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Senate Budget and Fiscal Review Committee California State Senate
Follow its sittingsSpeaker 3
Here. Blake Spear? Kobolden? Here. Choi?
Here. Doracio? Grove? Artado? McNurney?
Me? Doracio here. Menjivar? Richardson? Here.
Here. Smallwood Cuevas? Weber Pearson? Here.
Speaker 1
We have a quorum. And just one last thing, because I'm going to invite the first panel to come up. I have to step out of the hearing at 11:15, and Senator Nilo graciously said he would pick up the slack. As I told him, I have to go to the bill signing of the bill he opposed. So I'm really glad that he is picking up the slack by keeping the committee going when that happens.
You're welcome. Yeah, your welcome is on the record. We'll now begin with our first panel. We have Ryan Woolsey from the Legislative Analyst Office, Sabrina Adams from the Department of Finance, Miranda Dietz from the UC Berkeley Labor Center on the first panel. And did I leave one of you out that's presenting?
Gina? Yes. Okay. And Gina, who are you with?
Speaker 1
Perfect. Sorry you're not on my notes here. So each of you will get five minutes and we will have questions of the committee afterwards before moving to the next panel. But we do need to move along today because we don't have all the time in the world at the end. Having said that, welcome to the committee.
We'll go in the order of Ryan, Sabrina, Miranda, and then the food center. Welcome to the committee.
Speaker 5
You, Mr. Chair and members. Good morning. Ryan Woolsey with the Legislative Analyst Office. We've been asked this morning to provide a high level overview of the impacts of HR1 on Medi Cal and CalFresh.
I'll be speaking from a handout that's been distributed to you, starting on page two with some very high level background. Medi Cal and CalFresh are among the largest health and human services programs administered by the state. They provide health coverage and food assistance to millions of Californians with combined annual spending in the hundreds of billions of dollars. HR1 makes significant changes to both Medi Cal and CalFresh in three main areas, and I'll walk through each of these in turn. The first is work requirements.
Turning to page three. HR1 expands work requirements in both Medi Cal and Cal Fresh by requiring part time work or participating in other qualifying activities, focusing on able-bodied working age adults that don't have certain challenges that would make a part time requirement difficult, such as disabilities or caring for younger children. In Medi Cal, the requirement is new and applies to the childless adult population. An estimated three point five million people are expected to be subject to this requirement, and we estimate that one to 2,000,000 of these may end up being disenrolled from coverage. Turning to page four.
Federal law already required work participation for able-bodied adults without dependents in CalFresh, but until recently the state had a waiver from this requirement that applied to all counties. HR1 expands this CalFresh work requirement in California by applying it to adults age 55 through 64 and to those caring for dependents age 14 and older. It eliminates exemptions for former foster youth, veterans, and homeless individuals, and it tightens rules for waivers from the requirement, effectively ending California's statewide waiver. With these changes, over 800,000 individuals are anticipated to be subject to this work requirement and over 600,000 may lose food assistance. On other eligibility changes, turning to page five, HR1 makes certain non citizen groups, including asylees, refugees, and others, ineligible for assistance in Medi Cal and CalFresh.
An estimated 200,000 people in Medi Cal and 72,000 people in CalFresh are expected to lose benefits as a result of this change. In Medi Cal, HR1 increases the frequency of renewals for the childless adult population from once annually to twice annually. It also requires the state to impose a share of cost for certain services for the childless adult population in Medi Cal, subject to a minimum income floor. The last group of changes in HR1 relate to program financing. Turning to page six.
HR1 and Medi Cal tightens rules for health care provider taxes that are used to help pay for the Medi Cal program. In California, this will primarily mean a reduction in the size of the state's managed care organization tax and a fee on private hospitals. We estimate that this will result in ongoing annual costs of a few billion dollars a year. HR1 also reduces the federal share of costs for emergency services provided in Medi Cal to undocumented immigrants from 90% to 50%. This is estimated to result in costs of $658,000,000 General Fund in twenty twenty six-twenty seven.
Turning to page seven for CalFresh financing changes. HR1 reduces the federal share for administrative costs from 50% to 25%. This shifts approximately $480,000,000 a year in costs to the state and another $190,000,000 a year in costs to the counties. Then on page eight, H. One imposes a share of benefit costs in CalFresh, depending on the state's payment error rate.
If the state's payment error rate remains at its most recent level of about 11%, the state would be subject to the highest level of share of costs under HR1 of about $2,000,000,000 a year. In conclusion, I'll highlight a few issues for legislative consideration. First, the state faces significant structural budget deficits. And in light of these, it will not be possible to backfill lost federal funds and lost benefits from HR1 absent significant other budget actions. There are other resources available to individuals who are affected by HR1, but these are limited and will not be able to fully replace Medi Cal and CalFresh.
There are three areas that we think are key to supporting a successful implementation of HR1. One is to focus on automation and data sharing, to reduce manual processes and limit unnecessary interactions with enrollees. This may help to lessen the risk that people who remain eligible for benefits are not inadvertently or incorrectly disenrolled because of administrative burden. It's also important to consider how best to support initial and ongoing county responsibilities since counties are on the front lines of implementing HR1. And finally, we recommend that the legislature take steps to ensure that implementation of HR1 aligns with its priorities by enacting key decisions in statute and adopting mechanisms to ensure ongoing legislative oversight, especially in cases where federal guidance is still forthcoming.
That concludes our comments, and my colleague and I are able to take questions when the time comes.
Speaker 1
Thank you very much. We appreciate your comments. We'll move to the Department of Finance.
Speaker 6
Good morning, Chair Laird, members of the committee. Sabrina Adams with the Department of Finance, here to present today on the fiscal impacts of HR1 on the Medi Cal and CalFresh programs. Also noting that the Department of Health Care Services and Department of Social Services are here to speak to the programmatic impacts of HR1, as well as some of the mitigation efforts as the state moves to implement these new federal requirements. So to begin, across health and human services, the governor's budget includes an additional $1,400,000,000 general fund in fiscal year twenty six-twenty seven in response to HR1 and also includes a $2,400,000,000 reduction in federal funds. And further federal fund reductions are estimated to grow to over $12,000,000,000 by fiscal year twenty twenty nine-thirty.
So breaking down this $1,400,000,000 general fund a little bit further, Medi Cal accounts for an increase a net increase of $1,100,000,000 of these new general fund costs. And the main drivers of these new Medi Cal costs are a reduced federal match for emergency services for certain populations, as well as a lower support for the Medi Cal program from the hospital quality assurance fee because California's submission was not deemed approvable by the federal government. The governor's budget also requests administrative resources totaling approximately $24,000,000 general fund over four years to address new DHCS workload and requirements. For Calfresh, the governor's budget reflects a net increase of $300,000,000 general fund in the budget year, and this is primarily driven by the updated administrative cost sharing provision that reduces the federal share for this program from 50% down to 25%. These resources that are included in the governor's budget build upon one time resources that were included in the 2025 Budget Act.
So, after H. R. One was passed, the administration and the legislature took action to provide resources for the Department of Health Care Services and Department of Social Services to begin some of the early implementation and mitigation efforts of H. R. One.
So, within the 2025 budget act for Medi Cal, there's 4,500,000.0 total funds, one time for the department to plan and begin the implementation. And for CalFresh, the 2025 budget act provides approximately 87,000,000 to respond to HR1. Within these CalFresh resources, there's approximately $55,000,000 to support to improve the CalFresh payment error rate and an additional $20,000,000 for the CalFood program to help mitigate some of the immediate impacts of H. R. One.
And as mentioned, these two departments will expand on how they're utilizing these resources in the following panel. And so, lastly, as the LAO had discussed in their presentation, there are various provisions of HR1 that become operative in future years. For Medi Cal, full implementation of all HR1 provisions are anticipated by fiscal year twenty twenty nine-thirty. And the governor's budget estimates a decrease of $14,200,000,000 total funds in Medi Cal, as well as caseload disenrollment of up to 2,000,000 individuals by fiscal year twenty ninethirty. The two biggest drivers of the projected decreases in Medi Cal funding and caseload are driven by the federal work and community engagement requirements, as well as six month redeterminations for specified populations.
There are also some additional changes for the Medi Cal program, which the LAO had outlined in their presentation as well. Additionally, California's MCO tax does not comply with the HR1 requirement that prohibits the state from taxing Medicaid providers at higher rates than non Medicaid providers. And so a future MCO tax under the current federal law, as well as California's Proposition 35, would make a future MCO tax relatively insignificant. So to put this into further perspective, the last MCO tax provided over $20,400,000,000 across four fiscal years, which comes out to approximately $7,000,000,000 annually on average to support the Medi Cal program. And these are costs that would have otherwise been borne by the general fund.
However, effective January 2027, the total size of any future MCO tax would likely be around $75,000,000 due to the HR1 rules as well as California's Proposition 35 limitations. And lastly, for CalFresh, the major HR1 cost drivers for this program are the administrative and benefit cost sharing provisions. As mentioned previously, in the governor's budget, there are additional general funds as a result of the change in CalFresh administrative costs, which reduces the federal share from 50% down to 25%, effective October 2026. And lastly, the other HR1 cost driver for CalFresh is the benefit cost sharing provision. Beginning July 2027, states are required to pay a percentage of the CalFresh benefits, which was previously 100% federally funded, dependent on the state's CalFresh payment error rate.
That concludes my remarks, and I'm happy to answer any questions at the appropriate time.
Speaker 1
Thank you very much. We're doing questions at the end. So we'll move to Miranda Dietz from the UC Berkeley Labor Center. Welcome to the committee.
Speaker 7
Thank you so much. Good morning. My name is Miranda Dietz. I'm the director of the health care program at the UC Berkeley Labor Center. At the labor center, we research issues that matter to workers, including health insurance and Medi Cal, which is an important source of health care coverage for millions of California's low wage workers and their families.
Today, I want to share our projections for how many people will lose full scope Medi Cal coverage by 2028 as a result of the changes imposed both by HR1 and the Medi Cal changes passed in last year's budget. Let's see if I can advance the slides. There we go. Thank you. Sorry about that.
So, as you've heard, HR1 makes a number of changes to Medi Cal. There are three that have a major impact on how many people are enrolled. Number one, the work requirements for the new adult population, sometimes called the expansion population. These are the mostly childless adults who gained coverage in Medicaid thanks to the Affordable Care Act. There's the more frequent eligibility redeterminations for that same group.
And then third, there's a set of lawfully present immigrants, refugees, asylees, and others who, because of H. R. One, will no longer be eligible for federally funded Medicaid and who the governor's budget proposes be moved to restricted scope medical. The twenty five-twenty six state budget also included a number of changes to Medi Cal, and the two that have a significant impact on how many people are enrolled are, number one, the enrollment freeze for undocumented adults and, number two, instituting a $30 per month premium for adults who have unsatisfactory immigration status. This is a group that includes not just undocumented enrollees but also lawfully present immigrants such as green card holders who've had them for less than five years.
Combined, we project that these policies will result in up to 3,000,000 Californians losing full scope Medi Cal by 2028. I should note these are projections, and there's considerable uncertainty around the impacts of these policies, though our estimates are largely in line with what others are projecting. The way in which these policies are implemented will certainly have an impact, but I want to highlight that there are also policy choices the state could make that would minimize the impact of HR1. So for each of these three policies that I highlighted as part of HR1, the state has a choice: For work requirements and more frequent eligibility redeterminations, HR1 requires these apply to the federally funded new adult population. The state could decide to apply these burdensome new requirements only to the federally funded Medi Cal populations.
Currently, the administration has stated that they plan to also apply these to state funded enrollees, namely to those with unsatisfactory immigration status. Similarly, the governor's budget included the intention to move refugees, asylees, and other lawfully present immigrants who will lose their federal funding to restricted scope Medi Cal. The state could instead move them to state funded full scope Medi Cal. If the state made these choices to limit the impact of H. R.
One, we project that 570,000 Californians would keep their Medi Cal coverage. Next, I want to turn to who we project will lose coverage and why. There are really two main reasons that people will lose coverage: red tape and immigration status. Fundamentally, HR1's work requirements and more frequent redeterminations are going to result in people losing Medi Cal not because they're not eligible for Medi Cal. Rather, it's these burdensome bureaucratic requirements that lead them to losing coverage even though they remain eligible.
And this is particularly true for folks who are ages 50 to 64. The six month redeterminations mean it's just twice as likely twice as many chances for folks to lose their coverage for procedural reasons. The other reason folks are going to lose coverage is because of their immigration status. People who've lived, worked, and paid taxes in California, often for years, will lose access to the comprehensive Medi Cal benefits that, until recently, were available to all low income Californians, regardless of their immigration status. Many of those who lose coverage will be workers.
That's because two thirds of the adults currently enrolled in Medi Cal are working, either full time or part time. Most of the rest should qualify for an exemption, whether because they're medically frail or a caregiver or are enrolled in school. And yet we know from the example of other states that many will lose coverage despite their eligibility. What will happen to folks who lose coverage? Some who are working or have a worker in their family may be offered job based coverage, but that comes with costs.
However, many Medi Cal recipients, even those who are working, don't have the option of job based coverage. Some work too few hours, others are at small businesses that don't offer coverage or are self employed. There's covered California and the individual market, but as we understand it, these folks who lose Medi Cal will not be eligible for subsidies, making that coverage unaffordable for these low income Californians. Most of the people who lose Medi Cal will become uninsured. And we know that being uninsured means reduced access to care, reduced financial security.
When people are uninsured, they're much less likely to get the care they need. When people are uninsured, they live sicker, die younger, and are one ER visit away from financial ruin. There's significant research on the impact of the Medi Cal expansion that shows us that health insurance and Medi Cal matters. It improves people's access to care, it reduces mortality, and improves health outcomes. In conclusion, HR1 and the state changes to Medi Cal could lead to up to 3,000,000 Californians losing Medi Cal coverage in the coming years, but the state does have choices: to limit H.
R. One's red tape and immigrant exclusions and protect coverage for our state funded Medi Cal populations. Thank you.
Speaker 1
Thank you very much. Appreciate your comments. We'll now move to Gina Platagnino from the Food Research and Action Center. Welcome to the committee.
Speaker 4
Thank you. Good morning. Thank you for giving me the opportunity to come and talk to you on why investing and protecting access to CalFresh is sound fiscal policy. My name is Gina Platanino, I serve as the director of SNAP Policy and Advocacy at a national organization that focuses on eradicating poverty, related poverty hunger. I am an expert on food security issues, particularly CalFresh and SNAP, having worked as an attorney for many years on this issue and serving in the in the previous administration as a senior policy adviser in nutrition and agriculture for the Domestic Policy Council at the White House.
I want to talk today about two main things. First, I want to talk about the impact of the safety net in our local economies. CalFresh is more than a food program. It is one of the stronger stabilizers for households and local economies. When these benefits are cut, as my colleagues have shared, the consequences ripple across entire communities.
First, hunger and homelessness will rise. Research shows that food insecurity is one of the strongest predictors of housing instability. When families lose cow fresh, they shift limited dollars from rent to food, putting them at higher risk of eviction, shelter entry, and street homelessness. Cities and counties already overwhelmed will feel this immediately. Second, local economies will shrink.
CalFresh brings in more than $12,000,000,000 a year to California communities. Every dollar generates up to a dollar 80 in economic activity. And under HR one, if the state doesn't act, California will lose millions of dollars each year. Third, health costs will rise. CalFresh improves health, reduces hospitalization, lowers rates of diabetes, complications, and decreases mental health crisis.
When people lose benefits, we see more ER visits, more uncontrolled chronic illnesses, and more depression and anxiety. Those costs fall directly on medical, county hospitals, and city emergency services. Finally, local governments will be forced to fill the gaps as the colleagues have shared, and food banks, cities, churches, and nonprofits cannot replace federal food assistance at this scale. When CalFresh is cut, it is communities, cities, and individuals that feel the impact directly. I wanna focus the last two minutes specifically on the time limits.
These time limits, according to various estimates, California estimates that they will impact almost a million people. These are some of the poorest individuals in the state. Many work already, many live unrecognized health conditions. Many cycle through unstable hours or gig jobs, and many lack transportation, stable housing, or the documents needed to prove the exemptions. They will lose food, not because they refuse to work, but because the rules do not match the reality of the jobs available to them.
Time limits do not increase employment. The theory behind time limits is appealing. If people risk losing food, then they work a set number of hours. They will work more. But decades of evidence, thirty years of research, has shown that that is not what happens.
Multiple state and national studies have shown that all it does is that it creates no meaningful effect on employment or earnings. Even when researchers control for local labor markets, demographics, motivation, and other factors, the findings do not change. Employment remains flat. The jobs simply do not appear because food is taken away. For many affected Californians, work looks like this, unstable gig hours, inconsistent shift work, seasonal jobs, temporary placements, age discrimination for job seekers over 50, transportation challenges, untreated health conditions.
None of these barriers get solved by taking food away. Time limits cut food, not poverty. They do that incredibly effectively. They reduce SNAP participation. Stay after sites will see twenty to thirty percent of targeted adults fall off SNAP after time limits return.
In some states, case loads will drop by half. But these drops do not reflect new jobs, they reflect lost foods. Time limits harm health and increase costs. Food is health care, and when time limits remove food assistance, physical unhealthy days rise significantly, people experience unhealthy weight loss, signs of malnutrition, not improved health, exercise drops because people reduce activity to conserve energy, chronic diseases like diabetes and heart disease worsen, and food insecurity increases depression, anxiety, and suicidal ideation. Research on veterans show that food insecurity more than doubles the risk of suicidal thoughts.
National mortality studies show that adults facing food insecurity have significantly higher rates of early death. And even though SNAP is federally funding, the consequences are not. States and counties pay for ER visits, hospitalizations, crisis services, and Medicaid costs to grow when hunger grows. Time limit shift costs, not reduce them. As SNAP regional directors, in terms of time limits, have said that they are one of the most complicated, which is something that people need to take into account as we look at payment error rates.
States must first identify who is subject to time limits, track hours in unstable jobs, verify medical exemptions, process appeals and recertifications, and manage churn and higher error rates. And the people targeted by time limits often have the hardest time navigating these systems. People without housing, transportation, ID, Internet, or phones, People who need the most support end up facing the steepest administrator hurdles. As you consider the fiscal implications, I urge you to please look at and ensure that administrative access is included, that enough resources go in because everything you do for Cal Fresh will reduce the health care impacts that will come out of Medi Cal. Thank you.
Speaker 1
Thank you very much. We appreciate your comments. We're going to move to questions. Let me ask members. I'm going to ask a few to begin.
Does anybody want to be added to the list? Siotto? Richardson Manjivar? Everybody on this side? Yes.
Okay, great. Then let me ask a few level setting questions. Let's start with the legislative analyst and the Department of Finance. Even though you sort of addressed this, what's the estimate on procedural disenrollments? Not changes in eligibility, but the fact that the process is so hard that people will step away from the program.
Do you have estimates on that for Medi Cal and SNAP?
Speaker 8
Jason Constantaro, Celio. So we don't have exact estimates of the sort of breakout and disenrollments from procedural versus just sort of not meeting the work requirements. But those who have sort of studied this have there's a sort of wide variety of different assumptions. For example, some assumptions have estimated as many as half of disenrollments could come from the sort of procedural issue. But there's a lot of uncertainty.
And as you can imagine, the really key uncertainty there is that it's highly dependent on how it's sort of implemented at the state. And so that makes sort of pinpointing that effect really, really uncertain. But as much as half has been sort of estimated in various studies.
Speaker 6
I would just note that the governor's budget for Medi Cal estimates an impact of up to 522,000 individuals will be disenrolled as a result of the work and community engagement requirements and six month redeterminations, but would also note that the Department of Health Care Services is working to maximize efforts so that individuals are not procedurally disenrolled.
Speaker 1
And let me follow-up with what my next question was going I be wanted to understand what the budget reflects in terms of these. So it's right now, you're reflecting an estimated 522,000 caseload reduction because of the process changes.
Speaker 6
So that estimate for disenrollment impact is associated with those two federal policies. I think I would defer to the Department of Health Care Services as they talk a bit more about sort of their policy and program efforts in the later panel to sort of provide more details.
Speaker 1
We'll do that. But what I'm trying to understand to set the context for the discussion, the budget accepts that there will be a level of disenrollments in the figures that are recommended in the January 10 budget. Is that correct?
Speaker 6
There are estimated disenrollment impacts as a result of those two federal policies.
Speaker 6
There are associated decreases in federal funds associated with these two policy changes.
Speaker 1
Okay. Thank you. And then do you expect and I don't know, maybe start with finance. Do you expect significant regional variations and what the impacts are across California?
Speaker 1
I did see Ms. Dietsch nodding. So does that mean you might have something to say on this?
Speaker 7
Yes. We are working on regional estimates of the impact, particularly on the work requirements. There is an exemption for counties that have high unemployment rates. And so we expect that that will that, along with the differential Medicaid enrollment in different counties, there will be significant regional variation.
Speaker 1
And you're working on this, so you might have something to offer at some point that you could send to committee members on your work?
Speaker 1
Great. And does the legislative analyst have anything to add to those two comments?
Speaker 8
No, that was reflective. What I would point out is that there is an exemption for counties that have relatively high unemployment. So you on that just from that exemption alone, you're going to expect to see regional variation. And then counties, you have different demographics. And so very similar answer.
Speaker 1
Okay. Thank you. And then my last question, just sort of global, is what the likely impacts are on the overall health system. So we're talking about this loss. What's the impact on the overall health system?
And I don't know who wants to take a stab at that first. Well, we have one person moving to the mic and a couple moving away.
Speaker 7
Some previous analysis that my colleague did looking at the impact of the reduced federal funding as part of HR1 estimated that a $20,000,000,000 decrease in federal funding, which is sort of the out year projection, would result in around 200,000 fewer jobs in California, 134,000 of those directly in health care and the rest in other services, sort of the induced impact. Those are not necessarily people getting fired. It's sort of lower job growth than could be expected otherwise. So there's certainly a jobs impact. And then in terms of where that will be concentrated, again, in many ways it's too early to tell, but we expect that that would be concentrated in the safety net.
So safety net hospitals and clinics who are disproportionately caring for folks who are enrolled in medical today.
Speaker 8
I would just say we're still working with stakeholders. There have been a variety of sort of fiscal estimates that have come out from various stakeholders. We're still working with stakeholders to understand these estimates. But there have been some studies that have tried to get at some of the broader impacts. For example, there are some recent studies that try to estimate the effects on hospitals, and they've found they've projected that hospitals would face lower margins, higher uncompensated care costs, for example.
And this would be from having fewer people in the Medi Cal program and then having more uninsured people accessing services. But again, there's a lot involved in these sort of projections, so we're still working with stakeholders to better understand them. But there are some emerging studies that do suggest that particularly safety net providers would face higher costs, lower sort of margins as a result of fewer people being in Medi Cal.
Speaker 1
Thank you very much. We're going to move to our list of senators. First is Senator Ciardo and Senator Mengevar is on deck.
Speaker 10
Thank you for allowing me to ask some questions here and get some clarifications about how we're going to go forward in the future. You know, our medical program, and this is prefaced on the fact that the Medicare program since twenty eighteen-nineteen has gone from $93,000,000,000 to a current estimate of about $222,000,000,000. That's a huge increase and that's something that is not sustainable if we're going to keep increasing that amount in that in just the medical part of it. Is there a plan? Is there is there analysis being done as to why this program has been increasing by that amount in that span of time?
And what are we gonna do to slow this down? Because the only answer is to come up with more money and we're already doing structural deficits. So anybody wanna tackle that one?
Speaker 8
Sorry about that. So it is something we've been digging trying to dig into more. You know, there are Medi Cal is a complicated program with lots of delivery systems, so it is hard to get a global perspective on what all the cost drivers are. Some of the cost drivers have been from policy changes at the state. Affecting the general fund, in particular, has been those expansions to comprehensive coverage for undocumented individuals.
And that's because most of that cost falls on the general fund. It doesn't isn't there isn't as much federal cost sharing as there is sort of for other areas of Medi Cal. There also has been sort of regular program growth. This is because some reimbursement rates in Medi Cal are adjusted for inflation, as well as other factors. This would be rates to manage care plans, pharmacy related costs.
It's So something we're still digging into. But both policy changes and sort of underlying trends in the program seem to be drivers. And then the legislature did take some steps to try to slow this growth. In last year's budget, there were a number of budget solutions. Many targeted to sort of the UIS populate, the documented immigrant population, as well as to pharmacy spending.
And in our most recent outlook, we did find that those were having an effect on slowing the growth in Medi Cal. We still projected growth. And on net, we think it's still possible there would be overall growth in Medi Cal. But we project those would have a pretty notable impact on slowing that, otherwise would have been considerable growth.
Speaker 10
a lot of criticism for the Fed for cutting our Medi Cal budget. Has the amount that the federal government is putting into Medi Cal increased or decreased over the last year?
Speaker 8
You know, we might have to get back to you on whether the actual amount of federal funding has increased, unless the finance has that evidence readily available. Over time, in the last ten years or so, there has been sort of changes in federal cost sharing. For example, when we did the Affordable Care Act, much of the expanded eligibility was really borne by the federal government. So there have been, over the last decade or so, there have been major sort of changes in federal funding for Medi Cal. In terms of the year to year, though, I don't have that readily available, but perhaps my counterparts at finance might.
Speaker 12
Laura Aiella, Department of Finance. Overall, because we get, on average, about a 35% federal fund share across Medi Cal, the federal fund dollars that we have been drawing down, they have been increasing year over year because, overall, the program has been increasing, including increased enrollment. Of course, because of H. R. One and other policies, there are targeted reductions, specifically in federal fund matches and then other, like, provider taxes where we're getting significantly less federal funding, which is what we're dealing with this year in terms of much less federal fund match for certain populations.
Speaker 10
So the number, I think, is around $18,000,000,000 more this year than we had last year from the federal government.
Speaker 6
That's correct. The bed account estimate projects an increase of 18,000,000,000
Speaker 10
And the total amount is from it's now like 139 instead of $121,000,000,000 So what I'm kind of getting at, because that's probably an accurate figure, what I'm probably getting at here is that this is the same as our state budget. We're spending more than we're taking in, And we have no plan to decrease the amount of spending other than to add programs and add benefits that cost even more money, putting more stress on that. And that's not a good way to balance a budget.
Speaker 12
To clarify, the Governor's budget does not add any significant new spending. As mentioned before, the Governor's budget maintains mostly a workload budget. And to attempt to address those cost increases in addition to all of the solutions and the cuts that were included in the 2025 Budget Act. We've also the administration has also said that we plan on working closely with the legislature for May revision to help address the out year deficits that we're facing as well. So
Speaker 10
if the budget doesn't include any more new spending, then the $18,000,000,000 that the federal government is putting in should cover it, no?
Speaker 12
It's again, it's workload spending. So there are cost increases. And as we know, there's inflation and this is seen in the Medi Cal program.
Speaker 10
Okay. Thank you. There's also some concern that the state keep or federal government is shifting costs down on the state. And I'm going to speak as a voice for the counties and cities. The state does that to the counties and cities all the time.
In our efforts to try to minimize some of the financial impacts that we are suffering, we do that constantly. So to criticize the federal government for trying to right size their ship is I think a little hypocritical because we do that too. Why has the growth in the medical program more than doubled in seven years in costs? Do we know that? I think we might have covered you covered that a little earlier.
So
Speaker 8
Yeah, correct. It's a mix of policy changes and then also, you know, just underlying cost growth. And I'd also emphasize that some of the if you're looking on a total funds basis instead of just the general fund, some of the cost growth has been borne by other fund sources. We expanded the state's Cemcio tax, for example. There was Prop 56 that provided more funding to Medi Cal.
So there's been other non general fund sources that have also increased in the Medi Cal program.
Speaker 10
All right, thank you. I'm just going to cover one more area because I want to give my colleagues an opportunity to ask their questions as well. I want to cover the work requirements for able-bodied childless adults. What is why do we not want people because these work requirements aren't just part time, twenty hours a week of work. They could be part time school, which is nine units if you're going to a college or junior college.
Or they could be community service, which I can think of many community service groups that go out into our communities and do things every week that somebody could be part of. We have a community cleanup, a beautification committee that works in Wildemire. Every week, every Saturday, they get together and do that. These are able-bodied people. And please, please stop picking on the fifty to sixty four year olds like they're not able-bodied because I am beyond that.
And I think there's a lot of people beyond me, beyond that, including almost everybody up here that would argue that we're plenty able-bodied. So the people that are able-bodied, why is it such a difficult lift to get them out of a house where they will be permanently on whatever assistance it is that they need at the time, into the world where they can open up some opportunities to not be so dependent anymore. Because if you don't get them out of the house, they're going to stay dependent forever and we're going to keep adding to those costs that were describing before. In other words, the costs are just going to keep going up and they're not going to go down. The only way they go down is when when people get old and and pass away.
If we're just going to keep adding to it, we're we're this program is going to continue to be out of control in its costs and we can't afford that. We can tax people more to pay for it, but then they'll just move out of the state like they're doing. So back to my work requirement. Why is that? Why is having somebody go out and do twenty hours of community service such a huge lift for able-bodied people, even if they're 50 to 64 years old?
Speaker 12
I'll take that as a hypothetical question. We can respond to how the department is implementing, and the Department of Health Care Services will be up here later to talk about the programmatic implementation of that. But why it's a heavy lift, I can't for a person to get out of their house, that's not something I
Speaker 4
If I may, I so it's the first time that we're seeing it for the most part except for one state that had already piloted this within the health care aspect. But we have thirty years of evidence within this the CalFresh to SNAP program to show that most individuals who are time limited are working. It's just that the commutation part that is difficult. We talk about the volunteer part. Volunteering is a part of privilege that ensures that, you know, most individuals who are doing are undergrads, high school students, telling an individual who doesn't have the resources enough to eat to, on top of that, working maybe nineteen point five hours to work, you know, to go volunteer on top of that.
Also want to flag that the new requirements also allow for individuals who are parents, caretakers with children 14 and up to also make sure that they can document that. So single parents will be detrimentally impacted, particularly in summer hours where they have to make sure that their kids are being taken care of. So it really is a matter of thirty years of research that has shown that people are working, the gig economy is real, and the last thing I'll add is that SNAP is not a permanent program. It's a cyclical program. People enter SNAP because they have lost their jobs, their wages have been reduced, or they have a caretaker, a person that they have to caretake for.
They're in the program from either six months to twenty four months. Right? And making this program more difficult when recession, when employment opportunities are not there, it makes people have to choose between paying for rent, paying for other resources that are incredibly important. And lastly, it does increase administrative costs. That is the biggest issue, the part that it takes on the counties, on the states to operate this, and from individuals having to prove that they are working for many other reasons.
Speaker 1
to be because you're the only one on your side of the aisle that's asked to ask questions. So I've let you go, excellent. Alright, thank you.
Speaker 10
The MCO tax that you had mentioned, it got rejected. You said our version of whatever it is we were trying to do got rejected. What part of it was so different than what other states do that did not have their MCO tax rejected from the federal government? Why did ours get rejected?
Speaker 12
To clarify, the current MCO tax has been approved through the end of the term, the original term that we had requested approval for, which is December 2026. And what we're referring to is future MCO taxes, and HR1 applies those requirements to everyone, to all states. So we're talking about future MCO taxes.
Speaker 10
So other states are getting it probably in the future that we're not because of the way ours is structured.
Speaker 12
Is that a We structured it in any certain way for the future. We haven't applied.
Speaker 10
All right. And our error rate at 11%, we can't get that down. Save us $2,000,000,000.
Speaker 15
Lourdes Morales with the Department of Finance. The state, through the current error rate for the CalFresh program, is about 11%. As mentioned by my colleague, though, the 2025 budget act did include resources that the Department of Social Services can speak more to that are intended to support various initiatives to bring down that error rate.
Speaker 10
So we don't need to go into that right now. But if we could get a report back to this committee maybe that tells us what that error rate is and how we can get it back down, it'll save us $2,000,000,000 if we have to invest a couple 100,000,000 into fixing whatever it is that's causing that. I'd rather do that than just pay out $2,000,000,000. So that's that's the end of my questions.
Speaker 1
you. Thank you very much. We're gonna move to Senator Menshevar, and Senator Richardson is on deck.
Speaker 17
Thank you, mister chair. I I agree with senator Sriracha that it isn't sustainable. And I definitely think, to Elio's point in the report, if we don't increase revenues, we won't be able to continue to support these programs. So another plug for revenue conversations. But I also wanna address a comment that was meant that we cost shift a lot to counties and that we shouldn't we shouldn't be hypocritical if the federal government is doing that to us.
I would agree with that only if the cost shift wasn't due to the 170 to $191,000,000,000 that DHCS got. And as a result of that, a lot of these programs are being cut. I would agree that we'd be doing the same if we were cost shifting to the county just to create a paramilitary, kidnapping task force in The United States. And then the county would be okay to be mad at us for cost shifting, for, creating the putting the National Guard onto our streets and kidnapping people. But we're not doing that.
So I think this is different cost shift. The federal government was not balancing a budget. It was looking to triple a massive influx in DHS. And by doing that, that's how they cut programs and funding to our state. So just a really, really different point there in why we're doing cost shift.
Even though I still also think our cost shift to the county is really detrimental and gonna be really impacting our our our counties, and I know, and I've mentioned this, that I'm looking forward to see how we're gonna be supporting our our counties because they're gonna be seeing the brunt of all of all this impact. Yeah. So to that, I'll start. I have four questions I'd like to ask. The first one is, Miranda, you mentioned this.
LAO recommended state oversight directions since the federal direction doesn't really exist, and you recommended that we should focus on that. I'm wondering if you have any suggestions or policy ideas in that space. What would you recommend in terms of oversight or red tape that you talked about?
Speaker 7
Yeah. So there's a number of implementation questions for the work requirements and the six month redeterminations. And ways to the goal, and I think DHCS has expressed this as their goal as well, is to get as many people as possible to go through sort of automatic checks so that the state can say, yep, you're eligible or, yep, you're exempt from this and people can keep their Medi Cal. One of the points to make, though, is that the state has this decision to make about whether these burdensome red tape work requirements apply to the state funded Medi Cal folks. That's a choice that's not required by the federal government.
And given that these the main effect of these work requirements and six month redeterminations is for folks who are eligible or should be eligible or should be exempt, losing their coverage begs the question of whether these policies make sense to apply to populations where they're not required.
Speaker 17
And, Eliot, I don't know if you had any thoughts on policy oversight or implementation oversight. Yeah.
Speaker 8
So it is a little you know, providing very concrete guidance is a little difficult because we're still learning more on the federal guidance front. But in sort of the abstract and in theory, I think what we would recommend is, you know, trying to adopt your priorities in statute. There already is some trailer bill on H. R. One, so that there already are will be some statutory changes that are needed.
There also might be cases where the administration might need some flexibility because of changing federal guidance. And in cases like that, we think you could also explore other oversight mechanisms like TLBC notification or reporting requirements, more data reporting, things like that that also ensure that you still have some oversight over things, particularly as they if they raise notable sort of policy considerations.
Speaker 17
Okay. Thank you. And my next question is regarding the removal of full scope to refugees, fire recipients, assailies. We've offered this care since the nineteen sixties. Back in the day, this was a a population that was seen vulnerable population.
Something that's been offered for going on over fifty years, I'm wondering, is this a population that's just grown exponentially, that's the the funding is just, you know, just not meeting the growth? Has it been steadied? Or what I'm trying to get a little bit more insight or explanation as as to adhering to removing full scope from them. Maybe DOF, if you can
Speaker 6
I'm not sure we have that breakout for that population growth, but I can turn to my colleague to see if she has any additional details.
Speaker 12
Laura Yalla, Department of Finance. I came up here to defer to the Department of Health Care Services because we don't have that data. I don't know that we can speak to how that population has grown. We know approximately the current number that will be impacted.
Speaker 17
Okay. I'd love for the second panel if that can be addressed, to see if it has grown, it's maintained about the same. And is this gonna be like the, expansion population that we did last year where it was a freeze and those on it are gonna be able to continue, or those that currently have it are losing it and no longer can sign up?
Speaker 12
For you're talking about the 200,000 individuals? Yes. Those will be transitioned into restricted scope when the federal government removes the federal funding.
Speaker 17
So it's both a removal of health insurance and no one can sign up moving forward in Correct. Those Correct. Okay. And they will have what kind of health insurance?
Speaker 12
It would be restricted scope services, so emergency care and pregnancy related care.
Speaker 17
Does our current UIS population have that right now? Those are signed up.
Speaker 12
The current population is eligible for full scope services until the freeze, and then nobody will be able to enroll into full scope, only into restricted scope Medi Cal.
Speaker 17
Okay. Thank you so much. My my next question is regarding the verification and the technology. You know, I've been hearing places like One Generation in my district to help seniors and so forth. The lack of access to technology and if to a two step verification is implemented, the difficulties for senior to verify.
I know that there is some funding, about in the governor's budget, 4,000,000 for navigators to assist with Medi Cal, eligibility, enrollment, and retention. Is that meant for incidents like that? Or where is where is that money going to assist people to stay on these programs?
Speaker 12
I think the Department of Health Care Services can provide more details on that.
Speaker 17
Okay. So I'll wait for that. And then my last one, Gina, I'd you you talked about CalFresh and so forth, but, you know, we're the governor is also proposing a baseline of $8,000,000 for food banks. Usually, it's sat around 60,000,000 to 81,000,000 since COVID. If we are if people are falling off of Calfresh and we are also further influxing our food banks, what do we anticipate to see, and where can these food banks get additional support if not from us?
Speaker 4
Yeah. It's important to know that, you know, food banks were created in the eighties as a response to other cuts, and there was an emergency response. Right? Food banks were always supposed to be a disaster response. Unfortunately, with the pandemic, they have become the to go to to individuals, so it's not enough.
They are working incredibly hard. A million may seem like a lot, but I just also wanna caution that for every meal that food banks are providing, SNAP provides nine. CalFresh provides nine. So it's incredibly dramatically the impact. So as you're seeing people who are getting cut off SNAP coming into the program, you're going to need more resources.
And not just for food, but for staff capacity in order to be able to manage this.
Speaker 17
Are there any other federal grants that exist to supplement for food or anything like that?
Speaker 4
SNAP. SNAP, right? Yeah, Calfresh. SNAP and other calor nutrition programs like WIC, school meals, which will also be impacted by some
Speaker 1
Thank you very much. We'll move to Senator Richardson, and Senator D'Arrazzo is on deck.
Speaker 18
Thank you, Mr. Chairman. I have about two or three questions and then a very brief statement. Mr. Woolsey, you mentioned on page 10 of your presentation that other resources might be available to help with the impacts of HR1.
Did you mean those to be funding additional resources, or were they the three items that were noted here in your report?
Speaker 5
So what we were referring to there is, on the health side, counties do have a pre existing responsibility to provide what is called indigent care, very basic care for those without coverage. This is something that continues to be a requirement. However, it's limited in the sense that it's not as expansive as current Medi Cal coverage. And a lot of the funding that counties were receiving to support this through realignment has since been redirected, especially since the Affordable Care Act. So there's limitations in that way.
On the food side, one of the things we had in mind was the food banks, and they, of course, are limited in terms of the funding that they receive. There is the state funding that was mentioned through CALFU. There's also some federal funding that food banks receive through the Emergency Food Assistance Program and others. It's our understanding that the majority of funding for food banks is from private donations. But as was said before, we expect that these alternatives are not going to be able to fully backfill the loss of Medi Cal and CalFresh.
Speaker 18
Thank you. And Ms. Adams, you briefly went over that the MCO tax, if I understood you correctly, you said it equated to about $7,000,000,000 per year. I think it was in the 20s over a four year period or something. So I think you said the average was $7,000,000,000 But then you clarified what you expected the reduction to be.
And then I was surprised that a few minutes later, your colleague said that, well, we really haven't applied for future MCOs. So my question is, one, could you clarify again from $7,000,000,000 to what? I thought it was 700 and something million, but if you could clarify that answer. And then, if the if the gentlelady next to you could also clarify if you're saying we haven't applied and we don't have a projected loss, that seems contrary to everything that I've been hearing about a huge reduction in MCO. So if you guys could just go over that, it would be really helpful.
Speaker 12
And to clarify the numbers that my colleague, Ms. Adams, mentioned are is the current funding that we received. So it was a three year program, but we spread it out across four fiscal years. But if you divide it by three years, the number that the amount of general fund support that we received was approximately $7,000,000,000 nearly $7,000,000,000
Speaker 12
For future federal For future submissions to the federal government of the MCO tax, once the federal requirements are implemented due to H. One, any new program will have to comply with those new requirements. And so we estimate that the maximum we could likely get under the new HR one requirements for provider taxes is 75,000,000 total revenue. And the equivalent of the nearly 7,000,000,000 general fund support that we get, it would be approximately 6,000,000. And that is both due to HR1 requirements and Prop 35 limitations.
But that's for the next MCO tax that when we submit if we submit one to for federal approval, not the current program.
Speaker 18
So and I do have an MBA, but I'm sorry, I'm not quite following you. You're saying you anticipate we're going to go from $7,000,000,000 to 6,000,000,007
Speaker 18
what I thought I heard. Okay. And again, the requirements are what we've already been talking about that they would have
Speaker 12
to meet. There are specific provider tax requirements implemented by ATARA1, yeah. Certain limits.
Speaker 18
Okay. And then my thank you. Then my last, I just had two questions. I'd like to make a statement. You know, back in, I believe it was 1996, we had what was called, the welfare to work program.
Discussion about how were people going to receive services. All of a sudden, people are, you know, gonna have to go to work. There was a limited period of time. So I did look that up because I've heard people talk about it. And there was, in 1996, there was, a reduction of 50, a dramatic caseload decline.
Welfare rolls fell off by over 50% from 1994 to 2004. So, to say that these kinds of changes aren't going to be impactful I see some people might have laughed but, clearly, we've been there before, and we have seen that. And I just wanted to speak to why some of those declines might happen. One, it's one thing to say someone get off your couch and go to work. Well, first of all, you have to have transportation to go to work.
And not everyone has gainful transportation, and transportation costs money. Number two, a person, an individual here said, well, can go to school. Well, you know, look at how much it costs to take nine units to go to school. It costs money, again. And it gets to the point where sometimes the cost of the transportation, the units, and all of that begins to not really balance out for the number of what you may be getting.
And then, there was there was also an article that I read, and it talked about, well, why why did people survive with welfare to work? And part of the cuts were that there was this economic boom. And right now, frankly, we don't have an economic boom, to my knowledge, for entry level workers. In fact, it's the contrary. The CEOs have predicted that we're going to lose 50% of jobs of what entry level people could make.
So to say to someone, it kind of reminds me of a Martin Luther King speech of, you know, pull yourself up by your bootstraps, but, you know, heaven forbid, you need to give me some boots to put on. So to say that people are gonna have these jobs when we know, and I've said this a couple times, I took my mom to Denny's and a little robot came and brought us our food, open the shelves and you grab your food out. So, to assume that the jobs are going to be there, the money for the units are going to be there to go to college, and you're going to have money for transportation, all, you know, I think is what causes these challenges, and we as members should be sensitive to of why these impacts we anticipate are going to happen. Thank you, Mr. Chairman.
Speaker 1
Thank you very much, Senator D'Arrazo and Senator Smallwood Cuevas on deck.
Speaker 20
Thank you. Thank you very much. I just I know we we've gotta get to the nitty gritty of of all the numbers because they they add up. But, really, what we're talking about today is California as a donor state. Don't forget that.
We're a donor state. And we're looking at millions of hardworking residents lose their access to health care, to medicine, to clinic visits, and to put food on the table. All of that in exchange for $4,000,000,000,000 in tax cuts for the same CEOs who rely on the labor of the people. And we're paying for the ice to terrorize our families and our communities. That's that's what's going on here.
We're looking at balancing the budget on the backs of the same people who are the backbone of our state's economy. That's what we're really looking at. Let's imagine a 60 year old 62 year old housekeeper. She spent decades keeping one of California's top industries hospitality to serve their guests. She becomes ill and can't work eighty hours that month.
She loses access to medical, can't get health care. The only place for her to receive care is in the emergency room. Now, we just shifted insurance premium cost to the county hospital system for an expensive emergency room bill. With these cuts, we can't provide preventative care, which means more emergency room bills down the line and harder for everyone to get to true emergency care. The same housekeeper turned 63 and can no longer work after decades of back breaking labor that toll takes on her body.
Now, with HR one, she can no longer access nutrition assistance and starts to go with less food. All of this to pay for tax cuts for the same corporate CEOs who gained their fortunes from this workforce. And to pay paramilitary force terrorizing our communities. Now I have a few questions. For the administration, counties estimate 6 to 9 and a half billion dollars in new annual county costs because of HR1, largely driven by people losing medical coverage and turning to county indigent care.
So, who is expected to absorb these costs if counties lack sufficient realignment funding?
Speaker 12
Yeah. As the administration has stated before, it's something that we're still looking into and working with counties on. We have heard a variety of different numbers, and we I can I think from the administration's standpoint, just to reiterate, we can't backfill or provide funding for every dollar in new cost, But we are in discussions with counties, and we hope to work collaboratively with them to see how to best provide services to Californians?
Speaker 20
And similar what are you thinking about the infrastructure that the counties are going to need to provide indigent care programs, since the funding for these programs was used to expand Medi Cal and implement the Affordable Care Act?
Speaker 12
We don't have any proposals in the governor's budget, but happy to continue discussions with the legislature on that.
Speaker 20
Okay. And also Department of Finance. What are the estimated dollar impacts of the 2025 cuts to the undocumented Medi Cal expansion and the proposal to remove full scope Medi Cal, including increased emergency department and inpatient costs, higher county indigent care spending, increased uncompensated care for hospitals and clinics, and costs associated with untreated chronic illnesses, and delayed preventative care. What do you say to that?
Speaker 12
That analysis is not something the Department of Finance is able to conduct, but perhaps my colleagues from the UC Berkeley Labor Center can provide any insight into research on that.
Speaker 20
Okay. How many Californians are expected to lose their full scope coverage?
Speaker 7
Our projections are that up to 3,000,000 Californians would lose. This is inclusive of both citizens, unlawfully present immigrants, undocumented immigrants, everybody all of the impacts of both HR1 and the state budget changes would be up to 3,000,000 people losing coverage.
Speaker 20
Then, given that the administration reaffirmed the 2025 cost to the undocumented Medi Cal expansion, what alternative budget options did the Department of Finance consider to avoid the proposed reductions in immigrant health coverage? Given that the administration reaffirmed the last cuts to undocumented Medi Cal expansion, what alternate budget options did you consider?
Speaker 12
I can't speak to any to the deliberative process. The governor's budget reflects, ultimately, the administration's decisions on how to address the budget deficit and the structural deficit in the out years, but happy to continue discussions with the legislature on alternative ideas.
Speaker 20
Okay. Because obviously, we're dealing with cuts here, which means there's another way of addressing those issues, which is generate revenue from other sources. So basically, what you're saying is because of the proposal, the budget proposal, presented by the governor, no other, alternate revenue sources were considered?
Speaker 12
The governor has stated that he is not interested in entertaining or pursuing any additional revenue increases. So, if the legislature would like to propose something, we're happy to, hear any ideas. But the governor has stated multiple times that he's not interested in pursuing any new taxes or revenue proposals.
Speaker 20
Okay. So 3,000,000 people. That's it. We're we're being asked to allow 3,000,000 people to lose their health coverage.
Speaker 12
I think the one thing that, from the administration's standpoint, that we'd like to flag is that the revenues have been increasing. Even the administration or the Department of Finance specifically updates revenues on a monthly basis. And monthly revenues are up even compared to the time of the governor's budget. And it's not we the Department of Finance does not see it as a revenue problem because we are we have been getting increased revenues. It's a structurally imbalanced budget that we have to address, and we see it as an expenditure problem.
So that is the administration's perspective.
Speaker 20
Okay. Because the problem is that it's really on the backs. There's a very different picture here with the worst impact being on immigrant, the immigrant population. That's the problem. It's not that there is deficit and that's a problem.
But how do you address that by just pointing out one part of our population and one part of our community that contributes so much to the economy in every single way. And we're finding that out, unfortunately, because of the the raids, how the economy where the raids have taken place is suffering enormously. The small businesses are suffering, the clinics, the hospital, every everywhere there's impact because of what is taking place. So you have that going on, and and then we're cutting their access to health care. And then we say, well, there's we don't have a choice here.
I think that's that's a wrong message to send from a state like California. Thank you, mister chair.
Speaker 1
Thank you very much. We'll move to senator Smallwood Cuevas, and senator Gomez Reyes is on deck.
Speaker 21
Thank you, mister chair, and, very much appreciating the discussion. I just wanna remind us, I I think we had some comments made earlier about how we got here on HR one, and I wanna be clear because I think it's important for Californians to know that h r one was primarily a tax bill. And it made permanent the 2017 tax cuts, and it added new tax reductions, which resulted in 4,500,000,000,000.0 in federal revenue losses across ten years. Let me repeat. The Trump administration pushed h r one as a tax bill to reinforce 2017 tax cuts, and it added new tax reductions that equaled nearly 4,500,000,000,000.0.
Now where did the tax benefit go? More than half of the tax benefits went to the top 10% of earners with about 1,000,000,000,000 going to the top 1%. So the administration the federal administration took this money out of the general pot that helped to fund our health care system, and it gave it to the top 1%. So now we've got to figure out what do we do to backfill that here in the state of California. In addition, HR one imposed these work requirements, and I appreciate the colleague from Inglewood who talked about the 1996 welfare reforms that devastated black and brown communities.
Since 1996, when mothers were kicked off of welfare reform, they had to go to work. So that's why everybody's working right now. So we're implementing these work eligibility requirements which will require us to hire more people to check fact check something we already know. People on Medi Cal are working, costing us, again, more millions of dollars that we have to backfill. In addition, HR one restricts eligible communities that have had access to Medicaid and, in our state, Medi Cal for decades, refugee, asylum seekers, humanitarian immigrants, they now don't have access or restricted access to care.
And then we are removing millions of undocumented families. Because the Trump administration gave $4,500,000,000,000 in federal revenues to the top 10% earners, and 1,000,000,000,000 of that to the top 1%. So I just wanna say this is how we got here, and it is so disingenuous to infer that we're getting more Medicaid investment in the state of California through this bill. How disingenuous. Over almost 50% of our folks in my district need Medi Cal.
Speaker 21
And my good friend who raised this erroneous hypothesis about what the administration is giving us, I've found he almost has a third of his constituents on Medi Cal. We've got to make sure that people have adequate health care. And I do appreciate the administration saying revenues are up. And any other time, that might be worth something. It might be relevant, but not when Donald Trump has taken $4,500,000,000,000 and given it to the top earners and given 1,000,000,000,000 of that to just 1%.
I'm sorry. We've got to look at revenues. This is not business as usual. This is not touting that revenues are up because we have a AI bubble that hasn't burst yet. And thank you to the LAO for raising the precarious nature of our revenues, we cannot be left to cut three million people off of their health care.
We just came out COVID. We know three million people without health care puts all of our residents at risk. Look at the measles outbreak that's happening right now in other parts of the country. Do you think measles cares that someone is undocumented when they walk into a grocery store or they walk into a restaurant or they walk into any community space? I wanna say that we've gotta come to some new realizations here about the moment that we're in, and this moment doesn't end in 2026.
Unfortunately, we're in this situation for a few more years. And so we've gotta have, yes, a structural solution, but it needs to be an urgent and immediate solution now. We can't wait. So my questions that I have have to do with these work requirements because I wanna just say when welfare reform was done in the nineties, the boom was the service economy. So we had seen the deindustrializations of places like my district where the good union manufacturing, we make stuff, jobs disappeared.
Then there was welfare reform, and everyone had to go to work. And guess where they went to work? Low wage, bad jobs. And my community is suffering now from low wage, bad jobs through this service economy immersion that has left these welfare reform recipients and mothers still in poverty today. So those 1996 welfare reform folks, they're still in the safety net.
So work requirements, we know based on the really and I wanna appreciate all of you for the the details and the research that you shared with us and the data because what it showed me is that work work requirements decrease coverage, which we know people are just going to fall off because they can't get all of this paperwork done. And certainly, how does our system come online to deal with the amount of errors that we know will happen? So we know coverage is gonna decrease. People are gonna lose coverage. But we also know it does not increase work because, let's be honest, there are not enough good jobs out there.
If there were, we wouldn't have so many people in the safety net. So do any of the studies that you all have looked at, and maybe I've missed it in all of the information that was shared, but do any of these studies show that there is sustained employment gains from Medicaid work requirements?
Speaker 7
The studies that have looked at the relationship sort of find the reverse, that having Medicaid is helpful for people being able to get and maintain a job. So it's sort of reverse causation. Having Medicaid helps people get coverage. Sorry, having Medicaid helps people get a job and maintain that job.
Speaker 21
Okay. So then you don't have health care, then what is the causation is what?
Speaker 7
These are more correlation, but the hypothesis to test would be, yes, that if you don't have that Medicaid coverage, it would be harder to maintain a job and find a job.
Speaker 21
Okay. So the point I want to make here is that folks are gonna lose their care because of all of the bureaucracy that is gonna come around all of this eligibility. That likely means they're probably gonna lose their employment. So this is the encounter. This is this is, again, folks who are working, who are on Medicaid, Medi Cal, who are now doing what we have asked them to do.
Now we're gonna go through they have to pro approve eligibility and all of this paperwork, and they could lose their coverage, which, as you're saying, could lead to them losing their employment. So I wanna just reiterate, we're creating ripple effect problems here, that are not, addressing anything but, again, costing California more money and hurting Californians. My next question, I wanna, ask, the LAO this question. Our short term general fund savings rely on coverage loss, and that that's a nice way of saying people are going to be dying because they don't have health care. And it shifts the long term cost to emergency care, the county indigent health systems, and providers we know are already strained.
In fact, our county is scrambling now to figure out how they are gonna raise revenues, which, unfortunately, some of the solutions are, again, gonna hurt local residents that are being thought about. So my question is downstream costs like hospital closures and county indigent health spending, how does that account in the overall estimates of what this cost will cost the state long term?
Speaker 5
So, the thing to keep in mind is that, certainly, as you're saying, there are significant downstream impacts from all of these changes that are going on. But whenever you're doing an estimate, it's important to think about what's the perspective that that estimate is taking. And most of the estimates we're talking about today are in relation to the state budget and won't capture, a lot of the impacts that you're talking about. Those impacts are difficult to estimate. They're often further down the road, but that doesn't mean they aren't real.
But, yeah, a lot of the estimates we're talking about today and that we've cited are single year or the next five years or so state budget numbers. Okay.
Speaker 21
So and that also, again, deeper and deeper fiscal crisis prolonging the fiscal crisis we're in because we know these costs are out there. We have to begin to calculate and measure the long term effects. My my next question has to do with, SNAP, and miss, Platoneo. Snap work requirements will not increase work, but they will increase hunger, and we see that. What are the nutritional and health consequences of losing food assistance?
And I'm concerned because we have a lot of food insecurity already in our district. Skid Row is in my district. What what does this what does this look like?
Speaker 4
Just just wanna clarify that SNAP has had work requirements since the seventies. What happened in '96 and what's happening now is called time limits. Right? Which means that people can only get snapped for three months in a three year period. And it's important to make that distinction because people are working.
They just can't document. Right? So it's inputting that documentation. We have plenty of research, thirty years that we've been dealing with this, of individuals being cut off. That shows that there will be physical and unhealthy days rise significantly.
And these are various studies that I'm happy to provide by universities across the country who have done that. You know, like I said, people experience unhealthy weight loss, signs of malnutrition, and not improved health. Research on, like I said, on veterans shows that it doubles the risk of suicidal thoughts. And it's important to know that HR one takes away the exemption where veterans used to be exempted and now will fall will fall back to this. Right?
And we do know that national mortality studies show that those facing food insecurity have a significantly higher rates of early death. And even though so we're also gonna see you're talking a lot about CalFresh. You're gonna see increased ER visits because we also have plenty of studies that people on SNAP are less likely to be long term hospitalized. They're also save around 2,000 to $3,000 in health care costs in terms of prescriptions. They don't have to choose between what we call food and medicine, meaning when you are hungry, delayed gratification, meaning I need to eat now versus the medicine that I need to take, which also increases health care costs.
We do know that increases of depression, anxiety, and like I said, in suicidal ideation, we have so many various studies that can really talk about that it really doesn't increase employment or any things, but it just makes people a lot more ill, and it does increase a lot of more health care cost.
Speaker 21
Thank you for that very sad and scary reality. And I wanna add the children because we know when kids come to school hungry, they can't learn. And we know what impact that has on our future, particularly in communities where we have half or a third, of our residents in need of of these, benefits and care. My my last, point and and question that I have is, you know, given that Medi Cal covers nearly a third of Californians, I'm curious what analysis do we have in terms of the fiscal impacts of these cuts on the racial makeup and linguistic makeup of these folks most impacted and the disparities that will emerge in this projected coverage loss. And I don't know who wants to to answer that that question.
I also wanna add to that. I think it was UC Berkeley who talked about the 134,000 jobs that will be lost and the lower the extended or lower job growth that will exist, particularly in these clinics and other safety net, health care centers. I'm curious, what is the racial and gender demographics of those who will be most impacted by this loss, of coverage? So maybe folks can answer that question.
Speaker 7
That's a great question about the racial and gender, sort of the demographics of the job loss. I don't have that data. In terms of the impact of the loss of Medi Cal, we project that about 1,200,000 of those 3,000,000 folks losing Medi Cal would be folks with unsatisfactory immigration status who are disproportionately Latino and otherwise don't have particular breakdowns by race or gender for those losses.
Speaker 12
Department of Finance doesn't have a breakout by gender or race. Our projection of the individuals so our total the administration's total projection of disenrollment due to HR1 is about 2,600,000 by 2930, so 2,600,000 less individuals. And of that, we project approximately 281,000 individuals would disenroll who have unsatisfactory immigration status. Well,
Speaker 21
I want to say this coming from an organization that dealt with civil rights. I wanna tell you it's disparate treatment. These are gonna be disparate outcomes. Overwhelmingly, these are people of color, black and Latino. In the health care sector, overwhelmingly, these are women of color.
And I sit in BNP committee every year. There's a conversation about the shortages of individuals who wanna work in the health care field and what a crisis we're looking at in terms of workforce shortages. This is an administration that we know from the highest office. Its leader is discriminatory against Latinos, against black people. It's very, very, very obvious that this is a white supremacy agenda in this elected office.
And it is not surprising that who is gonna be disproportionately impacted, who's gonna experience disparate treatment are the very people who are the majority of California. We are people of color, majority. We are the moral majority of the twenty first century, and we cannot do this president's racist work for him. We must protect people of color, our majority. We cannot allow disparate outcomes on our watch, and therefore, we have got to figure out a way to deal with the 4,500,000,000,000.0 in federal tax revenue that has been given to the 10% of earners, the top 10%, and the 1,000,000,000,000 that is going to the top 1%.
Revenues has got to be part of this solution to stop this racist attack on California.
Speaker 1
Thank you very much. Just before I go to senator Gomez Reyes with senator Cabaldon on deck, let me just say we have three more on the list. We have another panel. We have questions of the other panel, and then we have public comment. You're till five?
Pardon?
Speaker 1
five? I'm gonna be in the rules committee at 01:30. I don't know where you'll be. But we have got to discipline ourselves a little more. We will move to Senator Gomez Reyes.
Speaker 9
Thank you, Mr. Chair. Many of the questions have already been asked. The sentiments have been shared. I did want to begin with just a few perhaps rhetorical questions, but questions that need answers on the record too.
California has been a donor state for years and years. Is California still a donor state to the federal government?
Speaker 22
Yes. Ann Hollingshead with the Legislative Analyst's Office. So, the term donor state generally refers to a situation where a state remits more in federal taxes to the government than it receives back in expenditures. It's difficult because doing a nationwide study on this question, right, where you're sort of itemizing each state's individual budget and each state's balance of payments, is difficult and therefore lagged significantly. There are, you know, there are studies on this, but they're sort of a few years out of date, so it's difficult to answer the question that you said now.
So, it's difficult to answer the question in the sort of now terms. But the most recent information we have does suggest that the state continues to remit more in federal taxes than it receives in federal expenditures, yes.
Speaker 9
Thank you so much. Something that has been talked about a lot is that we're talking about people when we're talking about medical coverage or CalFresh, or we're talking about any benefit that is going to be reduced. We're talking about Californians who are going to not receive these benefits, as opposed to just a budget item. We're talking about Californians. And almost always, we're talking about Californians who are paying taxes.
When we talk about benefits to immigrants, we know immigrants are paying taxes. Finally, they received medical coverage. That was a long fought battle and it was a great victory, and now those benefits are being taken away. The one other thing that has been mentioned, and I appreciate that my colleagues have continued to mention it, is that under HR1, 2,500,000,000,000.0, depending on how we look at it, to 4,500,000,000,000.0, counts for tax cuts to the highest 10% of income earners, and 1,000,000,000,000 specifically to the top 1%. This is a big loss in benefits that would be provided to all of Americans, more specifically to the share that Californians should receive.
We've talked about the structural deficit. Absolutely, we need to deal with this. But as has been mentioned, it's a structural deficit that has been created over the years. The taxes have still been paid by Californians. It has been a problem we have created.
The administration, the legislature, we have created it. But the taxpayers have continued to pay their taxes. And yet, when we talk about balancing this structural deficit, we're balancing it on the backs of the very people who have continued to pay their taxes. And mainly because we have certain projects we want to continue to fund. The fact that up to 3,000,000 Californians are going to lose medical coverage should, under any circumstance, be something that we should look at and say, this cannot be accepted.
And when we say something can't be accepted, we have to look at options. We can't say, we can only do it this way, but we can't look at any other option. We have to look at options. Otherwise, we know that those 3,000,000 Californians are going to now be without medical coverage. And we've already heard what the trickle down, to use that phrase, how that's going to affect the health, the life expectancy, the employment, the suicide rate, how that's going to affect Californians.
One of the things that has been talked about over this period of time has been the fact that we need to get more people to work. We have a lot of people who are working, but they are working for employers who pay unsustainable wages, and then somehow provide no medical coverage. And not only do they not provide medical coverage, they help their employees fill out the form so they can get free medical coverage from the state of California. That's a problem. If our workers are working for an employer who benefits, who profits billions of dollars because of the labor of those workers, then we have to find a way for those employers to provide at least minimal coverage.
Those are options. Those are the things we need to look at. We're all smart enough to know that there have to be options. If we don't want to tax people, we find other options. We have to find those options.
I don't have a question, but I do want to reiterate something that others have said over the years, and that is that our budget represents our moral values. And if we are here to protect the people who have elected us, then we are here to make sure they have a roof over their head, that they have medical coverage so that they're not going into the emergency rooms, overloading our counties, because counties we know are responsible for providing indigent health care. And the burden on them, I don't know how they're going to do it. What was done at the federal level was intentional against many states, especially some states like California. What we are now doing to our counties, we've got to make sure it is not intentional, but we do know that they are responsible for providing indigent health services.
We also know that food banks and other community organizations, as was noted in the LAO report, and I'm just reading what is written, food banks and other community organizations provide additional food assistance, but their capacity is limited by the funding they receive from federal, state, and private sources. Well, we know the federal sources are going to run dry. The state is saying, we have no options. We have to look at options.
Speaker 9
absolutely have to look at options. I I again, I want to close by stating something that is so important and I want us to remember. And that is that our budget is a representation of our moral values. And if the federal government is telling us that they have no options for us because they've given the money away, as has been mentioned, to ICE to come and terrorize our communities, or as tax breaks to those who really don't need any more tax breaks, they're making plenty of money, then we, the state of California, have to look at options so that we then don't overburden our counties, who are then going to be looking to us in other ways. Thank you.
Speaker 1
Thank you very much. We're going to move to Senator Kibaldin. Senator Nilo Sontek.
Speaker 3
you, Mr. Chair. We began the hearing with some remarks that could only really be described as a bizarro description of the situation that we're in, and that was that the federal government had to enact HR1 because of the deficit. And the deficit is something we should all be deeply concerned about. It has significant implications in terms of our ability to meet the nation's needs.
And so federal government was doing the responsible thing by tackling the deficit, whereas California has had a workload increase of $18,000,000 in our Medi Cal program. And that's an example of runaway spending. But it's actually the opposite in the world. HR one didn't tackle the deficit. It wasn't necessary to tackle the deficit.
It is the largest expansion in the deficit that we've seen in generations. If you would if the state of California said, hey, guess what people of California, we are going to increase spending by 18%. And we're going to increase our deficit, which we're not allowed to have, but if we had one, we're going to increase our deficit by a third. And also, 3,000,000 Californians are also are gonna lose their health coverage. California would be in revolt.
Arkansas would be in revolt in the same any democratic society would be in how could you be so badly managed that you could increase spending by that much money, increase the permanent deficit on us and future generations by that much money, and still strip away basic health care and food from so many people? Like how does that add up? Well, adds up for the reasons that have been noted already. That even though this 18% in federal spending is twice as much as the $18,000,000 workload on a percentage basis, workload increase in Medi Cal that we heard about earlier, twice as much. But it's 63% decrease in corporate taxes.
That's what is driving HR1, an animus towards people, but fundamentally a set of tax measures that drive up spending and reduce revenues by a massive amount forcing this quote unquote cost shift from corporations and billionaires to states and counties and ultimately to people. And the beneficiaries have been noted earlier, but HR one increases the federal deficit by a trillion dollars, which might sound like a familiar number because we've heard $1,000,000,000,000 a couple of times during this hearing because it's the exact amount of money that is going to the top 1% in tax cuts. $1,000,000,000,000 to the top 1%, $1,000,000,000,000 deficit along with 10,000,000 people losing their health care. That's far beyond a bum deal. That's criminal.
And that's what we're grappling with here. And irony, you know, I'm I'm along with my colleague, the senator from San Bernardino is joining me on the new committee that's that's responsible for technology and AI, that the that the tech related billionaires, they've all been saying, look, don't worry about job loss because what we really need is a universal basic income because you're not going to have to work. But don't worry, there will be we'll cover your, you know, your rent and and your food and your health care and cost of living through other means like a universal basic income system. But instead, we're taking food and health care coverage away from those very folks that we're talking about, except they're the poorest among us this time. Until next time it'll be the slightly less poorest among us, and then the slightly less poor until it's all of us.
And instead giving those dollars away in tax cuts to the top 1% who say that they're for universal basic income. So that's the story about what's going on here. It is not a question of who's the more fiscally responsible government. We don't have a trillion dollar deficit or anything like it. Instead, have a $30,000,000,000 structural deficit, which is real.
And I want to encourage the conversation that my colleagues are sparking about revenues in the vein of what the Center for San Bernardino has talked about in terms of options. And we need to look at all of those. We need to have all the options on the table. I do also want to say, though, that there are I've been on this committee since I was elected. There are not $30,000,000,000 worth of revenue options out there.
We will not solve the structural deficit solely or even mainly by tax and revenue measures. As the senator from San Bernardino noted, I'm agreeing with you about everything, but, you know, without hurting the the very people that represent, workers and families, there's a limit on the on the amount can be sold only by revenue. So we need the full range of options, and none of those allow us to say, and therefore, we don't we can't consider any real cuts. We are going to have to consider all of it as we go forward. I would encourage you from finance and LAO, keep challenging us and we will keep challenging you to come up with and take seriously the full spectrum of options that we're going to need to be able grapple with this challenge.
Just a couple of smaller notes. I'm hopeful I'm not going to ask because we don't have time, but I'm hopeful that the Department of Finance and the Governor's Office, as we work to find solutions to the red tape coverage loss through a variety of mechanisms, and I know we'll take that up in our next panel more specifically, that the administration won't take the view that if we find a way that costs $5,000,000 to stop the coverage loss, administration won't come back to us and say, well, that's going to cost $268,000,000 then because we had already banked the savings from everybody losing their health care due to red tape. Let's please not play that game about already taking for granted some of the most manipulative cynical cuts here, which is let's just nag people to death until they lose their food and their health care. And then if we find solutions together, we just can't start scoring those in the budget or in the May revise as well. We'd lost $273,000,000 of savings because we solved this problem for the folks that would have otherwise lost their coverage.
Second, I just want to point out that 35 counties in California don't at all provide direct indigent health care. They're in the CMSB program. They're almost entirely represented by the center from Healdsburg, the center from Jackson, and myself, but the chair of our committee represents one, and a couple of other senators have one or two. So as we look at the impacts on counties, we need to be sure that we're looking at the impacts on the ecosystems of health care in those counties. The county operated systems, but also hospitals, clinics, local health plan local and regional health plans are also critical in terms of the damage and the harm that they're facing, but also in being part of the solution.
So, appreciate the panel. Very much looking forward to the next one, and thank you for the opportunity to make a few comments, Mr. Chair.
Speaker 1
Thank you very much. We're going to go to Senator Nilo, and Senator Archuleta is asked to make a brief comment afterwards to bring us home. So Senator Nilo.
Speaker 2
Thank you, Mr. Chair. I will try to be brief, although, you know, I've always said before that phrase is followed by an endless stream of words. I'll try not to follow that rule. A news flash, by the way, recently California is no longer a donor state.
In recent years, we have become a recipient state. That's been news that's been disseminated in the last year or so. And with regard to federal government trends in Medi Cal spending, this was discussed before, but there's been a 15% increase from the current budget year to the proposed twenty six-twenty seven year, increasing from $121,000,000,000 to $139,000,000,000 and from over a two year period, it has increased by $31,000,000,000. So, the historic figures, while we're prospectively, we're looking at significant challenges, I don't deny that at all. I think it's important to point that out.
Now, I have one question. I had a couple, but I'm only going to ask one, and then one more comment that hasn't been discussed. Our cost for SNAP is going to increase significantly if we don't do something about our error, our processing error rate, which is currently about 11%, which at that level, according to the LAO's report, will increase our expenses by about $2,000,000,000 Question. Why do we have such a high error rate? And secondly, what are we going to do about it to avoid that 2,000,000,000?
Speaker 15
Eurides Morales with the Department of Finance. So you're correct. The current error rate at this point is about 11%. So sort of under the terms of HR one at that percent,
Speaker 15
sort of maximum sort of penalty, which is about $2,000,000,000 in out years. However
Speaker 2
I apologize for interrupting, but I just want to make it clear. We have had this error rate, which is subject to cost penalties, and the federal government just hasn't been exercising it. Is that correct?
Speaker 15
I'll have the department sort of speak a little bit more about the history sort of of the error rate in the
Speaker 2
will just wanted clarify that. I'm not as much interested in the history as I am interested in the future. Why and what are we going to do about it?
Speaker 15
So, the sort of penalty rate will ultimately be dependent on our error rate in the federal fiscal year we are in at this moment. And so, as I mentioned earlier in this panel, there were resources provided as part of the 25 Budget Act for the Department of Social Services to initiate various efforts to bring down the error rate. And so they can speak more to those sort of specific provisions, but that's sort of work that is underway at this point. Okay.
Speaker 2
With regard to that other issue, you can get back to me. But clearly, this is a pretty important issue, and it has been, I seems to me, a fairly well established trend. So we have a lot of work to do to reform a number of years of past behavior in order to make up for it in the future and avoid that additional $2,000,000,000 Now
Speaker 15
If I can just make one additional comment. I will say the state's error rate is not very different from sort of the national error rate, just to sort of provide some historical context there.
Speaker 2
So, misery loves company, we love everybody. I understand. Legitimate point, but doesn't deny the relevance of the question that I asked. So thank you for that. One point that I want to discuss that hasn't been discussed, and that is the shape of our economy.
And the fact that the lack of a job, the unemployment rate, is certainly a driver of demand for health and human services. And it has been said that the best poverty program is a good job. And we, unfortunately, have a very weak employment economy. There was an article in the Mercury News either earlier this week or last week, that was written by, George Avalos about pointing out the fact that while we are the fourth or fifth largest economy in the world, we also, in the country, have the highest unemployment rate. And a lot of it is, as this article points out, our own doing.
Three quotes from experts on this from that article. First, over the past few decades, California has built an edifice of hiring costs and regulations that discourage employers. I might add that, our lack of paying down our unemployment insurance debt to the federal government from the pandemic is certainly not a job encouragement policy. Second quote, California will continue to rank low in job growth until it begins to address the core impediments to hiring. Last quote, the conclusion of the article at the end, serious work is needed to restore competitiveness.
This is not a time for boasting about how big our economy is. If our unemployment rate was closer to normal, it would be half of what it is. That would be potentially millions of people that do not currently have a job and probably qualify for these services who would have a job and perhaps not qualify for not need these services. So I'd just like to point out, as we really haven't discussed, but it is a pretty important part of it, and that is unemployed economy reduces the demand on health and human services.
Speaker 1
In the process of having Senator Archuleta close this out, I'm going to turn the gavel over to Senator Nilo as I'm going off to the bill signing. And unfortunately, you'll probably still be going when I'm done. But we still have the next panel, questions of the panel, and public comment. So let's move to Mr. Archuleta to bring us home, and then we'll move on.
Speaker 16
Thank you, mister chair. I'd like to go ahead and thank every one of the panelists that are here. You know the old saying, don't kill the messenger. Well, I believe you're the messengers. The messengers from the state of California where we stand.
Well, we're the messengers as well because we're trying to give you a message about our communities, about our districts, about how we feel of the people we represent. And, the impact of HR one is devastating, no doubt, here in California. We talk about trillions like it's millions, but that impact has cut quite a bit into California's budget, no doubt. But we have to figure out, and we've heard it time and time again. We are a state that is so blessed with so much, but yet we don't acknowledge those who give so much.
The minority generations that that we see. The you know, across the spectrum, we heard our senator mentioned about minorities, the black and brown, who've given so much to our state and yet here we're turning our backs to a degree, not because the state, but because HR one. So I think the message is how are we going to backfill and do it in such a way that we, are not punitive as HR one is to those who are undocumented, those who need help. Because without them, look what it's doing to to our communities. If you, turn the clock back before this administration took office, people were free to walk the streets of Compton, Watts, and Willowbrook, and East Los Angeles, and Pomona, Pacoima, and everyone else.
And not fear about being picked up off the street. And not fear about being separated from their families. And yet, as a nation, we're funding that type of work because of ICE. And we hear it time and time again in our communities across California. So your message to us is we have to act, but our message to you is to please be sensitive to what our constituents are saying.
And the governor has been supportive for our veterans. We just signed a bill yesterday, and, supporting our veterans, but we have work yet to be done. And I will say this, I am proud of California. We will get up off our knee and and and show the world that California not only is the fourth largest economy in the world, but it deserves that distinction because we're gonna go ahead and hold hands and we're gonna go ahead and and make things work. We're not gonna turn our back on our minorities.
We're not gonna turn back on the immigrants that have given so much to our country, and we're gonna find a way, but that is up to you. Help us find a way to make sure we don't hurt this population. And when it comes to cutting education, we can't. We have to educate everyone. We talked about medical and Medicare.
It's so important. We also talked about the the the children that received that first meal in the morning and maybe a second meal during the day might be their last. And, so cutting, we've gotta be careful. We've gotta continue to provide service for those who've given so much. So take the message as we've received it that we are going to continue to work together as legislators to help our communities, and we'd just like to thank you all for being here.
And that is my message. Thank you, mister chair. Yes.
Speaker 17
Thank you. I appreciate you indulging me here, mister vice chair. I just wanted to note because we've been some focus on the error rate. I I I think it's important for everyone's everyone to know that the average error rate in The United States is 10.9, very similar to our error rate. In fact, HR one is gonna scoop in close to 90% of the states under the error rate.
I think there's approximately six only six states that are not gonna be caught up in the HR one error rate new limitations. The highest the state with the highest error rate sitting at 25 is the state of Alaska, but her their senator got a sweet deal to be exempted from h r one. So, of course, she was excited to sign that bill. So let's really facts our fax. We are not above national average.
We're sitting at most red states are gonna be caught up in this h r one implication as well, so we are not an anomaly in this in this area.
Speaker 2
Thank you for that clarification. And I didn't intend to make it comparative. It was pointed out in the answer when I responded that if misery loves company, we've got a lot of friends out there. But the point is that we need to do something about the error rate, as does everybody else. At any rate, thank you all very much for this panel talking about the impacts of HR1.
We will now move to our second panel, Possible Efforts to Preserve Access to Healthcare and Food. The presentations will be by a larger group this time. Michelle Boss, Director of the Department of Healthcare Services Jennifer Troia, Director of the Department of Social Services Carlos Marquez, Executive Director of the County Welfare Directors Association Linda Nguyen, Associate Director of Policy Advocacy with the Western Center on Law and Poverty Ronald Coleman Beza, hope I'm pronouncing these names correctly, Managing Director of Policy for the California Panethnic Health Network, and Josh Wright, Director of Government Relations for the California Association of Food Banks. So I suppose we will go in that order, beginning with Michelle Am I pronouncing that name Yes. Right you.
Speaker 25
Thank you, Mr. Vice Chair, members of the committee. Michelle Boss, Director of the Department of Health Care Services. As discussed in the previous panel, HR1 makes devastating changes to the Medi Cal program and will potentially cripple the health care safety net that many of our Medi Cal members and all Californians depend on. HR one, enacted on 07/04/2025, mandates new eligibility and enrollment requirements for Medicaid programs nationwide.
California must comply with these federal changes, which include community engagement and work reporting requirements for certain adults, changes to eligibility criteria for certain groups of noncitizens, six month renewal requirements for specific groups, and cost sharing, provisions. These requirements are significant. Under HR1, the Work and Community Engagement provision, which requires adults eligible as part of the new adult group, which this is the Affordable Care Act optional expansion group, to demonstrate work participation. It's estimated this will result in 233,000 individuals in Medi Cal losing coverage by 06/01/2027, rising to 1,400,000, members by 06/01/2028. Six month eligibility checks, which require the state to conduct eligibility redeterminations every six months rather than annually for the adult expansion group, will lead to an estimated 289,000 members, losing coverage by June 2027, ultimately rising to 400,000 individuals.
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. We will use state, federal, and other data sources to verify eligibility whenever possible, reducing paperwork and preventing coverage loss due to administrative issues. We will 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.
We will streamline the Medi Cal renewal processes with clearer forms and simplified six month renewal steps to help members stay enrolled. We will educate and train those who serve our Medi Cal members, provide counties and our coverage ambassadors, our community partners who share information to help Medi Cal members navigate coverage with training, practical tools, and ongoing support to assist members effectively. And we will provide timely and transparent communication to our members. We plan to share updates through multiple channels so members have sufficient time to prepare for and comply with the new requirements. The department will use texting for critical updates, distribute culturally appropriate tools, and engage our coverage ambassadors.
Our goal is to make this transition as smooth as possible by providing clear information, reducing administrative burdens, and working closely with our members, counties, health plans, and community partners. On January 29, we released our HR one implementation plan, which outlines California's strategy for implementing the Medi Cal program updates required under HR one. No other state has released such a plan. California is a leader in planning ahead for the changes to the Medicaid program and ensuring systems, eligibility workers, partners, and members are aware of what these changes mean for them. The implementation plan provides detailed guidance on how DHCS will implement these changes while working to minimize disruption and maintain coverage continuity.
To familiarize our implementation plan with our partners and the general public, we held two all comer webinars, last week with over attendance of over 200,000 individuals. We posted the recordings on our website, and we are really doubling down on our efforts to outreach to outreach and outreach early to our community and critical implementation partners. Additionally, DHCS is committed to educating and training those who serve our Medi Cal members. We are designing and delivering comprehensive trainings, flow charts, and other tools to help support our county operational planning and staff development. Currently, the department is holding monthly work group meetings with county staff to share updates about HR one and engage in dialogue about implementation related to the new eligibility requirements.
After implementation of these provisions, we plan to conduct county visits to help ensure consistent implementation and provide continuing technical assistance across the state. As discussed and noted in the governor's budget, HR one changes Medi Cal eligibility requirements for DHCS and our county eligibility workers. We are working with our counties to evaluate the needed support for county implementation of these provisions. We also recognize the importance of partnerships with other stakeholders, including our managed care plans, providers, advocates, and community based organizations, again, to prepare and implement these changes. Through a collaborative and multi phased approach, DHCS and stakeholders will ensure that members are properly equipped with the information and support they need to adapt to the upcoming changes.
This multiphase approach includes two parts. Phase one is building awareness and preparation for these changes. For example, just, last week, we launched our text campaign, outreach campaign, to raise awareness to the Medi Cal members who may be impacted by the work and community engagement requirements. These messages are translated into all 19 threshold languages and written in plain people first language. For phase two, we will shift the communication style to a call to action, creating messaging that has urgency and having our implementation partners share broadly with the community.
The implementation plan lists multiple channels we anticipate using to elicit stakeholder feedback and share important information related to HR1. Additionally, the Governor's budget includes 4,000,000 for clinic navigators to help assist reaching out to help eligible individuals apply and successfully complete the health care coverage enrollment process, retain coverage, navigate the health care system, and gain timely access to medical care through community based care management. The scenario that Senator Menjivar is a perfect example of how these clinic navigator dollars could be used. Additionally, the department plans to build upon the excess of our Coverage Ambassador Program that was launched during the public health emergency unwinding and redetermination process. Coverage ambassadors are people in our communities who help our members understand coverage, understand how to navigate the coverage.
We provide tool kits, webinars, social media content, and informational documents to help our ambassadors. To date, we have over 6,000 individuals signed up to be coverage ambassadors. I will now turn it over to Tyler Sadwyth, Chief Deputy Director and State Medicaid Director, to get into further details on our mitigation strategies.
Speaker 26
Thank you, and good morning to the committee. My name is Tyler Sadwyth. I'm the State Medicaid Director. The Department of Health Care Services is committed to maximizing the use of state, federal, and third party data sources to confirm eligibility without burdening members and to avoid red tape. As Director Boss mentioned, using administrative data to automatically confirm eligibility is one of our guiding principles, and it is a key strategy to minimize coverage loss due to H.
R. One in Medi Cal. One statistic from the few states that have implemented work requirements in Medicaid underscores how critical this strategy is. Based on the experience of these states, among the population of Medicaid members who were subject to work requirements and who the state could not automatically verify, these individuals had to manually report information, and the average disenrollment rate for this cohort was seventy seven percent. Accordingly, wherever possible, the department will leverage available electronic data sources to identify individuals who meet exemption criteria and individuals who are not exempt but who are already in compliance with the new rules.
This process, referred to as ex parte, is the most powerful tool to maximize coverage retention in Medi Cal and reduce red tape on Medi Cal applicants and members. The electronic data sources will provide exemption related information, income and wage information, so that people can be exempt or deemed compliant on the back end. We are able to exempt some individuals using Medi Cal eligibility data, such as an aid code. For other individuals, we will leverage a comprehensive set of data sources, including our Medi Cal claims data, CalFresh and CalWorks data from CALSAS, state wage data from the California Employment Development Department, income data from the IRS and vendors such as Equifax, vendors with income data from the gig economy, data from the Veterans Affairs, higher education, the State Department of Rehabilitation, and other agencies. In addition, the department is evaluating which diagnosis, drug, and procedure codes can be used to establish medical frailty, which is one of the exemptions passed in the law.
We are taking a comprehensive approach to developing criteria, which is a key lever to ensuring coverage retention. We have undertaken a robust stakeholder engagement strategy soliciting feedback on the draft criteria from the chief medical officers of all Medi Cal managed care plans, the American Medical Association, and external clinicians affiliated with nearly a dozen medical societies and disease specific organizations representing a broad range of clinical specialties. This comprehensive approach is intended to ensure individuals do not lose Medi Cal as a result of HR1. As the director mentioned, we are streamlining the Medi Cal renewal form to assist the Medi Cal members and consumers with keeping their Medi Cal and making the experience easy for them. We're looking to connect with members in a variety of ways that meet their needs and their preferences, including mail, phone calls, text messages, and a member facing app that will support them with the application and renewal process.
One group of members that may be at high risk of losing coverage due to HR1 are individuals experiencing homelessness. The department is partnering with counties, Medi Cal managed care plans, and community based organizations to address the challenges that individuals experiencing homelessness will have in verifying eligibility for Medi Cal and maintaining access to Cal AIM services like enhanced care management, community supports, behavioral health care, and essential health services. Three initiatives that provide face to face interaction and outreach to Medi Cal members experiencing homelessness include enhanced care management, community supports, and street medicine. Enhanced care management, or ECM, deploys community based care teams to engage homeless individuals, often directly on the street, to help them navigate the Medi Cal eligibility process, gather documentation, and maintain continuity and coverage. Care managers assist in enrollment, renewal, and tracking eligibility milestones.
There are 14 populations of focus for ECM, and the population of focus that represents greatest utilization out of all 14 is adults experiencing homelessness. ECM continues to grow quarter over quarter, year after year, as we collaborate closely with plans, CBOs, and providers on uptake. UCM provides key linkages to medical care, behavioral health care, and community supports. Two community supports focused on housing, including housing transition navigation services and housing tenancy and sustaining services, account for two of the top three most utilized community supports. Last month, we launched transitional rents, the newest community support for the behavioral health population of Focus.
And like ECM, community supports grow consistently quarter over quarter and year over year. We are pleased to report that community supports are cost effective. They are working as intended. They are providing upstream preventive supports that treat the whole person in lieu of more costly, more intensive services. Analysis from an actuarial firm shows community supports are reducing utilization of emergency care, inpatient hospital stays, and nursing facility stays, representing net health care savings.
Finally, street medicine delivers health and social services directly in environments where individuals live, eliminating barriers posed by traditional settings, and they include help to support members with completing Medi Cal applications and renewals. The department has many efforts underway through performance based opportunities in BH Connect and other technical assistance to increase uptake for ECM and community supports for this population. As part of HR1, we are partnering closely with the Department of Social Services to align implementation approaches with CalFresh. We are committed to close collaboration with CDSS and counties. Our shared goal is to safeguard access and equity while navigating the changing federal landscape.
This coordination ensures that policy changes are aligned, operational impacts are minimized, and members experience a streamlined process. We are collaborating to expand the use of electronic and administrative verifications across programs. This includes exploring shared data sources and automated processes to reduce duplication, enhance efficiency and eligibility determinations, and minimize the burden on counties and members. Because California has an integrated eligibility system with CalFresh and CalWorks, Medi Cal is able to use that data already in CALSaws to exempt individuals. And we're able to use income and job information from CalFresh for the purposes of Medi Cal redeterminations.
Thank you for your time. Happy to answer questions after the panel.
Speaker 2
That sounds like a good segue to the Department of Social Services. And I would point out that we have five more presentations, and we certainly want to hear everything that you have to tell us regarding preserving access. But if you could keep it rhetorically economic, would be most appreciated.
Speaker 27
Will do. Good morning. I'm Jennifer Troia. I'm the Director of the Department of Social Services. This hearing has already emphasized a great deal that H.
One makes extremely significant changes to federal funding and eligibility for both Medi Cal and CalFresh. Our department oversees the administration of CalFresh, or the SNAP program. Although it's been said, I think it's important to emphasize again that CalFresh is one of the most effective tools that we have to combat poverty and food insecurity. Each month, the program serves over 5,300,000 low income individuals across California. It allows them to not only address food needs, but also free up limited resources in their budget for other essentials such as housing and medication.
As you've also heard, H. One is expected to cut federal funding for SNAP or CalFresh in California by at least 2,300,000,000.0 to $4,300,000,000 annually. As we approach the implementation of H. R. One, we have a priority of protecting benefits for Californians as much as we can, and we are grounded in a few key principles.
First, we're working to mitigate harm whenever possible and provide clear communications for clients and counties. Second, as much as possible, we're making evidence based decisions by using data and research to inform our choices, monitor progress, and make adjustments. And finally, we're committed to engaging transparently. This means actively seeking insight from partners, including the counties that administer CalFresh, people with lived experience, and others representing a variety of perspectives. In addition to the changes to eligibility for non citizens, one of the biggest impacts, which we've already been discussing quite a bit this morning, of HR1 on CalFresh is the changes to the CalFresh time limits, especially for people who are considered able-bodied adults without dependents, or ABODs.
Prior to HR1, and when California was not under a waiver, people who were considered ABODs were limited to three months of benefits in a thirty six month period unless they were exempt or they met work or community engagement requirements. HR1 significantly expands who is subject to this time limit of three months of benefits in a thirty six month period. It increases the age group subject to the rule from 18 to 54 instead of 18 to 64. It lowers the age of who is considered to be a dependent child for purposes of the parent's exemption, from having a child 18 to a child 14. It eliminates exemptions for people who are homeless, adults under the age of 24 who were in foster care, and for veterans.
In the other direction, it does add an exemption for American Indians. Other exemptions that remain include being pregnant, medically certified as physically or mentally unfit to work, or participating in the Office of Refugee Resettlement's trainings program. H. R. One also significantly narrowed the criteria for federal waivers of the application of the time limit.
We released key policy guidance to counties regarding implementation of all of these new rules at the 2025. Statewide implementation of these changes related to the ABOD rule will begin on 06/01/2026. That means that starting June 1, counties must screen new applicants and existing recipients for an exemption before applying the time limit. This timeline reflects the time that is necessary to automate our eligibility system and to train our eligibility workforce to ensure consistent statewide implementation. Individuals who are not exempt must work or engage in a qualifying activity to maintain benefits for more than three months and document that to After the accounting for individuals who we already know are exempt from the ABOD time limits because of data we already possess, We estimate that there are 609,000 people who will newly be subject to the time limit rules because of HR1.
Combined with an approximately 346,000 individuals who would have already been considered ABODS prior to HR1, this means that approximately 955,000 people will be subject to the time limit policy and could be at risk of losing benefits if they're not exempt or meeting the work requirements. In the face of this complex program change, we are actively partnering with counties, the Kelsaus Automation System, advocates, community based organizations, and other state agencies to prioritize solutions that minimize harm to vulnerable recipients. First, we're working to ensure that everyone who meets the criteria for an exemption receives that exemption. In addition to identifying individuals who we already know qualify for an exemption, we are looking for other ways to maximize existing data to maintain benefits. For example, we're exploring whether the in home supportive services, wage, and provider information could be an additional source of information that we have access to and can utilize for purpose.
For those who are subject to the rule and who are not already known to be exempt, the counties must conduct an exemption screening before the time limit can be applied. This will occur at the time of application, or for existing recipients, at their next recertification. What I want to emphasize is that this means the majority of exemption screenings will occur over a twelve month long period, which spreads out the workload and allows time to be dedicated to this activity at an existing touchpoint. Second, we're working to connect people to qualifying activities and to minimize administrative burdens so that eligible people can maintain benefits. For example, we are expanding our CalFresh employment and training programs and providing technical assistance to counties that don't currently offer those programs.
We're participating in a joint California Health and Human Services Agency and California Labor and Workforce Development Agency work group to improve local cross system collaboration and facilitate workforce connections. Given the work requirements and renewal changes for Medi Cal, CDSS and DHCS are closely collaborating, as you've heard from DHCS as well, to minimize administrative hurdles and maximize benefit retention. Whenever possible, we're looking to streamline requirements across the programs. Finally, in terms of communication and engagement, we've launched an extensive partner engagement series, county office hours, and policy training opportunities. The department is also developing and sharing specific resources and tools For example, we're developing an ABOD outreach toolkit.
We're creating a county resource toolkit to streamline exemption screening and better connect clients to qualifying activities. In addition, we're exploring with DHCS the possibility of client tested joint communication materials to help clients understand the similarities and the key differences between CalFresh and Medi Cal's program requirements. Previous speakers also outlined the basics of how H. R. One shifts administrative costs from the federal government to the state and counties, and how a state's payment error rate, or PER, determines the timing and amount of any state costs related to paying for a portion of CalFresh benefits, which, again, have historically been funded 100% by the federal government.
Given this potential significant fiscal impact on the state connected with the PER, CDSS has embarked on a multi year accuracy improvement initiative, which is grounded in data and informed by communities, counties, and partners. We've been conducting a statewide analysis of the most significant error drivers to help us identify and implement strategies to lower our PER. As a reminder, the PER includes both under and overpayments, and it can be things that, are in error because of the county's error or the error on the part of the client. As an example, early in our analysis, it became clear that households not reporting an income source change account for 27% of the dollar value of payment errors. Eliminating this type of error could reduce our payment error rate significantly.
That early analysis has led to investments related to income verification, including, first, a new consent based verification tool that we will roll out to be especially helpful for people who are engaged in nontraditional employment, like gig work, to make it easier to report that work. Second, expanded use of income verification sources, like the work number, to reduce the burden of providing verification of application and recertification and to indicate possible income received that may be over the threshold. And third, automation of a payment verification system match, which provides income information from the Social Security Administration and the Employment Development Department. These new income verification tools are set to launch throughout 2026. Beyond income verification, another example is that we'll be piloting a new proactive communications strategy later in 2026 to remind clients of reporting requirements and answer common questions they may have.
Our continuing root cause analysis includes site visits, eligibility worker and client interviews, client surveys, focus groups with community based organizations, and this information will help inform further investments to reduce our payment error rate. We plan to use the information gleaned from both these qualitative and quantitative analyses to work with our partners to inform how we prioritize accuracy improvement strategies and evaluate the success of those solutions. Further components of this work, some of which have already been prioritized and others which likely will be, include additional system automation, such as alerts or reminders for workers, increased worker and client education and training, new tools and resources for counties, expanded quality assurance tools to improve real time monitoring of error trends, and more. In summary, stepping back, the changes that HR1 makes to CalFresh are profound. The millions of Californians we serve are relying on us to collectively minimize the harm that those changes cause and continually improve our operations of the CalFresh program in these deeply challenging times.
Thank you for holding this hearing on these important topics. At the appropriate time, I'm happy to take your questions. I also have our Deputy Director over the Family Engagement and Empowerment Division, Alexis Fernandez Garcia, here with me.
Speaker 2
Thank you, and thanks for the additional comments with regard to the error rate. That's helpful. Next, we have Carlos Marquez, the Executive Director of the County Welfare Directors Association.
Speaker 28
Thank you. Thank you for the opportunity to detail the impacts of HR1 on county governments and also discuss how the legislature can mitigate the worst harms of HR1 on the communities we serve. HR1 threatens California's county administered safety net in in three ways. It imposes higher stakes on the individuals and families we serve. It increases the workload on the workers who rely who are relied upon for access and retention of these vital benefits.
And it deprives state and county governments of the funding necessary to implement these complex new policy changes. These changes are so fundamentally at odds with the culture of coverage and program access that counties in the state have embraced and successfully cultivated over the last decade that our focus now is squarely on harm reduction since we know from the existing body of evidence that we cannot prevent harm entirely. Leveraging the county eligibility workforce offers a clear, proven, and cost effective path for the state to reduce the downstream impacts of unmitigated hunger and uncompensated care. We know that when work requirements have been studied, most disenrollment happens because people are unable to navigate these new reporting requirements and procedural hurdles, not because people aren't working. This means that the greatest lever counties have at our disposal to mitigate harm is our county eligibility workforce.
When they are well trained, when they are adequately funded, and when they are fully staffed, they have demonstrated over the last decade that they can meet the state's ambitious program goals. Counties are currently preparing eligibility workers to implement a two pronged approach to maximizing program attention in the face of HR1. First, executing accurate and robust screening for exemptions so that work requirements are not inappropriately imposed on individuals with qualified conditions or life circumstances that may make them eligible for one or more exemptions. Second, educating, navigating, and verifying work requirements for individuals who do not qualify for an exemption and must meet new work requirements in order to retain benefits. The first of the two pronged approach, the robust and accurate screening for exemptions, is really a cornerstone of our harm mitigation strategy, as Director Troia mentioned, because it promotes both program accuracy and program access.
Federal law provides a range of mandatory and optional exemptions that may apply to a substantial share of affected enrollees. However, some of these exemptions, we still believe, will require significant manual work that will be worker driven at the county level, particularly for individuals who do not have a data footprint. If counties can be successfully positioned to proactively identify and apply these exemptions at intake renewal and, in the case of CalFresh, any time a worker becomes aware of information that may qualify an individual for an exemption. Individuals who live with conditions or life circumstances that limit or prevent their ability to meet work requirements will be appropriately exempted and should never face a compliance trigger. However, the disclosure of sensitive information that may qualify an individual for one or more of these exemptions will hinge on robust worker engagement, a discerning and a trained ear by the worker to probe further when appropriate, the rapport and the trust building necessary to actually get that sensitive information surfaced by the client in the first place, which could mean the difference between retaining benefits and losing benefits.
The second part of this two prong approach is, of course, to educate, navigate, and verify work requirements for individuals who must comply. That requires a build out of new partnerships and a strengthening of existing partnerships between public agencies, employers, higher education, nonprofits that can support and sustain client referrals and placements so that clients may meet the requisite hour requirements for retaining benefits. Counties are engaging with their local WIOA workforce development boards, higher education institutions, adult schools, CBOs, and so many more to really engage in the planning and the process mapping for an uptick in referrals and to help clients meet the standalone or combination of these available, hour requirements. Our counties are also, leveraging, staffing infrastructure, data insights, and institutional memory from existing welfare to work programs like CalWORKS and work readiness programs like CalFresh employment and training to quickly ramp up proven skill building and placement strategies in the new context of CalFresh and Medi Cal. Even once a client is properly or successfully referred and placed, alerting and counseling a nonexempt client who experiences a drop in hours, that they may be at risk of losing the benefits.
And then being able to screen them, for example, for a good cause exemption, which would be temporary but could be based, for example, on lack of transportation, will really be vital in helping our most vulnerable clients retain benefits. However, while counties are fully exhausting this critical planning window to strengthen county readiness and design a harm mitigation framework that will minimize precipitous program drop off, counties do not have adequate funding to implement these plans today. In fact, plans are being written as several counties are simultaneously instituting hiring freezes, facility consolidations. And absent additional funding, some counties are even being relegated to consider layoffs. Not only are counties navigating the uncertainty of having to implement policies that have either never been tested in California in the case of Medi Cal or haven't been implemented in California in the case of CalFresh.
But they are also contending with the uncertainty of whether or not there will be state general fund investments in implementing HR1. The sooner counties can get a reliable signal from the legislature and the administration, like our friends at DHCS have given us, that this work will be funded, the sooner counties can focus on scaling up and persuading their leadership to hold off on some of those cost cutting measures. So our assessment currently in terms of workload is that within the CalFresh program, in order to implement a harm reduction approach, Our workers will need an additional four hours per client per year in order to screen robustly for exemptions and for those for whom work requirements apply, helping navigate those clients through compliance. We also estimate in the Medi Cal program that the clients who are impacted by work requirements will require an additional three point five hours per case per year. We believe that an additional one point two hours will be required for workers to make sure that they're keeping pace with those second redeterminations at six months.
So these are not inconsequential to the budget. Those hours have real costs because they require that we hire even more eligibility workers. We estimate that in CalFresh, we would need at least 400 additional new eligibility workers, and in Medi Cal, at least an additional 2,000 eligibility workers to be able to implement HR1 not just compliantly but responsibly. The final thing I would say is some of you did refer to some of the costs around potential indigent care systems, and we're happy to answer those questions as well. County coalition put out, led by CSAC, put out some numbers that estimated the collective cost to counties around HR1 are anywhere from 6,000,000,000 to $9,500,000,000 So with that, looking forward to engaging further in the discussion.
Thank you.
Speaker 2
Thank you very much. Next is Linda Ngui. Am I pronouncing that? No, I'm not. Good morning.
Linda Wei. Ngui, okay. Associate Director of Policy Advocacy for the Western Center on Law and Poverty.
Speaker 29
Thank you. Again, Linda Wei with the Western Center on Law and Poverty. Thanks for the opportunity to speak today and holding this hearing. Thanks to the Affordable Care Act and state leadership to expand Medi Cal, California slashed the number of uninsured from 18% in 2013 to less than 6% in 2024. Unfortunately, due to H.
R. One and last year's budget actions, these gains are being eroded and, if not stopped, will result in millions of healthcare coverage terminations. Studies show that Medi Cal expansion resulted in reduced disparities across race, ethnicity, income, and education levels and decrease mortality overall and for certain conditions. The long term impact of reducing access to NetECAL will be to reduce this progress, increasing disparities and increasing mortality. Similarly, CalFresh is the state's largest and most effective anti poverty program, preventing hunger and providing economic stability to families and communities.
The long term impacts of cutting people off CalFresh is increased poverty, hunger, educational deficits, chronic health issues, debt, and homelessness. Our communities will also experience losses in revenue and economic decline from reduced revenues for farmers and grocers. These safety net programs aren't just in insurance card and groceries, but economic stabilizers that directly reduce poverty, prevent eviction, and help people live healthier, longer lives. Through H. One, the resources our low income families depend on are being taken by the federal administration to provide tax breaks to billionaires and corporations and expand DHS's budget.
Our taxpayer dollars are being gifted to the already wealthy at the cost of eligibility restrictions and administrative burdens to our safety net. People with Medi Cal and CalFresh already have a duty to report any change in circumstances that might affect their eligibility, such as change in income, family size, or address within ten days. Doubling the frequency of Medi Cal renewals and newly imposing for Medi Cal and expanding work requirements for CalFresh diverts funds from strengthening safety net programs to bureaucracy that terminates coverage. Advocates for those experiencing homelessness are gravely concerned with HR one's administrative red tape. It's hard enough to get paperwork to people without permanent addresses and for them to gather proper verifications.
Now they, along with 5,000,000 people, are expected to do it twice as often. That's twice the risk of losing coverage, twice the risk of having an emergency, and only then finding out that they don't have coverage, placing greater strains on hospitals and the health care system. To the Chair's earlier question about procedural termination rates, we know when Medi Cal renewals were restarted following the public health emergency unwinding, the overwhelming majority, over 90% of Medi Cal disenrollments, were for procedural reasons. This went down to about 65% following the state's adoption of allowable coverage strategies, but jumped back up in July when the state ended many of those strategies. On the CalFresh side, Department estimates 72,000 legally present humanitarian groups will be cut off from CalFresh be beginning this April, and 660,000 Californians will lose their food benefits later this year unless the state takes action to backfill these cuts by expanding the California food assistance programs and funding CARET benefits.
To truly protect Californians from federal CalFresh and Medi Cal cuts, the state must step up and reverse the cruel redistribution of wealth resulting from H. One. We have heard that the state cannot afford to backfill these cuts, but we are here to tell you that neither can the families who depend on CalFresh to put food on the table nor the families who depend on Medi Cal to live healthier lives. Recognizing revenue solutions will take time, we recommend the following strategies that the state can take now to improve systems to protect eligibility. This includes, as the Director mentioned, automating systems in ways that preserve people's coverage by auto verifying eligibility requirements through e data and reinstatement of allowable coverage protections that decrease paperwork terminations while preventing eligibility errors streamlining member centric efficiencies to ease enrollment and renewal reporting For instance, simplify applications and reporting to allow people to report changes through multiple channels like email, text message, and one click options instead of multi step online and paper processes.
Continued stakeholder engagement and effective culturally and linguistically appropriate outreach to CalFresh and Medi Cal enrollees by trusted community based navigators, short term investments to reduce the payment error rate that could save future general fund obligations by eliminating reporting barriers, strengthening access to call centers, and expanding county worker training and support and finally, requiring data collection, public reporting, and evaluation to better measure what methods are most effective. We appreciate the administration's principles to protect coverage, but its proposals echoes the federal government's targeting of immigrants. It applies work requirements and more frequent Medi Cal renewals to state funded immigrant populations when HR one doesn't even require that. This is not equitable and inconsistent with California values. The administration is already treating immigrants differently through current Medi Cal enrollment lockouts, termination of dental coverage in July, and costly $30 per person premiums next year.
Instead of protecting immigrants, the administration's proposal is set to cut coverage for immigrants who are still reeling from last year's budget cuts and hostile federal government. We urge the legislature and administration to confront federal harm head on and advance California values by exploring nonregressive revenue solutions. Thank you.
Speaker 2
Thank you very much. And next, we'll have Ronald Coleman Bates, I'm probably mispronouncing that too, Managing Director of Policy for the California Panethnic Health Network.
Speaker 30
last Yes, certainly. Good morning, chair and members. My name is Ronald Coleman Baeser here on behalf of the California Panethnic Health Network. CPEN is a health policy organization that brings racially and ethnically diverse communities together to further and advance health equity. We appreciate the opportunity to be here today to share our thoughts on how we should be responding to coverage losses that will result from HR one and state budget decisions.
Over the last year, the president and republicans in congress have made it their top priority to attack immigrants and people of color across our country by their policy actions, through their budgeting, by how they have unleashed law enforcement to kidnap children, families, and workers across our state. We know what their agenda is. We hear the message loud and clear every single day. Immigrants and people of color are not welcome here. But here's the thing.
While this is the message being pushed out of Washington DC, here in California, we should actually be leaning into our values. We should not be running from them. So you can imagine how shocked and disgusted many people in the health advocacy community were when they saw governor Newsom's proposal that seeks to eliminate full scope medical coverage for 200,000 humanitarian immigrants across our state. Individuals losing care include survivors who have been granted asylum, people who are often survivors of torture inflicted because of their racial, ethnic, or sexual identity, or even because of their political or human rights activism. Many of these people have endured sexual assaults or trafficking, beatings, or even witnessed the murder of their family members and are often suffering PTSD.
Losing full scope Medi Cal benefits and only having emergency Medi Cal means that someone no longer has accesses access to the services that they desperately need. They will lose preventive care, non emergency dental coverage, and even access to prescription drugs. Essentially, they'll lose access to all non emergency treatments and not be able to manage chronic chronic conditions, and death could result from an illness that could have been easily treatable or even preventable. While the governor claims that this is the result of a new federal policy change of h r one, h r one does not automatically trigger Californians losing coverage. In fact, this legislature would have to take a proactive vote to reverse policy and fiscal commitments that have been in place for decades in order to strip coverage away from these people.
Both Democrat and republican administrations have stood by these commitments in the past. Current state law requires these individuals to be covered in full regardless of any changes at the federal level. Enough damage has already been done and has yet to fully be realized as a result of budget cuts that happened last year. We established a freeze that started on January 1, the carve out for adult dental for all UIS individuals starting on July 1, which legislators can actually stop now. We also have the fourth largest economy in the world, our state, asking immigrants in poverty pay to pay $30 a month in premiums starting in July next year.
All of these decisions should be reversed. It's not time to also sock away money and reserves while we're also sitting here considering proposals to strip away coverage from Californians. We also must have some type of dedicated revenue stream that provides funding for Medi Cal to ensure we have the dollars in the system to appropriately provide for the medical needs for all of our state residents. We need courageous and bold action from policymakers at a time when cuts can actually kill people. While coverage losses may be inevitable, it is incumbent upon you all to ensure we can keep as many people in our Medi Cal system as possible at a time when eligibility cuts, work requirements, and more often renewals are put in place to push people out.
Investments must be made to ramp up capacity for navigation and eligibility support, specifically using community health workers, promotores, and health representatives as a solution. In this climate, CHWPRs will continue to be a trusted link that help families navigate changes and stay connected to care, preventing eligible Californians from falling through the cracks and chain in a changing Medi Cal system. CHWPRs have always been a core part of California's health workforce in times of crisis. They rose to the challenges during COVID nineteen, supported communities through wildfires. California actually already has an infrastructure in place that can be scaled up quickly without reinventing the wheel.
In 2025, the Department of Health Care Access and Information, HCAI, invested 6,000,000 to strengthen connections between CHWPR organizations and immigrant legal service providers for referrals and linkages to key services. We urge you to build on that existing investment by expanding CHWPR and CBO capacity to provide health navigation at the scale needed during this critical time both in HCAI and through partnerships with counties. Medi Cal changes will create confusion for beneficiaries and increase the risk of unnecessary coverage terminations due to paperwork and administrative barriers, particularly for communities that already face language access barriers and heightened fear. We must do everything possible to have multiple layers of support for individuals in danger of losing Medi Cal to keep them covered or find alternative county or local options if they lose coverage. Getting to university is a getting to universality is a California value, and that means fighting for our most vulnerable Californians to make sure we maintain access to coverage, and that is going to require all of you to do hard work.
While Medi Cal already operates more efficiently than other parts of our health care system, It's going to be important under these federal threats to make sure that we redouble demands that public dollars prioritize patient care over any profits in our system. HR one was the biggest transfer of wealth we've seen in generations. People in poverty lose, while large rich corporations and the wealthy hoard more resources that legislators should be capturing to make sure we aren't cutting people off of coverage. Let's raise revenue for Medi Cal. Let's reject additional cuts to strip health care from Californians.
Let's not cut any optional benefits in these difficult times, and let's ensure that we can do everything we can to invest in community based solutions through community health workers to make sure that we can prevent people from falling through the cracks. Thank you.
Speaker 2
Thank you. Now I know I have the pronunciation of the next name Wright. Pardon the pun. Josh Wright, Director of Government Relations with California Association of Food Banks.
Speaker 14
Hello. My name is Josh Wright. I'm the Director of Government Relations for the California Association of Food Banks. We represent 43 food banks that partner with nearly 6,000 agencies across the state, and our mission is to end hunger in California. Our latest estimate based on the census household post survey indicates that approximately 22% of households in California are currently facing food insecurity, while nearly 27% of households with children are food insecure.
Black and Latino households face even deeper disparities. We know that HR1 will exacerbate food insecurity California by including the largest cuts to CalFresh in the program's history. I wanted to start by reading two quotes from people on what the loss of CalFresh would mean to them. The first one, the exorbitant amount at which food is already increased makes living with HIVAIDS and disabling pain challenging enough. But to strip me of the little extra room from CalFresh would only put more undue stress on my life, and I'm just trying to survive and hopefully thrive in life one day.
The second one, as a domestic violence survivor who was starved by my abuser, not having food in my house triggers me to feel off balance and frightened that I will starve, and it takes a toll on me mentally, so much so that I do not function on a daily basis. This is just a couple of examples of the real human impact that HR1 will have on the lives of the estimated seven hundred and thirty two thousand Californians who will lose access to Calfresh this year. Many Californians turn to food banks in times of crisis, and we expect that there will be a significant surge in demand as HR1 key provisions take effect. We polled our members in November, and 92% of food banks reported increases in the number of households served and in the amount of food that they distributed. This increase in need comes as food banks are already serving a record 6,000,000 Californians per month, up from 4,500,000 during the height
Speaker 14
pandemic. While serving more people, food banks have lost federal funding. Last year, food banks received 38% less food, over a $100,000,000 less, from the USDA's emergency food assistance program, known as TFAP, than we did the previous year. And as was noted or discussed in the first panel, our CalFood funding, which is our state funding that we receive, is set to reduce down to $8,000,000 up or down from $80,000,000 that we received last year. So we are losing funding in both state and federal funding.
This means that food banks are already in the difficult situation of serving a record number of people with less federal funding before the cuts in CalFresh and HR1 go into effect. As these full impacts begin to take effect, we believe several actions will be important to reduce the harm. First, it'll be essential to keep as many people connected to CalFresh as possible. As already been noted today, it's important for the state to support county workers so that they have the capacity to provide robust client engagement and exemption screening. Additionally, the state should fund the CalFresh outreach network, which has been affected by the cost shift provisions in HR one.
CalFresh outreach assisters are members of the communities that they serve and provide prescreening, language assistance, and other support services to people who may be eligible for CalFresh. The program last year prescreened approximately 1,400,000 individuals for CalFresh eligibility and yielded an estimated $1,300,000,000 in CalFresh benefits. The cost as a state to sustain this program will be $14,000,000 Second, we believe that the state should bolster the emergency food system by providing food banks with additional funding through the CalFood program, which allows food banks to purchase California grown and produced foods. As people fall off CalFresh, they will need help immediately, and our food banks consistently rank additional CalFood dollars as the number one resource they need to serve more people. Third, the state should make investments to increase our resilience for the future by starting the process of creating the California Anti Hunger Response and Employment Training Program, the CARET program.
This would create state funded CalFresh equivalent benefits for Californians subject to the new time limits. Equally as important, we urge the legislature to support the efforts led by Nourish California and the California Immigrant Policy Center to fund CalFresh equivalent benefits to the 72,000 humanitarian immigrants who will be cut off from the program this year. We believe a combination of all of these strategies is necessary to address the hunger crisis that our state currently faces. We look forward to partnering with the legislature this year to protect and strengthen the state's nutrition safety net. Thank you for your commitment to ensuring that all Californians have food on their tables.
Speaker 2
Thank you very much. Appreciate it. That concludes the testimony from our panel, and we I have, those, of my colleagues that have questions or comments. Senator Gabaldon, Senator Menjivar, are there others? Senator Richardson and Smallwood Cuevas and Archuleta.
Senator Cabalda.
Speaker 3
Thank you so much, Mr. Chair, and a big thank you to the panel both for highlighting the very human impacts and just the scope and the severity, and also moments of hope about what we can do. And also thanks to the administration, both departments are exceptionally well led, and the strategies that are being undertaken I think are very encouraging. I'm struggling a little bit into this, the last panel, about if the governor's already scoring essentially the full amount. Mean, if one page of the budget says we're going to completely fail at rescuing anybody from losing their eligibility due to red tape and this procedural nagging.
And then the other page says, and these two departments are doing everything that they can, and they've got 17 initiatives, and here's how they're going to work, here's how they're committed. So I'm hoping you'll be able to reconcile that because it seems like the incentives may not be set up properly here, and so I'm trying to understand how you're considering your obligations within the administration to do both things, not widen the deficit but also, achieve what we've all agreed and know the governor agrees to, is that nobody should be kicked off of these systems for these procedural reasons. So I'm hoping to get there as well. A core about what you've described, which I think is very important to emphasize because in the 1970s or '80s, if you went and you applied for any of these programs application was already pre filled out with your hours worked and your wages and your time volunteering for Habitat for Humanity and all these other things, you would have freaked out. Like how did Yolo County get this information?
I barely even know this about myself. This is awful. Because our privacy regime was very different, and that was a radical change. And many of the policies that we put in place, for all the right reasons were to make sure that stuff like that would not happen. So our data sharing protocols are far more restrictive than almost any California would recognize.
There are 27 companies that know my exact location, but my college and my high school can't talk to each other about what was effective or not effective at me learning geometry. So we have much tighter controls around data sharing and the use of data and the persistence of data that is in the public sector with all the public sector accountability than we do in the private markets. And so it comes to a fore because your two agencies and others, with substantial funding and support from the legislature, have made investments in things like automatic determination, which is an automated decision system as well. That's absolutely critical that we're using the data and the resources that we have to automatically say yes. No essay is required for Medi Cal.
For the vast majority of applicants, you need an interview to exercise discretion about eligibility because it's just the facts. It's a few data things and some verifications. Unless you're the one trying to get them and figure out, well, do I fill out that information? How do I validate that? But we have so many of those facts, or they're easily within our reach.
And so I'm very encouraged by the progress on the automated determinations. Even the fact, I think, that one of you mentioned that I think 77% of them, essentially said, would they fall off coverage even after that process. But that, in some sense, is a validation that that system is largely accurate. It can't be 100% accurate, especially on exemptions. It cannot be 100% accurate because human beings have different circumstances that the data cannot capture under the best of circumstances.
But it is increasing in its accuracy and its scope. And the most that we can use that, the better. And I think five or six years ago, we would have said, well, we need more navigators for that sort of work. And that has always felt to me like we need more financial aid officers. No, what we needed was a shorter financial aid form.
We should make an HR block available at every corner. No, we need an easy form. Sometimes the answer is to not require all that intervention and not have to get an appointment at your local clinic with a navigator next Thursday in order to make the process a little simpler. So system I'm a huge fan of. I think we need to do this much more generally to protect people, and then also to make sure folks are getting the benefits they need to use these automated systems and the data that we collectively, the state of California and our local partners, have in order to say yes more frequently, even before the question has been asked in some circumstances.
Some of the concerns I've heard about that often are, well, but what about the human beings doing the eligibility determinations? Will we see massive job losses? And obviously, that's not the case. We haven't seen that happen in this case. And then as Mr.
Marck has noted, even with these systems and their growing effectiveness, there are so many human cases. And HR1 just makes it worse or better with all of these other discretionary things that have to be reviewed and understood at the human level. And so even with more automated decisions, we also need additional eligibility workers to do something that only human beings, not AI and not a spreadsheet, can do. And this is a perfect example of that situation. So I'm encouraged.
I'm going to be watching really closely. I am introducing legislation today. I've been collaborating with our leaders on this work, the chair of the labor committee and the chair of the budget subcommittee that covers this, but really to try to bring to strengthen the system with respect to the hours worked part of the data system so that that gap that HR1 creates in terms of what we can use to have individual clients not have to go track down these numbers and keep track of them, potentially get them wrong, that we'll be able to do that. Unfortunately, we don't have anything on the community service side. We heard earlier that, you know, there's a lot of nonprofits around the state just waiting for folks to come volunteer.
I'm not sure how that's going to work. When I go to Habitat for Humanity, we're working on a house in Dixon. And you say, hey, what are you here for? Well, I'm here with my daughter. She really wants to become a carpenter and this lake is a good exposure.
Okay, what are you here for? Well, got a habitat house when I was younger and I want to pay it back. What about you? Well, this lot's been vacant in my neighborhood for so long. What about you?
Oh, well, need my immunotherapy treatment, and my next redetermination is coming in a couple months, and I didn't get enough hours of work. And so I'm here building this house because I have to show hours for Medi Cal. That's Haptive Humanity doesn't want that. None of us want people to be volunteering for community organizations and nonprofits solely in order to meet some HR1 nagging requirement that they have to show six more hours of work or volunteer experience. That's not no one wants that.
And we don't have a system to track that, neither do the nonprofits. And we're not going to. So I think this was raised earlier as what a great boon this is for non profits. It's quite the opposite, and extremely cynical to think that if I've got to show up pregnant at a home built site for Habitat for Humanity so we don't get an error rate determination that the county thought I was pregnant three months ago, they haven't revalidated that I'm still pregnant, and so I'm showing up with a hammer and climbing ladders. So that's all the statements I want to read, but if I could return to the beginning of my comments and just ask that question about how to reconcile the budget's assumption that everybody will lose coverage as a result of these changes, and your department's commitment to work with us and counties and the communities in order to assure that we prevent that harm to as many of the Medi Cal clients in California as possible?
Speaker 25
So, maybe I'll start. So, as part of the governor's budget, we estimate that when in full implementation, 1,400,000 members will lose coverage as a result of the work requirements. And we came to that number starting with the 4,600,000 who, must meet the work requirements, the kind of the optional ACA optional expansion group or the new adult group. And then we've gone through and kind of based on the kind of automated ways we think we can detect if they met the work requirement or exempt from the work requirement and came down to the 1.4 number. As we continue to refine how to do those exemptions, particularly in the medically frail, area, those numbers will ideally get smaller.
So, the 1.4 will get smaller as we continue to think about all the data points that we can use to match. And we have detailed charts that are available on our website and as part of our, public presentations in terms of where we started, how we are automatically exempting, and you can see the numbers go down based on the different criteria or exemption, exemption category. And so that's how we're thinking about it, and we are hoping and driving to getting that 1,400,000,000.0 even lower so that we can really maintain coverage for more Californians.
Speaker 3
But then, can I quickly follow-up? So, but then, will you get a call from our friends from the first panel at financing? What are you doing? We have $275,000,000 in this budget that we were counting on that savings for. Could you slow that down?
How are that's the tension I'm trying to explore
Speaker 25
I mean, we're very clear with where we're going, and you can I mean, in all of our budget documents in terms of we have TBD for some of these because we have not yet finalized the medical frailty? The medical frailty criteria, I think, is going to be one of the bigger areas where we think we will be able to more, accept more individuals. And so that is, we've been very transparent in terms of these numbers, and in the conversations with our administrative partners.
Speaker 27
If I could just add, I would say, similarly for CDSS, we did also start with a larger universe and then identified those where we have the data to exempt them out of the gate, and so they're already not included. And the 665,000 who we are estimating may fall off are the ones who have to be screened separately for the exemption in the first place. We, too, are continuing to work on refining those estimates, and if there are any updates, we'd be including them in the May revision. We're looking at what has worked in other states, the strategies we've talked about to try to figure out what we think the success rate will be. The additional thing that I would add is that our program is an entitlement program, and it is caseload based in the budget.
And so, to the extent that more individuals do wind up being eligible, they will receive their benefits, and counties will receive additional administrative funding corresponding to how the caseload ultimately comes out. So if we you know, it is always the case that our estimates are not exact because it's an estimate and it's the best we can come up with. To the extent that our estimates are off, it is possible for us to receive that additional funding through the entitlement provisions and the mechanisms in the budget that allow that to be added.
Speaker 2
Thank you, Senator Cabaldin. Next is Senator Meenjivar. After that, Senator Rich.
Speaker 17
Thank you, Mr. Vice Chair. Try to squeeze in a couple questions here. And, sir, I can't remember your name, but my first question is to you. You talked about all the automated the the phase in and so forth.
I'm wondering what demographic or population, I'm sorry if I missed that, is not going to be eligible to be captured under the automated process.
Speaker 26
Thank you, Senator. So, at this point, we are seeking to apply all of the automated, methods to either exempt people based on federal exemption criteria or determine that they satisfy the federal requirement using administrative data for everybody who is subject to it. So the Affordable Care Act of adult expansion population, it's you know, 4,600,000 of our 14,000,000 members fall in that category, and we're working sort of vigorously to use that ex parte process for as many as we can. So there's no specific sort of
Speaker 17
There's no job sector that would preclude them from being automated. So
Speaker 26
there are you know, our ability to perform those ex parte determinations depends on the data being available in different data sources. So for one example, based on the type of job they have, we're working to partner with a vendor that has data on gig economy because that may not be captured in IRS or EDD or Equifax. And so those are the types of steps that we're taking to be comprehensive and make sure we can cast the widest net possible, including acquiring new data sources for that purpose, such as gig economy data.
Speaker 17
Okay. And would you have to do the verification twice if you're both on CalFresh and Medi Cal? Is it one time?
Speaker 26
So our goal is to be able to sort of do that one time and perform exemptions that sort of serve as a determination for the other programs. That's the strategy that we're driving towards.
Speaker 17
Perfect. Thank you. Doctor. Bass, you quickly talked about the $4,000,000 that I asked about. Is that going dollars straight to counties to distribute, or an RFP for people to apply?
Speaker 25
Doctor. We're using the model it's for clinic navigators. And these dollars are federal dollars and dollars from health care or health plan foundations. And so, reimbursement dollars and going to the clinics will establish a grant program for these dollars.
Speaker 17
Okay. So, clinics to help with the Medi Cal verification? Correct. So but not a lot of with the CalFresh? No funding for CalFresh assistance on that?
Speaker 31
So we have an existing CalFresh outreach network, but they were impacted by reduction in administrative funding that applies generally to SNAP. And so, starting 10/01/2026, those partners in our network, over 160 of them statewide, will receive 25% reimbursement instead of 50% reimbursement for their costs. Okay, great. And
Speaker 17
back to you, Director. My example was the seniors, but if they're not going to the clinics, they're not going to get that additional help? It's only those who go to clinics that are going
Speaker 25
to get additional navigation services? This this particular grant program is through the clinics. Yes.
Speaker 17
Okay. When we rolled out CountAim, we struggled in getting ahold of a lot of people. I know some of the campaign awareness, like, we're gonna call members. But with CountAim, we saw that numbers were incorrect. We couldn't get ahold of people.
Are we gonna encounter that same barrier as we're doing outreach with members now? Or because of CalAIM, have updated numbers of members that we can
Speaker 25
do outreach with? So through the, public health emergency unwinding campaign and effort, we did a lot of address corrections through that process because, you know, members hadn't been outreached by to do the redetermination for years during COVID. And so, there was a significant effort, related to updating addresses, you know, return envelopes, you know, the kind of the engagement to correct those addresses and information, working with the managed care plans who had more recent information and syncing up those address records. And so, I think over the last years, as a result of that outreach, because of the public health unwinding, our address records are better, not perfect, continuing need to do that. We are also using text messaging in a different way than I think we have previously.
Really, we just started in early February to do that initial outreach to the 4,600,000 who may be impacted by work requirements, so trying to think about what are other modes of engagement for our members.
Speaker 17
Okay. Did you want to add anything to that? Deputy Director? Okay. Okay.
And then can I get a little bit more information in the report that you've put out on the phasing? You talked about DHCS will implement optional short term hardship exemptions. What are the short term hardship exemptions?
Speaker 25
Sure. So there are a few. I would say one of the most in particular is related to high unemployment rate. 22 counties will qualify for that, and we have it outlined in the document of which those counties are. Alpine, Calusa, Fresno, Glen, Imperial, Kern, Kings, Madera, Merced, Sutter, and Tulare Counties could qualify for this exemption.
That's about 16% of the Medi Cal population who could qualify for this temporary exemption.
Speaker 17
We don't have to ask them for worker requirements? That's right. And it's short term. How long can we get that exemption for?
Speaker 26
So, we're waiting to sort of receive guidance from CMS about how to apply that. Generally, our default assumption is it would be for the look back period. So, for people who are subject to work requirements because of HR1, they're now also subject to six month redeterminations. And so the goal would be to see at any point in the prior six months if they resided in one of the counties that meets this unemployment rate threshold, we would be able to exempt them.
Speaker 17
Okay. Thank you. I'd like to switch over to the individuals with developmental disability. A lot of them are exempt from the worker requirements. But I think there's correct me if I'm wrong here, director a little over 13,000 in the expansion population are the same streamlining approach that we're doing for everything else going to apply for automating this population as well?
Yes. So we will
Speaker 25
be using data feeds from the Department of Developmental Services and data that we already have for those individuals and would be exempting them from the work requirement.
Speaker 31
That's right. So to the extent that data is available, we would be able to access that under some of the shared work that we're doing. And then if the data weren't available, we have a category of exemptions that a worker can determine based on that screening.
Speaker 31
it could be a temporary, maybe one that is not on record. And through that screening, the worker can collect that information, document it, and approve the exemption.
Speaker 31
Right. Process as We'll kind of try every way that we possibly can, try to exempt as many people automatically, and then, as a second effort, move to that individual exemption screening with a worker.
Speaker 27
add on your prior question, Senator, as well. There are still some waivers available for the ABOD requirements as well in individual counties that experience high levels of unemployment. So, we do have three counties that had a waiver, and I think I just heard maybe that four additional were approved yesterday. They are smaller counties, but nonetheless, every time a county does qualify for that threshold, we will apply and get a waiver as much as possible. There are also some short term good cause determinations that can be made to allow for, the application of good cause on a short term basis if someone is attempting to meet the work requirements and experiences a temporary challenge that counties can apply.
Speaker 17
Kinda to senator last question, mister Reischer. Kinda to senator Cabotto's question. If we're getting some exemptions and we're continuing to add to that list, that's gonna be a very volatile savings. So how are we gonna account this is a question for department of finance. How are we then gonna account the we have five counties that are eligible, and we're gonna be getting that federal funding coming in.
In three months, we're not. The next three months, we are. That seems very volatile. How do we keep up in tracking
Speaker 25
what we're saving? These are estimates just like everything we put forward. You know, we do the best we can with kind of the data we have, the assumptions we make. We're transparent about our assumptions that we're making. And then, you know, at governor's budget, it may revision, revise based on updated data or updated assumptions.
So I would I would liken it to basically any budget proposal where this is the information we have today. This is based on x, y, and z. Yeah. And then over time, that may change.
Speaker 17
But just seems like every year potentially will Correct. The middle of the budget year as we pat. Okay. Okay. Thank you.
Speaker 28
Senator, if I may, I just wanted the opportunity to respond to Director Troia's response to Senator Cabaldon, just for the public record, even though he's no longer here. And because it goes to your questions about savings, to be fair, counties and the administration still are reconciling a disagreement about the cost of workload associated with HR1 implementation. So, the rebase effort that was very successful, in our opinion, in funding the administrative component of CalFresh that happened a few years ago. That's essentially the methodology that's being relied upon, to fund the retroactive entitlement process that Director Troia just described. The difference that we're trying to spotlight is, we actually think that the administration's assumptions, that it would only take maybe an hour and twenty minutes for every newly impacted ABOD client to do the full screening and the compliance.
We disagree. We think it takes closer to four hours. And so, to be clear, that entitlement retroactive funding process that Director Troy had just described, we do not believe would result in commensurate reimbursement of the administrative costs associated with implementing a full harm reduction approach. What it would result in is a continued ongoing delta between what we say the program costs in term according to the, outdated methodology at this point, doesn't reflect the HR one changes, and what we're actually spending. So there would be a gap in expenditures.
I just really want to be clear about that because I assume that, you know, we would have a gap and that we would be bringing that discrepancy to the legislature in future years. Thanks, Carlos. Mr.
Speaker 2
Vice Chair. Thank you. Next is, Senator Richmond, followed by Senator Smolut Cuevas.
Speaker 18
For the sake of time, I'd like to ask for the record, if we could have the presenters to share with us a copy of your notes. It amazes me here at this level that we don't get a copy of the notes of presenters. That's something I think I'm going have to bring to rules or whatever. It just really doesn't make any sense. So, if you could if you're willing, I guess it's a request if you would submit a copy of your notes to the committee.
If not, right this moment, you know, in short order would be great. And then, the second thing I'd like to request, to the degree that you could give us specific details, whether you've heard people ask questions, whether it's demographics, statistics, whatever. We're all in the business of, you know, hopefully you've gotten it that I think we concur with much of what you've said, and we have the ability to say that. But what makes a difference is when we can give specific numbers of people that, have been impacted. So, to the degree that you could share some of that in your notes would be really helpful.
How many people you help? How many are impacted? What are the groups? Why is it these certain groups? And what are they also missing that why it makes these cuts so detrimental?
Giving us that kind of data really helps us to advocate on your behalf. Thank you.
Speaker 21
Doctor. Yeah, thank you so much for the presentation, and I agree with having something in writing that helps us be able to track and follow and continue the conversations based on the really rich presentations that were made today. And I agree with one of the speakers who talked about this sort of crossroads that we're at in terms of, you know, the state not being able to backfill the funds and neither can poor working communities of color be able to fill this gap. So the question is who and where does the gap get filled by? And that brought me to a question that I had for Mr.
Bass, who really eloquently talked about the impacts on communities of color, and particularly this sort of overinvestment in the wealthy and the disinvestment in poor communities of color due to H. One. Do we have a sense of how many workers work full time in the state of California and rely on our public health care systems like Medi Cal?
Speaker 30
might not be aware of the data available as it relates to how many full time workers we have in states. I believe, we have 14 or 15,000,000 individuals enrolled in Medi Cal right now out of, the the workforce. But but would also just say, you know, and and just to to underscore, I mean, this was the biggest transfer of generational wealth we have seen in in a in a long time. You know, what HR one does to, source the Department of Homeland Security to also give tax breaks to the richest Americans and rich corporations hoards money that should be going to the communities that need it the most. Yes.
Speaker 21
And and I agree with with that. I guess my question is I I wanna get some specificity on the number of working people who are working full time, but yet are relying on the taxpayer, payers, to provide their health care. I think it's important for us to be able to really understand and get real specificity in terms of, you know, who are these wealthy corporations, who are these wealthy 1% folks who are benefiting from H. R. One, but yet are sending their workers to us.
So that's something I want to follow-up on, and hopefully we can get some more data on that. The other next question I'm going move on for the sake of time, but this is the point that we need more details on. The other question I wanted to raise has to do with the automation question, and this is because of the work that I've done working with unemployed workers for for many years and helping them access health benefits. And one thing I wanna say, when you are a low wage working family, your cell phone might be on today. It might be off tomorrow.
When you're a working family, your address may be a certain address, but then at the end of the month, you're evicted and you're in a new address. I wanna say when you are, in need of communicating you through automation, there are a lot of gaps and breaks in the system for for working class folks, particularly those who on who are on Medi Cal and systems navigators, warm handoffs, folks who are in continual relationship, community based organizations that are in continual, meaning, like, at the bus stop where these workers might be to get to whatever job they're trying to do to help their family stay afloat, have regular contact with them. I think we need to really look closely at this question of automation. It seems that this automation is not going to obviously solve the structural problems. But do you anticipate many beneficiaries will still need to verify compliance?
And how much of the verification process will automation address? Because I'm a little unclear about how automation is going to play a role, particularly with these vulnerable, very precarious populations.
Speaker 25
So, we estimate so, in terms of the Medi Cal work requirements, 4,600,000 Medi Cal members are subject to these work requirements. We would exempt individuals based on the data we have, and then we would also exempt individuals based on the data that we have who meet the requirements. So, maybe eighty hours of work, for example, or $580 per month. And so, with that, then we get down to about 2,800,000, who, do not meet the work requirement or are not automatically exempted. And from there, this is where, you know, this kind of the paperwork having to go into the the county office or having to really demonstrate their ability to meet the requirements or be exempt.
About 50% of that will, you know, not be, become disenrolled. So, taking us to about 1,400,000 disenrolled because of either not meeting the requirement, not being exempt, or not being able to provide verification that they met those requirements. I will also just note, to your point about community engagement, I think that is what we're leveraging our coverage ambassadors for. This is 6,000, individuals who are part of community based organizations who are at the bus stops, who are in the community, and we are empowering them with tools and information to really kind of educate our members about these upcoming requirements. We are also working closely with our Medi Cal managed care plans and our providers.
So, they are also educated in this space so that when a person goes to the clinic or goes to the next doctor's visit, they know, oh, your next redetermination is on this date. Don't forget. So, really trying to empower all the touches that our members have with the general health care delivery system so that they can take action and are made aware of these changes through multiple channels.
Speaker 21
Yeah, I appreciate that. And I think given the scale of the problem, the existing navigating team is probably insufficient for the task at hand of making sure that we have a way of capturing these millions or over a million folks who are gonna need need care, which, obviously, more costs and investment is needed there. My my final question has to do with the employment unemployment exemption. And I heard the counties that were listed, many of these are rural counties, and glad to hear that there's some protection. Although being unemployed should not be a benefit for you getting your health care.
But it's unfortunate that that's where we're at. But I do wanna point out that there are over 400,000 black women in my district. And based on unemployment statistics, is the fastest growing of unemployed workers in the country. Their unemployment rate has jumped from 3% to 7.3% in the last year and a half. And as we're thinking about how we're finding those populations of individuals who should be exempt based on unemployment, I don't think the county is where it needs to stop.
I think we need to go a little deeper into disproportionately unemployed populations that also are vulnerable to needing to be on Medi Cal and other public subsidies. Black women are primary breadwinners. We don't have a lot of household income. It's usually mom and kids. And so when we see a tripling of their unemployment data, you damn bell.
They're best assured it's going to impact the family level and the community level. So I think we need to look at other ways to calculate unemployment here, and we need to look at those populations that have chronic and disproportionate escalating unemployment now. And I will say, you you could say, well, these are just black women, but one thing I know about black unemployment, it is the canary in the mind. When black unemployment begins to rise, it is coming for everyone else. So if black women are at 7.3%, white women, white men will be seeing very high numbers in the coming year.
It usually is about an eighteen month, twenty four month lag in these unemployment numbers. So, we need to figure out a program and a way and a strategy to address this, particularly because if this is any indication and if past trends hold, we will have to be looking at ways to deal with unemployment in other populations to ensure they have access to benefits.
Speaker 16
Thank you, mister chair. I appreciate the, the time, and I certainly appreciate the panel. As we said to the first panel, don't kill the messengers. And, obviously, you know, perhaps you felt that you're, scrutinized, But, no, we appreciate what you've done. The research and the data you've given us because we're able to share with you about our districts, our communities, and so on, and our concerns.
Of course, HR one is, as I've mentioned, it's a devastating impact on California. And, as I said, we're talking trillions like it's millions, but, it is devastating to the state. And everyone who is looking to the state of California for a sense of security, fear not. We are going to do what we can and I know that each and every one of you that represent your agencies are gonna step up, whether it's the food banks, whether it's working with the governor's office, and I know you're gonna step up. And automation is obviously part of the future to go ahead and get to people as quickly as possible, run them through the system so they can be eligible as quickly as possible.
So I wanna say thank you. And I also want to, put it out there that one of the things that I'm really concerned about is that we, emphasize how important CalFresh is to the millions of people that that are there and and and to the children and those that are trying to get an education. And we don't realize that a lot of our students in college are CalFresh recipients. And, on weekends, they will find a food bank nearby. No doubt.
So we're all in this together. So we're gonna go ahead and and deal with HR one the best we can. And I think the message we wanna give is that we will continue to be California and we will continue to have a soft heart, for those who need help. And I wanna thank you for being here today. Mister chair, thank you.
Speaker 2
Thank you. Excuse me. Thank you very much. One question for Mr. Wright with regard to food benefits, but specifically food banks.
They are supported significantly,
Speaker 2
think, by private donations. And it would seem to me that to double down on that fundraising effort in the face of might be declining government benefits in the same area, I would suspect they would probably get a pretty good response from that. So just a suggestion.
Speaker 14
Yes, we will do all we can to raise as many funds as we can from every source, you know, as we face an unprecedented increase in need. So, yes, absolutely. I will say about 20% of our funding comes from TFAP, and that's where we've lost $100,000,000 last year. 8% of our funding comes from Cal Foods, so if we lose that so it is a significant portion of our, funds do come from public dollars as well, but absolutely, we will be doing all we can from all sources, and I know a lot of communities will step up as best as they can in response.
Speaker 2
And Senator Smallwood Quavis left, but I was heartened by, heartened might not be the right word to use because she was talking about serious unemployment challenges, but I'll refer back to comments that I made before relative to our economy. Even though we're the fourth, fifth largest economy in the world, we are not a strong employment economy. And many people believe, maybe not everybody here, but many people believe that that is not insignificantly due to state policies relative to the encouragement, or lack thereof, of hiring employees. Now, we're at the end of all of our presentations. Thank you all very much to both panels.
And at this point, we will take public comment.
Speaker 18
Mr. Vice Chairman, I just wanted to let the public know this meeting was originally scheduled two hours. We're now almost at four. You probably know that better than we are. So unfortunately, some of us had multiple meetings backing up.
But I just want you to know I have staff that's present taking down the comments of of what you're sharing because I don't want you to feel, you know, you're not being heard. Thank you very much.
Speaker 2
And that is a very good comment. When we have, long meetings like this, we end up with not a full committee behind the dais as there's public comment, but I will be here and others that can stay. But staff is watching this to make sure that we receive the important points. So, proceed.
Speaker 33
Thank you. I appreciate, those comments. Thank you. Tom Renfrey with the California Association of Alcohol and Drug Program executives. For people with substance use disorders and people cycling through jails and reentry, Medi Cal is the difference between staying in treatment and falling through the cracks.
HR one puts that continuity at risk. New work reporting requirements and more frequent renewals create real barriers for people in recovery, especially those who are unstably housed in residential treatment, recently released from custody or trying to stabilize their lives. Even when people qualify for exemptions, they can still lose coverage because they miss a notice, can't verify paperwork in time, or don't have reliable access to phones or mail. We are urging the legislature to act by first protecting continuity of care by requiring automatic exemptions and continuous eligibility for people in substance use disorder treatment and during reentry, so that no one loses Medi Cal mid episode of care. Second, fund automation and navigators so people can stay covered without navigating complex paperwork while in treatment or custody.
And third, set clear guardrails and oversight on implementation so that burying people in paperwork does not become a backdoor coverage cut for the highest risk populations. Thank you for receiving our comments.
Speaker 2
Thank you. And one clarification for everybody here. If you can keep your comments to less than a minute, I can see, based upon the number of people that we have here, the last people, may have places that they need to go and might not have their opportunity for the public comments. So, brevity is valued, but your message is important, too.
Speaker 34
I will do my best. Good afternoon. Christine Smith with Health Access California. We do appreciate members making such clear connections to the Trump administration's cuts, the uniquely devastating health health impacts ahead, and the need for revenue. We do urge the legislature to push back on the harmful cuts and support the 200,000 lawfully present immigrants who are being kicked out of Full Scope Medi Cal.
These are refugees, asylees, trafficking, and domestic violence survivors, among other groups who are here lawfully and for decades have had access to Full Scope coverage. We also urge the legislature to consider long term sustainable revenue solutions that will hold employers responsible for employees on Medi Cal. Thank you.
Speaker 35
Good morning, members. My name is Marshawn Tappan, associate director of policy and advocacy at the San Francisco Moran Food Bank. I just wanna start off just talking about some of the cuts with HR one from the SNAP Ed cuts to the standard utility allowance cuts to the able body rules to the waiver not being renewed, to changes in ABO. California is doing a lot, and we understand that. And we know you guys can't backfill everything, but we need California to do as much as possible during this administration because the more people with less benefits, the more people struggle with food insecurity.
So I just wanna keep that out there and and actually put a face to the statistics because people are out there struggling who look just like us. So I just want to say that. So please support restoring the cuts at HR one. Thank you.
Speaker 36
Good afternoon. I'm Keeley O'Brien with the Western Center on Law and Poverty. As we know, H. One prioritized tax breaks for the ultra wealthy over the health and well-being of our communities. But we cannot ask millions of Californians to sacrifice their health care and food benefits in order to backfill the budgets of billionaires just so they can hoard more of the wealth that we built together in offshore accounts.
We urge this legislature to confront this harm head on by requiring the wealthy and corporations to pay their fair share and directing that funding to the people HR1 seeks to abandon by funding CARET benefits, CFAP expansion, and the other solutions outlined by my colleague today. As Senator Ray has said, our budget represents our values. Let's prove that California values actually mean something. Thank you.
Speaker 37
Mr. Chair and members, Greg Herner, on behalf of two eleven San Diego, we're here in support of with the California Association of Food Banks for the $14,000,000 for outreach funds. I think it bears repeating that this brings in $1,300,000,000 in federal dollars and has $1,000,000,000 of downstream impacts on our communities, in addition to all of the other impacts you hear if we don't make sure that we can provide the services needed to help people navigate to stay on these types of benefits for nutrition. Thank you.
Speaker 38
Good afternoon. Yasmeen Pellebo with Justice in Aging. As the state grapples with the budget deficit caused by HR1 and generally the volatile nature of our state budget, it's incumbent on this legislature to secure new and sustainable funding to support our safety net programs. The policies in HR1 will have trickle down effects on the entire Medi Cal program and state budget. Often in times of budget deficits, the state looks at cutting Medi Cal optional benefits, like adult dental and home and community based services, like in home supportive services and adult day health care.
And while these are optional under federal law, they're not optional for the people that rely on these programs to stay home and stay healthy. California's HCBS system supports over a million Californians. Cutting these critical programs either now or in the future is not only shortsighted, but will ultimately cost the state more in the long term. We urge the legislature to take bold action to secure new revenue, because the alternative solution is balancing the state budget on those that are already struggling the most. Older adults have the highest senior poverty rate of any age group in the state, and older adults are the fastest growing group of people experiencing homelessness in the state as well.
Thank you.
Speaker 2
Thank you very much. Again, please be mindful how many people are behind you.
Speaker 39
Sure. Thank you. Darby Kernan, on behalf of in child poverty in California. These federal cuts are decimating our communities. We are losing California's critical investments in our on the ground response system of Cradle to Career.
California has invested millions of dollars in these programs, and those funds have ended. Our federal dollars have been wiped out. And these programs are in our communities, helping keep people out of homelessness and poverty. And they can be the on the ground response system we need to keep people in Medi Cal and CalFresh. Thank you.
Speaker 40
Afternoon, Mr. Chair, members. Dylan Elliott here on behalf of the County Medical Services Program, CMSP. In the 35 rural counties served by CMSP, over 124,000 Medi Cal beneficiaries could lose their health care coverage. I want to be clear that, the CMSP program and its participating counties are in no position to assume the ongoing financial responsibility for health care needs of these newly uninsured individuals in the absence of significant state investment resources to support the cost.
Appreciate the committee holding this hearing and look forward to ongoing discussions. Thank you. Mr.
Speaker 41
David Campos, on behalf of the County of Santa Clara, we run the second largest public hospital system in the state, and we are not here simply to say fix our problems, without we doing what we can. We actually for the first county to pass a ballot measure, measure a, that brings in 330,000,000. Just yesterday, our Board of Supervisors cut 200,000,000 in our hospital system, but we are still dealing with a billion dollar deficit that is coming up because of HR1. Counties are the lifeline for so many of the poor people and the working people of this state. We need your help.
We cannot do this on our own. We need you to protect Medi Cal enrollment, to provide funding for public hospitals, and to deal with indigent care, because these people are coming to the public hospitals, those 3,000,000 that we were talking about. Thank you.
Speaker 19
-Yesenia Robancho with End Child Poverty California. We urge you to beat back federal cuts with courage, and urge you not to mirror federal racist and ableist policies at the state level. California must act so millions of families don't go hungry and die on our streets for not having access to food and health care assistance. We also urge you to adequately support county eligibility workers as they are lifelines to our families as workers are forced to implement these cruel changes. On state medical work requirements, how many more of our abuelos and mothers will have to die before we stop these cruel cuts to immigrants on medical?
And we urge you to raise progressive revenues so no child must go hungry in our state, so none of our abuelos die on the street, So, families aren't forced to live in our streets, in the fourth largest economy in the world. Thank you.
Speaker 42
Mr. Chair and members, Tim Madden representing the California Chapter of the American College of Emergency Physicians. And as you've heard from nearly every panelist, as well as a number of members, the impact on emergency departments is going to be significant as a result of H. R. One.
Thank you, Senator. I'll make it even shorter. We've in recent budgets, it's included solutions to help emergency physicians buttress the emergency department. We would ask the committee to consider those again moving forward. Thank you.
Speaker 31
Thank you very much. Vanessa Kahina on behalf of the California Academy of Family Physicians asking the state to do what it can to alleviate the worst of the worst parts of H. R. One that are going to eviscerate our primary care safety net. We also need to keep health care for immigrants, regardless of how they got here.
Really appreciate you holding this hearing and look forward to working with you on solutions.
Speaker 43
Afternoon. Dan Oakenfuss with the California Foundation for Independent Living Centers, and I appreciate your time today. I am here to speak on a couple issues that are very important to people with disabilities that are served by our independent living centers. We have 24 centers across the state staffed by a lot of social workers who are referring people with disabilities to various services like IHSS, and the cuts to the governor's budget, especially to IHSS, is going to really affect a lot of the ability for our consumers to live independently at home, and we just want to warn everybody about those consequences. Thank you so much.
Speaker 11
Thank you so much. Good afternoon, chair and members. Parshan with you Aspire. Here to echo what many folks have already said, but also talking about some opportunities. I know it's tough right now, but we have an opportunity in the state in supporting our students' access to CalFresh.
On average, we have only one out of every four students getting CalFresh, who should be getting those CalFresh dollars, and we are leaving $3,000,000,000 on the table every year. So, if we can focus more and support that infrastructure within the higher education system, which we have many folks this week with Chetna Summit coming out there to talk about just that, we can actually tackle that and get a lot of those fundings untapped California. These are taxpayer dollars that should be coming back to our state. In addition, we'd like to just elevate that we are fully in support of the Cal Foods budget ask for 60,000,000 ongoing and 50,000,000 one time, and we appreciate your time.
Speaker 44
Ms. Hi, chair and members. My name is Bess Smoker with the California Food and Farming Network. Hunger is being exasperated by H. R.
One, and it ripples across our entire food system. Many workers who grow, harvest, process and sell our food, especially farmworkers, are themselves food insecure. The impacts of HR1 are also not happening in isolation, with ICE rates catalyzing impacts. We know that in addition to CalFresh benefits being cut, even those who are still eligible are often fearful of receiving benefits for fear it can impact their citizenship or safety. When CalFresh participation declines, the harm also extends beyond households.
Farmers, particularly small and mid scale producers, lose critical income. Programs like the California Nutrition Incentive Program, or CNIP, allow Calfresh users to double their dollars, and those dollars flow directly into local economies. Considering these compounding impacts, we ask the legislature to honor the commitment to expand eligibility for CFAP, create state funded nutrition benefits for California's cut off from CalFresh due to the punitive time limits we heard about today, sustain and increase CalFood and the California Nutrition Incentive Program, and lastly, we encourage the legislature to identify alternative revenue streams due to these historic cuts. Cuts.
Speaker 45
Thank you, Mr. Vice Chair and members. Brendan McCarthy with the California State Association of Counties. I appreciate the robust discussion about folks losing the Medi Cal coverage and impacts to county indigent care programs. I do want to note that county indigent care programs are not comprehensive health care insurance.
Are not a substitute for Medi Cal. We have noted, collectively, the cost of 6,000,000,000 to $9,500,000,000 per year from H. R. One to counties, indigent care being a very important part of that. But the realignment funds that formerly supported those programs were redirected by the state to other purposes, so counties no longer have resources to rebuild those programs.
My colleagues from the public hospitals will talk about the unique impact of public hospitals for HR1. My colleague from CWGA talked about the county admin impacts. But it is important to note, this is not an exhaustive list of impacts. There can be other impacts we're still exploring, for example, in behavioral health or county public health programs that we're still digging into. Obviously, counties don't have the resources to address these alone, and so we look forward to the partnership with the legislature on this.
There are a couple issues I also want to very briefly touch on that were covered in the committee's prior hearing, overview of the budget. Counties opposed the shift of IHHS costs to the counties, given the shortfall in realignment funds the counties currently have. While we're happy with the $500,000,000 for HAP funding in the governor's budget, we continue to advocate for the full $1,000,000,000 that is provided in prior years. We are deeply concerned about the Governor's proposal to make Medi Cal mobile services a county funded optional benefit. That would shift tens of millions of dollars of cost to the counties.
And then, finally, we continue to advocate for full funding for Prop 36 to implement that measure. Thank you very much.
Speaker 24
of the committee. Katie Rodriguez with the California Association of Public Hospitals and Health Systems. We represent the 17 public hospitals across California who serve 3,700,000 patients annually. And really glad you're having a hearing here on enrollment eligibility. It's incredibly important we keep as many people enrolled as possible.
And, you know, up to 2,000,000 could lose coverage from HR1. And so, we're cognizant they're not going to not need access to care. They're going to show up in our emergency rooms. And we are facing a $3,400,000,000 annual cut just from HR1 alone. So, would ask, in addition to looking at keeping people enrolled, that you look to support public hospitals, safety net systems, and counties in terms of implementation and navigating the cuts from HR1.
Thank you.
Speaker 46
Kelly Brooks, here on behalf of the urban counties of California and the counties of Ventura, Riverside, Santa Cruz, Calusa, and Alpine. Counties are concerned about how the coverage losses and access to food that you discussed this morning will exacerbate existing health disparities and economic disparities. We are urging the legislature to provide support to counties in three areas. One is to ensure Californians retain their Medi Cal and CalFresh eligibility through county workers. Second, to support restarting county indigent programs.
And third, to support public hospitals. We really think that state partnership is going to be vital as we navigate the next several years, particularly around all of the economic instability. Thank you so much for having this hearing today. We look forward to working with you.
Speaker 47
Michelle Good afternoon. Michelle Gibbons with the County Health Executives Association of California. We represent local health departments throughout the state. I want to echo the comments from my colleagues at CSAC around county indigent care programs and the resources that it will take to rebuild those programs. I would also just give a little bit of an update that local health departments are also faced with rebuilding these programs at the same time that just this week we got word that hundreds of millions of dollars are going to be pulled from local health departments due to some of the federal actions.
And so we don't have those resources on standby. These systems are not going to be rebuilt overnight. It's going to take investment to start us for the infrastructure and then also the investment for the services, as well. Thank you.
Speaker 48
Afternoon. Denise Choisol with the California Coalition for Youth. We wanted to call attention to the elimination of the work requirement exemptions from for former foster youth and individuals experiencing homelessness, which includes our transition age youth experiencing homelessness. This niche population struggles with unemployment. According to the report from PPIC last year, workers aged between 20 and 24 and those without a high school diploma have the highest unemployment rates.
Higher unemployment among young workers is typically given the time it takes to find a first job or to enter a career, But these young workers have also had by far the largest increase in unemployment by 54% since 2022, more than twice as much as every other age group. Additional data shows that those without a high school diploma is the biggest indicator that a youth will be homeless. There is a great need for ensuring that these transition age youth have access to such a basic need of food. We urge the legislator to take into consideration the unique challenges former foster youth and homeless youth have accessing food stamps and retaining their health care coverage. Thank you.
Speaker 49
Nora Angela is with Children Now. Thank you for hosting this important hearing. Children Now is proud of the progress the state has made in covering all kids, and we are concerned this is threatened by federal cuts. We also know there is a lot more work to do to ensure children get the preventive care, mental health, dental, vision, and hearing care they need for their development and well-being. If we want to see continued improvements in health outcomes for our children and youth, we need to maintain the critical investments in children's health care.
We look forward to working with you to protect and strengthen children's health.
Speaker 51
Chair and members. Jean Hurst here today on behalf of the University of California. UC's academic health centers represent 7% of the state's hospital bed capacity, and are the second largest provider of Medi Cal inpatient care and the largest provider of Medi Cal outpatient care in the state. UC Health is deeply concerned about eligibility changes made by HR1, which will strain our ability to deliver care to all Californians. Our emergency rooms are regularly operating at or beyond capacity, and HR1 will worsen those challenges.
These changes will also increase uncompensated care costs, which for UC hospitals already totaled $1,300,000,000 for Medi Cal in 'twenty three-'twenty four. HR1 will also reduce federal funding for emergency services provided to individuals with unsatisfactory immigration status and restrict a critical financing tool for public hospitals. Combined, these changes alone will reduce reimbursement by $165,000,000 a year. In addition, H. I caps federal student loans for professional programs, which will exacerbate health workforce shortages and create additional barriers for disadvantaged students.
We look forward to working with the legislature to help mitigate these devastating impacts. Thank you.
Speaker 52
Afternoon. Josh Gogger on behalf of the California Association of Diaper Banks. As safety net supports are scaled back under H. R. One, more families will face heightened diaper insecurity, increasing reliance on diaper banks to help families remain stable as federal assistance declines.
Diapers are a critical basic need but are not covered by SNAP. When food insecurity rises, diaper need rises simultaneously. Families are forced into impossible trade offs food, rent, utilities, or diapers. This can exacerbate childcare barriers and lead to missed work. Unfortunately, state funding for California's diaper banks is again set to expire at the end of this fiscal year, with the governor's budget neglecting to extend the program.
Luckily, the legislature has stepped up two years in a row to extend the program through the leadership of Senators D'Arrazo, Archuleta, Blake Spear, Perez, Richardson, Umburg, and others. And we again ask for your support for $16,500,000 in this year's budget negotiations. This is the time to expand state support for diaper banks, not eliminate it. Thank you.
Speaker 53
Thank you, Vice Chair and members. Trevor Nelson with the California Alliance of Child and Family Services. I'm here to urge you to reject the Governor's proposal to strip full scope Medi Cal coverage from 200,000 immigrants here in California, many of whom are survivors of domestic violence, trafficking, and other traumas. For years, state leaders have recognized that these populations are some of our most vulnerable and have acted to ensure they receive the care they need. Without this care, vulnerable individuals will be torn away from the doctors, therapists and medications they need to survive.
Survivors of domestic violence or trafficking may be forced to remain in abusive situations longer than they otherwise would because leaving will mean they lose food or medical support for themselves and their children. We look forward to working with the legislature, along with DHCS, to ensure these populations receive the care they need to be healthy and thrive. And please protect immigrants in our state from these harmful medical cuts. Thank you.
Speaker 54
Good afternoon, Vice Chair and members. Beth Malnowski with SEIU California. I want to align ourselves with the concerns from our county partners at CWDA, CSAC, CAPH, and CHEAC, all really speaking to this burden being placed in our counties that we know they cannot handle, that will have detrimental impacts on eligibility, urgent care, and the future of our public hospitals, as well as our HSS workforce. So, I want to ask your consideration as we move forward. How do we make sure that we are addressing these concerns head on?
To this point, I also want to express our commitment to our Health for All coalition and the requests we have forward to make sure we are rejecting the proposals that have been forward by the administration that would create further harm to our communities at a time when we need to be doing everything we can make sure we are not making the problem worse before we make it better as it relates to coverage and eligibility. And to that point, I want to really appreciate the discussion today around the interplay between workforce and benefits. In particular, I want to appreciate the question that Senator Smaller Quebe has put out there to all of us and challenge us to think about how many people are working today that are also on our programs of coverage. Speaking specifically to Medi Cal, our SCAU California estimates is that roughly 3.7 working adults are on Medi Cal today. So, when we talk about this interplay of work and coverage, we need to think about the behavior of employer and holding our employers and our corporations accountable to make sure they are paying their fair share for coverage that we are paying for with public dollars today.
Thank you. Look forward to your conversations.
Speaker 55
Afternoon. Katie Layton on behalf of the Children's Specialty Care Coalition. Our members are pediatric specialty physicians who treat children and youth with complex medical conditions. We're very concerned about the coverage losses that will take place under HR1. While the new rules do not necessarily apply to children, we know that when parents lose coverage, oftentimes their children do, too.
As providers who interact directly with patients and families, we look forward to being helpful partners in the effort to keep eligible individuals enrolled in Medi Cal. We do have a particular ongoing concern about those that age out of the California Children's Services Program at age 21, and hope that they can be exempt from work requirements. And lastly, the impact to Medicaid financing is another major concern, especially given the significant workforce challenges that already exist in pediatric specialty care. So we look forward to working with the legislature to protect this vital network so that physician shortages and access challenges do not become even worse. Thank you for the opportunity to comment.
Speaker 56
Ezer Pembantouan with Alameda County Community Food Bank. We request 60,000,000 ongoing and $50,000,000 one time in CalFood funding for food banks, and we also urge the legislature to protect and maintain the planned 2027 expansion of CFAP benefits to Californians 55 and older, ultimately remove immigration based exclusions for all ages, and restore lost CalFresh benefits for the 74,000 humanitarian immigrants impacted by H. R. One. Thank you.
Speaker 23
Hello, Vice Chair. Brian Maramontes with Ask Me California. I just want to say appreciate hearing today. A couple comments. As the state grapples with the unknown effects of H.
R. One on our budgets, we do urge the legislature to provide sufficient resources to eligibility determination workers and avoid passing budget cuts to the public workforce or the vulnerable, including seniors and the undocumented. We also urge the legislature to support OCA's work to prevent cost overruns in response to H. R. One.
And also, number three, increase revenue by ensuring corporations that are thriving in a post H. R. One world contribute their fair share. We look forward to collaborating with the committee to find solutions to mitigate H. R.
One's impacts. Thank you.
Speaker 24
Good afternoon. Tracy Ryan with Rural County Representatives of California. I want to echo the comments made by our county partners here today. And being brief. We have two asks.
We ask that the legislature and the administration work on increasing county eligibility workload funding, and also to reestablish dedicated funding to counties to serve the indigent population that will be redirected. Thank you.
Speaker 57
Afternoon. Nina Weiler Harwa with AARP California. Thank you for a very informative hearing today. As you know, AARP represents older Californians, 50. And some of our comments in the letter we'll be sending in will include the caregiver work requirements, and ensuring that ABOD individuals who are family caregivers are properly defined.
And fortunately, Director Boss did issue an all county welfare's director's letter, actually going a bit beyond what the Raised Family Caregiver Act is saying, including older adults, including care cures for older adults. So we appreciate that. We also align ourselves with some of the previous comments about adequate funding for individual for staff that's working on these redeterminations. Certainly, are essential. We know how hard it is to reach people, and that outreach has to be continuous and easy to read.
We will also be submitting some comments around how those some of these administrative burdens can be further eased. Thank you, and thank you very much.
Speaker 58
Hi. Good afternoon. My name is Christine Trung, and I am a proud member of SEIU Local seven two one and a constituent of Senate District 22. I am also a first generation Vietnamese refugee and the daughter of a twenty five year employee of the the Department of Public Social Services. Currently, I serve as an intake eligibility worker for DPSS in LA County.
My job is to process CalFresh and Medi Cal applications. Together with my union, you are looking at the state's social safety net. Like many here, we are public servants. This makes us uniquely qualified to add to this discussion, so I appreciate those waiting in line and this committee's patience if my comments exceed one minute. Earlier, we heard numbers in the billions and trillions.
My colleagues and I live in a different set of numbers, and I want to ground this committee in those numbers too. The CalFresh income limit for a household of one is a gross monthly income of $16.96. An able-bodied adult 64 qualifies for Medi Cal at $18.00 3 gross per month. A Californian receiving the maximum benefit in weekly unemployment insurance will not often qualify for food assistance. They may or may not qualify for health insurance.
My personal gross annual income as an eligibility worker in 2025 was a gross 55,000. I want to situate these figures within the context Senator Smallwood Cuevas highlighted. The vast income gap between everyday Californians and the wealthiest 1%. The numbers I referenced are numbers my coworkers and I know by heart. Earlier, Senator Sayarto asked about sustainability and why it would be such a, quote, difficult lift for able-bodied adults to lose their, quote, independence on programs such as CalFresh and Medi Cal.
Speaking frankly, I take offense to those comments. Embedded in that is the false assumption that the people who rely on CalFresh and Medi Cal are somehow separate from taxpayers, separate from working Californians, separate from the state's economy. The issue raised by the senator was about sustainability, but that is not the burden of working class Californians to bear. The issue for me is about fairness and equity. I ask us to consider whether the wealthiest 1% of Californians are paying their fair share and whether major corporations benefiting from working people's labor are making comparable contributions.
I want to emphasize and corroborate what Ms. Platonino said earlier. Hunger and homelessness will rise if insufficient measures I'm sorry, sufficient measures are not taken to mitigate the impact of HR1. The main beneficiaries of food assistance are the elderly and children. That is true.
Last November, during the government shutdown, it was workers like me who told applicant after applicant that we wouldn't we did not know when their benefits would come. That's what it means to sit at the intersection of federal, state, and county policy. Workers like me see the impact first. We see daily what happens when systems fail. That makes what we're discussing today devastatingly simple to understand.
Thank you.
Speaker 32
Good afternoon. My name is Joseph Martinez, I'm a resident of Pueblo, California. I am a SEIU seven two one member, and I work for Los Angeles County's Department of Public Social Services as an eligibility worker servicing the West San Fernando Valley. We must guarantee the longevity of our Medi Cal and Safety Net programs, and one way that we could do this is by passing AB seventeen ninety, ensuring that big corporations pay their fair share of taxes in California. These programs are essential, and I see it every day, not only professionally through the clients that we service, but also, personally.
I am the son of a single mother of five who depended on the safety net programs to pay her rent and feed her kids. The impacts of HR one are just going to negatively and disproportionately affect the community that relies on these programs for survival. Please do the right thing, and thank you for your time.
Speaker 59
Good afternoon. Johan Cardenas with the California Panacnek Health Network, also here on behalf of the Food For All Coalition, urging the legislature to expand CFAP for adults, 55 and older and remove immigration based exclusion exclusions for all ages. We also are calling for the restoration of CalFresh benefits to humanitarian immigrants impacted by the h r one. Overall, food fraud reduces hunger, improves health, and fights poverty for all Californians. Thank you.
Speaker 60
Good afternoon, members. George Cruz on behalf of the California Behavioral Health Association. HR one directly impacts behavioral health providers and Medi Cal work requirements and six month redetermination are going to drive coverage loss through paperwork failure. The HCS has projected that one point four million Californians are going to lose medical coverage, but when the coverage drops, providers will still be providing that crisis response, and the care they provide will go unpaid, treatment will stop and restart, and the relapse to hospitalizations will increase. Here's how that looks like on the ground.
We will have a community mental health clinic keep a patient stable through outpatient treatment. The patient will lose Medi Cal due to a missed renewal. Their medication stops. The patient decompensates. Law enforcement then transports them to the emergency department, and the clinic loses that reimbursement, and the system pays more for that specific crisis.
This gets even worse because of the immigrant eligibility changes that deepens that strain, and people engaged in treatment will lose that full scope Medi Cal. Will lead to higher acuity with no payments. So CBHA is urging you to work with stakeholders to find solutions to continue care for all Californians. Thank you.
Speaker 61
Good afternoon, Mr. Chair and members. My name is Tasia Stephens. I'm with UDW ASPEN Local three thousand nine hundred thirty, representing 225,000 IHSS and child care providers across the state. Every day, our members make it possible for seniors, people with disabilities, working families to live with dignity, stability, and independence.
Their work is the backbone of our care economy. That's why we strongly support equitable, sustainable revenue solutions that keep IHSS strong, accessible, fully funded for the long term. California cannot continue to rely on unstable or temporary funding to support services millions depend on. Thank you.
Speaker 62
Good afternoon, Vice Chair, members of the committee. My name is Danielle Bautista with the United Way of California. Federal cuts to health care and food resources, as we know, will lead to worse health outcomes and increased costs for Californians. Already strapped budgets will be even more already strapped household budgets will be even more strained. According to our real cost measure study, over 3.8 California families already do not earn enough income to make ends meet.
As the fourth largest economy, California has the means to ensure that our most vulnerable communities have the resources to they need to thrive. These are resources such as affordable and accessible health health care and food supports. We understand tough budget decisions lie ahead, and we urge the legislature to prioritize mitigating harm caused by H. One on our most impacted households and to ensure that the California state budget is not balanced on the backs of our most vulnerable communities. And we look forward to working with you.
Thank you so much.
Speaker 13
Afternoon, Mr. Vice Chair and members of the committee. My name is Osama Mohaddim, and I currently serve as the Legislative and Government Affairs Director for the Council on American Islamic Relations California Chapter, which is the nation's largest Muslim civil liberties organization serving California immigrants through free legal services as well as immigration services and accessible resource support. Considering that our state prides itself in being a sanctuary, it's critical that our investments reflect that, especially in the face of a nationwide campaign to vilify vulnerable communities, such as Somali and Afghan refugees, and manufacture consent for these types of campaigns to harm them. The governor's proposed budget undoes decades of settled health policy to comply with Trump's h r one.
It's unconscionable to balance our budget on the backs of the most vulnerable, while our nation's wealthiest enjoy compounded wealth gain. We urge the state legislature, as well as the administration, to raise revenues, push to fill this gap, and ensure that California's most marginalized continue to receive their basic food and health necessities. Thank you.
Speaker 63
Right. Good afternoon, chair and members. My name is Loyal Terry, I'm here on behalf of Economic Security California Action. Among many things our organization does, we convene a national affordability coalition with over 60 organizations, began affordability tours in many of our districts, and have engaged with community based organizations, small businesses, and statewide partners throughout California who are experiencing real hardship due to the federal administration's conduct and incompetence. We are hopeful that there will be strong legislative vehicles this year to address our state's revenue shortfalls that are impacting our health care system and social safety net.
These cult these cuts ultimately hurt black and brown as well as working families who need your support now. Thank you.
Speaker 64
Hi, there. Good afternoon. I'm Julie Sherman. I'm director of public policy for The Arc of California. We're an organization that represent people with and developmental disabilities, as well as their families, and the workforce that supports them.
So I just wanted to come up today to talk about work requirements, and how much of a deterrent work requirements actually are for people with disabilities to be able to work. So one of the main exemptions to CalFresh is that you are unable to work for twenty hours per week. So if you are a person with a disability, and you do happen to work which a lot of people do happen to work you'll have to tick that box to say that you're unable to work twenty hours per week, which is a huge deterrent. Right? You're not going to want to potentially commit fraud on the government.
So therefore, you'll actually be deterred from continuing to work. Other things that we're seeing in HR1 that we find very disturbing is the fact that it is so complicated to understand for the average person. So I'll give you an example. Under Medi Cal, to be under 138% of the federal poverty line to qualify for Medicaid, you have to earn less than 22,000 a year. So in our minimum wage here in California, that's twenty five hours of work per week.
We're telling people that they must work twenty hours a week, but if you work over twenty five hours a week, you actually are no longer eligible for Medi Cal. Now there is an exemption to that. There is a workaround, which is if you earn the federal minimum wage for twenty hours per week, which is $580 a month, then you can be exempt. And that works out at about thirteen hours a week. So therefore, if you work thirteen hours a week or under twenty five, you can be in compliance with work requirements.
But I just want to bring that point up of how difficult and technical this is to understand for the average person, right? You obviously have to be very into understanding policy, to understand what exemptions and what workarounds that you can actually avail of. So it's definitely going to have a huge impact on people with disabilities. Not every person with a disability receives disability benefits, so not everyone is going to be automatically exempt. And a lot of folks are going to find it very difficult to, obtain those exemptions.
So, thank you for your time.
Speaker 65
Good afternoon, vice chair and members. My name is Monica Madrid. On behalf of the Coalition for Humane Immigrant Rights Chile, I respectfully urge the state to invest in protecting access to Medi Cal and food benefits for communities excluded under HR one and to ensure that there are no further further cuts to Medi Cal for our immigrant communities. We ask we also ask for investments into the e save in program and add and additional funding for immigrant legal services. These investment keep are critical to keeping immigrant families healthy, stable, and able to contribute fully to California's economy and communities.
Thank you.
Speaker 66
Good afternoon, Mr. Chair and members. Mandy Isaacsley here on behalf of the California Primary Care Association. As the legislature considers the impacts of H. One, it's critical this conversation doesn't happen in a vacuum.
Taken together, these policies create compounding harm. As patients lose coverage due to HR1 and state enrollment restrictions, community health centers will see a significant increase in uncompensated care at the same time that their core reimbursement, PPS payments for state only Medi Cal populations, including individuals with UIS, is being eliminated later this year, 07/01/2026. We urge the legislature to reverse this cut or, at a minimum, delay it until 07/01/2027, while more comprehensive discussions continue on viable alternatives. Health centers are projected to lose at least $1,600,000,000 in the coming budget year alone. There's no way for community health centers to absorb these cuts without forcing reductions in hours, services, staff, and potentially clinic closures.
We urge the legislature to take action to ensure the community health centers are not effectively defunded through these policy decisions. Thank you.
Speaker 67
Good afternoon, mister chairman, members. Raymond Contreras with Lighthouse Public Affairs. I have two testimonies. First, on behalf of Fullwell. Fullwell is a Bay Area, rooted nonprofit public policy organizing focus on expanding access to healthy, affordable food, and improving food systems for low income communities.
We strongly support California's investing in a robust twenty first century safety net that mitigates harms stemming from HR1. This would also invest sufficient resources in creating a stronger one going forward. One way to accomplish this is to infuse the CalFresh Fruit and Vegetable EBT program with $100,000,000 in the twenty six-twenty seven budget. This will allow programs to this program to operate one year round, uninterrupted, and expand into California regions regions that are currently underserved. This will be a timely investment reducing hunger and improving health outcomes and supporting our state's agricultural economy.
Thank you. Going on to my second one, on behalf of Meals on Wheels California, as mentioned, H. R. One will weaken SNAP access. And when federal food assistance shrinks, when the impact shows up immediately for our aging communities living on fixed incomes, especially those with disabilities or complex medical needs.
Many seniors already receive limited SNAP benefits, and any additional barriers or reductions will push more people towards hunger and isolation. Meals on Wheels programs across California are a proven backstop when federal safety nets falter, ensuring seniors who cannot shop or cook for themselves still receive medically appropriate meals. We must also prioritize the reauthorization of state Modernization Act funding, which is set up to expire next year and is a necessary step to stabilize the senior nutrition programs protecting vulnerable older adults and avoid high downstream health care costs. Thank you very much.
Speaker 44
Afternoon. Anayeli Marlin with the California Immigrant Policy Center. We urge the legislature to protect the expansion of CFAP to Californians 55 and older regardless of immigration status and urge the legislature to restore benefits to the humanitarian immigrants who are losing access to CalFresh starting in April due to HR1. We need a permanent solution that addresses a long standing issue of food insecurity in immigrant communities that is only getting worse as federal tax increase. I also want to align my comments with my colleagues at the California food banks as we work in lockstep to find solutions that provide food access to our most vulnerable Californians.
We also urge you to continue investing in deportation defense programs as HR1 allocates $170,000,000,000 to DHS, which will only increase mass raids and deportations. Thank you.
Speaker 2
Those of you at the end of the line here are to be commended for your sticking around so long.
Speaker 68
Thank you, and good afternoon. My name is Manuel Pazar Regine with the California Immigrant Policy Center. We are proud co leads of the Health for All Coalition. Both HR1 and the January budget proposal drastically attacked our immigrant communities' access to health care, we urge you to fight against any additional Medi Cal rollback. This year's budget proposal reaches one step further by proposing to exclude immigrant Californians from full scope health care, that is, those who will lose federally funded Medi Cal eligibility in October because of H.
R. One. These include, but are not limited to, refugees, asylees, survivors of domestic violence, among others. Allow me to reiterate, we cannot continue to say that we are protecting our immigrant communities while simultaneously stripping their access to the vital programs and services they desperately need. This is a time to show our state's values and ensure we do not create a two tiered health care system that only provides support to some.
Thank you, and have a great day.
Speaker 50
Good afternoon. Michele Welcava with Nielsen Merxmer representing San Diego County, Contra Costa County Imperial County Yolo County and Lake County I want to align my comments with CSAC urban counties and rural counties of California I would just implore the legislature and finance to bring counties to the table as you guys are discussing legislative proposals We're the subject matter experts. We can give practical and operational analysis of proposed solutions, and we really do need to be a partner with you guys if we're going to find a solution for it. So thank you.
Speaker 69
Afternoon, chair, remaining member, and staff, and, audience. My name is Oscar Sandoval. I'm with the Center for Healthy Communities at Chico State University. We work with every public college in the state to help them with any technical issues related to SNAP applications. We also do CalFresh outreach, and we're partially funded by the state to do that work.
We really just want to make sure that students and their needs are centered in any conversations around Medi Cal, around housing, around SNAP. What we're seeing is, quite frankly, in all 58 counties when you have 58 counties, you have about 58 different ways of doing things. And whether it's data streamlining, whether it's having a consistency in the process for review or anything like that, a lot of the time we only have about, I would say, about 25% of eligible students that in the state that are on SNAP. So we roughly estimate that about $3,000,000,000 are being left on the table, that in a situation where we have about a $3,000,000,000 gap in our state budget, that can come in real handy right now. On top of that, we estimate that every snap dollar contributes to about 1 point dollars 8 in an economic downturn, which right now with the sky high prices of groceries, the limited bandwidth of so many of our food banks would be really beneficial to our state SNAP recipients.
So we urge you to please center students, as well as consider supporting SB nine sixty one, Senator Ashby's bill, which would go a long way in streamlining the process for eligibility for our students and just clarify everything for both our campus staff and our county staff. So thank you again for your time.
Speaker 70
Good afternoon, chair and, committee members. On behalf of the Latino Coalition for Healthy California, California must prioritize restoring full scope medical access to all Californians. Regardless of immigration status, including eliminating the freeze preventing some Californians from enrolling into medical. California has a history of supporting immigrants across our state, the majority of whom are Latin. Limited coverage health programs can help in the interim, but health equity can only be achieved when we all have access to quality health care with full scope benefits that prioritize cultural competency and the and dignity.
Additionally, we ask that the state leverage promotoras de salu to assist communities communities with new h r one requirements, reject subjective state funded populations to new Argyll's federal eligibility requirements, and provide health access to lawfully present populations losing care on October 1.
Speaker 2
And that appearing to be the end of the public testimony, this meeting is adjourned.
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