Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services
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Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services California State Senate
Follow its sittingsSpeaker 2
These are some of the system changes that are needed to comply, as well as some of the data quality compliance efforts and related eligibility functionality. How the funding is going to be split is about 80 six-fourteen, 86% for DHCS and then a 14% for covered California. That concludes my prepared remarks. I just want to say again that it's undoubtedly an all hands on deck moment. We look forward to partnering with you and all of our stakeholders here today and in the coming months and years ahead to make sure that we can showcase each of our departments and offices' work in uplifting our communities.
Thank you.
Speaker 1
Before we go over to the second question that you'll be responding, I see new faces. Who's with who? Zin Ma with the Legislative Analyst Office. Okay. And you're due with.
Speaker 1
Okay. Is there anything LAO would like to add to the overview? We have nothing further to add. Thank you. Perfect.
I'll turn it back to you, ma'am, for question number two.
Speaker 5
Female On the solutions or the technical requirements specifically? On Madam Chair.
Speaker 2
Female Certainly. So it was a technical adjustment of that $60,000,000 It wasn't actually a new budget request or an ask that was tied to this. It just reflects a new commiserate spending authority that was already budgeted for the DHCS and the covered California side. And so, you'll see that corresponding request in the OTSI budget.
Speaker 5
Okay. So, again, it's simply an expenditure authority. The budget is already provided by
Speaker 5
It's but it's just already allocated, yes. DHCS is included in their May revise for twenty six-twenty seven and ongoing, and Covered California also is contributing their budget, which they plan for at an annual basis.
Speaker 1
Moving on to issue number two. Nancy Sir, if you want to just swing a chair over. You can stay up here. Good
Speaker 7
morning. Thank you for this opportunity to present. As you can see, I have the experts from my team here, and we're going to start off with Deputy Director Aloni Jackson, who will handle the first question about the budget.
Speaker 8
Good morning. In response to the agenda item, a brief overview of our proposed twenty six-twenty seven budget. It is projected there'll be based on the Governor's budget, it's projected there will be $240,770,000 to OICR, of which $227,000,000 comes from the general fund. We were also allocated priority or position authority for 39 positions. Two of these are new positions, and the justification for our budget change proposal will be covered by our ombudsperson, Lisa Hartz, later today.
And a majority of our budget is for juvenile justice realignment block grant funds and local assistance dollars. The remaining remainder of our budget, about $19,700,000 of our budget is for state operations, technical assistance grants, and support to counties for providing juvenile data, as well as the remainder roughly is for personnel costs and state operations contracts. Any questions? If not, I will pass it over to our Data and Research Division Chief, Camilla Holloway, to answer the committee's questions about DDJ realignment report.
Speaker 9
Good morning. To begin hopefully, I'm coming through. Okay. To begin, I'd like to acknowledge the PowerPoint slides that were provided and that we can revisit those slides when and if requested. And now, I will give the main findings.
OICR's SB eight twenty three, DJJ Realignment Report, finds that California has successfully shifted responsibility for youth formerly committed to DJJ from the state to county based systems. However, implementation quality and readiness vary widely across counties. While Secure Youth Treatment Facilities are now the primary placement, many counties continue to adapt legacy facilities and systems to meet SB eight twenty three's rehabilitative intent. Qualitative findings highlight that youth outcomes are strongly influenced by relationships, continuity of care, and individualized treatment, while quantitative data shows variation in SYTF utilization, transitions to less restrictive programs, and returns to custody. Data infrastructure gaps currently limit the state's ability to track long term outcomes consistently.
Speaker 7
I'm going to go ahead and address these very specific questions you have about our recommendations around the S. Y. T. F. S, the S.
Y. T. F. Programming, the IRPs, the review hearings and the LRP's and then the reentry and support. So, asked specifically what the recommendations of OICR for SYTF settings.
As you know, we are launching in our fifth year, and we have a lot of lessons learned. And then we also have our five year realignment report that has some general recommendations. But specifically to SYTF settings, I have three recommendations. Based on the number of contacts that our ombuds division receives each year, and the fact that adolescents spend most their most critical formative years in the facility now, we would recommend that each facility conduct regular climate surveys of the youth and staff to monitor and improve conditions of confinement where indicated. The second recommendation is that each facility, it would be a best practice for them to have a youth advisory council.
We're finding that not only do we have a statewide youth advisory board, but facilities that have a youth advisory council that have learned to communicate with probation leadership in an organized, predictable, and respectful way are highly successful ways of keeping the facility climate in good shape. We also recommend robust incentive based behavioral management programs that are implemented by behavioral health, county office of education, and probation. These are best practice for safe, secure, and thriving facility environments. Most schools in both in and out of facilities in California use a Positive Behavior Intervention and Support, PBIS. As a model, San Luis Obispo is a great example of where the juvenile court schools implemented PBIS and probation adopted it for the full facility.
San Luis Obispo is a model for the state. With regard to SYTF programming, core programming may include dual enrollment and higher education access, vocational training, and CTE opportunities. Life skills, financial literacy, behavioral health, wellness support, substance use disorder services, restorative justice, and access to credible messengers. Whenever a facility can partner with Department of Rehabilitation, Rising Scholars, Underground Scholars, and Project Rebound, we see that youth are obtaining AABA degrees, certifications that give them life skills for once they are released, And often these are adolescent youth are stepping into a life as a student with an automatic support system when they partner with these other state resources. With regard to the individual rehabilitation plan, this is a living document, and it should follow the youth during their time in the SYTF and into the LRP, and to continue support after they complete their baseline term and are placed for reentry supervision.
We recommend that the IRPs guide placement decisions, services, and transition. IRPs should clearly link to treatment needs, progress indicators, and readiness for stepping into the community. With regard do you have a question? A question? Okay.
Okay. With regard to the progress review hearings, in the spirit of the collaborative court model, highly successful therapeutic court model, we recommend that the multidisciplinary team be convened prior to a progress review to discuss modifications to the IRP, baseline term reductions, and the progress of working towards an LRP. At the progress review hearing, the parties should be given a report detailing these discussions. We recommend that progress review hearings serve as substantive forums for assessing youth progress and readiness for less restrictive placement. We recommend that courts receive timely, meaningful information to support consistent and informed decision making.
With regard to LRPs, we have seen a myriad of LRP options develop over the last two years throughout the state. We promote promising practices for community based residential transitional housing, practices linking the LRP directly to college attendance and or vocational training, along with highly structured ongoing treatment rehabilitative goals to support the youth's success coupled with one to one credible messenger mentoring. We are available to provide technical assistance to assist counties and CBOs in how to leverage existing resources to fund these initiatives. We recognize that building this new opportunity to live in a community while completing one's baseline term is complex and requires identified funding and warrants careful planning by all the stakeholders to be successful. With regard to transitional planning and reentry support, if not already being done, we recommend counties conduct a new assessment to inform modifications to the IRP within the ninety days of release to align with the CalAm Justice Initiative ninety day in reach provisions.
This would be a transitional assessment that includes supportive and rehabilitative services needed in the community, which may be different than the needs for an LRP. For example, permanent housing, family reunification, long term transportation, and mental health needs. With regard to what data would assist in tracking youth outcomes, we do give an overview in the package that you have received, but OICR identifies the need for integrated longitudinal data systems that track youth outcomes beyond placement counts. Relevant data includes recidivism, time spent in placements, how long youth are spending in custody prior to adjudication, transition to LRP and subsequent returns to custody, and why. Educational engagement, behavioral health service continuity, and equity indicators.
Cross system data integration is essential to evaluate long term outcomes and system performance. OICR is in the middle of developing a data dashboard, a system wide, a statewide data dashboard that will include county by county integration of data. Much of it is already in the public domain, but the items that I cited would be particularly helpful to tracking how well we're doing with SBA 2.3. And if there are no further questions for me, I would like to go back to Camilla Holloway to answer questions that you have about net widening.
Speaker 9
So, for your question regarding net widening and how OICR will continue to monitor signs and implications of potential net widening, the available data does not show net widening. Direct directing the subcommittee's attention to our last slide, beginning with fiscal year twenty twenty four-twenty five, AB 169 enables OICR to receive data twice a year regarding the respective number of SYTF commitments. According to our most recent AB 169 data, the average number of SYTF commitments is approximately the same as the average number of DJJ commitments prior to realignment. So we're at three thirty three versus three thirty four. At least some, if not all, of the rise in commitments in fiscal year twenty twenty two-twenty three and twenty twenty three-twenty four may be the result of legislation such as Assembly Bill two thousand three and sixty one, which raised the legal standard and shifted the burden of proof for transfers to adult court.
This bill applied retroactively, allowing some youth to return to the juvenile system. Additionally, the number of youth committed to an SYTF rose between twenty twenty one-twenty two and twenty twenty two-twenty three due to 140 youth returning from the Division of Juvenile Justice to SYTFs as DJJ facilities closed. Commitments declined in fiscal year twenty twenty three-twenty four and twenty twenty four-twenty five to three eighty six and three thirty three, respectively. The number of youth adjudicated for 707B offenses and PC290. 008 offenses increased between twenty twenty one-twenty two and twenty twenty three-twenty four but decreased by year twenty twenty four-twenty five.
Some increases in 707B adjudications and SYTF commitments may include youth previously transferred, to adult court who were returned to juvenile court following legislative changes, but the available data does not allow OYCR to identify how many youth were returned each year. OYCR continues to monitor for signs of potential net widening through our semi annual AB one hundred sixty nine data. I will now turn this back to Deputy Director Ilani Jackson to answer questions regarding Title II.
Speaker 8
Great. Thank you, Camilla. So, a brief description of the pending issues with federal Title II grant funds. As you know, OACR became the designated state agency to be in charge of the federal formula grants from the Office of General Justice and Dignity Prevention on 07/01/2024. We received, applied for, and received the federal year '24 grant award, which covers 10/01/2024, to 09/30/2025.
The transition to OICR as the DSA from BSCC, the prior DSA, occurred mid three year cycle of grant awards that they already had. So, the challenge that we are facing is multi pronged. One is our grant award for the funding that we received cannot we cannot start paying until October 1 for work performed 10/01/2024, and ahead. So, there's a three month period, 07/01/2004 to September '4, that we don't have the ability to pay grantees, sub recipients, as they're referred to, for invoices that were received for work that was performed. So that's one challenge.
Another challenge is that our grant award wasn't actually fully approved from the federal government until 04/15/2025. So, have limited our ability to pay grantees for work performed within our award period from 10/01/2024, to 04/15/2025. Then, lastly, another prong in this challenge is that the solicitation that the federal government has to post for us to be able to apply for future funding, so another $4,100,000 another $4,100,000 for federal award year '25 and federal award year '26 has not been posted yet. There has been no solicitation offered from the federal government to date. They say it's coming.
We don't have a date to look for. We check daily for that release. That impacts grantees also who are award recipients, because we only received $4,100,000 We only received one award period's worth of funding. So that is the challenge that communities are facing who are Title II subrecipients of the Title II grant award. We have put in a request for a retroactive authority to spend during our full grant award period, so for 10/01/2024 to 04/15/2025.
We are pending a decision from the federal government to enable us to do so. We also partnered with BSCC as part of the transition of the DSA going from them to us. We submitted a request for an administrative funding adjustment, is what it's formally called, to transition the unspent funds from the Title II grant awards that BSCC had to OICR. That was submitted back in November '4, and we are still pending decision from OJJDP, and that is roughly around $14,000,000 that should have that we are anticipating coming to us. I know you're going to say a question.
Okay. I will pass it back over to Camilla.
Speaker 9
Okay. So next, I will be providing a brief update on OYCR's work with counties the Department of Finance to implement the JJRBG funding formula beginning 07/01/2026. So, the JJRBG funding formula will be distributed consistent with statute. OICR continues to engage with stakeholders to discuss the funding, the formula revisions, and implementation. OICR offers designated office hours and is available to answer questions from stakeholders at any time, specifically about the JJRBG data submission.
And by May, OICR will have data that will be compiled for the use of calculating the twenty twenty six-twenty twenty seven JJRBG allocations. And now, I will pass this over to Elisa Hartz, OICR's ombudsman.
Speaker 1
Yep. We'll wait a little bit. Okay. That's we're still that will be the next item. Okay, does LAO have anything to add?
Speaker 1
Okay. Thank you. Great. So I'll start I'll go backwards. We'll start with the JJRPG funding, In particular, L.
A. County. Given the fact that a lot of the youth are moving from Los Padrinos to Barry J. Nydorf, and Barry J. Nydorf was never now under the new law won't be eligible for funding because they have been found unsuitable.
Are you is LA County now going to be in a situation where they're going to have youth in two facilities that they won't be able to provide funding for?
Speaker 7
What I can say is that that is a very that's a county decision. The money goes out to the county, to the Board of Supervisors, the CEO, and the county is responsible for adhering to the statute. We don't
Speaker 1
The statute won't allow them won't allow the Board of Supervisors to provide funding to an unsuitable location?
Speaker 7
That would be yes, that would be what the statute says, and we are not involved in how counties end up allocating their funds, or to whom.
Speaker 1
Would OYCR be engaged in how services are going to be how effective services are going to be given now that they're not going be able to utilize JRBG funds?
Speaker 7
Well, we will continue to get annual reports on and part of the annual report is to tell us how they're using their funds. Not, of course, a line by line, but generally. So, we would expect to see how those funds are being spent and where in the JJRBG annual report.
Speaker 1
Okay. So, we'll wait till next year to see how the lack of funding is going to impact?
Speaker 7
Yes, and the county may pull dollars from other places, as you know, so it really is a very intricate local puzzle.
Speaker 1
Yeah. Okay. Just a concern, I mean, they're cutting $50,000,000 just today on public clinics, so I don't think they're going to be able to find funding elsewhere. The lack of available funding, in particular for our problem child that is LA County, I think shouldn't wait for a whole year. Maybe this is for you, Madam Mamba's person, but shouldn't wait for a whole year just to see how their the services are going to be provided there.
Also, Title II grant funds, it just seems like a really terrible situation to be in. It doesn't seem like there's a solution to this. We're just beholden to the ability for the federal government to allow to transfer the $14,000,000 and that seems to be it. Is that correct?
Speaker 8
We are trying we are exploring any possible alternate option that would allow a state solution to access the unspent funds?
Speaker 7
We have had many, many meetings on this. This is a very big deal to us. We've had meetings internally. We've had meetings with the Department of Finance. We've had meetings with BSCC, and we are committed to finding a solution.
And so, that is something that we're not going to let rest. This is something that's on our minds every day, and so we will continue to keep you aware of how we move forward.
Speaker 1
Okay. Great. And because we're not the new application is not open for the additional 4.1, does that mean we can't like those vendors will no longer provide services, or are they going to continue to do it with the hopes that we will one day?
Speaker 8
So we there has been at least one of the 12 subrecipients who has stopped providing services because it's, you know, unfeasible. They have been kind of trying to hold on until funding was released. The other we have also tried one of our initiatives with within OACR is the Justice Serving Network, and it's cohorts of community based organizations that are being connected to ways to enroll become enrolled Medi Cal providers for also, you know, funding sustainability. So we did also create a cohort of the 12 sub recipients to try to also, as a means, to find additional funding in the absence of the Title II funding being released. So as Director mentioned, we are trying to see what else we can do at the state level to give the CEOs, you know, the funds and find pathways to get them the funding that they deserve for the services that they've been providing through this grant.
Speaker 1
Okay. Thank you. Moving into net widening, I do recognize the perspective of OYCR, but I'm wondering if certain counties have gone from if certain counties have increased, you know, from sending to DJJ to now a higher threshold of SYTFs, are we looking at individual county trends and net widening? And connected to the question, I know in the report, one of the appendix, one of the stakeholder recommendation was a statewide definition of net widening so that we don't have a this is our perspective, this is your perspective of what net widening is. Would that be helpful to have a statewide definition on that?
Speaker 9
Yes. I do agree. We have provided kind of in all of our presentations that we've had on the DDJ realignment report what the net widening concept is. And we also, I do agree, should have a standard definition easily available when asked. And I also wanted to address your question about individual county examination.
That is something that we plan to do. As Director Lucero mentioned, We will be having a dashboard that will be presenting the We'll data by also have an internal dashboard that we plan to use to provide internal guidance around site visits and technical assistance to counties. We also have within our upcoming report, the AB 169 report that will be posted this year. We'll be examining by county and by region some of the differences that we're seeing in commitments and to transfers LRPs.
Speaker 1
Can OICR, alongside with stakeholders, do that statewide definition, or do you need statutory authority to do define net widening?
Speaker 7
I mean, we are certainly open to doing that, and could get we are in regular contact with our critical stakeholders, like CPOC and CAYCJ. So, we could certainly do that, and I do think that ultimately, however, it is just like the term recidivism, it is something different to other, you know, has a lens on what that means. And I think that we're finding that the net widening definition, too, could have a different lens from our different stakeholders. But we are certainly open to doing that, and now that we do have our data research and policy chief, who I know has her is developing relationships throughout the state. I think that that is something that her team could work on.
Speaker 1
Thank you. My final topic is on the report, and you know, and I've seen OICR does briefs, reports, webinars that are shared. But in the actual report, judge, let me say, what you shared with us, great recommendations, but that's not really in the report, the public facing report. The actual report I felt fell a little short. The recommendations you shared with the community right now go into more details, which I would have loved to see in the actual report.
Because if I'm not mistaken, like, I when I read the policy recommendations out of the report were three things, create a work group, talk to stakeholders, and create a task force. And in fact, I thought the OYCR is the actual group that creates recommendations versus recommending to us to create more task groups and more working groups. What you shared, I would have I felt like that's what the report should have had. The appendix you have in the report actually went into more details of what you talked about. So, I just want to know where the misconnection is of what you shared with us and what's in the report.
Speaker 7
Well, I think I was looking more at the detailed. The report was the high level feedback from the stakeholders. As you also saw in the handout, we give an overview of who was involved in the report. So, what we tried to do is we tried to make sure that we got the perspective of our critical partners, probation, other government partners, defenders, judges, youth, and then public sorry, youth advocates. So, what you saw in the body of the report was the compilation of feedback from the folks who were interviewed for the report.
And what I I'll have to tell you, we did struggle with how to answer that question today. We weren't sure if you were wanting us to just tell you what the report said or what we saw and heard and continue to hear because this report was done I think they stopped gathering data, applied survey research last May. And this is a very dynamic area. So, we continue to get more information and look at how to hone the rollout of SB eight twenty three more every day. And so, that's why today we struggle with do we tell them what we want to say about each of the topics that you pulled out, or do we just go back to the generalizations that we made in the report, and that was what we learned from the field?
Speaker 1
I would say, you know, the goal of creating these, you know, one of the goals of OYCR, you know, is to guide a statewide approach, and if this is what the state is receiving in the report, and this is what my colleagues get, and we don't all get to hear what you shared, then we're going to go off of the report. It'd be useful to have what you shared with us, Judge, in those reports because that's what we turn to for possible legislation and policy intervention. So I'm grateful that you were able to bring that in this committee in the next report. That's the kind of details that would be helpful in the report.
Speaker 12
Good morning, senators. My name is Elisa Hartz, and I'm OICR's ombudsperson, and I'm joined by my colleague, Ahmed Nem. I'm offering a brief overview of the ombudsperson workload, BCP, which addresses the rising workload resulting from the increased authority of the division and the increase in the number of complaints. To date, so as of February 23, the Ombudsperson Division has received ten twenty five complaints, and every year since its establishment in 2022, it has received an increasing number. In 2024, as reflected in our report to the legislature, the division received two ninety six complaints, conducted 84 site visits, mailed out 5,711 Youth Bill of Rights posters and 39,315 brochures, and we handled 2,490 helpline calls.
In 2025, the division received over 400 complaints, which is a 40% increase from 2024. We conducted 99 site visits, which is a 70% increase in investigative site visits from 2024, and we handled over 2,500 helpline calls. In 2024, as reflected in our report to the legislature, about half of the complaints took over 120 or more to resolve, which far exceeds our target of a maximum duration of sixty days. While there are many reasons that a case may remain open for sixty days, including delays in receiving records and the time necessary to implement a complaint resolution, workload challenges unnecessarily impede and delay the timely investigation and substantiation of complaints. The BCP is seeking two additional positions, one Attorney III and one Analyst II.
These two positions are expected to help reduce the time needed to complete complaint investigations, improve the quality of investigations, expand our training capacity, and increase the independence of the Ombuds Division consistent with professional standards. The subcommittee specifically asked for more information on legal interpretation issues that we have encountered with counties regarding our access to youth and records. There are several statutory elements where certain counties, probation departments, and county counsel have divergent statutory interpretations that impact our site visits and investigations. In at least one site visit, we have been prevented from meeting with youth in groups due to a statutory interpretation relating to our access to youth, taking the position that we can only meet with youth individually. Most departments allow us to meet with youth in groups or in any form that we would like.
This makes our site visits less efficient and effective and will prevent our ability to conduct youth bill of rights trainings as we intend to do and as we're planning to roll out hopefully this year. We have heard also that some counties believe that they do not need to post the Youth Bill of Rights posters or provide the brochures that OICR prepared and that they can simply post a copy of the statute and pass out copies of the statutory language. The materials that we prepared are written in youth friendly language, as we were required to do by statute, and are geared towards assisting youth in understanding their rights. There are also diverging views among County Council about our access to records. We frequently request youth grievances and their resolution to understand how the facility responded to the issue raised by the youth.
In one county, we have been repeatedly denied access to certain grievances that name staff because they have been designated as personnel records legally required to be kept confidential under Welfare and Institutions Code 2200D4. Youth regularly file grievances against detention officers alleging abuse, discrimination, inconsistent discipline, disrespectful treatment, retaliation, and excessive use of force, among other issues, and indeed, we encourage youth to file grievances to allow for local resolution when possible. Not being able to access these records means investigations will be delayed, credible complaints may not be substantiated, and investigations will lack an understanding of how departments are responding to youth grievances, which is often a critical part of our investigation. There are also complex issues with County Counsel when our request for records causes or relates to ongoing internal affairs investigations. Some counties provide records such as videos and incident reports during their internal affairs investigation, while other counties provide them only at the end of their own process.
The Attorney III position, in particular, will be vital in supporting records requests, review and enhance investigations, engage with county counsel and youth defenders, and provide legal counsel to the ombudsperson.
Speaker 11
Thank you, Madam Chair. Orlando Sanchez with the LAO. We have no specific concerns with this proposal at this time, but we do want to note that this would create ongoing general fund commitments, and given the state's budget condition and that the state's facing in future years, the state will have to find ongoing solutions if this proposal is approved to offset that in the future. Thank you, and happy to take questions.
Speaker 1
Thank you for that flag. Thank you for that robust background on that. Appreciate it.
Speaker 13
Thank you so much for your presentation. Just, you know, just from listening to you, it seems like there's a lot of roadblocks, a lot of obstacles to you actually being able to complete these investigations in a timely manner. So, what is it that we can do from a legislative standpoint to assist in that?
Speaker 12
Well, I think excuse me. First of all, endorsing the BCP that we've presented will be very helpful in providing us more staff and more resources. I think there are potentially a few statutory tweaks that could help us just increase the consistency among the responses from departments. I think you have 58 counties, 58 county council, 58 probation departments, and this is a new thing. It's the first time there's been a statewide ombudsperson who has the ability to investigate complaints in local jurisdictions.
So, I think it's normal that there would be some kind of cleanup needed in order to ensure consistency across the state. That already happened to a large extent with AB five zero five, and it's been really helpful, but there are still some remaining issues. Some of the issues are a little bit thornier relating to the personnel matters, which I think we're still working through with individual counties. So. So, are
Speaker 13
there certain counties in which it has seemed to be more seamless and less obstacles? Because, I mean, personal issues should be the same in every county. It's just how you manage them. So, just wondering if there are certain counties that are doing a better job than others.
Speaker 12
Yes. Many counties are being highly responsive to our requests and are giving us, for instance, full access to grievances without regard to the personnel this argument that there's a personnel matter, which we would disagree with.
Speaker 13
And it might be nice if you could provide the committee with a list of those counties that have better practices so we can figure out if there's anything that we need to do to make all counties aligned. Thank you.
Speaker 1
Thank you so much, Senator. Appreciate that. Thank you for presentation. We're now moving into the next department. State Council on Developmental Disabilities.
Issue four. Hello, you may begin.
Speaker 14
You, Chair and members. Aaron Caruthers with the State Council on Developmental Disabilities. Just as a brief overview, the State Council on Developmental Disabilities, with the leadership of 31 governor's appointees, is an independent state agency. We're not under agency formal or any other department. We have statutory authority to work with people with developmental disabilities and their family members to give them the information, the tools they need to navigate systems, to get services, to make changes.
Additionally, we have authority to advocate and seek those changes, too. So in the end, we're really disruptors. We disrupt systems to make them work better, be more accountable, be more efficient, to better serve the people they're there to work for. We do this with federal funding. We are a line item in Congress's budget.
There's a developmental disability council like ours in every state and territory, and I am grateful and maybe a little bit surprised to be able to say we are supported by this president and this congress. For the $8,000,000 the terms and conditions of the grant asked the state to do a few things, and that brings us to the request before us today. For the request, we, in coordination with Health and Human Services Agency, are requesting $730,000 in general fund for twenty twenty six-twenty seven and ongoing to support an interagency agreement that we have with the Department of Social Services. Social Service provides us we contract with them to provide accounting, human resources, legal, IT, all of the administrative functions that we need to function as a state agency. As a condition of the federal grant, the state says, We'll agree to provide these administrative supports, and the federal government says, Out of the 8,000,000, you can't have any more than 50,000 of it to pay for these supports.
That's a pretty low cap. We have a few other reimbursement sources. We're able to pull from that. Over the years, there's $390,000 is what we've been able to pay for this interagency agreement. It's actually it's been that amount for the last twenty years.
Costs have increased substantially. It's over $1100000.01200000.0 dollars and this request is really to fund that gap.
Speaker 15
Will Owens with the LAO. We have no not raising concerns with this proposal at this time. Thank
Speaker 1
you. Okay. How has it really looked like in the past decades, funding it at 390,000? You just
Speaker 14
What it's looked like is Department of Social Services has just absorbed the cost. So, they are taking out of Hyde for the difference.
Speaker 1
They're absorbing the cost, we're paying for it now. We're still paying for it
Speaker 16
now. It's their staff at the Department of Social Services are technically doing work to support state council. That's accurate, but they're not they're absorbing the costs. They're not allocated those dedicated funds for purposes of supporting state council.
Speaker 1
So, I guess I'm just wondering, Eliel, given the comment that your Orlando mentioned just previously. The work is getting done. It's been getting done for twenty years. Why would we add to the structural deficit?
Speaker 14
I think there was a complicating factor last year as Department of Social Services went through the budget drills of OE and E reductions, personnel services reductions. This last year complicated the situation. It got it just got to the tipping point where they said, We really need some help. Can't absorb this anymore.
Speaker 17
Kay Lemot, Department of Finance. So social services is unable to absorb the costs anymore, and they don't necessarily have to continue providing administrative services without the additional funding they're requesting.
Speaker 14
So last year, there were the budget drills that each department needed to reduce their number of positions, and OE and E expenses. So after DSS went through that across their department, this was a piece where they said, Okay, we've given all we can, and now we have less
Speaker 17
on vacant positions. There's two. There's a four point one zero and four point one two. So the first control section looked at other areas in which they could reduce costs.
Speaker 16
Okay. And I think to Erin's point, I think it just it complicated the picture at social services. So, when they brought this proposal forward, and that gap is fairly substantial, and then the BCP outlines the workload associated with each of the positions that, you know, the in the BCP, it breaks out the percentage of time that individuals at social services spend on supporting state council, and so that's how we arrived at that kind of that gap analysis of, like, what's the Okay. What's the shortfall?
Speaker 1
Moving on to the next department, Emergency Medical Services Authority. We're going to start with issue five on the overview.
Speaker 18
Thank you, chair and members. Gabrielle Santoro with the Emergency Medical Services Authority, or EMSSA. As noted, we've been asked to provide an overview of our department. So, EMSSA is responsible for the equitable coordination, administration, and integration of statewide EMS system to reduce suffering and save lives throughout the state of California. The agenda does a good job of providing an overview of our major programs, but I'll go through each of them.
The first is the Disaster Medical Services Division in coordination with the governor's office of emergency services, the Department of Public Health, hospitals, ambulance companies, and other entities. We are responsible for disaster preparedness, response, and recovery across the state, providing assistance to local entities, including the deployment of teams and resources. Next is the Professional Standards Division, which is referred to in the agenda as the EMS Personnel Division. This division is responsible for the licensure investigation and discipline of paramedics statewide, as well as for establishing standards for training and scope of practice for EMS professionals. Third is the Quality and Planning Division, which is referred to in the agenda as the EMS Systems Division.
This division is responsible for the review and approval of local EMS plans, as well as requests for approval for provider contracts. The division also provides oversight for specialty programs, including EMS for children, trauma, STEMI and stroke, and community paramedicine and triage to alternative destinations. This division includes the Health Information Exchange that manages the California EMS Information System and the Pulse Form, which is the physician's order for life sustaining treatment form. That concludes my overview. Happy to answer any questions.
Speaker 18
Okay. There was a question noted in the agenda regarding progress made for AB seven sixteen and when the required report should be expected to be available. As noted in the agenda, resources were authorized in the 2024 Budget Act to implement AB716. Those ongoing resources were included as part of statewide efficiency vacancy reductions. As such, we don't have a projection at this time of when the report will be available.
EMSA continues to plan for implementation of the reporting requirements under AB716. The statutory framework is in place, and EMSA is focused on promulgating regulations, monitoring the issue, and providing information and support to stakeholders as appropriate. We do remain committed to the goals of AB seven sixteen, which includes increasing transparency and ground ambulance transportation rates across California.
Speaker 1
Department of Finance, clarifying question. So the expenditure authority of 521,000 was for the two positions, and then annually to create the report was $321,000 was the were the funds so both those line items were removed
Speaker 18
happy to okay to clarify you're right that there was one time funds of 521,000 which include 321,000 for two positions and then 200,000 one time for temporary resources in order to promulgate regulations. It was the ongoing resources of 321,002 positions that were included in the vacancy savings drill.
Speaker 18
So, it was intended to promulgate regulations. However, as EHMSA did not have the full resources at the time, we did not use that 200,000. So, the 200,000 is still at EMSA? The we've passed the deadline for the authority to expend that, so it went To the Yes.
Speaker 1
Okay. Can you clarify for me two part here? I mean, it's hard to say that you still committed to it when the report was due two years ago. It's very hard to take that at face value. The second part is, given that even though vacant positions were removed, that does not remove the responsibility to follow through with the statutory with the law that the governor signed.
Removing positions does not remove that responsibility. So, think this is a complete this is there is a failure in this moment with this bill in meeting the responsibility of a law. So I'd like a little bit more of a timeline of when this actually is going to be delivered to the legislature. I recognize we're cutting vacant positions, but that does not remove the responsibility to follow through with the law.
Speaker 5
that there are certain deadlines that have been delayed. I would reemphasize my colleague's points that EEMSA is in the process of evaluating administrative options to have flexibility to work towards achieving the goals of the legislation. At this point, we're not able to provide any specific timelines as to when the reporting requirements will be met.
Speaker 1
The funding was cut last year. So, we're about six, seven months into the process of the funding have been cut. So, in the six, seven months, does that mean EMSA has not come up with a solution? So, if you're still in the process to come up with a solution?
Speaker 19
So, when we consider how the departments will work to continue meeting all of their operational costs, including meeting legislative requirements, there are administrative flexibilities that departments can use, but they do take time. It could look like reprioritizing workload. It could look like diverting resources to other purposes, including Ledge requirements. And it could require reclassifying positions and then going through that hiring process. So, unfortunately, it is not something that can sort of just be turned on immediately.
It does take time. And I would just, again, as we've said, you know, this commitment still stands. We understand that the requirement is still in law, and the administration is committed to meeting this to making updates on this bill and getting it implemented.
Speaker 1
You know, as legislators, you know, you're seeing BCPs to add funding for other departments, and you don't see a commitment for funding for our colleagues' bills. It's a little it's an uncomfortable situation to be in. Okay. Senator? Thank you so much.
Moving on to next issue, issue six.
Speaker 18
We were asked to provide an overview of our first BCP, which is a request for one time general fund augmentation of $2,600,000 in twenty six-twenty seven for encumbrance or expenditure until 06/30/2028, to replace critical disaster response vehicles essential for statewide medical operations, noting that Emsis fleet includes five medium trucks, three box trucks, and one refrigerated box truck that have exceeded the twelve year replacement threshold and have become increasingly unreliable. So, this one time resource would allow us to replace those assets.
Speaker 1
Great. Thank you. I just had to give up my 2007 Nissan Oso. I recognize that. I gave it up two years ago, but I'm a little concerned with the optics of this BCP given our situation in the state.
I do recognize, like, these are emergency vehicles. I'm not taking away from the value of that, but this is asking for expenditure up until 2028. I would it'd be if we could do a phased in approach, potentially looking at that in the May revise. Are there some trucks we can do right now and do a one year expenditure, come back next year and see where we're at? But it's hard to sell, hey, the state needs nine new trucks.
And then I think it's almost around the same time. I'm not advocating for any. I'm just saying like this is around the same time we're cutting for like IHSS backup provider. I think it's exactly almost like the same amount of dollars there, just like the optics of that. So, I think my humble recommendation is, can we phase this in?
Finance.
Speaker 5
Renee Thompson, Department of Finance. I just wanted to add a little bit of extra context. So previously, the department has experienced supply chain delays and manufacturer backlogs with regards to acquiring the vehicles and then making the necessary modifications. So that is the reasoning, for, this extended authority in this instance is to ensure that there is no that the funding doesn't expire prior to everything that needs to be done with regards to acquiring and modifying the vehicles.
Speaker 1
But in the next two years, can we focus on purchasing half of those vehicles? Is there that's what I meant for for that.
Speaker 18
Yeah, absolutely happy to consider that. Female Senator? Okay. Thank you
Speaker 18
Issue seven is for our security architecture compliance assessment BCP. EMBSA requests a one time general fund augmentation of 250,000 in budget year to complete initial activities in order to meet the IT security zero trust architecture, and multi factor authentication standards. I'm
Speaker 18
to move to the next question in the agenda, unless there's any questions for that one. Okay. There was a question about why the work was not completed in May 2024 consistent with the CDT information letter requirements. At this time, Eemsha does not have the resources in order to conduct these initial activities. We do recognize that we are out of compliance, and that is why we're seeking these one time resources to comply.
Speaker 1
So, it's a one time to do the vendor to do an assessment Correct. Of where we're at? Correct. That's going to and then the assessment's going to come back, and, like, we have to fix everything for the to verification.
Speaker 18
Yeah, look at what the results are and where we there might be opportunities. We'd have to do that assessment first to make that determination.
Speaker 1
Female What is happening right now that we've since we've waited since 2024, what's happening? Are we at risk? Are we
Speaker 18
I mean, we're doing what we can to monitor. We work in collaboration with OTSI and CDT to evaluate, but I think having this third party will make sure that we have security, because it's not only for the internal MCA department, but all of the individuals that have, like, health information that we want to make sure that we protect their privacy and remain secure.
Speaker 18
This is for the Human Resources Enforcement and Legal Workload BCP. EMSA requests four positions, 1,400,000 in twenty six-twenty seven and one 300,000 in twenty seven-twenty eight and ongoing from the General Fund to support HR enforcement and legal workload. The request will support ongoing emergency preparedness personnel, HR activities, investigations of alleged EMS personnel related violations and misconduct, oversight of licensees, and department wide legal workload. Happy to answer any questions.
Speaker 15
Will Owens with the Legislative Analyst Office. While we don't have anything necessarily to add about this specific proposal, I would just echo my colleague's previous comments about, given the state's kind of ongoing budget condition, this would represent an ongoing general fund cost, and the legislature will need to balance that against other priorities moving forward, given the structural deficit. So,
Speaker 1
let's talk about the, are we the root of the problem here? It seems, are we preventing, or are we just going to continue to throw money if we get more people, personnel dealing with substance use disorders, or any other personnel issues? What if the number continues to grow?
Speaker 18
I appreciate your the question and the concern. I would just note that MCIT, like, we want to support both, like, our EMS personnel, as well as the individuals that they're providing essential care for, and to have, on a timely basis, to process any allegations of misconduct, probation period, so that we can evaluate, like, who is prepared to, like, return to the community to provide those essential services and so that we ultimately can uphold, like, public well-being. I appreciate your note about substance misuse, and I think that that's part of it. We do conduct, like, bio testing, but ultimately, like, want to uphold the importance of, in a timely fashion, allowing folks who are prepared to be able to return to the community to provide those essential services.
Speaker 1
It just seems that we're being reactionary, and the numbers could continue to grow, and then we're going to continue to need more personnel here versus what are we doing to prevent further increases? Like, are we also investing? Is it you know, people who are first responders are disproportionately impacted by mental health matters, substance use disorders? I'm just wondering if we're investing in the beginning, so we're not just continuing to address as the numbers increase.
Speaker 18
That's a very fair point taken. We at this point, like, we don't have resources to address the front of the problem. We're just trying to be responsive, but hear you on the issue that you're raising.
Speaker 1
You know, again, you know, as we're, you know, we're sharing our it's how do we, you know, tell Californians, we have personnel issues here. We need more money so we can enforce the personnels more. It's hard. They need support. I get that.
I understand. Well, it's not even the support. This is just to enforce to make sure that they are you do it under required timelines so that they aren't potentially unsafe or unfit personnel. I get that. But taxpayers are not having to pay more for enforcing personnel that perhaps are unfit for the job.
Senator? Okay. Thank you so much for the presentation. Thank you. Moving on to our next department, Community Services and Development.
It's your nine.
Speaker 20
Morning, Chair and Senator. I'm Megan Rivers, the admin deputy director with the Department of Community Services and Development. I'll be presenting the department's two budget change proposal items. The first is related to the reappropriation request for the low income, sorry, the Low Income Weatherization Program, also referred to as LIWIP. The department is requesting reappropriation of an expended greenhouse gas reduction fund resources allocated in prior fiscal years to administer and support both components of the program.
LIHWIP provides energy efficiency and solar renewable upgrades to low income households in disadvantaged communities that reduce greenhouse gas emissions and lower household energy costs. The program currently focuses on providing services to low income farm worker households and multifamily affordable housing projects. The program lowers long term energy costs, improving housing health and safety, and reducing greenhouse gas emissions. Currently, these funds are set to expire on 06/30/2026. This request would extend the family the farm worker housing component of the program, the liquidation period through the '7, and would extend the multifamily housing availability to the end of fiscal year twenty seven-twenty eight.
The LIHWIP program administrators have accomplished notable achievements under their current contracts. However, labor shortages, high turnover of skilled workforce, building permit delays and equipment shortages have negatively impacted service operations. The operational challenges will prevent the full expenditure of the GGRF funds within the current liquidation period. If approved, the reappropriation would allow for fulfillment of over 1,500 farm worker households seeking LIHWIP services and the completion of approximately 70 multi family projects. The second item I'll cover is related to Proposition four, the climate bond.
So, the intent of Proposition four as it relates to the Department is to fund the continuation of the LIHWIP farm worker housing component. The funds coming through Proposition four will require a new procurement to select a statewide administrator. The expenditure plan for fiscal year twenty six-twenty seven is to complete program design and issue the competitive solicitation to select a statewide administrator. While we anticipate the general scope of the energy efficiency and solar PV services for farmworker housing to be in line with existing LIHWORTH farmworker housing program components. The specifics of the program design will be part of the development of the procurement in fiscal year twenty six-twenty seven and will also include stakeholder engagement.
That concludes my formal remarks. I'm happy to take any questions.
Speaker 21
Thank you, Madam Chair. Ginny Bello with the analyst office. We have no concerns with these proposals.
Speaker 1
Thank you. I think I just need some clarifying. Okay. So we have 36,700,000 to roll over. Great.
Because of the delays and so forth. And it seems like it's gonna cover the projects that are in the queue right now and have the ability to do more projects with the 36,700,000.0. Correct? Correct. Perfect.
Great. Given that we've had some delays, I'm wondering the and this is where I'm struggling. On the additional 9,000,000, it's for the same programs that we're having delays with?
Speaker 20
So, it is it's for the same so yes and no. The LIHWIP program as it exists right now includes two components, a multi family housing component and a farm worker housing The proposition four component will only continue the farm worker housing piece. But if we already have leftover funding, if we have money for more new projects, why would two part. Why do we need and
Speaker 1
we already have a vendor for that. Why do we need a new vendor and a new design program if we already have that? And two, will we then be in the situation in the next two years where the 9,000,000 was expended in time because of the current delays we're experiencing now? Do we need the 9,000,000 right now? And third part to that, under Prop four, it was set specifically for this program?
Specifically for this program? Correct. But can it be expended next year or so forth? I'm just wondering why we're putting into a fund now when we're still delayed.
Speaker 20
So, my understanding associated with proposition four is the funds that we have at our disposal right now is for state operations. So, for us to be able to do the program design, that's the component that we're focused on this fiscal year. So, it's the program design and to be able to then select an administrator. We're likely not to then begin actual service delivery until the next fiscal year. So, at this point in time with the reappropriation request, it should be that we are winding down one and beginning to start another under the proposition $4.
Your question about needing to do a solicitation is required through DGS and the statewide administrative process, where when we are allocated new dollars, we're supposed to go out for competitive bid. So, that's
Speaker 1
So, we can't just put it into the current program we have now? We would need spend money.
Speaker 20
We would need language to be able to do that if that was something that we were going to do.
Speaker 1
Because that would save us money and do have more money available just for actual services versus admin, right? I'm just wondering why we need
Speaker 20
a whole new design if the program already exists. Yeah. The as it's set up right now, it would then the department would be required to then engage stakeholders to then see if there were any tweaks that we wanted to make to make the program design better, and then to do the solicitation of a statewide administrator. So, that's the design of the program as it sets today. We could explore alternatives.
Okay.
Speaker 1
Yep. Does seem like a question. Yes. Echoing waste of money and time, Just seems a little bit. Okay, thank you so much.
No problem. Not the money for the services, just the
Speaker 1
All right, thank you so much for that issue. Moving on to the next department. Department of Rehabilitation, issue number 10.
Speaker 4
Good morning, Senator, members of the committee. Kim Rutledge, Director of the Department of Rehabilitation, and we have been asked this morning to provide an overview of our budget change proposal on strengthening, VR program capacity. So, what this budget change proposal would do is it increases DOR's federal fund authority by $60,000,000 annually and adds 54 permanent positions to the department with no general fund impact. The purpose of this BCP is to expand service capacity to meet increased consumer demand of the vocational rehabilitation program, stabilize staffing to maintain service quality for individuals with disabilities, and advance competitive integrated employment for people with disabilities per Senate Bill six thirty nine from 2021, and the Master Plan for Developmental Services. Our justification and the reason we are asking for this BCP today is that the number of participants that we have in the vocational rehabilitation program, which is the largest program in California and the nation to provide employment services for people with disabilities, has almost doubled since the COVID pandemic.
In 2020, we were serving around 100,000 consumers a year for employment services, and in fiscal year twenty four-twenty five, our caseload numbers have expanded to 176,000. And the other way to look at this is demand has grown by more than 20,000 consumers annually over the past three fiscal years. So, what we're asking for today is two different things. First of all, we are in an interesting position in California where every year, the base grant that we receive from the federal government, if other states give back part of their base grant, then we are able to ask for that additional money in a process called reallotment. We have been successful over the last eight years of getting, on average, dollars 60,000,000 additional dollars a year for the program through reallotment.
And so, the first part of this BCP just asks for ongoing match authority to be able to continue to pursue those funds. But that money alone is not going to be enough to address our rapidly growing case load amounts right now, which is why we are looking at the 54 additional positions. These positions would be fully federally funded through our federal base grant and these reallotment dollars, as well as through our ongoing VR grants, and will support the positions long term. Our staffing has remained unchanged for the past eight years despite this demand in services. So that is the summary of the BCP, and we're open to questions.
Speaker 15
Loans with the LAO. We have not raised any concerns with this proposal.
Speaker 1
you. It's really great for California. I just feel bad for people in other states that their states are not utilizing the funds that they could for their needs. But I don't have any further questions on this.
Speaker 1
you very much. Thank you so much. Are you surprised? He looks so shocked.
Speaker 1
Thank you, Senator. Moving on to the next department, Child Support Services, issue 11.
Speaker 23
Good morning. Thank you, Chairman Chivar and the committee. We had three items. We'll start with the overview of our department and our budget impacts, and that will be with Nan Chen.
Speaker 3
Good morning. Nan Chen, Chief Financial Officer for the department. The twenty six-twenty seven proposed budget for the department is $1,200,000,000 an increase of 22,000,000 total funds from the 2025 enacted budget. The primary increase is primarily due to two significant budget adjustments. The first is an increase of $17,600,000.06000000 general fund, for the restoration of a two year limited term reduction to local child support agency funding enacted in the 2024 Budget Act as a result of LCSA underspending.
As discussed in the agenda, DCSS anticipates that past underspending has dissipated, and LCSAs are fully utilizing available resources. This augmentation is needed to maintain existing staffing levels due to upcoming staffing cost increases. The second adjustment is an increase of 4,600,000.0 federal funds due to an estimated increase in federal performance incentives. The total federal performance incentive pool is adjusted annually based on national CPI or consumer price index. The total incentive pool has increased significantly due to past CPI levels.
Therefore, California's share has also increased. As CPI has fallen from those elevated levels, the department does not anticipate similar significant increases in upcoming fiscal years. Happy to take any questions.
Speaker 21
Thank you, Madam Chair. Ginny Bello with the analyst office. As you heard, there are no new major proposals in the Department of Child Support Services. There is this restoration of the 17,000,000 total fund, 6,000,000 general fund for local child support agencies administration. And that was part of a multi year effort, actually, to increase administration for local child support agencies that started back in twenty nineteen-twenty.
And the idea was that the local child support agencies had been frozen when they're at administrative funding for a couple of decades at that point. And so, there was this multi year approach to increase funding that was supposed to happen over three years. It was about $168,000,000 total funds, 57,000,000 general fund was the thought at the time. But because of budget situations, there have been pauses in that. There have been the recent temporary reduction that we did.
And so, what you're seeing here now is that restoration of $6,000,000 or $17,000,000 total funds is sort of in that vein, in that effort. It would get you to about 90% of that original phased in request. That said, it is a bit of a moving target because of the way the administration the administrative funding structure works. It really looks to see, well, how much does it cost local child support agencies to have enough funding to staff cases at roughly about 180 cases per staff. And so that's a moving target, right, because every year that increase, that cost of doing business increases.
So that's implicitly built into their calculations. So it's just something to be mindful of as you're thinking about this and what it means to fully fund the administration of child support at the local level. And even if we get to that ultimate goal, that what they said was fully funding it, there will still be these pressures related to cost of doing business that you hear across all human services programs, right? You'll hear it in CalFresh as we're talking about HR1, so that's very similar in that way.
Speaker 1
Thank you so much for the additional background. I struggled a little with this not BCP, just restoration, because the cases continue to go down, and the increase is only for, like you mentioned, cost of living, salary, benefits. So, workload is going down, but the cost to keep the person in the work is going high. That's bad government, absolutely bad government. In every other department that sub three sees, any scenario like this gets cut.
Every other department that is in this scenario gets cut. Workload is down, they get cut. Funding in CalWORKS for employer, it's not being utilized fully, gets cut. I'm just really curious as to why this department in particular does not get the same treatment as all the other departments and how we approach our funding. Department of Finance, I think this is a question for you.
If the federal government is going to augment already with 4,600,000.0, that's an additional that they didn't have the past couple of years. Given the caseload, I don't see it how we justify an additional $6,000,000 from general fund.
Speaker 16
Christopher O'Neill, Department of Finance. I think what you're seeing in this budget and this restoration is the sunset of that temporary reduction in the last two years. And I think based on our conversations with the department and seeing the trend line of LCSAs and their spending, you know, we've left that sunset in place and the funding coming back online.
Speaker 1
But cases are decreasing. What is increasing outside of salary benefits and cost of living?
Speaker 3
Can I add? Sure. So, one thing to kind of highlight is that the child support program in California is arranged a little bit differently than other social welfare programs. And so, the from the county perspective, they see the child support program as a state federal responsibility, even though it's locally operated. And so, the county staff, when the state, for example, does an adjustment for state salaries that's going up, they don't include anything for the county positions because they're technically not state staff.
And then, the same thing kind of happens at the local level as well, is that when a local county negotiates a new union agreement, they don't actually provide any funding to our local child support agencies. And so, the only way to just kind of maintain staffing levels, to just maintain operations, they have to either cut positions or receive new funding. And so, in effect, if we don't provide additional funding each year to offset those cost increases, then in effect there's a reduction of positions. And the LCSAs have kind of done that historically for decades since the inception of the program, and only recently have we been trying to sort of provide some additional funding to offset that erosion. And so, really, you look at from like roughly 2020 to about now, there's been about a 30% increase in staffing costs just for salaries and benefits, which is greatly higher than anything we've seen in the past.
And so, the kind of what Delia was talking about earlier, we've been adding funding, and that's really just to keep up. And so, since the funding methodology kind of lays out what the staffing ratios should be, there's actually not enough staff to handle the casework that's needed, and we're just doing what we can to kind of get by each year. And so, if we were to not receive additional funding, that would just be another pain on top of that difficulty, and we would see challenges in service delivery and erosion and things like that.
Speaker 1
Well, what's the difference between this and every other department that's struggling with the same thing?
Speaker 17
I just want to add, please correct me if I'm mistaken, but the decline is a lot slower or lower than the need for salary adjustments for the counties. What do you mean?
Speaker 3
Yeah. So, historically, just recently in these last couple of years, we've had a decrease of about 45,000 cases, but that's a one time decrease tied to the closure of foster care cases. When we kind of look further back, our caseload has been declining, but only about one, maybe 2% each year, depending on which year, but usually costs have been growing higher than that, roughly three or 4% each year, especially these last couple of fiscal years.
Speaker 1
Over the past three years, overall caseload has declined by about 60 to 70,000 cases.
Speaker 3
45,000 cases from foster care. But once you kind of take that out, really over a three year period, you're losing about maybe just 10,000 cases out of approximately a million, and so that roughly 1% decrease in caseload is quite small compared to a three or 4% increase in cost. So, we need something to
Speaker 1
I get that, but that's a terrible phrase, you know, where the staffing cost is three or 4% outpacing the decline of the cases. So, you're still outpacing the cost of actual services being delivered. It's that's Chairman Gebber, if I
Speaker 23
could add, Director Kristen Erickson Donahuey for the department, prior to the decrease, that two year decrease in the funding, We were seeing some increases in case load, which were due to the local agencies and our staff having the capacity to raise awareness of the program. Child support operates as a critical safety net program, and research that we are working to finalize shows that it is a great program for cost avoidance. So, individuals that receive child support need less in public benefits such as CalWorks and CalFresh, and so our ability to raise awareness of the program is deeply impacted by the funding decreases to the local staffing levels. Without those funds, they were not able to do more of the outreach, which raises awareness of the program and drives the case load increase so we can help people lift their children out of poverty.
Speaker 1
Even without the 6,000,000 general fund, you're getting a 4.6 federal increase. That's still more than the past two years. So, it's still in a better position given the time, given the structural deficit that we're in. So I'm just wondering, regardless of general fund, you're still going to get money from the federal government. That's a huge win the state can get without adding to the general fund.
And I don't see another you know, it's not you're in a situation that no other, really, departments are. You're getting money regardless. Do we have to tap into the general fund right now, given the PCPs, you know, Department of Finance of other departments needing? So, just a thought as we continue these conversations.
Speaker 16
Yeah, and we can certainly take that back, Senator. I think and my colleagues at the department also speaking to the 100 the case load ratio and trying to get to 180, we haven't quite hit that yet either, right? We're closer to 200. Yeah, we're closer to about 200. So, that's another consideration, too, is like as we're kind of looking at, like, those staffing ratios as well, we're still trying to achieve that 180 that was Sure.
Speaker 1
Yeah. But you're going to say this to me, and I'm going to throw back, we have not met child care slots that have been promised for years. So, you can't pick and choose. If we're not going to meet there, then, you know? So, it's hard for me to take that, and then later talk about other things we're not meeting.
Okay.
Speaker 1
Okay. Thank you so much. Appreciate it. Moving on to Department of Public Health. Oh, no.
Just kidding. Did I miss something?
Speaker 1
was my that was me. Sorry. Yes. You do. There we go.
Cal works. Yeah. Oh, yeah. Pass through a lot. Okay.
I forgot all that. Yes.
Speaker 23
Thank you, Madam Chair. Chris Nerickson, Donahedi for the department. We'd recently issued the supplemental report and want to give a briefing of the findings there, given the timeline before our hearing here. So, this report examines the cost that it would take to move to a full pass through process. So, the background is that families who receive CalWORKs benefits must assign their rights to child support.
There are good cause provisions where if it would potentially pose harm to the family, we can avoid a referral from the CalWORKs program to child support if it would harm them. So, our department establishes and enforces these child support orders. They represent approximately one fifth of our current caseload, which is exponentially higher for California than in other states. So, there are about 200,000 open cases that are currently assisted. Under current law, we pass through the first up to 100 for families with one child and $200 for families with two or more children, and that is on collections that are applied to the current monthly support.
As we see in the reports, we are passing through approximately $2,000,000 or $2,700,000 each month to these families. That money is also disregarded from their income for purposes of determining their eligibility and their grant amounts. There is a rising trend across the nation to moving to a full pass through concept. Since May 2024, for families who are formally assisted, California has been passing through all amounts collected that apply to those arrears, that back support that is owed to the government. So, we've passed through about $200,000,000 to families in that formerly assisted category.
And that's under a federal law option that does not require us to pay the federal share, which is 50% of those collections, and the remainder is retained by the state. So, for the currently assisted families, anything that we pass through above that $100 to $200 we would have to account for the federal share of those collections, that 50%. So, this report talks about how much could be increased if we pass through all of the funds. So, that would be the amount that was owed and collected for their current monthly support in addition to anything that applied to past due support. So, we see a big spike each year around March to May where we are intercepting federal and state tax refunds.
Those account for a fair amount of collections for these families. So, if we pass through everything, that could be an average of $11,500,000 a month to these families. And there has been further research in collaboration with the Department of Social Services about potential mitigation impacts and the options that exist to increase the disregard from income on their side or to keep it at the $100 or $200 range. So, the cost to do full pass through would be about $150,000,000 annually in state general fund. Alternatively, the state has options to pass through the state and county portion, and that would cost approximately $80,000,000 each year in general fund costs, in addition to one time automation and training costs.
Happy to take any questions you may have.
Speaker 21
just going say we're reviewing the report. We'll let you know if we have any issues to raise.
Speaker 1
Great. Thank you so much. I apologize. On the last point you just mentioned on the automation, how much do because it's you said three well, three to five years to implement it. How much is it going to cost us in the front end to the investment in automation?
Speaker 23
I would estimate 3,000,000 to $5,000,000 in automation costs, understanding that it requires change on both the child support case management system, as well as Okay.
Speaker 1
And is that the same automation that would be needed if, for some reason, one day we phase in the 80,000,000 portion of the state and county fund, or do you have to do a different approach?
Speaker 23
I think that the cost would likely be the same for the automation, it just would be done differently in terms of bifurcating that cost and passing through the state portion versus the state and federal portion.
Speaker 1
perfect. The report also mentioned, I think page eight of the report around, you saw that some of the previously assisted, when they got that pass through, they came out of poverty. Are we tracking how many people this is impacting and moving people out of poverty just for the help us when we're asking for this, like, look, it's people coming out of poverty.
Speaker 23
Absolutely. I think the really interesting thing to see is the number of people, and when we look at the disproportionality we see in the child support program as well, to see people lifted out of poverty. We don't have great data right now on the income of the person who receives that support. We would like to, as part of our impact office, work through looking at a lived experience advisory council, where we can speak to our participants directly and ask them about those impacts.
Speaker 1
So, might also be some of the hindering if we want to do a currently assisted families, how much of them could be lifted out of poverty?
Speaker 23
I think that is well known in terms of the combined research with the Department of Social Services and DCSS. There are two different reports that were done, and that one was sent in about October from the Department of Social Services, and that looked at potential mitigation impacts. If we increase the disregard, folks would time out on aid because there is a sixty month time clock limit for receiving cash aid, but by receiving both the cash aid and the child support, they would more likely be able to reach financial stability faster.
Speaker 1
Do you have, by any chance, in that October report, the amount of people that would meet that threshold of the currently assisted?
Speaker 23
They did have some estimates. This is I'd have to find the page for that. They do have some fiscal estimates for the number of people that they believe would be timed out on aid Wow. Due to there is an unticking concept that we have in California where any amount of recoupment, it kind of gives the person back a month of eligibility if that amount is repaid. So, with the arrears pass through, those months do not untick because it's not recouped.
It's paid to the family. Yeah. So, the same would happen for the currently assisted family. So, they would time out of aid, but that's because they reach financial stability.
Speaker 1
Have we looked at if we're doing that for the currently assisted families, getting them out of that, is that in a sense a savings if they're no longer on CalWORKs?
Speaker 23
Yes, this report, that supplemental report from social services does provide an estimate of savings in terms of CalWORKs benefits from full pass through of child support.
Speaker 1
So, it's an annual investment of 150, but it will be less overall because they won't be on CalWORKs?
Speaker 23
I think it would still be there would still be cost associated with it, so it wouldn't entirely pay for
Speaker 1
cost neutral. Exactly. Okay. All right. Thank you so much for that.
Female Thank you. Now we can move on. Department of Public Health. Hi. Good morning.
You may begin. Sorry, Doctor. Helps
Speaker 10
turn that on. Yes, good. Actually, it's yes, still morning. Chair members, I'm Doctor. Erica Pond.
I'm honored to serve as your state public health officer and director of the California Department of Public Health for the last year. And I want to thank you, Chairman DeVar, the legislature, and this committee for the opportunity to share an overview of CDPH and some highlights on the state of the public health in California and for your ongoing partnership to protect public health. And just process, think I was going to combine issue twelve and thirteen a bit, and then we could go.
Speaker 10
yes. Okay. So, as far as an overview of the budget and program, just briefly, CDPH works to protect public's health and shape positive health outcomes for individuals, families, and thriving communities. We do this in close collaboration with local health departments and state, federal, private, and community partners 20 fourseven. As far as thinking about the CDPH programs as an overview, you can think about them in three big categories: monitoring, protecting, and promoting health.
In the monitor category, maintaining vital records and statistics, ensuring accurate statewide birth and death data, tracking reportable diseases and other significant public health diseases and threats and issues, and then protecting, preventing and controlling infectious diseases through education, surveillance, and response. Safeguarding environmental and consumer health including food safety and broader environmental health protections protecting patient safety by oversight of healthcare settings and quality standards preparing for and responding to public health threats and emergencies, strengthening readiness and resilience across communities, and delivering reliable public health laboratory services and timely information about health threats to guide decisions. Promoting health requires thinking about policies, systems, and environmental approaches to promote health and prevent chronic conditions such as heart disease, cancer, asthma, diabetes, and obesity via statewide prevention and health promotion programs. We also, underlying all of this, always work to advance health equity by focusing on disproportionately impacted communities and reducing disparities in outcomes. For twenty six-twenty seven, our CDPH budget includes $5,100,000,000 This includes $626,000,000 of general fund, 2,200,000,000.0 of special funds, federal funds is $2,300,000,000 and of note about 45% of our total budget.
Our state operations total is $1,800,000,000 so about a third, 35%, and our local assistance total is $3,300,000,000 Moving to the state of public health testimony, I want to just sort of convey that as your state public health officer, I consider the whole state of California as my patient. And today I'm here to share some highlights on the health status of the state and trends in California. You will be getting a very detailed written highlight and full state of public health report and there's a lot of very detailed information in there about California's population health status throughout the life course. Our full report identifies opportunities for population health improvement and highlights public health emergency responses and shares strategies and programs that address these areas. This morning I'd like to just start with some highlights and our major public health achievements and progress.
We can be grateful that public health investments and other efforts have contributed to significant and measurable improvements in the health of Californians for the past fifty plus years. In 2024, all cause mortality, cancer death rates, and cardiovascular death rates dropped to all time lows, and life expectancy reached an all time high. California can be proud to say that we have one of the lowest all cause mortality rates, infant mortality rates, and the highest life expectancy in the nation, thanks to the successes of public health, healthcare, and improved access to social drivers like education and healthy food that promote good health. I'm also very pleased to report we have finally turned the curve on overdose deaths, which decreased in 2024 for the first time in fourteen years. Collective efforts to increase access to naloxone, harm reduction services, substance use prevention and treatment, and culturally responsive community supports have all contributed, but we still have work to do.
We have now also achieved a consistent decline in sexually transmitted infections, including congenital syphilis, since 2021, after we saw dramatic increases since 2010. While this is also finally improving, these decreases are still three times higher than a decade ago. These decreases follow significant state and federal investments for public health to meet patients where they are and effectively test, treat, and prevent syphilis along with updated screening and post exposure medicine recommendations. California should also be proud that we lead on nutrition policy through executive action and first in the nation legislation in AB twelve sixty four to define and limit the harms associated with ultra processed foods and other harmful ingredients, phasing them out of school lunches by 2032. While we've made significant progress in those areas, there are concerning issues we must address.
Behavioral and mental health conditions are the major and increasing contributors to years lived with disability, hospitalizations, and years of life lost. Earlier I mentioned decreasing death rates in many areas, yet we're seeing increasing death rates in adults aged 25 to 44 years old driven by overdoses. When we look at impacts based on years of life lost, we see road injury, homicide, and suicide are additional leading causes for this age group. Statewide initiatives like the Children and Youth Behavioral Initiative, nine eighty eight suicide and crisis lifeline, suicide prevention and substance abuse prevention and treatment are all important to address this concerning trend. And thankfully, through the Behavioral Health Services Act, California will dedicate prevention funding for the first time to public health to lead a statewide population based prevention approach, where we can resource efforts earlier to promote social connection, resilience, and other prevention strategies.
While California's infant and pregnancy related mortality rates rank among the lowest in The U. S, severe maternal morbidity trends have increased between 2016 to 2023. And although pregnancy related mortality has improved post pandemic at fifteen per one hundred thousand births in 2022, it is still higher than it was a decade prior when it was nine point five deaths per one hundred births. Specifically, ongoing unacceptable racial disparities in pregnancy related and infant mortality with Black populations experiencing significantly worse outcomes must be addressed to turn these overall trends around. CDPH works with partners through programs like the Perinatal Equity Initiative and recently released our Black Birth Equity Action Plan to identify best practices and lays out a roadmap to close these gaps.
It's also important in public health and in this report to note that place matters. We see concerning disparities by region and place. For example, death rates were higher and life expectancy lower in rural areas compared to urban and coastal areas. Within counties we can also see huge gaps. For example, within LA County, the life expectancy in Redondo Beach is about 88 compared to the life expectancy in the Compton area which is 73.
That's a fifteen year gap. Identifying these gaps in health outcomes allows us to explore what are driving these health challenges and tailor prevention strategies and actions accordingly. I also need to emphasize that we continue to see increasing frequency and complexity of public health emergencies that we must stay prepared to respond to. Our emergency response center was activated for over 32 different and overlapping emergencies over the past five years. Given the overlaps, the cumulative days of activation added up to more than the five years.
We need a trained and resilient workforce and stable systems to support these public health emergency responses. Maintaining capacity to sustain these health outcomes we've gained is hard enough in public health, but amidst increasing natural disasters and public health emergencies, federal threats, and the acceleration in technology at an exponential pace around us, it's more important than ever to both preserve the resources we can and think creatively to innovate. We're really grateful for the future of public health investment to support previous gaps magnified during the pandemic. California is better prepared to communicate, coordinate policies, advance equity and community engagement, and respond to public health emergencies, including these federal actions. For example, the future public health allowed for a swift and coordinated bird flu H5N1 state and local response with enhanced rapid disease detection and investigation education and outreach and strengthened our multi sector collaboration.
After the devastating LA fires, the Eden fire shelter outbreak and infection control response was and recovery were possible with future public health funded staff. Other examples of the impacts of these investments include a CDPH wide intelligence hub and expanded emergency response training exercise and evaluation. At the local level, the Future Public Health supports mobile health staff to better reach and serve residents in rural underserved and isolated areas, meet the health and social services needs of farm workers, and has supported effective management of a large hepatitis A outbreak among the homeless to name just a few examples. Support for sustainable and modernized data systems remain critical to help us track, investigate, and manage cases, contacts, and outbreaks, manage vaccines, and monitor and respond to these health trends to protect the public. Public health cannot do our job alone.
As we navigate the volatility and challenge of this moment, we will continue our cross sector collaboration, innovation, and communication, and we're grateful for our talented and dedicated public health workforce, support from the legislature and the governor, and the opportunities amidst other world class leaders in our great state to forge ahead together to build a healthy California for all. Thank you for this opportunity to share California's health status. So I can pause there before we get to other questions. I have a lot of responses about our federal response too, so we could either do that next or we can talk about this for
Speaker 1
Let just do some questions on the report. What is California's life expectancy? I know you gave two cities. Do have it for all of California?
Speaker 10
And we will have some leave behind graphics that sort of pulled out from that report, but let me see if I can look quickly here. Our total life expectancy, looking at one graphic, is a little bit over 80. Okay. But we'll well, there's some graphics in that report, and we are definitely going to pull out
Speaker 1
some And you have, like, in the report, you can find every city's life expectancy?
Speaker 10
You cannot find every city, no. But we do have a geographic map showing sort of by regions, yeah.
Speaker 1
Great. And then on the behavioral health, those are the trends where we're going the opposite way. Is there an age group in particular that you found that
Speaker 10
Yes, as far as death rates, 25 44 year olds, we have increasing death rates, and the leading cause of death is overdoses in that age range.
Speaker 1
Wow, okay. Yeah. And then in the graph, it shows, you know, the allocation of where the funding comes, and last year, 45 the past couple of years, it's been 35 to 45 from the federal government. I know, given all the attacks and I don't know if this is part of your next presentation what do we anticipate that percentage should look like for this upcoming year?
Speaker 10
It has been a roller coaster, and I am going to talk a little bit in sort of the next question. You know, we the main cut so far that has actually happened and not been sort of blocked by either legal intervention or others was our nutrition and physical activity branch in HR1. The rest of it, the congressional budget that passed, actually it was fairly level, but then we had this threat of terminations last week. And I can talk more in detail about that in a moment.
Speaker 1
Then, I wanted to ask you about, you know, tobacco use and smoking is here in part of the report, prevention. Are we looking at youth in particular and the uptake in vaping as an issue under public health?
Speaker 10
Yes, our tobacco control group does look at vaping as well, and yes, is seeing sort of a replacement of cigarettes with vaping.
Speaker 1
In the report that you do, you know, is it like policy recommendations that come out of it, or here's the data, everyone figure it out?
Speaker 10
It's sort of a mix. In this report, as you can see, it's quite detailed about both the data, and then we do highlight some of the programs that we have or we work with partners on. There's some highlights on sort of achievements. There's, you know, and then we do have different sort of roadmaps for different things. I mentioned the Black Birth Action Plan.
We have a violence prevention roadmap now. So, there's sort of highlights in different areas. Some of them have more information than others about sort of actual interventions or strategies.
Speaker 1
And are you going to I'm just trying to see if the question is supposed to answer. Yeah, I think you're going to talk about the West Coast Health Alliance.
Speaker 10
Yeah, maybe can I talk a little bit about federal sort of response? Go ahead. Then they're happy to answer questions about this too. And admittedly, I kind of combined them in the anyway, so I think, as I think about the state of public health in general, the reality is in California and in our nation, our public health system is under attack. Our investments in prevention, protection, and improvements in health over the past few decades are all at risk due to these federal actions.
And we've always experienced sort of cycles of boluses of resources during and after a public health threat followed by dwindling and reduced support and funding, but I've never before witnessed such intentional and methodical attempts to dismantle the entire system. Specifically related to federal funding in your question, it's important to know that when you look at a CDC budget, 80% of that money goes to state and local health departments. So, when you see a potential cut of half, that means, you know, a huge, huge cut. And so, that's what we were facing in the middle of last year. And then, I already highlighted, but just to reiterate, about two thirds of our budget does go to local partners.
And then you've already asked about the 45%. So that's been for the last couple of years stable, and again, we've just been watching up and down. But we've been on an unpredictable and stormy course with multiple threats of funding cuts over the past year. Last March, and again, just this month, there were proposed rescissions of large and critical grants adding up to hundreds of millions of dollars and funding hundreds of positions at the state and local level. And then thinking about policies and loss of federal public health leadership, the dramatic dismissal of experienced public health leaders and programs at the federal level have far reaching impacts including loss of technical assistance, reliable data, data privacy, and other federal policies have been based on misleading information and unsupported claims.
This has also sowed a lot of confusion and public distrust in science, medicine, and public health. One of the most alarming areas is the devolving federal vaccine policy changes which can impact vaccine access and uptake. And I'm thankful for our strong immunization policies in California that have kept our communities safe from large outbreaks, but this success is at risk. We are seeing the highest levels of measles cases, outbreaks, hospitalizations, and deaths in The United States in thirty years, driven by populations with low vaccination rates. In California, which is the February, we already have almost as many cases in 2026 as we had all of last year.
And now we've had our first two small, but two outbreaks for the first time in five years, all in unvaccinated individuals. These declines in vaccination rates can result in preventable missed school and work and a greater burden on the healthcare system. A study over a twenty nine year period estimated that childhood vaccinations have prevented over sixty million infections, four million hospitalizations, and one hundred and thirty five thousand deaths to the tune of, these are all estimates, but sixty five billion of healthcare costs averted and $324,000,000,000 in societal costs averted for an estimate in California. I'm very proud and thankful to be part of our California efforts, to maintain evidence based vaccine policies and appreciate the partnership with this legislature to pass AB 144 to ensure Californians have access to life saving vaccines and screenings based on credible medical evidence. And I'll talk a little bit later about the timeline of that.
I know you had questions. So we've been fighting to sustain these hard earned public health achievements of the past several decades and maintain these capacities gained from resources added in the public health system overall during the pandemic. What we've been doing as a reaction to this over the last year that I've been director is refreshing our strategic priorities and really focusing on reimagining public health during this pivotal time. Reimagining includes prioritizing impactful efforts that are unique to our role and optimizing with a focus on efficiencies, partnerships, leveraging technology and creativity. And last December, we did launch the administration launched the Public Health Network Information Exchange or the Phoenix Initiative and we are partnering with national public health leaders to promote a more modernized and sustainable public health infrastructure.
Phoenix is going to strengthen our public health innovation, collaboration, and communication across sectors and at the state, national, and actually global level because of its loss in federal leadership. Over these past six months we formed partnerships including the West Coast Health Alliance, the four states of Hawaii, Washington, Oregon, a larger Governor's Public Health Alliance of 15 states, and we've joined the World Health Organization's Global Outbreak Alert and Response last September. Within California, we've created a cross sector public health for all Californians together coalition and with joint leadership with Covered California and our agency and UCSF to develop a cross sector network of public health and clinical professionals, health systems, academic and community partners to support public health and again strengthen partnerships so we can be stronger together. Communication is more important now than ever as well. Thus, we're working with the FACT coalition and an organization called Your Local Epidemiologist, which is also based here in San Diego, to formalize a community messenger network and better listen and respond to California's health questions and concerns with a project called Project Stethoscope.
I mentioned that the state is my patient and we're trying to listen more and also listening by using meeting the moment and how communications have changed. We're looking at social media monitoring, community driven insights, and targeted research because doing the traditional ways of media and outreach are not reaching people where they are. And then briefly, I'll just kind of talk about the AB 144 timelines and can turn to questions. So we did with AB 144, we created a brand new website. It's called Public Health for All, and it's a location where we are posting all of the immunization and preventative service recommendations pursuant to health and safety code 120,164, and this is the resource for the public, health insurers, and other stakeholders to look.
So, the minor changes we've made to the baseline immunization recommendations followed updates issued by the American Academy of Pediatrics and the American Academy of Family Physicians. So September, we posted updated recommendations for COVID, flu, and RSV vaccines in alignment with the AAP, AAFP, and of course that was in jointly with the West Coast Health Alliance as well. And then in December 2025, we updated recommendations for adult immunizations that the American Academy of Family Practitioners has. And then January, when the AAP updated their regular annual routine immunizations, we adopted that child and adolescent immunization. So we provide information to public and stakeholders following changes in federal immunization recommendations, including highlighting what we have not adopted.
So there were big changes in the federal immunization schedule in January that we have not adopted. So with AB 144, that website is where people can look to and what they should have access to, what health insurance regulated in California needs to cover. And we also have adopted a few new recommendations for preventive services from the U. S. Preventive Services Task Force post that 01/01/2025 date.
There one related to breastfeeding, some osteoporosis, and some other screening for another disease I'm forgetting. And these were very minor updates and deemed to be consistent with evidence based health guidelines. And we do have a procedure for making updated changes to immunization burden services recommendations. We'll post on the website and of course submission to OAL and filing of recommendations with Secretary of State to meet the statutory requirements. Maybe I'll pause then and get to and see what other questions you have about that.
Speaker 10
Keep moving on? Okay. So, was a question here about silicosis. Yep. Okay.
So we continue to conduct multi source surveillance for silicosis with an emphasis on engineered and artificial stone used to fabricate quartz countertops. As of February 19, we have confirmed five fifteen cases of engineered stone silicosis including twenty nine deaths and fifty five lung transplants. In 2025 alone, there were two fifteen cases more than any previous year and forty four cases already in this first couple months of 2026. Nearly all cases have occurred in Latino men and the median age is 46. We do have a dashboard now on our website as well that's tracking this and we recently published a paper on this in the American Journal of Public Health.
Just to highlight for everyone, know you're well aware, but want to, and thanks for your partnership on many of these things and leadership in this, February 2025 CalOSHA permanently amended its silica standard and prohibits dry cutting of engineered stone, requires advanced respiratory protection and added chest CT CAT scans to medical surveillance requirements. We now have the strictest requirements in the nation and the only occupational health standard for any exposure that requires that more sensitive chest CAT scan rather than a chest x-ray. And then in June 2025, we made silicosis reportable in California. So now we can track this even more closely. Then in October, Governor Newsom signed SB20, which is a Silicosis Training Outreach and Prevention Stop Act.
This assigned responsibilities to our department related to surveillance, education, and technical assistance, and improves the data sharing between CDPH and CalOSHA and our local health department partners. We do have four additional positions in the Auk Health branch that were included in the twenty six-twenty seven governor's budget. And then in November, as far as the last sort of thing that we've done more recently is another health provider alert that was released. We had done one in July 2023, but we issued it again to just increase awareness with providers, especially occupational health providers and local health departments about these growing case numbers and the requirements to report so that we can investigate and track this. There was also information on diagnosis and just how to report to us and information dissemination.
Speaker 1
I've visited the dashboard. I was just quickly refreshing my memory last night. And yeah, it seems like we might be on track to surpass our twenty twenty five cases. What more, you know, I know Cal OSHA plays a big role in this, so, you know, not all the onus is here, but is there a bigger role CDPH can play in this with silicosis?
Speaker 10
I think our role in general is really about training and education and working with awareness.
Speaker 10
Our occupational health team has been working really closely with CalOSHA and others that sort of take care and doing a lot more outreach to communities and to healthcare providers.
Speaker 1
I mean, even one of the reports from CDPH I saw, maybe it was on the actual report? Yeah, it was on the actual report. Yes. Perfect. On page 106 of the actual report, it said that it's really hard to prevent, if I'm not mistaken.
Give me a second here.
Speaker 10
While you're looking, can just acknowledge that these are very, very fine particles, it is very hard to prevent. An inhaled, you know, imagine sort of, you know, cutting silicone and it's just very, very fine particles that it's very easy to
Speaker 1
Controlling exposures to levels low enough to prevent disease is technically challenging, costly, and rarely feasible. So it just seems like we're going to continue to have cases. I just I don't want to see more of young men die. I just I'd love to continue just to find actual solutions here. I mean, I guess the only thing you would do is ban it, but like I'm just trying to find another solution in this space.
So I'd love to have you as a partner in that space.
Speaker 10
Yes, happy to talk offline around that. And some of this increased resources will help us do more outreach on this too that, of course, just came
Speaker 10
Sure. Question four. So, an update on the transgender, non conforming, intersex wellness and equity fund. So, since 2022, there's been a total of $27,100,000 that has been transferred to the Two Spirit Transgender, Gender Nonconforming, and Intersex Wellness and Equity Fund. We, call it the Two TGI Fund for short.
And, let's see, and there's $10,300,000 in FY twenty two-'twenty three, of which $6,800,000 was reappropriated, in 'twenty five-'twenty six for expenditure through 'twenty seven-'twenty eight, dollars 12,300,000.0 in FY 'twenty five-'twenty six for expenditure through FY 'twenty eight-'twenty nine, and then 4,500,000.0 in the FY twenty five-twenty six transfer from the ADAP Drugs Assistance Program. To date, we've awarded 80% of the local assistance funds appropriated to that fund, and this includes 40 grants to 23 community based organizations totaling 21,600,000.0, and these fund programs as outlined in the code. We're in early stages of planning for the release of the remaining 5,470,000.00 plus an additional $9,000,000 representing the planned transfers from the ADAP fund in each of the next two years, and we'll be issuing additional requests for applications in FY twenty six-twenty seven that will allow TGI serving organizations as defined in statute to apply for programs that include the expanded categories approved in last year's AB1487. Seven. So that would include diversion programs supporting transitional age to TGI youth, programs providing resettlement and social integration for two TGI asylees and immigrants, and workforce development training.
And then we'll publish these ARPAs for new and existing funding categories. Eligible community based organizations will drive the geographic and topical distribution of funding and services. And then our state ops funds are the resources to administer this fund.
Speaker 1
80%. Good on track. Okay, perfect. Thank you. Sure.
And the last question?
Speaker 10
Sure. The last question. I think I partially answered it in just sort of what we've been doing, And I think, you know, we're actively assessing how to mitigate these possible impacts. We did have, again, an informal threat last week to some of these HIV prevention and STD prevention and control grants last week that then we never actually got the full notice of awards, but we were told that Congress was notified. So, this is part of our roller coaster, but we are, you know, again, evaluating possibility of leveraging part of that sixty five week So, the
Speaker 10
No. They did not ever even issue the actual terminations, because then the lawsuit was filed, and my understanding is that's applicable. So, we got terminations for the public health infrastructure grant, and the climate related grant, and then we also got a follow-up showing that those were rescinded, and then the other notices were informal to Congress, but we never got formal notifications, but
Speaker 1
That's where the waste is, if anyone's, yeah, okay. Thank you. Perfect. Will, anything to add to any of that?
Speaker 15
Will Owens, Legislative Analyst Office, nothing specific to add to any of the presentation on these informational items, but just wanted to flag that given the chair's interest in the rise in mortality among young adults, 22 to 45, generally, recently, our office released a write up on that specific mortality increase age range, specifically focusing on the overdose death and some of the nuances within that. So through the chair, we'd be happy
Speaker 1
Yes. Thank you. Thank you, Will. Appreciate it. Thank you for the presentation on those two items.
Moving into, Issue 14.
Speaker 25
Good afternoon. Adrian Barrazza, Department of Public Health. I'm happy to start off with an overview of our Saphyr BCP, and I believe there is a follow-up question that I can respond to. So CDPH is requesting 15 positions and $24,500,000 in fiscal year six-'twenty seven, dollars 18,500,000.0 in 'twenty seven-'twenty eight, and $3,700,000 in 'twenty eight-'twenty nine and ongoing for MNO support of SATFIRE system. Ongoing funding is intended to support staff that are needed to plan to reduce reliance on the vendor and begin to transition some of the workload over to state resources starting in fiscal year 'twenty six, 'twenty seven.
And then I'm happy to move over to your other question. So essentially, we are working within the administration to assess all viable options to identify funding to support these systems.
Speaker 5
Riley Thompson, Department of Finance. So the administration is currently assessing the realm of the public health IT infrastructure. We're doing so within the understanding of the budgetary constraints that the state is facing as a whole, but that's an assessment that the administration is currently conducting.
Speaker 1
What would be the manual process that would replace all these different IT systems?
Speaker 25
That's a great question. So we would slip back into a time where we aren't able to handle the large data volumes that we have now. Certainly, we're nowhere near specific regard to Saphyr at the volume of submissions we were at the peak of the pandemic, but certainly, we are the submissions we get now exceed pre pandemic levels, and the current technology that we have is sufficient to support that. Without funding for Saphyr, we and, you know, we wouldn't have the ability to handle that volume of intake.
Speaker 1
And then, I mean, for the other four IT projects that are not getting funded, what process what that process looks like, that manual process for those?
Speaker 25
So I may need to call on Doctor. Watt to assist, but we exactly that, is that processes would become manual. Things would have become slow. We wouldn't have access to timely data. That would disrupt our ability to respond to emerging infectious diseases in a rapid manner, and that can lead to increases in disease burden and impact to the public.
Speaker 1
Like, for example, like, my Calvec? Calvec? Yeah. Like, what would it look like if we no longer have that? What do we go back to?
Speaker 26
We had a system prior to the pandemic that we used. That system is no longer viable. And so we we don't have a backup system for ICVAX.
Speaker 1
Okay. So the IT programs don't get funded. There's not even a system we can go back to? No. Okay.
So then what happens?
Speaker 26
We would not be able to do to carry out the functions of those systems. So we wouldn't be able to track our the vaccines that are administered through the immunization registry.
Speaker 26
The diseases could be tracked through Sapphire. So that's the intake system, and then the existing CalReady system is able to, you know, receive those data from Sapphire and categorize cases of illness, and then we use that to track the disease rates and things like that.
Speaker 1
I'm wondering, as a regular Californian, we invest a lot of money into uplifting a program, and then we let it fall. Is are we wasting? I mean, how do we describe that action?
Speaker 5
Riley Thompson, Department of Finance. I would just reemphasize that the administration is currently undergoing an evaluation of these public health IT systems. You know, we're not able to speak to any future proposals that might come forth, but the intent of the current evaluation that's taking place is to help us understand and prioritize and move our public health systems forward in light of this fiscal picture and overall budget, and it will help us inform any potential future proposals that may come forth. Okay.
Speaker 1
Does the lack of investment in these IT programs impact our what's the acronym again? What Doctor. Pan just talked about, our collaboration with the Western States?
Speaker 26
I don't think so. The work of the West Coast Health Alliance is primarily to look at evidence around disease trends, we would be able to track those, but also evidence that's happening that's coming from external to the department, so academic centers, vaccine manufacturers, and things like that. So we would continue to be able to do the work of evaluating that kind of evidence and basing our recommendations for vaccination on that. Okay.
Speaker 15
Will Owens with the LAO. Nothing down at this time, but available for questions.
Speaker 1
This is not specific to this. Maybe department manager, maybe you can answer it. The governor talked about bringing on two CDC officials to should I have asked you, Doctor? If you have an update on where we are with that?
Speaker 10
Sure. So, as part of that public health network information exchange, I mentioned, that was bringing on two, actually three advisors, and, I talked briefly about their kind of the way we think about their role and their pillars are innovation. So, Doctor. Susan Colominares, who was the prior CDC director for about a month, who also had worked in ARPA H, which is another sort of research and innovation arm of the federal government, advising us to really think about innovation and private public sector partnerships related to innovation and health and health data. And then Doctor.
Deb Howery, who was the prior chief medical officer for the CDC, is helping us with a lot of these collaborative efforts. So, she's working with us with West Coast Health Alliance and also with Governor's Public Health Alliance, helping us sort of as we our team is also tracking global threats more closely, so she's just helping us be a link across, and we're also she's helping us work with you may have heard there are other regional collaborations that are emerging, like the Northeast Public Health Collaboration of in the sort of New England area and New York State, And of course, with our existing partners across the country. So, there's an association of state and territorial health officials. So, Doctor. Howery has really been our collaboration sort of lead.
And then, were the two from CDC. Although, Jettolina had also been advising CDC under the prior administration, and she's the one really helping us with Project Stethoscope and the Community Messenger Network.
Speaker 1
How does that I mean, mentioned the first doctor, the first CDC person for a month that came on, working with health data, but we're cutting the IT systems that have and collect the health data. So, we're look it sounds like we're going to focus on global health data versus in house health data.
Speaker 10
Related to the global information, part of our joining the Global Outbreak Alert Response Network is being able to have access to that global situational awareness, and some other open sources that are happening. And then in general, I think this is really helping us to bridge with private partners as well, and really hoping to have a cross sector partnership with academics and private sector related to improved health care data trends.
Speaker 1
On the Phoenix and all that, wouldn't the IT programs that are wouldn't all these IT programs play an organic role with the Phoenix?
Speaker 10
We need these the way our current information systems are supporting this work is sort of the core. And I think the goal for the Phoenix Innovation is to really, excuse me, work more on interoperability and work more broadly across sectors.
Speaker 1
I don't know how you get to that if the systems aren't there for you to work broadly across sectors. Okay. Okay. Thank you, Doctor. Appreciate it.
I know I've been in this committee talking a lot about IT and, you know, programs. I'm not a fan of IT programs, but I'm just some of these play a really good role in collecting data. Okay, great. Thank you so much for the presentation on issue 15.
Speaker 25
So I'll follow-up with an overview on our vector borne disease program, BCP. The department is requesting $50,000
Speaker 1
I'm sorry, so sorry. I did have one more question on SAFIRE, just a clarifying question. Okay. So for the 24,000,000 in twenty six-twenty seven, is that and I can't remember is that so that's on top of what we included already for 2627 of the $20,400,000 that was in the budget last year?
Speaker 5
Can jump in. Riley Thompson, Department of Finance. So, the agenda does not accurately represent the resources that were granted in the '25 budget act. So, just to clarify, what was granted within the 2025 budget act was 27,100,000.0 in twenty twenty five-twenty six for Sapphire. There were not any additional resources beyond twenty twenty five-twenty six.
Speaker 1
So, it's not on top. It's just a standalone? Correct. Thank you for that clarifying answer. Okay, back to Issue 16.
Speaker 25
Okay, thank you. So, as I was mentioning, the Department of Public Health is requesting $50,000 in fiscal year 'twenty six-'twenty seven, and ongoing from the vector borne disease account to fully support program operations necessary to administer the vector control technician certification program, which is increasing cost due to increases in salary and benefits for the position managing the program. And I'm happy to take any questions you may have.
Speaker 24
Good afternoon. California Department of Public Health requests $3,640,000 in increased expenditure authority for fiscal year 'twenty six, 'twenty seven for our baby big program or infant botulism. It would include increases would be for manufacturing, stability, storage, and distribution costs, and associated regulatory requirements. As you know, CDPH is the sole manufacturer and distributor of Baby Big, and it's the only FDA approved treatment for life threatening disease infant botulism. It's a revenue generating, self funded program, with through Baby Big fee income revenue.
It requires the augmentation of authority to meet the increased costs associated with development and manufacturing of the next lot of Baby Big, and on a quicker timeframe to meet increasing demands. As you know, we had an unprecedented fifty one cases in the last year related to infant formula, and that's compared to our normal annual rate of twenty cases per year. Additionally, the program needs to take over the stability testing of the recombinant botulinum vaccine, as the Department of Defense will no longer be providing that service.
Speaker 1
Thank you. Any questions? No questions. Anything to add? Great.
Thank you so much. All right. Thank you. Issue 17.
Speaker 22
Good afternoon, Chairman Givarr, members of the committee. My name is Joseph Lagrama, branch chief of the ADAP branch with the Office of AIDS. I'm happy to provide an overview of the ADAP estimate. For twenty five-twenty six, the Office of AIDS estimates the ADAP budget authority need will be $444,000,000 which is $42,700,000 lower than reported in the 2025 Budget Act. The 8.8% decrease is driven primarily by lower medication and insurance premium expenditures than previously estimated due to decreased caseload projections.
Additionally, there are refinements to health trailer bill components that shifted from local assistant expenditures to state operations expenditures. For twenty six-twenty seven, the Office of AIDS estimates the ADAP budget authority need will be $443,700,000 which is $43,000,000 lower than reported in the 2025 Budget Act. The 8.8% decrease is driven primarily by the expiration of one time investments. Writing question number two, I'll defer to the Department of Finance.
Speaker 27
Nicholas Schiller, Department of Finance. For the two loans taken out of the ADEP Rebate Fund to the General Fund, I'll start with the first loan. A $400,000,000 loan was taken out in twenty three-twenty four and is expected to be repaid in twenty twenty seven, twenty eight, and a $500,000,000 loan was taken out in twenty twenty four, twenty five and is expected to be repaid in twenty twenty eight, twenty nine. The condition of the fund balance is at the beginning of the current fiscal year it was $323,000,000 and at the end of the fiscal year $239,000,000. The terms of repayment are that if either the ADEP rebate fund is in need of increased funding, then the loan can be repaid at an earlier date, or if the general fund no longer requires the funding.
Speaker 1
You're doing great. You're doing great. Okay, perfect. Can jump into questions. I'll start with you.
Can you clarify if the need if there's a need earlier, then it can be repaid earlier? Correct. Okay. I'm I'm wondering, given this current administration, is there a worry that the funds from the loan has been utilized for general fund, and that is there any attention to that? Are we worried about any of that in terms of repaying it back sooner or anything like that?
Speaker 27
So, because it's ultimately a loan, the way that the loan is used is not particularly critical because it will be repaid to the fund.
Speaker 1
Okay. And are we confident that the first loan payment will happen next year, and is that included already in the structural deficit of $20,000,000,000 perhaps?
Speaker 19
Sonal Patel, Department of Finance. So, on the first question, I think the department might have more to offer on the potential risk, but I can acknowledge the second. The governor's budget does currently project the loan repayment on the timeline that my colleague has mentioned. And apologies, Madam Chair, there was
Speaker 1
No, I think that was it. I think I just added. Would you like to add a little bit more on the liability part?
Speaker 1
Maybe that. Okay, perfect. Thank you so much. And then can we get a little bit more on the I think it's called the DIS workforce beyond this fiscal year investments.
Speaker 1
Yeah, just like long term strategy the administration has for the workforce.
Speaker 28
Right now, it's not in the ADAP estimate package. It was for this current year. Yeah. But it's not
Speaker 1
I guess I'm wondering, you know, hearing the report on the public health and the decrease we've had in STIs, is there a correlation? Because we've had, you know, this investment in the workforce. If we no longer have an investment, is that going to increase our STIs? I'm just wondering if we're looking at it that way or not.
Speaker 28
I'm not sure. I think having more funding, of course, we have been able to track the STIs better. DIS workforce is really needed. They do STIs, HIV, MPOXX. Having more funding, we were
Speaker 1
able to have Is that an eligible What was that? Is can you sorry, let me rephrase my question. Can you take out of the fund to pay for the workforce continuing payment? We did. Yeah, but can't And we you
Speaker 1
Because someone, like, you know, today, LA County mentioned the $50,000,000 that they're cutting, and specifically, it was, like, STI testing in particular. So, it seems like there's a need there. Yes, agreed. Okay. Let me see what else I got.
Speaker 19
And Madam Chair, I would just note, if there is a specific proposal that the legislature is interested in, we are able to provide technical assistance on.
Speaker 1
Perfect. I think the next one is going to be a stakeholder proposal, and I'd love your feedback on that after. Okay. I think I'm good for right now.
Speaker 30
Chairman Jevar, my name is Jonathan Froxweig. I'm testifying today on behalf of End the Epidemics, a statewide coalition of over 120 organizations advocating to end the interrelated epidemics of HIV, STIs, hepatitis, and overdose. These epidemics are harming hundreds of thousands of Californians, especially LGBTQ and BIPOC Californians, and cost the state's health care system billions each year. We already know what strategies work against the epidemics. Many are already being implemented in California.
However, they aren't being implemented at the scale needed to make meaningful progress due to severe underfunding. To give one example, in CDPH's last round of funding for PrEP navigation, a proven HIV prevention strategy, the department had less than $2,000,000 to award but received requests totaling over $35,000,000 The underfunding of these services is entirely unnecessary. According to the governor's budget, the ADAP rebate fund, which is restricted for use on HIV related purposes, will run a $2.00 $3,000,000 surplus in twenty twenty six-twenty seven. In addition, California has millions of dollars in opioid settlement funds intended for overdose prevention and substance use services. In other words, the state has more than enough resources to adequately fund HIV, STI, hepatitis, and overdose services.
That's why the End Epidemics Coalition is urging the legislature to use ADAP rebate and opioid settlement funds to make eight vital investments in these services. Building on existing effective CDPH initiatives, these investments include funding for HIV linkage to care, STI screening in emergency rooms, hepatitis C testing, overdose prevention programs, and other literally lifesaving efforts. The coalition is also requesting trailer bill language, and for that request, I'll hand things off to my colleague, Sebastien Perez.
Speaker 31
Thank you. I'm Sebastien with APLA Health. So we're also urging the committee to reauthorize CDPH to use ADAP rebate funds to backfill funding for HIV syndemic services cut by federal action. Last April, as you may remember, APLA Health and dozens of other organizations in LA received notices of contract termination for our HIV prevention services. The reason was ultimately that the CDC had failed to issue a notice of funding award before contracts expired.
This funding disruption forced us to lay off six staff and countywide we estimate that around 200 employees were either laid off or close to it. So to prevent similar disruptions, ETE and the LGBTQ caucus successfully pushed to authorize CDPH to use ADAP Rebate Funds to replace lost federal funding. That authority expires on June 30, and the AG's present lawsuit over federal cancellations of HIV grants points to future troubles for our services. ADAP Rebate Funds ought to be available to save HIV related programs. Please reauthorize this lifeline from the ADAP Rebate Fund.
Thank you very much.
Speaker 1
Thank you so much. Department of Finance, one of the requests in this proposal is for rental assistance and housing services. Is that an eligible item?
Speaker 19
We need to defer to the Department on that one. We don't have that SME, and we just know we just learned of this proposal last night when the agenda was released, so we don't have any specific comments at this time but can provide technical assistance to the chair with like for us to do that.
Speaker 1
Do think, you know, one of the examples that was given last year, I know we were part of that, where L. A. County was struggling, you know, was getting cut funding, and we were able to include the funding. I'm really glad that we did that. Do we need to provide additional statutory authority to the Office of AIDS to be able to use excess ADAP funds?
Is that a need, or is it just maybe I can ask myself, but I'm just wondering, or is this just a is this just part of the budget process in that?
Speaker 19
So the current budget process is a twice a year annual estimate process, which I think the chair is aware of. And through that process, the department and finance work together to identify priority proposals for funding in the current and budget year. I'm not sure if
Speaker 1
that's So we need to do anything else, right, outside of the budget conversations to meet any of these needs, I guess. Know what, I'm going take that question back, never mind. I would defer to my staff after the meeting. To the proposal investments in front, can you repeat the number you said that you believe the ADAP fund has? And DOF, is that the number that you have as well?
Speaker 1
okay perfect okay well we'll continue to have these conversations As you just heard of this proposal, we'll have we'll continue to talk about this and see if we can do anything in this space. Thank you so much.
Speaker 1
That concludes all our presentations. We're now going to be moving into public comment.
Speaker 11
Good afternoon, Madam Chair. Craig Pulsar on behalf of Equality California in strong support of the proposals for investment from the End the Epidemics Coalition.
Speaker 32
Madam Chair, George Miller on behalf of the California Association of Health Plans. We very much appreciate your comments about the lack of priority on EMS' part in providing the legislative required ground ambulance rate report. As you know, CAPP has to put our membership plans have to live under Office of Health Care Affordability's rigid, growth CAPS, and this we see this report as an important first step in towards trying in terms of trying to deal with cost drivers. Thank you very much.
Speaker 33
Good afternoon. My name is Rebecca Gonzalez, and I'm speaking today on behalf of the Western Center on Law and Poverty, Grace and Child Poverty California, and the Truth and Justice and Child Support Coalition. We appreciate the legislature and department's work to put families first in California's child support system, and we'd like to uplift the following priorities. We appreciate the partnership to prioritize the implementation of 100% pass through of child support payments to families who are currently receiving CalWORKS. Grateful for the work the legislature has done to provide full pass through for families no longer enrolled in CalWORKS, and it's time to end this harmful practice of the state paying itself back in the back of our lowest income families.
We also want to address uncollectible government owed child support debt, and to address the legacy of this harmful policy. DCSS should move quickly to implement current authority in the Family Code and cease enforcement of uncollectible state assigned child support arrears. And then lastly, we have two legislative priorities. One is to limit occupational license suspensions for past due child support payments to non custodial parents with higher incomes only. They're subject to license suspensions.
Our coalition is sponsoring this bill with Assembly Member Celeste Rodriguez, AB 2,195, so that low income non custodial parents are still able to seek job opportunities so they could actually pay child support. And lastly, we seek reforms to the debt reduction program in AB 2,395 by Assembly Member Sharp Collins to make that program more uniform and accessible and able to achieve the goal of providing individual debt relief to noncustodial parents. Thank you.
Speaker 29
Good afternoon, Madam Chair. Jack Anderson with CHIAC, representing our local health departments. Commenting on items within CDPH, just to provide some context, just want to underscore the great overview provided by Director Pon in that local health departments are facing unprecedented funding challenges as COVID era funding expires this July and potentially sooner with some of the recent federal attempts to terminate grant funds with the current restraining order through mid March. Health departments may begin to see their workforce and infrastructure return to pre pandemic levels. Did want to provide comments on CDPH IT systems.
CHIAC does express support for the governor's proposed investment in the Saphyr system, and we do urge the legislature administration to provide $97,600,000 for key public health IT systems that are not funded, including the My CAVAX system, CalConnect, the California Immunization Registry, and the Future Disease Surveillance System. Without funding, these systems are slated to end on 06/30/2026, with significant impacts to state and local health departments, including a return to less efficient administratively burdensome and manual work processes, including Excel spreadsheets, cold calling, faxing, and emailing, lab results, etcetera. So this is really key that these investments are provided to sustain these systems. Next, related to the ADAP rebate funds, GEAC does request $18,600,000 in ADAP rebate funds for the disease intervention specialist workforce. This program was previously supported with federal funds that expired earlier early this calendar year, and the 2025 budget act did provide a one time investment to support this investment.
It is supports 150 staff throughout local health departments in the state addressing STIs, so we do urge the legislature administration to provide those
Speaker 1
You said it also positively. Tiffany White with SEIU California. Just wanted to second the comments made by my colleague at CHIAC. We're definitely proud to be in partnership with them and health officers to guarantee that we have the investments needed for our public health IT. Thank you.
Thank you.
Speaker 6
Good afternoon, Senator and members. My name is Ash Wilhelm, theythem pronouns. I'm a graduate social work intern with Safe Passages in Alameda County, which is a member of the CRDP, which is the California Producing Disparities Project. And I'm speaking on behalf of Safe Passages and REMCO, the Racial Ethnic Mental Health Disparities Coalition.
Speaker 6
As the state implements BHSA and aligns funding with priority populations, we wanted to emphasize a central point. Prevention and early intervention infrastructure must remain intact during this transition. Many individuals now identified as highest needs, were once served or could have been served in community based prevention systems. However, if upstream capacity contracts, then the costs and demands will continue to rise. We are particularly concerned about the anticipated sunset of the CRDP funding this fiscal year.
CRDP has built culturally responsive prevention ecosystems and communities that are now explicitly named in BHSA priority populations, allowing that infrastructure to lapse risks widening disparities at this very time that the state is trying to reduce them. We encourage sustained investment in culturally responsive prevention, peer infrastructure, and community defined evidence practices as a part of your budget alignment of the budget alignment. Thank you for your leadership and consideration.
Speaker 1
Thank you. Come to government after you get your MSW, okay? Okay. We need more social workers here.
Speaker 35
My name is George Cruz on behalf of the California Behavioral Health Association. Our members contract with counties and serve justice involved youth, individuals with developmental disabilities and people experiencing behavioral health crises and they're reporting that demands for service remain high but the workforce capacity is strained. We support the state council on developmental disabilities request for administrative support as stable infrastructure allows for the coordination across systems for individuals with developmental disabilities who rely on behavioral health providers. We also support the emergency response budget request as emergency medical services are a central part of the behavioral health crisis continuum and reduce downstream hospital and justice system costs. And finally, just echoing on what our colleague said about CRDP, the California Reducing Disparities Project's funding ends this fiscal year.
CRDP does support culturally responsive community based prevention and early intervention, and these programs reduce crisis utilization, hospitalizations, and system involvement, and allowing funding to lapse will increase the long term costs. Additionally, giving ongoing changes to the behavioral health system due to Prop one, major shifts are already underway in counties across the state, and several prevention and early intervention providers are seeing their contracts cut and existing gaps in care are widening. The state cannot afford to lose the essential coverage CRPD provides in communities in every area of California, so we urge the continuity and sustained investments in provider networks. Thank you.
Speaker 36
Good afternoon, Madam Chair. I'm Katie Van Dyne with Health Access California. We were the sponsor of AB seven sixteen to ban surprise ambulance billing. We appreciate your questioning about the missing ambulance reports. We think these reports are really important for the implementation of the law by the Department of Managed Healthcare and tracking healthcare costs as they affect consumers' premiums.
As well, we would support funding allocations to ensure that the reports are completed, the missing reports and future reports moving forward, and asking for a timeline for the missing reports. Thank you.
Speaker 37
Good afternoon Chair, Laura Thomas with the San Francisco AIDS Foundation and a member of the End of Epidemics Coalition. Thank you for your questions and your focus in this hearing. We do believe at ETE that legislative language is needed to ensure that the California Department of Public Health has the authority to spend ADAP rebate dollars on, backfilling, federal cuts. And I also just wanted to highlight one of the proposals for investment to better address the overdose crisis in California, which is $10,000,000 in opioid settlement funds for drug checking. It's an innovative approach that uses mobile technology to provide real time info on the drug supply both at the individual level, coupled with information and tools around behavior change and overdose prevention, as well as providing community level early warning about changes in the drug supply.
So we ask that opioid settlement funds be invested in this life saving approach. Thank you.
Speaker 38
Good afternoon. Glenn Bacchus for Drug Policy Alliance, a member of the ETE, Ending the Epidemics Coalition. I wanted to center the request for continued funding of the overdose prevention and harm reduction initiative. Excuse me. CDPH describes the Harm Reduction Initiative and the Harm Reduction Programs as the backbone of the state's overdose prevention efforts.
These programs punch way above their weight. These programs get eight percent they're eight percent of the applicants to the state for the Naloxone distribution fund. They get about a third of the doses, and they account for more than half of the lives saved using that, more than half, more than every other applicant combined. So it's important that we wanted to support them and stress to the committee that these are by and large small CBOs. They're providing an amazing array of services to the most high risk high needs Californians.
There are 69 programs in 29 counties that need stable funding to contribute to continue to distribute naloxone and train people on how to use it, not just give it away, but teach people how to use it, Help people navigate into drug treatment, housing, other services, provide materials to prevent the spread of HIV and hepatitis. And I want to end with they contribute a tremendous amount of staff and volunteer time to these efforts, but they are dependent on the opioid settlement funds to continue their lifesaving work.
Speaker 34
Madam Chair. Brendan McCarthy with the California State Association of Counties. We appreciate your questions and comments on the funding for the CDPH IT systems. For all of the reasons explained by my colleague from CHEAC, we urge the legislature to fully fund those critical public health systems.
Speaker 39
afternoon. Josh Gogger on behalf of the Chief Probation Officers of California commenting on the DDJJ realignment discussion. As we've said many times before, probation shares in the goal of ensuring there is not net widening occurring. We strive to deliver rehabilitative services in the least restrictive environment that promotes reentry and protects public safety. However, analyzing net widening is more complicated than looking at population trends.
As noted in the agenda, prior to state DJJ prior, state DJJ populations were around six fifty. However, CDCR was projecting the population to increase to nine twenty eight by twenty twenty four-twenty five, largely due to Proposition 57 in reducing adult court transfers. That's an expected increase of 43%, even before policy changes noted by OICR in the agenda. SYTF populations can reflect many trends, including reduced reliance on adult court or underlying crime trends. Placement in an SYTF is a judicial decision, and as noted in the agenda, this population has committed more serious crimes.
46% of SYTF commitments were for homicide or attempted homicide. Therefore, we have concerns with approaches such as last year's trailer bill that, among other changes, makes over 40,000,000 per year available to counties only if judges transfer this population to an unregulated community LRP prior to the completion of their baseline term. We look forward to any discussions. Thank you.
Speaker 34
Afternoon, Chairman Givara. My name is Paul Curtis, and I'm with Sunburst Projects, a local nonprofit agency here in Sacramento that serves those living with HIV, as well as through our Sunburst Clinic, which provides prevention and education services. As an active member of the ET coalition, we ask the legislature to support our budget request for the entire amount. This includes 14,100,000.0 for Project Cornerstone, a program through the Office of AIDS that provides innovative, evidence based approaches to improve the health of those living with HIV who are 50 years of age and older. In California, the number of adults who are aging with HIV, again 50 and older, is increasing and currently constitutes approximately sixty percent of all those living with HIV in our state.
As a gay man who has been HIV positive for thirty nine years, I can speak directly to the unique health challenges facing those aging with HIV, which includes the need for specialized care and support. The state has made significant strides in addressing the needs through initiatives like the HIV and Aging Act, but more needs to be done. I urge you to support this specific request.
Speaker 10
Kat Deberg with the Health Officers Association of California representing the local health officers. We want to thank committee staff and the chair for the excellent line of questioning about the IT programs at CDPH. At the local level, these are the IT programs that we use, that health officers use to keep single cases of diseases from becoming outbreaks of diseases. So it's critically important that we fund those. Thank you for the hearing today.
Speaker 40
Senator, Bruce Palmer with the California Association of Public Health Lab Directors, in support of funding CDPH IT programs, in line with CHEAC and HOAC. Data is the lifeblood of public health. CAFEld members leading local public health labs are on the front lines identifying diseases that are impacting our communities. CDPH IT systems are the connective tissue that enables the use of this key data, which alerts and mobilizes the effort to prevent the spread of dangerous diseases. These systems make our public health programs efficient and effective in order to take full advantage of the resources we engage to protect the public's health.
Thank you.
Speaker 41
Good afternoon, Chairman Jawar. I'm Andy Stone with the HIV Advocacy Network. We're a group of HIV and LGBTQ activists fighting to end the HIV epidemic and to improve the lives of those most impacted. We strongly support all of the End the Epidemics Coalition's budget requests, and specifically, we want to uplift the $50,000,000 in ADAP rebate funds for housing services for people living with HIV. We know that when people living with HIV have housing, they can manage their care and stay healthy, and research backs this up.
Unfortunately, at least five thousand Californians living with HIV do not have stable housing, and this is something that we're positioned right now to make a big impact around. Modeled after the federal HOPWA program, Housing Opportunities for People with AIDS, this funding would not only address California's HIV epidemic, but leverage HIV funding to address the state's larger housing crisis. We urge you to support this important investment. Thank you.
Speaker 3
Good afternoon. My name is Justice Doomla with the Treatment on Demand Coalition, a group of community advocates providers based out of San Francisco. I am also speaking in support of the entirety of the End the Epidemics Budget Ask for use of ADAP and opioid settlement funds. Specifically, want to uplift 14,500,000.0 for rapid ART or antiretroviral therapy used to treat folks who get diagnosed with HIV. This program has allowed folks who get a diagnosis to begin their treatment within seven days of their diagnosis compared to seventeen percent of Californians who get treatment only within thirty days of their diagnosis.
As someone living with HIV in California, when I was diagnosed it took me a couple months to get on treatment, and so programs like these really help fast track people's treatment and improve their outcomes for living with HIV. Thank you so much.
Speaker 1
Thank you so much for your public comment. Before we adjourn, all items one through 18 are held open. And with that, sub three on Health and Human Services has adjourned. Budget, sub three.
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