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 5
Chair and members, my name is Marie. I've been boarding Southwest flights to Sacramento since I was in first grade. And these are some of my fellow advocates who have been coming here since they were babies, held by their moms in public comment, rolled into the room in their strollers. Most of our crew is in school today, or at IEP meetings, or audiology appointments. Year after year, we ask for the same thing, equal access to sound.
Research shows that children with access to sound by three to six months of age can develop at the same rate as their peers. I'm now in ninth grade in the business magnet program, where we're learning how to evaluate market failures, return on investment, and how government regulation works. I wanna walk through a few numbers and ask a few questions. When we started this journey, only 15 states covered pediatric hearing aids. Today, 35 states do.
Why is this so complicated in California? Since newborn hearing screening was adopted in 1998, only 9% of plans cover medically necessary hearing aids. As Doctor. Daniela Carbajo at Rady Children's Hospital has said, We do a beautiful job screening, but fail miserably at treatment. Is that a market failure?
And while we all choose different ways to communicate, the choice of whether a child gets access to sound shouldn't be dictated by our family's health plan. And in Southern California, why are children in the largest closed system being fit with adult hearing aids that are not appropriate for children and don't connect
Speaker 6
to classroom speakers, which gives them access to instruction? Since 2021, California has allocated three hun no. $30,000,000 to HACCP. Less than 300 kids have
Speaker 5
been served. About 20,000 children are still waiting. What is the return on this taxpayer investment? And why is Maximus's fixed fee three times higher than the dollars allocated to for children? Pediatric hearing loss is low incidence, but without early access, cost can reach $1,900,000 per child.
Speaker 33
So why are we identifying children early, but allowing health plans to shift the cost of treatment to taxpayers? One of the first pictures my mom took of me here in Sacramento was with my oversized turquoise backpack in front of the California for all sign, right next to the governor's office. Governor, after all these years of trying to fix this, why aren't we included in California for all? California invests in programs like talk, read, sing, but those benefits aren't accessible to infants and toddlers like us without access to sound. We wanna hear our moms and dads say, I love you, and go to school with our brothers and sisters.
Speaker 5
Our plea is simple. Don't let the process stop children from hearing this year. As doctor Dylan Chan at UCSF Benioch Children's Hospital testified in 2019, this is a developmental emergency that has been unfolding for years in California. It's not only devastating for families, but it is costly to society. And I'd like to turn it over to my mom to share a cost saving proposal that will serve more children.
Michelle, you
Speaker 4
Great. This is not new spending. It's a smarter use of existing dollars to serve more children, and it also reduces general fund exposure. This is a clear path forward, and it's aligned with the legislature's intent. And they've all wanted to say something.
You know It's time to let You California kids guys want to do it one more time? Ready? I
Speaker 1
Michelle, what's different with this proposal than the ones from previous years?
Speaker 4
previous years, we included everyone, including the kids in the exchange. And it's the reason why it was vetoed. Because if you include the kids in the exchange, that triggers an $11,000,000 deferral cost, according to CHIPERB. So, we're saying, let's do large group market, get the majority of the kids across the finish line this year, and we will continue to work at the federal level on the exchange in the coming years.
Speaker 1
Do you have a number of how many kids would be covered if we do this in the large?
Speaker 4
kids. We'll move across them. It's anywhere between 70 to 80%. We have asked the health committees for an updated CHIPRP report. I don't know if that has been requested, but the best we can guess is that it's 70%, 80% of the kids we get them across the finish line.
Speaker 26
It shifts every year. When we started, it was $10,000,000 for the kids, 6,000,000 for the vendor. It's flipped, where there's more money for the vendor now and less for the kids. And so, basically, the analysis that we've done is there's been 30,000,000 and we have a chart we can share, but there's been $30,000,000 allocated. Dollars 23,000,000 of that has gone to fixed administrative costs.
Speaker 4
The rest, about 7,000,000, was allocated for kids but went unspent. We were in a call with the Department of Health Care Services a few weeks ago, and at that time, two fifty hearing aids have been dispensed. And that is evaluated through the TARs. So, the
Speaker 1
Thank you so much. Thanks. Thank you. We'll take public comment on this issue.
Speaker 7
Hi. My name is Johanna Wonderly. I've been following this issue since 2019. It's time to let California kids hear.
Speaker 9
Thank you. Kim Stone, Stone Advocacy, on behalf of the California Children's Hospital Association in enthusiastic support. Thank you.
Speaker 10
Hi. My name is Casey Kane. I am a parent of a deaf and hard of hearing child. I'm an educational audiologist, and I am the current board president for California Hands and Voices. We've been fighting this fight for eight years, and it's time to let California kids hear.
Thank you. Thank you.
Speaker 11
Hi. My name is Caparissa. My daughter Avery is up here, and we've been coming here since 2019, and, it's time to
Speaker 7
My name is Rhonda Ressfold. I'm the executive director of a local school for kids who are deaf and hard of hearing. Wearing a little mini shirt because we see the little kids. They're in school right now, But I'm in support of this. I'm also a teacher of the deaf and hard of hearing from background.
Speaker 32
So for the last twenty years, I've seen the impact of kids getting hearing aids and kids not getting hearing aids. Thank you.
Speaker 11
Nora, Angela is with Children Now. We align ourselves with the testimony from Michelle and let California kids hear, and we urge you policymakers to take strong action to address the persistent developmental emergency around access to sound. Thank you. Thank you.
Speaker 14
Katie Van Dyne with Health Access California in strong support of ensuring there's timely access to hearing aids and services. Thank you. Thank you.
Speaker 15
Good morning. I'm Paul Wonderley. Four of these kids are minorly impacted by this, and some in full support. Let California kids here.
Speaker 1
Thank you so much. I just wanna share the resiliency from this group is so strong. I know that it's been eight long years. I've been with you on four years of that eight year long, hurdle. Just want to say I'm really grateful that you continue to come back and have not given up on this matter, even though we continue to fail you year and year again.
But I am very hopeful that maybe one day we'll get CMS to approve our request, at least for the for the individual plans on exchange. So thank you so much for coming. I hope that we don't get to a point where you're Michelle's age and you're still here testifying on these things, we fix this sooner rather than later. We recently told her, Marie, I'm
Speaker 4
Really hoping that's not the case. But we just we feel so touched by the strong leadership that we have had for the last eight years and with you for the last four years. This is a bipartisan issue everyone has backed us. You guys have always been with us, it means everything. So thank you.
Speaker 1
Thank you so much. Thank you. Bye. He liked it up here. So one additional addition addition addition.
One additional thing before we move on to HCAI department of finance, I would like the floor. Did you bring kids with you?
Speaker 46
Victoria Rappley, Department of Finance. As we begin today's hearing, which covers four departments and 26 issues, the administration would like to provide some introductory remarks to contextualize our discussions. As noted in previous hearings, both the administration and the legislature must address the broader issue of balancing the structural deficit so that we can sustain the state's vital programs that support millions of Californians. This means making difficult decisions to address the over 20,000,000,000 budget deficit that is projected throughout the multi year. We understand and share concerns related to federal changes.
Speaker 17
However, any conversation around mitigating HR one or federal policy more globally must balance addressing this deficit and limiting new costs so that we can responsibly support our core programs going forward. Furthermore, we would note that the hearing agenda includes numerous proposals for investment. To the extent these are legislative priorities, we can provide technical assistance on the proposals. Though, no, any proposals will have to be considered as part of the overall budget framework given the projected significant out year deficits. We understand these discussions must take place and look forward to working with the legislature to develop a sustainable fiscal plan that serves all Californians.
Speaker 1
Thank you. First time here? No. I don't remember your face. I apologize.
We'll leave a second. Second time. Okay. So I'm not there yet. Yes.
Okay. Great. Thank you so much for that. Moving to HCAI with our first issue. Morning, Madam
Speaker 19
Elizabeth Landsberg, HCAI, the Department of Health Care Access and Information, and that was a hard act to follow with those kids. I've been asked to provide a high level overview of HCAI's mission and programs. Our mission is to expand access to quality, equitable, affordable health care for all Californians by supporting high value delivery systems, resilient health facilities and workforces, and actionable health information and strategies. We have five main program areas. We are a leader in collecting data and disseminating information about California's healthcare infrastructure and publishing information about healthcare outcomes.
This work encompasses the Healthcare Payments Data Program, or HPD, the state's all payer claims database, which we have a budget proposal to fund ongoing. HCHI is the building department for hospitals and skilled nursing facilities, monitoring the construction, renovation, and seismic safety of these facilities, which I'll talk more about. We also have Health Workforce Program, seeking to build a health care workforce to serve Medi Cal members, to serve in medically underserved areas, and to reflect the Californians that it serves. You're familiar with our basic workforce programs. We also support programs that ensure Californians have access to reproductive health care, including abortion services.
On the finance side, HCAI has our Cal Mortgage program, which offers loan insurance to nonprofit and public health facilities. We administer the Distressed Hospital Loan Program, as well as the Small and Rural Hospital Relief Program. The HCAI has a number of programs aimed at improving healthcare affordability, including the Office of Healthcare Affordability, the CalRx program, and the Hospital Fair Billing program. And most recently, last fall, we developed California's application for the Rural Health Transformation Program, which we'll discuss later in the agenda. Question two should I move on, Madam Chair?
Question two asks for an update on the Calyrex program. So, I will start with our biosimilar insulin initiative. So, Calyrex has partnered with Civica Rx, a nonprofit pharmaceutical company, to develop both short- and long acting types of insulin. The 2022 budget included $50,000,000 to support development of the insulin products. And under our contract, we have those max prices locked in.
So, 55 for the five pack of pens and $30 for the ten milliliter insulin. Uninsured Californians or those with high deductibles today commonly pay $300 per vial and $500 for a five pack. This year, in January, we launched Calarex's first branded insulin glargine pen. That's a long acting at the $55 for a five pack. And this initiative introduces competition into a historically high cost insulin market dominated by a few manufacturers.
And so we are here to interrupt that very broken pharmaceutical market. The Naloxone Access Initiative. Two years ago, in May 2024, we contracted for the manufacture and distribution of Naloxone nasal spray, a medication that blocks the effects of opioids and can reverse an overdose. Our initial price was $24 for a twin pack, which was more than a 40% saving over the price the state was paying. We've now lowered that to $19 per twin pack.
Speaker 42
And we in April 2025, Calarex announced that our naloxone is now available to all Californians at the same low price. So, we are doing direct to consumer. We are also the primary supplier for Department of Health Care Services' Naloxone distribution program, which supplies over 2,000,000 boxes of naloxone per year, free of charge, to qualifying entities, community based organizations, fire departments, hospitals, and the like. Since the NDP began in October 2018, they've distributed over 8,000,000 boxes, which have been used to reverse more than two and twenty four thousand overdoses. As of March 2026, Calyrex's Naloxone Access Initiative helped save the NDP almost $50,000,000 We are now working on the school albuterol initiative.
Speaker 19
So, last year's budget included authority for up to $5,600,000 to support Calarex partnerships with CDPH, Office of School Health. And we are planning to launch a centralized ordering system to provide California schools with two albuterol inhalers and 25 spacers, so it can be used by multiple kids who are in respiratory distress and may not have their own inhalers.
Speaker 19
Yes, yes, K through 12 school. So, we're collaborating with the school nurses on a training program, and those that should start going out soon. I'll keep going. So, we've been asked to provide an update on the reproductive health care grant program. So, Proposition 35 Health Care Act includes $90,000,000 for reproductive health care services support.
So, the first $90,000,000 in 2025, HCAI administered two contracts, and all of those funds have been fully expended. And we're currently working on the contract for the $90,000,000 from Prop 35 for 2026. It's confusing because they're all $90,000,000 This legislature, in early action, did 90,000,000 general fund to provide grants to reproductive health care provider Planned Parenthood affiliates, and we have executed that contract, and that provides funding for family planning services. Almost $62,000,000 of that $90,000,000 has been paid on the grant, and we are preparing to process a last payment for the remainder. And then, last, we also executed a contract for $56,000,000 from the Abortion Access Fund for abortion services to ensure access to abortion, and most of those funds have been expended.
Of the $56,000,000 approximately 16,000,000 remains. And I wasn't going to go through the twenty twenty two-twenty twenty three programs. You just wanted the update on the funds. Is that correct? Yes.
Okay. Next, I've been asked to provide an update on the Office of Healthcare Affordability. OCA was funded and created four years ago by the legislature in the budget and pleased to provide an update. It was established to slow the growth of healthcare spending while maintaining or, we hope, actually improving equity and quality and access. We have three core work streams: spending growth, high value system performance, and review of market consolidation.
And so, these three efforts have been shown. Research has been clear that these together can help support a more affordable and sustainable healthcare system. On the spending target side, the Board did adopt in April 2024 the first healthcare spending targets. Those apply to all healthcare entities, hospitals, health plans, physician organizations. The target chosen by the Board was 3.5% this year, coming down to 3% by 2029.
And a spending target sets a limit on how much healthcare spending should grow each year. Because we heard for many months from consumers who were unable to access healthcare services at the hospital or faced very high hospital bills in their area, We did a meeting in Monterey, California, and have done did months of analysis to try to understand hospital spending costs. We did identify seven high cost hospitals who were charging prices at twice the average of other hospitals in California. And based on that, the Healthcare Affordability Board did decide to establish hospitals as a sector and to have a lower spending target on those high cost hospitals. So, target is 1.8% this year, coming down to 1.6% by 2029.
So, in order to understand the health care spending in California, we're collecting new data and publishing reports on that, and then, we're using that data also to measure the health plans against these spending growth targets. So, last June, we released our first baseline report with health care spending trends from twenty twenty two-'twenty three. And this summer, we plan to publish a report with the 2024 spending data. OCA, as I mentioned, has a number of initiatives to improve the quality and value of California's health care system, including increasing investment in primary care and changing the way care is paid for to really emphasize quality. So, we set standards and goals for alternative payment models.
Those were approved by the Board in June 2024. And these are intended to support greater adoption of value approaches that promote equitable, high quality, and cost efficient care. We also developed benchmarks for primary care because when we spend more on primary and early intervention preventive care, we see improved health equity, improved health outcomes, and lower overall spending. So, we developed a definition for primary care. The board set a benchmark, and that is a ten year benchmark.
And we're starting to collect data both on the APMs and on primary care. We also adopted equity and quality measures set so that we can measure equity and quality at the same time we're measuring cost. The third main component oversight of market consolidation because we know market consolidation is one of the cost drivers throughout the country. And so, we have new authority to review proposed mergers and acquisitions of healthcare entities. So, two years ago, there's a requirement that before there is a merger or acquisition involving a healthcare entity, they have to file a notice with us.
We review those notices. If we're concerned that there will be a negative impact to access or affordability, we can do a deeper cost and market impact review. So, in two years of that program, we've reviewed 40 transactions and done two full cost and market impact reviews, one that was recently published and the other that is in flight. In November, we also published an investigative study of hospital market competition in Monterey County, finding that the exceptionally high hospital prices in the region are due primarily to their market power, rather than high operating costs or superior quality of care. OCA is currently developing enforcement processes for entities who exceed the spending target, with consideration for health system performance measures.
So, this year is the first enforceable year of the targets. So, a lot of our board meetings have focused on discussing What
Speaker 19
This 2026. So, we'll be measuring the growth from '25 to '26. '25 was a baseline year, and '26 is the first enforceable year. So, we're having a lot of conversations with the Board in our public meetings about the enforcement process. There was a question specifically about the impact of H.
R. One and how we're thinking about that. So, OCA has publicly discussed the impacts of H. R. One with the Healthcare Affordability Board, which has the decision making authority over the targets.
And the consensus from the Board at this time was not to adjust the spending targets. We know that H. R. One will impact health care entities differently, depending on a range of factors, including payer mix. And if the spending targets were increased across the board, this could result in higher costs for commercial market consumers, undermining the goal of healthcare spending the goal that healthcare spending should not grow faster than household income.
Additionally, because OCA will report and enforce targets separately by market, this allows for evaluating the impacts of various factors, such as state and federal policy decisions impacting spending trends. So, we have the ability to look by market and by entity at what the factors were that if there were entities that exceeded the target and really try to understand what those factors were. So, that has been the discussion to date. And then, last, Madam Chair, was asked to provide an update on hospital compliance with the Alquist Act. So, this framework has been in place starting in 1971 and really guided by lessons learned from past earthquakes, including the Sylmar earthquake, where a number of hospitals collapsed the 'ninety four earthquake in Northridge.
So, this overall framework has been in place for many decades. California has made substantial progress toward compliance, particularly in strengthening the structural safety of hospital facilities. So, we think of the structural facilities, the bones of the building, and then the non structural facilities like, you know, are these panels going to fall off the walls? Is the electrical system adequately braced? Are the pipes adequately braced to actually be able to provide health care?
So, we'll talk a little bit about both structural and non structural. So, there are a little over four ten general acute hospitals in California with 3,500 hospital buildings. About 80 more than 80% of these hospitals have fully complied with structural standards. So, more than four in five hospitals California are fully compliant with structural standards, meaning we believe that they are safe to provide care after the big earthquake comes in California. A total of six forty nine buildings remain in the SPC2 category, meaning that we do not believe they are at risk of collapse, but we don't think they would be able to provide services after the big earthquake.
And 18 buildings remain in the highest risk category of SPC one. They are subject to a 2025 deadline due to collapse risk, and the state is actively working with these facilities to resolve the remaining high risk buildings. In addition to the structural safety, hospitals must continue to upgrade non structural systems that are essential to maintaining operations during and after an earthquake, including electrical systems, backup power, HVAC, and critical utilities. About half of hospital buildings remain in the lower performance categories for these systems, and there are some hospitals that are fully compliant with the 2,030 seismic requirements. All hospitals are required to submit seismic compliance plans to HCAI, and approximately 90% of hospitals have done so.
So, these plans identify whether hospital buildings will be retrofitted, replaced, or removed from service, along with a timeline for completion. I also want to note that HCAI administers the Small and Rural Hospital Relief Program. This legislature created that program a number of years ago. There are funds available for us to assist hospitals, small rural critical access and distressed hospitals, in helping them both design their approach to coming into compliance and actually funding construction. We have, to date, spent granted $16,000,000 in grants.
And we are ready and stand, you know, able and anxious to work with additional hospitals to get those dollars out and help them to comply. Compliance plans indicate that there are approximately 100 hospital facilities that don't expect to meet the 2030 deadline. Of these, are about 40 or under review for AB eight sixty nine reviews. So, under AB eight sixty nine, small rural critical access hospitals have the ability to come in and ask for an extension, and we do a case by case basis. They submit a compliance plan with milestones that we review and work with them on, and we can grant extensions for that subset of hospitals.
We do also have 60 hospitals who don't qualify for current statutory criteria. And, at the same time, a significant number of hospitals are actively advancing projects to come into compliance with the 2,030 requirements. I know that was a lot of information, Madam Chair.
Speaker 20
Jason Constantaro, Cellio. I just also wanted to note, if you're tracking initiatives at HCAI, another initiative that could be worth tracking is the sort of diaper access initiative. This was adopted in year's budget. There's another round of funding for it in this year's budget, as was agreed to as part of last year's multi year. And so, if you're trying to sort of do basic oversight, that's sort of another initiative.
Thank
Speaker 1
you. Okay. So you've addressed some of the additional questions I had, but on the workforce programs director, I'm interested to know the geographic breakdown of where the individuals are getting some of the support. I just want know where we're getting them, and is it helping with meeting the needs in terms of providers in hard to reach areas?
Speaker 19
Absolutely, Madam Chair. Thank you for the question. So, we do have a research data center at HCHI that's looking at that data by geographic region, and that's really critically important to us. So, we do determine which are HPSAs, which are the health plan or the health performance
Speaker 19
Health professions. See, I got to phone a friend. Health profession shortage areas, which are those MSAs, medical shortage areas? And so, we absolutely have that as a scoring criteria for all of our programs. Folks who get a loan repayment or scholarship have to agree to a service agreement to serve in a medically underserved area.
Any time we do something like the Song Brown residency or nursing training programs, we do look at geographic reach. We have full supply and demand models built out for the nursing workforce and behavioral health licensed workforces, as well as some work on the non licensed side. We're working on primary care supply and demand models. We built ourselves the oral health and maternal health. So, geographic region and profession is really important to us to use our state dollars in as targeted a fashion as possible.
Speaker 1
So, the research shows that we are being targeted and we have people in rural areas that have been awarded the support.
Speaker 19
Yes. There is still plenty of work to do. You know, I certainly don't want to suggest that we have met the needs of rural or other medically underserved areas, but it is an important criteria that we always look at with our programs. You'll hear more about the Rural Health Transformation Program and how we're focusing there as well.
Speaker 1
Is that something we proactively do? You know, we awarded For these next year, we get to look at where we didn't get to award any and put that into the back of our mind as we
Speaker 19
award next year's. Libby, if you want to come up. Libby Abbott, our Deputy Director for Health Program our Health Programs, I want to give her the opportunity to add. So it is an application criteria. It is something we score on.
When Libby and I are reviewing the proposed awards from her team, we always get a map and look at the counties. But what do you want to add?
Speaker 11
Red is good. It's a lag. You covered that really well. So, all the things Director Landsberg said, we have a number of different tools for assessing geographic shortage and trying to prioritize the allocation of our awards. Really, the only thing I would add is we do our best to prioritize the allocation of funding to where there is the greatest need.
But sometimes, we don't get applications from the areas of greatest need. So, yeah, there is work ahead of us, I think, to continue to do promotion and outreach. And we've also recently started a practice of every time we run a cycle looking at specifically the demographics and the geography of who was awarded, be that organizational or individual, and then trying to think about what that means for the way we run our next cycle. Do we need to do targeted outreach? Do we need to change our scoring criteria?
So, it's an active process, but very much top of mind.
Speaker 1
Okay, great. Thank you. I don't know if you, Deputy Director, would be the right person to ask. On the CYBHI initiative, the investments over five years, there's one part that says building a behavioral health workforce pipeline. I'm wondering if that's the programs we just talked about, or is there a separate thing under Yeah.
I didn't
Speaker 19
go into detail about kind of our four strategies, but pipeline and pathway is one of them. And under the CYBHI, we had eight different work streams, and one was about pipeline and pathway. So critically important if we're going to reach our equity goals that we have those pipeline and pathway Libby, do you want Yeah. Talk more about
Speaker 11
have two or three kind of smaller programs for pipeline and pathway, and it looks like a mix of different things. We offer funding to organizations that hit one of several categories of pipeline or pathway programs. So, for example, we will fund internships. We will fund career fairs. We will fund summer exposure for high school or early college folks.
So, there's a couple of different categories by program. That said, we're actually in the process. We've contracted out an analysis of what is the best ROI in pipeline and pathway, what does the national evidence say, what can we learn from what we've funded, What are other states doing? That analysis is actually meant to inform what we do with our BHSA funding. We've identified the need to strengthen pipeline and early pathway programming as one of our priorities for BHSA.
So we're going to take the outputs of that analysis, use it to set some design parameters, and try to fund what we think are the most high impact pipeline and pathway programs.
Speaker 1
My humble input here is having navigated this program to be a behavioral health worker. One of the biggest complaints we do we get is that we have to do two years' worth of unpaid work. So as much as we can, if there's funding, the pipeline the barrier into these jobs is that no one can go two years' worth of not working. So oftentimes, you'll work while going to school. But, however, if you work while going to school and that program also requires you to have another job, that's even more difficult.
So when I hear internships, I hope we're looking at master's levels, those social workers, licensed marriage family therapists, entities that have to do these hours. And if we can find a way to pay some of those programs while they're getting those hours, I think that would be a removal barrier into these jobs.
Speaker 11
I appreciate the input, and I'll just quickly make the distinction. So when I talk about pipeline and pathway, we're actually usually talking about high school or early college level intervention. We do have work targeted to our master's folks and are proposing a bundled approach, which I was going to describe later, but I'll just preview for you now, where we're going to fund education capacity expansion, but also fund the students who move through those master's programs, not just with scholarship, but with stipends for their internships and for their clinical time, and we support clinical placement. So we're really trying to attack it from all angles for the reasons you just described.
Speaker 1
Perfect. Thank you. Are you the right person to talk about the twenty first Century Nursing Initiative? I am. Okay.
There's been a couple of delays in this space. And so I'm wondering maybe this is also a DOF question. What has been done since 2022? There's been two twenty million dollars allocated for this program, but it's been delayed. So has any investment been made in this program thus far?
Speaker 17
I don't have any information on that specific program in front me right now, but I can take that back and see
Speaker 19
We do have a small amount of nursing funding. We have Sung Song Brown program funding that supports nursing education, and we do some loan repayment and scholarship through our we get a limited amount of funding through licensure renewals, but it's pretty limited. Okay.
Speaker 1
So, not okay. So, that's okay. Okay. And then, before I go into yeah, before I go into OKA. Great.
Thank you for the background on CalRx. I think, Deputy Director, I'm here.
Speaker 1
Thank you for the background on CalRx and everything where we're investing the school arbuterol, one really, really great initiative. I'm wondering if there is anything else coming down the pipeline of other types of medical treatments we're going to be investing in and making.
Speaker 19
Our Calarex team has done some analysis of other drugs that we think could be high impact for the state, but we don't currently have additional funding for this.
Speaker 1
Are you allowed to share just what we're thinking about, even though we don't have funding for it?
Speaker 19
EpiPens is one that's come to mind. We're certainly looking at GLP-1s Oh, wow. Okay. Just as a high need area. Okay.
I don't remember all of them. We're happy to follow-up if you're interested.
Speaker 1
Okay. So let's jump a little bit into OCA then. I appreciate the response and then HR1. Given that the board mentioned that they're not going to be adjusting, how then is that going to be incorporated in the enforcement piece of hospitals? We're not going to change the target, but are we going to change our approach?
I do know that it's a I forgot the term that is being used, but it's
Speaker 1
Progressive enforcement. What does that look? Is it just one time you get a warning? Or in real life, what would that look like? And then I think there exists a waiver, if I'm not mistaken.
The statute does
Speaker 19
talk about Waiver process. Allows a permissible waiver process. Has that established what that waiver process will look like? No, it hasn't. So, the OCA statute does define, as you note, a progressive enforcement approach.
So, for any entity that exceeds the target, our first step is to notify them of that, send them a letter. They have forty five days to respond and correct any data that they think there was a mistake made on. We then have a stage of technical assistance. There is also a permissive stage of having entities come testify at a public hearing. And then, entities we would work with to develop a performance improvement plan, or a PIP.
And the last and final stage of the progressive enforcement is around financial penalties. And financial penalties can only come into effect after all the other steps have been met, and she doesn't stick to their performance improvement plan. Also so we have the ability to look at them on the back end in terms of enforcement considerations. The waiver is permissible in the statute. And at this time, we have decided not to put the waiver in place, but rather to have the data analysis with each entity.
Speaker 1
So it's permissible, but it's not required? Correct. Okay. And it's the mindset of the department to not have a waiver process?
Speaker 19
Because we believe it would be duplicative of the ability to look at the data as part of the enforcement consideration technical assistance portion of the progressive enforcement.
Speaker 1
Okay. And, you know, we you know, the phrase for the past few years, affordability, the word has been thrown around, it could mean a lot of different things. When we look at the work of OCA and the intent of the board, is it that it's not so much on decreasing cost and making it more affordable, but it's more on we don't want it to grow exponentially?
Speaker 19
Well, think that's a really important distinction. We would love to be able to bring health care costs down tomorrow from where they are today. But, in many ways, OCA is a modest goal to simply slow the rate of growth, right? So, we're not saying entities won't be able to grow their spending. They have this 3%, 3.5% window.
But what's been happening over decades is that wages are barely keeping pace with inflation at 3%, and health care costs have been growing at 5%. So, it can seem very like a modest goal to slow the rate of growth and spending. But, absolutely, the plan the whole point of this is to make health care more affordable for consumers. But it's not going to solve a problem tomorrow.
Speaker 1
And, Director, oftentimes the limelight has been on the hospitals. Premiums have been jumping two to three times in the past year that we're going to be looking at enforcement. Is there a different approach in looking at premium rates increase versus the hospital increase? Well, I think it's really important
Speaker 19
to note that OCA is an all in approach, right? And it's important to be impacting every part of the market. So, absolutely the same spending targets apply to health plans, to the medical groups, and to the hospitals, except those hospitals who have the higher high cost hospitals. And so, we absolutely want to impact premiums over time. And we have an obligation under the statute to work with the Department of Managed Health Care to look at reasonableness of rates, and we should see a slow in that those premium increases that we've seen of late.
Speaker 19
Yes. And I will just note also, on the health plans, we're measuring their total spending, and then separately, we're also looking at their administrative costs and profits. Okay.
Speaker 1
When I don't know if it's Oka that comes in, but when we're evaluating targets and targets have gone past 3% or 3.5%, what are the cost reducing strategies that will then be talked about with these entities to come back in compliance?
Speaker 19
Yeah, absolutely. So, the California Health Care Foundation has been doing a lot of work on this recently. And they put out a series of pieces they call the 25% problem. So, their analysis and a lot of research shows that actually 25% of healthcare spending today is wasteful or harmful or unnecessary for the cost of care. So, we at OCA and the board, the staff, we're not telling each individual health plan executive, hospital executive how to meet costs.
But the research is clear there are many ways for folks to do it. Today, are getting some duplicative care. Data exchange framework, we hope, will help address that. Some of that duplicative care is actually harmful to patients if they're getting radiated multiple times. So, we think there are multiple efficiencies.
There is administrative waste and a lot of ways for health care entities to bring costs down. We have had a series of presentations about cost reducing strategies at our board meetings, things like doulas, things like moving surgeries to ambulatory care settings where they're lower cost. So, we're trying to we're at the same time not telling individual actors what they need to do and also trying to highlight some best practices that have been shown to improve health outcomes and reduce total costs.
Speaker 1
And, Director, I really appreciate it. I appreciate our relationship. We have a very open door policy and we continue to communicate. So, this next question is a bit depleted, if I already asked in our private conversations. But how do we take into consideration hospitals' investments in advanced technology, new medical treatment that they want to invest in, and bargaining should, after bargaining with the unit, the increases supersede the 3.5%?
Speaker 19
So, again, we will have the ability to look. Each entity that exceeds the target, we will have a back and forth with them to look at the data. If there was some huge investment in technology and that is something we should look at in enforcement consideration, we will have the ability to do that. As it relates to union negotiated contracts, there's a separate process whereby an employer can come to the table and say, we've there was a 3.5% target that was set. We just entered into a new contract with our unionized nurses that's at a higher amount.
We have the Board has the ability to adjust the targets upward, if that's the case. We're just having the conversation with the Board about that process and putting that into place.
Speaker 1
Okay. Looking forward for, as we move into the enforcement year, to see what that looks like. And these are all living platforms, see how we can adjust moving forward. The last question in this space not in this space, in your department overview is the diaper initiative. I actually am very interested in that.
I had concerns last year, I think, around this being open to everybody, about just doing a hospital space. Not everyone has give birth there. So, I'm wondering where we are in the program and any changes we're anticipating in its implementation.
Speaker 19
Sure. So, the diaper initiative that was adopted does take that universal approach. We are targeting hospitals in the higher needs area. So, the first year will we anticipate being able to reach twenty five percent of births. And so, we're looking at the Healthy Places Index and areas with more vulnerable patients.
And we are in the final stages of contract negotiation. No announcement yet on that.
Speaker 19
each year? We will give out as many diapers as are available. You know, we've had some preliminary conversations with the hospitals. But certainly, a family can decline the offer.
Speaker 1
And the partner or the contract that we the vendor we contract with, they'll have experience and background in being able to distribute these kind of diapers at a hospital setting?
Speaker 19
Yes, we did an RFA and received 14 responses and are in final conversations with one of the potential vendors.
Speaker 21
Good morning. A quick item, technical adjustments, BCP. We're requesting to increase expenditure authority by $700,000 in FY 'twenty six, 'twenty seven, and ongoing for four special funds. One of these is a federal source, and then three of them are special funds driven by licensing fees. And, basically, revenues have exceeded our projections.
We're asking for a bit more authority so that we can distribute those funds through grant making.
Speaker 1
Okay. Rebecca, Jason? No? I'm wondering, is this result request only for this year, or are we gonna do this request ongoing? Seems like there's a history of not providing enough expenditure.
Speaker 21
This request is for this year and ongoing. Okay. True. If revenues changes, we may have to
Speaker 1
cover Okay. Great. We're going to hold that item open, move to issue number three.
Speaker 19
HCI requests $8,800,000 general fund and two point three six health plan improvement trust fund ongoing in 16 positions to facilitate the transfer of the data exchange framework and the Office of the Patient Advocate from the Center for Data Insight and Innovation to HCAI. So, the transfer of OPA and DXF to HCAI has already been made administratively, and now formal budget action is needed. We think DXF and OPA programs are a good fit with HCAI, where they're embedded with similar functions, specifically with our data programs. So, we've welcomed them, really excited about the work. As you know, Senator Mengevar DXF was established in 2021 for that real time exchange of health and social services information.
The data exchange framework includes a common data sharing agreement and policies and procedures that set the rules of the road. So, we've been providing technical assistance. You're familiar with all the components of six sixty. And so, we are actually having our first Data Exchange Framework Advisory Committee one week from today, required by your bill, and moving forward on all the components for the legislative report. Happy to go into more detail about I'm going all to providers were supposed to execute contracts earlier this year, January 31.
Did everyone meet that? So we have more than 5,000 health care entities, including health plans, providers, hospitals, and skilled nursing facilities that have signed the data sharing agreement. Under your bill, we are required by January 1 to post the list of all of those entities, both those who are complying and who are not complying, and to continue to look at possible governance.
Speaker 19
We it is not as simple as it sounds to produce the list of those who haven't complied because we have to for example, there is no list in the state of California about who all the physician organizations and medical groups are. Actually, our data team and our OCA teams have been trying to build a physician organization index so that we have that. But we have to do the comparison of all the entities, get that licensed information, for example, on skilled nursing facilities and the like. Is there anything you want to add?
Speaker 24
The only thing I'd add also is that Senate Bill six sixty also allows for those entities to share extenuating circumstances for reasons why
Speaker 24
Alright. Issue number four, the long term payment care payment transparency staffing. HCa requests $597,000 from the California Health Data and Planning Fund, an authority for three positions fiscal year 'twenty six, 'twenty seven, and ongoing to implement portions of the new federal rules related to the Centers for Medicare and Medicaid Services, new minimum staffing standards for long term care facilities, and Medicaid Institutional Payment Transparency Reporting Final Rule. This final rule requires state Medicaid agencies to calculate, report, and publish the percentage of Medicaid payments for skilled nursing for services in skilled nursing facilities that are spent on compensation for various staffing categories. That includes direct care workers and support staff across both fee for service and managed care delivery systems, and do so no later than 06/21/2028, a risk losing federal funding.
The HCAI facility financial reports serve as the Medi Cal cost report. Therefore, changes to Medicaid rules affect the data collection programs that HCAI administers and will result in new workload, onetime and ongoing, to meet the requirements of the federal rule and revise the data reporting for over 1,000 skilled nursing facilities, and this request would support that Jason, additional workload for
Speaker 1
I forgot to turn to you on issue number three. Was there anything you wanted to add to the previous issue?
Speaker 1
Okay. Great. Thank you. We're going to hold the item open. Move on to issue number five.
Speaker 22
Issue number five, Assembly Bill fourteen eighteen, HKI requests $178,000 to fund one position in 2026, 'twenty seven, and annually thereafter from the California Health Data and Planning Fund to implement new reporting requirements related to health care workers' health coverage waiting periods pursuant to AB fourteen eighteen that was signed in November. Commencing 01/01/2027, the bill requires HCAI to annually collect and publish detailed data on employer sponsored health care coverage waiting periods from health facilities, including clinics and hospitals and long term care facilities, whether those waiting periods exist for the facility's employees, and if so, the length of the waiting period and the employee classification. The bill does allow HCAI to integrate this reporting into existing HCAI reporting programs, but HCAI doesn't not have the dedicated staffing resources to make these, changes to our reporting systems for data collection, data validation, and program administration to collect data from over 10,000 health care facilities.
Speaker 11
Thank you very much. I'll provide an overview of our planning activities for the Behavioral Health Services Act Behavioral Health Workforce Initiative. 3% of BHSA revenues are directed to the Behavioral Health Workforce Initiative. NSB three twenty six has directed HCAI to work closely with stakeholders and community to develop a five year Workforce Education and Training Plan, or WET Plan, which is the vehicle for articulating our BHSA funding priorities. So we began consultation in the summer of last year, summer 'twenty five, for the development of this plan.
Speaker 20
We conducted 21 statewide convenings with almost 300 stakeholders. We used that feedback to develop our strategic framework, and in the last few months have met with an additional 60 plus partners from state departments, the education sector, and community partners to brainstorm strategies that will serve the objectives in the framework. And I'm happy to share that we have really strong support for this work thus far, and strong support for kind of our proposed strategies to transform the way that behavioral health workforce is trained and supported. So, I'll share some of the key themes and the directions that we're proposing to take. Number one key theme that we hear again and again, the current behavioral health workforce does not have the skills needed to serve the clients of today, particularly those with significant behavioral health conditions who are in the county or county contracted behavioral health system.
Speaker 11
So we're proposing work to define the core competencies needed to serve those clientele in the county contracted and county system, and then to use those core competencies
Speaker 11
county on the job training for the existing workforce in the county behavioral health system. Number two, we also know that there are not enough health workers of the right type to meet demand in the county behavioral health system. We need investments to expand educational capacity for behavioral health training, but also to require programs that receive our funding to align training to the needs of the county behavioral health system and to serving individuals with significant behavioral health conditions. And then, as I described earlier, we intend to sort of bundle that institutional support for education capacity expansion with individual support for the folks moving towards those careers and through those training programs. So, that would be scholarship support, support for stipends and time in their clinical training, and then support for clinical placement.
Our modeling shows significant gaps in licensed as well as non licensed behavioral health professionals, such as peer support specialists and SCD counselors. And we hear that those non licensed professionals also need additional supports and coaching. There's higher degrees of variability and readiness when they enter the workforce. So we are, just like with our licensed folks, proposing expansion of training, but we are coupling that with or proposing to couple that with coaching and transition to practice support for non licensed professionals. Statute directs us to provide technical assistance to county contracted providers on BH workforce.
And after consultation with our stakeholders, we're proposing to expand that concept contracted so that they may optimize the use of the behavioral health workforce to serve folks with significant behavioral health conditions. So, we've heard good feedback on what the domains of that technical assistance would look like, but again, strong support for that concept. The idea here is that we want the county behavioral health system to be able to maximize, optimize the workforce, attract, recruit, retain, and support the folks to serve individuals with significant behavioral health conditions. And then, the final objective is one we spoke about earlier today, pipeline and pathway. We know that if we need to grow the workforce, we have to start at the beginning.
We have to show folks that they can see themselves in these careers. It's part of our effort to address equity and to diversify the workforce. And so, as I described, we are kind of going through an exercise to develop the design parameters for what the most impactful and effective pipeline and pathway programs could be. And also, under this objective, we propose to work with our education institutions to address some of the holes in career lattices so that folks who may enter in a non licensed can see their future, can stay in the behavioral health workforce, can continue serving the folks who need it in California.
Speaker 17
Yeah. So regarding the question of the $100,000,000 general fund offset. So the goal of this proposal is to preserve and protect existing behavioral health workforce programs currently funded by the general fund, especially given the significant out year deficit the year the state is facing. We do still consider this proposal in alignment with the aim of proposition one. With regards to the behavioral health workforce initiative, this proposal does not impact funding for the nonfederal share of BH Connect, and that work will still continue.
We're still evaluating what programs may be eligible to be funded under the behavioral Health Services Act. And the specific proposal will be updated at the May revision to describe which programs would be funded under that. Okay.
Speaker 38
Yeah. So just, again, speaking on the offset specifically, we think it raises kind of three key issues to consider. The first is that it's not quite clear to us that this is actually these savings are actually incorporated into the Governor's budget, and that's because we worked with Department to track all of the general fund changes, and we're able to tie everything out without assuming $100,000,000 in savings. So it's a little unclear to us whether this is sort of a signal into what we're looking at in May or if it's actually incorporated in the Governor's budget. The second issue really gets at question number three in your agenda that the staff raised, which is what are the eligible programs that would be supported by the funds?
Speaker 20
And I have to say here, we're not quite clear ourselves. The H. I. General fund spending in 'twenty six, 'twenty seven is about $175,000,000 So this $100,000,000 would be more than half of that amount. About 80 or so of that is for the BH Connect workforce initiative, but administration has indicated that a lot of that funding already has sort of an offset in the Medi Cal budget.
The rest of that is really for things like the Song Brown program and the Office of Healthcare Affordability. These are things that don't have an obvious behavioral health connection. And because of that, it's not clear to us that the legislature would want to really get a better sense of what these programs are before it incorporates any sort of assumed savings from a fund transfer. And then, the third and final point is that it's reasonable to be thinking about budget solutions. But really, the core issue facing the legislature is the ongoing structural deficit in the out years.
This appears to be a one time solution. So the focus we really recommend the road focusing more on the sort of ongoing structural changes rather than sort of one time solutions.
Speaker 20
of? Yeah, if you turn to page three of your agenda, that general fund amount in twenty six-twenty seven is about 175,000,000.
Speaker 20
that goes to the behavioral workforce, That's a different amount. I'm saying that they're proposing to offset $100,000,000 in general fund spending. Okay. That's more than half of their general fund amount. Got it.
So that's a sizable amount and we're not clear what if there's really that much behavioral health workforce in that sort of appropriation to offset. Okay.
Speaker 1
You. Very similar questions to what LAO has brought up. One of a couple of things. The subcommittee is not the first time that we've heard proposals of supplanting funding of general funds when we voters have voted for something. I think it's very disingenuous for Californians.
If we vote for something, it's to add value to our investments. And I've always been a huge fan of the behavioral workforce investments that we've made. And when this came about, I felt excited to add to this. I do recognize that we need to balance, the budget, but it just seems that we're always balancing the budget with outward facing services. And then I continue to see BCPs on growing our internal government exponentially.
I don't I am wondering if when looking to balance a budget, that mean, inwards, we should look at ourselves first versus cutting outward services, that we voted for with with prop one. I don't I don't know exactly the the connection in terms of what programs will be funded exactly, so I would like more information. It is also frustrating that it's April, we don't have that information, and we have to wait till May. I've shared and just systematically how that crunch time is really not conducive for a proper conversation to have back and forth. I wish I could have had more details on this earlier rather than later.
I think May just is not, it's not good for for, for for this process. So that's my thoughts on on the the offset part. If a 100,000,000 is being requested to offset, it leaves about $10,100,000 available for this purpose. This is supposed to be implemented in July 2026. What are we going to be doing with the $10,100,000
Speaker 19
Thank you, Madam Chair. So, as you note so, as Victoria from Department of Finance noted, most Is
Speaker 1
your name Victoria? I've been calling you Rebecca. Correct me. Oh, my God. You're staring at me.
Sorry, Victoria.
Speaker 19
Victoria Victoria noted so, yes, with the portion of the BHSA funds going to BH Connect, which is very important to draw down that $1,900,000,000 it would leave us with a pretty minimal amount. So, you know, as Deputy Director Abbott noted, we've been doing a lot of stakeholder engagement, and we'll use as many dollars as we have as meaningfully as possible.
Speaker 1
But what's the actual plan? What would Well, we've been forced to go through
Speaker 19
a wet planning process to hear from constituents about what their needs are, at the same time, this budget proposal. So, we've kind of been on parallel tracks.
Speaker 1
And the plan from the five year web plan is supposed to come out in spring twenty twenty six?
Speaker 19
Correct. We have a draft plan that we've been socializing. We've been presenting, and we're presenting next month to the commission
Speaker 11
as required. No, next month. The plan should be approved in June by the California Behavioral Health Planning Council. We have been socializing a plan against an estimate of $100,000,000 If indeed the budget solution moves forward and we remain with only $10,000,000 we will reconsult with our stakeholders on prioritization. There are, as I just described to you, five major objectives that we are trying to accomplish, and so I think it will warrant additional conversation on what to do with 10,000,000.
If I had to hazard a guess now, we get a lot of push on the idea that there are immediate training needs for the workforce described, to modernize them, to catch them up to the needs of today's clientele. With $10,000,000 I think that might be a direction we would pursue.
Speaker 1
Got it. And then going back to the actual program details, some things I heard that are completely different to what exists now, the stipends for paid internships and then the or something else that you oh, the placements part, those are new. But you also mentioned scholarships. Those already exist in the current programs right now. What is going to be the difference in these type of scholarships versus the workforce investments we have now?
Speaker 11
So we actually don't have significant funding for scholarships now. We leverage CYBHI funding to support some of our behavioral health scholarships, loan repayments, some of those traditional programs that Director Landsberg described are part of our toolbox. As that funding winds down, we have the BH Connect program, which you're aware of, up to $1,900,000,000 That does contains, for example, a significant recruitment and retention program. Our approach with BHSA is to get everything we can out of the BH Connect funding over the next several years while that is available, use the BHSA funding, which is flexible, to fill gaps on the things that we cannot fund with BH Connect.
Speaker 1
Sorry, Deputy Director. I'm going to just just because I'm looking at it, there's a lot. There's the Allied Healthcare Scholarship Program, the Advanced Practice Healthcare Scholarship Program, Associate Degree Nursing Scholarship Program, the Bachelor of Science Nursing Scholarship Program. So, there's a lot of scholarship programs
Speaker 11
that currently exist. And they have minimal funding, and two of those will be winding down that include behavioral health providers. So, you just mentioned, for example, two nursing programs. We will not be using BHSA funds, Exactly. BSA funds So, it's our behavioral health scholarship programs that prior to BH Connect were limited.
As I described, we do have significant funding under BH Connect.
Speaker 1
But I'm wondering, nursing training for behavioral, really important. Are we going to
Speaker 11
be tapping into? In BH Connect, nurses who serve in a Medi Cal setting and serve behavioral health clients are eligible for scholarship and loan repayment.
Speaker 1
What about the Psychiatry Fellowship Scholarship Program? Are we going to be adding more money into that, or is that a fully funded program that does not need any more assistance?
Speaker 11
Psychiatry fellowship program. So through BH Connect, we're funding both residency program expansion and fellowship program expansion. However, we're limited in the number of cycles that we can offer. So we have one open now for fellowship training. We'll have one open next year.
Our proposal with BHSA is to continue to fund psychiatry education and psychiatric mental health nurse practitioner training. And so that falls under one of the objectives that I described of expanding educational capacity in select areas.
Speaker 1
And then a lot of the focus sounds on the enhancement capacity for counties in terms of the employees that work in the on the county level, if I've understood correctly.
Speaker 1
A lot of that sometimes, what I hear anecdotally is we don't have enough employees to work in these spaces. The cases are so much. While we can prepare and get people ready for these jobs, are those are those positions going to be available? Will the counties have even the funding to hire them on? Is that a barrier to closing the gap here?
Is that being looked at?
Speaker 11
It's a great question. And I would answer in two parts. One, my understanding so we work closely with county and the County Behavioral Health Directors Association to shape these proposals. What I would take away is that they are if the people are available, they are ready to hire them. Okay.
We may ultimately, down the line, reach a point where that tension comes into play. I think right now, there are vacancies that are ready to be filled with the right folks. The second part of my answer is that TA package that I described. The goal of that package is to provide support to county and county contracted entities on how to get the most out of behavioral health workforce. So if they are resource constrained, for example, how can they maximize the use of non licensed professionals so that within a constrained budget, they're still getting the most they can out of both clinical and non clinical providers.
So that's how I would say we're trying to tackle some
Speaker 1
of the demand side constraints. Okay. Victoria, my request would be, if there's any details you can share with our office, with the committee members here, that give us a little bit more time to review, at least myself, give more time to review instead of waiting till the May revise, I would greatly appreciate more details on the offset and transfer and programming.
Speaker 17
Yeah. I'll take that request back and see what can be provided. We're going to
Speaker 21
Great. Thank you, Madam Chair. Scott Fristman, HCAI. I'll talk about the Real Health Transformation Program, addressing the questions in order. So, the California Rural Health Transformation Program is the state's implementation of a $50,000,000,000 national program authorized by HR1 administered by the Center for Medicare and Medicaid Services, CMS.
These federal funds are distributed to all 50 states based on a semi competitive application process over a five year period intended to strengthen access, quality, and sustainability of health care delivery for rural communities. So California was awarded $233,600,000 for the first budget period, which is January through October, 2026. It was the third largest award nationally. The California program is built around three integrative initiatives approved by CMS. Those are the transformative care model.
I'll talk a little bit more about rural workforce development, obviously a foundational piece, and then technology and tools for organizations. So, transformative care model includes investments in regional hub and spoke care networks, expands telehealth services, e consults, and evidence based care models, really focusing on primary care and maternity care, strengthens local capacity to reduce avoidable out of area travel for care. Essentially, we're trying to address the rural bypass issue. Rural workforce development supports workforce mapping, pipeline programs, clinical training capacity, and targeted retention and relocation incentives through grants tied to service commitments in rural communities. And then the third initiative is health technology and digital tools.
Speaker 62
These investments are in foundational infrastructure, including electronic health records, data exchange, interoperability, telehealth expansion, cybersecurity, other infrastructure needs. The program includes a rural health technical assistance center to support implementation directly to participating grantees across all of the three components of the program. So together, these investments in the plan focus on strengthening regional systems of care, access in rural communities over time, and reducing the need for rural residents to travel long distances for their health care. The program is designed to complement, not duplicate, existing state and federal programs by targeting gaps specific to rural health delivery systems, workforce shortages, and infrastructure limitations that are not otherwise addressed through existing funding streams. I'll just quickly touch on some of the key milestones.
Speaker 21
This opportunity was released by CMS in September. In November, we submitted California's application to CMS. At the December, CMS notified California of the award amount, 233,000,000 for the first year. At the January, we provided essentially a revised budget based on that amount to CMS. February, CMS issued a revised notice of award, which unrestricted the first 183,600,000.0 and CMS then asked for revisions to the remaining $50,000,000 of the budget we proposed relating to transformative payments for rural hospitals.
So, to the question, I'm going talk a little bit about that change that we were asked to make. So, CMS requested additional details about the proposal we had made and a revision to the original approach on the $50,000,000 which were designated for essentially supporting rural hospitals. CMS asked us to ensure that these funds are tied specifically to transformative activities as part of rural health transformation rather than serving as general financial relief or backfill to solve for any cash flow issues in rural hospitals. So, in response to the request, we made the following changes. We reallocated $15,000,000 to other approved program activities as listed.
So, part of the transformative care model, workforce development, and technology and tools. Then we redesigned kind of the transformative payments, which we term those for $35,000,000 Again, this would target a limited number of what we call strategically located rural hospitals. Let me speak to that a little The $35,000,000 number is key because CMS viewed these as provider payments, and there's a 15% cap to the award on provider payments. So that's $35,000,000 So they're classified as provider payments. And what we do with that is essentially put more definition around what the payments would be for if not for essentially cash backfill.
So what we did is establish clear eligibility and readiness and performance criteria to ensure that these payments are milestone based, time limited, and directly tied to participation in feasible components of the transformative care model that we touched on earlier. I think yeah, so CMS approved these revisions last week and released the remaining funds on March 31. So, what we're looking at in terms of strategically located hospitals, it would be based on assessment where are capacity issues, for example, if there's labor and delivery deserts or something like that. That would be an appropriate investment to purchase infrastructure and equipment to be able to stand up those services in a rural community that needs it. So, again, that was kind of the adjustment that was made with the original $50,000,000 proposal that we had had.
You know, it had more flexibility than was interested in CMS, so we made the change. So at this point, all 233,600,000.0 in federal funds are now unrestricted from CMS and available for distribution through the three program components as approved by CMS. None of the programs were eliminated due to the CMS review process, but we made the adjustments to those transformative payments for rural hospitals as required. In terms of authority, we also appreciate the fact that we recently got approval from the joint legislative budget committee to for current year spending authority to begin using these funds to move forward with the Rural Health Transformation Program. I would also note, going forward, CMS maintains oversight and approval responsibilities under the cooperative agreement that shape the implementation timeline.
This includes final approval of all grantee selections, administrative review of grant agreements and contracts, prior review of materials that may be publicly posted as a federal requirement. We have to obligate these funds no later than 10/30/2026. So it's gonna be kind of a breakneck pace. We are actively coordinating the program design now to build out those programs. We're doing internal review and CMS engagement to meet the requirements on accelerated timeline ensuring all federal funds can be effectively committed by October to support health care delivery in California's rural communities.
I would note that our performance this year with these funds will inform the scoring for our award amount in year two and so on over the next five years. So we're fully committed to moving these out in the most meaningful way and getting them to providers and rural communities. The second question, in terms of timeline for application to various grant programs. So the grant opportunities under the California Rural Health Transformation Program will be offered on a rolling and phased basis with multiple requests for applications anticipated over the life of the program rather than a single one time opportunity. So, again, we're working on design and grant guides right now.
We expect late spring, early summer this year, RFAs will be released for what we're calling accelerated partnerships for the transformative care model, workforce development critically, and technology and tools initiatives across all three areas. We would expect application reviews and award announcements, you know, in summer, early fall, again, subject to CMS approval. But we're looking to commit those funds by October as required by CMS. So, again, grantees must be approved by CMS before receiving the funds. CMS may approve, request modifications, or deny based on their review.
All funds must be obligated by October 30 consistent with the requirements. To be eligible, applicants must serve rural communities in California based on a HRSA definition. It's pretty straightforward. This may include rural hospitals, critical access hospitals, clinics, including FQHCs, rural health clinics, tribal clinics, tribal governments and tribal organizations, local government, nonprofit organizations, educational institutions to be sure, and training partners. And urban based providers to some extent that deliver services in rural communities.
Obviously in a hub and spoke when we're doing telehealth delivery, there's going to be service providers from outside the area. So funding, again, is intended for system transformation activities such as care model redesign, workforce development, regional coordination, and technology modernizations. Again, funds may not be used for routine operating subsidies, direct patient care reimbursement, or to supplant any existing funding streams. All grant awards are subject to CMS review and approval. So what we'll do is implement performance based grant agreements with regular reporting, federal compliance monitoring.
Program success will be measured through improvements in rural access to care, workforce capacity, and provider stability over time. And, again, these are measures that we included in part of our application. Happy to take questions. Okay.
Speaker 1
Really robust background. Appreciate it. Very interested in this. It was $50,000,000,000 total.
Speaker 21
We did well, and I use the term semi competitive. So, of the 50,000,000,000, the way they set it up was essentially every state was eligible to apply for a billion. So and then they split that with a floor of half over five years, half 1,000,000, and then the other half is competitive. So in the first year, what we were able to apply every every state was eligible to apply for 200,000,000, which we did, and we received 233.6. So we did well.
The application scored well. We're we're glad to see that, obviously. You know, and the way that it's set up, it you know, it's not based on population. So we have 2,800,000 people in rural census tracts in California, and so, you know, we're going
Speaker 21
Yeah, yeah. So, were happy to get third, and, you know, that's kind of how it was broken down.
Speaker 1
We were given 233,600,000 for this year. Have we been told how many how much money we're going to be getting next year?
Speaker 21
We don't. And I think it's interesting is that that's so, what they've set up is what's called a noncompetitive continuation. So, we have an award, but they will do some scoring based on how well we perform with these funds.
Speaker 21
Yeah. It is critical. So so we got we got 33 over what we applied for. So, it is possible that we could we could pull down additional funds in the next year if we do really well this year.
Speaker 1
Those extra twenty nine days are very important because I've seen a struggle with program funding allocation. You mentioned that we you just got approved from the joint committee. So that means you can, as soon as the RFAs are out, start.
Speaker 1
We don't have to wait till this budget is passed. That money can start going out. That's correct. And you anticipate that late spring, early summer for the first dollars to go out.
Speaker 1
However, you have to submit the grant awardees to CMS first before you any dollar goes out?
Speaker 21
Okay. So, we have weekly meetings with our program officer. I think they've been very productive meetings. And we have turned, you know, interesting, public facing materials are something that are reviewed. So, when we do a webinar or something that has gone through that, that's gone very quickly.
You know, I'm pleased to note. And so, yeah, we're basically ramping up that relationship to ensure when these grants start to flow that they're able to turn them around. They've hired an entire new staff for this Real Health Transformation office. So, we have a program officer and a kind of a backup program officer that deals with a couple of states. I've forgotten, you know, five or six states or something like that.
So we obviously are watching that and are sensitive to the timing because we want to perform at a high level and pull down more dollars in the next year.
Speaker 1
And So it's not like we can use these dollars just to give to financially distressed hospitals in rural areas.
Speaker 21
They they were very specific about that. And, in a in a professional way, but we've had serious conversations about how to use it. And, again, the the original proposal, we we tried to create some flexibility in the transformative payments for hospitals to, you know, to cover sort of the idea of stability so that they could participate in the program. And we just had to revise it to be even more narrow and more specific to transformational efforts in terms of, yeah, they're going to change the care model and, you know, we're going change the way they do, you know, maternity care. There's going to be, you know, remote access for specialty care or things like that.
So, it was quite a kind of a process.
Speaker 1
Did HR1 or CMS implement a extension process? Should we need more time to disperse? Okay.
Speaker 1
That's a no. And then on the provider payments, you lost me a little bit. Is that provider payments to help them stay in those rural areas, to help draw providers to the area?
Speaker 21
It's a good question. So what the term provider payment is something that CMS referenced. So, sort of came up with this idea. Again, it was a concept, the proposal around transformative payments to help a hospital that needed a bit to get steady so they could participate in these other Rural Health Transformation grant programs. And the interpretation was that's a provider payment.
And provider payments are capped at 15%. So, allow for provider payments, but they can only be used in the course of executing sort of activities or investments that are specifically related to the scope of the Rural Health Transformation Program.
Speaker 1
So, the $35,000,000 is going to be used? Yes, we can give it to providers.
Speaker 21
Correct, correct. And again, the idea would be, let's say, if you wanted to a rural hospital wanted to do something to move the needle on maternity care, which is one of our focuses, our targets, and there needed to be a purchase they needed to build out space. They needed to buy equipment to do that service for maternity care, that would be an appropriate provider payment. So, it can be used Oh, so
Speaker 21
It's not that. Exactly. It's just us providing essentially through the grant of payment to the provider. That's why they cap it at 15%. So, we can't give 100% of dollars to providers in that way.
But what it gives it does allow for, again, the idea you could buy some infrastructure, you could buy some equipment, but it's in the course of meeting the goals of the program.
Speaker 1
And one of the questions I had, but you covered it because I was struggling to find labor and delivery. I thought I missed it. I was like, Why aren't we talking about labor and delivery? So there is ability to use some of these funds to create labor and delivery locations, but also bring in providers. Because sometimes they have the space, they just don't have the providers for it.
Speaker 21
Correct. And I think there'll be dollars for workforce in that space. And again, it could be some of the provider payment to get infrastructure equipment. There might be technology.
Speaker 1
Where does that fall under that could do the labor and delivery infrastructure?
Speaker 21
Well, think the way that we set up the program is we highlighted primary care and maternity care as specific outcome goals, right, that we're going to measure towards. What the way we designed the three is actually, I think in all three areas, could apply,
Speaker 21
Okay. And, again, we're still doing some of the detailed design, but it could be infrastructure, it could be workforce, it could be technology that needs to be part of that. There's examples out there, and I think we're looking for innovative approaches. We've learned of some where there's an alternative birthing center, and you have on call staff in a rural area. So, things like that.
So, I think there's a set of opportunities. It wouldn't be just one. But overall, we did highlight maternity care as where we want to move the needle through this investment.
Speaker 1
This next issue came up just this year. It's never been brought up. Dialysis centers not being available in rural areas. I don't know if in the short time we were able to connect with the stakeholders if that came up. It was the first time it's been brought up to me this year.
Tribes talked to me about it. So
Speaker 21
It's interesting. Well, two things. It it it it I don't recall it coming up specifically. We did a rapid couple fire surveys and we did some webinars and some listening sessions before we went into this. You know, it wouldn't be surprising, know, workforce was high on the list and some others.
Dialysis didn't necessarily We come can go back and look. We you know, we are pleased about sort of the we've done our first tribal consultation to prepare for this program. There's a we have a 5% sort of set aside in these areas that a minimum that tribal organizations would be eligible for. But we can go back. Let me go back, and we'll take a look at the survey information that we got from stakeholders and see if dialysis comes to the top.
Speaker 1
Career pathways grants, 7,000,000 will go to rural region high schools. Counseling, mentorships, is this behavioral health for them? I didn't know what it
Speaker 11
Yeah. So we are looking at funding, again, pipeline and early pathway programs with rural health transformation funding. There's a concept around partnering with local high schools. What's, I think, exciting about the rural health transformation approach is it's going be very sort of, like, locally rooted and grounded. Another, we're also exploring sort of working with local workforce development boards on growing their own approaches.
How do you pull from your local population to get folks on the career ladder?
Speaker 1
Or help their junior college have those four year nursing degrees. I think that's also a big priority in these areas. One of the things that stood out, and this is not just for this, in a lot of things. Sometimes, often, we pay too much money for consulting contractors. $23,600,000 for a contractor.
I feel like you're the contractor here. You know, we are putting this together. What additional value would the we're creating a rural technical assistance center contractor bring that the department is not bringing?
Speaker 21
Sure. And that's very specific in terms of the rural technical assistance center, because I think some of those skills are skills that we don't have in house. So in the transformative care model, for example, doing hub and spoke, we believe there's significant work to be done around it's essentially organizational change management, but it's often in the clinical workflow. If you're not accustomed to doing telehealth service delivery, if you're not accustomed to doing e consults where you're bringing a specialist over, essentially with a digital solution. You know, that kind of work is not the kind of work that we do, but we're very much committed to providing hands on assistance to the rural providers that are interested in moving to those kinds of care models.
So, it is those are going to be really specialty services that we just don't offer. Now, and, you know, to Deputy Director Abbott's point, mean, the things that we can do, we will do. We'll be designing the workforce development grant making, which we're excited. But clinical care capacity is not something that we have to offer, so we're going to have to the thing that I think is important is that those are direct services to the grantees and the participants in the program, Okay. Not for
Speaker 1
And then, all of this that you described, I mean, we submitted already to the CMS, like, is these are set in stone programs.
Speaker 21
Yes, the concepts are. I mean, the details are being designed now. But, yes, generally, how we're going to make those investments and, you know, what the three programs are
Speaker 11
JULIE Director Landsberg spoke earlier. When you asked the question about how are we looking at geographic inequities and access to care, she spoke about, Historically, we've been the office that establishes health profession shortage areas. We are now sort of maturing our approach by developing supply and demand models for different areas of workforce. And we think that's a more accurate way to assess severity of shortage, because we're looking at actual population based demand for services, and then comparing it to the supply of existing workforce. We did that work last year for behavioral health at nursing.
We are, through the Rural Health Transformation work, which is focused on primary care and maternal health, going to develop our supply and demand models for primary care and maternal health. And why that's important is because we want to, for example, look at demand for maternal health services, and then target our funding for scholarships for midwives, or our education capacity expansion for midwives, or our offering of fellowships for family care physicians who provide OB services. We want to target that geographically to where we see the biggest gaps in demand. So it is an analytical tool that helps us target our dollars most.
Speaker 11
this is just putting it in data form? This is helping us prioritize. Because even let me give the example from behavioral health. We know that there are gaps in behavioral health care, and we developed this model. And now we actually know where the most severe gaps are.
So when we have limited dollars, we channel those dollars to the areas of most severe shortage. Same approach here with maternal health and primary care. We know across rural health that there are gaps, and we want to make sure that our dollars are going toward the areas with the most severe gaps. So for maternal health, if we're going to fund, let's say, the development of a new licensed midwifery program, we'd like to locate that program or incentivize the location of that program in, let's say, the rural North, if that's what we find has the most severe shortages.
Speaker 1
Perfect. Okay. And then so anything to do with infrastructure, creating a satellite clinic, all that are eligible for grants that are going to be distributed from this?
Speaker 1
I'm not. Okay. Great. Perfect. We're going to hold the item open, move on to issue number eight.
I mean, thank you so much. That's it. Thank you all. Moving on to our next department, Department of Managed Health Care. With issue eight.
Speaker 16
Ready? Okay. All right. I think it's afternoon. Good afternoon.
My name is Mary Watanabe. I'm the director of the Department of Managed Healthcare, and I have Dan Suthard, our chief deputy director, with me. I'll quickly just provide an overview of our mission and our budget. I'm happy to provide an overview of each of our offices, but I will say the agenda did a good job of going through those. Okay, we'll move quickly.
So our mission is to ensure health fund members have access to equitable, high quality, timely, and affordable health care within a stable health care delivery system. We license and regulate 140 health plans that provide health care coverage to approximately 30,200,000 Californians. We regulate more than 97% of commercial and government health plan enrollment in the state. Our proposed total budget for twenty six-twenty seven is 186,000,000 and seven ninety eight authorized positions. Just a reminder, we are specially funded by annual assessments on health plans and receive no general fund money.
And with that, I'll turn it over to Dan to cover two of our BCPs, and then I'll be back.
Speaker 26
Thank you, and good afternoon, Madam Chair. I'll start with SB 41. SB 41
Speaker 26
Sorry. Yeah. Go ahead. So starting with SB 41, the pharmacy benefit manager. So SB 41 builds upon previously established pharmacy benefit manager licensure requirements enacted in 2025 through AB 116 by expanding legal requirements related to PBM revenue practices and pharmacy network reforms.
The bill enacts sweeping reforms for PBMs and requires PBMs to be licensed by the DMEC starting in 01/01/2027. SB 41 limits how PBMs generate revenue by prohibiting spread pricing, requiring manufacturing rebates to be passed directly to health plans, and allowing only administrative fees to be charged. Additionally, this bill establishes new restrictions on how PBMs operate their contracted pharmacy networks, prohibiting discrimination against nonaffiliated pharmacies, and requiring PBMs to include any pharmacy willing to adopt standard terms. SB 41 requires the DMHC to issue formal guidance to ensure health plans and PBMs clearly understand and comply with the requirements of SB 41, conduct detailed legal research of health plan and PBM contracts, policies, related documents to ensure compliance, address provider complaints against PBMs, and compile and analyze new PBM data. Update medical survey technologies or methodologies and tools to assess compliance with the requirements of SB 41.
And to implement the requirements of SB 41, the DMHC is requesting seven positions and $1,700,000 in twenty six-twenty seven, increasing to a total of nine positions and $2,200,000 ongoing to implement the requirements of SB 41. I can answer any questions or move on to the next. Next item is prior authorization reporting, SB three zero six. SB three zero six increases transparency in the prior authorization process by requiring health plans and health insurers to submit prior authorization data to the DMHC and the California Department of Insurance. After reviewing the data and consulting with stakeholders, the DMHC will develop and issue a list of health care services that will no longer be subject to prior authorization requirements.
Speaker 57
The bill establishes a deadline of 07/01/2027 for issuing the list and 01/01/2028 for the health plans and insurers to implement the list of services that will no longer be subject to prior authorization. S p three zero six requires the DMHC to promulgate and amend applicable regulations to clarify the requirements of SB three zero six, review health plan contracts, policies and procedures, evidence of coverage, and disclosure forms for compliance with SB three zero six, address consumer complaints related to prior authorization, and publish a list of health care services exempt from prior authorization requirements, and finally, issue a public report on the impact of the prior authorization exemptions. To address this workload, the DMC is requesting four positions at 1,400,000 in twenty six-twenty seven, increasing to eight positions and 1,800,000.0 ongoing to implement requires of SB three zero six. Any questions on that or continue on? I'll turn it back over to our Director, Mary.
Speaker 16
Thank you. There we go. Alright. Beginning 01/01/2027, AB ten forty one requires a health plan or its delegate to notify a provider within ten business days to verify receipt of their application, to make a determination regarding the credentials of a provider within ninety days after receiving a completed provider credentialing application, activate the provider upon successful approval, and notify the applicant of the activation within ten business days. And if the plan fails to meet the ninety day deadline, the bill requires applicants' credentials to be provisionally approved for one hundred and twenty days unless certain circumstances apply.
And then beginning 01/01/2028, health plans and their delegates are required to use the Council for Affordable quality health care or CAQH credentialing form. To implement this bill we will issue guidance review plans contracts policies and procedures evidence of coverage and disclosure forms will also update our medical survey tools to review compliance We're requesting four positions and $1,200,000 in twenty six-twenty seven, increasing to five positions and $1,400,000 ongoing to implement these requirements. And that concludes our overview of the BCPs.
Speaker 1
Jason, anything to add? We're going to hold the item open, move on to a joint request on issue number 10.
Speaker 16
Alright. The governor's January budget included a proposal to increase access to treatment for the symptoms of perimenopause, menopause, and postmenopause through increased enrollee and provider awareness. The proposal specifies that health plans licensed by the DMHC, health insurers licensed by the California Department of Insurance, and Medi Cal managed care plans must cover services for evaluation and FDA approved treatment for menopause when medically necessary. In addition, health plans would be required to have a menopause program that includes a policy to provide an annual menopause assessment for enrollees age 40 and older during primary care and OBGYN appointments, a biannual notice to enrollees over age 40 that includes the definition of menopause and the services available to treat the symptoms of menopause, and also a biannual notification to primary care and OBGYN providers on best practices for care, including current clinical care guidelines for menopause care from nationally recognized professional associations, or the menopause society. When making a determination about whether menopause care is medically necessary, health plans are required to base their criteria on generally accepted standards of menopause care from nonprofit professional associations for the relevant specialty.
They're also required to have a process to reimburse primary care providers and specialists for menopause care, including care integrated into OBGYN or primary care visits. Health plans are required to have a policy to contract with primary care at OBGYNs with certification and credentialing by a nationally recognized organization such as the Menopause Society. This should be include a policy to incentivize providers to obtain and maintain their certification. There are also other business and profession code requirements related to continuing education to incentivize providers to complete coursework related to menopause. And finally, the proposal includes $3,000,000 for the California Health and Human Services Agency to conduct an outreach campaign to increase awareness of menopause symptoms and about the menopause transition and how to access treatment and evaluation.
To effectively implement and enforce these requirements, we will need to review plan filings, monitor health plan implementation, and verify continued compliance through our medical surveys. We're requesting two positions in 04/7000 in twenty six-twenty seven and three hundred and ninety one thousand dollars ongoing to address these requirements. So you had a question about the difference in this proposal compared to AB four thirty two, including the rationale for why the administration is making these changes. I will just note, I think the most significant difference is AB four thirty two would have limited utilization management for menopause related services and would have required that one treatment option in each four categories of menopause symptoms be covered without utilization management when deemed medically necessary by the treating provider. The trailer bill proposal addresses the need for increased enrollee and provider education about the symptoms and latest clinical care guidelines for treating those symptoms while maintaining the health plan utilization management practices.
The proposal specifies that health plans must cover FDA approved treatments, and we believe the requirement to use the nonprofit criteria when making medical necessity decisions will address some of those concerns. I will just note, I think there are over 70. I read an article yesterday that there's as many as 100 symptoms of menopause, so one of our concerns was, removing the requirement for the plans to use, utilization management prior authorization for that many symptoms, knowing that half of the population will experience menopause at some point, has the potential to increase costs of the health care, and also lead to unnecessary treatments because there's an easier pathway. So those were some of the greatest concerns. And I think I'll stop there and see if Tyler has anything to add?
No?
Speaker 6
Thank you, Director Watanabe, and good morning, Madam Chair. Tyler Sadwyth, State Medicaid Director. Very briefly, just with respect to the impact on Medi Cal. The proposal exempts Medi Cal managed care plans from changes to the health and safety and insurance code section of the statute, but it updates the welfare and institutions code to codify the existing comprehensive Medi Cal coverage for menopause treatments, including screening, evaluation, and treatment. In effect, the proposal has the effect of bringing commercial payers up to alignment with current Medi Cal benefits coverage.
Speaker 1
Okay. Thank you. My only question was a little bit more on the utilization. Like, what kind of utilization controls are going to be allowed within the TBL? 70 codes, it's a lot, but what guardrails are going to also exist?
Speaker 16
Yeah. No. So plans can do utilization management today. I think AB four thirty two would have removed that requirement for treatment of certain symptoms. Symptoms was not defined, so I think the concern is that could have been very broad.
So plans can, under this proposal, would continue to be able to do utilization management, but they would need to apply the nonprofit criteria, which would give more visibility but also would mean they are using the latest clinical guidelines. I think one of the things we hear over and over and if you're has showed up in your social media feed. I think the biggest concern is there was a 2002 study that linked hormone replacement therapy to breast cancer. And so there's been, I think, a lack of information for both enrollees as well as providers on what the latest clinical care guidelines are saying, which have kind of disputed, or we've kind of deviated from that study. And so the critical piece here is making sure that both health plan members and providers are up to date on the latest clinical guidelines, and then also that the plans are applying those clinical care guidelines, the most current ones, when they're making those utilization management decisions.
Speaker 1
Okay. And then on the $3,000,000 for the public awareness, you mentioned notifications to enrollees and providers. So it's just we're sending out emails? Is that our public
Speaker 16
So under the pieces, under the DMHC, the health plans will be required twice a year to send information to their members on what are the symptoms of menopause, what are your treatment options. Similarly, they will need to send information to their provider network about what the latest guidelines are from these. The menopause society is really the go to on this. Separately, through our California Health and Human Services Agency, there will be a public awareness campaign really to make sure the general public has the latest guidance on what are all of these symptoms of menopause, what can you do, who do you talk to. Again, that's not under the DMHC.
That'll be under our Health and Human Services Agency.
Speaker 1
Okay. By any chance, do you have a little bit more details, Department of Finance, on the campaign? The public awareness campaign?
Speaker 19
Angel Alonso Coronne, Department of Finance. With the public awareness campaign is still under development, and Health Resources Agency will be able to request in a budget augmentation when ready to implement this campaign.
Speaker 1
Yes. Okay. So, but no details on the public awareness campaign yet? Correct. Okay.
Details coming in May?
Speaker 1
Definitely tracking that to make sure we get more details on that. And that is it on this issue. Thank you so much. We're gonna hold and open. Short and sweet director.
Now sticking with DHCS on issue number 11.
Speaker 6
You. Good morning, Madam Chair. Toddler Todd with State Medicaid Director, Department of Health Care Services. First, I'd like to provide information about CalAm Enhanced Care Management and Community Supports. Enhanced care management or ECM in community supports continue to expand and mature statewide with strong uptake among high risk members, the population that these services are designed to reach.
These are members who benefit most from whole person, community anchored care. Is growing consistently across all counties. We have public reporting available on our website. And just to highlight some of the growth statistics, for Enhanced Care Management, 02/5000 unique members received ECM in the 2025. This represents an increase of 61% over the prior year.
Since launching ECM, more than 452,000 unique members have received this service. For community supports, in the 2025, 187,000 unique members received a community support, which represents a 51% increase over the prior year. Since launching community supports, more than 521,000 unique members have received a community support service. And in total, over 1,300,000 community support services have been provided. Availability has grown significantly since launch.
Although these are mostly optional for plans, every single Medi Cal managed care plan in California offers community supports. Every county in California has at least eight community supports available to all Medi Cal members, no matter which plan that they're enrolled in. In 43 counties, representing 94% of Medi Cal members, all members have access to at least 10 community supports, no matter which plan they're enrolled in. And in 24 counties, representing 75% of members, they have access to all 14 community supports. In terms of ECM, provider network growth has grown substantially.
When we launched this service at the beginning of Cal AIM, there were just 700 unique contracts. Today, there are over 4,000 unique contracts. Turning to the fiscal picture, as requested, the governor's budget projects for ECM $1,200,000,000 total funds in 'twenty five'twenty
Speaker 6
and $1,400,000,000 total funds in budget year. For community supports, except for the newest community support of transitional rent, the budget projects $1,100,000,000 total funds in current year and $1,100,000,000 total funds in budget year. I want to note these estimates reflect only the distinct cost of providing community support services. These estimates do not reflect avoided costs of more costly services that otherwise would have been provided, such as emergency department visits and patient hospital admissions and nursing facility stays. I'll talk more in a bit about our analysis of cost effectiveness of community support services.
But in terms of the budget, if ECM and community supports were discontinued, we would project a significant increase in high cost acute care spending due to higher levels of use of these intensive services. For transitional rent, the final community support, we project $55,000,000 total fund in current year and $225,000,000 in budget year. In terms of cost effectiveness of community supports, this is a complex area of analysis. In some cases, a member exiting a hospital might receive a community support like recuperative care in lieu of being admitted into a nursing facility. So we can capture that type of cost avoidance immediately.
For some other scenarios and other community supports, like asthma remediation services, which reduce the incidence of asthma exacerbations in care management, cost avoidance may be seen over a longer period of time, including multiple months or even years. In terms of community supports, we published a report in April describing a cost effectiveness analysis of 12 of the 14 community supports. For members who received a community support, we compared the cost of delivering that service to the savings that we achieved from reducing and avoiding inpatient hospital use, emergency department use, and long term care use and other services in the six months before and after the intervention of the community support. So, we have a fact sheet on our website. It shows that of the 12 community supports analyzed in this report, nine are already demonstrating cost effectiveness, and the three remaining services are on track to be cost effective over a longer study period, consistent with guidelines the federal government has for how to measure cost effectiveness for these types of interventions.
Just a couple quick highlights. Respite services were associated with a 61% net cost reduction. Personal care and homemaker services are associated with a 58% net cost reduction. Housing deposits achieved a 32% net cost reduction. Recuperative care associated with a 29% net cost reduction, and so forth.
We are finalizing by the end of this month an updated report that analyzes more data over a longer study period, including new analytical methodologies. In terms of enhanced care management, a formal evaluation of cost savings has not been completed. However, there are independent evaluations of the programs that ECM is modeled on and based on. The whole person care and health home programs both demonstrated Medi Cal cost savings by reducing avoidable acute care and emergency department use. The whole person care pilot showed annual Medi Cal savings of about $383 per member and $581 per medically complex members.
We are exploring the possibility of a formal evaluation of ECM outcomes and cost effectiveness. We have a formal independent evaluation underway. We are completing a full independent evaluation of community supports as required by our nineteen fifteen waiver special terms and conditions. UCLA and the RAND Corporation are completing this independent evaluation, examining the program's cost effectiveness and health outcomes with results due in 2028. Turning to the question regarding provider capacity and transitioning community supports into the state plan.
Provider capacity for community supports continues to improve statewide. Managed care plans report steady increases in executed provider contracts and expanding network growth across these services, as reflected in the submissions of their model of care that they send to us. We show on our website the number of provider contracts for community supports has increased from just seven thirty one when we launched this program to over 3,000 as of about one year ago. In terms of the transition of community supports into a state plan benefit, we are not pursuing that transition at this time. Instead, we are working to ensure continuity of community supports under the optimal federal authority for sustainability, which is managed care authority as an in lieu of service.
In lieu of services is a permanent option for state Medicaid programs enshrined in federal Medicaid managed care regulations, and it's memorialized in our approved managed care plan contracts. 12 of our community supports are covered under in lieu of services authority. As we described in our section eleven fifteen Cal A waiver renewal, which we posted for public comment and had public hearings in February and March, we're planning to transition the federal authority for recuperative care and short term post hospitalization housing from the eleven fifteen waiver into in lieu of services authority. This will allow us to incorporate those services and really ensure sustainability of these services into a consolidated service model, given there is a very significant risk CMS would not approve these upon the elevenfifteen waiver renewal, and thus these services would no longer be covered effective 01/01/2027. Turning to the question regarding how the department ensures managed care plans leverage local vendors and community based organizations.
We work closely and actively with all plans to promote the use of community embedded and community rooted providers. We emphasize and have consistently emphasized contracting with local providers and CBOs that have deep ties to the communities they serve, understanding these CBOs understand local needs, cultures, and gaps. So, in terms of oversight, we monitor the types of providers that our plans contract with to ensure they're engaging nonprofits and CBOs that reflect the cultural, geographic, and linguistic needs of members. We have regular monitoring meetings and additional oversight mechanisms to strengthen partnerships with these providers. To support these providers, the department has awarded over $1,600,000,000 in grant funding and in technical assistance resources to more than 2,200 CBOs through the PATH initiative, or Providing Access and Transforming Health.
As part of the independent evaluation of CalAIM that UCLA and RAND are conducting that I mentioned, they developed an interim evaluation report that we submitted to CMS in December. And this focused on the impact that PATH has had on CBOs in participating in Cal AIM. This report found that PATH is achieving its objectives of integrating CBOs that have historically not participated in Medi Cal, bringing them into Medi Cal for the first time for the purpose of delivering ECM and community supports. Among providers that received PATH funding or technical assistance, the vast majority were CBOs, 9193%, respectively. This independent evaluation found PATH helped cover these providers' initial operational costs and supported participation in CalAIM as intended.
We are also working closely with the California Healthcare Foundation to support CBOs to participate in CalAIM, including through funding provided by the foundation and the development of technical assistance resources and toolkits in close collaboration with the department to really support managed care plans and CBOs to enter into, as an option, an arrangement through community care hubs. Community care hubs are a way to enable CBOs to focus on their core competency, service delivery, and reduce the administrative burden of data collection and reporting, claim submission, compliance requirement, contract negotiations, and so forth. So, we have seen that these hubs really streamline these back office business functions for small grassroots CBOs and enable them to take advantage of Cal AIM. We've heard from plans that a DHCS endorsed resource explaining how these hubs can be operationalized consistent with federal and state requirements was really pivotal for them to expand these types of arrangements. Happy to answer any questions.
Speaker 31
Yes. Will Owens with the LAO. So on this item, last year, our office published an update on the implementation of ECM and community supports, benefits. So in general, we found that utilization of the benefits, was growing over time but was somewhat lower than anticipated at the start of these programs. Additionally, we noted that more information was needed to determine, whether these initiatives were meeting the goals, outlined, at the start, including reduction of costs and avoidance of higher cost services.
So, as mentioned by the department, there have been a few updates, since that report. More information has come out, and, I just wanted to highlight for the committee, a few updated issues for consideration from our original report. So first, the most recent data released by DHCS does show that utilization of these benefits, both ECM and community supports, has continued to increase since we published our analysis last year. And, as we discussed in a report that many of the barriers to increasing utilization of these benefits was mostly due to the fact that these were largely kind of provided by CBOs that were not as familiar with the Medi Cal managed care plan kind of billing ecosystem and how that all worked is much different operating model to what they usually did. So we would expect that as CBOs, providers, and managed care plans, got kind of more used to this benefit and working with each other that we would see utilization increase over time as things got streamlined, and that appears to be the case.
However, we would still flag for the legislature, that additional information, may be requested from the department regarding provider adequacy as well as barriers, for both plans and providers and patients, from accessing these services. These would be things that go beyond, simply number of provider contracts, but would be looking at things that are a little more closely related to things like timeliness of patients, accessing these benefits, reimbursement of timing of providers, things like that that dig a little bit more deeper and try to understand these barriers. Second, as mentioned by the department, DHCS released an annual report to CMS last year detailing some of the cost effectiveness measures of community supports, and they have an upcoming, evaluation as required by CMS that will be released, later kinda looking at CMS or the community support as a whole over a longer time period. In general, most of the services were shown to reduce costs and and, as the department said, reduce reliance on higher acuity care options such as inpatient and emergency department, utilization. So this type of analysis really is, critical for the legislature to assess the success of these programs kind of moving forward.
And kind of, adding on to to some of our recommendations last year, we would, suggest and the legislature may wish to work with the administration to determine how this type of analysis, could be done on an ongoing and sustainable way to evaluate community supports as well as ECM. As the department noted, ECM, the cost effectiveness is based on previous pilot programs that share some but not all components of the current ECM benefit. So, given the kind of growing utilization and and growing share of, general fund spending on this that that these benefits have shown over time, it's important for the legislature to understand how these cost savings are are still being had moving forward. With that, available to answer any questions.
Speaker 1
Thank you so much. Deputy director, I'm a huge fan of cost saving evaluations. Does this program only do that because it's a requirement by CMS? Or is this common of our programs?
Speaker 6
Thank you, Madam Chair, for the question. I would say that the resources that are allocated specifically towards the cost effectiveness evaluations of community supports are prioritized in a way, in part because they are federally required across a few different areas, including our nineteen fifteen BSTCs, the federal regulations that govern in lieu of services authority, which we're using for most of these services. And then, in addition, the CalAIM eleven fifteen STCs, where an independent evaluator will review. So because CMS requires such sort of rigorous and prescriptive and ongoing cost effectiveness determinations for these, we're able to receive the resources to do that level of analysis. Generally speaking, we do try to take into account sort of cost effectiveness of health care services when designing benefits in general, but not to the level of this rigor, if that's helpful.
Speaker 1
Yeah, a little bit. I guess I'm trying to figure out, is it just a money thing? If I were to want a formal evaluation, there have been stakeholders that have presented certain programs that say this will be cost savings down the line. And there's key points you even mentioned, you know, to avoid acute care, avoid people being in hospitals, not to this topic, but just bringing up things that have come up in the subcommittee or a private duty nursing or congregate health living facilities, ways to remove people from hospitals. So, I'm just wondering how to formally get an evaluation of other programs, see it has been so beneficial for CAWI.
Speaker 6
Thank you, Madam Chair. Yeah. And with congregate health living facilities in particular, I mean, we are actively pursuing the opportunity to carve that into managed care to enable for that because we do believe that's definitely better for members as well as for the budget.
Speaker 1
So how do you I mean, do I turn to you, Leo? Hey, do a formal evaluation.
Speaker 20
So I think some of the challenge here is, in cases where the department is required to look at cost effectiveness, sometimes their design works in a way where you can do that sort of evaluation. A lot of other policies that have been enacted over time, it can be much harder to isolate those effects because they come in a package of many other sort of factors. Okay. But generally, it is a I would concur that it is a high priority to sort of evaluate new things. This has come up a lot.
It's not just sort of new benefits, for example, like we're not aware still of an evaluation of how the Prop 56 rate increases sort of affected access. That would be another sort of key policy question.
Speaker 1
Is the same to MCO, Right? Same thing with the MCO tax. Or providers in this area.
Speaker 20
Yeah. That that one the MCO tax maybe it is because it still hasn't been implemented Sure. That that would be but but it it some of it comes down to sort of how it's designed. And sometimes, you need to design it in a way that that can contribute to the evaluation. The other thing I would just emphasize is that you sort of asked, is it just a money issue?
And really, you know, the legislature has many priorities and it isn't always just a fiscal consideration. Sometimes high priority policy issues cost more money, but they're high They enter access, they improve people's health outcomes. There can be other factors than just whether or not it saves money. So that would be an important consideration. True.
Speaker 1
Can you go over the you you you spoke on it a little bit. The they expire. The two waivers expire December 31. And you mentioned if we don't change something, will be contingent on the ability to renew. So we are able to renew, but we have to change some things?
Speaker 6
Yes. Thank you. Thank you, Madam Chair. So we are preparing to navigate expiration of the two federal waivers that we rely on for Cal A. And we have a nineteen fifteen, what's called a nineteen fifteen B waiver and what's called a Section eleven fifteen waiver.
12 of our 14 community supports are covered under in lieu of services authority, which is really established simply in managed care regulations. And states are typically able to cover services like our community supports as in lieu of services outside of any waiver. They're typically able to cover them in their plan contract, and they submit that to CMS for review and approval consistent with the regulations. In CAL AIM, in our 1915 waiver, we do have a lot of specific standard terms and conditions about reporting on our in lieu of services because we were very comprehensive and we kind of were innovative in addressing social determinants of health and health related social needs. And so CMS, when they approved our Cal A waiver, added a lot of extraordinary reporting requirements in our 1915 waiver.
But fundamentally, the authority for them is in the regulations and not subject to a waiver renewal. Two of our 12 community supports under Cal AIM cannot be covered as an in lieu of service because they entail room and board. They I figured they room and board. Yeah. So recuperative care and short term post hospitalization housing, the only way to cover them is in what's called the Section eleven fifteen waiver.
That also expires at the end of this year. We believe it would be unlikely that CMS would, under this administration, would renew our eleven fifteen waiver with recuperative care and with short term post ausposition housing. And so if we just asked for that, it's likely they would deny it And these two services would fall off a cliff. So we're in the process and what we proposed through our public comment period for the eleven fifteen renewal, we proposed to take those two services, really consolidate them into one because they're quite similar, and then move that new consolidated service into the in lieu of services authority so that it's similar to all of the other community supports. In doing so, we avoid the risk that CMS says, No, that's not approvable in the waiver.
In doing so, though, we have to remove the room and board component because room and board cannot be covered under a lieu of services. That's why it was in the 11/15 waiver. So we're modifying the service itself. We're taking out room and board, but we are strengthening some clinical competencies, clinical staffing around it. So it's a little bit more of a medically monitored service.
So updating the service, if you will, and then covering it in lieu of services to avoid this renewal process.
Speaker 1
At what point would we have to stop offering that service to have enough time to individuals getting kicked out of that room and board?
Speaker 6
So what we plan to do, as we navigate the renewal process and transition across different federal authorities, we are aiming for a seamless patient and provider experience. So the providers that deliver recuperative care and short term post hospitalization today, we've been engaging them heavily on this approach. And our goal is to make sure that the majority, if not all of them, are poised and positioned to deliver the new recuperative care service covered under the in lieu of services authority. So they would still be able to continue operating. Patients would still be able to continue getting services there.
The only fundamental difference is it's a different federal authority. And then technically speaking, we would no longer cover room and board. And technically speaking, room and board would no longer be explicitly part of the payment rate development. But we are making other updates to the service, as I mentioned, to strengthen some standards around it. We also are looking at the fact that we haven't updated these rates for inflation this entire time.
And so just updating it for inflation would increase. So, trying to make sure we're avoiding disruption for providers and patients as we do the transition.
Speaker 66
And to that note, under the recuperative care, just with Health Net alone, there's been some recent incidents. I think it's up to 500 people, a lot in LA County, that have been kicked out of their recuperative care facilities that Health Net partnered with Sole Housing. I'm wondering if the impending expiration of this have caused the cease of contracts and have kicked people off while the department put out a statement saying they didn't violate anything because they gave enough time within the guidelines to say they were gonna eliminate that. It does seem, though, that the plan has not been ethical in providing continuity of care of where these people have gone to. What else is the department doing to ensure?
Speaker 1
I mean, in South LA, there was a recent big one. I don't know if you're aware of all these situations. Is that connected to where everything you just mentioned?
Speaker 6
Thank you, Madam Chair. So we have worked closely with Health Net, with Sole Housing, both in Los Angeles as well as in Fresno County, where Sole Housing was also part of an interruption in their contract with the managed care plan to deliver recuperative care. Based on our understanding and our involvement in supporting members, these are unrelated issues. Sole housing was it's all an individual case by case issue, but in many cases, sole housing was admitting people without prior authorization and expecting to be paid and receive reimbursement without going through the typical and the required processes that Medi Cal managed care plans use to administer these benefits and ensure the integrity of the program.
Speaker 1
So was it more an issue on because it was also housing locations. So it was more an issue on the nonprofit's ability to follow the guidelines necessary. But, I mean, a person at the end that, you know, gets impacted is the patient, unbeknownst to them, you know, what is happening and so forth. A 100%.
Speaker 6
And that's why we worked very closely with Health Net and with all the plans involved and with Sole Housing to help make sure that, above all, sort of the transitions were prioritized and making sure that there was individualized one on one case management to make sure people had a pathway to go to as the underlying business dispute was being adjudicated.
Speaker 1
So unique situation. Nothing needs to be in place for guardrails, for other bigger picture issues on that. It was just this entity in specific. Do we see that
Speaker 6
as a pattern? We don't see the experience that we observed with sole housing in several different locations. That is not a pattern across community supports.
Speaker 1
Okay. You mentioned 4,000 unique contracts. Is that 4,000 unique vendors, nonprofits that clients have partnered with? Is that what you've alluded to?
Speaker 6
Yes. In ECM. And that's moment in time. I think historically, it's been 6,000, but, these fluctuate over time. So currently, based on the latest data available, 4,000 provider yeah, providers delivering this.
Speaker 1
And going a little bit more on one of the questions. I think it was the number three that you talked about, maximizing the benefits of local vendors. There was reports that a lot of the contracts were out of state vendors. Do we have an update of has that percentage changed? There was a huge percent of them that were out of state.
Have we focused more on in state contracts?
Speaker 6
Doctor. Yes. Thank you. Thank you, Madam Chair. So for ECM, over 99% are in state.
And so, that is not really an area that we've heard about. Within community supports, some just by nature are truly in state. We did hear early on, I think with medically tailored meals in particular, reporting and conversations with plans that initially as they stood these services up, there were concerns about providers located out of state that obtained some contracts. We've since engaged with plans and with representatives of CBOs, and we've learned from plans that they have changed their provider contracting strategies to focus more on not only in state providers, but specifically sort of the CBOs that this was intended for.
Speaker 1
Okay. And my last question is and I apologize. I can't remember the actual phrase. But there was an issue last year regarding the assisted living waiver. Yes.
A list that needed to be disclosed. No. I'm not hitting on the no here.
Speaker 6
Apologize, madam chair. We can follow-up. I'm not personally tracking that.
Speaker 1
Okay. Yeah. I've been trying to figure this out. I'll get back to you on the question. Okay.
That was it on issue number 11. Thank you so much. Move on to issue number 12.
Speaker 6
Issue number 12 is the California Community Transitions budget change proposal. The department is requesting limited term resources equivalent to one position, an expenditure authority of $165,000 in federal funds in budget year to support the California Community Transitions Program operations, noting this is 100% federally funded and has no general fund impact. Through the California Community Transition Program, which operates under the federal Money Follows the Person initiative, eligible individuals with disabilities receive transition coordination services to help them move from institutional care to community based living to receive long term services and supports and home and community based supports to mean independence at home or in their community. This program also plays a pivotal role in the state's efforts to update operational infrastructure, including through the no rung door system that is operated by the California Department of Aging. This position will help manage the administrative, operational, and monitoring workloads associated with these activities and comply with federal grant funding and reporting requirements.
Speaker 6
Issue number 13 is a budget change proposal related to a final rule that CMS passed in 2024. The department is requesting one year limited term resources equivalent to seven positions, four year limited term resources equivalent to 15 positions and expenditure authority of $7,275,000 total funds, of which 1.788 is general fund in budget here. In addition, we are requesting four year limited term funding authority for 15 permanent positions that we received one time funding for in last year's BCP. These resources will continue to support the department's ability to meet all federal and state requirements as part of the 2024 final rule, the Ensuring Access to Medicaid Services final rule, often known as the Access Rule. These resources are necessary to continue the planning, development, implementation, and ongoing administration, monitoring, and oversight for requirements starting to be effective this year.
The rule imposes permanent operational and regulatory workloads, and complete implementation requires long term staffing that far exceeds the limited term positions previously approved. And just as context, in HR1, Congress included a moratorium on several final rules that CMS had promulgated in 2024. However, Congress did not include a moratorium on the Medicaid access rule. So, as a result, ongoing resources are required to retain the initially approved positions and to achieve and sustain compliance in monitoring and stakeholder engagement in accordance with this rule.
Speaker 6
This is a budget change proposal related to human resources plus modernization. The department is requesting three permanent positions and expenditure authority of $4,535,000 total funds in budget year to continue the planning, procurement, and project implementation costs to modernize our human resources and related fiscal systems and processes. The department recently finalized the procurement for a new system, we are working on implementation planning. This system will result in streamlined human resources and fiscal reporting that are necessary to address current and ongoing federal concerns that CMS has raised in its financial reviews of our program regarding cost allocation documents in order to claim federal funds for administrative activities. This is necessary for DHCS to meet federal allowable claiming requirements and to not jeopardize significant federal funding and penalties and ongoing deferrals that we currently face as we administer a state only health care program for Medi Cal members with unsatisfactory immigration status.
There are no cost savings directly associated with this request. However, the system investment will ensure federal funding that is claimed meets federal auditing standards, and thus it will result in cost avoidance due to avoiding federal disallowances.
Speaker 1
No questions for me. Hold the item open. Move on to issue 15. Thank you.
Speaker 6
The department is proposing a technical cleanup in trailer bill language of existing statute related to the breast cancer research accounts. The technical cleanup corrects state department references from DHCS to the California Department of Public Health in the Revenue and Taxation Code. Specifically, the Revenue and Taxation Code, section 304,601.6, governs revenues that are allocated from cigarette and tobacco products surtax, which are deposited into the breast cancer fund. This fund includes two accounts, the breast cancer control account and the breast cancer research account. Together, the revenue in these two accounts is used for our Every Woman Counts program.
DHCS is the designated state department for the Breast Cancer Control account. California Department of Public Health is the designated state department for the Breast Cancer Research account. This proposal is necessary to restore and correct state department references to ensure appropriate designation of roles and responsibilities and ensure uninterrupted program operations, research, and public health services.
Speaker 1
Safe travels. Missed the flight, so I'm going on the next one. Department of Public Health. I do this to myself. I'm the one asking questions.
So Now moving on to issue 16.
Speaker 1
Not yet. Is the red on? I think it's off. Think it's off. The red light has
Speaker 33
Okay. Hi, I'm Doctor. I'm the division director for GDSP. And GDSP administers two programs funded through the Genetic Disease Testing Fund, the mandatory newborn screening program and the voluntary prenatal screening program. So the budget overview for fiscal year twenty five-twenty six, expenditures are estimated at $169,600,000 Of that, dollars 132,300,000.0 in local assistance and $37,200,000 in state operations, a $6,000,000 or 3.4% decrease from the 2025 Budget Act, driven by lower live births and reduced P and S participation.
For fiscal year twenty six-twenty seven, expenditures total 175,000,000, of that 138,300,000.0 in local assistance and 36,700,000.0 in state operations, a net decrease of 531,000 or 0.3% compared to the 2025 budget act. This reflects lower P and S volume, higher MBS costs from the Krabbe's disease expansion, and the end of a one time prior year resource authorized in 'twenty three-'twenty four. For fiscal year 'twenty five-'twenty six, we expect the number of newborns screened to decrease by one percent from the prior year. And for fiscal year 'twenty six-'twenty seven, the number of newborns screened is projected to decline further by zero point six percent. In twenty twenty five, twenty six, newborn screening expenditures are decreasing 1,200,000.0 from budget act levels and will increase 2,700,000.0 to 56,100,000.0 in fiscal year twenty six twenty seven, a five percent increase.
This is mainly due to a statutorily required Krabbe's disease expansion to the newborn screening panel as of 07/01/2026. This addition will require $5,500,000 in local assistance, of that $3,700,000 for lab and diagnostic work, and 1,800,000.0 for operational support. We anticipate that a roughly 20 fee increase per participant will likely be needed in fiscal year twenty seven, twenty eight for ongoing costs, and any such fee increase will be pursued through the formal rulemaking process. For c for prenatal screening for our cfDNA tests, for fiscal year twenty five-twenty six, we expect the number of tests to decrease by 1% from the prior year, and we expect a further decrease of 0.5% in fiscal year twenty six -twenty seven. For our neural tube defect screenings, we anticipate a 2% decline in fiscal year twenty five-twenty six.
We anticipate a further decrease of 0.5% in fiscal year twenty six-twenty seven. Prenatal screening for fiscal year 'twenty five-'twenty six expenditures will be $51,100,000 marking an 8.3% drop from the 2025 Budget Act. In fiscal year six-'twenty seven, expenditures will be at $51,300,000 which is down 7.8% from the Budget Act amount. In conclusion, GDSP's fund remains fiscally stable. We will continue monitoring reserves and prepare for future fee adjustments.
Thank you.
Speaker 1
How much do people pay for this now? For which? You said there was an increase of five there's going to be an increase of 5%?
Speaker 33
Yeah. The roughly $20 fee increase $20? For the yeah. Yeah. For newborn screening.
So how much people pay now? What's the current?
Speaker 33
We have to expand due to the statute in the RUSP edition of Krabbe's disease.
Speaker 33
Yes. And that's due to how labs work. So, fixed costs laboratories basically operate with a lot of fixed costs. So as actually volume goes down, the fixed cost per participant actually goes up and then our contract costs go up as well. There's an ongoing cost
Speaker 34
So there's an ongoing cost of $5,500,000 for adding the Krabbe disease. At this time of the next fiscal year, 2627, we were able to absorb the implementation cost. But in twenty twenty seven, twenty twenty eight, based from the fund balance that we are in currently, we are projecting that we might anticipate to do a fee increase, which the $20 is the projection.
Speaker 1
Is this the first time we're seeing back to back decreases in participation?
Speaker 34
For NBS, the decrease is in mainly because of the decline in the birth rate.
Speaker 34
Correct, yes. And then the other participation decline is mainly purely for the PNS because we lost the exclusivity.
Speaker 1
I don't see my generation changing their minds on this. So I'm anticipating more and more decline. So does that then equate higher and higher costs now moving forward with these programs if you explain that it goes opposite direction?
Speaker 47
MBS, mainly the fee increase is leading more so because we're adding new disorders, which those addition disorders is actually we need to have more expenditure authority because the complexity of these disorders, it depends on what type of reagents, what type of instrument we will be needing and the capacity that we need to run all these new disorders. So those things still needs to be assessed. But currently, we know that we're going live with Krabbe. We know exactly what we need to spend as an ongoing cost. And based on the condition of our fund condition currently, we are projecting that we might need to do this $20 fee increase in 2728.
Speaker 1
Love the name crab, I guess. Yeah. It's interesting how we name these things. But I guess I thought I heard that how lab works is the smaller the population that
Speaker 33
gets No, it's more like fixed costs. So if you have I'm going to just start with like an example of, if I'm testing 1,000 patients, right, I need x number of staff. I need reagents. And I need instruments for that. Even if I go down to 900 patients, I still need x number of staff, reagents and instruments for that.
Can't get a half You of an
Speaker 34
Yes. So some of our especially the follow-up for any positive cases or headline cases, we have a baseline cost that we usually pay our contractors and those are usually a fixed cost. And depending on the number of resources that they needed to assist us for any referrals, know, with the cases that we send to them, those are the things that really become like a fix in our contract.
Speaker 33
I think it's multifactorial. I'm not I don't think we have a full assessment of that. But I do think that when we lost exclusivity, that really impacted the state program.
Speaker 1
And what does that mean? Because if I say that, I feel like that means is our test not up to par to the private approach as to why people are opting out of ours?
Speaker 34
Yes. So currently, right now, we're providing an option to patient because meaning our program can only do SCA, cfDNA plus SCA, and we don't do any additional Sorry. Time
Speaker 33
employees. It's a cell free DNA test. And so we do two types of testing. So there's cell free DNA. Those go to private contract labs.
And then we have neural tube defect testing, which is and we do that in house. So there's two different types of tests. The neural tube defect testing, private labs really don't want to do. There's not
Speaker 33
So cell free DNA, though, it's a totally different ballgame. And also, the ease of ordering for practitioners within their own EHRs. They don't have to come to the state and fill out our you know, go online in our form. Also, the labs market to them, all these additional offerings that they could get are you know, may or may not be prudent, but they're not endorsed, I think, by ACOG. There's a lot of extra testing, bells and whistles.
Yeah.
Speaker 1
Okay. Yeah. Any gonna hold that item open. Thank you so much. Issue 17?
Thank you. Thank you.
Speaker 36
All right. Good afternoon. Fariha Choudhary, WIC Division Director. I will be providing an overview of the WIC expenditure and caseload changes, and then we'll move on to responding to additional questions requested by the subcommittee. So I'll start with an overview of WIC expenditures.
WIC's food expenditure estimate is $1,190,000,000 This is an increase of $67,400,000 or 6.4% compared to the 2025 Budget Act and driven by a food inflation rate of 2.8%. This figure is slightly offset by a forecasted diminishing growth of participation compared with prior estimates. And the anticipated expenditures of local administration are estimated to be around $350,000,000 which is an increase of around $7,900,000 or 2.32%. Food inflation and program participation are the primary factors that contribute to program costs. As an update on caseload: Program participation is projected to be stable.
CDPH estimates that average monthly participation will increase to 1,006,704 individuals, which is an increase of 0.11%, and we continue to monitor any changes in participation moving forward. In response to question two on the agenda, according to the most recent data, the WIC program serves 72.4% of eligible Californians. We have the second highest coverage rate of all state WIC programs and third nationally behind Puerto Rico and Vermont. In comparison, the national average is 56.1%. In responding to question three regarding an update on the implementation of WIC online ordering or shopping, CDPH has been conducting preparatory work and due diligence while we await the WIC online shopping federal final rule from USDA.
This has included participation in national work groups and consulting with WIC state agencies in addition to our current technology contractors. It has also entailed looking into the kind of regulatory framework necessary to implement WIC online shopping in California. And our prep work is framed with the mindset of making sure that WIC online shopping works within California's current varied vendor landscape, reducing food insecurity and supporting participants having multiple options to get healthy foods across the state and across public health nutrition programs. And then, in response to the last question in the agenda, whether CDPH has conducted any analysis to determine how WIC online shopping has impacted the availability of brick and mortar vendors for healthy foods in low income communities, At the national level, a few states have launched pilots with select vendors to demonstrate and test the concept of online shopping in WIC. In fact, the finalization of that federal final rule may be, influenced by ongoing analysis of impacts, including impact to the vendor landscape.
As a result of those pilots, we are not aware at this time of substantive impacts to brick and mortar vendors as a result of those specific WIC pilots. In California, our analysis and due diligence is tied to what we're hearing around those WIC specific pilots, and we'll be informing our next steps. Those may include the possibility of exploring the possibility of launching one or more pilots in California as well ahead of permanent implementation, and the development of those pilots will allow us to engage with vendors of more than one category, along with our state partners, and derive insights and strategies to maintain access in the current vendor landscape. I do want to add that substantive pilot work would ideally happen after the federal final rules are released. And in addition to making online shopping a permanent option, we do have to establish state level regulations.
And as part of that larger regulatory process, we are looking forward to hearing from our partners and taking their feedback into account.
Speaker 36
So the USDA had initially said that the federal final rule was anticipated in February 2026. There is no timeline that's been communicated after that point. Okay.
Speaker 1
No questions further? Alright. Item open. Thank you. Issue number 18, please.
Speaker 9
Good morning, good afternoon. My name is Calandra Park. I am with the Office of Policy and Planning here at the California Department of Public Health and part of the BHSA planning team. I am very excited to provide an update on the plan, which is the first item question on the agenda. As you may know, the final plan was released about a month ago, and this plan is centered on a statewide population based approach that prioritizes equity and prevention across lifespan.
So, in order to operationalize these strategies, CDPH is investing in evidence based and community defined practices, regional implementation models, and targeted funding for local health jurisdictions, tribes, and community based organization, all
Speaker 9
while emphasizing cultural responsiveness, stigma reduction, and integration into existing public health and behavioral health systems. We want to leverage the work that's already being done at this time. So right now, here at CDPH, we are currently moving from the planning stage into the implementation stage, which means there's a lot of work happening with a lot of different teams. Some of that includes preparing funding announcements, preparing funding announcements as outlined in the agenda. You saw some of that in the table that's included.
We are working on the process of disseminating information about the implementation work group, which will be working alongside CDPH to provide input on the program,
Speaker 9
implementation, providing feedback on what's working, what's not working, and also just helping us continually refine the strategies as we're implementing them. There is also a team that is developing a technical assistance hub that will be active online. We want the state to be looked at as a resource and an expert in this space. And so we are trying to consolidate all of that information to make that public. We are also continuing to meet with community partners and stakeholders, as we've been throughout the entire planning process.
That is an ongoing effort and ongoing priority. And of course, we are also developing an evaluation strategy and framework to make sure that we are monitoring the implementation to see what's working, what's not working, best practices, lessons learned, and refining as needed. And all of this has been in lockstep with CalHHS. We've been coordinating with them very regularly, at minimum weekly. We are also working very closely with our sister agency, Department of Health Care Services.
And I would be completely remiss if I did not mention that CDPH is establishing a new center for social and behavioral health, ultimately to consolidate all the work that is currently happening here at the department already. We also want to take that opportunity to promote behavioral health as a public health priority, which is kind of a paradigm shift right now. This new center will provide the leadership and the coordination and oversight, ensuring alignment of strategies and efficiencies throughout the work and implementation. We believe that this will also improve coordination across the vast array of existing behavioral health subject matter expertise that is currently kind of housed in different places throughout the department. So our goal is a more centralized and coordinated structure, and alignment, and strong leadership to guide this work.
That's all I have.
Speaker 1
Would you oh, just on this part, and then we'll turn to you on the second part.
Speaker 28
Yeah. Okay. Good afternoon, madam chair. Riley Thompson, Department of Finance. Sorry.
Let me
Speaker 28
bit closer. So as you heard from my colleague at the department, they've been engaging in planning for the use of the Behavioral Health Service Act resources. This offset proposal does account for that planning. It would leave funding available to the department to implement some of these activities that are outlined in the plan that we've been discussing. This proposed offset does not conflict with the implementation of Proposition one.
The funding will be utilized for population level behavioral health programming. As has been mentioned, the administration is working to prepare this proposal. There are two important contextual factors that have characterized the planning thus far in this conversation as a whole. The first is that when we are looking at these incoming revenues, we anticipate that they're going to be volatile. So with regards to all of the programming that we're discussing, there's a need for it to be flexible and scalable relative to those revenues that may fluctuate annually.
The second important contextual factor here is the state deficit. As we've been discussing, this budget picture as a whole is an important contextual factor for this offset proposal. Ultimately, the intention of this offset proposal is to protect and preserve this existing behavioral health programming that's being supported by General Fund within the context of the significant deficit that the state has to solve for.
Speaker 31
Yes. So Will Owens with YLAO. So, yeah, this is obviously related to an earlier item you heard with HCAI. So, yes, generally, understanding is that this estimate includes kind of current activities that the department is already doing that they believe would qualify under their new responsibilities under the BHSA for population based prevention. So the administration has indicated that more information on the specific activities that, would be funded by this new revenue, would be available at May Revision.
So at this time, our office is waiting until that specific proposal is out with the, specific programming to do a full analysis of that offset. But, just echoing some of my comment the comments from my colleague earlier, some of those same considerations apply but available for questions.
Speaker 1
Yeah. Definitely. Copy and paste my comments as well. But I just want to confirm I heard, because this is $50,000,000 of the $314,000,000 remain. And you were saying that of because $130,000,000 remain, what Ms.
Ms. Park mentioned, it's still going to go as planned, cause there's enough funding to do everything that you've mentioned?
Speaker 28
So the budget includes $184,500,000 in projected Behavioral Health Service Act revenues for that will be allocated to the Department of Public Health. If we take a look at that initial planning document, it estimates use of approximately $134,500,000 in funding. So that $50,000,000 is essentially the difference.
Speaker 1
So there is like $130,000,000 that's enough to cover everything you've mentioned, what you were trying to say that it's not going to impact the programming?
Speaker 28
Yes. So the offset was assessed within the context of the planning that has taken place so far. I think the only thing I would emphasize it's sort of an initial planning document that has been put together by the department. So to the extent that there's any sort of specific proposals that come forth from that, that will be Yeah. In a later
Speaker 1
That's right. And that's the details we don't have. This is the initial. We don't have the details here on the actual programming. And you said something explained the $50,000,000 are still going to be
Speaker 28
offset proposal exists within the context and qualifications of proposition one. The funding will be utilized for existing behavioral health programming that meets the qualifications.
Speaker 1
I just don't know anything on that details yet. Okay. Going to the initial draft a bit, I see the categories for investment and substance use disorder prevention programs being one of them. Is tobacco use going to be considered under substance use disorder? I don't know if it gets elevated to that level just because of the increasing youth usage of babes, nicotine, and so forth?
Yeah.
Speaker 9
So the youth population is a priority population. Tobacco, in particular, is a separate office that will be absorbed and part of the complementary work at the Center for Social and Behavioral Health. So there will be some synergy. But in final plan, tobacco is I don't think it's explicitly called out. It It's
Speaker 9
Not under a different plan, but within the center of social and behavioral health. So it will be in tandem and in alignment with the rest of the work.
Speaker 1
Just to flag, anecdotally, right, a lot of these I don't have data to turn to on this. But anecdotally, we're hearing that young girls are using ZYN, the pouches, to control their hunger directly connected to behavioral health there. I that's I feel like that's a synergy there. And given just the increase, I'm just wondering if, as you're doing the planning, if there's opportunity to tap into assisting in that space.
Speaker 9
Yeah, absolutely. So I only answered the first question on the agenda there. So I'll kind of go into the second question. But absolutely, there's opportunity and priority to address emerging issues such as this. And there are other there are many new emerging substances that we are tracking.
So let me just go back to the second question here about funding structure. How is the funding structure between statewide entities and initiatives and funding for local assistance for community based organizations and other local entities? So because CDPH's focus is the population as a whole, our priority is to invest in statewide initiatives, statewide reach, and prioritizing building the state capacity. The six components, as you see here, are I'll just list them once again are policy initiatives, and this is kind of where we would be able to address and respond to emerging issues, statewide prevention strategies, awareness campaigns, training technical assistance, community engagement and coalition building, and data and evaluation. So those are the six statewide strategies that we are maintaining and supporting here at the state level.
And also, all of our work is undergirded by being compliant with statute, of course. And so just to reiterate for today, the statute dictates that we benefit the entire population of the state, county, or particular community, that we serve identified populations at elevated risk for a mental health or substance use disorder and prevent suicide, self harm, and overdose. So with that, this is sort of how we develop the strategies in tandem and in full collaboration with the public. We had two rounds of public comment. We had two formal tribal consultations.
We have one more next week. And so we've engaged with a lot of partners one on one as well and had a lot of discussions around what's working, what's not, and what the needs are. So that's at the statewide level, but we know California is a vast, diverse state, diverse ethnically, population wise, geographically. The needs are all different all over. So we know that we need local strategies to complement the statewide strategies.
So the local strategies are intended to address those unique needs and disparities, in particular for the historically marginalized communities, the vulnerable communities. So funding for local assistance is intended to enhance that reach and amplify the work that's happening at the state level. So we want to target those communities that are particular in a certain region that may not necessarily benefit very directly from the state level approaches. So by doing this, we hope expanding the capacity, building the capacity of our local partners, creating local systems change, allowing them to be more culturally responsive and work on community driven and community informed strategies, and again, building that capacity at the community level and just encouraging that local level collaboration and alignment with the statewide work. The local assistance strategies are and these are some of the ones that are listed here in the agenda the community defined evidence based practices, trusted messenger campaigns, the regional policy and regional implementation.
So again, that also provides opportunity to respond to emerging needs. The tribal program, training and technical assistance, program to fund all 61 local health jurisdictions throughout the state, as well as a nine eighty eight outreach campaign. And just to drill down just a little bit, if this is of interest, in the first fiscal year, the breakdown between state and local funding is 52% at the state level, 48% local. And then in the second and third out years, the proportion flips, and the majority of the funding does go to local at 56%, with the remainder at the state.
Speaker 1
Thank you so much. Thank you. And we'll hold issue 18 open, move on to issue 19.
Speaker 37
All right. Hi. Good afternoon. I'm Mandy Posner. I'm the deputy director for the Center for Health Care Quality.
With me is Chelsea Driscoll as well as Michelle Bell. And nice to see you, Senator Menjivar, and Scott as well. We've been asked to provide an overview of five proposals. So we'll be doing that today. And I know Melissa Rellis is also here to speak to the second proposal.
Okay. So we'll just dive in. The first is the field operations strike team for the Center for Health Care Quality. The governor's budget reflects an increase of six physicians and $1,500,000 expenditure authority from the State Department of Public Health Licensing and Certification Program Fund to establish a dedicated strike team to address priority survey and investigation workload. We're requesting one health facility evaluator supervisor, three nurse surveyors, and two health facility compliance surveyors to establish a specialized strike team.
The strike team will be located in Sacramento, where CBPH is successfully able to fill open positions and rapidly deploy to high needs areas throughout the state, allowing for timely response to facilities impacted by internal, local, and regional emergencies. Additionally, the strike team will assist district offices across the state by providing support to complete their priority workload, especially reduction and elimination of backlogged intakes and increasing access to care by conducting overdue licensure surveys.
Speaker 1
Mo, do you have anything? I have a curveball, but I don't know if you ladies are the right people to ask
Speaker 1
time for the other regs. But I'm I'm wondering I have a if you're the right person for the hospice emergency regs. Certainly. That you can give me an update on that. That was due in January.
Speaker 28
Yes. Oh, is this one? Okay. So we posted the regulations for notice to let people comment on them, and we received some feedback that we needed to take back and do some revision work on. So we have been revising and updating those regs, and we plan to resubmit them to the Office of Administrative Law in this spring.
So I don't have a specific date for
Speaker 1
So if we still have to submit it to another entity and still wait for their feedback, Once that feedback happens, do we have to
Speaker 28
go back to stakeholders and get input on that revised? So we are going to post them again before we submit it to the Office of Administrative Law. So we have to post them for five days. And then after that, we submit them to the Office of Administrative Law. They have their review period.
And then they would be posted on their site, and then they would take effect five days after that. So people have seen the regs. They kind of know what we're expecting from them so they can start ramping up
Speaker 1
to get ready for that. Is there anything we're doing systemically just to be able to get some of these regs out sooner? I don't I mean, it's always, like, really I was gonna cuss. It was really, really weird situation. Like, there's always shitty situations that are occurring around the reg timeline.
So how can we prevent so that we can have REGs out in time before a situation occurs?
Speaker 28
I think part of the issue is resources. So we last year, we had a budget change proposal where we got some additional resources. So once we have all of those positions filled and we have more bandwidth to do the regulations faster, I think that will go a long way to get us where we need to be. So we're looking at where there are high risk areas that we And need to so we know that we have hospice that we have been working on, and APH, obviously, as well. So those are both emergency packages that we have been highly focused on.
But we are looking at other areas where we think that there may be potential concerns by monitoring our data and things of that nature, so that we're able to get ahead of it going forward.
Speaker 1
Now, should I wait for the director? I'd love a little bit more feedback on what happened this week, particularly because it was in my district. I can wait to have the director, if there is anything that you're able to share with me on So
Speaker 37
we can share a little bit. Okay. We did initiate some complaint investigations under our state authority earlier this week in LA County. We visited several hospice and home health agencies. And we have some ongoing enforcement actions at this time, so those investigations are still open.
We'd be happy to provide you with a full report once those have concluded.
Speaker 1
I definitely would be interested in the amount that were located in my district, in Van Nuys in particular. There was Of course. Some viral attention to that area. I'd also love to see the connection of these regulations and from that, how we can prevent some of these moving forward. And then the breakdown of percentage versus state violations and federal violations, most recognizing that a lot of the payments come are Medicare payments, so that's the federal oversight, just to see the balance on that.
And then the moratorium that exists right now, when does
Speaker 1
Okay. So it's six months almost. Is there an intent to extend that moratorium a little longer, given this just recent incidents? Or are we going to be lifting that up?
Speaker 28
So I think an important factor to have in mind is related to the moratorium is that after the regulations are in place, we're still going to have the threshold where the entity will need to establish an unmet need in the area. So it's not gonna explode the second the moratorium is lifted. We have safeguards put in that will keep the number of hospices to where it's going to be right sized.
Speaker 1
Okay. And I apologize. I don't know why I'm giving a little air to this question. But how many codes can you charge for in this hospice, in billing world? Like, is it a laundry list of things you can charge for under hospice?
Is it a short list?
Speaker 37
So I'll just say that that question is probably not to put it off to Department of Health Care Services.
Speaker 1
Have we seen that there's a need to get more hospice up and running a license?
Speaker 28
Definitely not in Los Angeles County. We have sort of a data and a seismic map that we are not a seismic map, a map that shows where all of the entities are located in the state. And so when we know that there's a high concentration of hospices in a particular area, we know that is not a county where we are going to allow a new hospice to start. There are places that may be in a rural area that may have a broader need. And so in that case, we would potentially allow them to open.
Speaker 1
Okay. And in the emergency recs I apologize. I haven't seen that the draft was posted, I'll make sure to get a copy of it. But does it talk about is it on how to get licensed, the requirements to get licensed, and then also on how to stay licensed?
Speaker 28
So the regulations talk a lot about the application process, when application is required, the documentation that needs to be submitted, the way that an applicant would need to justify that there's a need in the community they intend to serve. We also have things in there around nurse to patient ratios. We have requirements about your office space. I know that was one of the sort of questions that had come up. And so they will have to have exclusive use of their office space.
They will have to have certain components that are required to be present. So they have to be able to store medical records securely, have equipment and supplies, and really establish that they are a legitimate business office, as well as some care planning requirements, patient assessments, and things of that nature. So it covers both sort of the administrative piece as well as some of the care components.
Speaker 1
So DHIS is more on the billing side, you're the licensing. Who's more on the enforcement side?
Speaker 1
How do you flag? What are the how do you flag that there's potential room there's potentially fraud happening? What are the things yeah.
Speaker 37
Yeah. You may have some to add, but sometimes we'll receive complaints. It'll come in the form of complaints where there's indicators of fraud. Also, through some of our ongoing surveys, for example, we will come across indicators of fraud on-site. But oftentimes, we receive complaints, and that would result in us making an on-site visit to investigate.
And
Speaker 1
have we been investigating? Like, I mean, it's not like this week we just we knew of these things just this week.
Speaker 37
Correct. Yes. No, this is part of our ongoing work. We're regularly investigating complaints in all facility types that we license and certify.
Speaker 1
Okay. Are you able to share, you know, the awareness that the department had of the of certain facilities that were potentially committing fraud? How long the department knew or has been working on it?
Speaker 37
I think that we would need to take that back and provide that to you in writing.
Speaker 1
Okay. Thank you. I'm gonna hold the item up and move on to issue number 20.
Speaker 27
Hello. Melissa Rellis, the assistant deputy director for our Center for Preparedness and Response. Good afternoon, madam chair and member. So CDPH is requesting $2,400,000 in State Department of Public Health Licensing and CERT Program fund and the internal department quality improvement account for 2,627 and 2728, and then $2,500,000 beginning in twenty eight-twenty nine and ongoing. And that's assuming that all remaining hospitals are onboarded, and that would be our ongoing cost.
Speaker 38
So the hospital bed and emergency medical services data system, referred to as H Beds, will give CDPH access to real time monitoring data of hospital bed capacity in order to facilitate timely transfers and placements of patients and support response operations during public health and medical emergencies. The system will provide near real time bed capacity information supporting response operations for state and local public health, health care and emergency response officials. So currently, we have some GACS, general acute care hospitals already onboarded. So we need to onboard the remaining 329.
Speaker 38
So that's the goal is to onboard the the remainder and have all 389 onboarded. And then cover annual software subscription fees for real time hospital bed capacity data and support a COVID flu RSV module.
Speaker 1
You said assuming they're all hospitals are onboarded, is there potential that they won't all be onboarded? No.
Speaker 38
The goal is to have them all onboarded, but we're in the process of a competitive solicitation for a vendor.
Speaker 1
Okay. Anything to add on this? Okay. No questions further? Hold the item open.
Move on to issue 21. Thank you. Thanks. GACS. I'm going use it.
Speaker 43
dive into the next item? Yes, please. So into the centralized application branch license renewal and certification branch expansion. The Governor's budget reflects an increase of seven positions, 493,000 in reimbursement authority, and $493,000 in expenditure authority from the Licensing and Certification Fund to create a provider certification section and a provider certification unit to support licensing renewals and certifications. So CDPH reviews provider Medi Cal enrollment requests, and this new unit will address resources to reduce backlog, improve timeliness, and strengthen oversight with additional managers and analysts.
Speaker 37
The application backlog for Medi Cal certification requests has increased from three eighty in 'twenty two-'twenty three to approximately 2,244 in fiscal year 'twenty five-'twenty six, which is a 490% increase. Work in the new section is eligible for a 50% reimbursement via DHCS interagency agreement. Anything to add
Speaker 1
on this? I have no questions on this issue. We're going to hold the item open, move on to issue number 22.
Speaker 40
Michelle Dahl, Department of Public Health. The Governor's budget reflects an increase of $5,000,000 local assistance expenditure authority from the federal health facility citation penalty account towards civil money penalty funding to CMS approved projects to benefit nursing home residents. A portion of these CMP funds collected from nursing homes are returned back to the states in which CMPs are imposed. And then the state CMP funds may be reinvested to support CMS approved activities that protect or improve the quality of life of nursing home residents. Since twenty eighteen-twenty nineteen, we've seen a significant rise in approved project applications.
We are projecting that we'll receive 12 in fiscal year twenty five-twenty six. And in the last several years, we've received about 21. This increase in applications will lead to an increase in the number of approved projects and thus the need for increased expenditure authority. Current pending projects include two contracts totaling $1,900,000 for 2526 and 2627, plus $296,000 in 2627, which could further increase expenditures. Without this requested $5,000,000 increase, the authority will drop to a baseline of $575,000 which would prevent CDPH from approving new contracts or paying for existing multi year agreements.
CDPH is actively updating its website with CMP information and sending out all facility letters to encourage applications, which leads us to anticipate continued high application volumes in the future.
Speaker 1
What are the two contracts going to be doing? And then the other one, I see a list of programs that have been funded in the past. Does the money go to further continue those programs or is it for new programs?
Speaker 40
They're for new. So generally, these are about three years. And then they close out. And if they wish to continue, they need to reapply.
Speaker 40
So it's things like supporting gardening activities in nursing homes or even devices enabling residents with dementia to better communicate with family members. A really wide range, which is why I was struggling a lot to answer that last question, but I can get that to you.
Speaker 40
Open. Yep. Issue number 23. Okay. Internal department quality improvement.
So the governor's budget reflects an increase in 5,900,000.0 in state operations expenditure authority from the internal departmental quality improvement account. And this would support planning and implementation costs of the centralized applications branch, or CAB Online licensing application project. The CAB Online project will refresh and expand CAB's original automated license application system to all 33 health care facility types, rather than the two that it currently serves, with flexibility to add new types in the future. This system will integrate with other CHTQ systems, including ELMS, and allow facilities to pay licensing fees electronically instead of by paper check. CDPH plans to migrate existing applications by 2026 to technology that's supported by our IT division and also aligns with our future of public health technology strategy, and the current AEM software is outdated.
And integration of the online system with ELMS will streamline workflows, reduce manual steps, and improve provider satisfaction through seamless submissions. Currently, the project is in stage four of the PAL process, and the implementation start is delayed from July 2025 to August 2026. But we expect high user support needs in that beginning stage as we support facilities in adopting the system. CHQ is requesting two limited term ITS two positions, a software engineer and a business analyst, and assistance from existing staff in order to support implementation and maintenance for 33 facility types and 30,000 external users. Automating these submissions will greatly reduce correction times, going back and forth, speed approvals, and improve compliance.
And the centralized application branch will run reports three, six, and twelve months post implementation to measure progress.
Speaker 1
No questions on this, but can you also give me an update on the I know there's a pause in the psych regs for implementation. When does that go into effect officially, past the pause?
Speaker 1
it was a pause just to give more time, not to change the regulations, just to give more time to implement them.
Speaker 28
I think there Be ready. There there are some minor modifications. Generally, policy wise, I think we're consistent. We're just making some minor clarifications. And it was really to provide the time for facilities to ramp up and get staffed.
Speaker 1
Yes. It was a staffing part. All right. Thank you. Can I hold the item open and move on to issue number 24?
Thank you. Thank you. Alright. Good afternoon. Hi.
No. Not yet. Hi. Is it there? Yes.
Speaker 12
Afternoon. Monica Nelson, Fraud Center for Environmental Health, Assistant Deputy Director. And with me, I have Doctor. Weintraub, deputy director for the center as well. And we'll be covering the BCP for the radiologic health program.
CDPH requests $4,600,000 from the Radiation Control Fund in twenty twenty six-twenty seven and ongoing to support increased operational costs for the Radiologic Health Branch. This proposal addresses inflation driven cost increases and obligations that the branch can no longer absorb with its current expenditure authority. The branch licenses and inspects radioactive material users, registers and inspects X-ray facilities, certifies medical professionals, and maintains compliance with the California's agreement with the U. S. Nuclear Regulatory Commission and the Food and Drug Administration.
The requested funding will cover contract costs for account inspections, equipment maintenance, personal radiation monitoring, remote monitoring, printing mailing, and database support for the licensing of medical professionals and registration of medical facilities. It would also cover personal costs to fill vacancies and reduce backlogs. The proposed increase in expenditure authority is necessary to sustain essential operations and maintain compliance with statutory requirements. Also ensures timely certification of radiation professionals, and it reduces regulatory burdens on businesses and safeguards public and worker health. Would you like me to go straight into the question?
Regarding the question on current licensing fee structure and what it's going to look like in the future, our current fee structure, it does have it spans over 50 categories, anywhere from X-ray facility registration, technology certifications, radioactive material licensings, mammography, inspections, and other related renewals. But when looking at the future fee structure, the branch would apply a 20.3 across the board increase to all current fees. This percentage is the amount needed to bridge the gap between the current resources and the operational needs while keeping the funds solvent. However, because there are actually enough funds right now in the reserves, these increases will not be implemented until fiscal year twenty seventwenty eight. And of course, a detailed table showing the current fee levels and the proposed increase with the adjusted figures can be available to you via e mail after this hearing.
Speaker 1
On how much will be the increase? Like, what does 20.3 mean? Correct. Is that what you mean?
Speaker 1
I did. I actually wanted to know how much how much do they pay right now.
Speaker 12
So, for example, I can give a so, like, an annual renewal for because you said
Speaker 12
Yes. There's so many, but but I did have a couple here, like a mammography one. So it's currently $421. How much? $421.
It will come up to 506. X-ray inspection for the supervisors or the operators, it's at $123. It will go to 156. Would you like a couple more?
Speaker 12
Yes. And there was minor opposition back then with increases. So this will be the first increase in a really long time. The I don't know if you
Speaker 1
know this answer, but that's nine years. It will be ten years because it'll be implemented 2728 since a fee increase annual fee annual license fee increase. Is this common for other licensees, or have they been able to escape an increase?
Speaker 12
I will say it depends. It is different for different areas. But in this specific one, they were just bearing our team was having to stretch the dollar as much as they could and also try to pass the savings to our customers. In this in this case, it's just time to increase it. I got an email recently in
Speaker 1
my in my office, not on this profession, but a different profession, that their annual fee increase had just jumped up dramatically. And I was like, let me investigate who did that. And I voted for it. So I was like, me. That was my fault.
But I'm wondering, because his questions were like, why did it increase and so forth. When these happen, are they notified for the reasoning as to the increase? This just And we're constrained by when we're allowed to even ask for an increase. So it's based on the
Speaker 1
Just because you want more reserves. Exactly. Okay. And how long do you think the fund will stabilized with this 20.3% increase?
Speaker 1
Yes. Just want to know if we're entering a period where we're going to have to do more ongoing increases.
Speaker 28
Can jump in. Sure. Riley Thompson, Department of Finance. So obviously, it's context dependent, if there's additional activities that need to be done utilizing this funding over the next couple of years. But we are anticipating that once accounting for fee increase, that we're going to see expenditures that are lower than our total annual revenues.
So they'll be relatively balanced once accounting for this fee increase.
Speaker 1
Okay. So with this fee increase, it leaves a little bit of room for flexibility. Okay.
Speaker 23
And as we modernize our data systems, we'll also be able to start collecting some of the fees from people who've missed out on being properly licensed. So that's one of the benefits of What do you mean?
Speaker 17
when there's facilities that slip through the cracks, we'll be able to find them more easily.
Speaker 1
So are they practicing without our license? Sorry? Are they practicing without our license if they're slipping through the cracks?
Speaker 23
Not that we know of. Once if we ever know of anything, we definitely find out.
Speaker 1
Because I don't understand how there's what do you mean they're slipping through the cracks? What are they doing when
Speaker 12
it comes receivables? Yes. That's I think she's talking at the past due license and renewals. Sometimes what happens is when we mail the renewals to a certain location, the contact change or something happened.
Speaker 12
No. There it's for accounts receivables. We wanna help also. That will help us increase the revenues as well because we will be able to step more on top of those past due payments.
Speaker 1
But it's not enough to cover what is needed. You still need we still have to chase the people to actually pay and also do an increase. Right.
Speaker 1
Correct. Anything else? No. Okay. Thank you so much.
Hold the item open. Move on to issue 25. Thank
Speaker 25
Good afternoon. Maria Ochoa, one of the assistant deputy directors in Center for Healthy Communities. And we have the first two legislative BCPs. First
Speaker 1
have one to explain the first one. It's my bill. I just have a question on it. I know what I've asked the department to do, but the only one I just need clarity is on the one to review medical records to confirm the cases. If these are cases that are diagnosed in the hospital and it's on their records, why do we need to double confirm that it is, in fact, silicosis?
Speaker 28
over to my colleague, Okay. Hi there. So when we receive the records from the hospitalization, discharge, or emergency department data, it has the ICD-ten code diagnosis, as you just indicated, but we may not know their occupational history at that point and whether or not they're a confirmed engineered stone silicosis case. In So addition to the diagnosis of silicosis, we want to make sure that they're actually having an occupational history
Speaker 1
of the To be able connect it to this correlation. It. Okay. We can move on to the next bill. Okay.
Speaker 25
The next one is for SB twelve sixty four, the Real Food Healthy Kids Act.
Speaker 1
Sorry, lied. I have another question. I was looking at the report that CDPH had come out with. And as we're doing this, I just wanna make sure the the mindset of CDPH isn't that this is a hopeless thing. The reason why I got that is because in the report from CDPH, it talks, controlling exposures to levels low enough to prevent disease is technically challenging and costly, thus rarely feasible.
I look at that as we won't be able to accomplish much in this space. That leaves room for what is the incentive if CDPH feels like it's really not feasible to really do anything in this space. So I just wanna make sure as we're looking at this, this there isn't a mindset of, like, we're not going to be successful anyways.
Speaker 42
No, we don't believe that. We obviously really are trying to put a lot of effort into outreach and education and prevention and working with both employers and workers so that they know their rights, and also closely collaborating with CalOSHA. Okay.
Speaker 64
reassurance in that space. Okay. Okay. So CDPH requests $3,600,000 in 2027, 2,600,000.0 in 2728, and 2,600,000.0 in 2829 from the general fund to implement the provisions of AB twelve sixty four, which establishes the Real Foods Healthy Kids Act, or as we refer to it as the act, which regulates and monitors ultra processed and other foods of concern served within California schools. CDPH also requests provisional language for funding received in 2627 to extend encumbrance or expenditure authority through 06/30/2028 and to make 1,020,000 of the funding for the implementation and consulting contract costs available upon approval of PAL stage four.
Speaker 25
This request includes funding for staffing support for approximately nine to 11 positions in the next one to two years to complete the expected outcomes of this BCP. The act creates a legal definition for ultra processed foods and requires
Speaker 1
CDPH to adopt regulations to define ultra processed foods of concern and restricted school foods by 06/01/2028.
Speaker 25
The purpose is to reduce consumption of ultra processed processed foods of concern in schools and create healthier eating environments for California students. CDPH will develop and operate a data system that supports school food vendor reporting by 01/01/2028, and vendors are required to report beginning 02/01/2028. Schools are required to phase out ultra processed foods of concern and restricted food beginning in 2029, and vendors cannot sell to schools after 07/01/2032. And those foods can no longer be served or sold in schools after 2035. CDPH is required to provide training and technical assistance to school food professionals and school food vendors and annually report on progress to the legislature.
The next one is next group. Okay. Thank you. Okay.
Speaker 59
Hello, madam chair, committee member. Romeo Amion, deputy director for the Vital Records and Statistics Division, which is formerly known as the Center for Health Statistics and Informatics. Senate bill three thirteen requires the California Department of Public Health to remove parents' birthplace details from the public section of the birth certificate and list the information into the confidential section of the birth certificate. To comply with SB three thirteen, CDPH is requesting one position and an increase of expended authority of 258,000 in fiscal year twenty six-twenty seven and 163,000 in fiscal year twenty seven-twenty eight and ongoing from the Health Statistics Special Fund. 95 k of those funds will be used to upgrade the California Integrated Vital Records System or the electronic birth registration system.
Speaker 1
Okay. That clarified a lot because I was like, wait. I can give you my intern to cut and paste this word somewhere else. Because I was like, why do we need so much money to literally cut and paste somewhere else? But $9,595,000 dollars is to just modernize the whole system as well.
Speaker 1
Okay. I still think we don't need an extra person. I just felt like this unless I'm missing something, I'm literally just moving stuff around.
Speaker 43
There's also work that has to do with forms and updating the different forms because we are still manual. This is just for the registration system itself, there's other training materials. We'll call them auxiliary systems for the data to make sure that they are quality assurance is taken care of.
Speaker 1
Okay. So a little bit more than that. Yes. Okay. Do you have anything to add to this?
Speaker 31
No. And I'll just note that nothing to add but available for questions for the remainder of the chapter.
Speaker 1
Okay. Perfect. That one turned to you. Next one. Stop.
Oh. Who who's doing six for six? For the next remaining, I don't have any questions, so if you we can go as fast
Speaker 12
as you want. Alright. Good afternoon again. Sounds like a plan. For s b six forty six, CDPH request one position and 173,000 from the general fund in twenty twenty six twenty seven and ongoing to implement the new provisions mandated by its senate bill, which introduces heavy metal testing and disclosure requirements for prenatal multivitamins.
Speaker 41
Effective 01/01/2027, manufacturers of prenatal multivitamins must test products for arsenic, cadmium, lead, and mercury and publicly disclose those results online, including a link to the FDA's latest guidance. SB six forty six gives CDPH new responsibilities, including conducting inspections and reinspections of manufacturers and distributors investigating complaints and pursuing enforcement actions, such as recalls and embargoes reviewing labels and records to confirm compliance and disclosure requirements, as well as providing technical assistance and educational materials to industry stakeholders. CDPH also collaborates with the FDA to uphold federal standards and good manufacturing practices. This specific request is for one) environmental scientist who will conduct inspections, verify compliance, respond to inquiries, and provide guidance to helpful industry stakeholders, meet new requirements, and result complaints. Moving on to a b six sixty.
Speaker 12
CDPH requests two positions 369,000 from the Food Safety Fund in twenty twenty six-twenty seven and ongoing to implement the new provisions mandated by the bill. Effective 07/01/2026, food labels must display best of use by for quality and use by for safety. Replacing terms like sell by or other terms will help reduce food waste, benefit consumer health, and prevent misleading labeling. AB six sixty gives CDPH new responsibilities, such as creating educational materials to help industry comply with regulations, conduct timely inspections to ensure food safety and labeling standards are met, and verifying that corrective actions are taken and supporting resolution of compliance issues and complaints. CDPH also provides technical support to 62 local environmental health regulatory agencies, including training, investigations, and compliance assistance.
The requested funding will support a senior environmental scientist specialist to respond to industry inquiries, develop educational materials, and support field staff with technical issues. It would also cover an environmental scientist to conduct inspections, verify compliance, and provide guidance to help industry stakeholders meet the new requirements and resolve complaints. This proposal reduces food waste, improves consumer understanding, and supports health equity by ensuring clear and consistent labeling across California. Next one For the next one, you
Speaker 1
could just talk about what the position would do. You don't have to explain the bill.
Speaker 12
Yes, ma'am. The position is one associate health physicist to conduct inspections and compliance checks and one time cost for a vehicle and radiation test equipment to support those field inspections. And then we're happy to take any questions. Okay. You don't have the last one?
Okay. No. That's only up to $4.60. Alright. Thank you.
Thank you.
Speaker 1
Yeah. 669. Gotta be quicker than that. And just on the position, please. Okay.
Speaker 65
SB669. So the governor's budget reflects an increase of $515,000 in state operations from the licensing and certification fund 3098. And this is to establish a ten year pilot project where up to five critical access hospitals can participate in a pilot project to offer standby perinatal services. And this is for patients who are being transferred from an alternative birthing center or who present to the emergency department with an obstructical issue. And so the positions are limited term, and they are to support the development of the criteria for the pilot project.
Speaker 28
And so we have a medical consultant, research data specialist, an analyst, and an attorney. Those are all partial positions to lead up to the equivalent of two full time positions.
Speaker 1
Okay. No questions? Leave the item open. Thank you so much. Thanks.
That's it on department issues. We're going to go back to proposals for investment, Issue 26, and we have a couple for presentation. The first one is going be on the cost relief trailer bill language to prevent community based adult services closures. Each presentation has three minutes.
Speaker 53
Thank you, Madam Chair and members. Kathy Senderling McDonald here today for the California Association for Adult Day Services, and I'm here to talk with you about the Community Based Adult Services Program, which I thought until today had the best acronym, CBASS, but we have learned a new one today, so we'll we're have to As a a refresher on this issue, CADS is a statewide association representing providers of non medical adult day programs and medical model adult day health care, which we more formally know as the CBAS program. There are three sixteen CBAS programs statewide, down from a high of around three sixty pre pandemic. Specifically, we are asking for the adoption of trailer bill language that would require the Department of Health Care Services and Department of Aging to work with stakeholders, including CADS and our partner agencies and members, to identify cost relief options to help offset the extreme cost increases that our members have experienced in the two decades since we last had a rate increase. We have provided a draft of the request of language.
Speaker 44
You have that. We've also provided that to the department, and we also want to thank Senator Dorado for championing this issue in the Senate. CBAS providers support and assist people living with long term health, functional, cognitive, and mental health issues to optimize their individual potential and retain their independence. For our participants, CBAS participants are often the difference between living independently in the community and going into nursing care. We also save the state and managed care plans money because CBAS programs are so much less costly than nursing home care.
And finally, CBAS programs take stress off of caregivers. It enables them to care for their loved ones and help them live independently, while also caring for their own children and going to work each day, knowing that their loved ones are cared for during the day. And statewide CBAS programs serve about 45,000 individuals. And this actually makes our program the second largest HCBS program in California behind IHSS, which of course is much larger than that. For the past few years, CADS has come before you asking for rate increases, the Raise Our Rates campaign, and we know your work in championing that effort, as well as others here on the committee and in the Senate, has been tremendously welcome, and we appreciate it.
However, in recognition of the state's precarious fiscal position and the unknowns with HR1 implementation, we have changed our request. We're asking for this trailer bill language and really thinking about focusing on greater collaboration for our with our oversight agencies. We do still need those rate increases, and we will be back when the financial situation is better to ask for them. But right now, we're seeing a continuing closure crisis. 47 of our legislative districts have lost a CBAS center just in the last, five years, and 29 closures have occurred in that time.
And so while CBAS centers do open each year, we need to do something without a rate increase to try to figure out how to find cost relief. The trailer bill language specifically would ask those two departments to work with us to report back to the legislature in 2027, and thanks for your consideration.
Speaker 44
have not received any cost estimates from the department. We're hopeful that we can work with them in the spirit of partnership as we do on an annual basis. It's not intended to be a formalized work group. It's more intentional around collaboration. We're also thinking hard about, we don't know what's going to happen with the next governor over the next several years.
And so really getting that movement into place into statute to say, this does matter to the legislature. It matters to the administration. We know we can't do more right now, but we want to do what we can.
Speaker 1
The Department of Finance, if you can assess the cost to this stakeholder proposal and get back to me. I know you don't have it now. Yeah. Yeah. If you're able to put a cost to it, I'd love to are you able to do that?
Speaker 28
Yeah. We tend to be able to provide technical assistance. Okay. But as to assessing, you
Speaker 1
know Yeah. Is d h is anyone here from DHS? Wow. Tisk, tisk. Tisk, tisk.
Okay.
Speaker 44
We welcome technical assistance on the It was a first stab and intended to be as low key as possible while also moving the issue forward.
Speaker 1
D. A. S. You left too early. You always state for public comment.
Okay. Thank you so much.
Speaker 1
Thank you. All right. Next presentation. Nurse Midwifery Education Programs Funding.
Speaker 45
Good afternoon. Chair Menjivar, excuse me. My name is Sosten Madnett, here today representing the California Nurse Midwives Association. We're here today to discuss the urgent need to fund the California Nurse Midwifery Education Fund as outlined in, issue 26. So, as many, of us know, California is in the midst of a maternity care crisis.
Since 2012, 56 hospitals in our state have shuttered their labor and delivery wards, and that is 16% of all general acute care hospitals in California. In the face of this collapse, we have a massive bottleneck in our workforce pipeline. And while midwives attend fourteen percent of births in the state, there is currently only one nurse midwifery master's program in the entire state of California, and that's located at CSU Fullerton. In 2025, the legislature took a critical step by passing SB five twenty by Senator Caballero, which established the education fund to be administered by HCAI. The framework is already there.
The policy is already law. But what's missing is the appropriation to make it a reality. This is a strategic investment. Midwives can be prepared more rapidly and cost effectively than many other clinical roles, providing high quality care to both mother and child during a time when federal support for reproductive health is increasingly uncertain. So, we're requesting $2,000,000 in general fund to support the launch of these programs within the UCs and CSU systems through a competitive grant application process.
Speaker 25
And I will say we've already heard from a number of institutions that are interested in starting these programs, if the money was available. This funding will cover the essential start up costs, recruiting faculty, purchasing simulation equipment, and securing clinical precepting sites. And importantly, these state funds can be matched with other public and private dollars, as written in the legislation. So, we're asking HCAI to prioritize programs in areas with the highest demonstrated maternity workforce shortages. And we have discussed this issue in detail with HCAI staff and understand the department is committed to addressing the maternal health care crisis.
Speaker 45
Furthermore, we hope to see that HCAI leverages the federal Rural Health Transformation Grant funding, specifically the 62,400,000.0 earmarked for workforce development, which targets this issue specifically, to complement this investment for advanced practice clinician roles in our rural and frontier communities. So, we can't wait for more maternity awards to close to build up the workplace, and we urge you to approve this important funding.
Speaker 1
Thank you. I'm glad that you mentioned because I was going to ask you if you had conversations with the HIV.
Speaker 1
I don't know if you were here for their presentations earlier, but they shared a lot of different pots available. In your conversation, did they share that one of those pots you could be eligible to
Speaker 45
Yeah. So the workforce development program is one that we could potentially be eligible for. My understanding is that that would be for licensed midwives as well as nurse midwives. They're two different Yes. Programs, as you, as you know.
This bill was passed before the RHTP money came through at all, and we're continuing to put this was this bill passed last year. Legislation passed last year. And so, ideally, we would love to get some funding from the RHDP program. We also have this standing up right now too, and so we're gonna continue to to push for it just in case. My my understanding is that funding is also not potentially eligible until b b And this is something that I will tell you is an urgent need now.
Speaker 1
So, we're What about on the funding for the rural areas? I don't know if you were here for that presentation as well. I think it's also HCAI. I'm wondering in your conversations, did you talk about that program as well?
Speaker 45
We didn't talk specifically about that. We have had general conversations about our HCP program in general. Prior to knowing what the full framework was going to be for that, this legislation passed, as I mentioned. And this, what we're asking for here, could be used throughout the state as well. So it's not targeted only to rural communities, though that is where there is the most need.
And as you heard from folks just now talking about six sixty nine from last year, that really is for rural communities as well. We recognize the importance of that, too.
Speaker 1
Okay. I'd love if HCAI can get back to us as well to see if this is something that would be eligible under the rural program as well. DOF, if you could share that with them. Thank you. All right.
Thank you. Thank you so much. Really appreciate it. Our last for presentation is utilizing community health workers promotoras to keep Californians covered.
Speaker 63
Good afternoon, Madam Chair. My name is Omar Altamimi. Sorry, was a lot. My name is Omar Altamimi, senior legislative advocate with CPEN, the California Pan Ethnic Health Network. And I'm joined by my colleague Natalie Lupin, our senior policy coordinator here for any technical questions that might come up.
Speaker 46
First, I'd like to thank Senator D'Arrazzo for submitting our request to the committee. We're here today to urge your support for our budget request for at least $4,000,000 in one time funding to augment and expand HCAI's existing immigrant community health and resilience fund by strengthening CHWPR and community based organization capacity to provide culturally and linguistically responsive health navigation services. This investment is important now more than ever as immigrant families struggle to navigate major Medi Cal changes caused by HR1, state budget cuts made last year, and the cuts proposed by the governor for this year, which contain additional reductions and confirms the federal administration's plans to apply HR1 work requirements and more frequent renewal requirements to state only programs. These changes already have and will continue to create new confusion for beneficiaries and increase the risk of unnecessary coverage terminations due to paperwork and administrative barriers, particularly for communities that already face language access barriers and heightened fear. CHWPRs are our trusted messengers embedded in the communities most affected by medical changes and immigration related fear.
By expanding CHWPR led health navigation capacity, this proposal directly addresses the primary drivers of preventable coverage loss, lack of trusted information, language barriers, administrative complexity, and fear based disengagement. With a targeted investment, CHWPRs can scale health navigation and renewal support to help families stay covered as Medi Cal requirements become more complex or find lower no cost care if they are no longer eligible for critical services. California already has this infrastructure built in. HCAI's Immigrant Health and Resilience Fund invested to strengthen connections between CHWPR organizations and immigration legal services to provider sorry, to immigration legal service providers, including improving coordination, increasing referrals and linkages to appropriate health, mental health, oral health, and social services. Expanding CHWPR navigation capacity will complement the county led eligibility and renewal efforts by helping beneficiaries understand notices, gather documentation, and resolve issues before cases are discontinued.
This coordinated approach can reduce administrative churn and lessen strain on county eligibility workers. And for these reasons, we respectfully request our support for this proposal and happy to answer any questions.
Speaker 1
Thank you. Is this to bring on more CHWs or to continue the ones that are currently working? Continue the ones that are currently working. Okay. Do we know, like, when they're no longer going to be?
Speaker 47
So, basically, this request is it's adding more funds to a program that already exists at HCHI. There's already about 40 plus CBOs that are CBOs who work with CHWs who are in this program. Some key organizations like Vision e Compromiso and O Sol.
Speaker 1
So But is it because the funding's going to run now and they're no longer going to be able to work?
Speaker 1
to bring more CHWs. You said it's to continue the ones that already exist. So, I'm wondering, is their contract ending? And then they need the money to that's where I'm having it.
Speaker 47
Yeah. I would say so it I'll clarify that it could bring on more CHWs. The idea is that, you know, we it's only 6,000,000 right now to help fund 40 plus organizations. That's only a small amount. And so we're trying to provide more funds and to specifically focus on health navigation.
Right now, HCAI's infrastructure, health navigation is a piece of that. But it's also really focused on connecting immigrant legal services with the CHWPR CBOs. And so we need funds to really specifically focus on health navigation due to HR1 impacts and state budget cuts.
Speaker 30
Madam Chair, Mark Farooq, on behalf of the California Hospital Association, representing Mini GACS. Speaking in support of the distressed hospital loan program funding proposal in proposals for investment, this would call for an additional $300,000,000 to put into the program that has been exhausted. I just wanted to say that California hospitals were already under severe financial strain before H. R. One, and the additional federal funding reductions will worsen an already fragile situation.
Speaker 48
Since 2020, nine hospitals have closed in California. Through the previous funding in the distressed hospital loan program, that was able to keep the doors open on 15 hospitals. We this is a one time ask that we think will not exacerbate the state's structural budget deficit, but will potentially stabilize the fragile nature of some of the finances of some of these hospitals. Appreciate your consideration.
Speaker 1
Thank you, Mark. Two hours ago, I looked on, I was like, oh, there's not a lot of people. There won't be a lot of public comments. Silly me. People come towards the end.
Okay.
Speaker 44
Thank you, Madam Chair and members. Kathy Senderling McDonald here for the California Association for Adult Day Services in support of the proposal for investment from the Alzheimer's Association for Dementia Care Aware. We're pleased to support this effort. We are seeing a growing percentage of our service providers serving more and more patients who have cognitive impairments and dementia, and are pleased to support serving them better, as well as helping their caregivers provide better service. Thank you.
Thank you.
Speaker 1
Good afternoon. Kelly Larue here on behalf of Alignment Health Plan, who serves over 200,000 of California seniors, with about 70,000 who are eligible for both Medi Cal and Medicare. Just this week, CMS finalized a 2.48% increase in Medicare Advantage payments for 2027, reinforcing the role these plans can play in supporting providers and patients during periods of financial strain and ensuring that California optimizes Medicare funding in this challenging fiscal environment. High performing, highly rated Medicare Advantage plans, like alignment, improve outcomes while also providing more predictable funding to providers and the broader health care ecosystem, in addition to delivering richer benefits for dual eligibles. As CalAIM continues to evolve, we urge the subcommittee to support policies that preserve access to high quality MA plans and allow them to continue serving duals while advancing the state's coordination goals.
Speaker 49
Also wanted to flag for you for the California Urgent Care Association, we're putting together some information about providers who began taking Medi Cal under the TRI payments, and so we can get that cost savings and increase access numbers to you
Speaker 37
Kelly Brooks here this afternoon on behalf of the University of California Health to comment on two items. First, on the Rural Health Transformation Program. UC Health serves patients from 99% of California zip codes and is committed to expanding rural access to specialty and inpatient care. UC Health also supports building a sustainable rural health workforce to address care gaps in underserved areas. UC Health looks forward to continued collaboration with HCAA as they begin to roll out the grant funding application.
Speaker 50
On issue 26, UC Health supports CDA's request to reject the planned elimination of $311,000,000 in general fund support for proposition of 56 dental rates. UC's dental schools at UCSF and UCLA are key Medi Cal safety net providers serving children, older adults, people with disabilities, medically complex patients, and underserved families. These cuts would impact critical services, including pediatrics, hospital dentistry, oral surgery, orthodontics, endodontics, and special needs care. Thank you. Thanks, Kelly.
Speaker 23
Good morning. Angela Pontus on behalf of Planned Parenthood affiliates of California, representing the seven Planned Parenthood affiliates that operate over 100 community health centers and are providers in the uncompensated care grant program offering abortion and contraception care. The program is currently in its last round of funding, and therefore will not continue without an appropriation. Planned Parenthood is in strong support of the $30,000,000 request to continue the program for three more years at $10,000,000 per year, as Planned Parenthood providers and the other providers in the program need that funding to continue offering services for those that do not qualify for Medi Cal programs or otherwise have coverage. Thank you.
Speaker 5
Good afternoon, Madam Chair. Connie Delgado, on behalf of the District Hospital Leadership Forum. These are the 33 district and municipal hospitals in the state. Excuse me. We appreciate HCAI's presentation on the RHTP.
Speaker 52
As outlined in today's materials, this program represents a significant and timely investment to strengthen access, workforce, and innovation in rural communities. For the hospitals DHLF represents, many of which serve as the back bone of care in rural and underserved areas. This program is critically important. The focus on transformative care models, including hub and spoke networks, will help stabilize essential hospitals and improve coordination of care. The workforce investments will directly address persistent staffing shortages, especially in these hard to recruit regions.
You've heard some conversations about that, and you yourself mentioned. As the technology and infrastructure funding, including telehealth and EHR modernization, will help close long standing gaps in access and connectivity. We look forward to continuing to partner with HCAI and the legislature to ensure these resources are deployed and effectively reach the communities most in need. And also, we would like to offer support for the CHA sponsored $300,000,000 for the distressed hospital loan program. As you know, district hospitals
Speaker 44
Lina Workman with the California WIC Association, representing the 83 local WIC agencies that provide the WIC program. We would like to commend CDPH WIC as they are currently undertaking the herculean task of implementing the new food package. This vital targeted short term benefit supports 1,000,000 Californians each month, and its proven positive outcomes with great impact deserve our full support and investment. We strongly support their efforts to implement WIC online shopping. The long sought after flexibility by WIC families will facilitate equitable access to healthy foods by reducing barriers such as transportation in both urban and rural communities, easier shopping for WIC approved foods, mitigating ongoing immigration threats, and the stigma for utilizing public benefits.
Speaker 18
Good afternoon. Lizzie Guanzona here. I'm going to comment on two items today. First, on behalf of the Office of Kat Taylor on item 25 in support of the BCP to implement AB twelve sixty four, we urge legislature to approve this funding so the department can develop these rigorous science based regulations and provide schools with the technical assistance they need to serve healthier meals. Also here on behalf of the California Medical Association, on item 10, CMA applauds efforts to improve access to quality menopausal care and wants to ensure requirements placed on plans are contemplating the implementation impacts on providers.
To that end, CMA and ACOG are working with other impacted providers to provide feedback on the language and look forward to continuing conversations. Thank you. Thanks.
Speaker 41
Good afternoon, Madam Chair. Niko Molina, on behalf of Bayer. Bayer supports the Governor's budget proposal and the related budget trailer bill on prescription drug coverage for menopause treatments. While Bayer fully supports the TBL and funding proposal, we urge the legislature to consider revising the language to ensure that women experiencing menopause have access to the full range of treatment options, including innovative new treatments that might not otherwise be covered by insurance. Thank you.
Thank you.
Speaker 60
Good afternoon, Chairman Jevar. My name is Courtney Armstrong with the First Five Association. I'm here to speak on item 18 under CDPH's BHSA Population Based Prevention Fund. Despite past historic investments in children's behavioral health, the birth through age five population remains underserved and often overlooked. The sunsetting of the CYBHI community practice grants at the 2026, combined with the changes due to BHSA implementation, are going to widen that gap.
Speaker 54
For these reasons, First Five Association of California is requesting an additional $20,000,000 for the new CDPH population based prevention fund, specifically for the birth to five population. And we're also proposing two technical fixes for that fund. So first is designate 20% of the 51% youth set aside for the birth to five population. And the second is to clarify the statute to ensure that County First Fives are eligible applicants for those funds as local early childhood experts with deep community knowledge. Thank you.
Speaker 27
Good afternoon, Madam Chair. Jackie Anderson with CHIAC representing our local health departments throughout the state. Under issue 26, CHIAC respectfully requests the legislature and administration provide $97,600,000 for four key public health IT systems used in communicable disease and vaccination programs. These systems include MyCAVAX, CalConnect, the California Immunization Registry, and the Future Disease Surveillance System. The governor's January budget does not propose resources for these systems, and without funding, these systems are slated to shut down on June 30, with no contingency plans communicated to local health departments, health care providers, or other users.
The loss of these systems would force local health departments back to pre pandemic, less efficient, and administrative administratively burdensome workflows and processes to prevent and control infectious diseases. And these, practices would include manual spreadsheets, faxing, emailing, reports, cold calling, emailing, electronic data files, and manual labor to establish new workflows. These systems have saved countless hours of state and local health department staff time and have enabled more timely and actionable public health interventions statewide. California cannot afford
Speaker 30
Chair, Kathy Mossberg, behalf of Essential Access Health. I want to comment on one of the items for reinvestment on the uncompensated care program, to the point made by my colleagues in Planned Parenthood. These funds have now been expended after this last grant cycle. This has been a true lifeline for the providers and for those we serve. This was something put in place post Roe.
Now, with H. R. One, we're even in a worse situation. We're going to see more uncompensated care, and we need this program even more. So, I want to just urge your support for the $30,000,000 request, spend the money over three years, 10,000,000 a year.
Speaker 8
We also have some additional outside of a general fund that we could use in the abortion fund that was created last year and some of those insurance dollars. So, there's ways to offset some of that general fund request. So, we urge your support when the time is appropriate. Thank you.
Speaker 15
Afternoon. Ryan Souza, on behalf of Seres Community Project, lead organization in the CBO Medi Cal Coalition. Our coalition represents over 700 community based organizations, and we serve all community supports and all populations of enhanced care management. We just want to highlight the conversation around CalAIM, ECM, and community supports today. Our CBOs are local and doing the work from moving people from long term skilled nursing facilities to successfully living in affordable housing to helping keep people's diabetes in check with medically nutritious meals.
And we just want to say that DHCS was clear today. We are hearing from our organizations and individuals. These are innovative programs that are cost savings and that are working. And so we just want to support and keep this, you know, CalAIM ECM and CS as a priority both in policy and funding as the conversations move forward. We also have a brief here today I'm going to leave, which is in partnership with Center for Care Innovations.
And it really describes kind of the nature of the organizations doing the work and what's happening in the field right now.
Speaker 4
Good afternoon. Michelle Gibbons with CHIAC, representing local health departments as well. I just wanted to comment on issue 18, BHA population prevention. The local health departments that are in the plan are receiving $12,000,000 but we're being asked to create suicide prevention plans and then convene all the folks that CDPH then provides funding to locally and making sure we're all rowing in the same direction. 12,000,000 across 61 local health jurisdictions is not going to go very far, and it's not enough to complete that work.
Speaker 55
The challenge that we see is that the state is using a lot of those dollars for programs that they already pay for and leaving us with 12,000,000 and not really expanding that to anything more. So, we would love to continue that dialogue with the department, but also with the legislature to try to get a little bit more funding for local health departments so we could actually maximize the opportunity and show that public health can add value into this prevention space.
Speaker 6
Chris Conn, representing the ALS Network. I'm hearing continued support for the ALS Wraparound System of Care program outlined as part of item 26. This program allows ALS patients and their families to access clinics throughout the state, taking a huge burden off our healthcare system. Thanks for your considerations, and I hope there's a third flight.
Speaker 45
Good afternoon, Chair. George Cruz on behalf of the California Behavioral Health Association. We appreciate the state's commitment to behavioral health through CalAIM and want to highlight two areas where targeted investment is needed. First, on BHSA population health funding, we urged this legislature to support the budget request championed by Assembly Member Pelerin that allocates $30,000,000 from the Behavioral Health Fund to fund the California Reducing Disparities Project. CRDP is a proven prevention model that reaches communities not served by traditional system, and the state has already made significant investments in building that infrastructure.
Speaker 56
For every $1 invested, the state's seen roughly $5 in return, and CRDP's funding is set to expire in June 2026. Second, the enhanced care management and community health support. Community based providers are responsible for providing these services, current rates and infrastructures do not accurately reflect the true cost of care. Providers lack access to the same level of technical assistance as counties, which create uneven implementation and limit access. Thank you so much.
Speaker 1
Thank you. I have to stop public comment at three. I have to. So I get thirty seconds, y'all, each person.
Speaker 36
Good afternoon, Madam Chair. Jessica Moran with Capital Advocacy on behalf of Big Smiles, Children's Choice Dental Care, the Association for Dental Support Organizations, and Golden Age Dental Care, all in support of the 56 reinstatement of dollars, you know, representing providers who treat children all the way to the end of life, who treat patients in school, dental offices, and skilled nursing facilities. This finding is critical to maintain the dental network and make sure that we don't hinder access to care for an already vulnerable population. Thank you.
Speaker 58
Hi. Good afternoon, Madam Chair and staff. My name is Julie Sherman. I'm here on behalf of The Arc of California. We represent people with and developmental disabilities.
I'll be quick. We are just here again to urge the committee to reinstate the funding for Medi Cal dental. This is something that is very important to the special needs community. Thank you so
Speaker 28
Sarah Nocito, on behalf of the California Chronic Care Coalition, we are here in support of our partners at the Alzheimer's Association's Budget Act request for $5,400,000 over three years for the Dementia Care Aware program. Thank you. Thank you.
Speaker 13
Hi. Kat DeBerg with the Health Officers Association of California, in support of the stakeholder proposal for $97,000,000 for state IT systems, so that we don't fight twenty first century diseases with twentieth century technology. Thank you.
Speaker 39
Madam Chair, Bruce Palmer, with the California Association of Public Health Lab Directors who represent 28 local public health labs serving as part of the first line of defense against public health threats in our community. We are in support, in alignment with CHEAC, HOAC, and SEIU for this 97,600,000.0 for CDPH IT systems. Thank you.
Speaker 18
Good afternoon, Madam Chair. Trevor Nelson with the California Alliance of Child and Family Services, in support of funding for the Cal AIM Enhanced Care Management and Community Supports. These programs are essential to meeting the needs of our most vulnerable residents, and they are delivering results. I'd also like to speak in support of the $20,000,000 allocation for the population based prevention fund for children ages zero to five. Thank you very much.
Speaker 50
Good afternoon, Madam Chair, members. Raymond Contreras with Lighthouse Public Affairs on behalf of Fullwell and the continued support for Cal AIM. Since the launch of Cal AIM, specifically the medically tailored meals and medically supportive food, have connected with over two twenty patients across the state. We want to continue prioritizing equity across California. Thank you.
Speaker 29
Thank you, Madam Chair. Wes Sabre HealthRite three sixty. I want to stress the importance of preserving the California Reducing Disparities Project through our Essence of MANA program. We operate the only CRDP program specifically serving Pacific Islander communities. And without the continued funding for CRDP, we risk losing effective programs, a trusted workforce, and behavioral health infrastructure.
Speaker 62
I also want to uplift the Endepidemics Coalition requests and the California Hunger Action Coalition's request. Thank you.
Speaker 15
Melissa Cortez, on behalf of Homestyle Direct. Homestyle Direct provides medically tailored meals within the Kellyanne program. We do want to offer continued support for that program. But I also want to note that we did provide some recommendations to the department, copied this committee, on ways that we believe you can see additional cost savings within that program by standardizing eligibility and streamlining documentation required. Thank you.
Speaker 35
Thank you, Madam Chair. Eric Dowdy with the California Dental Association, here to support the reinstatement of the Prop 56 supplemental payment cuts for Medi Cal Dental. We see it as existential for the survival of the program and access. So we appreciate your support for that.
Speaker 22
Good afternoon, Chair Beth Malnowski with the SEA of California one hundred nine. My comments to those of Chiak and Hawak in supporting the public health IT investments of roughly $97,000,000 Additionally, supports the investments outlined earlier on the HK budget, particular ongoing investments to the data exchange framework, the HPD, and the Office of Health Care Affordability. Additionally, support their work implementing AB fourteen eighteen. And lastly, appreciate their focus of workforce on centering the Rural Health Transformation Program and workforce needs of rural California. Lastly, on the Department of Public Health budget, want to support the investments in the Center for Health Care Quality field operations strike team.
Thank you. Thank you.
Speaker 13
Laura Angela with Children Now. We are in support of the following: CHIAC's public health IT funding request the $26,000,000 request for gender affirming care support, CDA's proposal to cover prop 56 incentive payments, the $4,000,000 investment in CHWs and immigrant health care, and we support the additional funds and trailer bill language for First Vise. Thank you.
Speaker 51
Thank you. Good afternoon, Chair. Diana Luna with the County Behavioral Health Directors Association. We just want to express our gratitude to HCAI for their partnership and collaboration on the BHSA Workforce Initiative development. While we appreciate the partnership, we do want to raise one concern that we have with the draft wet plan, which proposes evaluating the impact of the BH Connect recruitment and retention program prior to making additional investments.
Speaker 64
While the BH Connect program has made meaningful progress, gaps remain in its scope. So we would really urge the reconsideration of this approach.
Speaker 2
Jennifer Tannehill for the California Dental Hygienists Association. We want to echo the comments of the Dental Association, and also just that we would like to make sure that we support the preservation of 56 funds for dental. It really impacts the alternative practice hygienists and their patients who are in nursing homes and those homebound, elderly, and disabled patients.
Speaker 13
Nicole Wortleman, on behalf of the Children's Partnership, in support of two stakeholder proposals, the Community Health Workers $4,000,000 as well as the $20,000,000 for zero through five mental health through First Five Commissions.
Speaker 52
Thank you, Madam Chair. Andrew Mendoza, on behalf of the Alzheimer's Association. We are sponsoring the budget request for the Dementia Care Aware. It is $5,400,000 to sustain a dynamic training program for three years. They have already trained more than 7,450 people reaching professionals in every California county, and they offer free CEUs and CMEs in exchange for that training.
Speaker 66
And we do believe that this has led to better detection and diagnosis of dementia, which can reduce unnecessary hospitalizations and emergency room visits, and can save costs to our shared health care system and which will help mitigate the impact of implementing HR1. Thank you.
Speaker 65
Good afternoon. Natalie Santamalia, Promotora with Vicionico Promiso, here in support for three budget asks, 1,000,000 to 4,000,000 one time funding request to bill on HCAI's infrastructure by expanding CHW promotoras and representatives and CBO's capacity to provide health navigation, a one time funding of 750,000 to the allocation of Department of Health Care Services to produce a report on the use of the community health worker benefit. And lastly, ask of 30,000,000 to to support the which is 14 CBOs working to support this, and 50,000,000 for Visionecompromiso. Thank you.
Speaker 32
Romelli Antoine with the Sacramento LGBT Community Center and a coalition of LGBT centers the state here in strong support of a $35,000,000 LGBTQ plus community center fund and $25,000,000 for gender affirming care. Centers such as ours provide critical care, such as mental health, housing support, HIV services, affirming care for youth, etcetera. Right now, with federal attacks, it's time for California to be a backstop for our youth and our community. Thank you.
Speaker 16
Danielle Zimmerman, ally mom of an LGBT kiddo and board chair of the new Placer LGBTQ plus Center. Just wanted to underscore the importance of providing these services in rural areas throughout California so that individuals have access to supportive medical professionals and services, legal help, safe gathering spaces, employment opportunities, all of the above, which benefits mental health. Thank you for including funding for LGBT centers in the state budget going forward. Thank you.
Speaker 3
Good afternoon, Chair. Matt Velles with the Latino Coalition for Healthy California, in support of the $4,000,000 ask to HCAVE to support community health workers CBO infrastructure. And additionally, we urge DHCS to provide utilization data of the CHWPR benefit and support the seven fifty ks ask to support this report. Thank you.
Speaker 3
Afternoon. EJ Aguayo. I'll be fast. I have a few. On behalf of OCHIN, we appreciate Senator Dali's championing of $20,000,000 to reauthorize and scale HHI's proven health IT and AI workforce program.
Speaker 68
On behalf of CAFP, we appreciate the dedication to and protection of Song Brown. Also on behalf of CAFP, we appreciate the administration's engagement on improving access to menopausal care. Look forward to continuing discussion on amendments to the proposed trailer bill language. Almost lastly, on behalf of Cal PACE, in support of the CADS budget request geared to prevent community based adult service closures. Lastly, on behalf of Vision Vision Thank you.
Support of the $4,000,000 investment.
Speaker 40
Accessing the CHW benefit and where those gaps are. And second, the formula now asks to expand CHW capacity through HCHI's existing infrastructure. This investment would deepen and broaden that reach for our health center. Thank you. Thank you.
Speaker 35
Hi, there. Lillie Doran with the Children's Partnership. I'm here to echo the comments of my colleagues at CPEN to urge the legislature to invest at least $4,000,000 one time funding to build on existing HCAI infrastructure to support CHWPRs and CBOs in helping California's children and families stay enrolled in Medi Cal, mitigate HR1 harm, and access care. We also strongly support a one time allocation of $750,000 for DHCS to publish data on utilization so advocates can better work with the state to improve this critically important benefit within Medi Cal. Thank you so much.
Speaker 8
Dorena Good afternoon, Madam Chair. Dorena Wong from Asian Resources, Inc. I have to comment on item 26. We also support the $4,000,000 allocation to HCAI to support CHWs. We've seen firsthand the importance and critical need for these CHWs to provide culturally and linguistically competent care.
We also support the $750,000 to make for the report to ensure the CHW benefit is effective. Thank you.
Speaker 61
Good afternoon. Whitney Francis with the Western Center on Law and Poverty. We appreciate that the menopause TBL implements coverage requirements, but have concerns that the language treats Medi Cal patients differently by not requiring annual provider assessment or patient notification. We urge low income Californians not be treated differently than those with commercial coverage. We're also pleased to see the department's commitment CalAIM, and to ensure the long term success of vital community supports, we recommend movement to make these services Medi Cal benefits.
Speaker 69
And we align our comments with previous colleagues supporting the two CHW asks and support the $26,000,000 request to protect transgender health care. And finally, we continue to urge the legislature to pursue progressive revenue solutions to protect health care for all Californians. Thank you.
Speaker 1
Just flagging that, this subcommittee has not received a formal request for the $750,000 from CHW. So if you wanna turn in this workshop a worksheet that has to be formally submitted.
Speaker 54
Good afternoon. My name is Prosperity, and I'm here on behalf of the current organization of San Diego serving refugees from Burma. Our community languages, including Karen and Karen and others, are rarely represented. So we are here to urge legislature to invest at least 4,000,000 to support community health workers and community organizations in helping all Californians stay enrolled in Medi Cal navigate changes and access to the care they need.
Speaker 2
My name is Muay, and I'm a community health worker with the Korean Organization of San Diego, also serving Korean, Kearny, and other Burmese speaking ethnic groups from Burma. In my five plus years working in this role, I have seen firsthand how important it is to have trusted messengers. The formula investment will fund trauma informed outreach and education done by community health workers like myself. Thank you.
Speaker 48
Anna Hello, Madam Chair. I'm Anna Chodos. I'm a geriatrician and internist at UCSF and professor of medicine and executive director of dementia care, where I want to just put in my support for the budget request for that. You heard we're just we've talked to thousands of people and trained them. We're just getting started.
Speaker 72
There's tens of thousands more people to train in how to do dementia care while the population is doubling before 2040. So thank you so much. We do not have any other state support to continue this program after this cycle. Thank you so much. Thank you.
Speaker 39
Madam Chair, Monica Miller. Behalf of Alzheimer's San Diego, Orange County, and Los Angeles, we're in support of the CADS request with Dementia Care Aware, as well as the excuse me, the CADS request, as well as the Alzheimer's Association request related to dementia care aware. Thank you.
Speaker 14
Thank you. Afternoon. Katie Van Dyne with Health Access California. HRA Issue one, we support strong implementation of the Office of Health Care Affordability. Consumers bear the brunt of the impacts of HR1, and we can't protect household and state budgets without addressing the drivers of high health care costs.
Speaker 55
HCAI Issue three, we support the BCP to transfer the data exchange framework over to HCAI and strong implementation of the program, including an independent governing, boarding, and enforcement. HCA Issue five, we support the BCP for AB fourteen eighteen. DMHC Issues nine, we support the BCP for SB 41 and SB three zero six. And for Issue 26, we support C. Penn's ask for the $4,000,000 document.
Speaker 9
Good afternoon. My name is Jasmine Asher. I'm representing the California Association of Orthodontists. On behalf of the California Association of Orthodontists, we strongly support restoring Proposition 56 funding for DentiCal at previous levels. Access to dental care is essential to overall health, and these funds are critical to ensuring that patients, especially vulnerable populations, can receive timely, necessary care.
Speaker 73
Loss of this funding would significantly reduce access to care and place additional strain on California's dental system. Thank you.
Speaker 58
Good afternoon, Chair. My name is Natalie Lupin with the California Panethnic Health Network. I'm here to urge the legislator to invest at least $4,000,000 one time to support CHWPRs and community organizations to help vulnerable Californians stay enrolled in Medi Cal amid new federal and state rules, making it harder to stay covered. Many families, especially in immigrant communities, are not receiving timely or language accessible information about these changes, so we must continue to fund their work. It's very critical and urgent.
Speaker 47
So please invest in community based care during this critical moment. Thank you so much. Thank you.
Speaker 49
Good afternoon. Johan Cardenas with the California Pannecna Health Network. On dental property seats, we're very you know, regarding dental property seats, you know, one million people will lose their dental coverage on July 1, so we must act now. We must protect that coverage. And finally, we also like to voice our support for the LGBT Community Center Fund's proposal as well.
Speaker 24
Thank you for your patience. Good afternoon, chair and members. My name is Vanessa Teran, director of policy with MICOP, the Mixteco Indigena Community Organizing Project. As we're all aware, the current federal administration's enforcement's actions are placing immense strain on our immigrant families in our region throughout and throughout California and the nation. I want to echo that the frontline people who are working through this are CHWPRs.
Speaker 8
They're the ones who have been the most essential of navigators for immigrant communities who are experiencing significant harm. MICOP currently is a recipient of HCHI one pillar pillar one funding as a subcontractee of Visionico Promisos Allianzas Coalition. This investment supports promotoras to do outreach and referrals for immigrant legal services and health care access.
Speaker 1
Thank you. We urge Shut it off. Thank you so much. That will conclude public comment. Budget subcommittee number three on health and human services has adjourned.
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