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Senate Health Committee California State Senate
Follow its sittingsSpeaker 3
And again, we've appreciated the chair's expert feedback and input on that. I do want to thank Senator Allen for his leadership in recognizing that the original policy put in place in part under his authorship might need to be revisited, and you know, his work and his part in the conversations over the last year has been critical. I don't think I would have been willing to come forward, you know, without having someone like him who was in the position of a prior author to help guide along where we are today. And hopefully that's in a landing spot, at least for today, for this committee, that you can support with an aye vote. The limits and audit requirements currently in place, as the author, Senator Jones, just said, is really what's at issue here, and the bill, we think, represents a narrow targeted reform, maybe a beginning of a longer conversation.
We'll see how the conversation goes in the legislature. And with that, as the senator said, we have witnesses. I think he already introduced them, and I'll defer to them at this time. Again, thank you to the chair.
Speaker 4
Thank you, Madam Chair, and it's a pleasure to address the committee. I am Richard Fox. I'm a California licensed physician, a board certified pediatrician. Been practicing for forty eight years. Also a California admitted attorney.
Parents sometimes contact me seeking medical exemptions from the immunization requirements for school attendance. I decline. I uniformly decline for several reasons. The first is that I know a number of pediatricians who have lost their medical licenses for writing such exemptions, including one who is a law client of mine. Such punishment is obviously intended not to correct but to deter doctors from writing such exemptions.
In the law, we call this an in terrorum effect. It works. I won't go anywhere near writing such exemptions, even when they're appropriate, because other than immunodeficiency and anaphylaxis, the criteria are too vague, arbitrary, and controversial, and the penalties for being wrong investigation and loss of license are too severe. Sometimes other doctors ask my legal advice about writing medical exemptions. My legal advice is simply, Don't ever write an exemption for any child.
It's not worth the risk. There are too many land mines with no clear guidelines and no safe harbors for medical exemptions in California, so you can always be second guessed. It's not worth the risk. Just send the patient to an infectious disease specialist at an academic medical center and let them take the risk. Taking that risk is a good way to ruin your career and end up financially ruined as well.
Why would any sane doctor risk it? Most California pediatricians work for large risk averse organizations. Why would those risk averse organizations let their doctors write immunization exemptions and expose the organization to costly investigation. Even though California law provides on paper for medical exemptions, the system for doing so simply does not work in too many cases. SB1377 restores balance, the ability for physicians to practice individualized care, and ensures families with legitimate medical needs are not left without options.
It would be greatly improved with clear guidelines and safe harbors for doctors and eliminating the loss of licensure as a penalty. I urge you to support SB1377 with a less vote yes vote, and help restore that accessibility. Thank you very much for your attention.
Speaker 5
Thank you. Chairwoman and Senate Health Committee members, my name is Amy Bond, and I'm the President of PERC and the Mother of Four. As the sponsor of SB thirteen seventy seven, I respectfully bring to your attention the serious and ongoing problems with California's current medical exemption systems and the negative impact on children. California's children are suffering right now. For seven long years, a minority group of our youngest demographic, medically vulnerable children, have suffered discrimination.
They are being denied equal access to education because valid medical exemptions are either unattainable, grandfathered exemptions are unrenewable, or the child is subject to retroactive revocations that debilitates them and their families with interruptive school removals, with no solution in place to remedy the discrimination despite having legitimate medical needs. Over the past five years, over 4,000 children had exemptions revoked, with 87.5% of the appeals with those exemptions being denied without distinguishing between form errors or medical reasons. Children are denied and refused medical care from institutions and offices, and these problems are all interconnected. A child cannot obtain an exemption if the doctor's discretion is restricted. A doctor will not write the exemption if the audit system threatens punishment.
A family cannot protect the child if the exemption is later subject to revocation by an administrative panel. A simple change to one part of the law does not solve the broader problem, because each part reinforces the other. Though this issue is severely stigmatized, reform is not only needed, it's necessary and incumbent upon all of us to ensure our children are not the victims of a poorly constructed system that effectually doesn't work for them. So, the issue at hand is whether children can obtain
Speaker 1
Thank you so much to those who come to speak as lead witnesses in support. We will now open it up for anyone in the audience who would like to speak in support of this bill. Please just state your name, your organization, and your position only.
Speaker 8
Hello, Denise Aguilar, Vice President of Freedom Angels Union, in support. Thank you.
Speaker 2
David Bolag representing the Moms for Liberty California Legislative Committee. Thank you, in support.
Speaker 9
Jessica Govereta with Informed Policy Advocates in strong support of this bill. Thank you. Thank you.
Speaker 10
Hello, I'm Doctor. Azadeh Katibi. I have a Masters in Public Health, and I'm in strong support of this bill.
Speaker 11
My name is Kris Dukes. I'm with Informed Policy Advocates, and I support this bill.
Speaker 13
I am Darlene Alquiza, CEO of Informed Policy Advocates, and strongly support the bill.
Speaker 49
Thank you, Madam Chair. Tom Sheehy with the Sheehy Strategy Group here today on behalf of the Informed Policy Advocates. We thank you for bringing this forward. We're here in support of SB thirteen seventy seven, and thank the author.
Speaker 1
Thank you. Seeing no further individuals who would like to speak in support of this bill, we will now open it up to anyone who would like to speak as lead in opposition. If there are any witnesses that would like to speak lead in opposition, we will take two speakers. You may come here to the table. And you have a combined five minutes.
Thank you.
Speaker 15
Thank you. Good afternoon, Madam Chair and committee members. I'm Doctor. Dean Blumberg. I'm a pediatrician here in Sacramento.
I specialize in pediatric infectious diseases, and I'm here to state my opposition to SB thirteen seventy seven on behalf of the American Academy of Pediatrics in California, representing over 5,000 board certified pediatricians, and the California Medical Association, representing over 40,000 physicians in California, and the California Immunization Coalition, a nonprofit, publicprivate partnership dedicated to achieving and maintaining full immunization protection for all Californians. The recent immunization legislation in California, has already been mentioned, SB two seventy six and SB two seventy seven, they've successfully addressed the previous epidemic of fraudulent medical exemptions that threatened the health and safety of California schoolchildren. These measures work. Valid medical exemptions are being issued, and the majority of these medical exemptions are for true medical reasons. The American Academy of Pediatrics has clear guidance on when children should not receive routinely recommended immunizations.
In my practice, as a sane doctor, I see patients that meet these conditions. I follow the mainstream guidance, and I issue medical exemptions for medical reasons. The California Department of Public Health also follows this guidance. The system works. Trained medical professionals have not lost the ability to issue valid medical exemptions.
Speaker 28
SB thirteen seventy seven would eliminate the current oversight and enforcement mechanisms that are working to ensure that medical exemptions are issued for true medical reasons. There's no reason to ignore the history and return to the days before this system was fixed, the time when a few fringe practitioners were issuing loads of medical exemptions for nonmedical reasons. For physicians who are writing medical exemptions for valid reasons, they have nothing to fear about them being reviewed and validated. Similarly, if a physician is issuing invalid exemptions, it just doesn't make sense to me to increase the limit to 10 inappropriate exemptions from five. If they're issuing a bunch of inappropriate exemptions, better to have the medical board review sooner rather than later.
Speaker 15
Even a small decrease in immunization rates can lead to the return of highly infectious preventable diseases, as the current measles resurgence illustrates. The COVID pandemic led to decreases in vaccine rates nationwide, and this has resulted in more measles cases being reported in The U. S. In more than thirty years. And the vast majority of these infections are in those who are unvaccinated or with unknown vaccine status.
And remember, measles is not just a fever and a rash. It may result in complications, including pneumonia, inflammation of the brain, and even death. Now is not the time to eliminate the system that works and does not need fixing. On behalf of American Academy of Pediatrics in California, the California Medical Association, and the California Immunization Coalition, I urge your no vote on SB two thousand three and seventy seven. Thank you.
Speaker 1
Thank you. You have about a minute and fifty seconds.
Angela Thank you. Thank you, Madam Chair, members of the committee. Angela Hill with the California Medical Association. In the interest of time, I'll just go ahead and say, to begin, that the California Medical Association did proudly co sponsor the framework that we're discussing here today to ensure that medical exemptions are rooted in clinical standards of care. And moving to the arguments that children who were originally exempted from the statewide review process and now require a new medical exemption can no longer find a doctor willing to submit an exemption, we are unaware of any physicians that are unwilling to issue valid medical exemptions.
Speaker 16
we do think that this should be a conversation with the administration, CDPH, and the licensing boards, not through this bill today, unfortunately. We thank the chair for her work to propose amendments that would aim to resolve our serious public health concerns with this approach as the bill is drafted, but we still have concerns by increasing the allowable revoked exemptions from five to 10 in a year for those that previously had no medical exemption review because of the grandfathering language in SB two seventy six. Passing this bill today would insulate providers from referral and review that would need to have that by their licensing boards, we think it gives validity to an argument that the system is broken when it is not, and for those reasons, we respectfully urge your no vote today. Thank you.
Speaker 16
apologies if I may for the committee. We have provided a technical witness from CMA, Alicia Sanchez, our Chief Strategy Officer. Thank you.
Speaker 1
Thank you. At this moment, we will have anyone else who's in the audience who would like to speak in opposition to this bill. Please come to the mic, state your name, your organization, and your position. Thank you.
Speaker 18
Thank you, Madam Chair. Ryan Spencer, behalf of the California Society of Pathologists, the California Radiological Society, California Podiatric Medical Association, and the American College of OBGYNs, District 9, all in opposition. Thank you.
Speaker 19
Thank you very much. Vanessa Quina with KP Public Affairs on behalf of the California Academy of Family Physicians here in opposition.
Speaker 20
Thank you. Angela Pontes on behalf of Planned Parenthood Affiliates of California in opposition.
Speaker 21
Afternoon. McLean Rosansky with the Alameda County Office of Education in opposition. We apologize for the late submission on our letter.
Speaker 2
Good afternoon. Kelly McMillan on behalf of the American Academy of Pediatrics California, the Children's Specialty Care Coalition, and the March in opposition. Good
Speaker 23
afternoon. Farrah McDade Ting on behalf of the County Health Executives Association of California reviewing the amendments but opposed.
Speaker 20
Good afternoon. Cameron Lawton with the California Immunization Coalition, and
Speaker 11
Afternoon, chair and members. Carmen Nicole Cox with the Cox Firm for Law and Policy on behalf of the California Children's Hospital Association. Appreciate the amendments. We remain opposed. Thank you.
Speaker 17
Kimberly Doctor. Haley McNear, I'm a Sacramento OBGYN in opposition to this bill.
Speaker 10
Doctor. Shulpa Matthew also is practicing OBGYN in Sacramento in strong opposition.
Speaker 1
Thank you. All right, seeing no one else in the audience, moving to the mic to speak. I want to acknowledge all the OBGYNs out in the audience. I know they're here for their lobby day. I will now bring it back to committee, Senator Menjivar.
Speaker 11
Thank you, Madam Chair. I'll take a stab here at the start of this conversation here. So currently in California we have a range between ninety three point seven to ninety seven percent in terms of vax rates of a variety of different vaccination rates. Correct me if I'm wrong. It's an A grade in the state of California.
So I'm wondering what we're trying to fix if we already have one of the highest grading of vaccinations. Why would we want to do anything that could potentially lower the vax rates that we have in California? Senator, you know, one of your supporters mentioned that our children are the victims of this system. But I would argue that victims of this would be the kids who are actually dying from measles outbreaks that are actually occurring right now. Texas last year, I think, saw two kids die out of this who were unvaccinated.
I think that is the ultimate definition of a victim. You know, they're dying from a preventable disease. How do you outweigh given our percentage of vax rates, given the fact that California isn't immune to these outbreaks? We're seeing measles outbreaks. Chaucer County has seen a huge rate, and ninety six percent of their cases are from unvaccinated kids.
Why would we tamper with that? That could increase our chances. Go back to what we saw in 2015, I think, in Disneyland with the outbreaks that occurred there, overarching, why would we want to change the system?
Speaker 33
A couple of things. Generally, this specific bill is very was originally very narrowly tailored just to affect the few number of children in California that are medically at risk for receiving a vaccination, period. With the amendments that the chair has proposed, we're even tailoring it even more narrow now to impact only those children that currently have the vaccine exemption, so that they can continue, as they progress through the school age into the next tier of either junior high or high school, they can keep those exemptions. So I appreciate the chair's very diligent work on this. She's been very gracious in educating me on a lot of this, and so that's why the two coauthors, Senator Cortezi, Senator Allen, and myself were able to come to what I believe some agreement with the chair on on where the bill is gonna is gonna do after today.
Speaker 2
I believe that's correct. I wasn't sure that that was actually going to get into the amendments, but I think that was something that the chair and I had discussed with the other two coauthors.
Speaker 1
Female The amendment would allow for another five medical exemptions for those who had had exemptions in the past.
Speaker 2
So again, it goes to currently, the with the amendments, the bill does if I'm if I and and, madam chair, if I say this incorrectly, please please correct me. It doesn't give new medical exemptions to new people. It extends the ones that have already been issued.
Speaker 11
With the amendments that you took, those who have it right now will be able to get renewed as they go to the next tier of education?
Speaker 1
I don't generally like to speak before other members of the committee are able to speak. Appreciate the authors, all of the authors coming to speak with me yesterday. This is a big issue, a big bill. And this is honestly not how it should be done, and we talked about it. This is not something that should have been dropped in on the very last day of language being dropped into a bill.
This is not something that you have conversations with the committee and the chair about less than twenty four hours before the hearing. From speaking with committee staff, they had heard about issues for people who had had medical exemptions finding difficulty getting doctors who had not already maximized on their five to give them an extension. I informed this committee staff and the authors that if there was any potential amendments that I could potentially, possibly, in any kind of way put through, it would be this. Right. But this is not the right way of doing it, and had I not said that to you, I would not be supporting this.
If there is an issue, this is not the way to handle it. If there is an issue with the process, then what you do is you have hearings so that those who are in charge of the process can come before and present real data. I just heard something that 4,000 had been revoked. That's not true at all. According to CDPH, since this has gone into effect, 30,274 medical exemptions have been issued, 19,675 were reviewed by CDPH, only 2,869 were revoked.
This is why we have actual hearings with the people who are in charge and have the real data before we start moving on significant issues like this. So since I'm talking, I guess I'll keep going.
Speaker 1
So, but I'll just since I jumped in. You know, there was a statement about, the beginning when this bill initially went through, or these policies initially went through, that there was a promise made that every child could get an exemption, and I don't see where that promise has not been kept. And I was even thinking, you know, this doesn't even restrict only pediatricians or family practice providers. Anybody can give a medical exemption. I can give a medical exemption.
So, to say that that promise has not been kept, I think, is a very false statement. Providers can choose whether or not they want to give an exemption, And the thought of having some kind of oversight does not deter physicians in any other way. When we write narcotic prescriptions, we are very much scrutinized. It goes into the Cures database, and if we have written too many, we
Speaker 1
flagged. But I don't think one surgical patient or any patient who needs narcotics to help with their chronic pain is complaining about the fact that they're unable to get their prescriptions that because there's an oversight, now they won't do it. Oversight protects overdoses, people getting hooked on medications, just like this oversight is actually protecting our children, not only those who are getting it, but those who are around them in their schools and other places. I believe that this is something, if there is an issue, that we need to have hearings on to figure out what the right method is, if we need to move at all. Anecdotal stories, people coming up to you on the street, it does not give you a full picture of what's happening, because for every one provider that's saying, I don't feel comfortable, you've got 10 others that say it's working.
So, want to I wanted to make that clear since I was since
Speaker 1
was being asked about the amendment. And even the number five, like, because it was less than twenty four hours, it just came up with that number. It's rooted in actual data, science, facts, which is what I like to move by.
Speaker 1
And so, in any other situation, outside of me having a conversation with you and Senator Cortezi, I would not be supporting this bill. And so, I don't want people to think that all of a sudden this is something that I agree with because I think that the way in which we've gone about this is not the right method, and I can't even say for sure if we need to specifically change anything. But I know Senator Valladares, you wanted to say something.
Speaker 27
Well, you for bringing this forward in the bipartisan fashion that you did. I think it was it's really important to note that this isn't a partisan fight, that this is what I believe is a bit of a trust issue. And let me just say this here, vaccines save lives, full stop. They are essential to public health. But there really are rare, real cases where a child should not be vaccinated.
And those families deserve a system that works for them, not against them. And I want to be clear about what these amendments actually do from my understanding because there's been, you know, a lot of different variations. This bill does not eliminate oversight. It restores existing law and still requires annual review of the immunization data with clinical review by a physician or by a nurse when there are real red flags like schools that have below a ninety five percent immunization rate or providers issuing high number of exemptions. And that's not no oversight.
Speaker 16
That's targeted oversight. So the real question here is a bit of balance and I can understand from the chair how especially on an issue so controversial how we want data and we want time to review that data. And those are great points to bring up. But we also if we create a system where every doctor feels second guessed, where liability increases, and there are families with legitimate medical needs that can't access care, then we don't build trust. And there is a balance that needs to be struck.
Speaker 27
I do have a question for Doctor. Fox. I was reading the support letters, the opposition letters, and I know the bill has changed, you know, pretty significantly. But Doctor. Fox, can you the opponents were claiming that the bill does dismantle oversight.
And can you also speak to the chair it wasn't a question, but to her pointing out that this five came out of nowhere. How was that decided on? Or was I'm not sure if that
Speaker 1
was So, I'm sorry. I want to so, when I was saying the five, I'm not sure if you have the latest amendments because, again, this was a very last minute thing. And so, when I said the five, it was the five that I came up with yesterday for the amendments. So I don't think that's something that Doctor. Fox could
Speaker 1
That's what I was saying. That part answered. That's why I was saying that this is something that really should be more data driven and not something that you just kind of pull out of the air. So,
Speaker 27
Doctor. Fox, if you'd like to weigh in a little bit about the still sense the reality of liability that doctors feel pressure.
Speaker 6
If I understand your question, I understand this bill does not eliminate oversight, you know, quality control, that sort of thing. What I'm asking for is to decrease the risk from the doctor's point of view of that oversight process by clear guidelines, safe harbors, and a more of a collegial educational process where if a doctor doesn't get an exemption exactly over the target, that they can get some feedback as opposed to an investigation where they have to hire a lawyer, take a lot of money out of their pocket to fight and invest, and audit an investigation, or lose their license. It's just too draconian, as you said.
Speaker 27
So, to the opposition, are you aware of any, you know, stories from doctors who have had to go through this process and what that process looked like for them.
Speaker 15
Can tell you that I read the newsletters that the Medical Board of California puts out that speaks to all disciplinary action that's been performed by them, and you can see the ones that have been performed for doctors who wrote excessive invalid medical exemptions. Some of them have voluntarily surrendered their license. Some of the physicians have had remedial actions taken against them where they need to take course for documentation or other purposes. So, it varies depending on the offense. I don't know the details of the individual doctor, but I'm sure the medical board has that information.
Speaker 1
give you that information. Since this was implemented, 26 have been 26 physicians have been disciplined by the medical board. Two have surrendered their license. Nine went on probation. Six had public reprimand, and nine had public letters of reprimand.
So, only two no longer are licensed to practice here in the state of California since 2021.
Speaker 27
And do we know how many that 26 of those that were disciplined, how many went through an actual audit? So,
Speaker 1
like I said before, there are over 30,000 medical exemptions that have been issued since this went into place. Over 19,000 were reviewed by CDPH 28, a little over 2,800 have been revoked eight thirty one were appealed, and 109 of those appeals were upheld. And I think your questions are extremely valid, which also shows why just doing a bill like this without having the information, without having those sitting here at the table, like an informational hearing that we have to answer those questions before we create a policy is extremely important.
Speaker 27
So I'll just I'll close with this. It is my understanding that this bill is going to be going to business and professions next where, you know, hopefully someone from the medical board will be there to answer questions. But it is an important conversation. It's a big conversation. I appreciate both your leadership and Senator Cortezi's leadership and willingness to take this on.
I'll move the bill when it's appropriate, and let's continue to work on this together as well.
Speaker 29
Thank you very much, Madam Chair. Just some kind of bringing and I was not personally present, I was monitoring some of the testimony, but I here from another committee. So forgive me if some of my questions seem basic or redundant, but bringing it back to fundamental purpose of the bill, either you or your primary witnesses. What is the exigent, urgent, immediate community public health community public health concern issue that this bill addresses, not process, not scope of practice, not the process that allows for the obtaining or appealing of a medical exemption approval or denial. What is the urgent, exigent, pending public health, community health issue that this bill seeks to address?
Speaker 2
Senator Padilla, if it's okay, I would like to answer that question in relation to the amendments that the chair has proposed and that I've agreed to accept because that's a different answer from the original language of the bill. Would that be okay?
Speaker 2
Okay. So the amendments that we're agreeing to accept after discussions, very good discussions with the chair and the two co authors, is the children that currently have medical exemptions as they age out of elementary school and into junior high school and junior high school to high school, they lose their exemption. So the chair has she educated me on that With her amendments, the committee's amendments, we're protecting those current medical exemptions for vaccinations. It's that simple.
Speaker 2
No. We're we she's we've basically rewritten the bill between yesterday and today.
Speaker 2
amendments. And while she's looking at her notes, I want to say unequivocally that I agree with the chair that this needs to be a process and there do need to be hearings, and that was something she brought up yesterday, that both the coauthors and I agree. And in retrospect, we should have started this conversation in January. That's why I'm comfortable with where with the amendments today moving a much smaller bill forward that protects children today that already have those exemptions and then start this start the bigger conversation to address those other concerns that have come up.
Speaker 1
Right. Okay. So this is what the amendment will say. This is what will trigger a review. Physicians and surgeons who have submitted more than five medical exemptions in a calendar year for who do not have a medical exemption that was issued on or before 01/01/2020, or physicians and surgeons who have submitted more than five medical exemptions in a calendar year for children who do have a medical exemption that was issued on or before 01/01/2020.
That is the bill. To Senator Valladares' question, the five was just a five.
Speaker 2
My understanding is the original five was just a five, I mean, I don't know that there was any public hearing on the original five. Yeah. So, to your point
Speaker 11
my constituents that's in me too support of this. She asked me for a hearing on this very topic last year. So I would say and when I was chair, so I would say that one of those requests were coming did come through. But I do have a question to CMA, or I think the TA, if through the chair, if I can ask this question to the TA, then she might be best poised to answer it. In the perspective of the providers, what does it mean to have four more ME's approved for each provider?
And if I understand correctly, right now they get four. If they do get to do four. If they do a fifth one, it gets flagged to CDPH, correct?
Speaker 10
Right. The fifth exemption gets reviewed. That doesn't mean, however, that they are revoking the exemptions. They're just reviewing them to make sure that they align with the AAP standards. And most of the exemptions that are reviewed continue to move through the process I mean, to be intact.
It's when the exemption that's been submitted does not align with the standards that it would then be revoked.
Speaker 11
So a provider, in theory, could do an endless amount of MEs, but they're just gonna be reviewed after the fourth one. And if they're all valid, they're all gonna get approved. Correct. Okay. So adding five more, in theory, doesn't you still get you still get an endless amount if so long as you're okay with it being reviewed.
But now
Speaker 1
Again, this is exactly why this should not happen this way. It should not happen this way. Conversations should be had.
Speaker 10
So, as we understand it, it would be saying that well, so after the review, if you then had five revocations so there's a five for review, and then you can be approved for however many, but if you have five revocations, that is when there's a referral to the medical board. This, as we understand it, would be adding another five revocations.
Speaker 9
Okay. So that's and I guess I would say most physicians are not submitting more than five. There are some practices who have a patient population by virtue of the care that they're providing, would be providing more than five, but many are providing less than five. So they're not ever having their exemptions reviewed. And that the physicians that we've talked to have not had issues with this process.
Speaker 2
I think it's also important, if I may interject real quick, it's current exemptions. So the five may be even a mute point because we're not issuing new exemptions. These are extending current exemptions under the current amendments.
Speaker 11
And to you, senator, or to your I would like, through the chair, if I could ask the parent here, you and your peers, what you're hearing from providers. Because, you know, CMA is sharing that what their members have not submitted any concerns of the program. You, on the receiving end, have a different perspective. So you're hearing concerns?
Speaker 27
Yeah, I'm the chilling effect and the fear that providers have is so severe related to the third party auditing. It's not that they don't care about their patients or that they're scared that they're doing something wrong. It's the third party review that triggers this chilling effect for them that they might lose their practice for an unfounded investigation, and the thing that physicians are telling us, too, that they're so scared, they were unwilling to even send in letters of support for the bill, for SB thirteen seventy seven, and that wasn't just a few, it was many, and it was an entire organization that represents doctors and physicians and surgeons where, when we put out an ask for support, they were so scared to even send in letters, because what they said, the reason why, if I could share why, they said that if they sent a letter in for support, they felt like that could potentially trigger some kind of target on their back, and that just by sending in a letter, it could be sent to the medical board just because they support the bill. But in everyday practice, the physicians that we're hearing from, as well, they won't this is what our experience is they won't write medical exemptions.
Speaker 5
Some of my colleagues called about 800 doctors. This was a few years ago, and asked if they would be willing to write a medical exemption for anaphylactic shock, which is one of the things that seems to qualify, and out of all 800, it was about eight eighty plus doctors, none of them were willing to write a medical exemption. So, I think there's a category of they're unwilling for all these different reasons. They're scared, and also, there's a category of some that can't, and this is my understanding, so correct me if I'm wrong, but in the current law, there are physicians that are completely disqualified from writing medical exemptions at all if they're on a list of either investigations or disciplinary action from the medical board, and so my understanding is that's a very, very large list of doctors that are automatically disqualified from writing exemptions at all just for that reason when it's completely unrelated to medical exemptions. And so, that was in the committee report
Speaker 1
Yeah, as no. So, again, this is why we need to have the people who actually have the information here in front of us and from the department. I've already went through the numbers of those who were on probation, those who had public reprimand, those who had a public letter of reprimand, and the two that had to surrender their license. So, think we're getting into areas where we don't actually have data nor the experts to back what is being said. Senator Vaid.
Speaker 27
Can would you mind, both from CMA and Doctor. Fox, can you clarify that when you reach issuing five exemptions, your an audit or review, whichever you want to call it, is triggered. Is it just a review of those five exemptions or is it a review of your entire patient portfolio?
Speaker 4
Well, I can speak to that very briefly because I just don't do it. It's never come up for me. I don't do one, much less five.
Speaker 1
So, can read from what is current statute. Clinically trained immunization department staff member who is either physician or a surgeon or a registered nurse shall review all medical exemptions. Okay, just the exemptions. Okay, seeing no further questions or debate, senators Okay. I Senator
Speaker 29
would just note, Madam Chair, sorry, I think I've seen the distinction in the language on the amends, and there is a narrowing of that process, and then without perhaps the Chair's broader points, a sufficiency of data to justify that in terms of its operational impact. So that's it. Second, I just note I don't hear an answer to the primary question here because ultimately at the end of the day this is about community public health and all the unique attributes therein, and there is a reason why these constructs are carefully put together. There may be another a number of other elements your bill seeks to address. They some of them may be legitimate.
In my view, a community health impact standpoint, I don't see it. So I'm not going be able to be supportive of the bill today, but I wanted to put that in the record, and I appreciate your work. Thank you, Senator.
Speaker 1
Thank you. Seeing no further discussion or debate, Senator Jones, would you like to close?
Speaker 54
Let me just first of all say that I agree with everything the chair has advised today and has advised the same things to us yesterday in terms of having an oversight hearing and or informational hearing structure hearing to get into this broader issue, and even the issues that are before us today with an appropriate deep dive. I will say that the data that's needed to support these amendments is common sense, because this was initiated in the middle of the pandemic. The number five, according to one of the co authors, is one of our current colleagues, was relatively randomly come up with. It's that was '20 before 2020. It's now 2026.
Speaker 3
You have families coming into physicians where an older child, older than one who wasn't even born yet during the pandemic, are coming forward and saying, I need an immunization renewal for my child who received one from you before, and now I need another one for the baby that was born in the meantime. And we have a system that's so constraining that if that doctor is already at this low triggering number of five, he's essentially going to send those patients away in many cases. I don't think that's anecdotal. I don't think that's without data. I think that's basic actuarial information that we all know on a common sense basis day to day.
It's not as if we have suddenly stopped propagating more children. I've seen that right here in the legislature among our own colleagues. Where do they go if doctors are unwilling to surpass that threshold? So this I thought the chair's recommendation was absolutely spot on, which said, look, that kind of situation shouldn't happen. The five should not essentially be counted twice for a child who's already received a medical exemption.
Unless we're going to go back and call out all those approved medical exemptions, those should continue to move on. And those five should not restrict the next child in that family from getting an exemption at all if it's needed on a medical basis. How many is that? I don't know. But I have a nephew that has a condition that one of the witnesses described.
I would not want him to be in that situation of essentially having a mandated vaccination to go to school that might kill him. So I do think that's an urgency at Senator Padilla, and I don't know what greater urgency there could be than making sure that for the sake of the ninety seven percent that can have exemptions, that two or three percent risk their lives. That's, to me, the ultimate urgency. Thank you.
Speaker 2
Thank you. And I'll just add to that, because that's excellent close. And I think we've kind of parsed this. There's a bright line between the original language and the new language based on the leadership of the chairwoman and her scientific expertise. And I'll add political expertise as well to get us to the point where we are today, where I believe we have a bill that I'm comfortable moving forward.
I hope the chair is still comfortable moving forward. And we've got a long process. I joked, if it's okay, with her that she wants to do an oversight hearing and I joked that I'm turned out and she said, It doesn't matter, I'm still coming. So I think we've got a lot of work to do. I think the bill is narrowly tailored enough today that we should all be comfortable moving it forward and looking forward to the amendments being accepted and then having the conversation in business and professions next week.
Thank you very much. I ask for an I vote.
Speaker 1
Thank you. Seeing that we have no quorum, we will move on this bill when we do have a quorum present. I do want to reiterate that my support is only because I had a conversation with you and I gave you, not that I think this is the right way in which we should be moving.
Speaker 1
Welcome. Now, We will now move to file item. Number eight. Nine ninety five by Senator Rez.
Speaker 8
Thank you. Good morning, Madam Chair and members. First, I want to thank your staff for working with us on the amendments for SB nine ninety five. I also want to thank Senator Richardson for being kind enough for letting us go before her. I do have a witness today who's traveled out from the state of Florida to be here to speak on behalf of her mother.
I will be amending the bill with the language agreed upon by your committee in Senate judiciary due to the double referral. Specifically, the amendments deletes the other inspecting agencies, including the Office of State Fire Marshal, the State Water Control Resources Board, Cal OSHA, and instead requires CDPH, if it identifies conditions that fall within the jurisdiction of another agency to refer those conditions to the appropriate state or local agency for further review or action, and it deletes a provision requiring the standards adopted by CDPH to be at least as stringent as those applied to behavioral health facilities licensed by CDPH. SB nine ninety five, the Massuma Khan Justice Act, establishes a statewide inspection and compliance framework for large and voluntary residential facilities in California, including privately operated detention facilities using existing state inspection authority and enforcement tools. These facilities house thousands of people who depend on them for shelter, food, medical care, and basic safety. Because individuals in these settings cannot freely leave, the state has a responsibility to ensure that conditions are safe, humane, and consistent with basic health and safety standards.
Yet across the country, inside private immigration detention centers, people are being denied their basic rights. They are being denied access to legal counsel, denied access to medical care, and even necessities as fundamental as soap, clean water, and safe food. And the consequences are devastating. Since January, ten people have died in detention centers, which is an average of one death per week. Last year alone, thirty two people died in ICE custody, the deadliest year in decades.
Inspection reports have repeatedly documented serious failures, including lack of medical care, unsafe food, unclean water, and the absence of basic hygiene. Regardless of where one stands on immigration policy, there should be an agreement on this. No human being should be subjected to inhumane treatment. No corporation should profit from human suffering, and no system should operate without accountability. And yet, accountability is exactly what is missing.
Currently, Californians' inspection authority applies only to counties, and three of the four counties with this authority have not conducted any inspections. In practice, that means many of these facilities offer with little to no meaningful oversight. Recent reporting has underscored the consequences of that gap. A news outlet found that San Diego County Sheriff's Officials failed to investigate at least seven reported sexual assaults at CoreCivic's Ote Mesa Immigration Detention Center in 2025. Instead, control of these cases was ceded to civilian administrators employed by a private, for profit prison contractor.
The facility's warden has the authority to determine how rape allegations are handled, treating them as administrative matters rather than criminal investigations because the facility itself is not a law enforcement agency. Advocates have also exposed the human reality in these facilities. At Ote Mesa, detainees have resorted to writing messages on small hygiene bottles, weighing them down with rocks, and throwing them over fences, hoping someone on the outside will hear them. This bill is named after Missouma Khan, a 64 year old resident of Altadena in my district. She survived the Eaton fire, only to be detained by federal immigration agents during a routine immigration appointment and transferred to the California City Detention Facility in Kern County.
Missouma has lived in The United States with her husband and daughter, both American citizens. She has no criminal record, yet she was held in a cold facility without warm clothing, without proper food, and without access to the medication she needed. Her story reflects a broader failure. Here in California, the Attorney General reviewed six immigration detention facilities in the state and found serious deficiencies, including inadequate medical and mental health care, insufficient suicide prevention protocols, and a lack of transparency regarding use of force practices. SB nine ninety five is grounded in a simple principle: If detention facilities operate in California, they must meet California's standards for safety, dignity, and human rights.
To achieve that, SB nine ninety five creates a uniform statewide system for inspecting and enforcing standards in large and voluntary residential facilities, including private detention centers. It designates the California Department of Public Health as the lead coordinating agency, working in partnership with fire, environmental, water quality, and workplace safety regulators to ensure a comprehensive approach to oversight. The bill requires facility operators to grant reasonable access to inspectors and maintain records demonstrating compliance. It establishes a tiered enforcement framework that ties penalties to the severity of violations, allowing for warnings and citations. And finally, the bill ensures transparency and accountability by requiring inspection findings to be documented and reported to the legislature within thirty days.
This bill is sponsored by MALDF, KIRLA, Public Counsel, the South Asian Network, and over 37 organizations, like the ACLU, Asian Americans Advancing Justice, and the California Federation of Labor Unions. And it is a priority for the legislative progressive caucus and building the California Dream Alliance, which is made up of 75 organizations. Joining me to testify on the bill is Rhea Khan, the daughter of Massuma Khan, Jeanette Zanapatin with Chirla, and Ritu Mahajan with public counsel.
Speaker 1
Thank you. And before you begin, we are going to establish quorum. Secretary, please call the roll.
Speaker 33
Senators Weber Pearson. Here. Weber Pearson here. Valadez? Here.
Valadez here. Caballero? D'Arrazo? Gonzalez? Grove?
Here. Grove here. Menjivar? Here. Padilla?
Here. Padilla here. Perez?
Speaker 1
Here. Perez here. Rubio? Smallwood Covus Thank you. A quorum is present and you may begin.
Speaker 21
You will have a combined five minutes Madam Chair briefly I have to bounce back and forth between it's I'm not being rude I promise But it's appropriate time. I'd like to move the bill.
Speaker 35
My name is Ria Khan, daughter of Massuma Khan. Thank you, Senator Perez and committee members, having me here today. I'm here in support of SB nine ninety five, the Massuma Khan Justice Act. I will share the experience my mom had while unjustly detained at CoreCivic facility in California City. I wish the circumstances of me being here today were different and that they didn't root it didn't root from such painful experiences, but here we are.
My mom has been in The United States since 1997. She came to this country legally to care for her sick child, me. She always followed the law. She does not have a criminal history. She is loved by everyone who meets her.
She is kind and wonderful, and she should not have had to go through the pain she endured at California City. On 10/06/2025, my mom was detained from her check-in appointment from Downtown Los Angeles. She was following the rules that she was supposed to follow. That same night, she was taken to the CORE Civic Facility in California City and kept there for a month. Getting her released was extremely difficult, as I'm sure you all are aware.
Speaker 44
During her time being forcefully detained at this facility, she was denied vital medications for weeks, given meals with no protein or proper nutrition, fed moldy sandwiches, bread with bugs inside, and clean drinking water was removed. People were developing rashes. Korsovik refused to give my mom her medications for high blood pressure, asthma, prediabetes, prescription eye drops for lens implants and glaucoma, hypothyroidism and back pain. She begged them several times a day every single day. My mom wasn't even given a Band Aid after she cut her finger on a tiny toothbrush.
Speaker 35
A week after she was detained, she has still not received her medications. When I visited her, I knew immediately that she was having a medical emergency. She was having shortness of breath. She was shaking. Her legs were severely swollen, painful and bruised.
She could barely speak. She had requested an emergency medical visit with the doctor but was given no importance. I'm sure that everyone knows that shortness of breath is always a medical emergency. So then tell me why not a single staff at that facility treated as one. Obviously, I was really upset, as I'm sure you all would be too, if you saw your mothers suffer like that due to medical neglect and a total disregard for an elderly woman suffering.
Her blood pressure that day was 169 over 101. Those are dangerously high numbers. Once I was even lied to by the facility nurse about why she hadn't received her medications. She had not seen the doctor for over two weeks, not even after her medical emergency. After requesting everyone from a staff member to the captain to the sergeant and chief many, many times, she was eventually given some of her medications.
Know that she was not given her asthma medication until two days before her release, and she was not given her eye drops at all. The medications she received were intermittent, and she had to regularly advocate herself to stay alive. She didn't choose to be there, and that doesn't mean that her life doesn't matter. The facility is kept at freezing temperatures with no sweaters provided to those being detained unless they purchased them from the commissary. My mom was asked to purchase medications from the commissary that they didn't even have.
It seemed like nothing we said or did could make them care. My mom had become hopeless just like many others in her situation. Some days we were left waiting to see her for four hours and even denied entry after driving 120 miles each way just for a one hour visitation. We waited in a hot waiting area with no air circulation, stood around with swarms flies around us. What they're doing is torture and dehumanization of those being forcefully kept there and we all know it.
My mom was ordered to be released on 11/05/2025 due to the hard work of her legal team and all the advocacy. But she has been scarred by the trauma for the rest of her life. She gets nightmares and is always anxious and fearful of going outside by herself. She doesn't speak or understand things the way she used to before this ordeal. This should not have happened.
My mom was not the only person who has been a victim of medical neglect and given inedible food and dirty drinking water in a detention facility. We've all heard the stories of other detained individuals of abuse and neglect. There have been way too many deaths due to medical neglect. No one should have to live in fear that they would never leave a detention facility alive because they were denied medications or because the food and water are not safe for human consumption. No family member should have to feel the helplessness we felt.
So many human beings imprisoned there have stories that are not being told. Many of them have no family or friends to advocate for them, no money to purchase the basics from the commissary. They do not speak up in fear of retaliation. They do not deserve to be abandoned and forgotten. They do not deserve to suffer and die.
This is why our family demand the need for government involvement and state oversight at these facilities. Human beings are not a business. They should not be in these private facilities to begin with. But at the very least, they deserve to have clean drinking water, food that is safe to eat, proper medical care, and humane treatment. Thank you.
Thank you.
Speaker 1
Right. At this moment, if there is anyone else in the audience that would like to come and give a me too in support of this bill, please come to the microphone, state your name, your organization, and your position only.
Speaker 20
Thank you. Hello. My name is Inez Caro. I'm here with End Child Poverty California, here in support. Thank you.
Speaker 24
Hi. My name is Addie McKeon. I'm from Los Angeles. I'm an organizer and activist, and I'm very much in favor of this. We need to shut down the concentration camps in our state.
Speaker 25
Hello. My name is Allie Barron, and I'm from Los Angeles. I'm a mother, and I'm a daughter, and I wouldn't want this to happen to my mom. Please make the right decision today.
Speaker 37
Thank you. Madam Chair, members, Sarah Fox, California Federation of Labor Unions in support.
Speaker 25
Good afternoon, Cleo Bluethenthal on behalf of the California Community Foundation in strong support.
Speaker 17
Afternoon, Monica Madrid with Coalition for Humane and Migrant Rides. Sheila, proud cosponsor in support.
Speaker 32
Hi, my name is Michelle Arkin, a resident in California, Los Angeles, and strong, strong support and beg you to vote yes, please. Thank you.
Speaker 6
Hi, I'm Katie Laffoon. I'm from LA. I'm just a person, and I am in strong support, and I honestly think no one should be able to vote no unless you've actually been there because they're not losing anything if they're doing anything wrong.
Speaker 38
Hello, Clint Carney from the San Diego Immigrant Rights Consortium and Survivors of Torture International in San Diego in support. Thank you.
Speaker 1
Thank you. Hello, I'm Trevenia DeFries. I'm a physician from San Francisco. As a doctor, I'm strongly in support. Thank you.
Speaker 18
Hello. Hector Perreta with the Inland Coalition for Immigrant Justice in strong support.
Speaker 19
Hi. I'm Elizabeth McKeon. I'm a resident of, Los Angeles in strong support. Thank you.
Speaker 7
Good afternoon, Shimming Sheer from the California Immigrant Policy Center in strong support. Thank you. Good afternoon. Zeenit Yaya with the ACLU in strong support. Thank you.
Speaker 18
Good afternoon, Madam Chair. Ryan Sherman with the Riverside Sheriff Association in support.
Speaker 1
Thank you. Seeing no others that wish to speak in support, I know we ran out of time, but if the two of you would just like to introduce yourselves and just say where you're from.
Speaker 31
Jeanette Smith Mathin, one of the co sponsors with CIRLA and proud co sponsor. Thank you.
Speaker 20
Hi, I'm Ritu Mahajan. I'm with public council, proud co sponsor. Thank you. Thank you.
Speaker 1
At this time, we will open it up to anyone who wants to speak and lead opposition to this bill. You can come and sit at the table.
Speaker 5
I'm not technically in opposition. Leah Barrow is on behalf of California Hospital Association. We do understand and respect the intent behind the bill. We have been working closely with the senator's office and the sponsors to find a workable solution to some of our concerns. We have concerns with some of the provisions in the bill that we believe would create additional oversight and duplicative oversight for health facilities that are already licensed and regulated under some of the most stringent regulations in the nation, and so we don't want them to inadvertently be looped up into this.
Speaker 39
So, we are, grateful for the conversations that we've had, and we will continue to work with you on finding a workable solution.
Speaker 1
Thank you. If there's anyone else in the audience that would like to give a me too in opposition, please come to the microphone at this time. State your name, your organization, and your position. Seeing none, I will bring it back to the committee. Senator Minshvar.
Speaker 11
Senator Perez, that was actually going to be my question. I know the analysis spoke about some, duplicative, inspections. If you could share a little bit more on your, the work that potentially can come in addressing that.
Speaker 50
I've now done multiple bills in this space of trying to figure out how we respond to some of the concerns that sometimes are overlapping into federal authority. And so, in navigating issues, particularly with the supremacy clause, you know, we are mindful that as we are designing our legislation that we are applying these laws not just to federal facilities, but also to any local and state facilities that would be considered private detention facilities as well. And so, we have been talking with the hospital association in terms of the definition issues, some of those overlapping definitions that we're running into as we're navigating some of those constitutional issues. And so, that's an ongoing conversation that we'll continue to work on resolving. But that is why you see that definition be broad to include some of those institutions.
Speaker 11
Yeah, I definitely understood that. Yeah, you're trying to get around the supremacy clause. I get that. I'm wondering as conversations continue, if we can align some of the standards. That was it.
Not to exclude because I know you need that broad definition, but just aligning.
Speaker 8
Yeah, certainly. I mean, look, I think at the end of the day, my goal here is to make sure that we are providing tight regulation and oversight of these facilities. As you just heard from Ria today, what has happened to her mother, Ms. Suma Khan, is just completely unacceptable. I had the opportunity to sit down and meet with them in my office back in December, and there are very few things that I can tell you have just completely shaken me.
And I you know, her story, I just the fact that this happened within our state's borders is utterly unacceptable. And so, you have my full commitment that I am up for doing whatever we need to do to have tighter oversight, to have tighter accountability, to make it very clear that we're not going to allow for corporations like this to profit off of human suffering. And whether that's through fines, whether that's through pulling permits, whether that's through addressing this with insurance, we are all ears. I have very strong feelings about this issue, just given what I've seen happen to one of my constituents who is a fire survivor.
Speaker 1
Thank you. All right. Seeing no other comments or questions, first, I wanna thank you so much for coming and sharing the story that has happened to your family and your mother. As Senator Perez was stating, that should never happen, in this state, in this country, and I apologize for that. I know it's just words, but we, as a legislature, are doing what we can to ensure that that does not happen again to anyone else or anyone else in your family.
So thank you for coming. Thank you for sharing, for being vulnerable enough to tell your story. Senator Perez, I think what you are doing is extremely important. If the federal government isn't going to do its job to make sure that these private detention operators are fulfilling their legal obligations to make sure that the detainees are safe and have access to just the basic health care that they need and other basic necessities, then we do have an obligation as a state to step in, to protect Californians ourselves. I do recognize that there are some constitutional issues involving separation of powers that make it really challenging to structure oversight and that it may you have to do it in a way that it will survive any kind of legal challenge.
And in doing so, in order to avoid appearing to impose more requirements on federal activity that is different or more burdensome than what is imposed here at the state, these bills are grouping, private detention facilities with licensed behavioral health facilities that can also keep people involuntarily, on a civil commitment. And I do understand the concerns from the California hospitalization on the fact that unintentional cause for this to be a duplicate process or overlapping regulation over some of these facilities that are already licensed. And I know that's not your intention. And I know that you are going to continue to work to try to fix this. I do share those concerns, but I am going to wholeheartedly support this bill today because I do think that it is an important issue and I do think that we must find a workable solution.
I do want to encourage you, though, because it's such a huge issue. And when you're dealing with federal oversight, it's really important to engage the administration and ensure that the attorney general's office is also a part of the process in crafting this, along with the other stakeholders, to work on a solution that meets constitutional requirements, so that, you know, whatever we pass doesn't end up getting held up in a court with appeals and appeals and appeals. But, appreciate so much you bringing this forward today, and you may close.
Speaker 8
Well, one, appreciate that, Senator and Chair. I want to let you know we've absolutely been having conversations with the Department of Justice, as well as with the Attorney General. I'm very mindful of, you know, issues in regards to litigation. I was very happy that one of my bills was upheld in court when we went before the Ninth Circuit. And so, I think our office has a lot of familiarity now after my first year with navigating some of that, and we'll, you know, continue to be mindful of that and have been having those ongoing conversations with the hospital association as well.
So, we want to make sure that these facilities are following the law, and all private detention facilities in the state of California are following the law because that's what they should be doing, And finding out that they're committing human rights abuses and constitutional rights violations and human rights violations is utterly reprehensible. And, you know, I think we must do everything in our power to remedy that. So, I respectfully ask you all for your I vote. Thank you.
Speaker 1
Thank you so much. And a motion was made already by Senator Grove. The motion is do pass and re refer to the committee on judiciary. Assistant, please call the roll.
Speaker 33
Senators Weber Pearson. Aye. Weber Pearson. Aye. Valadares.
Aye. Valadares. Aye. Cavallero. D'Arrazzo.
Gonzalez. Grove. Menjivar. Benjevar I Padilla Padilla I Perez I
Speaker 1
Perez I Rubio Smallwood Cuevas That vote has five votes. We'll place that on call. Thank you. We will now move back in the file to file item number three. SB ten eighty nine by Senator Richardson.
Speaker 40
Well, all right. Good afternoon, everyone. It's, nice to see you, madam chair and members of this committee. I would like to start off by confirming my acceptance of the committee amendments and thank the chair and staff for working to make SB ten eighty nine a true valued benefit to the state employees and ultimately to all Californians. Today, I want to have a frank conversation about weight.
Chronic weight disease is a serious problem in The United States. Of the thirty nine point five million people in California, approximately twenty four point five million adults between the ages of 18 and 64 years old living in California suffer from some sort of weight issue. Being over a healthy weight comes with many challenges, such as precursors to cardiovascular diseases, diabetes, neurological disorders, chronic respiratory diseases, and digestive disorders. Additionally, chronic weight disease extends beyond the need to lose pounds. It can also contribute to 13 types of cancers, some of which are colon and rectal cancer, gallbladder, renal cell carcinoma of the kidney I may need the chair to help me with some of these words liver, ovarian, and also thyroid cancer.
In addition to types of cancers that a person suffering with chronic weight disease may experience, there's also significant over 200 comorbidity conditions that also apply. Things like high blood pressure, heart disease, susceptible to strokes, fatty liver disease, diseases of the gallbladder and the pancreas, and kidney disease. This one I may need help with, Madam Chair. Glucan gain, a peptide, GLP-one receptor, and antagonist are a class of drugs such as semiglutide and trizepatide that mimic a natural gut hormone. Stated more simply, like my language, GLP-1s can work to stimulate the insulin secretion, thereby suppressing an appetite and delaying gastric emptying to promote significant weight loss.
Let me say it even more simply. What that means is not feeling hungry, and not feeling hungry most of the time. GLP-1s are demonstrating more and more the capacity to improve the health in a variety of areas, even beyond weight loss. Recent studies have shown they can help with cognitive and behavioral health, lowering risk of heart attacks, stroke, liver disease, and potential benefits against dementia and Alzheimer's. Chronic weight management can be related to reduced labor participation in terms of earnings, increased early mortality, absenteeism, disability, and health care costs exceeding $1,000,000,000 and a 2.6% reduction in California's gross domestic product.
Barriers to the reduction, maintenance, or elimination of chronic weight disease come down to, ultimately, access and cost. So, why did SB ten eighty nine need to take this approach? Frankly, I met with health plans. I brought forward a bill last year and the health plans essentially told me they provide medications and services that employers require. So, CalPERS is the largest public pension fund and manages health benefits for more than 1,500,000 public employees.
As the largest purchaser of public employee health benefits in California, the program provides coverage to over 1,200 public agencies and schools. For this reason, SB ten eighty nine would support and encourage and actually require that CalPERS would offer not require of every health plan, but actually offer that they would have available similar to if a person needed vision, a person may pay more to have VSP, a person may pay more to have dental, a person may choose to pay more for long term health care. This is something giving the individual, the worker, the opportunity to choose based upon their health program whether this would be something they would want to pay a little bit more for to improve their livelihood. Recently, a federal executive order was authorized by the most favored nation prescription drug pricing. California can lead by offering competitive pricing through CalRx at an affordable price.
This would allow CalPERS, the largest state employer, and 29% of California adults to receive reduced costs, and employees would be thereby more productive and creating a workforce savings. Now, I'm going to speak a little more personally. I think it's important in the work that we do that we speak truths and I think since I'm working on this particular bill, it's important that I tell a little of my story. My entire life, I was never thin. I always participated in sports, very aggressive sports, all of my life despite intense regimens, playing basketball in college, trying out for the Olympics, and being in the top 20 guards in the nation.
Weight was always something that was on my mind. After having both my mother and father diagnosed with diabetes, I began to think a little more seriously about what the relations to weight meant. It was only after my mother was diagnosed with esophageal cancer, and going down to weights of one hundred fifteen, that she was now removed from not having diabetes. So, there was some correlation to her weight, and how that related to also her vulnerability with diabetes. My physician, I had, subsequent tests.
My normal annual exam, which has now become more like two years instead of one year I'm working to do better, Doctor. Weber. I promise. My physician conducted the various tests and said, yes, based upon my numbers, based upon my BMI, my blood, I'm going to get an updated test results and personally present it to the chair, hopefully before our summer recess to show her my results, but I'm happy well, let me before I get to the endpoint. So my physician recommended that I would have a prescription of Zepbound.
My insurance company denied it, and said that they didn't cover that prescription, and they would not reimburse for Zepbound or any other GLP-one. So, I was stuck on my own. Here, I had a pre diagnosis of potentially being susceptible to diabetes based upon my results my test results, And I had a choice to either continue to gain more weight, which is what was happening, or, to wait until I became actually diabetic to then be qualified to have, this medication. So what happened? My physician prescribed Zepbound, so I had a choice of either paying cash, which is what a lot of people, unfortunately, are stuck doing.
That cost has been in the excess of over $1,000 a month, or I could choose to purchase a compound. And compounds, I don't want to get in a debate with the compound people, so I will shy away from that, but most feel that it's probably better if you could afford the brand, that that would be better based upon how the medications are combined and the pharmacies being regulated and all of that. So because, based upon money, I chose to spend over $600 a month on a compound, most people cannot afford $600 a month. We're talking about that's like paying for a car, and in some cases, people, that's actually paying for their rent. So, prices have gone down a little bit, not enough.
I now pay direct for the brand, and I'm still paying over $450 a month. It's not fair, in my opinion, that individuals who receive Medi Cal or other insurances had the opportunity to have a prescription at a lower price, approximately $249 and half of that was covered by their insurance. So, now we're talking about paying $125 and individuals who had the same situation would have to pay more, and oftentimes choose that they could not receive the medication. So, what is SB ten eighty nine about? It's about that I started Zepbound on August 15, and dating to April 11, I've lost 42 pounds in thirty three weeks.
That's averaging 1.27 pounds per week. So, this was not SB two eighty nine is not about me getting a prom dress, or going to the Academy Awards, or just wanting to look cute in a bathing suit. This was about even though I would like to do all of those things, I must admit. This is, frankly, about people who have difficulty in suppressing an appetite, despite tremendous exercise, are still unable to suppress their diet to the point of being able to, when you're full, feel full. And that is now what happens with me.
Speaker 18
When I eat, I actually feel full, and I stop eating. Whereas before, if you're not feeling that I'm full at that point, sometimes you've still eaten until you're really to the point that you're full. So, I respectfully ask for your I vote for SB ten eighty nine. We have accepted the committee's amendments gladly, and we look forward to offering at least for state employees to begin to have the same right as anybody else would have to medication to help them, but what we've also done in this bill is we have said to assist with CalRx that they would then begin to partner with manufacturers, whether it's generic or the brand, to be able to offer, ultimately, on their discretion, whether this medication would be available to all Californians. I would say, as a member of the budget committee, I have put in a budget request for funding for CalRx that they could, in fact, do the process of being able to offer GLP-1s to not only state employees, but ultimately all Californians if they so choose.
Speaker 37
so much, Madam Chair, Madam Vice Chair, members of the committee. My name is Sherri Gonzales and I have the great honor and privilege to represent the American Diabetes Association. We are in support of SB ten eighty nine. We are not the sponsors of the bill, but we are in strong support and we are, of course, grateful to the esteemed author. The bill ensures that California state and local government employees have access to GLP-one medications, treatments that represent one of the most effective tools we have to prevent and manage type two diabetes.
Speaker 41
These are not cosmetic weight loss drugs. They improve insulin sensitivity, reduce blood glucose, support healthy weight loss, and cut the risk of developing type two diabetes by as much as sixty percent in people with prediabetes. California has a diabetes crisis. More than three point five million adults already live with diabetes, and another ten million adults in California live with prediabetes. The toll is enormous.
Over $40,000,000,000 a year in health care costs and lost productivity. Prevention is our best chance to reverse this trend, and GLP-one medications allow us to intervene before diabetes develops. Yet, too many Californians who could benefit cannot access these treatments because insurers exclude or severely restrict coverage. That inequity worsens health disparities, especially in communities of color and among lower income families who are already hardest hit by diabetes. By requiring coverage for GLP-one medications, SB ten eighty nine will save lives, reduce health care costs, and move us to true health equity.
The science is clear. When people can access proven prevention tools, we prevent disease, not just treat it. On behalf of the American Diabetes Association, I urge your I vote on SB ten eighty nine to give more Californians a fair chance to stop type two diabetes before it starts. Thank you.
Speaker 1
Thank you. If there's anyone else that would like to speak in support of this bill, please come to the microphone, state your name, your organization, and your position. Thank you.
Speaker 42
Madam Chair and members, Tim Madden representing the California Chapter of the American College of Cardiology and the California Rheumatology Alliance in support.
Speaker 9
Natalie Pita, on behalf of the California Academy of Family Physicians, in support.
Speaker 6
Thank you. Muriel Conception, family physician, I stand in support. Thank you.
Speaker 1
Seeing no one else coming to speak in support, if there's anyone in the audience that would like to speak and lead opposition, this is your time to come forward. Seeing no one, if there's anyone who would like to do a me too on opposition, you can come to the microphone. Please state your name, your organization, and your position. Seeing no one, we'll now bring it back to the committee. Senator Valladares.
Speaker 27
Thank you for your leadership on this. I also want to say happy birthday to you and to my daughter, who shared the same birthday. And I'm happy to move the bill when it's appropriate.
Speaker 11
Senator, just to add that, last Thursday, during budget sub three in Health and Human Services, I asked a question to HCAI's Director Landsberg on what else CalRx was going to be looking at. And she mentioned GLP-one. So, think, you know, we are already, the department is investigating this as a potential of another, treatment that we can invest in to make it more affordable to people. So, hopefully get some good news out of that soon.
Speaker 40
Yes. And hopefully, SB ten eighty nine will push them a little in that direction.
Speaker 34
I also want to thank the author for bringing this bill back. I believe in the science of GLP-one. I'm a living experience of it, and I feel so much better. I've had so many of my relatives pass away from complications of diabetes, and I really appreciated the witness's comments. And for me, I think about, you know, fast forward thirty years from now, I feel that we have the tools to save people's lives today.
And this is an invention, an American contribution that is going to save people's lives and also save the state money down the line as we are able to treat people through this medication, and they won't develop these complications that are far more costlier down the line. So, yes, this is an important bill. It's a revenue bill because we will save money as we invest in this treatment for many Californians. So, thank you for being brave enough to bring this bill forward, and I look forward to voting for it today. Thank you.
Speaker 1
Thank you. Seeing no further questions or comments, Senator, would you like to close?
Speaker 40
Yes. One, I'd like to say that one of the senators here on the dais, I won't point the individual out, we were practicing for softball. And for the first time in my life, the trainer that we had said, you know, you need to run from here to the fence, and it was probably at least I'd say probably about 150 feet. And for the first time in my life, I went to run and I could not run. And that was I said, this is ridiculous.
I mean, I've always been athletic. And so I think it really spoke to sometimes you just have to get to the point that you say enough is enough. The problem is I was blessed enough that I could figure out how to scrounge up, you know, dollars 500 a month, but most Californians cannot do that, and we should not be in the position where people can't run 100 feet or can't, you know, bend over without, you know, pains in their sides or whatever it is. People should all have the opportunity to be better, and this is proving people can do better. I did have one member who had a couple questions, who's not here yet, but for the record, I wanted to answer.
Are GLP-1s a lifetime medication? It was said to me as my physician, GLP-1s are just like anything else, blood pressure, whatever. In order to continue to suppress the appetite, yes, it probably is a lifetime commitment. And more people need to be honest about that. Do you have to stay at the same level?
You know, ten, twelve point five, or 15? No, but certainly, it is a lifetime commitment. And I think last year, some of the insurance plans had expressed, if they make this investment and offer this medication and have this cost, are people just going to drop off, you know, two years later and then come back with the same situation? So, we do need to do a better job of making sure people understand that this really is an ongoing commitment. And the other question was asked, are there any side effects with GLP-1s?
People, it is in their own medications. They note digestive issues, dizziness, fatigue, headaches, nausea, and a word I think you probably don't want me to say that starts with a D, but you can guess what I'm saying. We have a doctor she's so sweet when I say these words. She's like, yeah, yeah, I've been there, done that. I would say for myself, one time in now, what, six, seven months, I had a little allergic reaction, and that was I went to an environment that was a lot hotter, geologically, a place that was hotter, and I had changed the levels, and since then, I have not had any rashes.
Every once in a while, I may be off schedule by one day than my normal every day. I know I'm sharing probably TMI, but my point is I want people to get to the point that we can be comfortable about saying what people are experiencing and that they can get better, and that's the bottom line. So, that, I urge an I vote on SB ten eighty nine.
Speaker 1
Thank you so much, Senator Richardson. The motion has occurred by Senator Valladares. The motion is due passed and we refer to the
Speaker 33
Committee on Labor, Public Employment and Retirement. Assistant, please call the roll. Senators Weber Pearson? Aye. Weber Pearson, aye.
Valadares? Aye. Valadares, aye. Caballero? D'Arrazzo?
Gonzalez? Grove? Mengevar Mengevar aye Padilla Padilla aye Perez Rubio Smallwood Cuevas aye Smallwood Cuevas aye
Speaker 1
Thank you. That vote has five. We will place that on call. I do see, Senator Stern in the audience, so we will go to file item number five, SB twelve twenty one. And you may begin whenever you are ready.
Speaker 43
Okay. Thank you, Madam Chair. Switch gears here to a major mental health and public safety issue that is affecting not a huge number of Californians, but a very critical population that we need to be looking after. SB1221 deals with a type of conservatorship called a Murphy's conservatorship. And this is specifically for people who have committed serious and violent crimes, like murder, rape, arson with injury, but those crimes are related to a mental health disorder that they suffer from.
This bill seeks to address what we feel is now a gap and uncertainty in law that both the support and a very welcome and collaborative opposition both identify as a serious issue, a decision called Innery Lurkey, where the courts ruled that these conservatees, who were previously under the wardship of the state, could not be detained, even temporarily, while awaiting placement in department of state hospitals. The alternative to this is that these individuals are simply going to have their cases dismissed and released. Now, we're talking about out of a total number, say, mental health patients, take for example, in LA County, we've got about 6,200 mental health patients. And right now, seventy six of those are Murphy's Conservatees. So, about less than one percent of the population.
I think overall, within Department of State Hospitals, we're talking about fifteen percent or less. So, not a huge number of people, but a very important group of people that desperately need care. I want to really appreciate not just the chair, but the committee, the great Reyes, for digging into the details of this bill, and really addressing, I think, some of the central concerns from the opposition. I was reading through the California Behavioral Health Director Association's opposition letter, and after talking to them before the hearing, and some of their central concerns is that we're going to reach into the broader LPS process, and try to get into conservatorships writ large. Committee has a very important amendment that we're accepting, that will clarify that this bill is only about these Murphy's conservatives, that we're not trying to impact the broader LPS population.
Speaker 31
Likewise, the committee also has an important amendment that we're taking today, to address, this issue that we don't necessarily want there are limited state beds in the state hospitals, and we don't want to necessarily have these conservatives cut the line of other LPS conservatives waiting, because we know we just simply do not have enough behavioral health beds in state, period. And I think it's a little outside of this bill issue, but there that is an outstanding budget challenge, and a resource challenge that I want to try to remedy this year, for our county behavioral health directors, and for our department of state hospitals. But here before us today, I think what we're trying to do is, really improve, the identification of who is awaiting these beds, to make sure that they have access to treatment, and that not to insert, say, the DAs into all LPS proceedings, and to give that sort of criminal dimension to what is really a health issue, but specifically in these Murphy's processes, to make sure that there aren't sort of abuses of discretion, and that there are dismissals because of this Henry Lurkey decision that send these people back to the streets, where they will very likely either do harm to themselves, do harm to others, or be victimized out there.
Speaker 43
These are individuals that are currently deemed dangerous by the court. That is why they are Murphy's conservatives. And so, I think it's a problem that both the opposition and the support acknowledge. It is a hard one to solve. It is not just going to take this bill.
It is going to take resources too. So, I would respectfully ask for your aye vote, and I look forward to the conversation. And, again, appreciate the chair and accept all the amends.
Speaker 1
Thank you. You have a combined five minutes for your testimony today. Thank you. You.
Speaker 42
May it please, the chair and members of the committee, I'm Matthew Greco on behalf of the one of the cosponsors, the San Diego County District Attorney's Office. I'm also a thirty year prosecutor and the author of the California Criminal Mental Health Manual. Of the over 1,100 conservatees in San Diego County, there are less than 30 Murphy conservatorships. These are convicted and convicted murderers and alleged murderers, attempted murderers, arsonists, rapists. The worst of the worst.
At the time of the Lurkey decision, San Diego had five murderers and a sexual assault defendant all waiting for their designated placement to become available at the Department of State Hospitals. And, lo and behold, in San Diego, as in many other counties throughout the state, the public conservator was forced to scramble to find placement outside of a local detention facility. Courts were forced to quickly identify alternative placements for high risk individuals, often without clear statutory guidance or without meaningful input from, individuals responsible for public safety, the public, or the victim or their families. The practical effect of Lurkey has been a profound statewide, chaos. Prosecutors, were required to litigate the placement of individuals, and yet, as that was occurring, these proceedings frequently occurred without clear authority for the district's attorneys to participate in this rush process.
Speaker 19
Despite their responsibility, legislatively, to protect the public and represent victims' interest. Victims and their families were left without a voice in proceedings that directly impacted their cases, leaving the victims feeling revictimized. SB1221 directly addresses these challenges through targeted reforms. The bill ensures that determination of grave disability dangerousness are evaluated based on an individual's condition outside of a controlled, treatment or custodial setting. It also explicitly authorizes, access to conservatorship investigation materials to ensure meaningful participation in hearings as an advocate for public safety, ensuring that courts receive a complete, informed perspective when making placement decisions.
Speaker 42
SB1221 ensures that victims' voices are represented in decisions that directly affect their safety, protects the public, and protects, the defendants that suffer from severe mental disorder and are placed in Murphy conservatorships.
Speaker 10
Afternoon, Chair Doctor. Weber Pearson, members of the committee, Aaron Meyer, Associate Clinical Professor of Psychiatry at University of California San Diego, speaking on behalf of the California State Association of Psychiatrists in support of Senate Bill twelve twenty one. Grape disability cannot be determined by a snapshot. A point in time assessment in a structured setting tells you very little about whether a person could survive safely in the community. In those settings, basic needs are already met.
Speaker 44
So the real question is, what happens outside? A proper determination requires a longitudinal view, and that same flaw, where dangerousness and grave disability is determined in a structured setting, applies to people who may be in administrative segregation, where they have limited opportunity to act violently. A housing decision designed to manage risk should not be used as evidence that risk no longer exists. These violence determinations are necessary because Murphy conservatorships are different. They're different than LPS.
They're not just about treatment. They explicitly require consideration of public safety, and the conservatorship investigator is not required in their report to address public safety at all. Even the California Public Guardian has recognized this in their legislative platform, that other agencies with a public safety lens would be better for these determinations. So we have also troubling examples of abuse of discretion, where decisions to exclude individuals from Murphy conservatorships were based on narrow interpretations of mental illness, the nature of the offense, or even cost. So that's not a clinical standard, and it's not a public safety standard, so SB1221 introduces a necessary check and brings an additional appropriate voice into a process that is too often closed to scrutiny.
It aligns decision making with clinical reality and statutory intent. This is a targeted common sense fix, and I respectfully ask for your I vote.
Speaker 1
Thank you. If there's anyone else in the audience that would like to speak in support of this bill, please come to the mic. State your name, your organization, and your position.
Speaker 4
Madam Chair members, Dan Filisato, on behalf of the Los Angeles District Attorney's Office in support. I've also been asked to, state the support for the Crime Victims Alliance and the California District Attorney's Association.
Speaker 1
Thank you. Seeing no one else wishing to speak in support, if there's anyone in the audience that would like to speak as a lead in opposition, this is your time to come forward to the table. Good afternoon. You both have a total of five minutes combined. Thank you.
Speaker 38
You, Chair and Senators, for the opportunity to speak to you today. My name is Anne Rishi, Director of Legislative Affairs for County Behavioral Health Directors Association of California, representing the leaders of the public behavioral health agencies that serve the mental health and substance use disorder needs of California's Medi Cal, uninsured, and underinsured populations. CVHDA respectfully stands in opposition to SB twelve twenty one. We greatly appreciate the amendments discussed here in committee today and look forward to our continued dialogue with the author's office on the language in order mitigate our concerns. However, CBHDA remains concerned with the impact of including DAs in what is inherently a civil court process under LPS.
Speaker 45
We appreciate the committee's proposed amendments to narrow the focus of the bill to apply more narrowly to Murphy's conservatives. However, the entire premise of Murphy's LPS conservatorship is that the individual in question is too sick to even engage in a criminal court process. We also remain concerned regarding the concept of bed prioritization at the state hospitals. Counties are very aware of the challenges with finding suitable treatment options for Murphy's conservatees at the local level, and this bill will not change the array of options, but rather arbitrarily restrict our ability to manage the flow of patients. CBHTA is also concerned about the unintended impact of policy changes brought about by recent lawsuits, but we are concerned that this bill would only add to those challenges rather than resolve them.
It is out of concern of these unintended consequences that we will continue to work with the author's office once these amendments, and thank you all for your time today.
Speaker 38
Thank you. Good afternoon, Sherri Doctor. Weber Pearson and members. I'm Evan Fern, public policy advocate with Disability Rights California, here in opposition to SB twelve twenty one. We appreciate the committee's work on proposed amendments.
We look forward to reviewing the updated text, but our current understanding of the proposed committee amendments does not change position. Changing California's bed prioritization structure would be disruptive and a misuse of resources. Counties recently and carefully collaborated with the Department of State Hospitals and the California Mental Health Services Authority to develop the current allocation system. Counties are not equipped to handle this great of a shift at this time. Without first putting in place adequate supports to transition people to less restrictive placements, there's a real risk that LPS conservatees would fall back into cycles of homelessness, disengagement from services, and law enforcement contact.
SB twelve twenty one would inappropriately turn a civil proceeding into a quasi criminal proceeding. The bill would give district attorneys unprecedented power over conservatorship proceedings, including access to highly sensitive and private medical records and reports. If people are afraid that what they disclose in a conservatorship investigation could be used against them in court, they won't talk. This bill would also grant district attorneys power to challenge placing a conservatee in a less restrictive setting. The Americans with Disabilities Act requires people with disabilities to be served in the least restrictive setting appropriate to their needs.
District attorneys, respectfully, are not qualified to opine on the appropriateness of various treatment settings. The law already states that placement in a less restrictive setting won't be approved if it would pose a threat to public safety. SB twelve twenty one would also disproportionately impact people of color. The bill would have the greatest impact on people who are in our state's institutions and people who are currently or at risk of becoming unhoused. People in both of these groups are disproportionately likely to be people of color.
A recent UCLA study concluded that reliance on conservatorships as a means to secure both long term shelter and mental health treatment is a signal of systemic gaps in California's safety net systems of care. Rather than continuing to cycle people through carceral systems, we must prioritize and fully fund services that break cycles and lead to disability. For these reasons, we respectfully request your no vote on SB121.
Speaker 1
Thank you. If there's anyone else in the audience that would like to register a Me Too in opposition, please come to the microphone, state your name, your position, and your organization. Just a moment.
Speaker 1
Thank you. Seeing no further individuals wishing to speak, I'll bring it back to the committee if there are any questions. The bill has been moved by Senator Valladares, and I don't see any questions from the committee. I want to thank the senator for bringing this bill forward. You know, I understand that this is a significant issue after we've had, you know, conversations, a significant issue in your area, in the LA area.
And so, there are still some significant outstanding issues with this bill, but some of which are not necessarily the purview of this committee. So, agree with the opposition with the concern of having the DA involved in any part of the conservatorship, but that's not really a part of the health committee. And so, didn't really touch too much except to narrow it to say this bill is about Murphy conservatorship, so let's not do it for all conservatorships. And with the bed prioritization, completely understand it's not a mandate. It's just letting them know that they have the ability to do this.
The only other thing that I would suggest, because you and have had many conversations about this and even ways in which we can potentially fund more or find more money for the counties to be able to have more beds and more resources. We had talked about improving the data collection because as we were trying to figure things out, it's there. It's just not in one easily recognizable, concise place. And so, as you're moving the bill, if you're able to move the bill forward, I would suggest thinking about ways in which you can also include a way to capture the data to see how many of these individuals, you know, in one place aren't able to get beds, how many are waiting, how many are now being switched over to Murphy conservatorships, all of these things, in one particular place so that at the end
Speaker 1
But really appreciate the conversations that we've been having and, the bill has been moved, so you may close.
Speaker 43
Okay, thank you, Madam Chair. And I will commit to you, getting that data in a sort of published format that's going to be more easily accessible, is something we definitely plan to, try to ascertain. You know, some of the most recent data we have, as you mentioned, does show LA with a larger number of individuals that are awaiting placement. I will say, you know, I've always sort of, in my mind, especially with people suffering from severe mental illness, we've been trying to seek the most, the least restrictive means necessary, and try to find alternatives to carceral care. I think that always should be the first priority, especially in like misdemeanor populations.
In this particular circumstance, we're talking about very serious and violent crimes, and a much smaller set of populations. So, while I'm extra sensitive to some of the issues raised by disability rights about trying to find the least restrictive means possible, The law works a little differently with these Murphy's cases. And so, I know this is tough stuff, and no one likes the idea of someone to be held in any kind of locked setting, in a locked psychiatric facility. These are places that you don't want to see anyone end up, but because they've committed serious crimes, there's you're really left with no choice in these particular circumstances. This doesn't mean that the restoration process doesn't continue.
This doesn't mean we don't try to give people a second chance. And, in fact, there's really exciting work going on in the LA County Jails to the center from South LA. We took a tour down there with Smart Justice last year, with some of the leadership, to look at what they call the fifth step down in the Twin Towers, where we're actually trying to make that jail setting not a place of suicide, and of horror, and sort of locking people up, and treating them in a way that was having serious, serious problems within our jail system, but in fact, having people who have much more serious sentences, people actually on death row, embed with those groups that are seriously mentally ill. And these mental health assistants, you all should look it up, there's a guy named Craigen Armstrong, who's literally, he's sentenced for life, and has found new purpose, taking care of these individuals all day. So, it's not just a warden, or a PO, or even a clinical psychiatrist, but that you actually have peer based support in the system.
And we've seen huge results of people graduating out of these forensic inpatient care, and the sort of most, most restrictive settings, and finding new pathways for them to get the care they so desperately need, to find ways to not do forced medication, and find ways for them to actually build social relationships. And so, I don't want to give, such a dark and grave outlook on what the future can be for this population, but I know that they cannot just be dismissed onto the streets and let go, because we'll be abandoning our duty to them. And so, for that reason, and for the reason that, you know, everyone else in the community deserves the right to live safely, and not subject to this kind of threat from our neglect in the mental health system, I would respectfully ask for your I vote, and, I commit to you to continue to work on this with both the opposition and to find some solutions here. So, thank you.
Speaker 1
Thank you. The motion by Senator Valladares is due as amended and re referred to the Committee on Rules. Assistant, please call the roll. Senators Weber Pearson.
Speaker 33
Aye. Weber Pearson. Aye. Valadares. Aye.
Valadares. Aye. Cavallero. D'Razzo. Gonzales.
Grove. Mengevar. Padilla. Aye. Padilla Aye.
Perez. Rubio. Smallwood Cuevas.
Speaker 1
That's three to zero. We'll place that on call. We will now move to file item 10 SB twelve eighty four by Senator Smallwood Quavis. Right here.
Speaker 1
Okay. We will actually go to file item 11 SB thirteen twenty three by Senator Rubio. File item 10 SB thirteen twenty three by Senator Rubio.
Speaker 17
I think I was waiting for one more witness that went outside. But we'll get going. You may begin. Thank you, Madam Chair and members of this committee. I'm proud to present SB1323, which is a patient protection and dignity measure that strengthens existing laws for individuals receiving medical care while in immigration custody.
This bill clarifies and reinforces the fundamental right that should always be upheld. At its core, SB1323 is about ensuring humane treatment, transparency, and accountability in a medical setting. Under current law, health care facilities must limit immigration enforcement access to non public areas. However, existing statute does not address the communication rights of a patient when they're in immigration custody. As a result, detained individuals may be isolated and unable to notify family members during a medical crisis.
Speaker 12
Reports indicate that some individuals in custody have been denied communication with loved ones, have delayed care, especially, extreme cases when they're dying. SB1323 requires healthcare facilities to inform staff and volunteers on how to respond to requests from individuals in immigration custody and allow patients to notify a family member or loved one of their location and condition. SB1323 ensures communication is timely, consistent across facilities, and ensures that no one receiving medical care in California is cut off from their loved ones simply because they are in ICE custody. One particular case in my district, was a man who had had a heart attack, last year. He had high blood pressure.
Speaker 17
And when he was taken in, family struggled to locate him to ensure that he had his medication. Months later, he was able to communicate that he had never, gotten his medication and his condition had worsened. These are a few small cases that are often highlighted, but we've known of other very serious cases where people are shot. They're dying and family members don't get to see them, don't get to talk to them until it's too late. With me today, as a witness, joining me is Hector Pereira on behalf of the Inland Coalition for Immigration Justice.
I know we have also Jeanette Sonny Patten on behalf of Coalition for Human Immigration Rights who will be speaking on behalf of this bill. Thank you.
Speaker 18
Good afternoon, Chairwoman Pearson, members of the committee. My name is Hector Pereira. I'm the political manager for the Inland Coalition for Immigrant Justice. We are a regional coalition of a little bit over 40 organizations that serve the immigrants in San Bernardino and Riverside County. We provide legal services, community organizing, policy advocacy, but we also manage the rapid response hotline for the Inland Empire, which gives us a direct view into the fear and violence that our communities are facing on a daily basis.
We've seen the sharp escalation in violence, including an incident last August in San Bernardino where federal agents fired three unprovoked shots into a family's vehicle. Similar incidents are happening across California. A farm worker in Camarillo died after being chased by federal agents. A peaceful protester in Santa Ana was permanently blinded. And just this month, a man in Patterson in Northern California was shot seven times by ICE agents.
These are only a fraction of the harms caused by excessive force. And these harms aren't isolated to incidents of arrest. The harm these individuals face continue when they are sent to detention centers across the state, notorious for their inhumane living conditions and their egregious records of human rights violations. Through our work around the Adelanto ICE Processing Center, we've documented four in custody deaths due to systemic medical neglect since the beginning of this administration, contributing to the over thirty deaths nationally, the deadliest record since CHS was created. Many more individuals suffer from untreated injuries sustained during their arrests and chronic conditions.
Speaker 3
And let me be clear, this medical neglect is purposeful and intentionally cruel. We've worked with detained individuals that have been hospitalized because of their pleas for medical treatment, are disregarded until they are in urgent emergency conditions, light threatening conditions. When they are hospitalized, federal agents intimidate hospital staff into blacking out their information, a practice that is used for some criminal detainees, but not at all required for civil immigrant detainees. Federal agents monitor private medical interactions and restrict access to families and legal counsel. In one case, one of our partners had a hospitalized client who was told that if they hinted to their family members where they were receiving treatment, they would be completely cut off from their families and not allowed to make any more calls.
Speaker 18
In another case, a family was only notified when their loved one was on their deathbed. And they received the call to rush to the hospital to say their final goodbyes, even though that individual had been hospitalized for days. This state must do everything in its power to protect against these abuses and ensure detainees have the right to contact their loved ones when they are hospitalized and in critical conditions. And this is the bare minimum. By supporting thirteen twenty three, you are supporting basic human dignity.
And for these reasons, I respectfully request your I vote.
Speaker 31
Okay. Jeanette Sonny Patin. I'm the Director of Policy and Advocacy for the Coalition for Human and Human Rights. I'm here to testify in support of this bill. This is a really straightforward measure.
It really does provide it does help strengthen both existing privacy protections by clarifying that individuals in ICE custody retain their rights while receiving medical care. This is a critically important measure, as my colleague here mentioned. We have seen ICE enforcement activities take a dark turn in California. They have become a lot more violent. Just recently, I met with an individual who was arrested.
And before our rapid responders were able to document what had happened, they had shoved him in the back of an SUV face first. And so, this individual was critically injured. Fortunately for him, he or unfortunately for him, he is a kidney dialysis patient, and so he was released from ICE detention within a day. However, in another instance, we also represented an individual or a gentleman in his immigration case, and he was also under ICE custody at UCLA Harbor Medical Center. In this instance, the federal government did not have a warrant for his arrest, nor was he issued what we called a notice to appear or had any court order to have him in civil immigration detention while at the hospital.
Speaker 36
His family tried to call and see if he was there, yet the hospital would not allow neither his family or immigration counsel to see the patient, although he had suffered a catastrophic injury as a result of his arrest. The family was not given information about their loved one despite, again, making several calls, and several organizations had to intervene in order to allow the patient to have access to legal immigration counsel while at the hospital. And after much targeted advocacy that we did from several organizations, they did allow the family to finally have family visitation with the patient. But that was also taken away pretty quickly without any justification. The hospital decided that they just all of a sudden would no longer allow his family to see the patient, which was extremely devastating for him.
Speaker 31
In this instance, again, this person was under quasi civil immigration detention. And, you know, again, there was no civil detainer or anything of that nature. So, in these circumstances, you know, what we're really asking for is for patients to be able to have their families notified for treatment plans to be created. And the gentleman that I just spoke of, we did work hard with the hospital to have a treatment plan. He was going to be released.
Whether he was going to be released to his family or whether he was going to be released to DHS and ICE, he would still need a treatment plan, yet the hospital would not do that. And so, these reasons, we just think there needs to be more transparency and uniformity in California.
Speaker 1
Thank you. If there's anyone else in the audience that would like to speak in support of this bill, please come to the microphone, state your name, your organization, and your position. Seeing none, if there's anyone that would like to speak as a lead witness in opposition to this bill, this is your time to come forward. Seeing none, if anyone would like to give a me too in opposition to this bill, please come to the microphone, state your name, your organization, and your position.
Speaker 22
Hi. Kelly McMillan on behalf of the California Dental Association. We're opposed unless amended as reflected in the analysis, and we look forward to working with the author.
Speaker 1
Thank you. Seeing no further, individuals wishing to speak, we'll bring it back to the committee. Don't see anyone on the committee with any questions or comments. Senator Rubio, would you like to close?
Speaker 17
Thank you. You know, as you just heard, these are not isolated incidents. They keep happening over and over again. And because I know this may be perceived as an immigration issue, I want to remind, you know, those listening that, U. S.
Citizens have been detained as well. There was a young lady who was shot, U. S. Citizen, who was not allowed to notify her parents. So, this could be anyone's mother, daughter, father.
And at the very least, we need to ensure that the treatment is humane, no matter who you are. Let's start there. But it has the violence has been escalating, the treatment and the isolation. And we know, based on some stories, that, you know, a lot of, families are now, having to deal with mental health issues and the detainees because of that isolation. And I don't think it's good for anyone to leave families destroyed, you know, really, crying over their loved one.
I think we need to do better as human beings, as legislators. I think it's our responsibility to ensure that the care that patients receive in the hospital is, you know, with the utmost respect and allowing them to communicate with their families, I think, would help alleviate some of the issues that we're seeing now. With that, I respectfully ask for an I vote. Thank you.
Speaker 1
Moved by Senator Smallwood Cuevas. The motion is do pass and re refer to the Committee on Judiciary. Assistant, please call the roll. Senators Weber Pearson.
Speaker 33
Aye. Weber Pearson. Aye. Valadares. No.
Valadares. No. Caballero. Dorazo. Gonzales.
Grove. Menjivar. Padilla. Perez. Rubio.
Aye. Rubio. Aye. Smallwood Cuevas. Aye.
Smallwood Cuevas. Aye.
Speaker 1
We will now go to file item number nine SB twelve eighty four by Senator Smallwood Cuevas. As she is walking, if there is anyone else who needs to present, I would suggest that you come down now. Thank you. You may begin.
Speaker 34
Thank you, Madam Chair. I am very thankful to the committee chair and staff for all of their diligent and hard work on this bill. I will be accepting all of the committee amendments, and that includes the increase the employer threshold from 50 to 100, designate the State Department of Health Care Services as the entity responsible for preparing the report, and privacy protections for enrolled employees, and clarifying that Medi Cal is intended to function as a public safety net, and as the payer of last resort. So, with that, I am proud to present SB twelve eighty four, which ensures that billion dollar corporations do not shift their labor costs onto the taxpayers. More than 3,000,000 working Californians rely on Medi Cal, not because they are unemployed, but because their wages are too low or employer coverage is unaffordable.
Nearly one in five California jobs is held by a Medi Cal enrollee. That represents more than $20,000,000,000 in public spending connected to the workforce. Medi Cal was designed to be a safety net and a last resort, and we know how difficult it is to maintain that safety net. But when wages do not keep pace and coverage is out of reach, Medi Cal fills the gap,
Speaker 34
taxpayers bear the cost. I want to address a point raised by the opposition in this bill. This bill does not assume that every employer with workers on Medi Cal is acting in bad faith. But under existing law, large employers, those with 50 or more full time employees, are already required to offer health care that meets minimum value and affordability standards. And we know many of our businesses are doing that, large and small.
When significant numbers of full time workers still rely on Medi Cal, it raises legitimate questions about whether coverage is truly affordable or accessible in practice. SB twelve eighty four does not assign blame. It simply provides transparency so policymakers and the public can better understand where the gaps remain. And without that transparency, we cannot have an honest conversation about what is driving these costs or how to address them. In my district, I hear from workers who are doing everything right and still falling behind.
And I represent cities in a county where the fastest growing jobs being created, unfortunately, are low wage jobs. And so, one of the workers I had the chance to learn about and meet is Diego, a resident of L. A. County of over thirty five years. He and his wife both work, and they clean houses.
And he lives with chronic rheumatoid arthritis, where severe knee pain and diabetes is constant. At the start of this year, he lost his full medical coverage and was left with emergency only care. Now, he cannot access regular doctor visits and must pay out of pocket for medications he depends on. Despite working and paying taxes for decades, Diego and his wife are barely able to cover rent. He told us he fears that if he needs surgery, he simply won't be able to get care.
His story is not unique. It reflects a broader pattern where hardworking Californians, many in essential jobs, cannot afford basic health care, while the companies they work for remain highly profitable. That also puts responsible employers who do do the right thing, who do provide care, health care for their workers at a competitive disadvantage. This raises a fundamental question about fairness and sustainability as we grapple with the impacts of H. R.
One and our health care costs here in California. At a time where we are facing real budget crises with these federal threats that weaken our Medi Cal system, families are struggling to get by. We have to ask, is it fair or sustainable for tax payers to subsidize the labor costs of billion dollar corporations? A 2026 report found that, at many of the nation's largest low wage employers, a family of three still qualifies for Medi Cal, even on a full time salary, while CEO pay averages about 900 times that of the median worker. California cannot afford to look away with corporations that drain the very programs we are fighting to protect.
If public dollars are being used to support a company's workforce, the public has the right to know. SB1284 brings transparency and accountability to this issue by requiring the Department of Health Care Services to publish the names of large employers with workers enrolled in Medi Cal, along with the estimated annual cost the program associated with those employees. The data creates accountability, transparency, and Californians are demanding it. Over 70% of voters, and there have been recent surveys done, support requiring large corporations to take responsibility for their workers' healthcare, instead of shifting the cost to taxpayers. That support is bipartisan, Democrats, independents, and Republicans.
Voters across the aisle see this for what it is, a matter of fairness. SB twelve eighty four responds to that call in a measured way. It simply brings transparency to how public dollars are being used because without transparency, we know nothing changes. With me today to testify is Beth Malinowski with the SEIU California and Christine Smith with health care I'm sorry, with Health Access.
Speaker 37
Beth Chair and members, good afternoon. Beth Malinowski with SEIU California. As a union of eligibility workers, a union of health care workers, long term care workers, and a union of low wage workers, we proudly co sponsor SB twelve eighty four. As our author shared, for too long, working people have relied on Medi Cal for care. Why?
Because of poverty wages, because employers have not offered affordable comprehensive coverage, because workers have been held to part time hours just out of reach of employer sponsored benefits. Fast forward to 2025, the Trump administration, a GOP led Congress, was quick to create a false narrative that our nation's Medicaid program was caring for the lazy, the unproductive, the unworthy. We know better in California. With HR1 linking work and Medicaid, we must now recognize that employers have long relied on public benefits to care for their workforce. Here are some of the facts.
Speaker 52
Nearly four in five Californians in poverty live in families with at least one working adult. Half of adult workers living in poverty are employed full time. Only 34% of low wage workers receive employer sponsored coverage. And as a result of this, nearly two in three non disabled, non elderly adult enrolled in Medi Cal work. Now, as California is saddled with the herculean task of implementing work requirements, work requirements that we know from past experiments in other states are not going to increase the availability of good paying jobs, are not going to increase the number of people working, but will increase the burden on states and individuals to prove work, ultimately leading to fewer people in care.
Speaker 37
We know we need to do a better job understanding the interplay of work and Medi Cal. A part of our responsibility to administer our state's Medicaid program, we need to look at the data at the employer level and understand the trends. With this information reported to legislature, the body will be best positioned to hold employers accountable to address underlying policies impacting these trends, and at the end of the day, make sure we have a Medi Cal program designed, administered, and financially supported in the best way possible. With that, I respectfully ask for your I vote today. Thank you.
Speaker 46
Thank you. Good afternoon, Madam Chair and committee members. My name is Christine Smith with Health Access California, and we're proud to support SB twelve eighty four. According to a January 2025 report by the California Health Care Foundation, nearly 20% of all California workers were enrolled in Medi Cal in 2023. California's Medi Cal program currently provides coverage to nearly 15,000,000 Californians, including children, older adults, people with disabilities, and working families.
In 2014, California expanded Medi Cal to include adults ages 19 to 64 without dependent children, with incomes below 138% of the federal poverty line. Medi Cal ensures that millions of Californians can see a doctor, fill a prescription, or get behavioral health care when they need it. Now under HR1 passed by Congress last July, this population is at risk of losing access to care. The cuts included in HR one threaten to unravel years of progress on health care coverage and affordability. Up to 2,000,000 Californians are expected to lose health care coverage due to devastating medical cuts, and 217,000 California jobs are at risk.
Speaker 22
Risk. HR one also includes the work requirements that further threaten the health care Medi Cal enrollees. Data analyzed by KFF and reported by the UC Berkeley Labor Center demonstrates that most Medi Cal members who can work are already working. When people who depend on Medi Cal lose their coverage, they lose access to life saving medications, in home care, dependable emergency room care, and other vital services. This report will be critical to understand how many employers are relying on California taxpayers to fund health care for their employees and their dependents, and as a result, the impacts on the state budget.
Speaker 46
When families lose access to preventative care, like routine checkups, cancer screenings, blood tests, addiction treatment, We lose our freedom to stay healthy, keep our jobs, and maintain our economic independence.
Speaker 46
to address health care funding gaps to ensure a stable economy and protect our quality of life. We respectfully ask for your I vote.
Speaker 1
Thank you. If there's anyone else in the audience that would like to come and speak in support and give a me too, please state your name, your organization,
Speaker 37
Sarah Fox, California Federation of Labor Unions, we're proud to cosponsor this measure. Thank you.
Speaker 33
Mariko Yoshihara, on behalf of UFCW, Western States Council, in support. Good
Speaker 47
afternoon, Chair and Members. Connor Guzman on behalf of Teamsters California in support.
Speaker 6
Thank you, Madam Chair and members. Megan Subers on behalf of the California Professional Firefighters in support.
Speaker 9
Chloe Hermosillo with the California Immigrant Policy Center in support. Thank you.
Speaker 1
If there's anyone in the audience that would like to speak as lead opposition to this bill, this is the time to come forward to the table. Thank you. You have a total of five minutes for your Good
Speaker 23
afternoon, Madam Chair and honorable members of the committee. I'm Andrea Lynch, and I'm here on behalf of the California Chamber of Commerce. We apologize for the late notification, but we received new information regarding this bill, and we're required to take a position on this bill. SB twelve eighty four would require DHCS to report Medi Cal enrollment data identified by employer name, effectively creating a government run public shaming registry built on incomplete decontextualized information. The bill's premise that any employer with workers on Medi Cal is offloading its obligations onto taxpayers is simply unfounded.
Speaker 48
Medi Cal enrollment reflects a wide range of factors, including workers who voluntarily prefer Medi Cal over employer coverage, part time or seasonal employees who are not eligible for benefits, and new hires still in waiting periods for benefits. Listing an employer's name next to an enrollment account without any of this context implies that employers are responsible and exposes good faith employers to unfair public scrutiny, litigation, and reputational harm. SB twelve eighty four treats employers as the sole architects of a problem shaped by market forces, state and federal policy, and individual worker choice and decisions beyond any employer's control. And for these and other reasons, we respectfully oppose SB twelve eighty four. Thank you.
Speaker 1
Thank you. If anyone else in the audience would like to come and speak in opposition, this is your time to come forward to the microphone. State your name, your organization, and your position. Seeing none, we'll bring it back to the committee. Anyone in the committee?
Senator Padilla?
Speaker 29
Thank you, Madam Chair. Just thank the author for bringing the bill and the sponsors. I think there's an important dynamic we're beginning to realize here in this data as it affects availability of coverage. I won't overly characterize it here, Madam Chair, but I certainly would if it was appropriate. So, I appreciate the ability to address this issue.
This data's important. It'll be the first steps towards what I hope will be another step to address this phenomenon that does not help people who work hard or employed, being shuffled off to be under the state's beneficial program. So, appreciate the author. I'm happy to move the bill at the right time.
Speaker 13
to say thank you to the author for bringing this forward in time where Medi Cal and people's health care benefits are being cut and, you know, not understanding, you know, which employers are doing what and feeling like, you know, we've got no answers, this is an opportunity for us to be able to, you know, get some more information, but actually do something for people, that is ensure that they have health care access, which is ultimate the reason why we're all here and got elected, right? So, I appreciate you, and I appreciate your witnesses for coming forward, too.
Speaker 8
Senator Perez. Also want to express my support and thank the author for bringing this forward. I think this bill is just asking for a report, right? And I think that's one of the most fundamental and basic things we can do is get accurate data on this issue. I've certainly seen a bunch of independent nonprofit organizations try to assess this, but I do think it's incumbent on us as the state to come up with our own numbers and to assess this issue.
So, thank you.
Speaker 1
Okay. Seeing no one else, I really want to thank the senator for bringing this bill forward and really understanding the time that we are entering. And there are different people, different, as Senator Press said, organizations that have stated or assumed certain things, but it's really critical as we figure out how we're going to deal with this next phase that we actually have accurate information. And so I thank you. I am a proud co author on this bill.
It's it's very important that we have this information. And with that, would you like to close?
Speaker 34
Thank you so much, Madam Chair, and to all my colleagues for your comments. You know, COVID taught us a lot, and the one thing it taught us is how important our health care access is and how important it is for us to maintain our public health systems. I think to come at this conversation about blame and shame is the wrong tone. We appreciate our caregivers who are in our medical and health care systems. They are doing tremendous, stellar work, and it's expensive work.
Speaker 43
It's hard to maintain a public system that ensures that every individual in our state is able to live. Preventative care and direct immediate care. So, you know, I think that this is a time and I know this is we are in the, you know, the capital, and this is where battle goes down, but there's some things where we have to take a pause and say, you know, how do we work together to fortify, to strengthen, and to make sure we have a system that works, and that there is shared responsibility in that. That's what this bill is getting at. Let's just start with understanding where we are, and what our common point of departure is, and how can we ensure that we are respecting those employers who are shouldering their weight of paying for healthcare, and we are figuring out ways to ensure that we have a system that can sustain individuals who may be working in employment that is not providing that care because, after all, what COVID has showed us, virus and death does not discriminate, and therefore, we have to protect Californians and make sure our public safety nets like Medi Cal are protected.
Speaker 1
Thank you. Assistant, the motion by Senator Padilla is to pass and re refer to the Committee on Labor, Public Employment, and Retirement. Assistant, please
Speaker 33
call the roll. Senators Weber Pearson. Aye. Weber Pearson. Aye.
Valadares. Caballero.
Speaker 33
Dorado. Aye. Gonzalez. Aye. Gonzales.
Aye. Grove. Vengevar. Padilla, I. Padilla, I.
Perez, I. Perez, I. Rubio, Smallwood Cuevas, I. Smallwood Cuevas, I. Seven zero,
Speaker 1
we'll place that on call. We will now move back in the file to file item seven, SB nine forty two by Senator Caballero. And as she is walking down, if Senator Meenjivar or Senator Blakespeare would like to come down to present their bills, they can. Thank you. You may begin.
Speaker 23
Thank you, Madam Chair, for the opportunity to present SB nine forty two, a bill that would create state oversight of for profit private detention facilities to meet the same standards of care and confinement to protect the health, safety, and humanity of individuals held in non criminal confinement facilities. The purpose of for profit private detention centers in California is to involuntarily detain immigrants pending a civil immigration adjudication that could lead to their exclusion from the state or deportation from the country. As part of their contracts with the federal government, private detention center operators agree to adhere to a minimum set of standards created by ICE. These standards include provisions that ensure safe and adequate food services, medical care, personal hygiene, religious practices, sleeping conditions, and environmental health and safety. Recent reports from multiple government oversight bodies, such as the U.
S. Department of Homeland Security's Office of the Inspector General, the federal government's Accountability Office, and our own California Department of Justice, have repeatedly identified unsafe conditions, inadequate food supplies, and poor or nonexistent medical care for those in private, in for profit private detention facilities. California routinely regulates other civil confinement facilities to ensure that while they are providing health related and custodial services, that they are also protecting the health and safety of those who have been involuntary confined to their facilities. The vast majority of these civil confinement facilities are privately owned and operated, and there is no question that the state has a legal obligation to ensure the protection and well-being of the people who have been involuntarily confined to these facilities. So, why are those who are detained in private for profit detention centers not entitled to the same health and safety protections afforded to every other detained person in California?
The answer is, they should be. And it is our obligation to ensure those protections are enforced. SB nine forty two makes it clear that no private company who chooses to operate a civil confinement facilities in California should be exempt from the same basic public safeguards that apply everywhere else, particularly when under contract to the federal government, they've agreed to do so. Before I introduce my witnesses, I'd like to take this opportunity to thank the California Hospital Association for their collaboration and engagement. I'm committed to finding solutions to the issue they've raised, and look forward to working with them.
With me to testify in support of the bill is Francis Davila, Manager Community Advocacy with Acacia Center for Justice, and Hamed Yazdan Panna from Immigrant Defense Advocates, who is available to answer any technical questions you might have.
Speaker 25
Good afternoon. Good afternoon, Chair and members of the committee. My name is Frances Davila, I'm an immigration attorney with the Acacia Center for Justice. Thank you for the opportunity to testify today in support of SB nine forty two. This bill closes a critical gap in California law by establishing meaningful state oversight of private detention facilities, which have a documented history of health and safety violations.
It ensures that the state, not the operators responsible for those violations, conducts investigations, and enforces compliance with required conditions of care and confinement. Last year was the deadliest year for individuals in immigration custody in more than two decades. 2026 is already on pace to surpass that toll with sixteen reported deaths, some of which occurred in California, making legislative action imperative. Despite operating within California and profiting from contracts to detain people, these private detention facilities are not subject to the same comprehensive state health and safety oversight as other civil confinement facilities. This absence of state oversight puts detained immigrants who often have little ability to advocate for themselves at serious risk.
Speaker 14
Recent reports from individuals attained at the California City Detention Facility exposed widespread medical neglect and unsafe living conditions, including denial of essential medications, unprofessional medical conduct, untreated medical emergencies, nonfunctional plumbing, and drinking water contaminated with unsafe lead levels. These conditions increase the risk of preventable illness and medical crises. In Cal DOJ's 2025 report on mental health services and immigration detention, it found that despite federal guidelines discouraging the isolation of detainees with mental illness, people with serious mental health conditions were routinely placed in segregation, sometimes for months at a time. These findings illustrate how private detention operators, shielded from meaningful accountability, routinely disregard basic standards of care, often with deadly consequences. For example, on 01/06/2026, Luis veteran Yanes Cruz died at the Imperial Regional Detention Facility after experiencing chest pain and shortness of breath.
Speaker 25
A nurse had sent him back to his cell, and he died two days later from an untreated heart attack. On 02/27/2026, Alberto Gutierrez Reyes died at the Adelanto Ice Processing Center after also experiencing chest pain and shortness of breath. After Alberto's 19 year old son visited him, he told his mother, Mom, dad's skin is yellow. His face is yellow. Alberto became seriously ill and asked multiple times to see a doctor, yet the private contractor failed to respond.
It's important to clarify that these individuals are subject to civil confinement and are simply awaiting a hearing or to return to their home country. Yet, they're often subject to punitive and harsh conditions designed to encourage them to give up on their case and accept deportation. Private detention facilities fail to provide adequate medical care, allow treatable conditions to worsen due to delayed or denied treatment, and ultimately shift the burden of care to local hospitals, exacerbating our state health systems. As noted in a 2024 medical manuscript on detention healthcare, the federal government accountability office found that repeat deficiencies do not result in facility closure or financial penalties. The result is a system in which deficiencies in health care provision are ignored or overlooked, and when identified, rarely result in accountability or improvement of condition.
SB nine forty two equips the legislature, the California Department of Health, and the public with the information necessary to expose unsafe conditions and hold private detention operators accountable. Thank you. Thank you.
Speaker 1
All right. At this time, if anyone else would like to speak in support of this bill, please come to the microphone, state your name, your organization, and your position only.
Speaker 38
Good afternoon, Madam Chair and members. Usama McLibbon with the Council on American Islamic Relations California in support. Thank you. Thank you.
Speaker 1
Good afternoon. Ortensio Rodriguez with the Acacia Center for Justice in support. Thank you.
Speaker 9
Chloe Armacillo with the California Immigrant Policy Center in strong support.
Speaker 1
Thank you. If there's anyone in the audience that would like to speak as lead opposition for this bill, this is the time to come forward.
Speaker 39
Leah Barrows on behalf of California Hospital Association. We don't have an official position on the bill. We have expressed concerns with the author's office. We didn't take a position because we do understand the need, and we acknowledge that this is something that is necessary. Our concerns are related to additional oversight and duplicative oversight that could happen for existing health facilities that are already licensed.
We have been working very closely with the author's office, and we thank the author's office and sponsors for working with us. We are nearly there. So, thank you for having a solutions focused mindset and helping us to get here. Thank you.
Speaker 1
Thank you. There's If anyone else that would like to give a me too in opposition of this bill, this is your time to come forward. State your name, your organization,
Speaker 1
position. Seeing no one coming forward, we'll bring it back to the committee. If there are any, Senator Padilla.
Speaker 29
Just thank the author. I'm proud Principal Coe. Be happy to move the bill.
Speaker 32
Thank you. I also want to thank the author. You know, we have to come up with a lot of creative, but smart ideas, being able to pass muster legally, on all different levels. Because we just, it's the only way to stop somebody who has so much power and what he's doing in our communities. So, I appreciate all the thought.
I caution myself and all of us to make sure that we're really trying to coordinate somehow. The coordination on the legal front is really important because I found myself with one of my bills being asked by legal minds like reconsider how you do it because that could lead to something that's unattended and could hurt us in the end. So, I'm just saying generally not that you're doing that but there's so much that we're doing that we've got to make sure it's well coordinated. So, thank you.
Speaker 13
would say, aligned with the same is that, you know, we need to do everything we can. These detention centers are god awful. In fact, I was just talking to some of the rapid responders district, in Long Beach who had mentioned, one of the individuals who passed away in Adelanto, and it's horrific, to know that this is going on in our own state. So, any tool that we can use through our health departments to be able to combat this type of terror happening. And with, you know, whomever wants to come out and support, we're glad to see that.
But we've been we're excited to see that, because we don't want the terror. We don't want folks in detention centers in the first place. But on top of it all, we need to know what they're up to, and ensuring that we have a full authority where we can to be able to hold them accountable. So, thank you for bringing it forward.
Speaker 1
Thank you. All right. Well, Senator, thank you so much for bringing this bill forward. When Senator Perez was presenting her bill earlier, which is also trying to get at this lack of oversight in these facilities, I did talk about how I understand that there are some constitutional issues because we're dealing with federal institutions, and so we really have to be very careful about how these bills are drafted. So, I'll just say the same thing that I said earlier.
I wholeheartedly support this effort. We must do better. I do share the concerns and understand the concerns from CHA about the risk of overlap and confusion. I'm so happy to say that you guys are almost there because we couldn't figure it out, but you know, you guys are working, so thank you. But I also want to encourage you, like I did Senator Perez, as this bill moves forward, to continue engaging in conversations with the administration and the attorney general's office and other stakeholders because this is an extremely important issue.
And I would hate for us to pass it, do all this work, and then we can't really implement it because it gets caught up in the legal system. You know, it's extremely important, wholeheartedly supported. And if you'd like to close, this is your time.
Speaker 23
Thank you, Madam Chair. And I really appreciate all the comments. We're mindful of the fact that it's important to be very specific and very logical in how we're building the bill. Bottom line is, we already have civil confinement facilities that are licensed, and are inspected, and that can face fines, and a forfeiture of a license. Non public general acute care hospitals, non public psychiatric health facilities, non public mental health rehabilitation centers.
All of those have individuals that are housed twenty four hours a day, and that are housed there for non criminal behavior. So, the bill is drafted very carefully to ensure that the kinds of oversight that we're looking for is consistent with the kinds of oversight that we utilize in other facilities as well. And so with that, I would respectfully ask for your aye vote.
Speaker 1
Thank you. The motion has been made by Senator Padilla. The motion is do pass and re refer to the committee on judiciary. Assistant, please
Speaker 33
call the roll. Senators Weber Pearson. Aye. Weber Pearson. Aye.
Valadares Caballero. Aye. Caballero. Aye. Dorado.
Aye. Dorado. Aye. Gonzalez. Aye.
Gonzalez. Aye. Grove. Menjivar. Padilla.
Padilla. Perez. I. Perez. I.
Rubio. Smallwood Cuevas. I. Smallwood Cuevas.
Speaker 29
All right. Thank you, Madam Chair. That brings us to are you going to present? 12? Yeah.
File item number 12, SB950 by Chair Weber Pearson.
Speaker 1
Good afternoon committee members. Today, I will be presenting SB950, which will ensure timely access to FDA approved medically necessary treatments for Californians with early onset Alzheimer's disease. I thank the committee staff for working with our office, and I do accept the committee amendments. Alzheimer's disease is a progressive, irreversible, and chronic neurologic condition marked with abnormal buildup of amyloid plaques that damage and destroys nerve cells in the brain. It affects seven million people nationally, with about twelve percent residing here in California.
As stated, a hallmark indication of Alzheimer's is the abnormal buildup of the amyloid plaque in the brain. MRIs can detect this buildup, but, for many years, little could be done to slow or stop the disease once identified. That reality began to change with the development and FDA approval of medications that modified the progression of the disease itself. Landmark clinical trials found that these therapies can meaningfully reduce amyloid plaque and slow clinical decline of early Alzheimer's disease. These innovative medical make throughs finally provide families the time and hope that they deserve.
Medicare, Medi Cal, and CalPERS provides coverage for these treatments, covering a significant proportion of Californians living with Alzheimer's. While this is amazing progress, it also illuminated an important gap. Those younger and newly diagnosed tend to have private or commercial insurance, and therefore can be subject to individual plan to plan determination for coverage and utilization management. As identified in the CHAPERB analysis, disease modifying therapies and medications to treat symptoms are not universally covered. SB950 addresses that gap by ensuring broad, equitable access to these treatments, regardless of one's insurance.
Timely and easy access to these medications is important, and there is currently no FDA approved disease modifying therapies for later stages of Alzheimer's disease. One extra denial, one more phone call, one more failed medication, one extra month waiting an IMR decision. For these individuals, these delays, or barriers, can mean the difference between receiving life changing treatment and losing the opportunity altogether. Although step therapy protocols are not widely implemented in California, we have seen its impact in other states. Individuals who are eligible and medically appropriate have been routed to treatments that solely address their symptoms, all while their disease continues to progress.
SB nine fifty ensures that Californians will not face those same delays. SB nine fifty ensures that all enrollees on plans, regulated by the state, can access medically necessary FDA approved treatments for Alzheimer's disease, prohibits step therapy protocols, addresses potential discrepancies in coverage based on benefit classification, preserves utilization management and prior authorization process, and establishes Alzheimer's as an exigent circumstance to ensure expeditious coverage, determination process. It is also important to highlight that the SHIBURB analysis determined that the premium impact of this bill is low, about 3¢ per member per month. And at its core, this bill sharpens existing law, aligns coverage policies to reflect the necessary urgency of this disease, all while maintaining what is considered extremely low cost impact. Today, I have Andrew Mendoza with his Alzheimer's Association and Doctor.
Don Hueman, a retired professor professor, excuse me, who will share his journey with Alzheimer's.
Speaker 29
Thank you very much. The witness is welcome. State your name again for the record. Each of you will have two and a half minutes. Thank you.
Speaker 30
Alzheimer's Association, proud sponsor of SB950. Thank Mr. Chair, members of the committee, and staff for your, efforts and time dedicated to advancing this important legislation. We appreciate Senator Weber Pearson for her, recognition and prioritization of earlier intervention strategies to improve brain health. SB950 clarifies existing law to ensure that people living with Alzheimer's disease have coverage for the treatments and their plans that their doctor deems medically necessary.
And it streamlines access by removing unnecessary barriers for care. The disease modifying treatments approved by the FDA present a paradigm shift for those contending with an Alzheimer's diagnosis. And these therapies and lifestyle interventions provide a proactive measure for delaying cognitive and functional decline. California recognized the importance of providing coverage for biomarker testing with legislation championed by Senator Limon, which helps many assess the risk for Alzheimer's disease. These developments encourage early detection and diagnosis.
Speaker 42
Treatment is the natural next step for an early intervention strategy. Unfortunately, issues in our health care delivery system often delay someone from receiving a diagnosis from primary care, and a lack of specialists delay confirmation. They could exit their eligibility window for these treatments during that time. Thereafter, co occurring conditions, the lack of infusion sites, qualified providers, or the costs incurred from the necessary tests can all be prohibited for someone seeking access to care in addition to lacking insurance coverage for these treatments. They are only available for people in the early stage, and as the senator said, that most folks are 65 that will be living with that condition, and this is really targeted at folks that are, diagnosed with early onset, prior to turning age 65, which represents less than one percent of people living with Alzheimer's in California.
Speaker 30
As the senator also mentioned, the cost for this is extremely low, but as well, the utilization is expected to increase in a very modest way. Access to these treatments would, however, provide a very meaningful difference to the lives of individuals continuing with the diagnosis at a young age as it affords time to create plans and cherish family. SB950 is important for ushering in a new era of treatment for Alzheimer's disease, and we appreciate Senator Weber Pearson for meeting the moment and closing a gap in insurance coverage that could have significant consequences if left unaddressed. I appreciate your time, and I'm respectfully asking for your I vote at the appropriate time. I'll now turn it over to our advocate, Don Kuehman, to discuss his experience participating in research and receiving treatment.
Speaker 39
Thank you, Chair and members of the committee for your time, and Senator Weber Pearson for authoring SB950. My name is Donald Cuman. I'm an advocate with the Alzheimer's Association and live in Lincoln, California. In 2016, my life abruptly changed when I had my DNA analyzed by 23andMe, and learned that I had two APOE4 alleles, which put me at substantial risk for developing Alzheimer's disease. As a result of that information, I volunteered for two Alzheimer's prevention clinical trials to do something positive.
Speaker 50
To enroll in the trial I'm in now at Stanford University, I underwent a PET brain scan, which revealed a buildup of beta amyloid plaque in my brain. But cognitive testing demonstrated normal cognition, indicating that I have preclinical Alzheimer's disease. After five years participating in the clinical trial, I'm now in a two year open label extension of the study, where I know that I'm receiving infusions of the anti amyloid drug, Lekembi, every two weeks, plus being monitored for side effects and cognitive changes. I'm acquainted with four other people who are receiving anti amyloid drugs for Alzheimer's disease. They report cognitive stability and maintenance of independence.
One reports being stable for nine years. Another is a neighbor who faced challenges obtaining care in a timely fashion in order to begin anti amyloid treatment. My hope, and the hope of others receiving treatment, is to remain cognitively and physically stable longer, and thereby lessen the burden and cost of care for our families. I participate in Alzheimer's research because I believe that advances will allow us to build upon current anti amyloid therapy to create precision medicine for individuals, much as we have done for the treatment of cancer in my lifetime. I will not live long enough to see many of these advances, but my children and grandchildren will benefit from them.
SB950 will improve access to the disease modifying treatments that are changing the trajectory of my life. I am respectfully requesting your I vote at the appropriate time to increase access to these life changing treatments for eligible individuals, irrespective of their insurance provider. Thank you again for your time and consideration.
Speaker 29
Thank you very much, doctor. At this time, we'll take any individuals or organizations who would like to register support for the bill. Welcome. Please approach the microphone. State your name and affiliation for the record.
Sandra Poole on behalf of Western Center in Law and Poverty in support.
Speaker 1
Evelyn Nieves on behalf of the California Black Health Network in support.
Speaker 46
Sarah Nocito on behalf of the California Chronic Care Coalition in proud support.
Speaker 14
David Ginsberg, former employee with UC Davis, health prevention, and advocate with the Alzheimer's Association. I fully support this bill.
Speaker 4
My name is Kevin Roos. I am an advocate with the Alzheimer's Association, and I support this bill.
Speaker 19
My name is Linda Roos, and I support this bill. I'm an advocate also for Alzheimer's.
Speaker 50
Hi, I'm Mark White, also an advocate with Alzheimer's Association as you might guess. This bill is really important. I fully support it. Thank you.
Speaker 44
Andrew Koch, a volunteer advocate for the Alzheimer's Association. I ask your support for this bill. Thank you.
Speaker 26
Danielle Parsons with the California Assisted Living Association. Our membership includes memory care providers, and we're in support of the bill and thank the author for her leadership on this topic.
Speaker 1
Mr. Chair and members, Monica Miller on behalf of Alzheimer's Los Angeles, Alzheimer's San Diego, and Alzheimer's Orange County in support. We thank the author for her leadership. Thank you.
Speaker 46
Sarah Birch on behalf of the Association of California Healthcare Districts and Leading Age California in support. Hi, Kate Kreiner with the Alzheimer's Association in support.
Speaker 29
Kate Thank you. Are there any principal witnesses in opposition to the bill? Please come forward. Can approach the table. When you are comfortable, you can proceed.
Each of you will have two and a half minutes. Please state your name again for the record. Thank you.
Speaker 46
Thank you, chair and members. Cassidy Heckman on behalf of the California Association of Health Plans. I want to start by thanking the author, her staff, and the sponsor for their early engagement with us on this bill. However, we are regrettably opposed. As outlined in our letter, one of our primary concerns is the misclassification of pharmacy and medical benefits for drugs that are administered in clinical settings by providers.
Speaker 51
This section of the bill sets a concerning precedent for our members, as benefit design is an area that has traditionally been within a plan's purview and helps them manage costs associated with healthcare. However, we are aware there are amendments coming that may help address this concern, and we look forward to reviewing them when the bill's in print. Additionally, we are also concerned about the requirement for health plans to cover all FDA approved drugs for the treatment of Alzheimer's and dementia illnesses. This requirement prevents plans from updating their formularies as new data emerges and limits them from designing products that are both affordable and appropriate for a specific diagnosis. That said, we are also aware the amendments may address this concern, and we look forward to reviewing that as well.
Finally, we do remain opposed to legislation that bans the use of step therapy. While we appreciate the caveat that a plan does not have to cover all drugs without step therapy, we are concerned with the provision that states this is dependent on at least one anti amyloid being covered without it. This grants immediate access to a drug that has not been strongly proven to improve health outcomes and has a high list price. Again, I want to share our appreciation for the amendments and the early engagement. However, we must remain opposed today.
Thank you.
Speaker 28
Afternoon, chair and members. Matt Aiken, on behalf of the Association of California Life and Health Insurance Companies, also respectfully opposed to SB950. Would like to align my comments with my colleague at CAP. Our organizations are deeply sympathetic to the author's intent to help individuals with Alzheimer's disease and dementia. We also appreciate the amendments and efforts to refine the bill.
Speaker 15
However, we still have some concerns that this bill moves too quickly to mandate coverage of these drugs before the evidence supports their widespread use. These drugs were approved for a narrow population and, as noted by the CHBERP analysis, have shown, at best, modest effects in slowing cognitive decline. These effects generally fall below clinically important difference thresholds, with not enough research as to whether they improve real health outcomes. Given the intensive treatment requirements, potential for severe side effects, and limited number of providers who have experience prescribing and providing this treatment, we are concerned that this bill will accelerate utilization of these drugs before their value is proven and the infrastructure for treatment is available. For these reasons, we are respectfully opposed, but we appreciate the author and sponsor's engagement on the bill and look forward to future conversations.
Speaker 29
Thank you. At this time, we'll take individuals and organizations who would like to register opposition to the bill. If so, please approach the microphone, state your name and affiliation. Seeing no one come forward, bring it back to the committee for comments or questions. Vice Chair, Valladares.
Speaker 27
Well, first of all, I'd love to be added as a co author in this bill. I'm going to be supporting this. I was actually shocked to learn that this coverage didn't currently exist. And, you know, I have, quite a few family members, with dementia, and I don't know that I've ever necessarily talked to them about their coverage. But what I do know, and maybe it's just my age, is more of me and more of my friends are getting older and we have aging parents.
This is becoming something that all of too many of the people I know are dealing with. So, it's necessity, and I want to thank you for your leadership on it.
Speaker 23
Thank you very much. I want to thank you for being here for your testimony. I really appreciate the courage it takes to show up and have a conversation about Alzheimer's. My mother passed from Alzheimer's, from the impacts of Alzheimer's. And it was a very painful journey for myself and my brother and my sister.
And thankfully, she had insurance, which covered the cost. I like my colleague did not really think about the impacts of not having care and not having health insurance. But I can't imagine trying to navigate a system where you have to pay for it yourself or where you can't get help in terms of diagnostic help for different things that you need to know about. So I know it's going to cost. We probably need well what we need is more research.
That's the bottom line and so I'll be supporting your bill
Speaker 8
Thank you. First of all, I just want to say and kind of reiterate some of the comments that Senator Valadez just made. I, too, was really surprised to discover that these are not already covered by all health plans and insurers. I think I've certainly seen many of my family members and probably almost all
Speaker 8
if we don't have a family member, know someone with a family member who struggled through dementia, it can be really painful. And I can't imagine, in addition to all of the challenges you're facing trying to support your loved one, then having to navigate possibly not having those treatments be covered by insurance. I mean, that's just completely absurd. So, I really appreciate you bringing this forward and identifying this as an issue. It's one certainly very important to me and my loved ones.
So, this is a great bill. I'd love to be added as a co author as well, and thank you for all your work on it.
Speaker 17
Thank you. I have a question. I'm sorry. You know, I just walked in. I was presenting.
But I want to just know, do we know the numbers in just the state of California of people suffering from dementia? I'm so sorry. You probably said it.
Speaker 30
Yes. We do know individuals that are living with Alzheimer's in California. Dementia, of course, is the umbrella term. It would be a bit wider. I don't have that number available.
Speaker 17
I have a curiosity about I know that I'm hearing that younger and younger people, do we know like is there records of like the youngest folks that have experienced it?
Speaker 30
Yes. The youngest person that's been diagnosed with Alzheimer's is in China, and they were at 18 years old.
Speaker 17
Wow, that is shocking. I've read something that really just caught my attention. And I know that we tend to think of this as an older person's issue. But I think now it's becoming all of our issue. And if we don't tackle this, it will continue to affect all of us.
Yes, thank you for doing this, and I believe I'm a co author as well, but I wanted to highlight that point because a lot of the times, again, we ignore the issue because we tend to be either younger or it's not our issue, but I think it's time that we all step up on this particular area. It's been said already, there's so many family members that I know, neighbors that I know, and it almost it's a little bit like cancer. It just touches everyone at one point or another. So, I want to thank you. I did, listen to some of the testimony earlier today, and thank you for that.
And, I just want to say that I hope that we continue to expand on the work. It's something that is important to me, and I've been advocating for it, and I want to just make sure that I support you in your efforts. With that, I also, would like to urge an I vote. Thank you.
Speaker 29
Thank you. Senator, any other members of the committee have questions or comments on the bill? If not, chair will entertain a motion. Senator D'Arrasso moves the bill. The motion is due pass as amended and re refer to the committee on appropriations.
Clerk will call
Speaker 33
Senators Weber Pearson? Aye. Weber Pearson, aye. Valadares? Aye.
Valadares, aye. Caballero? D'Arzo? D'Arzo I. Gonzalez?
Aye. Gonzalez I. Grove? Benjivar? Padilla?
Aye. Padilla I. Perez? Rubio? Aye.
Rubio I. Smallwood Cuevas? Aye. Smallwood Cuevas I.
Speaker 29
Seven. Ayes are seven. That will be placed on call. And I think our chair is returning, and I will pass the gavel back.
Speaker 1
Thank you. We will now move back and file order to file number two SB nine eight nine by Senator Blake Spear and Unberg and you may begin whenever you are ready
Speaker 24
Okay. Ready? Okay. I'm pleased to sponsor SB nine eighty nine, which is sponsored by the California Professional Firefighters. And I appreciate my witness waiting all afternoon to be able to testify.
So, thank you for your patience. This bill would expand access to CARE Court and help more Californians with untreated psychotic disorders receive the care they need. CARE Court was created to provide a structured, coordinated pathway to treatment for individuals with severe mental illness who are too often cycling through emergency rooms, jails, and repeated law enforcement encounters. While early implementation shows promise, there are barriers in the current petition process that are preventing the program from reaching many of the individuals it was designed to serve. Today, first responders are often the first point of contact for individuals in crisis, but current law makes it difficult for them to file a Care Corp petition.
To do it, they must navigate a complex court filing process, obtain sensitive medical records, and appear in court. As a result, many individuals who would benefit from Caracort are never connected to the program. SB nine eighty nine creates a more practical and effective pathway by allowing first responders to request that county behavioral health agencies review and file care petitions on their behalf. Counties are required to assess these requests within thirty business days and file a petition when eligibility criteria are met or likely to be met. Finally, the bill directs the Department of Health Care Services to develop a standardized referral form to provide guidance to first responders and establish data reporting requirements to improve transparency and program performance.
This approach reduces administrative barriers and better aligns responsibilities with expertise, ensuring that individuals in crisis are connected to care and not lost in the system. SB nine eighty nine builds on the promise of CARE Court by making it more accessible, more accountable, and more effective. I'll be crossing amendments in Senate judiciary that address the opposition's concerns that were raised by counties. With me today in support, I have Megan Subers on behalf of California Professional Firefighters Association.
Speaker 1
Thank you, and you will have a total of five minutes for your presentation.
Speaker 6
Thank you, Madam Chair and members. Megan Subers on behalf of the California Professional Firefighters. And I do apologize to the committee and the author. Her number one star witness did have to leave to go back to shift in San Jose, but I'm going to do my best to incorporate some of his talking points. So, on behalf of California Professional Firefighters, we are sponsors of SB nine eighty nine.
My president from San Jose Firefighters Local two thirty, Jerry May, who was, going to be here with me today, wanted me to share a few things. Firefighters routinely see people on the worst days of their lives and do whatever they can to help them. For people with severe behavioral health conditions who are unable to access proper treatment or are not equipped to take care of themselves, we may respond to them again and again, knowing that we will see them again soon. The CARE Act provides an important pathway to get vulnerable people to treatment they need, but unfortunately, there's been little information shared at some in some local jurisdictions about how care can be implemented and how first responders can participate. Just from our own engagement with our members, we've heard from the County Of Alameda, the City Of Alameda, San Diego, where there has been very, very good engagement with our fire department.
Speaker 8
Training has been provided, information has been provided about what first responders can do under the CARE Act in terms of being petitioners themselves, and they have successfully done that at the local level. In other parts of the state, the information flow has been different, and that is where we have come to you with this proposal with Senator Blakespeare. Myself and Jerry May both sit on the CalHHS Care Act Advisory Working Group, and through engagement there and learning a lot from all the different counties that have presented to us in that forum as well, this idea of a referral has come forward. It is something that exists in current law for LPS healthcare facilities who can make a referral to the county. The county can use their licensed specialists that are in house at the county to do the investigation and to complete the petition, and that is the process we are really trying to mirror here, which is maintain the ability for a first responder to do a petition if they've got the training and it's working in the places that I mentioned, but also provide the opportunity for a first responder if they've had repeated engagements with an individual, and they think based on their training and assessment that that individual could potentially be eligible, make that referral to the county for the county to do that investigation and determine whether or not they are eligible.
Speaker 6
So, that is what we are hoping to achieve with this bill, and would be pleased to get your support today. Thank you.
Speaker 1
Thank you. If there's anyone else in the audience that would like to speak in support of this bill, please come to the microphone, state your name, your organization, and your position. Seeing none, if there's anyone who would like to speak as lead in opposition, this is your time to come to the table. Thank you, and you will have a total of five minutes.
Speaker 38
Thank you. Good afternoon, Chair Doctor. Weber Pearson and members. I'm Evan Fern, public policy advocate with Disability Rights California, here in opposition to SB nine eighty nine. Once again, we appreciate the committee's work on proposed amendments.
Speaker 21
We look forward to reviewing the updated text, but once again, our current understanding of the proposed committee amendments doesn't change our position. DRC has been engaged with CARE Act implementation from the start, including through the CARE Act Working Group and regular work with community members who are directly impacted and share their experiences with us. While we share first responders' concerns that there are too many individuals in our state who continue to cycle through emergency services, streamlining processes for referring people into CareCourt is not the solution. People who are in CareCourt now aren't getting connected to services. The first CareCourt annual report tells us that fifty six point four percent of people in CareCourt did not receive at least one ordered mental health service.
Speaker 38
Eighty two point two percent of people in Care Court did not receive at least one ordered social service or support. There were also high indicators of unmet needs. Twenty five percent of people still had criminal justice involvement. Twenty one percent had visited an emergency department. Twenty percent had inpatient hospitalizations, and twenty percent experienced LPS holds.
CareCourt is also fiscally irresponsible. CareCourt was estimated to cost $713,000 per participant per year in fiscal year twenty twenty three-twenty four. That's more than the median cost of a single family home in 35 California counties. More than 40 times the cost of full service partnership programs, which provide comprehensive services including housing, food, case management, medical, and mental health care. Care Court interferes with relationships.
If an individual is referred to Care Court and found to be eligible, they're enrolled whether they like it or not. When someone is put into a program involuntarily, they're not likely to engage with it and we see that with how few people have completed the CareCourt program. They're also less likely to trust or seek future help from the person who put them there in the first place. Kirkwood is also not holding counties accountable. Though it was marketed as a means of holding counties accountable to provide housing and services, evidence to date shows that counties that fail to do so have not faced consequences.
Meanwhile, the individuals whom our state's housing and mental health systems have failed are being called into court to appear before a judge. Firefighters and traditional first responders' precious time shouldn't be used for mental health calls. Instead, we must build on the success of peer led, community based programs that successfully divert calls, such as peer led hotlines and warmlines that answer calls and texts that would otherwise unnecessarily go to 911 and mobile crisis response teams that respond to mental health calls that would otherwise unnecessarily receive a fire, police, or ambulance response. For these reasons, we respectfully request your no vote on SP989.
Speaker 1
Thank you. If there's anyone else in the audience that would like to register in opposition, please come to the microphone. State your name, your organization, and your position.
Speaker 6
Sarah DeKen, on behalf of the rural county representatives of California, the urban counties of California, and the California State Association of Counties, we haven't opposed unless amended, but we really appreciate the author and the sponsors working out with us. Once those amendments get crossed in judiciary, we'll be removing our opposition. Thank
Speaker 45
Good afternoon, chair and members. Amara Sheed with the County Behavioral Health Directors Association of California. We too had an opposing less amended position. I want to echo the sentiments by, my county partner and look forward to continued working with the author's office and sponsors. I've also been asked by Calvoices to come forward and provide a Me Too in opposition.
Thank you.
Speaker 1
Thank you. Seeing no further members of the audience that would like to speak, we'll bring
Speaker 34
it back to committee. Senator Smallwood Cuevas. Thank you, Madam Chair. And I appreciate, the intent behind the bill. I I represent a very diverse district.
I have Downtown L. A. And Skid Row, South L. A. And Culver City.
And, you know, and part of the tension is, you know, we want to make sure that we care for people who are, what I say, experiencing hell on earth on our streets. And we want to support them and get them out of that hell. At the same time, we want to make sure we're respecting their civil rights. We want to make sure that you know, we have accurate diagnosis. We want to make sure we have trained professionals who specialize in this sort of mental health crises, you know, ensuring that we aren't institutionalizing people and starting that process based on information that might not be fully accurate.
So, it's really hard for me to fully be behind this bill because I'm struggling with that tension. And at the same time when we hear $713,000 per participant and then we're not folks are not getting the right care, it also is is very concerning. But I guess my question is and and and I also want to say in my firefighters in my district are incredible and extremely busy. I mean, they are responding. We are in a high density area, an urban area.
There is a lot happening in Los Angeles.
Speaker 34
my question is and I I want to ask the firefighters this. How, you know, do fire how do firefighters how would they implement this? And does this take them away from the already over overburdened sort of fire houses that, you know, are trying to do the traditional work that they are charged with, as this sort of escalating mental health crisis is obviously creating other demands on their time. So, can you walk me through how that decision gets made? And the other question I had is just in terms of the referral
Speaker 34
Is there a street team or a strike team that is with firefighters when this happens that can assess that this is an individual that meets the eligibility and the requirement for the referral system? I'm trying to understand how all of these skills and responsibilities, and especially with a thirty day review and going back and who's responsible for that, how does the fire service take that on?
Speaker 6
Thank you, Senator, and through the chair. Really appreciate those questions. And I will share with you what is happening in Alameda County in terms of how they actually have implemented care and do the petitions as the fire service. So, in Alameda County so, under current law, under care today, a first responder, including a firefighter and a law enforcement officer and EMS personnel can be petitioners today. So, there is criteria in the welfare and institutions code that outlines what a repeated interaction with the individual means, and that's how you are able to decide as a first responder if you want to move forward with a petition yourself.
In Alameda County, the county and the management there in the fire department have focused on this as being a way to get some individuals into this type of care and treatment. So they actually do have a unit there that is staffed by firefighters. They've gotten trained on how to initially try to fill out the 101, the form 101 in care, which is like the initial petition form. They can communicate with licensed healthcare professionals to help them fill that out if they don't feel like they can fill that out themselves. And then they can submit the petition to the county.
As a petitioner, you have to show up to that first court hearing. So, in Alameda County, the firefighters who've chosen to do this work do show up to that first court hearing as required under law. That is actually one of the reasons why we've started talking about this referral process because in Alameda County, it's working great, but I don't know that that would work everywhere. It may not work in L. A.
City, where they're stretched so thin, and we're all very aware of all the needs that that fire department has, right? So, the referral process, in our mind, would give them an opportunity to not have to do that petition and not have to show up at that first court date. And but if they've identified someone that they think would could benefit, they could fill out a referral form, give that to the county, and the county can do it as an internal petition, which is a process that exists for counties today. So, the county social workers and behavioral health licensed professionals at the county would be the ones that would actually try to follow-up with that individual based on the information that's provided to them in the referral, and see if, by their own assessment, if that individual would actually be eligible for care, and then move forward with the petition.
Speaker 34
And so, and this process of the referral that you say that already exists now?
Speaker 6
Yeah. So, in existing law, there is I have the code section somewhere, but it exists for LPS facilities under care. So, if an LPS facility has an individual in their care that they think could, once they're released, be a candidate for CARE Act treatment, they can make a referral to the county, and the county does that as a petition. Okay.
Speaker 34
Thank you for clarifying that. And then to the other the opposition witness, my question is, given the scale of the crisis that we're seeing on so many of our streets, how do we ensure that there's some meaningful treatment and support while protecting the rights and dignity of these folks? Because I hear that there's some concern about that.
Speaker 38
I think one of the things that we are supportive of is alternatives like mobile crisis response, peer led warm lines. And so I think that those are some ways that we can strike that balance. And we can also get back to you with a more detailed response to your question.
Speaker 34
Thank you both for fielding those. I'm still thinking about this and trying to see where I land on it. I understand the need. I'm just not sure how it will apply in my community.
Speaker 17
Yeah, thank you. I have a couple of questions. But, you know, this is one of those interesting bills that I hear both of you, and I agree with both the supporters in the opposition. But, you know, something has to be done. So, I respectfully, want to share that I for example, I grew up, near Skid Row, as a matter of fact, so I know those areas well.
And this is a crisis that just keeps growing and growing, and something needed to be done. But, my question to you is, you shared that every area is different in terms of their success, And I'm just trying to understand a little bit more the barriers of not being able to reach. We know that it's resources, so L. A, for example, is overwhelmed, and they have a lot of things to take care of versus a smaller area. Is there a mechanism, and I don't know, maybe this is for the author as well, where they kind of share the best practices and things that have been implemented?
I'm thinking as a teacher, I remember we used to have a portal where you would just share information and we had best practices so no one had to reinvent the wheel, but I'm just wondering if there's a mechanism that we have where people can share information when they found success and joined something.
Speaker 6
Go ahead. I'm happy to share what I know. So, as an organization so, CPF actually, early on, tried to do our own internal education of our membership. Our leadership held a webinar. We invited CalHHS and DHCS representatives to that webinar.
We tried to get the word out far and wide amongst our own membership about what care is and how a first responder is integrated into it under the law. I think where we've hit sort of a roadblock, and hopefully it's temporary, is, you know, every county has to prioritize differently. And so, the resources, like I mentioned, in some of the Bay Area counties seems to be there, and they seem to want to focus on this. And in other counties, it's taken a little bit longer for them to, I think, integrate the fire department. It seems clear to me also that there is more coordination with law enforcement, and I think because law enforcement has a more natural tie to the court process, they're more familiar with showing up in court for things the fire department is not.
So, that could be another reason that it's just kind of differentiating across the state. But to your specific question, we've tried to do that internally. I think it's a very good point, and I am hoping through this advisory group process that I'm still a part of, maybe that's something that they continue to look at is to highlight the counties that are doing it well, and that can become a best practice. But it's a good point.
Speaker 17
Because I think that's important. You know, a lot of the times, things don't work, not because they cannot work, but it's lack of understanding, lack of resources. If we can streamline process sometime in the future that connects those resources or where they help each other, I think it
Speaker 17
successful. I do think it's necessary. And I always like to defer to those on the ground level, like our firefighters or police officers, who constantly are having tasks with navigating this crisis. And, again, I am sympathetic to the opposition, but it's a crisis and we need to continue to do what we can solve this in a humane way where people get care. So, I do want to thank you for that testimony, and thank the author for bringing this forward.
Thank you. Senator Mentjivar? Thank you.
Speaker 11
I think Senator Ambose, your joint author or your principal we held a informational hearing last year on Care Court in his district. I had a bill running simultaneously on changes to Care Court. But one of the number one feedback we got that informational hearing was let Care Court breathe. That there is a lot of things like you've mentioned in the opposition that still from the first ever report of it seeing that this is a brand new program that the more we kept adding on it on its during its infancy, the harder was going to be for it to be successful. So much so that I held my care court bill because of the feedback we got from the informational hearing.
Speaker 34
And one of the things that stood out to me was that the large percentages that you've the opposition noted from 50% of one social service to 80 something percent of another behavioral service not being offered to individuals. I worry that if we add another referral service to the counties, that would deviate their ability to stay on top of the services that need to be offered to the people currently in CARECOR. I worry that there will also stretch the timeline that we also saw of, the response to family members, the timeline they need to investigate, these cases, that those worries still exist when I saw this bill in further bogging down the system. So those are my concerns there. My question to you, senator, to the sponsor here would be, I hear that because some departments don't have the ability to go to the first report hearing and we need to make sure they're doing fire service related work, what information would be needed to give in the referral service in the referral process counties to be able to investigate?
Speaker 11
Doesn't that still require a level of engagement from them for the county to take on the investigation?
Speaker 6
Sure. So, thank you, Senator. And through the chair, the bill directs the department to come up with what the referral form should look like, but I will just speak to what was presented to us that San Diego County uses for their health facilities. It's one page, and I can pass it around here if you'd like to see it. It's one page and has some very basic information that is needed for the respondent potential respondent, the person that's filing the referral, and that is what goes to the county to be able to locate that person and do the follow-up based on the referral.
So, in my simple mind, hopefully, would look very similar to what already exists for the health facilities with different information because we're not going to know about a seventy two hour hold, for example, but we will know that we've run a call on that person 10 times in two weeks or something like that and what kind of behaviors they may have been exhibiting at that time. So, there would need to be some adjustments, but hopefully, it's just one page. The CARE 101 form is four pages and requires very detailed information about hospitalizations that have occurred, treatments that may have happened while that person was in the hospital, and frankly, sensitive medical information that the firefighter is likely not privy to in most instances. So, that is sort of the difference between the two forms that would in our mind.
Speaker 11
For the referral system that exists right now for the LPS institutes, that has a little bit more of a housing stability environment that allows perhaps the county to be able to directly find the individual right before they're getting discharged versus this scenario where perhaps it might be a frequent flyer, but it might be a frequent flyer in different blocks within the same jurisdiction of the fire station. Adding another additional layer of potential roadblocks for the county dragging it dragging down the system as well. That's why I also see the difference in this kind of referral system versus the referral system that exists right now. Because of those outstanding concerns, Senator, it is in a bill informed that I'll be able to support today. I forgot if it's double referred, if I'll see it again.
Should any additional amendments be provided, perhaps I can reconsider.
Speaker 17
months ago, I had a retreat with my staff, and one of the parts of the retreat was to invite, and we had a battalion chief with LA Fire Department talk to us, and this was in the McArthur Park area. He talked about how the majority of their calls were for severe mental health issues. They didn't have the authority or the resources to fully help. So, instead, they treated the immediate crisis as best they could and more than likely, they saw that same person just a few days later in crisis again. I say that because this firefighter was speaking as sincere from the heart as anybody could want.
Speaker 32
On the other hand, I greatly respect disability rights. You help us not to cross the line. You remind us of how this, what the humanity behind it in a different way. So, it's hard to know when we're crossing the line. But one thing that you have I'm sorry, what was your name again?
Evan. Evan. One thing you brought up today is the effectiveness and I think Senator Menjivar brought it up as well, is the status of where do we stand with care court. Really, what's going on, because I sort of heard the opposite of what Senator Menjivar meant. I remember hearing some report about how few people were taking advantage of it.
Very small numbers in different counties. Nowhere near what had been projected, nowhere near. So, I guess, know, that's a very legitimate issue to bring up today. And how do we get to the bottom of it? You already had some sort of a panel or report back.
But, I think that's a really important part, piece of this puzzle is how is CareCore doing? What do they need? What are we supposed to do to help it, not hurt it? And you're looking, firefighters are looking to help that process, but we may be creating a different problem, but we don't even know just because it sounds right. So, I'm in that kind of a predicament, but it seems like we need to bring this back.
I also don't want to deprive wherever it's possible, because this is not a requirement, right? So, wherever possible, wherever they do see that they can use this as a tool, I wanna be able to give that to them. If I thought it was going to be in the hundreds of people, that'd be a whole different thing. And it's part of the information we don't have, it sounds like today. Unless one of you two does know what the number of Care Court people there are or cases there are now.
Speaker 24
Could I respond? I'm sorry. Oh, no, it's okay. Is that okay? I just want to recognize that I think both comments are accurate in that CareCore is underutilized and it's definitely underperforming.
So, it was expected to be serving a lot more people and those who are tasked with doing it feel that they have a lot of obligations on them, the county, And there are many who interact with the system who feel that it's very much bogged down in process. It's actually it's important to ground through some things about Care Court. So, Care Court is 100% voluntary. This is not a conservatorship. This is not an involuntary commitment.
Speaker 13
There was a lot of talk about Care Court helping people who weren't well enough to consent, but in the end, what Care Court is is 100% voluntary. And so, if what we're seeing is that the entrance points into participating in Care Court are it's so restrictive right now that very few people are participating and we see so much unmet need, which is what the opposition witness talked about, unmet needs and counties not being held accountable. A lot of these problems, the question of course, this bill is very, very narrow. This bill is not actually dealing at all with the big, big problems that we have on our streets and the real, really serious suffering that we see. This is very narrowly tailored to address the fact that first responders are the ones who are on the front lines of responding to repeat calls from individuals who, if they were connected with the care system, might be willing to participate, basically.
Speaker 24
So, we already have a third of care participants who fall off. They don't participate, or they're too severe, so they are not actually accepted into the care process. So, a full third. And recognizing that our first responders have a really good idea. They're looking at what it is that happens in this other area of LPS referrals and saying, We'd like to be part of that too, and to say, Let's allow another entrance point for care court.
And so, recognizing what it is that this bill is doing and what it's also not doing and all the other things that we need to be doing. I think it's important just to address Senator Drazo's point that we are very far from crossing the line because this is voluntary. And I actually went and witnessed Care Court for several hours, which is hard to do because you have to get permission from every single patient in advance in order to go to Care Court. So, I talked to the judge. I talked there were four judges who run the entire care court system, the county behavioral health staff members, and then watched what was happening.
And everybody who's involved in it and was coming to court, and there's a judge in a robe and there's a very official feeling, but they are so grateful. They are receiving help and care that they have never been able to receive before. And in the same way that people who are lucky enough to be able to be connected with a deed restricted affordable housing unit are so grateful, this is that same experience of saying, we need to make this accessible to more people because they are able to get treatment, they are able to participate in stable housing, and to be dealing with their unmet health needs. So, this bill, the firefighters who've said this is the specific place where this could help us to allow more people to get connected and to have a relationship with the county where they file the petition. You know, they're it's not reasonable for a firefighter to have to come up with medical records.
You know, they're not able to access medical records for people, but they want to be able to refer to the county who is able to ask for the evaluations that are needed. So, that maybe addresses more than what your specific question was right there, but I just wanted to make sure and add that. I think was it Senator Drazo that was yeah.
Speaker 32
I don't know if there's anything that either the two witnesses want to add on that issue. If not,
Speaker 38
Yes, thank you. I think one of the things that we're concerned about is that CareCourt still isn't connecting people to services. And people enrolled in CareCourt continue to cycle through emergency systems. And it's also adding paperwork and process to an already paperwork and process heavy program. And so in that way, we're not sure that these changes are going to fix those things.
Speaker 1
All right. So, we're seeing no further comments from committee members. I want to thank, Senator Blake Spear and, Senator Umberg for, bringing this bill forward and once again allowing for us to have a conversation about Care Court. You know, I do agree with what Senator Meenjivar was stating. It seems like every year we have multiple bills dealing with Care Court, and we recently just initiated it.
And without really being able to step back and see what's working, what's not working from a holistic standpoint, I do think at times some of this is very piecemeal, which I don't know if that's really beneficial for the people that we're trying to help. That being said, this bill is very, very narrow. I initially did have significant problems with it because it was a mandate, on the county and understanding that the county is already underfunded, under, you know, under resourced to force them to do something like this would just be another added burden that they probably wouldn't be able to do well. The amendments remove that mandate. So really appreciate that.
And for this committee, I will be supporting it. I do know that it's in another committee that I will be seeing, but I will support it in this committee. And with that, you may close.
Speaker 24
Okay. Well, thank you. I just want to acknowledge that there is a lot of work to do to help people, and there are a lot of different systems we could have, but this is the one we do have. And so, making sure that it is serving people, that it's helping people, that it's accessible, That's really what this bill is about. And so, I respectfully ask for your I vote.
Speaker 1
Thank you. At this time, I will entertain a motion. Moved by Senator Rubio. The motion is due pass and re refer to the Committee on Judiciary. Assistant, please
Speaker 33
call the roll. Senators Weber Pearson? Aye. Weber Pearson, aye. Valadares?
Aye. Valadares, aye. Caballero? Aye. I.
Oh, Caballero I. D'Arzo? I. D'Arzo I. Gonzales I.
Gonzales I. Grove? Menjivar? Padilla? I.
Padilla I. Perez? Rubio? I. Rubio I.
Smallwood Cuevas? I. Smallwood Cuevas I.
Speaker 1
on call. That's eight to zero. We'll place that on call. We will now move back to file item six SB nine one five by Senator Menjivar. You may begin when you're ready.
Speaker 11
Thank you, Madam Chair, fellow colleagues. There, I know this is, I think, the third bill in this committee today that is focusing on a very similar topic. And we know that there have been numerous reports of federal immigration agents interfering with medical decisions or being present in the same room as patients when under their custody, even while providers trying to deliver healthcare. These are actions that have no place in health care and it is a clear violation of the patient's rights. So, SB nine fifteen seeks to close the gap between existing law and practice by empowering health care provider entities with the tools to uphold the privacy health investigation rights of a patient brought in under immigration custody.
And just to share an example of the incidents SB nine fifteen is attempting to stop from happening, our Harbor UCLA Medical Center, the LA Times reported having a patient with serious leg injuries post an encounter with ICE agents earlier that day. ICE agents brought that patient into the hospital and shackled him to the bed for several days. The patient was unable to speak privately with doctors, violating his right to private communications with their providers. He was interrogated while in pain and under medication. The patient also did not have access to external communication as the hospital use, pseudonyms known as blackout policies preventing both his family and legal counseling, from being able to, access him pseudonyms.
Sorry, I said that wrong. Did I say it right the second time? I think so. Okay. The patient was monitored by federal agents for about a month and was not even charged and was released from the hospital after.
And that is just one example as there have been many cases that have come to light as we have heard from several providers and advocates that ice is remaining in the patient rooms or due to lack of guidance and some hospitals are even deferring to ice to guide them on what they can or cannot do with the patient. There needs to be a clear overarching guidance to ensure that patient privacy and health care rights are maintained not only when ICE agents try to enter hospitals, but also to address when individuals are under their custody. And that's why SB nine one five will, with the committee amendments that I am taking in UDISH due to the double referral, will do the following. Make it clear that I shall not remain in the patient room unless there is a credible risk of harm to staff or the patients as determined by healthcare provider entity, and allow the providers to use a blackout policy only if the provider determines that there's a credible risk of harm to a patient or other persons. And if they do that, they have to be documented in the medical record.
It will allow healthcare providers to share immigration support resources to the patient and their family members and add clarification on the discharge process and ensure that any discussions with the clinician at the receiving facility are documented. And if there's a barrier in ensuring that communication happens, and that the discharge communication is not completed, please for it to be documented on the discharge papers. And finally, upon the patient's authorization, provide the discharge summary to the patient's family, the patient's representative, and assigned counsel. While there are outstanding questions on liability for healthcare provider entities, that is not the purview of this committee. Those conversations will be ongoing in the following, committee where you dish and I will sit down and make sure we address and further amend this bill to address the liability issues.
Madam chair, I'd now like to turn over to my two witnesses.
Speaker 1
Thank you. You will have a combined five minutes for your presentation. Thank you.
Speaker 52
Good afternoon. My name is Doctor. Sakatar Khalsa. I'm an emergency medicine physician working at a large safety net hospital in San Francisco. As a doctor, I stand in strong support of SB nine fifteen.
In the last several months, I have been involved in the care of several patients in ICE custody who were brought into the emergency department for medical care. My ability to provide life saving care for these patients has been severely restricted by ICE's behavior. ICE officers have refused to step out of my patients' room during sensitive exams and conversations and have attempted to act as surrogate medical decision makers. They have denied me the ability to call my patients' families and update them on their loved ones' condition. They have refused to allow me to connect my patient to legal counsel.
And they've even pressured me to discharge my patient to their custody without providing any information about the medical capabilities available at their facility. Just for an example to illustrate some of the things that I've talked about, we had a patient come in very confused, not answering questions appropriately, not really answering anything at all. And I stepped in trying to act as a medical surrogate decision maker, basically deciding which treatments the patient would say yes or no to, which was completely inappropriate. Additionally, ICE officers pressured healthcare workers to discharge this patient prematurely. And they were successful because of the tactics that they used to intimidate healthcare workers.
Speaker 25
And so on the way out, this patient could barely lift her head from the bed because she was discharged prematurely. ICE has instilled fear in our hospitals and has kept us from doing our job. I have personally experienced and been witness to other health care workers grappling with the fear and uncertainty of providing basic care, worrying that they might be threatened with legal recourse, lose their license, or be racially profiled by ICE agents. This has all led to worse care for our patients and has added another layer of fear among healthcare workers. I've spoken with healthcare workers across California, and there is a shared concern.
Speaker 52
Without clear guidance and protection, patient care will continue to be compromised. SB nine fifteen does not ask healthcare workers to do anything new. It simply affirms that we can provide the same standard of care we already give every other patient. This bill is about dignity, safety, and the fundamental principle that all patients deserve equitable care. Thank you.
Speaker 36
Thank you. Good afternoon, Chair members of the committee. Celine Bedincourt with the California Pan Ethnic Health Network, CPEN, proud cosponsor of SB915. As Doctor. Khalsa shared, providers want to support their patients.
SB915 empowers healthcare provider entities to establish the procedures and designate the staff needed to uphold patient rights consistently across the state. SB nine fifteen builds upon this legislature's commitment to ensure that healthcare facilities are a safe place for all patients. Last year's SB 81 restricted immigration enforcement's access to healthcare facilities and protected health information. SB915 extends those protections further, ensuring that patients already in civil immigration custody receive the same standard of care, regardless of how they entered the facility. These patients have limited ability to advocate on their own behalf.
Speaker 45
SB nine fifteen gives provider entities the clear authority to inform patients of their rights, limit officer presence in patient care areas, facilitate access to communication with loved ones and legal counsel, and ensure appropriate discharge planning, all to the extent possible and in a manner that protects the safety of patients and staff. The provisions of this bill are aligned with policies recently adopted by Los Angeles County Public Hospitals. SB nine fifteen does not ask any provider to obstruct federal officers or put themselves in danger. Healthcare provider entities may designate personnel to implement the provisions of this bill, consistent with the framework already established under SB 81. With the committee's amendments, the bill establishes guardrails against automatic deferenced immigration enforcement, while providing flexibility to adjust for credible risks of harm.
Speaker 36
Documentation of noncompliance creates a record that supports patients and their legal representatives and assists the state in tracking violations of laws violated by immigration enforcement. SB-nine 15 is needed to restore dignity and care, and we respectfully ask for
Speaker 1
your I vote. Thank you. At this time, if anyone else would like to come and register their support for this bill, please come to the microphone, state your name, your organization, and your position.
Speaker 32
Linda Way with Western Center on Law and Poverty in support. Thank you.
Speaker 7
Yesenia Robancho with End Child Poverty in California in strong support, also including my mother who experienced this at White Memorial Hospital. Thank you. Thank you.
Speaker 47
Omar Altamimi here with CPEN, but here to speak on behalf of members who were not able to be here. Latino Coalition for Healthy California, Courage California, Council of American Islamic Relations California, all in support.
Speaker 17
Thank you. Monica Maggiore with the Coalition for Humane Immigrant Rights, Sheila, in support. Thank you.
Speaker 7
Chloe Hermosillo with the California Immigrant Policy Center, co sponsor in strong support. Also, support for the Southeast Asia Resource Action Center, CRAC and Ejas Del Campo. Thank you. Thank you.
Speaker 2
Good afternoon. Johan Cardenas with the California Connected Health Network, also here on behalf of other partners. We have Wenbezino, California Latinas for Reproductive Justice and Asian Resources Inc. In strong support. Thank you.
Speaker 47
Zeenit Yaya with ACLU CAL Action in strong support. Thank you. Ximing Chair with the California Immigrant Policy Center on behalf of Immigrant Defenders Law Center and CYREN, which is the Services, Immigrant Rights, and Education Network, in strong support. Thank you.
Speaker 1
Trevenita Fries. I'm a physician at San Francisco General Hospital. Thank you.
Speaker 7
Jennifer Sigujanta, resident physician at Children's Hospital of Oakland in strong support.
Speaker 9
Thank you. Sonia Carreer, resident physician in San Francisco, California in strong support. Thank you.
Speaker 16
I'm Carly Nivens. I'm a trainee physician at Children's Hospital Oakland in strong support.
Speaker 9
Thank you. Hello, Avila Nachapina, resident physician at Children's Hospital Oakland in support.
Speaker 46
Hi, I'm Anna Escarissa, resident physician at UCSF Children's Hospital Oakland in support. Thank you.
Speaker 24
Hi, my name is Doctor. Francesco Sergi, emergency medicine resident physician in strong support.
Speaker 43
Matt Leje with the SCAU California in a supportive, a minute position. I appreciate the author for taking this on. Really important conversation and the work by the committee. Thank you.
Speaker 1
Thank you. Seeing, no other further members wishing to speak in support, if there's anyone in the audience that would like to speak and lead opposition, this is your time to come to the table. Thank you. And you have a combined five minutes.
Speaker 20
Afternoon. Vanessa Gonzalez with the California Hospital Association, here with an opposed unless amended position. I want to thank the authors, sponsors, and committee staff for their engagement and look forward to the continued discussions. First, we understand and are aligned with the overall intent of the bill, ensuring that everyone who needs care receives it regardless of their circumstances. Hospitals are committed to providing equitable care to all.
At the same time, hospitals are also responsible for maintaining a safe environment for staff, patients, and visitors. Workplace safety is our primary concern with this bill. SB nine fifteen would place health care providers in the role of managing interactions between patients and federal immigration enforcement officers, raising serious safety concerns for both staff and patients. The bill could create potentially dangerous situations by restricting officer presence and limiting hospitals' ability to maintain a safe environment. The committee amendments are a step in the right direction, as they allow for safety considerations.
Speaker 41
However, it is not the role of the health care providers alone to determine who may pose a credible risk. Today, safety decisions are made through coordination between the care team, patient, and the law enforcement officer, since hospitals are not in a position to independently assess security risks. At the same time, clinical decisions, including treatment and care, are made by the care team, not law enforcement. This bill also does not address how providers would meet the requirements of the bill if federal officers refuse to cooperate. This creates uncertainty for hospital staff and clinicians and raises serious safety and liability concerns, particularly if situations escalate.
Speaker 20
These are important gaps that will need to be addressed. While we understand that this is an important issue, we want to ensure the bill strikes the right balance and does not create conflicting or unclear obligations for hospitals and their staff and clinicians, particularly in real time interactions with federal officers. We are committed to continuing to work with the author to address these concerns to ensure the safety of our staff and patients. Thank you. Thank you.
Speaker 49
Good evening, chair and members. George Sorries with the California Medical Association here representing over 50,000 physicians and medical students of California. We apologize for not submitting a letter, but we are respectfully opposed unless amended to this bill by SB nine fifteen by Senator Menjivar. We want to thank the author for the recent amendments and the dialogue that we've had with her and her staff so far, and we look forward to continuing those. This bill attempts to deal with a serious and disturbing issue that our physicians and patients are tragically facing in various clinical settings as it relates to immigration enforcement officers.
To be clear, we are not okay with immigration enforcement being in the facilities that our physicians practice in, and this obviously instills fear in patients and healthcare professionals patients from seeking medical care. And we do not condone the federal government actions on this issue or any other for that matter at this time. However, the current model in this bill would require physicians or other members of the care team to assume legal and law enforcement responsibilities when interacting with immigration enforcement personnel in a manner that is not implementable. While well intentioned, this could put physicians and patients at even more risk. This type of mandate can make a worse workplace less safe for clinicians that are asked to engage with immigration officers in a way that can be confrontational, such as requesting a badge number and the name of a non compliant immigration officer.
Speaker 24
We've had various accounts over the last year or so from our members, from CMA physicians, where they have, you know, had ICE agents in their facilities and have kind of, you know, tried to ask to remove them from the room or not, and they've been very defiant, and it's, I think, created an even more hostile environment. So while this is extremely well intentioned, we want to work with the author on it, it's been difficult to implement this in practice. We recommend amendments that focus on clear liability protections for any physician subject to the provisions of this bill. I know the author mentioned that in her opening, and we'll continue to work there on that. And then also a clear exemption for the physician if they feel that this interaction hinders their delivery of care.
Speaker 49
Our physicians are committed to treating every patient with dignity, confidentiality, and compassion, but we have to address the unintended consequences with this bill. Thank you for listening to our concerns. Happy to answer questions.
Speaker 1
Thank you. If there's anyone else in the audience that would like to register their opposition, this is your time to come forward. State your name, your organization, and your position.
Speaker 22
Hi. Kelly McMillan on behalf of the California Dental Association. We're opposed unless amended and look forward to working with the author.
Speaker 1
Thank you. Seeing no further members of the audience that wish to speak, I will bring it back to the committee. Senator Padilla.
Speaker 29
Thank you, Madam Chair, I want to thank the author for bringing the bill. It's not an easy topic. It's a great and appropriate and timely attempt to resolve some very complex and difficult issues in the operational health care space when you're looking at the standard of care for a patient. You're looking at the treatment environment. You're looking at a lot of different interventions or not happening in one moment in time that may be affected by a change in those circumstances, as the doctor, your primary witness knows, can happen in a matter of seconds.
Speaker 20
And in one minute, you're dealing with one care environment, one set of assessments and interventions and treatment, and then the next second, it changes completely. And that's relevant. I think I'm going support the bill moving forward today because I think it's the right conversation and the right objective. I will say, there are clearly and I know the author's well aware and it's been referenced in the analysis there's a lot of complex questions about burden and liability, and a lot of other complicated questions that will need to be addressed in the committee on the judiciary, clearly. But in terms of making sure that at the time a patient is received into care, regardless of what their disposition will be, custody, out of custody, you know, that environment needs to be primarily focused on care, reasonably.
Speaker 29
These, particularly emergency medicine, already has protocols on top of protocols about assessing the safety for providers of the emergency department, and there's already protocols about if somebody starts acting let's not forget that ED physicians and supporting staff are professionally trained in assessing people's condition. We can't make the argument that they are only qualified to assess their medical condition. But if they start getting crazy, that they're not competent to say, hey, security, this person's getting crazy. I think that's not really a sufficient argument. Those protocols and stuff are in place.
The care environment needs to be primarily centered on care, And it needs to respect the rights of a patient regardless of their immigration status. I think there's a way to do this. I do hear the concerns that will need to be addressed. And they won't be easy. So I really admire the author for being brave and want to tackle this very necessary and timely conversation.
And with that, I just wanted to put those comments and observations in. Thank you, Madam Chair.
Speaker 32
Yeah. I also want to thank the author and all of you. This is I could see you all want to get to the place of protecting your patients and continuing to do so. It's really good to see that. You know, usually it's this where you totally disagree on what you want to get out of it.
So I thank you all and I thank you for being so concerned for our community. What this community is going through is so inhumane and we're learning as we take the next step. So I'm sure whatever you come up with in this process, in six months is probably going to be different because we don't know what that crazy person is going to expect and demand of people like yourselves on the ground. So I, I really, I really am grateful to you for taking this on right now. And I ask you to stick with it because in six months or a year, you're going to have to redo it and do something different because you learned on the ground.
I especially want to make sure that the word gets out in our community that they can go to a hospital, that your response may not be perfect. We don't know every single situation that's going to come up. But when the word gets out in our community, mean, gets goosebumps right now. When the word gets out in our community that the hospitals and the clinic are safe, as safe as you can get, then that's very powerful to keep us going until we get through this. Thank you.
Thank you.
Speaker 17
Senator Rubio. Thank you. Well, first of all, I want to thank those in hospital settings, just everyone from nurses to support staff. You know, the important work that you guys do is incredibly important. And so, you know, I agree just in general, everyone I think has the same general sentiment that hospitals should be safe spaces.
And I know cases where currently families are not going to get care, just for the fear that has been created. You know, it's not the hospital's fault. It's not the nurse's fault, but definitely, you know, I do appreciate what you do. I want to align myself with the comment of Senator Padilla in the interest of time. You know, I do want to say that there are some concerns for me in terms of the burden on hospitals and nurses already, but I know we're all trying to get there, you know.
I know that I have a bill that's similar, that's a little bit more narrow, and it was narrow on purpose because I feel that, as he already stated to Nirapadia, that the primary focus should be care. And I know it's scary times when, you know, we know that the federal government doesn't respect laws, and there could be confrontational, and everything else that comes with it. And I know that our nurses and our doctors should be focused on care. But there is a middle ground somewhere, and so I want to state for the record that I don't want to necessarily, you know, put that much more burden on nurses and everyone else that's focused on doing their job. But, again, there should be a middle ground.
You know, I hope that the author would consider that comment in terms of trying to find if there's more solutions to this piece of legislation. But thank you, Senator. I know that, again, everyone in this room, I think, feels the same way. It's just how we get there is probably the question. I will support the bill and hope that that conversation continues.
Thank you.
Speaker 23
Thank you, Madam Chair. I'll be brief. I wanted to thank the physicians for showing up today. It's so great to see you all here. It warmed my heart.
This is really important, important work and the fact that you're here today means a lot. I think to many of us who want to see women and doctors of color. Yay, I'm excited. Really appreciate the author and the work that she's doing here and say that I think it needs work. But I think we can get there.
It looks like everybody's interested in going in the same direction. My concern was about the impact of on the staff having to make decisions about in its purest form pissing off ice and then having it be a much more difficult situation. Also the fact that you have a situation where the patient may not understand what's going on and that may heighten their anxiety. And if you're dealing with complex issues, that's a concern. And then also what happens when if and when ICE refuses to do anything that they're told to do, to show a badge, to leave the room, to do any of that.
We just need to have a protocol and then the liability on both the staff member and the hospital is really important. I think we want to absolve them from a situation that can unfold that is not something you can predict. And I know that for myself, if I was in that situation, you know, I've got training as a lawyer. I know what my rights are. I know what the rules are, but it's different when you're in the situation is exigent and you've got to make decisions and choices.
And I'd hope I'd make the right one, but I probably wouldn't be very polite about it. So I think you can get there. And so I appreciate you working on this and everybody's willingness to have conversations. Thank you.
Speaker 1
Now, seeing no further conversation from the committee, want to thank the senator for bringing this bill forward. The initial bill was much broader and did put potentially the staff a little bit more at risk where we did not have the ability to determine whether or not we wanted ICE to leave, it was they must leave and that would have definitely put providers in a sticky situation. You know, when I, I read this bill and I hear and I see a health care provider entity, it doesn't necessarily mean that the health care provider has to be the one that is doing all of these things. And in fact, there is already a method in place in hospitals because these are not the first time that we've seen patients come in who are under someone else's care. You know, we oftentimes will deal with patients that are incarcerated for other reasons.
And, you know, I've never had to take the badge number or any of that information, but I do know that that information was taken from someone else within the health care facility. And so, as this bill if this bill is moving forward, then I would just strongly suggest that you continue to work with opposition and maybe try to utilize some of the procedures and pathways that are already in place for others who are in custody and just try to align it because, you know, as a health care provider, that's not necessarily what we're there to do. And depending on the type and where we work in the hospital, you may or may not be comfortable with that. Someone who works in the emergency room sees things that are very different than someone who's on the floor. If I'm a dermatologist coming in for a consult, I'm not used to certain things that someone else may see.
So, taking all of that into consideration, but also understanding that, you know, we do see patients that are, you know, incarcerated, and we do have, you know, hospital protocols for that. So, with that, really appreciate you taking the amendments. And would you like to close?
Speaker 11
Thank you, Madam Chair. And I just want to really clarify because I heard from a couple of colleagues, there already exists in the bill language of what happens if an ICE agent refuses to comply. It already says so in the bill, so I don't need to address any of those concerns because they've already been addressed. So it does say clearly that if someone refuses, if a federal agent refuses, the entity simply has to document that. That's that's it.
They're not, body checking them at the door. Just write that on their documentation. If they're on and there's also language says, to the extent possible, grab the badge number. It doesn't say you you cannot leave without grabbing the badge number of the officers. So, that's already been clarified in the bill.
So, that addresses some of the concerns that I've heard from my colleagues. But what we don't want to have is what is happening right now, one hospital in LA in particular was investigated and saw that the case management of that hospital was calling ICE to get permission to do something with their patients. That's what we want to prevent because that's not law either that you need to collaborate with ICE to see how you provide care and who you provide that information to if there is a next of kin or if there's approved individual that gets the health report. So that's also what we don't want to happen. I mentioned in the beginning that I will be addressing further liability issues in next committee.
I have just met as of recently with CHA yesterday on my commitments on that for the Tuesday hearing of next week. But we did our best in this just to clarify what happens if they say no. Whatever else needs to be addressed in the liability piece, we will. But hospitals already under SB 81 had to have already have a point person in place that has to respond and be, the focal person for anything immigration request related. So this isn't going above and beyond what they're supposed to be doing already.
This just simply empowers providers to feel comfortable to do it. This isn't a every single person that comes under ICE custody. You have to do this. Some providers have even held press conferences asking for more ability to do this. So this bill gives them the ability to do it should they feel comfortable.
It's not a mandate on them. It's the ability to give them some empowerment if they wanna do this. With that, respectfully asking for a nigh vote.
Speaker 1
Thank you, senator. We'll entertain a motion. Moved by Senator Gonzales. The motion is to pass and re refer to the committee on judiciary assistant. Please call the roll.
Speaker 33
Senators Weber Pearson aye Weber Pearson aye Valadares no Valadares no Caballero aye Caballero aye Darazo aye Gonzalez aye Grosve Grove? No. Menjivar? Aye. Benjivar?
Aye. Padilla? Aye. Perez? Rubio?
Aye. Rubio? Aye. Smallwood Cuevas? Aye.
7
Speaker 1
on call. 72 will place that bill on call. Senators, what we are going to do now, before I do my last two bills, at the request of our vice chair is to just go ahead and take up the consent calendar and do file item number one.
Speaker 1
need a motion for the consent calendar which is file item number four SB eleven eighty six. Sayarto with amends. Move by, Senator Mingevar. Secretary, please call the roll. Senators Weber Pearson.
Speaker 4
Valadez Valadez I Caballero yes Caballero I Drazo Drazo I Gonzalez Gonzalez Grove Grove I Menjivar Menjivar I Padilla Perez Rubio Rubio I Smallwood Cuevas Senators Weber Pearson. I Weber Pearson. I Padilla. I
Speaker 1
99 to zero will place that on call. We'll now move to file item number one SB thirteen seventy seven move the bill that has been moved by Senator Valladares Assistant, please call the roll. The motion is due passed and we refer to the Committee on Business Professions and Economic Development.
Speaker 33
Senators Weber Pearson. Aye. Weber Pearson. Aye. Valadares.
Aye. Valadares, aye. Caballero? No. Caballero, no.
Dorado? No. Dorado, no. Gonzalez? No.
Gonzalez, no. Grove? Aye. Grove, aye. Menjvar?
Padilla? No. Padilla, no. Perez? Rubio Smallwood Cuevas
Speaker 6
I need to do eleven and thirteen. I've already done twelve. Oh, you've already
Speaker 21
done twelve. Got it. Sorry. Thank you. Welcome back to Health Committee and we're going take a vitamin eleven by our chair, Senator Weber Pearson.
It's SB eight seventy four. Go ahead, ma'am, when you're ready.
Speaker 1
Good evening, colleagues. Thank you for the opportunity to present SB eight seventy four. I will be accepting the committee amendments described in the committee analysis that will be taken next week during Senate Public Safety. SB eight seventy four strengthens oversight and standardization of behavioral health treatment for services in Medi Cal. Behavioral health treatment services include applied behavioral analysis, commonly referred to as ABA treatment, and other behavioral interventions prevent or reduce behaviors that interfere with learning and social interaction, most commonly for individuals diagnosed with autism.
Recently, utilization of ABA services has grown significantly in both Medi Cal and the commercial market here in California, and across the nation. Some of this growth is by design, as the legislature has passed many bills to reduce barriers in families that faced accessing ABA services, and to ensure that children could access behavioral health treatment early, when can be most beneficial. However, as a result, a referral for behavioral health treatment services is simpler than any referral for many other Medi Cal specialty services. And many of these providers do not have the same licensing requirements as for other Medi Cal services. At the same time, there have been several media reports documenting ABA services that were overcharged or overprescribed, and at least one ABA provider in California has been charged with false billing and settled.
Additionally, at the beginning of 2022, the federal office of Inspector General initiated audits of Medicaid payment services for ABA in several states. In four states reviewed to date, audits identified significant improper payment and compliance issues resulting in substantial repayment obligations. Prior to introducing this bill, I had, in fact, considered requesting an audit of the program. However, an audit reviews largely for compliance. The real issue is whether the benefit itself needs additional parameters or guidance to ensure that children who need the benefit are the ones who get it.
And that families aren't unwittingly signed up for more hours than necessary. Furthermore, we must prevent services from being delivered by paraprofessionals who, without adequate supervision, and who were not even required by statute to be fingerprinted, despite their work with children. SB eight seventy four requires DHCS to take the following actions to evaluate and improve Medi Cal's behavioral health treatment services by requiring background checks for BHT providers who are not already subject to fingerprinting during licensing, convening a stakeholder work group to advise on standards for BHT services, issue and maintain clear clinical guidance for BHT service based on stakeholder input and federal guidance, and report to the legislature on BHT utilization and recommendation to improve program integrity and compliance. Back in 2014, when these services were first added to Medi Cal, there were very few providers and much less awareness of services available. The services and the field have changed significantly since, so now is a good time to conduct a thorough review.
I respectfully ask for an aye vote, and with me today is Liz Kumar from the California Association for Behavior Analysis, and Katie Andrew from the Local Health Plans of California. Thank you.
Speaker 21
Katie Thank you. Go ahead and proceed when ready, and you guys have two minutes each.
Speaker 13
Thank you. Good afternoon, Chair and members. My name is Liz Kroldar Kumar, and I am a board certified behavior analyst, and I serve on the board of directors for CALABA, or the California Association for Behavior Analysis. For over a decade working and consulting with behavioral health providers across California, I hear from many providers who are reluctant to accept Medi Cal families. And this is not because they don't want to serve those families.
It's because the system has become so complex and inconsistent that it's just not viable. Each managed care plan has its own rules, its own forms, its own timelines. And for providers who do participate, credentialing alone can take over two hundred days. That's two hundred days that a family is waiting while their child goes without care. That is the problem that SB eight seventy four begins to solve.
This bill creates a deliberate, multi stakeholder process to evaluate how behavioral health treatments like applied behavior analysis are implemented within the Medicare Medi Cal program. And it's looking specifically at credentialing, documentation, and authorization requirements. It brings together providers, plans, and consumers to make recommendations that are grounded in clinical reality and not just administrative convenience. And it does this without making abrupt changes that could disrupt access to care. And it even strengthens consumer protection by requiring those background checks for unlicensed providers, which is a practical step given just how much of the behavioral health workforce operates without licensure.
This process creates a thoughtful pathway to consider long term solutions, including potential licensure frameworks, in a way that is data driven and doesn't disrupt the existing workforce or access to care. CalABBA looks forward to actively participating in this process to help ensure the resulting policies reduce administrative burden, reflect evidence based standards, and expand access to high quality care for Medi Cal benefits. SB eight seventy four gives California a real framework to fix a system that's currently pushing providers out and leaving families behind. We respectfully ask for your I vote. Thank you.
Speaker 32
Thank you. Good afternoon, chair and committee members. My name is Katie Andrew, and I'm with the local health plans of California. LHPC represents all 17 local community based Medi Cal plans, serving over 9,000,000 Californians. We are proud to support SB eight seventy four because it advances important safeguards in the delivery of behavioral health treatment services for vulnerable children in the Medi Cal program.
Speaker 53
SB eight seventy four takes meaningful steps to strengthen program integrity by convening a stakeholder work group to inform clear, statewide guidance on how BHT services should be delivered. Today, variation in standards can create confusion for providers and inconsistencies in care. SB eight seventy four helps us move toward a more coordinated, accountable system. Just as importantly, SB eight seventy four comes at a time of heightened federal scrutiny of Medicaid programs, making it critical that California demonstrates strong oversight, consistent standards, and accountability in how services are delivered and documented. We want to thank the chair and your staff for the amendments reflected in the analysis, and also which we feel is critical to ensuring patient safety while avoiding duplication, inconsistent standards, and unnecessary administrative burden across plans and providers.
We appreciate the author's leadership in advancing efforts to ensure the safety of children in the Medi Cal program who need BHT supports and ensure a more consistent and accountable delivery of the BHT benefit. For these reasons, LHPC is in support of SB eight seventy four and respectfully urge your I vote in favor of the bill. Thank you.
Speaker 21
Thank you both for your testimony. This is a time for witnesses to come forward and state their support. Just name organization and position, please.
Speaker 51
Thank you. Cassidy Heckman on behalf of the California Association of Health Plans in strong support.
Speaker 21
Thank you. Anyone else? Those in opposition, if there's lead witnesses in opposition? Thank you. Please proceed.
You have two minutes. Five minutes? Two minutes. I was informed I
Speaker 21
Can I defer to staff on this committee? Sorry. Typical? Yes. Okay.
Doctor. You
Speaker 21
Okay. So, I give them each two minutes each, so I'll give you four minutes since you're by yourself. Thank you. Doctor. Thank you.
Speaker 19
Chair Weber Pearson and members of the committee, for the record, I am submitting appendices A through E, 110 pages, which your office confirmed this morning. You all have this packet. These materials were also transmitted to the United States Health and Human Services Office of Inspector General and CMS, and you are hereby served. My name is Doctor. Henne Cooperstein.
I'm an autistic policy analyst, and I am with the Degree Institute. We are here to oppose Senate Bill eight seventy four, unless amended. Our effort did not start here today. We, the autistic patients, identified patterns in Medi Cal's behavioral health system. We saw what was happening to us and to our autistic children who were harmed from applied behavior analysis.
ABA is not a health benefit. It is a human rights violation. We documented it. We submitted our findings. We proposed fixes.
We asked to meet. We were told bring forward legislation, and we did. In your appendices, you will see the corrective action plans with the recommendation for audits, which you chose not to complete. And so, in the next appendix, we completed the audit for you. Then, we were told that this work group will not be structured as we proposed in the legislative section of our packet.
That is why I am here today, because Senate Bill eight seventy four creates a work group that includes parties with financial stakes in the outcome. That is asking the Foxes to guard the henhouse before because it is because if the state cannot demonstrate program integrity, federal financial participation can and will be deferred. I have succeeded in four states, and I will not stop. I assure you, the Washington Post was very interested in our audit and cited our keywords specifically that ABA is nothing but glorified childcare, and California lawmakers are underwriting with a blank check, a human rights violation. As an autistic consumer of public programs, my survival depends on Medicaid.
Without it, I will face institutionalization as I had before. This bill does not protect patients. It protects a system already under federal scrutiny. I would like to remind you that applied behavior analysis is conversion therapy. It targets autistic presentation.
Speaker 35
If I do not wish to make eye contact, or am incapable of making eye contact, I am recommended behavior modification treatment to make my behavior present in a performative manner so that you can feel more comfortable around me. That is not a health benefit. In 2018, I published research by surveying four sixty individuals who were exposed to applied behavior analysis, eighty six percent had documented severe PTSD, not just average PTSD. Being exposed to twenty to forty hours a week from when you are a very young child, even before you are diagnosed, to behavior modification treatment is no different than conversion therapy, which targets a behavior that you are born with. And it isn't a problem unless you are forced to integrate in a society that finds your very existence to be a problem.
Speaker 19
We are not a disease. We are a group of human beings, and each and every one of you now, thanks to the high prevalence, has a loved one with autism, and there is an autistic person in every cul de sac. We have not asked to be modified. We have not asked to be monetized. We don't want this industry to continue.
We have asked you to please make sure to remove these offensive CPT codes from the state plan and this bill needs to die.
Speaker 21
Thank you for your comments. I apologize for interrupting you but we allowed you four minutes but thank you for your comments. Is there any other individuals in opposition to the bill? Please come forward to the mic. State your name organization seeing none.
I'll bring it back to the dais Senator Padilla moves the bill. Senator Gonzalez. Thank you,
Speaker 13
Just to acknowledge the opposition, Doctor. Weber, can you just acknowledge perhaps what she's stating and clarify and just give us a little bit of insight on what, if anything, you can respond to because I do appreciate the witness for being here. You're very articulate. Thank you.
Speaker 1
So, from my understanding, from what I'm gathering, her concern is with the actual therapy itself, which is, something that is allowed from a federal Medicaid standpoint. What this bill doesn't refer to that. It just notes that we have some issues within our system. We need to tighten it up. We need to evaluate for better and more streamlined process procedures, making sure that those who receive this therapy, that the federal government has said is fine, are actually those that need it, and to make sure that those who are with our kids are actually, if not licensed, actually have a background check.
Speaker 21
Thank you. Thank Sorry. Thank you, Senator Gonzales. Senator Cavallero? So
Speaker 30
let me let me ask this because I was very impressed with your testimony. It's not the first objection that I've I I've heard in regards to this. And I guess I'm trying to figure out you're trying to set a structure around something that we get money from the federal government to manage And what's the process if it ends up that and I don't have enough information on the therapy to know the description of the therapy is very similar to conversion therapy. And I have not supported conversion therapy in any of its forms. And so, I'm trying to figure out that there's process and then there's a there's got to be a way to be able to go back in another bill and say this is a therapy we shouldn't be even allowing in the state.
Speaker 1
So, I wouldn't go that far as to say that it's like conversion therapy. However, we do have someone who can probably speak a little bit more to that. So, I will turn it over to my witness. Great.
Speaker 13
Thank you. Yes, I am a board certified behavior analyst trained in applied behavior analysis. And I first would want to acknowledge the opposition's statement. Field of behavior analysis has had a long and controversial history. The field now is moving and has moved towards listening to those who have come forward to say that they've had these poor experiences.
Speaker 40
I myself have seen evolution within the field itself to no longer do things like eye contact training and things like that. So, I would not categorize it as conversion therapy in its current form, but we are a field that is providing services to people with autism and intellectual disabilities and by people with autism and intellectual disabilities. Many of my colleagues are on the spectrum. They themselves have received ABA treatment in the past, and the field itself is working towards being more compassionate and listening to our autistic consumers. And I think that is in the bill as well to make sure that it's not just the providers calling the shots.
Speaker 13
It's the consumers themselves, providers, the Medicaid medical plans as well. We're working together to come up with these guidelines.
Speaker 23
So, it does the working together include individuals that that are autistic as part of the conversation?
Speaker 23
Okay. Well, the witness says no, but then there's a yes. So here's what I'm trying to get to. I really appreciate this because I I've had conversations with in home support care workers that have autistic children and feel like they can't get any services and they don't know how to help them and and or they take care of another person's child and they need help and services. And so I was struggling with what's the solution here, which is a different conversation.
But, but if I understand this bill. So, so there's work to be done. I guess that's what I'm saying is there's work to be done. But what the bill is trying to do is to ensure that we don't have welfare fraud. And if that's the case, I think there's we need to do everything we can to ensure that that well, let me just rephrase it.
It's that people aren't getting welfare or they're not welfare. Sorry, I'm in medical. It's late. I'm hungry. That there's not fraud in the system paying people to do things that aren't doing services or not receiving.
And so, am I right or do I have
Speaker 1
it wrong? Yes, you are correct that basically ensuring that those who need services are receiving the services that they need and those that do not need these kind of services are not getting these services or providers billing for these kind of services for individuals that don't need it. Additionally, having individuals providing some of these services who are not licensed and not being supervised is very problematic for me, and that's why there's a background portion. And I also want to state that in the bill amendments, when they talk about the stakeholder group, the work group shall include the following: consumers with autism and consumer advocates for organizations led by individuals with autism and organizations serving families of autistic children. So, they will have a voice at the table, actually multiple voices at the table with this convening statement.
Thank
Speaker 23
you for that. I appreciate it. I just needed to understand it and I think there is work to be done. Let me just say that. I appreciate this discussion.
Thank you very much. And thank you for being here because I think you raised some really, really important issues. And it's a question of making sure that the door is open so you have a seat at the table and that there are opportunities to have conversations about what's appropriate and what's not and what is treatment that is assisting both caretakers as well as children themselves. So thank you for bringing this forward. Appreciate it.
Speaker 32
Senator Drazzo. Yeah, I just want to reiterate or reconfirm what my colleague just said. I appreciate when someone has a different point of view and how important that is to keep our system functioning at the highest standards, at the highest levels. And so you need to be commended for coming here and raising the issues and the author of this legislation, this bill has included involvement of the autistic community in this process. So whatever you can do, senator, continues strengthens that even more, I think would be a benefit to all of us.
Thank you.
Speaker 21
Thank you. Thank you. Any other comments, questions? So I'll start. Thank you for being here.
You brought up some very relevant points. And you appear to have I haven't read the entire document, but we did receive it. And you appear to have done your research and got your background. The author said that she's they're specific on the panel or the community group that's going to work with this, that there are three or four positions for autistic families. And every time someone says that, you shake your head no.
So I'm going give you the opportunity to respond and explain why you think that with the language in there that specifically says they are including that, why do you feel that it's not so?
Speaker 19
We drafted this bill. We drafted the language for this bill, and it is in the corrective action plan in one of your appendices. In that particular bill, we specifically stated that it should be autistic people who have technical expertise in conducting these integrity oversight mechanisms and investigating policy and analysis, not persons with autism who are being tokenized to give free emotional labor so you can all pat yourself on
Speaker 19
back. I am not a person with autism. I am an autistic professional and subject matter expert. So, is nothing in the amendment at this time that includes me. It's expanding to make sure that the industry continues to self regulate itself, pat themselves on the back, and say, oh, and we brought our affected patient group to the table.
I'm here as a professional and a subject matter expert. I'm not here because I'm a person with autism. I'm affected by this particular, very high risk, federally identified high risk, volatile treatment that has been completely leading to the Trump froze all of the funding in Minnesota because of what started in an autism clinic. We reported that to the feds first. And California doesn't have a mechanism to which we can investigate consumer feedback, as Minnesota didn't have a mechanism to investigate kickback schemes and other Ponzi like structures, which are identified in this particular report.
Speaker 21
Thank you. Thank you. To the author, did you want to respond, or do you have a response, or to your witnesses? I'll take it from either anyone.
Speaker 1
No, all that I will say is that, like any work group that we create, it is a broad coalition of individuals, those who are impacted, those who represent, and those who are family members, and that is what this, work group also has.
Speaker 21
Okay, thank you. Any other comments? Do I have a yes? No. Do I have a motion?
You did. Sorry. Senator Padilla moved the bill. Secretary, please call the roll. Oh, I'm sorry.
Would you like to close? I'm sorry. No, I know. I'm very poking. We don't cheer very often.
No, no, no, no, no, Senator, would you like to close? Yes, I apologize.
Speaker 1
No, no, no, it's fine. Fine. I want to thank all of those who came out to speak today, those who spoke in support, and for the witness who came in to speak in opposition. And to be fair, if it were not for her, I would not be here with this bill. She was the one who contacted the health committee and provided this information and has been in constant communication with health committee staff about some of the issues in this particular area.
And so, it was the things that she brought forward that made me say we needed to move on this. Not necessarily wait on an audit, because we know that audits can take a very long time. And some of the things that I was finding out about because of her work, I felt needed to be moved on a little quicker. So, really want to appreciate that, our staff, and with that, request an I vote on SB eight seventy four.
Speaker 33
The motion is do pass and re refer to the Committee on Public Safety. Senators Weber Pearson? Aye. Weber Pearson, aye. Valadares?
Caballero? Aye. Caballero, aye. D'Arzo? D'Arzo, aye.
Gonzalez? Gonzalez, aye. Grove? Benjevar. Padilla.
I. Perez. Rubio. I. Rubio.
I. Smallwood. Cuevas. Smallwood. Cuevas.
I.
Speaker 21
That bill has seven to zero. It is on call. Thank you all for your testimony. Senator Weber Pearson, you can also address item 13 SB ten thirty seven at your earliest convenience. Thank you.
Speaker 1
Okay, we're almost done you guys. SB ten thirty seven with the loss of federal enhanced premium tax credits, many covered California enrollees will experience, on average, a 97% increase in monthly health insurance premiums. It is estimated that about 400,000 Californians could drop off coverage because of affordability. Eight in 10 Californians say that health care affordability is an important priority. Health insurance is way too expensive, which is what we can all agree on.
And health insurance premium growth is surpassing the median household income and cost of living increases. Californians are worrying about seeking health care, rationing medications. And this year, early retirees are asking are risking their retirement nest eggs by dropping out of insurance altogether. The Office of Health Care Affordability is looking closely at health care costs and setting targets to slow the growth trajectory. But the intent of this bill is very simple.
SB ten thirty seven connects the work of OCA with reviews health insurance regulators that are doing right now when reviewing health insurance rates. We are asking regulators to do more than just check proposed rate increases for actuarial soundness. We are asking regulators to also evaluate these rate increases for consumer affordability. This includes premiums and cost sharing. I have Katie Van Dyne from Health Access California here to speak in support and Omar Alta Mimi from the California Pan Ethnic Health Network.
Thank you.
Speaker 26
Thank you. You each have two minutes. Please proceed when ready. Good evening, Madam Chair and members. Katie Van Dyens for Health Access California, and we strongly support SB ten thirty seven that will implement enhanced rate review and detail how health plans will show the benefits of the Office of Health Care Affordability cost growth targets in their rates.
The most common question we get about OCA is when will consumers see premiums go down? SB ten thirty seven moves California forward at answering that question. The bill requires health plans and insurers to explain, in the rate review process, how the OCA cost growth targets are affecting premiums, copays, and deductibles they are asking consumers and employers to pay. The existing law already requires insurers and plans to demonstrate the impact of the OCA targets on rates. SB ten thirty seven provides more detail on how they will do that.
It requires that if they say rates are going up because of high cost drugs or other cost drivers, that they reconcile that with data already being collected by OCA. Because OCA is analyzing cost drivers, the health plan's justification for higher rates should be checked against this new data. DMHC and CDI are already reviewing rates this year and 2027 now, and the OCA targets apply this year and in 2027. OCA's limits on cost growth should result in lower rates for consumers. That's the point of OCA.
OCA has an approach limiting spending growth across plans, insurers, hospitals, and large physician organizations. And over time, it will result in lower premiums. In fact, the UC Labor Center says that if we had the targets three years ago, families with employer coverage would have saved $5,800 in premiums. SB ten thirty seven helps ensure those savings are realized for consumers. The bill requires review to show the impacts of rate increases on affordability through consumer cost sharing, and this information is already in DMHC and CDI public reporting.
The bill importantly entires unreasonable rate increases definition in the Affordable Care Act, codifying the ACA definition to the state law to protect against attacks at the federal level. This bill requires regulators to consider if the health plan has excessive tangible net equity when determining if the rate increase is unreasonable or unjustified. Yes, the state already looks at this measure of financial solvency, but if a Medi Cal managed health care plan has reserves well above 1000% of the required reserves, the regulator should ask, does that health plan really need that much over the minimum? Either their rates are too high, or they should be spending more money to provide better access to care, or both. This bill just looks to consider that when looking at required reserves.
We are proud to support this bill and respectfully ask for your I vote. Thank you.
Speaker 47
Good evening, Madam Chair and members. Omar Altamimi with CPEN, the California Pan Ethnic Health Network. CPEN is proud to be here in support of SB ten thirty seven, which will codify federal law and ensure that regulators can make determinations about whether rates are unjustified, unfairly discriminatory, or otherwise unreasonably burdensome. California is in the midst of an unaffordability crisis that is accentuated by rising health care costs. No Californian should be choosing between putting food on their table or seeking care.
CPEN released a report in February titled Paying the Price, which outlined the highest cost drivers of unaffordable health care in our state and highlighted important disparities with low income, uninsured, and communities of color most impacted. Some of the findings of that report are particularly striking. In 2024, more than half of Californians said they skipped or postponed care due to cost, a number that rises to a startling three fourths when it comes to Californians with low incomes. Californians currently owe more than $10,500,000,000 in medical debt. Of the 3,000,000 Californians struggling to pay their own or their household medical debts, nearly one in three owe $4,000 or more.
Speaker 11
More than 1,000,000 Californians couldn't afford basic necessities because of medical bills. Paying for food, rent, and heat is a challenge for all Californians struggling to pay medical bills, but the burden falls disproportionately on low income households, communities of color in certain counties. HR1 and the GOP's failure to extend enhanced premium subsidies will only worsen these conditions for Californians by reducing or eliminating health care access for our most vulnerable communities, including communities of color, limited English proficient, immigrant, and LGBTQ plus communities. We've already seen this play out in 2026. According to Coverity California, new enrollment is down 32% from last year with mid- and lower income communities of color particularly impacted for these reasons.
Speaker 21
You. Thank you for your testimony. Anyone else in support? Please come to the microphone, state your name, organization, and position.
Speaker 30
Hello, Chair Committee members. Brian Montes with California Teachers Association in support. Thanks.
Speaker 20
Vanessa Gonzalez with the California Hospital Association in support. Thank you. Anyone else?
Speaker 21
We'll take witnesses in opposition. Please come forward. Good evening. Your two lead witnesses, you have two minutes each. Please proceed when ready.
Speaker 54
Thank you, chair and members. Nick Luizos, on behalf of the California Association of Health Plans. Regrettably in opposition to ten thirty seven. Members, we're at a critical juncture in the legislative process. We know that rising health care costs are a real concern for individuals and families.
That's why you see health plans and CAP in committee every week promoting policies that lower spending on the largest cost drivers of premiums. And you also see a supposing costly mandates that drive up premiums. We respect the author's passion for affordability, and indeed, we're working with Doctor. Weber Pearson on a separate bill to lower drug spending in the state of California. Members, California has robust consumer protections in place, and health plans are tightly regulated already and must comply with extensive transparency requirements for how they set prices and spend consumer health care dollars.
Existing law already requires plans to spend 80% to 85% of the premium dollar on direct medical care, and any excess must be returned consumers as rebates. Premiums are not arbitrarily set. Every rate is certified by actuaries, excuse me, and reviewed by state regulators, as was mentioned, and made available for public comment before it ever reaches a consumer. These are not just a simple check. Regulators can deem those rates as unreasonable, and health plans do what they can to avoid that.
Speaker 48
This is a level of scrutiny that no other actor in the health care space has to comply with, only health plans. The problem is that the underlying cost drivers of healthcare premiums are increasing rapidly. Hospital costs have increased more than 265% over the past five years, and pharmaceutical costs have jumped by over 70% over the same period, far outpacing inflation and wages. This bill adds a new layer of regulatory oversight and essentially a third rate reviewer, and we just respectfully disagree that this will do anything to address the underlying cost drivers of the system. So we're committed to being a part of the solution.
Speaker 54
Again, we are promoting bills to try to lower health care costs in the state, and but we respectfully oppose this particular measure.
Speaker 12
Madam Chair and members, Stephanie Watkins, on behalf of the Association of California Life and Health Insurance Companies, also regrettably in opposition today. As my colleague mentioned, we shared the legislature's goal of ensuring all Californians have access to comprehensive, affordable healthcare. Unfortunately, as drafted, SB ten thirty seven introduces a new and subjective rate review process. Most specifically, while we understand the desire to delink the existing definition of unreasonable rate increases from the federal Affordable Care Act in order to reflect California's specific market, the framework proposed in this bill creates significant implementation challenges. As currently drafted, we believe this introduces numerous, undefined terms that have the potential to make the process not only confusing but potentially inconsistent across regulatory bodies.
Speaker 51
We're concerned that the lack certainty regarding compliance will lead to significant regulatory confusion, as well as an increased cost of the system. The bill also appears to combine the functions of the Office of Healthcare Affordability Application and the cost targets with DMHC and CDI's rate review process, which are fundamentally distinct and different. Rate review is a prospective process that ensures premiums can cover future claims, while OCUS spending targets retrospective analyzing performance over several years, making these measures in the reasonableness review of premiums is not actually sound or and or appropriate. Additionally, the bill incorporates the concept of excessive tangible net equity into the rate review process, which reflects a misunderstanding of the insurance solvency and its role in protecting consumers. Importantly, T and E is a consumer protection requirement designed to ensure health plans hold sufficient reserves to pay claims during emergencies and catastrophic events.
Speaker 12
Premiums in T and E are not directly linked. It's already monitored by the DMHC and the Financial Solvency Standards Thank you.
Speaker 21
Thank you. Thank you. That was very good. Thank you. Any other witnesses in opposition?
Please come to the microphone. Seeing none, I can bring it back to the dais Yes, ma'am. I just
Speaker 34
have one brief question. When discrepancies are found, what happens? How do they get resolved? That's one question I had.
Speaker 34
In terms of the implementation, in terms of the ways in which we are looking at the rates and where we might see discrepancies, how is the information that we're collecting used, And what actions can be taken to try to rectify or resolve them? Yeah.
Speaker 53
Thank you for the question, Senator. In the bill, for the specifically around, like, if there's an excessive tangible net equity, and there's these excessive reserves, which are looking at there's required reserves that have been on the books for some time, and they do look at this as a financial solvency measure at FSSB. They this just says that the Office of Health Care Affordability and DMHC and CDI would consider if there is this excessive when they're making their determination, whether the rate is unjustified or unreasonable. And for DMHC and CDI, under the existing law, their authority is to if it is deemed unreasonable or unjustified, that the health plans would have to notify purchasers that that's the case, and then that would kind of empower the purchasers to do to understand like the health plan that I'm contracting with has access has the unreasonable or unjustified rate.
Speaker 34
Sorry. Oh, it's on. Was saying then they would make the choice about what to do with that plan, whether to continue or to.
Speaker 26
Yes, yes, exactly. It puts it in the purchaser's hands to make that determination so they know what the decision was at the regulator. They don't have the authority to reject the rate. Okay. But or the regulators don't.
And then in terms of if they are looking back at the Office of Healthcare Affordability data and seeing looking at the cost drivers, this bill just that the health plans would have to reconcile what's the difference, if there is a difference, and what they're seeing at that data that's looking at, like, cumulatively what's going on in, like, the large group the commercial market and the Medi Cal for Medi Cal managed care plans and seeing is there a difference going on here based on what's in the proposed rates for future years that are being proposed through rate review.
Speaker 21
some very good numbers about how the rate is structured and how there's already information that's provided to different agencies or organizations regarding the rate structure and how plans are regulated and so that we don't have increases, or drastic increases, or deficiencies, whatever word you
Speaker 21
finish that statement so I can understand or explain to me? And do you want to respond to question that was answered?
Speaker 12
I would just say that under the current process, both CDI and DMHC have a robust process where we file with them our rates and all the supporting documentation and information. Those are actuarially sound. They're reviewed by both departments, depending on who your regulator is, and determined to be unreasonable or reasonable. And then, if there is an unreasonable determination, then that is required by statute to be publicly known and also provided to the purchaser, so that they're aware of that. I think those are important pieces to the process and for purchasers to understand that.
We just think as this bill adds to that layer, it's taking kind of apples and oranges, it's adding things that are looking at it from a different way. And we're concerned that by doing that, you don't necessarily take into consideration the immediate look at what your actual value is for this year going forward, but instead are looking at what last year or something else happened. And so, I think that's really important for us to look at this point in time and look at the current process. I think we're open to conversations that there are ways to address deficiencies. But right now, as the bill stands, I think we really question whether or not this is going to actually provide additional information versus provide more administrative burden on the plans, which this is just going to feed into additional cost to the ratepayer?
Speaker 1
And so, I think that is one of the key components. Currently, the way in which the rates are reviewed is perspective. It's looking forward. It does not take into account whether or not the rates they proposed the year before were actually correct or if they actually went up a little too high or two years ago. And so, that is what this bill would allow to take into account is not just what you're proposing to go forward, but how did you do last year when you proposed it?
How did you do two years ago when you proposed it to increase? And so, shouldn't just assume that every year you're going to have an increase in your premiums, nor should we assume that the what you assumed at the beginning of the year was correct. I mean, we do that. We always talk about the fact that our budget projections are off, and, you know, we're able to go back and look and review those. And so, that is one of the key components that is missing with the current review process.
Speaker 21
Thank you. Sorry. Okay. And then I'll finish after Senate You would go right ahead, ma'am. It's Okay.
Speaker 17
Well, I just want to ask Mr. Luisa about I mean, you talked about earlier how you have to go through the process already, the regulatory process, and the rates cannot be discriminatory. They have to be actuarially sound. Give me a little bit more of that so they're not allowing you to go backwards, right? Just look forward.
Explain that a little bit further. Want to
Speaker 54
Well, actually, if I could also add on to Stephanie's comment. In the individual market, the covered California is an active purchaser, so it also negotiates rates with health plans. And then, those have to be approved by the departments as well. So, I just wanted to add on to that. So, that's an extra level of scrutiny in the individual market.
I guess, the way I would answer that, I according to the principles of actuarial soundness and accounting, you would, as an actuary and I'm not an actuary, so I'm just kind of pretending here to be one but what little I do know is that they do take experience into account when developing the rates going forward. So, they look at what happened in the prior year. Did they undershoot? Did they overshoot? And I think those are things that an actuary would take into account as they were developing the rates.
Speaker 17
That's what I was thinking as you were saying. Because I know, you know, as I was chair of insurance for so many years, it's very similar the way they do insurance and home insurance and other insurance. But I'm just wondering, I know that it falls, I would say, on CDI, the Department of Insurance, to figure out I mean, you guys are doing what you're asked to do, right? And provide the information. Then they go through the process.
They're the ones that decide whether or not the rates are adequate fair. So I kind of struggle a little bit, because I know that putting more on you could cause that higher cost. But, you know, I want to support the chair, and I'm going to vote for it. But I can see it because in my head, I'm thinking everything that I know from the insurance side from sitting there for seven years. And sometimes it's hard because the way the system is set up, you have to go through this sort of tedious process to go through the CDI and provide all that, and you think that that's kind of adequate, right?
And this is another layer, so I'm not disagreeing, with the tier either. But I don't know, I just encourage more conversation on that point because I know on the, insurance side, I've dealt with so many issues in terms of like delays and everything else that already is a lot on, it burdens the industry and that's through no fault of your own. It's just the system we voted for and the system that's set up. So I do want to just acknowledge, what you have to go through in terms of getting to the right rate, but just wanted to add that. Thank you.
Speaker 21
back to what I was wanting to ask, and with all due respect to the author. I was asking because, you know, I listened to you talk, I sat on insurance committee for years before, not as the chair, but sit on the committee. And I think about it related to homeowners insurance or insurance policies that we discussed in that committee. And I'm trying to parallel what we're talking about today. Allstate State Farm, Farmers Insurance Group, Hartford, American National, Falls Lake Insurance, Kimber Independence, Tokyo Marine.
I mean, there's a whole litany of insurance companies that left state because they couldn't get rate approvals to cover the cost of what they have to provide. Now, a lot of those costs come from either replacement value for fire prone hazard areas, and I realize we're talking about health insurance, but a lot of the cost for the health plans is mandated coverages and mandated policies that are passed out of this building by this legislature, and then you have to cover those costs when they're billed by the provider. So what I and then you can't get the approval for the rate or they're going to regulate your rate, but your rate is already regulated because you have to turn it into the Department of Insurance, right, for an approval? Kind of the same process as like an Allstate or a GEICO. You submit your rates based on what?
Like a billing code or like on a plan, on a coverage, based on age, based on all kinds of factors? Or and then you have to get a rate increase from or you have to get approval from the Department of Insurance, right?
Speaker 54
Yeah, yeah, we do that. Yeah. And the rating factors are defined in law that you can use. It's age and a few other things that are escaping me, but they are defined in statute, the type of rating factors that you can use to develop the rate.
Speaker 29
So, I'm assuming the insurance industry, based on people's different health issues and the things that are covered, you could have a lot of people with cancer one year, and a lot of people with health insurance, and heart issues, or cardiovascular cardiovascular issues, a lot of babies delivered, and the next year, it kind of went down by twenty percent, so your costs are fewer, because you're not reimbursing the health care cost of a larger scale of what happened the previous year. So, I deeply respect the chair and her position as a OBGYN, but this to me is a very scary place to be that we're going to regulate the insurance plans in order to where we can't if you can't cover cost, you're not staying, right? You look at any industry, you look at Valero, they're like, I'll write off a billion dollars, see you, and now we have a catastrophic issue with fuel. You look at insurance companies that I just named, they're like, yeah, thank you, not doing business in California. And I would hate to have that happen to some of our largest plans or smaller plans, but this and then, we have a rate review a rate review but not rate regulation.
Speaker 21
So I have to correct my statement on that. Anyways, thank you. Thank you for being here. I understand your issue as well. I'm with Blue Cross in the real world.
I own a business and my insurance rates went up. You can I yell at Nick all the time over it? You know, 30%, right? And my age of my employees changed by one year, and that's just ludicrous. But I also know that covered California comes into a cost of that because they have to cover a piece of that.
Don't you guys still cover like a pro rata share of that or not?
Speaker 54
Well, if you're an individual, can get subsidies if that's what you're talking Yeah. And are provided, but there's combined state and federal funds.
Speaker 21
Okay. Thank you. Yeah. Did you want to respond? I don't want to cut you off if you did.
Oh,
Speaker 26
I I was just on the subsidy side. Unfortunately, we are we are losing the subsidies here in California. Yeah. But I did I did just want to mention that that this bill is as we were talking about before, is looking at how will the Office of Health Care Affordability costs targets impact the rates. And the existing law already says that the plans just have to demonstrate this.
This bill is providing more detail in how they're doing that in terms of what and adding more detail about what is looking at the impact on affordability and what's going into the Department of Managed Health Care and Department of Insurance reports in terms of what's going to impact on cost sharing. That's something that they're publicly reporting now. So, we see there would be there wouldn't be a new administrative burden, as well as on untying this from the Affordable Care Act. That's been the law for fifteen years. So it is something that health insurers have been under for.
So targeting rates, like you said, from the Office Office of Affordability,
Speaker 21
just pick a number. And I don't have a number, right? But so $10,000 you're going get to pay a baby and they're going or have a baby, or whatever the procedure is. And the plans have to reimburse it. What if it costs the medical providers?
What if I mean, she's an OBGYN. What if it costs $12,000 to have a baby? Then they lose $2,000 on every baby that's born. That's my concern. If we're going to regulate I mean, it's almost like a communist country.
Like, can you're going to we were going to require you to cover health care plans, but you're only going to be able to build this rate, and we're going to monitor what you do. And I get that we have to eliminate fraud. I really do. I think that we're running rampant with fraud, and we have to make sure that nobody's gouging anybody, particularly the employer or the individual that's insured, because they're just trying to get insurance coverage so they have quality medical care. So I get that piece.
I just don't know I can't get there. So I'm going to stop because it is late and everybody's looking at me like I have two heads. But I just want to make the point that I do respect the author, I do, but I don't think this is the way to get here, and I think we're going down a rabbit hole worse than we would, because you know, people aren't going to have health care coverage. They're just not. And then what happens when sick people show up at the ER?
That state mostly on Medi Cal rates, picks up the bill on that. So thank you very much for all your testimony. Appreciate it. Any other questions? Move the bill.
Senator Dorado moves the bill. Madam Senator, please close.
Speaker 1
Thank you. And thank you so much for clarifying that, because the department does not approve the rate.
Speaker 1
We do not have the authority to approve within the health care space. They bring it, they review it, and that's it. Additionally, it's interesting that when you were just mentioning, you know, what if they say you can bill for this, but it actually costs us. That's what's happening now, right? Like, that's why we keep talking about Medi Cal reimbursement rates because we're saying one thing.
So, it's not like it's not happening within the health care system. But the reality is that the growth of health insurance premiums is not sustainable at all. Some people are paying more for health insurance than they pay for their rent. And when they are expected to pay even more when a family member needs a doctor, reducing healthcare cost is a shared responsibility of health insurance companies need to do their part, and be really good stewards of premium dollars that they charge. And so, with that, I respectfully ask for an aye vote on SB ten thirty seven.
We'll continue to work with opposition, but, we need to do all that we can to reduce the cost of health care in our state.
Speaker 21
Thank you. It was moved by Senator D'Arzo. The recommendation is due pass, and re refer to the committee on appropriations on SB ten thirty seven. Madam Clerk or Secretary, please call the roll. Senators Weber Pearson.
Speaker 33
Aye. Weber Pearson. Aye. Valadares Caballero. Aye.
D'Arzo. Aye. Gonzalez. Grove. No.
Grove. No. Menjivar. Padilla. Aye.
Padilla. Aye. Perez. Rubio. Aye.
Rubio. Aye. Smallwood. Aye. Smallwood.
Aye.
Speaker 21
To 1. We'll leave that open for final roll call in a little bit. I'm assuming members of the health committee if you are not here and please come we're going to go through the role
Speaker 1
We will go through the role at this point starting from the very beginning to make sure that we've captured everybody who is here but I strongly recommend that if you're not here and you want to vote, you come down. All right. Starting with the consent calendar, please call those members who were not here for the original vote. Senators Perez small would quiver
Speaker 1
aye that is 10 to zero. We'll leave that open for a very brief minute. Now we're going back to file item one. Please call those members who were not here for the original vote
Speaker 33
as file item one. The current vote is three to four with the chair voting aye and the vice chair voting aye senators menjivar Padilla oh no sorry menjivar Perez Rubio Smallwood Cuevas
Speaker 1
That vote is three to four. We will keep the roll open for a very limited time. We will go to file item two, SB nine eighty nine. Please call the members that were not here for the original vote. Senators Grove.
Aye. Grove. Aye. Menjivar. Perez.
Nine to zero. That vote is nine to zero. We will leave the roll open for a very limited time.
Speaker 1
We will now move to file item number three, SB ten eighty nine. Please call the members that were not here for the original vote. The current vote is
Speaker 33
five nine zero with the chair voting aye and the vice chair voting aye. Senators Caballero? Caballero aye. D'Arzo? D'Arzo aye.
Gonzales aye. Gonzales aye. Grove aye. Grove I. Perez?
Rubio? Rubio I.
Speaker 1
zero. We will leave that open for a very short period of time. We're moving now to file item five SB twelve twenty one. Please call the members that were not here for the original vote. Current vote is three zero with the chair voting aye and the
Speaker 33
vice chair voting aye. Senators Cavallero? Aye. Cavallero? Aye.
Dirazzo? Aye. Gonzalez? Aye. Gonzales?
Aye. Grove? Aye. Grove? Aye.
Menjivar? Perez. Rubio. I. Rubio.
I. Smallwood Cuevas.
Speaker 1
Eight zero. We will leave that bill open for a very short period of time. We'll now move to file item six SB nine fifteen by Senator Minjevar. Please call the absent members. Senators Perez.
Smallwood Cuevas. Aye. Smallwood Cuevas. Aye. Eight to two.
That is eight to two. We'll keep that open for a very short period of time. We'll move to file item seven, SB nine forty two by Senator Caballero.
Speaker 33
Senators Valladares, Grove. Aye. Grove. Aye. Mengevar.
Rubio. Aye. Rubio.
Speaker 1
That is nine-zero, and that bill is out. We'll move to file item eight, SB-nine 95, by Senator Perez. Please call the absent members.
Speaker 33
The current vote is five zero, with the chair voting aye and the vice chair voting aye. Senators Caballero? Aye. Caballero? Aye.
D'Arrazzo? Aye. Gonzalez? Gonzalez I Grove Grove I Rubio Rubio I Smallwood Cuevas I Smallwood Cuevas I 11 to
Speaker 29
Can I just double check real quick? Do you have a bill recorded for me on item eight?
Speaker 1
Will now move to file item nine, SB twelve eighty four by Senator Smallwood Cuevas.
Speaker 33
Please call the absent members. Senators Valladares? Grove? No. Grove, no.
Menjivar? Rubio? Aye. Rubio, aye.
Speaker 1
That's eight to one. That bill is out. We will now move to file item 10, SB1323 by Senator Rubio. Please call the absent members. Current vote is three to one with the chair voting aye and the vice chair voting no.
That's seven to two. That bill is out. We'll now move to file item 11, SB eight seventy four by Weber Pearson.
Speaker 33
Please call the absent members. Senators Valladares Grove Menjivar Perez that
Speaker 1
is seven zero that bill is out We'll now move to file item 12, SB nine fifty by Senator Weber Pearson. Senators Caballero
Speaker 1
nine zero that bill is out. We will now move to, file item 13 SB ten thirty seven by Senator Weber Pearson. Please call the absent members. Senators Varadares, Benjivar, Perez. Seven to one at seven to one that bill is out we're going to go back over those that are not out very quickly starting with the the consent calendar.
Please call the absent members. Senator Perez So,
Speaker 1
10 to zero that bill the consent calendar is out. Item number one please call the absent
Speaker 33
members. Senators Menjivar, Perez, Rubio, Smallwood Cuevas. So I have three to four.
Speaker 26
That is three to four. That bill fails. We will now Okay. We are now at file item two SB nine eight nine.
Speaker 33
Please call the absent members. Senators Menjivar Perez. So, nine to zero.
Speaker 1
Nine zero. That bill is out. We're at SB ten eighty nine. Please call the absent member. Senator Perez.
100. 10 to zero. That bill is out. Or at file item five SB twelve twenty one Senator Menjivar Perez small small would
Speaker 1
eight to zero that bill is out file item six SB nine one five please call the absent member senators Perez
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