appreciate the legislatures and the committees efforts to keep health care access at the forefront of these discussions here, and we would like to, you know, emphasize that CAP remains committed to working closely with stakeholders to maintain affordable coverage and care, support strong enrollment, and protect the progress California has made in expanding access to affordable healthcare. Thank you for this conversation.
Speaker 32
Afternoon. Katie Layton on behalf of the Children's Specialty Coalition. While the new eligibility requirements under HR1 do not specifically apply to children, we are concerned about the potential coverage losses for youth nineteen to twenty one in the California Children's Services Program, which provides care to the state's most medically vulnerable children and youth. Acknowledging that the lack of federal guidance makes decision making difficult, we hope to see those enrolled in CCS as well as those transitioning out of the program at age 21 exempted from work requirements under the medical frailty definition and would also request strong consideration be given to exempting parents of caregivers of CCS children older than 13 given the heavy demands of caring for a medically fragile child. We thank the legislature and DHCS for the planning and outreach that is underway, and as providers, we also look forward to helping communicate key information to patients and their families.
Thank you.
Speaker 33
Afternoon, madam chair and members. Jack Anderson with GEAC representing our local health departments throughout the state. Individuals who lose health coverage as a result of the HR one policy changes, particularly those, who are determined ineligible due to the work requirements, may turn to county indigent care programs, which in many counties are administered by our local health departments. It is important to note that the state previously redirected 1991 health realignment funds and slowed the rate at which those revenues could grow, leaving counties without resources to serve this population returning to county indigent programs. CSAC, along with our county organizations, estimate that the cost of providing care to this population, could range from $2,000,000,000 to $5,500,000,000.
We respectfully request that the legislature and the administration partner with counties, to ensure that we can meet this mandated responsibility to provide care to this population. Thank you.
Speaker 13
Good afternoon, chair and members. Beth Monowski with SEIU California. I really just wanna second the remarks of my consumer allies around the work we can be doing together and the work teachers are already doing to make sure we're mitigating as much harm as possible, and hopefully do everything we can to lower the number of individuals who lose coverage as a result of HR one. Want to speak specifically to some of the comments made around county readiness. Wanna appreciate the champion that we have, Senator Rishiavo, and championing our county eligibility workforce in particular as it relates to Medi Cal.
As was noted, our counties do need more support. So SEIU is standing with CWDA and supporting a $230,000,000 ask that was referenced earlier to support our county eligibility workforce that relates to HR one Medi Cal implementation. Additionally, as you heard from my colleagues at CAPH, we know that folks will continue to get sick, will continue to need care regardless if they have coverage or not, and for that reason, really looking to partner with all of you and making sure for the first time since, I think, 2005, we see a major investment in our public hospitals. So we see really a down payment of $500,000,000 to support those public hospitals. And lastly, I wanted to really second the comments that my colleague from CHIAC just made recognizing the state of urgent care programs today in California.
They need support, they need attention, so they can be what we need them to be once again. Thank you.
Speaker 15
Good afternoon. Thank you so much for having this important conversation. My name is Alexis Heaton and I'm with California Coverage and Health Initiatives. I work with over 30 nonprofit community based organizations, First Fives, and county organizations. We ask the legislature to stand firm against any further cuts that would impact undocumented populations impacted by last year's stage budget cuts specifically and do not include the harmful work requirements the state funded populations.
We also urge the legislature to push back on any harmful Trump cuts and support the 200,000 lawfully present immigrants who are being kicked out of full scope Medi Cal by the Trump administration in emergency situations. Thank you so much.
Speaker 34
Madam chair members, Jean Hurst here today on behalf of the University of California. UC academic health centers are a cornerstone of California's health care safety net. As designated public hospitals, they provide high quality care regardless of insurance status or ability to pay. Additionally, they serve as referral centers for hospitals and clinics across the state to ensure access to California's most complex and lifesaving care, including cancer, burn, transplant, and trauma services. In twenty twenty four-twenty five, UC cared for patients from 99% of the state's ZIP codes.
UC's academic health centers are the second largest provider of Medi Cal inpatient services statewide. With 1,800,000 Californians projected to lose Medi Cal coverage, our academic health centers are bracing for patients with worse health outcomes and increased uncompensated care costs for UC's hospitals and clinics. It is not just Medi Cal recipients who will be impacted. The impacts will be felt by all the patients we serve, including patients with commercial coverage, as our already overflowing emergency departments become even fuller, and it becomes harder to accept transfer patients. We urge the legislature to minimize procedural disenrollment and invest in the safety net system
Speaker 1
you. And I actually would just pause for a sec. If I could ask the members on the dais to take their conversation elsewhere since just to respect our our members of the general public. And as a reminder, you have one minute and we are talking about HR one and the impacts of HR one on medical enrollment and the state's implementation framework. If you're here specifically to speak about undocumented individuals or immigration, we do have that panel coming up next.
So if you could save those comments for that panel. Thank you.
Speaker 35
You, madam chair, members. Dennis Cuevas Romero with the California Primary Care Association, statewide association that represents community health centers and clinics. Really just wanna appreciate the conversation about reducing harm and making sure we do everything we can to streamline processes to make sure people in the state remain covered. Also, just wanna flag the appreciation of the conversation on health enrollment navigators. That's gonna be critically important to make sure folks are are remain covered.
Do wanna just highlight, it's our understanding there's no general fund dollars currently allocated health enrollment navigators. CPCA is working to with DHCS to try to secure private foundations so we can get this federal match. So we really appreciate the ongoing conversation, and that that's gonna be very important. Thank you.
Speaker 36
Good afternoon, Chair Addison members. Trent Murphy with the California Association of Outfall and Drug Program executives. We represent substance use disorder treatment providers across the state of California. First, I wanna acknowledge and thank DHCS for their thoughtful work on the implementation strategy, relying on automation and data matches before requiring member verification. From a provider perspective, that approach is really critical to reducing that procedural disenrollment we're all really concerned about and easing the burden on counties and providers.
Our primary concern we hear from treatment providers is administrative churn. Many individuals served by substance use disorder treatment programs may qualify for exempt exemptions such as medical frailty or participation in substance use disorder treatment programs, but may face challenges navigating reporting and verification requirements. So one area we believe the state could be especially successful is lever leveraging the ECM providers like we talked about earlier in the committee. These providers often have the most trusted relationships with patients and can help ensure members understand requirements and maintain coverage, but they need resources to be successful. Thank you.
Speaker 37
Good evening, madam chair and members of the committee. Alexis Rodriguez with the County Welfare Directors Association. I wanted to thank assembly member Schavo for highlighting that counties are the frontline administrators of Medi Cal who will implement HR one work requirements and the six month redeterminations. As the agenda laid out, nearly five five million expansion adults will be forced to comply and that 2,800,000, 60% of that population cannot be automatically verified and will need a county worker to do that work. Without intervention, 1,400,000 will disenroll mostly due to paperwork barriers not ineligibility.
So we are requesting $231,000,000 general fund in twenty twenty six to twenty seven growing in financial years twenty seven to twenty eight for counties as an upstream investment to support exemption screening, verifications, and more of that work. So I wanted to thank Assembly Member Schiavo for her leadership and Assembly Member Stephanie for highlighting this need. We appreciate the excellent staff resources that underscore how resources for county eligibility workers is critical to maximize coverage retention and appreciate DHCS's commitment to work with us. This funding is about bending If
Speaker 1
you if you could wrap up. That's been Thank a you. Thank you. We'll move to the next person. Thank you.
Speaker 38
Evening. Well, EJ Aguayo on behalf of, California PACE Association, which advances the program of all inclusive care for the elderly. I'd like to thank, DHCS for exempting PACE, participants as medically frail from the work requirements. Also wanna offer our willingness to help support any of the electronic verification enhancement efforts. Also, on behalf of, Vision, eCompromiso, we, need to make sure are included in all aspects of education around eligibility and reenrollments as trusted leaders in the community.
We look forward to engaging the legislature and governor in partnership to keep Californians covered. Thank you.
Speaker 39
Hello, chair and members. My name is Laura Muether with the Lutheran Office of Public Policy and we are a member of the End Child Poverty California Coalition. We urge our legislature to adequately support the county eligibility workforce as they are a lifeline for California households. County eligibility workers will need every resource available to them to ensure they are the first line of defense against reducing and mitigating the harms of HR one. Thank you.
Speaker 40
You, chair and members. Natalie Peeta on behalf of the California Academy of Family Physicians representing over 11,000 family docs, residents, and medical students across the state. Oh, sorry. Primary care is the foundation of our healthcare system. Family physicians provide comprehensive continuous care that keeps patients healthy and prevents costly ER visits and hospitalizations.
CAFP believes healthcare is a human right and that health coverage should be universal. We urge the legislator to make decisions that maintain and expand coverage for as many Californians as possible, including improving eligibility and enrollment systems and increasing state investment in our social safety net. When someone gets sick or injured, they will seek care somewhere in our healthcare system. Strong primary care ensures that that care happens in the right place. CAFP urges the legislator to prioritize primary care as the cornerstone of California's health system.
Thank you, and we look forward to continuing conversations about how California can best respond to HR one.
Speaker 41
and I live in Sacramento County here. And I'm with California's disability rights, but I'm not gonna speak for California disability rights. I'm gonna speak for me. Why is Medi Cal important to me? Because without Medi Cal, I couldn't get my physician.
I couldn't get my drugs. I couldn't get my services. Without Medi Cal, I drugs are very expensive. I saw how much it costs, $45 a bottle, if I didn't have Medi Cal and that coverage. K?
It's important to me because this program is it helps me be able to be independent. When you have fibromyalgia, you have everything going wrong with you, and you have to take five to six pills, and you have to take pills to go to sleep. You have to take pills for the pain. You have to take pills for everything. And so I figured how much that's gonna cost me.
That would cost me nearly $300. If you want psychiatry services without Medi Cal, $160 an hour. This is why this is important. If I lose Medi Cal and IHSS, or in my case, Medi Cal, I couldn't get out of the house. And think about that.
How many people do you know can't get out of the house because they don't have their drugs? So would it please push back against Trump's harmful cuts and support 200,000 lawfully present immigrants who are being kicked out of full scope Medi Cal because they're gonna have the same issues I'm gonna have. And please say no to new cuts or new hurdles. Instead, raise revenues to fill backfill the cuts to Medicaid and save essential programs. Thank you for listening.
Speaker 42
Good afternoon, chair and members. Omar Al Tammimi here with the California Panethnic Health Network. First, on the working community engagement requirements and biannual renewals, these will procedurally penalize our most vulnerable communities, increasing the number of barriers to accessing care. As a result, individuals who would otherwise qualify for care might be dropped due to procedural issues rather than their eligibility for coverage. We urge the legislature to approve every flexibility available to prevent loss of coverage.
CPEN is generally supportive of DHCS's plan to conduct outreach efforts with affected community health navigators and CHWPRs, but more needs to be done. Counties must work with CBOs to ensure outreach enrollment is culturally and linguistically responsive, and people are not losing coverage due to lack of translated notices or in language help. We urge DHCS to provide clear guidance for health plans and contracted CHWPRs and providers on how to quickly and effectively bill for services tied to outreach enrollment. And finally, we urge GHCS not to apply work requirements universally on all Medi Cal beneficiaries, including immigrants who may not be authorized to work. Additional HCAI funding for CHWPR services is instrumental here in ensuring eligible communities get the assistance they need to stay covered.
Thank you.
Speaker 43
Hello. My name is Marvelles with the Latino Coalition for Healthy California. As was noted, these cuts to Medi Cal including HR one will disproportionately impact Latine indigenous communities, who make up over half of all Medi Cal recipients. LCHC appreciates the investments in outreach strategies including CHW promotoras. That is why we encourage DHCS to provide utilization data on the CHWPR Medi Cal benefits so we can further leverage community health workers in the implementation of HR one.
We also request to reject subjecting state funded populations to new burdensome federal eligibility requirements like work requirements and provide health access to humanitarian populations set to lose care on October 1. Thank you.
Speaker 44
Hello, chair and, assembly members. Thank you for, convening today, with the California Rural Indian Health Board representing 70 federally recognized tribes and 20 tribal health systems. As California responds to federal changes under HR one, we encourage the state to ensure that federal protections for American Indian and Alaska Native people remain clearly visible in California's plans moving forward. Tribal health is grounded in federal and trust responsibility, and state policy should continue to reflect the unique relationship. However, these protections do not apply to our tribal health programs.
Many of our tribal health programs rely on Medicaid to for additional funding. So with that being said, for tribal health programs, these losses threaten staffing and service delivery, and we serve lots of the rural areas across California. So we encourage the state to advocate against these work requirements and anything that would harm service delivery. Thank you.
Speaker 32
Good afternoon, madam chair and members. It's Danielle Bradley with the California State Association of Counties representing all 58 counties in California. HR one represents a fundamental shift of fiscal responsibility from the federal government to state and counties for safety net programs and you know, increased Medi Cal work eligibility is one of the key components driving costs for HR one implementation in counties. The introduction of work requirements along with six month eligibility redeterminations will make it more challenging for individuals to keep their health care coverage. Counties
Speaker 32
the ones performing the critical work that is needed to help certify exemptions, support timely processing of more frequent redeterminations, and perform essential outreach, follow-up, and connections to resources. CSOC is support is supportive of investments to address this increased county workload which will help maximize the number of individuals who can retain their life saving coverage, secure additional federal funding, and prevent increased costs in other parts of our health system. Thank you.
Speaker 45
Good afternoon, Madam Chair and members. Michelle Welgaba with Nielsen Merxamer. I'm here on behalf of San Diego County, Contra Costa County, Lake County, Imperial County, and Yolo County. Forgot. But I want to align my comments with those colleagues that have come before me from UCC and CSAC, but to tell you that we do appreciate the conversations that you're having right now to try and find solutions, to try to minimize the harm to some of these vulnerable communities.
I would urge you to really consider bringing counties to the table so that we can be your partner when you're vetting potential solutions so that we can help you understand how they will be operationalized at the county level. Thank you.
Speaker 46
Good access. Hello, assembly members. Thank you so much for holding this hearing. My name is Jessica Lehman. I'm a member of Canary Resistance, a statewide disability organizing group and a member of the LTSS for all coalition long term services and supports for all.
Our communities are under attack in so many ways, especially immigrants, trans people, and people with disabilities. Many people with disabilities get Medi Cal not under the Medi Cal Aged and Disabled program but under Medi Cal expansion. Many people have disabilities that aren't going to qualify as exemptions for work requirements either because they're not yet diagnosed, they might be mental health disabilities, many other types of disabilities. And there's many caregivers, right? Actually, the person who came and got me out of bed this morning, helped me get ready so that I could be here so that I can do my job and live my life depends on Medi Cal and is currently looking for a job, right?
And so I think about what will happen to all of these people and what will happen to me if I lose the people that are allowing me to live my life. So I really want to ask you to backfill the cuts to Medi Cal that are from the federal government. We know that you're losing money. We know it's going to take more money to do the critical outreach. And you have to come up with new revenues to
Speaker 46
Yes. Thank you so much for doing the right thing for Californians and the midst of this really horrendous time.
Speaker 47
My name is Christine O'Keefe, and I live with cerebral palsy. Thank you for giving me the chance to speak today. I have had a speech impediment my whole life. Because of that, people do not always understand me when I talk. That is why I use AAC AAC gives me a voice.
It allows me to share my thoughts, my ideas, and my story. Today, I also work as an AAC mentor. I help other people with disabilities learn to use communication devices so they can express themselves too. When someone says something for the very first time, like I love you or I did it, it is life changing. None of this would be possible without Medicaid and the support I receive through my regional center.
These services help with my personal care and provide the equipment I rely on every day, like my wheelchair and my AAC device. These supports are not extras. They are the reason I can live independently, work, and give back to my community. Medicaid is more than a program. It is dignity.
It is independence. And for people like me, it is our voice. Please protect Medicaid and protect the lives of people with disabilities. Thank you.
Speaker 19
also a member of SEIU twenty fifteen. Although I do not speak for SEIU twenty fifteen today, I will associate myself with the previous remarks of the SEIU representative. I am also Mehdi Mehdi, as is my spouse, who is my major client. And I just want to tell you that recently we did lose our Medi Cal because of not getting paperwork done because she was in the hospital, and I got to see what our medical bills would be without Medi Cal. And eventually we did get the coverage back and went through a whole lot of hoops and got all that stuff covered, but it would have bankrupted and devastated us.
So I wanna thank you for everything you're doing to try to lessen the paperwork and keep people from falling off. But even with all that, the counties will not be able to absorb what you're asking them to absorb in the IHSS system. And without IHSS, my partner is in a nursing home and likely having an early death unless I do the work for free, which also devastates us. Please find a way to mitigate this. Thank you.
Speaker 48
Good afternoon, members. I'm Evan Fern on behalf of Disability Rights California. Any cuts to health care services will disproportionately impact the people who use them the most, people with disabilities, who need ongoing care to survive and to thrive. We appreciate the efforts to streamline verification for exemptions to new HR one paperwork requirements. This will also benefit people with disabilities who use medical programs that aren't related to their disabilities and who would still need to prove that they meet the definition of medically frail.
Additionally, preventative care matters for everyone, but for people with disabilities who lose access because of erroneous disenrollments, chronic conditions can worsen and quickly become life threatening emergencies. We must take comprehensive steps to protect people with disabilities whose only option is Medi Cal and ensure that they can stay enrolled. Everyone deserves access to the medication and services they need to survive. Thank you.
Speaker 49
Everyone. Lily Doran with the Children's Partnership. We're a statewide advocacy organization advancing health equity through policy, research and advocacy. I just really wanna, echo the comments from my colleagues at LCHC, really encouraging DHCS to leverage CHWs and really publicize utilization data so we know whether we're reaching the communities most in need, especially as it relates to mitigating HR1 harms. And I also want to just urge the comments from my fellow consumer advocate partners here.
I really appreciate the dialogue and the work from the legislature to mitigate these harms. Really want to encourage the legislature to also reinstate key unwinding flexibilities that help streamline Medi Cal renewals and keep people covered. So, just thank you.
Speaker 1
Seeing no other public comment. I'm just gonna take a point of personal privilege to make a couple comments and first, I wanna thank my colleagues up here for their decorum. Sometimes things are set up here that don't sit well with all of us. They don't sit well with the public. They don't sit well with the audience.
And it takes, in my opinion, a tremendous amount of restraint to not react to those things. And so first and foremost, I wanna say thank you to my colleagues who kept their own decorum and stayed focused on the issue. But the other thing I I wanna say is there were some comments made up here around feelings. And a number of times that comment was made that, people are having feelings about this situation. And I just would say to the general public, number one, I think that's somewhat of a sexist comment to make when you have a diocese that is majority women to point out that people have feelings about this.
I think, I think folks need to take a step back and really assess where that kind of comment is coming from. But number two, I would say that I think we're all here because we have feelings. You don't run for office because you don't have feelings. You don't choose a life of service because you don't have feelings. In fact, it's the exact opposite.
Usually, you run for office because you do have feelings and you wanna fix problems. Usually, go into the medical field or into advocacy or into a state department because you do have feelings and you wanna change society for the better. So I just I wanna close this panel by saying thank you also to our panelists. I appreciate all of you staying. You could have left during public comment.
I know that was very lengthy public comment, but I wanna appreciate your decorum as well, for staying and listening to the folks that have really come to beg us for help. And this happened last year. We had hundreds of people come to the microphone and say, if you cut x, y, or z program, we will likely die. And so we did tremendous work last year in the budget to try to stave off the most detrimental, the most harmful of cuts, but the reality is those cuts are here now. And so we're working very hard as a committee.
We're working very hard as a full budget committee. The administration has put forward some proposals. My ask would be that you come back in your May revise, this to the administration having done a little better because I think there's a lot of folks that feel like, the proposal that we saw in January is coming in a little flat. So I just would encourage the administration to go back and rethink that, to go back and watch this testimony. We're about to have a panel on immigration and the effects of h r one on, people of a variety of documentation statuses, and that is going to be even more challenging, I would say, than this one has because we know in that panel, we're gonna talk about entire populations losing coverage.
And so I just would encourage as the administration is thinking about May revise, to come back with some improvements in the proposal. And, you know, we are we are obviously here to work with you. So thank you to our panelists. Thank you to doctor Hakim for taking a huge time away from your patience today to be with the California State Legislature and to our departments and with that, we will move on to issue three which is about the impacts of HR one and federal actions on immigrant access to care. Yes.
Yes. And it sounds like we've got I'm just looking through my notes. A panelist who has a flight to catch. So we are gonna change our testimony, and I understand the constraints of this flight very well. So we're gonna turn to our final issue, and we're gonna invite to the witness table representatives from Covered California, the Department of Health Care Services, MICOP, and CBD IO.
We may not have enough space at the witness table, but we wanna make sure that MyCop representative is at the table. Okay. I understand that plate and very well. I take it myself if you're going back to Central Coast. So we'll put my cup up first if you don't mind and then we will move on to the other panelist from Covered California, DHCS, and then CBD IO.
So, with us now is Vanessa Turan from Micop to share the organization's perspective on how these changes are affecting the communities they serve in terms of the impacts of HR one and federal actions on immigrant access to care. Welcome.
Speaker 22
Thank you, Chair Addis. Good afternoon, Chair Addis and members of the committee. My name is Vanessa Teran and I serve as a director of policy with the Misteco and Dijana Community Organizing Project or MICOP. I would like to begin by acknowledging that I live, work, learn, and collaborate on unseated lands of the Chumash people and what is now called the California Central Coast. I also want to acknowledge the Miwok and Nissan communities who land this building sits on today.
Thank you for the opportunity to share the health care access needs of the indigenous and immigrant communities during a time when many of our families are experiencing deep uncertainty. Across our region, community members are navigating both the emotional toll toil of immigration enforcement actions, and growing concerns about access to health care. Recent enforcement activity has contributed to widespread fear in our communities. Families are increasingly hesitant to leave their homes, to go to work, children are missing school, and many adults are withdrawing from daily activities out of concern about potential immigration enforcement encounters. These circumstances also place tremendous strain on families.
When a family member is detained or removed, households often lose their primary source of income, leaving remaining family members who navigate housing instability and financial hardship. Since January 1, the eight zero five Rapid Response Network has documented hundreds of detentions across the Central Coast. Eight fifty five reports in Ventura County, six fifty five in Santa Barbara County, and a 127 in San Luis Obispo County. Behind each number is the family whose stability, health, and access to care are severely at risk. Our organization was founded in 2001 in one of our county's ambulatory clinics, Clinica Las Islas in Oxnard, California where we began providing food and diaper distributions.
Today, as we celebrate our twenty fifth anniversary, we serve approximately twenty, zero indigenous community members annually through more than 20 programs focused on labor justice, behavioral wellness, policy, and advocacy, social services, and humanitarian assistance, and research and evaluation. Working alongside state and county partners, we help community members navigate complex systems including health care, education, and the judicial system so families can access essential resources such as food, housing, culturally responsive mental health services, support for domestic violence survivors, and recovery assistance after natural disasters and pandemics in collaboration with our local public health departments. For over a decade, My Cup has been actively engaged in advancing health access across California. One of our strongest partnerships with government agencies is through our Medi Cal Health Navigation Program. Following the Health for All Kids expansion in 2015, My Cup played an active role in enrolling undocumented youth in Medi Cal.
Since then, we have continued working towards a broader health for all vision by helping indigenous farm worker communities understand and access health care. Today, our staff continue informing and enrolling families while educating community members about policy changes that may affect their health care coverage. Through this work, we see firsthand the barriers indigenous communities often face including language access, racial discrimination, and implicit bias in in the health care system. At Micop, we provide services in indigenous languages such as Misteco, Sapoteco, Purepecha, with Spanish as a shared language. However, recently, many families have been experiencing deep concerns about whether the personal information they share in Medicare applications could be used against them.
This fear has created hesitation about applying for health care coverage or renewing benefits. In Ventura County, our organization works closely with Gold Coast Health Plan to support Medicare enrollment and navigation. Our navigators assist families with new applications, renewals, provider selection, and the resolution of enrollment issues. Last year, we reached over 1,000 community members through outreach and education during the winter. In total, in 2025, we supported over 7,000 individuals through our Medi Cal navigation services.
This year to date, as of the start of this year, we have completed a 190 new medical applications in a 119 renewals. That's just January and February of this year up to a couple days of this March. These numbers represent thousand of families whose access to care could be placed at risk if policy changes further undermine trust between communities and health care systems. Another important program we operate on is our Medi Cal doula program in Ventura County. Through this program, Micop trains indigenous birth workers known as Barteras to provide cultural and linguistically appropriate support during pregnancy, labor, and postpartum.
Dulas provide health education, advocacy, emotional support before, during, and after childbirth. For many mothers, having someone present who understands their language and culture makes an enormous enormous difference in their case experience. Our doulas have already supported multiple births at VCMC, Ventura County Medical Center, and continue to support indigenous migrant families through pregnancy and up to one year of postpartum. Across the center coast, however, indigenous communities face significant health disparities. A recent demographic study in estimated about 8,000 indigenous people live and work in the county and many of them are farm workers.
The study found that eighty five percent of indigenous migrant adults did not have access to health care insurance and the majority of our families were living before below the poverty line. These disparities are deeply concerning especially as new research research from UC Berkeley Labor Center estimates that medical enrollment could decline dramatically due to the federal and state policies. The projections estimate that in Ventura County, we could see 61, zero fewer people enroll in Medi Cal. In Santa Barbara County, forty forty six, zero fewer in San Luis Obispo County, about fourteen, zero fewer. For many indigenous families, losing medical does not mean transition to employer based coverage or private insurance.
In most cases, it means becoming uninsured. We share this information today because health care access depends on trust. When families feel safe seeking care, they enroll, they see their doctors, and they receive preventative services that keep communities healthy. But when fear discourages people from accessing coverage or seeking care, the consequences extend far beyond individuals, families. They affect the health of entire communities.
We respectfully urge your support and that all policy makers continue safeguarding medical access through health navigators to ensure that policies do not unintentionally discourage vulnerable families from seeking the care they need. Thank you for the opportunity to share our experiences today.
Speaker 1
Thank you. Miss Teran, I we're going do things just a little bit out of order because I know you have to leave the hearing. I have one question for you. Let me just see if my colleagues have any questions for you in specific before we go on to other panelists and then we can conserve your time. Of course.
Okay. My, you have a lot of folks in the room here. You've got Covered California. You have DHCS. You mentioned Health Navigators.
Is there anything else you would want, these folks through me to know about how to make the process work better for those that are gonna have to manually enroll or you know, go through these reverification processes twice a year now.
Speaker 22
Absolutely. You know, Shiho really hit the nail on the head as they say in English idioms. We need the human connection. When we do not have health navigators, we can create all the video assets, all the communications, and the texting systems that we need but the, if you talk to most Medi Cal recipients, it is that human touch, someone that can tell them, when do I renew? How do I evidence my work attestation where I'm getting paid by cash?
Where I need to evidence that I've completed community service hours of that policies enacted. It is through health navigators, CHW, promotoras, community organizers, health advocates that community can continue to stay enrolled and maintained. We have indigenous farm workers who are undocumented, who their their only life savings is through whatever they worked up to through their lives. Their life expectancy is very low in comparison to other Latinos and other communities. So, we have a community member who's who's really scared of losing his dental care coming up.
He also has problems with vision. He's wondering what does it mean? What do these policies mean if you if you scratch out all these other elements? And so I think the important part is we should invest in making sure that whatever we're rolling out, we have to do it in partnerships with our county. We have to do it with our CBOs.
We also have to have conversations so that everything is translated in a community form or community forum, in a stakeholder forum. We can't we have already the best practices. This isn't new. We've worked to create this system now. It isn't something that's necessarily challenging but CBOs are going to be expected to pick up the bear of the brunt.
We're going to have to do the renewals every six month without the additional funding. We're going to do it because it saves lives. We're going to do it because it's necessary because that is our community. That is our family members. That is my godmother who's on Medi Cal.
So, this is this is essential. So, I think I really urge that we create new strategies that really honor the community experience. I do have some facts and figures that I wouldn't wanted to provide from a recent health care community health care coalition engagement with our local managed health care plan at least in the county that I'm in in Ventura County in the Central Coast. Gold Coast Health Plan membership is estimated at 230,027 individuals. Half of all children under five in Ventura County are Gold Coast Health Plan members.
One third of Ventura County residents are Gold Coast Health Plan members. One sixth of Ventura County seniors, some of the most vulnerable are also Gold Coast Health Plan members. This is an important fact right here. Gold Coast sides experienced approximately eight, zero in membership loss over the last two months. What does that tell us?
They're currently conducting an analysis on the membership drop off and the reason why. They believe this is a critical part that the recent state and federal eligibility changes have impacted their enrollment.
Speaker 1
Thank you. Really appreciate it. And you're welcome to stay for as long as you have. Thank you. Yes, you're welcome.
So, we'd also we have Anna Renas from CBD IO as well as Covered California and DHS since we're going through kind of first person testimony. Maybe we'll go to you miss Arenas and then over to Covered California and and DHCS. Hi. Thank you so much.
Speaker 50
Starting in 2027, upcoming changes to Medi Cal will include new work requirements, eighty hours a month, proof with proof of pay stubs. These changes might significantly impact many community members especially those working in seasonal jobs and receiving payment through in cash. Taking example, our farm workers. Many individuals in our community work in agriculture, construction, cleaning service, or others seasonal positions where hours are inconsistent. During slow seasons, they may not meet the required number of work hours even though they are actively working when jobs are available.
As a result of these impulse work requirements, their medical coverage could be placed at risk through no fault of their own. To require proof of eighty work hours monthly will mean many will no longer qualify even if they are barely making ends meet. Additionally, some workers are paid in cash, leaving them with no way to prove their income to Medi Cal. Without proper documentation to verify income, community members may face delays, denials, or even lose coverage completely. The consequences of losing Medi Cal coverage can be serious.
Without affordable health coverage, community members may delay or avoid seeking medical care because they are cannot afford the cost which we're already seeing. This not only affects the community's well-being but it can also result in more frequent emergency room visits and higher medical cost overall. Farm workers are the backbone of California's agriculture industry and economy. Yet policies are being creator, created to bury their health to health coverage risk, pushing their health to the back end. The people who grow and harvest our food should not have to sacrifice access to health care Simply because their work is seasonal or difficult to document.
Thank you.
Speaker 1
Thank you so much. Maybe since we're talking medical, we'll go to DHCS and then end with covered California if that's okay.
Speaker 4
So just to speak to a few of the agenda items in in item number three, effective 10/01/2026, h r one narrows the definition of qualified noncitizens that remain eligible for federally funded Medi Cal. This change will exclude certain immigration statuses, which significantly reduces federal funding for this population. Given the state's significant projected out year deficits, the administration cannot backfill for this change in federal policy. As such, the budget proposes to move these individuals to restricted scope Medi Cal. If the state were to, continue to provide full scope Medi Cal to this population, the cost is projected to be 786,000,000 general fund in the budget year, growing to 1,100,000,000.0 general fund ongoing.
The agenda asked kind of what some of the assumptions were for for this fiscal. We assume implementation date of, 10/01/2026 per HR one, assumed no ramp up or drop off assumptions, just that also almost like a lift and shift of these individuals to maintain full scope coverage. And then we essentially compared the cost to provide this coverage today, recognizing the significant federal funds that support this coverage compared to the cost of providing these services with significantly reduced federal fund. In addition, the administration is applying HR one work and community engagement requirements to all impacted individuals enrolled in the program regardless of immigration status. The intent is to implement these policies uniformly to all individuals enrolled in Medi Cal.
This will ensure really that uniform application of these rules, Not until actions in the 2025 budget due to fiscal constraints did Medi Cal ever distinguish between different populations in the Medi questions about the administrative costs for implementing work requirements for the unsatisfactory immigration status population, including system changes and county workload. We do not have a separate cost for implementing these these requirements as, you know, satisfactory immigration status compared to unsatisfactory immigration status. And we do not yet have the final cost for system design just generally to implement work requirements of as we've discussed a little bit, we are still in contract negotiations with some of the data sources that would be used across across all populations.
Speaker 1
Thank you so much, and we'll move to Covered California. Thank you for your patience.
Speaker 3
Yes. And thank you again, for hosting this important hearing today. As my colleague, director Boss, mentioned, recent federal actions through HR one, as well as federal marketplace rules limit immigrant eligibility for a variety of social programs, including subsidized marketplace coverage through the federal tax credits and other federal programs. As a result, individuals who are today able to afford coverage will now face substantially higher costs and may, as assembly member Bonta talked about on the first panel, lose their access to insurance altogether. For many immigrants in California and in this country, as my fellow panelists highlighted, these changes come at a time of significant vulnerability and add more barriers to those who must already navigate in health care and beyond.
To give a little history here, since the inception of the Affordable Care Act, US citizens as well as lawfully present immigrants have been eligible to enroll in Marketplace coverage and receive the full amount of federal premium tax credits and cost sharing reductions as other Marketplace enrollees. Unfortunately, HR one significantly narrows eligibility for lawfully present immigrants across, multiple programs, again, including marketplaces, undermining affordability, potentially pushing coverage out of financial reach for many. Starting in 2027, and so for us, this is a January 1 implementation as opposed to October, these specific groups of lawfully present immigrants will no longer be eligible for any federal premium tax credits and cost sharing reductions. And we are talking about individuals who are generally income ineligible for Medi Cal by definition of being enrolled in covered California. And while some categories will remain eligible for federal financial support, the largest of which is green card holders, this eligibility change will affect approximately 123,000 of our current enrollees representing more than 90% of the immigration categories that have always been eligible for financial assistance through Covered California funded by the federal government.
Chair Addis highlighted some of these statuses when she opened the hearing, some of the most challenging circumstances that brought them to this country, again, legally, refugees, asylees, as well as those with work or student visas, victims of domestic violence or other serious crimes, as well as as many more. These individuals can still enroll through Covered California and in a Covered California plan, but only at full cost without any financial help, which would render coverage unaffordable for many. This represents $600,000,000 in federal tax credits that, again, these individuals will no longer be eligible for and would no longer come to cover California. To put a stark number, to to this, the average increase that in cost on a monthly basis for these individuals is approximately $650 each month for in moving from subsidized to unsubsidized coverage. I also want to mention that HR one did eliminate tax credit eligibility for lawfully present immigrants with incomes below a 100% of the federal poverty level who are ineligible for federally funded Medi Cal due to the five year bar.
But while this is a large impact in other states in California, this population is generally covered under Medi Cal, but that is a provision of HR one. Further, federal rules last year eliminated marketplace eligibility altogether. They may not even under federal rules purchase a covered California plan nor are they eligible for financial support through the federal programs that we delivered. To comply with federal law, this change had to be implemented in August 2025 when we disenrolled approximately 2,300 DACA recipients. That number was relatively low as they only gained eligibility, the open enrollment before that change was implemented by the new administration.
We are deeply focused on preparing for this change and doing what is within our power to support our enrollees who will be impacted by this loss of federal support. We are developing an organization wide strategy to help lawfully present immigrants navigate these eligibility changes, spanning outreach, communications, community engagement, leveraging our community, our in person enrollment partner workforce of which we have 14,000 individuals that do this work across our communities. And in 2026, we will be working to provide public education and awareness, partner and stakeholder support, as well as consumer transition support. And again, we'll be working and listening to stakeholders and partners about how to best do this work as we head towards this open enrollment period. In closing, we know partnership will be a critical part of our efforts to serve those lawfully present enrollees who may not be able to maintain their coverage in 2027 with these affordability changes, and I look forward to hearing from the remainder of the panel and to answering any of your questions.
Thank you.
Speaker 1
Thank you, sir. Any questions from the dais? Any members up here? I know we've had a bit of conversation already on these topics today, but Assemblymember Banta. Thank you.
Speaker 6
I think we are all, deeply just taking in the gravity of what you all are presenting from a systemic level and then also just incredibly moved by the testimony of our individuals who came up to talk about, the direct impact of this all these decisions on on them. So forgive us if we are slow to integrate that because hashtag we all have feelings. Thank you so much, Chair. I I wanted to just ask the LAO in in your report Where's LAO? We'll
Speaker 1
bring the LAO. If somebody doesn't mind giving giving a little bit of room to LAO, grab a seat up here.
Speaker 6
Given the I'll ask the question while you all are getting situated. Given the challenges that we've heard about the impacts of implementing the HR one workload on counties and the potential loss of coverage for procedural reasons and others related to the work requirements. Can you share just some of the LAO recommendations of alternative strategies that the legislature should be exploring around implementation of the work requirements. It was in your report.
Speaker 2
So you mean to to mitigate disenrollment associated with the work requirements? Mhmm. Yeah. So with regards to applying the work requirements to adults with unsatisfactory immigration status
Speaker 1
you move the mic? Oh, I'm I think we're not picking you up on the microphone. If you don't mind moving it closer.
Speaker 2
Hello. Can you hear me okay? Yeah. So with regards to the administration's proposal to apply the community engagement requirements to you to adults with unsatisfactory immigration status, We we do feel that this could increase workload for for counties, especially because administrative data on income and work may not fully capture the UIS populations. For example, the administration, has discussed, tapping into some of the third party data on work and income, such as Equifax and and Trueve, But a lot of these data linkages rely on, social security numbers, which, many, UIS adults, may not may not have.
And yet the state would have to bear, a lot of the the 100% general fund costs for for some of these populations even though they're not fully captured in in these data linkages. And so one of the issues for consideration that that we raise in in in our report on on Medi Cal is that there may be ways alternative ways of achieving budget savings alongside some of the the the changes that have been proposed by the administration. Even if budget actions focus on adults with UIS, there may be other approaches. For example, lowering the income threshold for state state only coverage to better target resources toward higher need populations rather than than subjecting this population to the the community engagement requirements.
Speaker 6
as Covered California has been looking at this basically, precipitous fall for many people who are in this category of, permanently legal citizen permanently legal residents, who have been, essentially had their coverage decimated under HR one. Recognizing that they are not income eligible for Medi Cal, they are will no longer be eligible for covered California for the exchange. Are there any alternatives for making sure that that 123,000 people have the ability to have some some type of coverage that you all have done any scenario planning around?
Speaker 3
Yeah. Thank you for that question. And I I think the answer is there is no clear source of comprehensive affordable access to health care. We're going to be working very hard throughout the coming year to identify any resources that are available, whether those be county based programs, whether those be health care providers that are available on a fee basis, etcetera, so that we can do, again, what can be done to refer this population to resources that are available. But I don't think we should pretend that there is a clear and obvious answer.
Some people can, for example, get employer based coverage through a spouse or partner or family member. Some people may consider changing their work. Right? These are really big and hard circumstances, but again, absent funding to subsidize coverage through Covered California for people that do not have access to employer based coverage, no, there is not another clear place to go. Nothing
Speaker 1
else, assembly member Banta. Any other questions from the dais? No. I I just have one, I think, for the administration. You know, we've heard, a lot of devastated news, basically.
And if you feel like the trailer bill encompasses all the things that we need to be thinking about right now or if we may we may want Department of Finance back up. I'm not sure, who's best to answer this. But if the trailer bill language really has encapsulated all of the pieces that we're gonna need to address, when it comes to h r one, when it comes to documented and undocumented individuals, the change in what we considered unsatisfactory immigration status, how we're gonna navigate that. While the dollar amount may not take care of it, this the construct of the trailer bill encompass everything we need to be thinking about.
Speaker 11
Sabrina Adams, Department of Finance. I would just reiterate what my colleague from Department of Health Care Services said in the prior panel that the HR one trailer bill implements sort of the federal requirements that take effect prior to 2028.
Speaker 4
And I will note, and we've been working with committee staff and and advocates on one of the definitions that I think we need to kind of work on and and clarify, but I that but the the framework is there. I think some technical changes that are are likely needed.
Speaker 6
Yeah. This is a question more for d DHCS. So we know that, HR one imposed these work requirements. The state of California, of its own volition and voluntarily decided to apply those work requirements to, you you undocumented immig people with undocumented immigrate unsatisfactory immigration status. Can you all just lay out for us what the rationale for that decision was?
Speaker 4
It's to provide, kind of uniformity of our eligibility requirements across all populations in the Medi Cal space. And so from from that lens, from implementing kind of the Medi Cal program regardless of kind of your immigration status and recognizing, I know that in 2025, we did take actions because of fiscal constraints to make distinctions, but prior to that, we've really implemented the program consistently and uniformly across across populations. Right.
Speaker 6
I said this earlier. Two wrongs don't necessarily make a right, and certainly not in this situation. Right? We are all sitting here fighting mightily against the actions that have been taken by the federal administration under Trump. We've been talking about the devastating impacts that they will have, you know, because of the federal government's actions, I think it might behoove us to have a deeper analysis other than parity, to justify doing the same thing for for those people who are within our control to be able to provide better better care for in the state of California.
So I'm sure this will be a a point of ongoing conversation. I just don't understand why we would easily and proactively buy into a hateful, MAGA laden justification for eliminating health care for people when we intentionally created our own health care system or a payment system for those who were, a part of the expansion population. So, you know, these are tough conversations. I just it is really hard to have 40 plus, 50 plus people here, hundreds of people that I've talked to that many of the folks on this panel have, spent a lot of time with in in our own districts talking to to to justify California willingly taking these actions with a simple explanation of they did it, so we have to do it too.
Speaker 4
Appreciate the comments. These are very heavy. Just broadly speaking, everything we're discussed today that we discussed as part of the 2025 budget actions, very heavy policy discussions, and just given the state's fiscal constraints, just things that we will need to work together to prioritize and, decide together.
Speaker 6
Just on the on the fiscal pressures, this is a budget hearing. I think I heard you say that you didn't have an estimate for how much it would cost the state to implement these work requirements. Is that the case?
Speaker 4
We don't have a distinction between UIS and SIS or unsatisfactory immigration status and satisfactory immigration status. We do have a kind of a comprehensive understanding of just what the policy changes will take to implement.
Speaker 6
And what's that number? I don't have it. And then also as folks are looking for that, do we also have a number a known number for the cost to counties to implement the work requirements? Maybe from the LAO? Can you say that one more time?
Sorry. The cost to counties. So cost to the state for implementing these, particularly the work requirements or any of these changes, cost to the counties for implementing these work requirements, administrative costs, others. And I don't know if color covered California also has potential implementation costs associated with responding to h r one.
Speaker 4
So in terms of administrative costs to the state and counties to implement these changes. We're working with counties on their county admin costs. We don't have a number that was part of governor's budget. That is something that we continue to work with them on as we think about, how more things are automated and as we get additional federal guidance. With regards to the state costs, there are some minor costs with regards to the IT changes, and then we have the our BCP, with state operations costs including the 17,500,000.0 for the outreach and engagement.
So we have a BCP outlining our administrative costs that I can pull up really quick. Expenditure authority of about 33,000,000, 15,000,000 general fund for with the state ops cost, including that 17,500,000.0, outreach and engagement plan.
Speaker 6
Any other numbers to share in terms of the cost? And for counties, I I'm just I'm reviewing a report from the California State Association of Counties that came to visit us, last week. They indicate that the price tag for, HR one is $9,500,000,000 every year. Indigent health care, the counties will incur up to $5,500,000,000 a year in new costs to provide, low cost medical services to individuals, to public hospital systems, $3,400,000,000 a year, in federal funding cuts. And I think this one is the most pertinent pertinent to the question I'm asking, county eligibility workforce.
It will cost nearly $600,000,000 in new workforce costs to implement the eligibility requirements? So that is
Speaker 4
the piece that we're still working with counties on. We acknowledged in our budget that came out in January that we are still working with the counties on that on what it might take to do these requirements. We did not include dollars in there because we are continuing to still see how much can be automated and what federal guidance will will dictate in terms of how we can process this, but we did acknowledge at governor's budget that this is a conversation that we are engaging with with our our, County Welfare Directors Association and counties on. We we acknowledge that.
Speaker 9
Thank you. I just wanna add to it what it looks like for the city and county of San Francisco in terms of the need. I talked with our with Trent Rohr who heads up the Human Services Agency, and they need an additional 67 eligibility workers and eight eligibility worker supervisors for a total of 75 just to deal with the new requirements. And so that's one county. And I I know you haven't come up with an estimation, but it's it's almost it seems, well, cruel is absolutely the word that comes to mind, but there this is urgent, and I feel like we're not meeting the urgency of it.
And and that's no criticism of you. I'm just really worried that not only do we not have the money for the workers, but where are the workers? What are we doing to even get the workers and we're and dealing with the workforce issues here to address this crisis.
Speaker 1
Any comments just on the workforce piece of it, outside of the budget piece, but just where are the workers? I know you mentioned a number of different kinds of workers, but anything No.
Speaker 4
Mean, this is kind of a lesson we learned with the public health emergency and the unwinding and the redetermination process. We paused redeterminations for a few years, and county eligibility workers had not done that work for a few years. So there was a lot of training that was needed just to kind of bolster just that that knowledge with a lot of the new workforce. And so, with those kind of lessons learned, that's part of the reason we're, working with them to kind of continue to refine what it might take, thinking about, again, all the automation, the numbers that you see before you, the 1,400,000 in particular related to, work and community engagement requirements. We're continuing to refine that, and we'll have new numbers at May revision based on new data sources that we have.
And so these are all parts of the conversation of what is the calculus in terms of what a county might need to determine eligibility. But that is part of the 238,000,000, requests from counties in this space.
Speaker 1
Got it. I'll I'll I'll just make one comment before we go to public comment, and I just I wanna reiterate what we heard from miss Terron and miss Cerenas, from MICOP and from CVDIO in terms of the value of human outreach and, you know, should we move forward with the seventeen point five and the 4,000,000, and there was a lot of talk around tech. And I do think that piece is important, but I also hope we're really paying attention to our practitioners that are, you know, every day working with people directly and, and and putting procedures in place that really will, it's a different workforce than I think assembly member Stephanie is talking about, but those, you know, folks that can have direct contact in terms of helping people, you know, get signed up, fill out the forms, the promotores, the, you know, the direct outreach that might be out in the fields, in the farms, in the workplaces to help, help people. And I think about the number of folks that were cited earlier that actually are working, but on Medi Cal and how those employers might pay a role in terms of making sure people are redetermined.
There's other legislation, I think, that is around how we could get those employers to pay a role in helping foot the bill. But also, I think they can play a role in terms of making sure folks get their redetermination and be important partners in that. So with that, we'll turn to, if nothing else on the dais, we'll turn to public comment. And again, this is for impacts of HR1 and federal actions on immigrant access to care. And if you could state your name and or organization and keep it to one minute, it looks like we have at least a half hour, maybe forty five minutes of comment just on this issue.
So, and if you can tighten it up, I've given everyone a minute today but if you can get it in less than that, we would certainly appreciate it because we still have public comment for items not on the agenda. So welcome.
Speaker 51
Yes. Thank you. My name is Tweeda with the Southeast Asia Resource Action Center, a national civil rights organization that empowers Cambodian, Vietnamese, and Laotian communities to create a just society and convene 17 Southeast Asian CBOs across California. I'm here to speak for the Union Community, a Southeast Asian indigenous and refugee community that calls Sacramento home. Many of us have settled here after the Skip War.
And last month for the Lunar New Year celebration, our community partners at Union Community Services and Halo hosted a flu vaccine clinic right at the community center. Because it was culturally trusted, it worked. Elders got protected, families stayed safe, and trust was built between the community and our public public health system. But that progress is, fragile. Federal cuts have already pushed humanitarian immigrants from, preventative care to emergency only coverage.
Now as a state considers its own budget, additional cuts would compound this harm hitting the Indian and other Southeast Asian communities the hardest. And so we urge legislators to consider long term sustainable revenue solutions to continue these essential safety net programs. Thank you so much for your leadership.
Speaker 39
Good afternoon. I'm Diana Honek with the Multifaith Action Coalition, which represents nearly 50 congregations in Contra Costa County. Our shared faith values honor human dignity of every individual and calls us to speak out for the health and well-being of all people regardless of immigration status. We request that the legislature fight any further, funding cuts impacting the undocumented populations already reeling from last year's budget cuts. We also ask that the state not impose unnecessary and harmful requirements work requirements on state funded populations.
In our Contra Costa County, our health director estimates that about 900,000 people in our county will lose coverage due to HR one. Without access to health care, people will not only die, but also delay care and show up in emergency rooms in worse conditions, raising the cost of care dramatically as has been noted. Our county systems, especially our county and rural hospitals, will simply not be able to withstand the financial strain of providing unreimbursed care for such large populations statewide. Thank you.
Speaker 52
Good afternoon, madam chair and members. Manuel de Pasaragin with the California Immigrant Policy Center, proud co leads of the Health for All Coalition, also including and Child Poverty in my comment. Both HR one and the January budget proposal attack our immigrant communities' access to health care. We urge you to roll back cuts from last year and reject any additional, proposed cuts to Medi Cal. Before the passage of HR one, the state voted to implement deep cuts to, Medi Cal to the Medi Cal program.
The LEO's estimate of 1,500,000 immigrant Californians losing coverage by 2030 due to these cuts is unacceptable. This year's budget proposal takes it one step further, proposing to exclude immigrant Californians that will lose eligibility for federally funded Medi Cal in October. These include refugees, asylees, survivors of domestic violence, and others. We cannot continue to say that we are protecting our immigrant communities while simultaneously stripping their access to vital programs and services they desperately need. Now is the time to show our state's values and ensure we do not create a two tiered system, that supports only some.
Thank you.
Speaker 53
Good afternoon, madam chair, honorable members. David Campos, deputy county executive for the county of Santa Clara, which runs the second largest public hospital system in the state. We actually serve about 75,000 residents that benefit from the state only Medi Cal program. Putting aside the ethics and the morality as we criticize Trump for how he's treating undocumented people and the morality of some of the things that we're proposing, we just simply want to note three things. One, the undocumented people that we're talking about, even if it's costing a billion dollars to, bring back the Medi Cal coverage, they pay more than $8,000,000,000 in taxes to the state of California and local governments.
The second point is that when it comes to public policy and anything involving a response to what Trump is doing to the undocumented, uniformity should be the last word that grites anything we do. We should be doing the complete opposite and and certainly not be in uniformity with Trump. And then the last thing is this, and and we hope that the guard governor will be considered with the May revise. But if he doesn't do that, we hope that the state legislature steps in because, as has been noted by senator Durosso and others, this doesn't, make people go away. The 75,000 people that we serve are coming back to the counties.
It simply shifts the cost to the counties. Thank you for
Speaker 24
Good evening. Linda Way with Western Center on Law and Poverty. Appreciate the excellent analysis, chair's leadership, as well as assembly member Bonta and Stephanie's championing against the administration's proposal to amplify federal harms. We urge the legislature to reject these cruel and more severe proposals, specifically we oppose subjecting state only populations to work requirements and more frequent renewals. This proposal is legally and logistically problematic, costly as it adds red tape, and punitive to immigrant communities who are still reeling from last year's budget cuts.
We also oppose cutting full scope Medi Cal to humanitarian immigrants that would move 200,000 people, most of who have had Medi Cal since inception, to restricted scope. This means that people will have to wait until their health becomes a life threatening emergency to get care. Thank you.
Speaker 23
Good evening. Yasmeen Pellev. On behalf of Justice in Aging, like my colleagues before me and after me, we're also in opposition to the proposal, to subject undocumented individuals and UIS populations to the work requirements, also opposed to transitioning the 200,000 humanitarian immigrants into state only Medi Cal. I'll add that in addition, that same population of the humanitarian immigrants also lost their Medicare eligibility under HR one, and so for those who are both were dually eligible for both Medicare and Medi Cal, losing their Medicare and now losing their Medi Cal will again mean no options for health coverage, and so if the state were to put these folks into state only coverage, they would be able to remain having some amount of health care. Otherwise, just more people uninsured.
Thank you.
Speaker 11
Good evening. My name is Christine Smith with HealthX of California. We urge the legislature to push back on harmful Trump cuts and support the 200,000 lawfully present immigrants who are being kicked out of full scope medical by the Trump administration. These are refugees, asylees, trafficking, and domestic violence survivors who are here lawfully and who have for decades had access to full scope coverage. We wanna emphasize the huge difference in restricted scope and just the tremendous loss that that would be if you were to go into emergency room with an asthma attack, you would be able to breathe when you left, but you would not get an inhaler.
Under the proposed, January budget, again, these people would only have access to emergency situations, And we also urge the legislature to stand firm against any further cuts that would impact an undocumented populations impacted by last year's state budget cuts. And, specifically, do not please do not include the harmful work requirements on any populations that would not be federally required. We're also really concerned with the impact of the work requirements in the freeze. Kelly
Speaker 26
Brooks on behalf of the California Association of Public Hospitals. We are opposed to the January budget proposal to eliminate full scope Medi Cal coverage for, humanitarian immigrants. This is a policy choice that harms our patients. Second, I would note that in the, on the FMAP issue that's outlined in the agenda, public hospitals estimate a loss of $330,000,000 in federal revenues just for us. It that funding is outside of state budget impacts because we put up we're the only group of hospitals that put up the nonfederal share of Medi Cal inpatient fee for service days.
Thank you.
Speaker 54
Hi. My name is Geraldine Abilo Caradenaas. I am a patient advocate, as a medical student. I had a a few years ago, I had a patient with an active asylum case after witnessing her partner murdered and giving birth to their child with severe disabilities requiring full time care. She reminded me of my own family who in the nineteen eighties fled El Salvador, and began working here in in LA County, as custodians living in a one bedroom apartment with 12 other people.
I'm able to stand here today in part because of public programs that allowed me and my mother to survive a complicated birth, a public workforce program that allowed them to become county social workers, and, state medical school who is allowing me to pursue my goals. I urge the legislature to consider the long term effects of rolling back coverage or making that care even harder to access with monthly premiums or impossible work requirements for folks already working multiple jobs just to live paycheck to paycheck. Currently, our county emergency departments have patients managing preventable medical emergencies in waiting room chairs that could have been addressed at a lower cost with accessible primary care. Thank you.
Speaker 55
Good evening, madam chair and honorable members. My name is Alan Marroquin. I'm a medical student here in Sacramento, and I stand in solidarity with the Health for All coalition and their stance on this issue. As a physician in training, I have the privilege of working with and taking care of people from all over the world, from all walks of life. I'm here today to be a voice for my immigrant families and neighbors who have been living in fear of leaving their homes, going to work, and now as a result of recent budget cuts losing their access to health care.
We are a nation and a state of immigrants. Our immigrant population plants, harvest, and cooks our food. Immigrants clean and build our homes and workspaces. Immigrants take care of our children. Immigrants are business owners, professors, law enforcement, military, legislators, physicians, and leaders in our community.
And in this state, immigrants are Californians. As a voice for my immigrant families and neighbors, we urge the legislature to stand firm against any further cuts that would impact undocumented populations and specifically to not include the harmful work requirements for state funded populations. We urge the legislature to consider long term sustainable revenue solutions to continue essential safety net programs. The solution is not uniformity. It is equity and basic human decency.
As the wealthiest state in this nation, we can do better than this, and we should. Let's continue working together to save lives and not take them. Thank you.
Speaker 56
Good afternoon. My name is Ijeoma Uche. I am an MD PhD candidate at UC Davis, and through my clinical training and research, I've seen how often our healthcare system fails mothers during pregnancy and after birth. These gaps contribute to The US having the highest maternal mortality rate amongst all other industrialized nations, and these harms disproportionately affect immigrants and undocumented families. One in seven pregnancies are affected by gestational diabetes.
Because pregnancy is one of the few times families connect with our health care system, it offers a critical opportunity for prevention. These mothers also face upwards towards a tenfold higher increased risk of type two diabetes and their children facing higher risk for obesity and other metabolic diseases, basically shaping the health of two generations. Policies that require mothers to repeatedly prove work eligibility even six months every six months ignore the reality of the postpartum period, which is after birth. Many mothers are recovering from childbirth, caring for a newborn, and often do not have access to paid maternity leave. For immigrant families already navigating new the new health care system, often in other languages, these barriers will push families further away for preventative care and keep mothers and children healthy.
Protecting access to care during pregnancy and postpartum improves maternal health and supports healthier families and prevents costly complications in the future. Thank you for listening.
Speaker 1
And I'll just remind you to, if you could keep it to a minute or less would be super helpful for those at the very end of the line.
Speaker 42
We'll try. We'll try. Good afternoon, chair and members. Omar Altamy with the California Panethnic Health Network. CPAP urges the legislature to reject governor Newsom's proposed cuts that would see over 200,000 asylees, refugees, and trafficking and domestic violence survivors lose coverage.
These draconian cuts target some of our most vulnerable communities and undo decades of state and federal law. As has been stated before, we cannot balance our budget on the backs of our most vulnerable communities. We must be pushing forward conversations on revenue instead of discussing draconian cuts that will reset decades of progress in this budget year. Thank you.
Speaker 49
Good afternoon. Lily Doran with the Children's Partnership. I just wanna thank you all again for the thoughtful dialogue and timely discussion here today. We urge the legislature to reject any further cuts that would harm immigrants already affected by last year's budget reductions. We strongly urge the legislature to stand against harmful federal cuts, oppose Medi Cal work requirements, and ensure state funded coverage for the nearly 200,000 lawfully present immigrants losing federal Medi Cal.
We look forward to continuing to work with our partners, with the legislature, and the administration to address these challenges while protecting Californians California's children and families and upholding our commitment to health care for all. Thank you for your leadership.
Speaker 18
Good evening. My name is Rosa Bay. I'm the co deputy director at the East Bay Community Law Center in Berkeley. We're here as part of the Health For All Coalition. We are the largest provider of free holistic legal services to low income people in Alameda County.
Every year, we serve thousands of people who are fighting to remain housed, to remain together with their families, and to access critical benefits, which includes medical care that they need to survive. It should be a surprise to no one in this room that things are getting much, much harder for our clients under this administration. California has the power and responsibility to not add to their hardship right now. Some of our clients are being detained by immigration, and they're losing their employment based health care as a result. Their families are often left with no backup, no safety net now under these changes, and to hold them in this very vulnerable and scary time.
We're seeing the cascade of impacts from threats to their housing, to their ability to access food and health care, all hanging in the balance. It's unconscionable. We can do better. Thank you.
Speaker 57
Good afternoon. My name is Cleo Bluethenthal here on behalf of the California Community Foundation, where we are committed to protecting the civil rights of Los Angeles' immigrant communities, fostering their full participation in the region, and supporting the implementation of policies that advance their access to basic services like health care regardless of legal status. The stakes today are extraordinarily high. Los Angeles County is home to nearly 1,000,000 undocumented immigrants. One in five children in LA County live in a mixed status household.
These are not statistics. These are our neighbors. They're our coworkers, and they're the people that are rebuilding our neighborhoods after the fires. We stand here today with our partners in the Health For All Coalition and with immigrant communities across LA and California to make three urgent requests. First, we urge the California legislature to hold the line against any further cuts to health care coverage for undocumented populations.
Second, we ask the legislature to reject the harmful work requirements for state funded populations. Third, we urge you to push back on the Trump administration's harmful cuts and to support the 200,000 lawfully present immigrants in California. Under the proposed budget, these individuals would be stripped of full scope Medi Cal and left with emergency care only care.
Speaker 57
on you to pursue long term sustainable res revenue solutions, and we thank you for
Speaker 1
your time. Thank you. And I'll just a quick reminder if you can give it to a minute or less.
Speaker 58
Good afternoon. My name is Meida Danuka, and I'm a third year medical student at UC Davis here with the Health For All Coalition. I'm mainly here for my four year old patient with global developmental disability, physical and intellectual disabilities whose parents came to The United States without documents in order to seek medical care for her. When I met her in the hospital where she was admitted for a severe life threatening infection, her father was only able to leave his near constant work for a brief evening visit. She was admitted for over a week and her mother had already been deported.
Medi Cal allows for my patient to access the kind of complex coordination and long term care that she needs to survive. Medi Cal saved her life. Although her father might be eligible for an exemption with the proposed work requirements for Medi Cal coverage due to his daughter's disability, he will then have to find that he could be eligible and then get support with documentation on his third language. As several community members with disabilities pointed out during previous public comments, many of the proposed implementations and workarounds may pose additional barriers to lifesaving care. The proposed budget cuts jeopardize millions of lives who contribute billions of dollars towards our state tax revenues.
Thank you for your time.
Speaker 14
Good afternoon. I'm Marissa Harris, a student doctor with plans to practice here in the community when I graduate. I'm here as a private citizen in solidarity with the Health Who Are All Coalition and do not represent my institution. Every day, I work to prevent permanently damaging outcomes for my patients with common illnesses. With access to primary care, we can treat strep throat before it becomes heart damage, hypertension before it causes a stroke, or manage diabetes before it causes multi organ failure.
When left untreated, it's my colleagues in the emergency room who see these patients and sometimes not soon enough to prevent these awful outcomes. Approximately 200,000 lawfully present immigrants are being kicked out of full scope Medi Cal by the Trump administration. And Under the proposed January budget, these patients will now only have access to care in emergency situations. Additionally, increasing logistical burden like work requirements poses barriers for patients disincentivizing them from accessing health care and increasing the workload on the already heavily burdened emergency rooms in our community. I urge the legislature to push back on these harmful cuts and stand firm against any further cuts that would impact undocumented populations that were already greatly affected by last year's state budget cuts.
We ask not to include the harmful work requirements for state funded populations as they can pose burdens that discourage patients from accessing consistent care. We urge the legislature to consider long term sustainable revenue solutions to continue these essential safety net programs. Thank you so much.
Speaker 13
Good evening, chair and members. Beth Malnowski with SCA of California. As you all know, we are a union, a proud union of immigrant workers, and proud part of the steering committee for the Health for All Coalition. And really, from the second remarks of the many Health for All representatives today, with regards to the needs to make sure we are rejecting a lot of damaging policies that we have before us. As has really been said today already, we cannot be balancing this budget on the back of immigrants.
We cannot be balancing the budget on the backs of their health on working families. We have to make sure that we honor our prior commitments to health care coverage for our communities. I think really what conversation today highlights is how it's so important that we're moving forward conversations around revenue solutions, really focused on our medical program and maintaining coverage. Thank you.
Speaker 58
Good evening, Chair Addis and members of the committee. My name is Danielle Bautista with the United Way California, the State Association of United Way throughout the state. We believe that every Californian should have access to the resources and opportunities that they need to thrive, and we urge the legislature to stand firm against any further cuts and harmful work requirements that would especially impact our immigrant populations. These cuts, we know, will lead to worse health outcomes and increased costs of accessing health care for individuals and families. As the world's fourth largest economy, California has the means to protect its residents, and United Ways of California remains strong in our belief that the state budget should never be balanced on the backs of our most vulnerable communities.
Thank you so much for your leadership on this issue, and we look forward to working with the legislature on ensuring continued access to affordable health care. Thank you so much.
Speaker 43
Yanmar Velez with the Latino Coalition for a Healthy California. State Medi Cal changes from last year's budget will disenroll individuals. Undocumented families will be frozen out because they won't be able to pay $30 premiums as they struggle with obtaining work due to fear of immigration rates. This is what California is doing to Californians. And this is something that needs to be reversed.
LCHC urges no further cuts to Medi Cal. Restore health for all including ending the freeze. And really appreciate the question around where are the workers. That is why we are asking for utilization data of the CHWPR benefit and want to work with the department to get that data. And additionally, we urge no work requirements for state funded or health for all populations.
Thank you.
Speaker 35
Good evening, madam chair members. Dennis Cuevas Romero with the California Primary Care Association. Wanna align my comments with many of my Health For All coalition colleagues. Also just wanna acknowledge with the expansion of the UIS population starting October 1, We appreciate the ongoing conversations with the department on how to reduce harm as it relates to other federal policy changes like PERRORA to that may really impact how health centers continue providing care to our immigrant rich communities. Thank you.
Speaker 57
Hello, madam chair and members. My name is Elena Sans Maria with Cal NextGen California. I echo the sentiments of my health care consumer colleagues and urge the legislature to stand firm against further cuts that would impact undocumented populations impacted by last year's state budget. Cuts specifically do not, include harmful work requirements for state funded populations. We urge the legislature to push back harmful Trump cuts that support 200,000 lawfully present immigrants who are being kicked out of
Speaker 57
the Trump administration. Under the pros proposed January budget, these people now only have access to emergency care situations, which is unacceptable. The legislature must protect the essential safety net programs and the people they serve. Thank you.
Speaker 59
Good afternoon, chair and members. I'm Monica Madrid, with the Coalition for Humane Immigrant Rights, CHILA, a proud steering committee member of the Health for All Coalition. CHILA, we serve immigrant families across California who rely on these safety net programs to survive and stay healthy. We urge the legislature to stand firm against any further cuts that would impact undocumented communities, including harmful work requirements for state funded programs. Last year's cuts already forced many families to be choose between food, rent, and medical care.
Additional barriers will only push vulnerable Californians into further into crisis. We also urge you to push back on harmful federal cuts that are stripping roughly 200,000 lawfully present immigrants off of full scope Medi Cal. Limiting care to emergencies does not protect public health. It simply delays treatment until the conditions become life threatening and more costly. Finally, we ask the legislature to commit to long term sustainable revenue solutions so essential safety net programs remain available to communities who depend on them.
Thank you.
Speaker 28
Good evening, chair and members. Karen Stout here speaking on behalf of UnidosUS. I just wanted to echo the comments that we've heard throughout the day about the importance of protecting our immigrant communities and continuing to preserve their health care access. UnidosUS is deeply concerned about the potential impact of planned rollbacks to Medi Cal eligibility, especially for Latino families. These cuts will further limit patient access to routine and preventative health care, leading to difficult and negative out health outcomes that are completely preventable, impact health care providers by reducing reimbursements for providing said care, and reduce access to affordable health care for thousands of low income people across the state.
We urge you to continue to oppose these dangerous cuts, and we thank you for completing the hearing. I also wanna give a brief comment on behalf of the California Nurse Midwives Association. You've already heard most of our testimony, but we just wanted to echo, all of the support people have had for immigrant communities today, particularly around those involving, pregnancy care. Thank you all.
Speaker 60
Yesenia Robancho with End Child Poverty California, again reiterating the same points that the Health For All Coalition has already shared. We shouldn't be mirroring Trump's agenda here in the state of California. An additional thing that we need to take into consideration if the department can do an analysis on how this may impact communities during tax time who may be subject to a state penalty for not having health insurance coverage, not because they don't want to, but because they can't afford it or because they are being barred from it due to enrollment freezes. This is an analysis that will be important as we continue these discussions. And similar to what our folks are already saying, we urge you to consider revenues to ensure that our undocumented communities are not keeping our Medi Cal system afloat, but we're taxing corporations and billionaires appropriately so they pay their fair share to the system.
Thank you.
Speaker 61
Good afternoon, Dorina Wadihaz El Campo and also a member of the Health For All Coalition. We are a nonprofit organization serving farm workers and their families. We're here to urge the legislator to push back on the harmful Trump cuts and support the 200,000 lawful present immigrants who have been kicked out who are being kicked out of full scope Medi Cal. Under these proposed January budgets, these people will only have access to care in emergency situations. In Contra Costa alone, it is estimated that about 90,000 people will lose their coverage.
We are a small organization working really hard to ensure that our members have access to health care and with all the harmful cuts, it has been both difficult and heartbreaking as many of our communities have worked years paying into a system that they cannot benefit from. It was mentioned earlier, it's about $8,000,000,000 that our immigrants contribute. Many are elderly community members who are not eligible for retirement, who have chronic health issues, and are in need of life saving medications, who will no longer be able to access their medications due to the high cost involved. We also know that only allowing people to access emergency care thank you. Sorry.
Speaker 27
Hello. My name is Maribel Mendoza, the cofounder and executive director of nonprofit Ijaz El Campo, also a health for all coalition member and also a proud daughter of one time undocumented immigrants from Michoacan, Mexico. We urge the legislator to stand firm against any further cuts that would impact undocumented populations impacted by last year's state budget cuts and specifically do not include the harmful work requirements for state funded populations. Outside of the COVID nineteen pandemic in the California wildfires, many of our undocumented farm workers are exposed to occupational hazards like valley fever and the detrimental effects of working with pesticides. And with the impending house farm bill, it will be making these health issues even worse, adding more barriers, excluding them, or finding ways to push them out of our health care systems will provide to will prove to be life and death.
We urge legislator to push back on harmful Trump cuts and support the 200,000 lawfully president president immigrants who are being kicked out of full scope medical by the Trump administration. That's it. Okay. Thank you. I had so much to say.
I'll email it.
Speaker 46
Does that work? Okay. Excellent. Hello again. Jessica Lehman with Canary Resistance and the LTSS For All Coalition.
Just have a couple of points to add to the wonderful public comments already made. One is for immigrants with disabilities, it's even harder to get any kind of exemption that they might qualify for, especially there's this weird catch 22. If you don't have Medi Cal, how do you get a disability diagnosis to then show that you need an exemption from work requirements so that you can get Medi Cal? And I mentioned caregivers already. More than half of home care attendants or caregivers in California are immigrants.
It is huge. I have a friend with a disability who lives in Bakersfield who was talking about the challenge that she has in getting caregivers. She talked about people who are her workers and her friends who have been deported and how she's trying to help them and how is she trying to stay in her own home, stay out of an institution, get the care she needs. As assembly member Bonta, my assembly member, raised, it is unconscionable to apply work requirements more than is required by the federal government right now. The only solution to all of these problems is to raise revenue to fund health care without depending on the federal government.
Thank you.
Speaker 48
Good evening. Once again, this is Evan Fern on behalf of Disability Rights California. Applying new paperwork requirements to people in programs not subject to HR one's requirements will needlessly take care away from even more people. And if they're undocumented, they won't be able to reenroll at all, even if they previously qualified. Refugees, asylees, and survivors of trafficking and domestic violence being cut from full scope Medi Cal are more likely to experience post traumatic stress disorder, a disability that can often be managed with treatment.
Disabilities don't care what your immigration status is. People still need ongoing and life sustaining care. It's cruel to accept that these immigrants with disabilities will die from treatable and preventable conditions because of these cuts. Thank you.
Speaker 1
Seeing no other public comment for items on the agenda, I'll say thank you to our panelists for your testimony and maybe just one last comment to urge DHCS to I wanna echo the comments about people with disabilities as a former special education teacher for a very long time, as well as a teacher of immigrant children with disabilities and with intensive medical conditions that when you're making your outreach plan and going through those motions to try to ease the burden and covered California as well, that you're really thinking about the population of people with disabilities that are also immigrant and also speak English as an additional language and how important it's gonna be for that very specific population that I don't think we've talked about enough, but I wanna appreciate the public comments on those issues. So thank you for joining us, and you're welcome to stay for comments not on the agenda, but we certainly respect your time and note that you, probably need to go. So with that, we'll close this out and open up to public comment for items not on the agenda. Seeing nobody come to the mic for public comment not on today's agenda.
We'll say thank you to everyone and we are now adjourned.
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