NO MHM. GOOD AFTERNOON. THIS IS
THE ASSEMBLY BUDGET SUBCOMMITTEE
NUMBER ONE ON HEALTH AND HUMAN
SERVICES. TODAY'S HEARING IS
FOCUSED ON HEALTHCARE, ACCESS,
AFFORDABILITY AND WORKFORCE. ONE
NOTE ABOUT WORKFORCE ABOUT OUR
HEARING. IS THAT ON APRIL 17TH.
WE WILL COVER BEHAVIORAL HEALTH
ISSUES, INCLUDING BEHAVIORAL
HEALTH WORKFORCE, AND THEREFORE
THIS IS NOT THE FOCUS OF TODAY'S
HEARING. WE WILL BE DISCUSSING
THE 1ST 1ST 13 ISSUES IN TODAY'S
AGENDA WHILE THE REMAINING FOR
OUR NON DISCUSSION ITEMS AS
USUAL WITH NON DISCUSSION ITEMS
. WE WELCOME PUBLIC COMMENT ON
THEM AT THE END OF THE HEARING,
SHOULD THERE BE ANY I WANT TO
REMIND EVERYONE THAT ALL PUBLIC
COMMENT ON ALL ISSUES ON THE
AGENDA WILL BE TAKEN AT THE END
OF THE HEARING. AFTER THE LAST
ISSUE HAS BEEN PRESENTED. WE
WILL FIRST TAKE PUBLIC COMMENT
FROM INDIVIDUALS WHO ARE HERE IN
THE HEARING ROOM, FOLLOWED BY
PUBLIC COMMENTS FROM INDIVIDUALS
ON THE FARM. THE PUBLIC COMMENT
. CALL IN NUMBER IS ON THE
SUBCOMMITTEE'S WEBSITE, AND IT
ALSO WILL BE ON THE LIVESTREAM
SCREEN ONCE PUBLIC COMMENT HAS
STARTED, AND I WILL ALSO SHARE
IT RIGHT NOW. THE PHONE NUMBER
IS 87769. AND THE PUBLIC ACCESS
CODE IS 13151 7. WITH THAT. LET
US BEGIN WITH OUR FIRST PANEL.
ISSUE ONE IS ON THE PROPOSAL TO
TRANSFER 333.4 MILLION FROM THE
HEALTH CARE AFFORDABILITY
RESERVE FUNDS TO THE GENERAL
FUND. THIS PROPOSAL WILL BE
PRESENTED BY THE DEPARTMENT OF
FINANCE. PLEASE BEGIN. THANK
YOU, MR CHAIRMAN AND MEMBERS
MADAGASCAR LARA DEPARTMENT OF
FINANCE. THE BUDGET ACT OF 2022
PROVIDED THE STATE CONTINGENCY
APPROPRIATION OF 304 MILLION
FROM THE HEALTH CARE
AFFORDABILITY RESERVE FUND IN
CASE MORE GENERAL FEDERAL
GENEROUS FEDERAL SUBSIDIES WERE
NOT EXTENDED BEYOND 2022. OR IF
THE STATE IMPLEMENTED HEALTHCARE
AFFORDABILITY MEASURES.
FORTUNATELY THE FEDERAL
GOVERNMENT EXTENDED THE
SUBSIDIES FOR THREE YEARS AND
THE CURRENT SERVICE LEVEL FOR
CALIFORNIA REMAINS WITHOUT ANY
REDUCTION IN SERVICES. THE
LEGISLATURE ALSO PASSED SB 9 44
, WHICH WOULD HAVE REQUIRED
COVERED CALIFORNIA TO REDUCE
COST SHARING IF FEDERAL PREMIUM
SUBSIDIES WERE EXTENDED. WELL
CITING THE MERITS OF THE BILL IN
THIS PLEASURE OF WORKING WITH
THE LEGISLATURE TO ENACT
COVERAGE EXPANSIONS THROUGH
MEDICAL THE GOVERNOR VETOED THE
BILL. DUE TO CONCERNS OVER A
DOWNTURN IN REVENUES.
SUSTAINABILITY FOR A NEW STATE
ONLY PROGRAM. AND THE NEED TO
HOLD THESE FUNDS IN RESERVE
UNTIL AFTER THE FEDERAL
SUBSIDIES AND SINCE THAT TIME,
STATE REVENUES HAVE DECLINED
FURTHER. AND AS SUCH, THE
GOVERNOR'S BUDGET NOW PROPOSES
TO USE THESE RESERVES
TEMPORARILY. TO HELP THE STATE'S
BUDGET SITUATION. TRAILER BILL
LANGUAGE WOULD IMPLEMENT THE
PROPOSAL, AND IT JUST POSTED ON
THE FINANCE WEB PAGE.
SPECIFICALLY IT WOULD REVERT THE
$304 MILLION CONTINGENCY
APPROPRIATION. AND DIRECT THE
CONTROLLER TO TRANSFER THE
RESERVE BALANCE OF 333.4 MILLION
TO THE GENERAL FUND. THE FUNDS
WOULD BE REPAID TO THE RESERVE
FUND AFTER THE SUBSIDIES END.
AND WITH THAT, I'M HAPPY TO
ANSWER ANY QUESTIONS YOU MIGHT
HAVE OR MOVE ON TO THE QUESTIONS
IN THE AGENDA. WHATEVER WHATEVER
YOU WOULD PREFER, PLEASE ADDRESS
THE QUESTIONS AND THE AGENDA AND
THEN WE WILL CONTINUE WITH THE
PANEL, OKAY? THE FIRST QUESTION
IS, IS THE ADMINISTRATION AWARE
OF THE FACT THAT IT WAS CLEAR
LEGISLATIVE INTENT TO USE THE
INDIVIDUAL MANDATE PENALTY
REVENUE TO REDUCE THE COST OF
HEALTH CARE THROUGH COVERED
CALIFORNIA? THE ANSWER IS YES.
THE SECOND QUESTION FOR WHAT
REASONS IS THE ADMINISTRATION
PROPOSING TO DO THIS THROUGH
TRAILER BILL? AS COMPARED TO
PROVISIONAL LANGUAGE. UM I THINK
IN THIS CASE, EITHER TRAILER
BILL LANGUAGE OR BUDGET BILL
LANGUAGE WOULD SUFFICE. AND WE
JUST CHOSE TRAILER BILL FOR THIS
PARTICULAR PROPOSAL. THE THIRD
QUESTION IS THE IS THIS INTENDED
TO BE ALONE? IF YES, FOR WHAT
REASONS DOES THE PROPOSAL, NOT
CALL IT ALONE AND INCLUDE THE
STANDARD LANGUAGE USUALLY
INCLUDED FOR LOANS TO THE
GENERAL FUND. THIS PROPOSAL IS
NOT ALONE. WE'RE PROPOSING TO
SWEEP THE FUN BALANCE. AND REPAY
THE FUNDS AFTER THE SUBSIDIES
END. THE QUESTION FOR US HOW
MUCH INDIVIDUAL MANDATE PENALTY
REVENUE IS COLLECTED ANNUALLY.
THE ANSWER IS ROUGHLY 330 TO
$350 MILLION ANNUALLY. QUESTION
FIVE IS HAS REVENUE IN THE FUND
IN PRIOR YEARS, NOT BEEN
EXPENDED. AND IF SO, WHAT
HAPPENED TO THOSE FUNDS? THESE
REVENUES FROM THE PENALTY
ACCRUED TO THE GENERAL FUND,
WHICH IS CURRENT LAW. UM SO THE
FUNDS HAVE BEEN USED JUST FOR
OVERALL STATE BUDGET PRIORITIES.
QUESTION SIX HOW MUCH REVENUE
HAS BEEN COLLECTED FROM
INDIVIDUAL MANDATE PENALTIES
THAT HAS NOT BEEN USED TO REDUCE
THE COST OF HEALTH CARE FOR
CALIFORNIA'S RECOVERED
CALIFORNIA. THE FEDERAL
SUBSIDIES MAINTAIN THE CURRENT
SERVICE LEVEL. SO THESE FUNDS
HAVE BEEN USED FOR OVERALL STATE
BUDGET PRIORITIES. WHAT'S THE
JUSTIFICATION FOR NOT REDUCING
THE COST OF HEALTH CARE AT THE
START OF A RECESSION WHEN THERE
IS A NEW DISCRETIONARY WHEN
THERE IS NEW DISCRETIONARY
SPENDING IN THE GOVERNOR'S
BUDGET? AND VERY LARGE RESERVES.
THE ANSWER IS, UH, YOU KNOW,
GIVEN THE ECONOMIC UNCERTAINTIES
, UM CONTINUED DECLINES IN
REVENUES. AND COMPETING
PRIORITIES FOR AVAILABLE FUNDS.
UM THAT'S WHAT WARRANTS THE
SUBSTANTIAL RESERVE REFLECTED IN
THE GOVERNOR'S BUDGET. AND THAT
COVERS ALL THE QUESTIONS IN THE
AGENDA. THANK YOU. DEPARTMENT OF
FINANCE. NEXT WE WILL HAVE BETH
COUPLE WITH HELP ACCESS WHO IS
REPLACING DIANNA DOUGLAS? WHO
COULD NOT BE HERE, MISS KAPIL.
THANK YOU, MR CHAIR AND MEMBERS.
ON DAY, ONE OF HIS
ADMINISTRATION GOVERNOR NEWSOM
PROPOSED AN INDIVIDUAL MANDATE
AND COMMITTED THAT THE REVENUES
FROM THAT INDIVIDUAL MANDATE
WOULD BE USED TO IMPROVE
AFFORDABILITY. THAT MONEY HAS
NOT BEEN USED. OUR ESTIMATE IS
THAT BETWEEN 1.2 AND $1.3
BILLION HAS BEEN COLLECTED. IT
IS AND APPARENTLY SWEPT INTO THE
GENERAL FUND ON AN ONGOING
BASIS. THAT WAS NOT THE INTENT.
WE HAD SERIOUS QUESTIONS ABOUT
THE INDIVIDUAL MANDATE MANY OF
THE CALIFORNIAN TO DO NOT OBTAIN
COVERAGE DO NOT OBTAIN COVERAGE
BECAUSE THEY REGARDED AS
UNAFFORDABLE. I WANT TO TELL YOU
THAT LAST WEEK COVERED
CALIFORNIA DISCUSSED INCREASING
THE DEDUCTIBLE FOR THE STANDARD
SILVER PLAN TO $5400 A YEAR AND
THE MAXIMUM OUT OF POCKET TO
OVER $9000 A YEAR. REMEMBER THAT
MOST PEOPLE IN COVERED
CALIFORNIA MAKE 25 TO $50,000 A
YEAR? WE'RE ASKING THEM TO SPEND
MONTHS OF INCOME ON THE
DEDUCTIBLE. AND YET WE ARE
TAKING THIS MONEY THAT THE
GOVERNOR PROMISED ON DAY ONE IN
HIS DAY, ONE PROCLAMATION TO
HELP WITH AFFORDABILITY AND
PUTTING IT INTO THE GENERAL
FUND. WE ARE OPPOSED TO THIS
PROPOSAL FOR THAT REASON. I
WOULD ALSO ADD THAT AS OF LAST
WEEK COVERED, CALIFORNIA
RELEASED NEW SURVEY DATA
INDICATING ABOUT HALF OF THEIR
ENROLLEES, SKIP OR DELAY, DOCTOR
VISITS AND SKIP OR DELAY FILLING
PRESCRIPTIONS. AND YET, HERE WE
HAVE A PROPOSAL THAT WILL
CONTINUE THESE DEDUCTIBLES OF
THOUSANDS OF DOLLARS. AND DOCTOR
VISITS OF $50. FOR A PRIMARY
CARE VISIT AND $90 FOR A
SPECIALIST. IS IT ANY WONDER
THAT PEOPLE DON'T GO TO THE
DOCTOR WHEN THEY'RE ASKED TO PAY
$90? SO FOR THOSE REASONS WE ARE
OPPOSED TO THIS PROPOSAL AND
APPRECIATE THE COMMITTEE HEARING
IT. NEXT WE WILL HEAR FROM LUKE
RUSHMORE. OH, WITH THE
LEGISLATIVE ANALYST'S OFFICE.
THANK YOU, LUKE. TOMORROW WITH
THE LEGISLATIVE ANALYST'S OFFICE
. GIVEN THE STATE'S BUDGET
CONDITION, WE FIND THAT THE
PROPOSAL MERITS CONSIDERATION.
HOWEVER IT MAY NOT BE CONSISTENT
WITH LEGISLATIVE PRIORITIES TO
RIDE A LITTLE MORE BACKGROUND.
PREVIOUSLY THE STATE ESTABLISHED
THREE YEAR PREMIUM PROGRAM FROM
2020 TO 2022 THAT WOULD USE
GENERAL FUND TO PROVIDE PREMIUM
SUBSIDIES. IN 2021 CONGRESS
APPROVED ENHANCED FEDERAL
PREMIUM SUBSIDIES THAT
SUPPLANTED THE STATE SUBSIDIES,
REPLACING THEM AND FREEING UP
THE GENERAL FUND THAT WOULD HAVE
BEEN USED FOR THOSE STATES. SET
ASIDE THE 333.4 MILLION THAT'S
NOW IN THE HEALTH CARE
AFFORDABILITY RESORT FUND USING
THIS FREED UP FUNDING. UM IN
THAT SENSE. THAT TIME THERE HAS
BEEN AN EXTENSION OF THE FEDERAL
PREMIUM SUBSIDIES THROUGH 2025.
UM. HOWEVER PRIOR TO THAT
EXTENSION WHEN THE LEGISLATURE
WAS CONSIDERING THE BUDGET
PACKAGE FOR LAST YEAR, UM, THAT
IT WAS UNCLEAR WHETHER THERE'S
EXTENSIVE WOULD HAPPEN, WHICH IS
WHAT LED TO THE CREATION OF THE
CALIFORNIA PREMIUM SUBSIDY
PROGRAM, WHICH WOULD PROVIDE AN
ONGOING SUBSIDY PROGRAM FOR
COVERED CALIFORNIA. UM THE STATE
PROGRAM WOULD ONLY PARTIALLY
REPLACE THE FEDERAL SUBSIDIES
WHEN THEY EXPIRE. HOWEVER, UM.
IN ANTICIPATION OF THE FEDERAL
FUNDING MIGHT BE EXTENDED FOR
THESE PREMIUM SUBSIDIES. THE
BUDGET PACKAGE ALSO INCLUDED
LANGUAGE STATING THAT THE FUNDS
COULD BE USED TO PROVIDE
ADDITIONAL FINANCIAL ASSISTANCE
BEYOND PREMIUM SUBSIDIES ON AN
ANNUAL BASIS TO SUPPORT COVERED
CALIFORNIA CONSUMERS AND WOULD
USE THE HEALTH CARE
AFFORDABILITY RESORT FUNDING THE
FIRST YEAR AND THEN ONCE THAT
FUNDING WAS DEPLETED, WOULD
REVERT TO THESE IN GENERAL FUND
AND FOLLOWING YEARS. THE
GOVERNOR'S PROPOSAL. IN ADDITION
TO THIS TEMPORARY TRANSFER FROM
THE HEALTH CARE AFFORDABILITY
ZOR FUND TO THE GENERAL FUND
WOULD ALSO NOT APPROPRIATE THE
PLANNED GENERAL FUND FOR PREMIUM
SUBSIDIES CITIES BEGINNING IN 23
24. 25 26. WE FIND OUT WHAT THE
PROPOSAL UM. IS NOT CONSISTENT
WITH PAST PRIORITIES OF THE
LEGISLATURE. IT COULD AMERICAN
SID ORATION GIVEN THE BUDGET
SITUATION BECAUSE IT WOULD NOT
REDUCE THE LEVEL OF FINANCIAL
ASSISTANCE THAT COVERED
CALIFORNIA CONSUMERS CURRENTLY
RECEIVE, ALTHOUGH IT COULD HAVE
USED TO PROVIDE ADDITIONAL
AFFORDABILITY ASSISTANCE. UM
HOWEVER, WE NOTE THAT IF THE
LEGISLATURE CHOOSES TO MAINTAIN
THE FUNDING TO PROVIDE
ADDITIONAL FINANCIAL ASSISTANCE
, IT WOULD EXASPERATE THE BUDGET
PROBLEM AND ADDITIONAL FUNDING
WOULD BE NEEDED TO BE FREED UP
SOMEWHERE ELSE IN THE BUDGET TO
ADDRESS THIS SHORTFALL. THANK
YOU. THANK YOU. I WILL NEVER
BRING IT UP TO THE DIOCESE FOR
QUESTIONS FROM MEMBERS. DOCTOR
WOULD THANK YOU, MR. THANK YOU,
MR CHAIR. UM LET'S KAPIL YOU
SAID THAT. UM SO WE'VE BEEN
COLLECTING THIS AND NOW IT'S
OVER $300 MILLION A YEAR FOR
SEVERAL YEARS, THE CLEAR INTENT
OF THE LEGISLATURE, BUT THIS WAS
THAT THIS MONEY WAS MEANT TO GO
TO AFFORDABILITY. AND. FOR THREE
YEARS. YOU KNOW THOSE YEARS IT'S
BEEN SWEPT INTO THE GENERAL FUND
AND DID IT FROM THE GENERAL WAS
THAT APPLIED THEN TO
AFFORDABILITY PROGRAMS AS FAR AS
FAR AS WE CAN TELL THERE, THERE
WAS ONE YEAR AS THE L A. I
BELIEVE SAID, WHEN THE WHEN
COVERED CALIFORNIA DID DO
PREMIUM SUBSIDIES, STATE PREMIUM
SUBSIDIES. WHEN THE FEDERAL
GOVERNMENT ACTED, THEY BACKED
OUT THAT MONEY. UM PARTLY
BECAUSE OF THE LEG TIME. YOU
KNOW WHEN WE ALL GO TO FILE OUR
TAXES ON APRIL 15TH OR I GUESS
IT'S NOW. OCTOBER 15TH. WE WILL
BE FILING FOR THE PRIOR YEAR.
THERE HAS BEEN A THE THERE WAS A
NEED FOR GENERAL FUND FUNDING
INITIALLY, SO I'M NOT. I REMAIN
UNCLEAR AS TO ANY WHETHER ANY OF
THE ACTUAL MANDATE PENALTY
REVENUE HAS GONE TO THE
AFFORDABILITY HELP OR WHETHER IN
YEAR ONE. WE WERE USING GENERAL
FUND BECAUSE THE LAG AND
COLLECTING THOSE REVENUES. AND
SO I WISH I HAD A BETTER ANSWER
TO YOUR QUESTION. BUT IT'S IN
ANY CASE, THEY SEEM TO BE. WE
HEARD FINANCE TODAY THEY SEEM TO
BE SWEEPING WHAT THEY'RE
COLLECTING NOW. YEAH, I GUESS I
GUESS THE WORD SWEEP IS THE
DISTURBING PIECE OF THIS. I
REMEMBER THIS THING CALLED
PERHAPS 56, WHERE PREVIOUS
GOVERNOR SWEPT MONEY. AND OF
COURSE, THAT WAS ALL GONE AND
WHILE IT SAYS THE WELL, YOU HAVE
SAID, MR FROM FINANCE, THERE IS
AN INTENT TO REPAY THIS. UM, BUT
WON'T CALL IT ALONE. MEANS YOU,
DON'T YOU IT? I'M SORRY WHEN YOU
WHEN YOU INTEND TO REPAY
SOMETHING THAT IMPLIES ALONE,
BUT BUT YOU'RE YOU'RE ON WHAT?
THEY'RE UNWILLING TO CALL IT
ALONE AND CREATE TERMS FOR THAT.
DISTURB IT. $5400 PREMIUM FOR
THE SILVER PLAN IS NOT
AFFORDABLE. UM 9000 OVER 9000
OUT OF POCKET FOR SOMEBODY IS
NOT AFFORDABLE. IT'S NO WONDER
PEOPLE AREN'T GOING TO THE
DOCTOR. I THINK THERE WAS A
RECENT P P I C POLL IN THE LAST
SEVERAL YEARS, HAS SAID 85 PLUS
PERCENT OF PEOPLE IN CALIFORNIA.
CONSIDER THE COSTS OF HEALTH
CARE WOULD BE VERY, VERY
IMPORTANT. AND WE'RE DOING
EVERYTHING WE CAN TO TRY TO
IMPROVE AFFORDABILITY. BUT IN
THE EXCEPT THE MANDATE, WHICH
WAS DESIGNED TO IMPROVE
AFFORDABILITY IS BEING SWEPT FOR
OTHER PURPOSES. UM IN TIMES,
HONESTLY, WHEN THE BUDGET WAS
RIGHT WAS ROBUST. SO I, YOU
KNOW, I'M SORRY. I FIND I FIND
THIS ON UNACCEPTABLE FROM MY
PERSPECTIVES, AND I WOULD HOPE
THAT THE LEGISLATURE WOULD
REJECT THIS. THANK YOU ALL. KEEP
IT WITH THE CHAIRPERSON. AND IF
I CAN, I'D LIKE US TO DIG IN A
LITTLE BIT ABOUT THE THIS
INTENTION TO BE ALONE OR NOT.
YOU SAID A FEW TIMES THAT IT WAS
TEMPORARILY AND THAT IT WOULD BE
REVERTED BACK. SO WHY ARE WE
UNWILLING OR UNABLE TO USE
LANGUAGE SIMILAR TO LOANS THAT
WE DO AND OTHER PARTS OF OUR
BUDGET? YEAH I THINK THAT THE
WAY THE WAY THAT WE HAVE, IT'S
STRUCTURED IT WOULD PROVIDE THE
STATE WITH THE MAXIMUM
FLEXIBILITY. AS YOU KNOW, WE DO
TRACK YOU KNOW, OUT YEAR ISSUES
THAT IMPACT THE BUDGET AND IN
OUR LONG TERM FORECASTS, BUT THE
STATE YOU KNOW, BUDGETS ONE YEAR
AT A TIME, AND WE GO THROUGH OUR
DELIBERATIVE STATE, YOU KNOW,
PUBLIC PROCESS TO CRAFT OUR
BUDGET EVERY YEAR. BASED ON YOU
KNOW THE STATE OF THE ECONOMY
AND THE FUNDS AVAILABLE. I'M SO
YEAH, UH, THIS PARTICULAR ITEM
YOU KNOW, WE ARE TRACKING IN OUR
LONG TERM EXPENSES WITH THE
INTENTION OF REPAYING THE FUNDS
WHEN, WHEN THE SUBSIDIES AND.
AND DOING SO. THE WAY WE HAVE IT
STRUCTURED, WOULD GIVE THE STATE
THE MAXIMUM FLEXIBILITY. UM BUT
I THINK, UH, YOU KNOW, AS FAR AS
YOU KNOW, SO OUR PROPOSAL IS NOT
TO STRUCTURE THIS AS A LOAN. UM
YOUR YOUR COMMENT THERE SAID IT
WAS NEGOTIATIONS THAT IT WAS
BACK AND FORTH BETWEEN THE
ADMINISTRATION AND LEGISLATURE
AND THUS, LAST YEAR WE HAD
ENTERED INTO A NEGOTIATION AND
WROTE THE LAW TO APPROPRIATE THE
FUNDS THAT I'M STRUGGLING. TO
UNDERSTAND WHY THOSE FUNDS WERE
NOT SPENT AS LEGISLATIVE INTENT
WAS CLEAR. WHAT THAT FUNDING AND
SO I'D LIKE TO UNDERSTAND HOW
WE'RE COMFORTABLE NOW. TO TAKE
THOSE FUNDS AND TO SWEEP THEM
INTO THE GENERAL FUND. WHEN
THROUGH NEGOTIATIONS WE HAD
NEGOTIATED AND APPROPRIATED
THOSE FUNDS WITH CLEAR INTENT.
HOW ARE WE NOW COMFORTABLE TO
SWEEP THOSE FUNDS TO THE GENERAL
FRONT? I THINK THE PURPOSE OF
THOSE FUNDS AND QUESTIONED WAS A
CONTINGENCY BECAUSE WE DIDN'T
KNOW WHAT THE FEDERAL GOVERNMENT
WAS GOING TO DO. AND SINCE THE
GOVERNMENT FEDERAL GOVERNMENT
ACTED YOU KNOW AND BOUGHT OUT
THE STATE MONEY THAT THAT
EXPLAINS WHY THE CONTINGENCY IS
NOT NEEDED IN IN THE GOVERNOR'S
VIEW. UM. WE HEARD FROM THE LAO
THAT IT WAS THE SUBSIDIES, WHICH
WERE UM THE FEDERAL GOVERNMENT
HAD WERE HIGHER THAN THE STATE
WAS SUGGESTING WHERE THEIR UPPER
OTHER OPPORTUNITIES FOR US TO
PROVIDE ADDITIONAL FINANCIAL
ASSISTANCE OUTSIDE OF WHAT WAS
BEING PROVIDED WITHIN THOSE
SUBSIDIES. AND WHY DID WE CHOOSE
NOT TO FOLLOW THROUGH WITH THOSE
ACTIONS? YOU KNOW THE
LEGISLATURE PASSED SB 9 44,
WHICH WAS WHICH WOULD HAVE
CREATED A STATE PROGRAM AND THE
GOVERNOR VETOED THAT BILL, YOU
KNOW, DUE TO CONCERNS OVER THE
DECLINE IN REVENUES THAT WERE
OCCURRING AT THAT TIME, AND
SINCE THAT TIME HAVE HAVE
CONTINUED AT GREATER LEVELS, SO
THAT THAT WAS SOME OF THE
CONCERNS THAT WERE IDENTIFIED IN
THE MESSAGE GOVERNOR DID SIGN
AND IT IS DR WOODS. BILL, MAYBE
25 30. I BELIEVE THAT EXTENDED
COVERED CALIFORNIA BENEFITS TO
UNION WORKERS WHO WERE STRIKING.
AND THAT WAS NOT FUNDED AND THE
GOVERNOR'S JANUARY BUDGET AND
WOULD HAVE SEEMED IDEAL FOR US
TO USE THIS RESERVE FUNDS TO
HELP TO SUPPORT AND I'M
WONDERING NOW, IF WE'RE GOING TO
SWEEP THIS TO THE GENERAL FUND,
DO WE INTEND TO FUND DR WOODS
BILL WHICH WAS AGAIN SIGNED INTO
LAW BY THE GOVERNOR? YEAH THAT
BILL IN QUESTION IS SUBJECT TO
AN APPROPRIATION, WHICH WAS NOT
PROVIDED THROUGH THE BILL NOR
THE BUDGET PROCESS. SPECIFICALLY
FOR THAT PURPOSE. UM SO THIS
CROSS OVER, THOUGH, WHERE THE
LEGISLATURE BUT 300 MILLION TO
HELP WITH FINANCIAL ASSISTANCE.
SIGNED A BILL BY DOCTOR WOULD,
BUT NOW YOU'RE SAYING WE DIDN'T
APPROPRIATE FUNDS TO HELP WITH
FINANCIAL ASSISTANCE? IT WOULD
SEEM THAT WE'RE TALKING PAST
EACH OTHER HERE. AND I THINK
WHAT I'M TRYING TO HAVE THE
ADMINISTRATION HERE IS REAL
LEGISLATIVE INTENT TO ADDRESS
THE AFFORDABILITY ISSUES THAT SO
MANY CALIFORNIANS ARE STRUGGLING
WITH. SO I'D LIKE TO GET A SENSE
OF HOW WE'RE OKAY. BOTH SIGNING
THE BILL AND THEN SAYING THERE'S
NO FUNDING WHILE SWEEPING FUNDS
INTO THE GENERAL FUND. HOW HOURS
HOW DOES THAT MAKE SENSE? YEAH I
THINK IT'S JUST, UM YOU KNOW THE
NATURE OF THE PROCESS OVER TIME.
THESE DECISIONS ARE PAYING THIS
DECIDED, YOU KNOW, BASED ON THE
LATEST ECONOMIC INFORMATION. AND
WE UNDERSTAND THAT THESE ARE
TOUGH CHOICES, YOU KNOW FOR THE
FOR THE LEGISLATURE AND THE
GOVERNOR AND MAKING THESE THESE
BUDGET DECISIONS. AND WE
UNDERSTAND THAT THERE'S A LOT OF
. NEEDS YOU KNOW, IN THE PUBLIC
FOR SERVICES, SO WE UNDERSTAND
THE DIFFICULTIES OF MAKING THESE
DECISIONS. I'D LIKE TO BRING A
MS KOEPPEL AND IF I CAN YOU
SPOKE ABOUT HOW HALF OF ALL
ENROLLEES OR STRUGGLING, CAN WE
PUT INTO CONTEXT, THE DECISIONS
THAT THE ADMINISTRATION HAS
MAKING AND WHAT EFFECT THIS
WOULD HAVE ON AVERAGE
CALIFORNIANS WHO ARE TRYING TO
MAKE HEALTH CARE AFFORDABLE. AS
WE UNDERSTOOD THE LEGISLATURE'S
INTENT LAST YEAR IT WAS THAT IF
THE FEDERAL GOVERNMENT EXTENDED
THE ASSISTANCE WITH PREMIUM
SUBSIDIES THAT THERE WOULD BE
HELP WITH COST SHARING DOCTOR
WOULD SPILL. UM, WHICH UM, WE
JUST. AS A FAIRLY SMALL BUDGET,
ASK ASSOCIATED WITH IT. UM ON
THE ORDER OF ONE OR $2 MILLION,
WAS ASSUMED TO BE PART OF THIS
LARGER PUZZLE AS YOU'VE
CORRECTLY IDENTIFIED. I WOULD
ADD THAT SECRETARY GALLEON
BRIEFING ADVOCATES ON THIS
BUDGET PROPOSAL WHEN QUERIED
ABOUT WHETHER WHAT WOULD HAPPEN
AFTER THE FEDERAL SUBSIDIES. UH,
EXPIRED, SAID THAT THEY WOULD
THINK ABOUT WHAT SHOULD HAPPEN
THEN. SO WITHOUT THE KIND OF
LANGUAGE YOU'VE BEEN CAREERING
ABOUT ABOUT LOANS WITHOUT THE
CLARITY ABOUT HOW MUCH MONEY HAS
BEEN COLLECTED, WHICH I DIDN'T
HEAR FINANCE ACTUALLY ANSWER
THAT QUESTION. WE HAVE OUR
ARITHMETIC, TOO. ADD UP ON A PER
YEAR BASIS. HOW MUCH IT IS, UM,
WITHOUT THAT KIND OF CLARITY
THAT YOU'VE IDENTIFIED, UM THIS
WILL SIMPLY DISAPPEAR INTO THE
GENERAL FUND AND NEVER BE USED,
AS THE GOVERNOR SAID ON THE
FIRST DAY OF HIS ADMINISTRATION
, AND AS THIS LEGISLATURE HAS
REPEATEDLY INTENDED SOME ASK
FINANCE AGAIN. IF WE CAN UNDER
QUESTION SIX, WE HAD ASKED HOW
MUCH REVENUE HAD BEEN COLLECTED.
YOU SIMPLY HAD STATED THAT IT
HAD BEEN SWEPT INTO THE GENERAL
FUND. CAN YOU QUANTIFY HOW MUCH
REVENUE HAS BEEN COLLECTED?
SINCE THE INDIVIDUAL MANDATE HAS
BEGUN? I WOULD SAY, YOU KNOW
THAT I HAVE NOT USED THE TERM
SWEPT BUT JUST THE NATURE OF THE
. OF THE PENALTY IS THAT IT
ACCRUES TO THE GENERAL FUND ON
THE NATURAL SO THAT THAT'S NOT
AN SOMETHING THAT THE
ADMINISTRATION IS DOING. IT'S
JUST THE WAY THAT THE LAW IS SET
UP. ON THAT ON THAT REVENUE
STREAM. UM DO WE HAVE A DOLLAR
AMOUNT OF REVENUE WAS THE AMOUNT
THAT'S COLLECTED IS THE 333 130
MILLION TO 350 MILLION ANNUALLY.
I HEARD YOU HEARD. SWEEP SWEPT.
SWEET BEANS SWEPT IN. I DON'T
KNOW. I MEAN, I HEARD YOU USED
THE WORD SWEET. WE INTEND TO
SWEEP THIS MONEY IS WHAT I HEARD
YOU SAY. MY NOTES. SAY THE SAME.
OKAY WELL HERE AND I'M NOT SURE
I APOLOGIZE FOR, UH FOR THE
STATEMENT AND SORRY, SIR. HOW DO
WE ENSURE THAT THESE DOLLARS
ULTIMATELY GET SPENT AS THEY
WERE INITIALLY INTENDED? BY
LEGISLATIVE INTENT. HOW DO I
STAY FOCUSED ON MAKING SURE THAT
WE CAN ADDRESS HEALTH CARE
AFFORDABILITY. I THINK YOU KNOW
THE ADMINISTRATION'S CONCERNS
REMAIN ON. UH, YOU KNOW, WE HAVE
CONCERNS WITH STARTING UP A NEW
STATE ONLY PROGRAM AND CONCERNED
WITH SUSTAINABILITY. FOR A NEW
PROGRAMS GIVEN THE CURRENT
ECONOMIC SITUATION. DO YOU WANT
TO MAKE ANY COMMENTS ABOUT
REDUCING DURING THE RECESSION
ARE THESE IS THIS THE RIGHT TIME
FOR CALIFORNIANS AS THEY'RE
STARTING TO EXPERIENCE MANY OF
THE COST PRESSURES HOW DO WE
ENSURE THAT WE'RE ADDRESSING
AFFORDABILITY EFFECTIVELY? I
THINK YOU KNOW, THROUGH THE
BUDGET PROCESS. UM YOU KNOW,
PRIORITIES ARE DETERMINED THAT
YOU KNOW THE GOVERNOR'S BUDGET
CONTINUES THE MEDICAL EXPANSION,
WHICH WAS YOU KNOW, CLEARLY A
PRIORITY. AND HIS BUDGET
MAINTAINS THAT, UH, YOU KNOW FOR
THOSE, YOU KNOW, ON THE LOWEST
ECONOMIC SIDE OF THE SCALE. AND
. YOU KNOW, WE UNDERSTAND THAT
THERE IS ADDITIONAL, UH, WANTS
AND NEEDS FOR OTHER POPULATIONS
. AND UNFORTUNATELY DUE TO THE
FISCAL SITUATION, THE CONCERN
REMAINS ON SUSTAINABILITY. AND
MAKING SURE THAT WE DON'T HAVE,
YOU KNOW, START UP THINGS THAT
WERE NOT ABLE TO CONTINUE SO
THAT THAT'S PART OF THE
DIFFICULTY. EARLIER YOU WERE
PRETTY CLEAR TO SAY THAT YOU
UNDERSTOOD LEGISLATIVE INTENT
REGARDING THE INDIVIDUAL
MANDATE. PENALTY. AND SO I LIKE
TO COME BACK. DO WE FEEL
CONFIDENT THAT WE'RE SPENDING
EFFECTIVELY TO HELP TO REDUCE
DOWN COSTS FOR ALL CALIFORNIANS
? AGAIN? I'LL BRING UP THE DATA
POINT THAT HALF OF ALL
CALIFORNIANS ARE DELAYING CARE
OR DELAYING PRESCRIPTIONS. DO WE
FEEL THAT OUR PROGRAMS ARE
EFFECTIVELY ADDRESSING
AFFORDABILITY? I WOULD CONSIDER
THAT TO BE, UH, YOU KNOW
SOMETHING THAT IS WORK IN
PROGRESS, AND IT'S EVERYBODY'S
CONCERNED ABOUT AFFORDABILITY.
SO I THINK THERE IS AGREEMENT ON
THAT THAT IT'S JUST DUE TO THE
ECONOMIC SITUATION. THIS MAY NOT
BE A GREAT TIME TO START UP NEW
PROGRAMS. I'M STRUGGLING AND I'M
HAPPY TO PUT A PIN IN IT FOR
TODAY, BUT I'LL COME BACK TO THE
HARD FOUGHT NEGOTIATIONS THAT WE
HAD LAST YEAR. TO PLACE THIS AS
A PRIORITY FOR US AS A
LEGISLATURE TO FUND THAT I'M
TRYING TO MAKE SURE THOSE
DOLLARS EFFECTIVELY STAY WITHIN
THIS AREA TO ADDRESS
AFFORDABILITY, AND I'M NOT
HEARING FROM THE ADMINISTRATION
THAT SAME COMMITMENT AND SO I
LIKE TO FIGURE OUT HOW WE CAN
EFFECTIVELY GET ONTO THE SAME
PAGE AS WE WRITE THE BUDGET THIS
YEAR. TO MAKE SURE THAT OUR
PRIORITIES ARE REFLECTED AND
WHAT ACTUALLY GETS IMPLEMENTED.
AND I'M STRUGGLING TO HEAR THE
ANSWERS THAT THERE IS A
WILLINGNESS TO COMMIT TO ALONE.
THAT INSTEAD WE'RE GOING TO TAKE
THESE FUNDS AND SWEEP THEM OR
BRING THEM INTO THE GENERAL FUND
THAT I'D LIKE TO UNDERSTAND HOW
WE CAN HAVE THE CONFIDENCE THAT
IF WE PRIORITIZE THIS AGAIN AS
THE LEGISLATURE TO ADDRESS
AFFORDABILITY THAT IT WILL
ACTUALLY BE IMPLEMENTED. SO IF
WE'RE ABLE TO COME TO SOME
AGREEMENT AS THE LEGISLATURE
WHERE IS THE ADMINISTRATION AND
HELPING US TO MAKE SURE WE CAN
IMPLEMENT AFFORDABILITY
MEASURES. YEAH I'D BE HAPPY TO
TAKE BACK. YOU KNOW THE CONCERNS
OF THE COMMITTEE. AND YOU KNOW,
I CAN, UH. YOU KNOW, RAISED THE
POSSIBILITY OF A LOAN AND SEE IF
THAT WOULD BE ACCEPTABLE OR AND
ALSO MENTIONED THE CONCERNS
ABOUT AFFORDABILITY. UM DOCTOR
WOULD. YEAH LOOK, I'M IN MY
NINTH YEAR IN THE LEGISLATURE
AND I HAVE SPENT MY ENTIRE
CAREER FOCUSING ON AFFORDABILITY
OF HEALTHCARE ACCESS TO
HEALTHCARE, HIGH QUALITY
HEALTHCARE. WE HAD. YOU KNOW THE
INDIVIDUAL MANDATE WAS NOT
INTENDED TO CREATE FUNDS FOR
OTHER GOVERNMENT PROGRAMS
OUTSIDE OF HEALTHCARE. IN MY
FROM MY PERSPECTIVE, I DON'T
THINK I WOULD HAVE SUPPORTED IT.
IF THAT WAS THE WAY I THOUGHT IT
WAS GONNA END UP UM, WHEN I LOOK
AT SOME OF THE OTHER CHALLENGES
WE HAVE IN HEALTHCARE WORKFORCE
, THIS WOULD ALL BE EASIER TO
SWALLOW IF THE MONEY WAS BEING
USED FOR WORKFORCE IF THE MONEY
WAS BEING USED FOR OTHER
PROGRAMS THAT ARE BEING CUT.
LIKE INDEPENDENT LIVING SERVICES
OR DISABILITY OF OTHER OTHER
NEEDS OF THE DISABILITY
COMMUNITY. HOW ABOUT, YOU KNOW,
DURABLE MEDICAL EQUIPMENT THAT
HASN'T SEEN. YOU KNOW ANY
ADDITIONAL RESOURCES IN LORD
KNOWS HOW MANY YEARS BUT THEY
JUST TAKE IT AND SWEEPING INTO
OTHER PROGRAMS OF STATE
INTEREST. JUST IT JUST IT JUST
FEELS LIKE A VIOLATION OF WHAT
WE THOUGHT WE WERE DOING, AND
CERTAINLY WHAT WE INTENDED TO
DO. IT'S PRETTY CLEAR WHAT WE
INTENDED TO DO. OBVIOUSLY THE
GOVERNOR HAS THE ABILITY TO DO
THIS. BUT IT IT DOESN'T. IT'S A
BITTER PILL TO SWALLOW. QUITE
FRANKLY. IT REALLY IS. AND
MEANWHILE HEALTH CARE CONTINUES
TO BE UNAFFORDABLE. 54% OF
PEOPLE HAVE DELAYED SOME SORT OF
TREATMENT IN THE LAST YEAR
BECAUSE OF THE COST. AND MONEY
THAT WE HAD DESIGNED FOR
AFFORDABILITY. JUST GET SWEPT
INTO ANOTHER PROGRAM, AND WE
DON'T EVEN KNOW WHERE IT'S GOING
TO GO. SEEING NO FURTHER
QUESTIONS ON THIS ISSUE. I WILL
. THANKS VERY MUCH. THIS PANEL
WE WILL NOW MOVE ON TO ISSUE.
OUR SECOND ISSUE IS THE OVERVIEW
OF THE DEPARTMENT OF HEALTH
CARE, ACCESS AND INFORMATION
BUDGET, WHICH WILL BE PRESENTED
BY DIRECTOR ELIZABETH LANDSBERG
. DIRECTOR LANDSBERG PLEASE
BEGIN WHEN YOU'RE READY. THANK
YOU VERY MUCH. MR CHAIR AND
MEMBERS. ELIZABETH LANDSBERG,
THE DIRECTOR OF THE DEPARTMENT
OF HEALTH CARE, ACCESS AND
INFORMATION HERE TO GIVE YOU AN
OVERVIEW OF OUR DEPARTMENT AND
OUR BUDGET. OUR CURRENT YEAR
BUDGET IS ONE POINT
5,000,000,338 MILLION PROPOSED
FOR FISCAL YEAR 23 24, THE
DECREASE OF MORE THAN A BILLION
IS DUE TO ONE TIME FUNDING. AND
FUNDING AVAILABLE FROM PRIOR
YEARS. WE ARE REQUESTING NINE
POSITIONS IN THIS BUDGET, WHICH
WOULD BRING US TO 702 POSITIONS
ARE STAFFING INCREASED FROM 6 29
27. OH TWO INCLUDES 64 POSITIONS
APPROVED AND FUNDED IN THE 22 23
BUDGET AND NINE POSITIONS
REQUESTED IN THE PROPOSED
BUDGET. H GUYS MISSION IS TO
EXPAND EQUITABLE ACCESS TO
QUALITY, AFFORDABLE HEALTH CARE
FOR ALL CALIFORNIANS THROUGH
BRAZILIAN FACILITIES, ACTIONABLE
INFORMATION AND THE HEALTHCARE
WORKFORCE EACH COMMUNITY NEEDS
AND I'LL JUST GO THROUGH VERY
QUICKLY ARE FIVE PROGRAM AREAS
ON THE DATA SIDE BY COLLECTS,
ANALYZES AND DISSEMINATES
INFORMATION ABOUT HOSPITALS.
SKILLED NURSING FACILITIES,
CLINICS AND HOME HEALTH AIDES
HOME HEALTH CLINICS. WE ALSO
HAVE IMPORTANT DATA REGARDING
PATIENT OUTCOMES. UH THIS WORK
ALSO ENCOMPASSES BUILDING
CALIFORNIA'S ALL PARA CLAIMS
DATABASE, THE HEALTHCARE
PAYMENTS DATA PROGRAM, WHICH
I'LL TALK ABOUT IN THE NEXT
AGENDA ITEM. HK IS THE BUILDING
DEPARTMENT FOR HOSPITALS AND
SKILLED NURSING FACILITIES,
MONITORING THE CONSTRUCTION
RENOVATION AND SEISMIC SAFETY OF
THESE FACILITIES. OUR PRIMARY
GOAL IS PATIENT SAFETY TO ENSURE
THAT EACH FACILITY REMAINS
FUNCTIONAL IN THE EVENT OF A
NATURAL DISASTER, INCLUDING
MAJOR EARTHQUAKES, AND JUST A
NOTE OF PRIDE IS THAT ONE OF OUR
STRUCTURAL ENGINEERS IS TODAY
LEADING A DELEGATION TO TURKEY
TO ASSIST IN THE RECOVERY. AFTER
THE SERIES OF CATASTROPHIC
EARTHQUAKES THERE AND CONDUCT
RESEARCH IN AN AREA WITH SIMILAR
SEISMICITY TO CALIFORNIA. WE
ALSO HAVE THE CALIFORNIA HEALTH
FACILITY CONSTRUCTION LOAN
INSURANCE PROGRAM OR THE CAL
MORTGAGE PROGRAM, WHICH OFFERS
LOAN INSURANCE TO NONPROFIT AND
PUBLIC HEALTH FACILITIES TO
DEVELOP AND EXPAND THEIR
FACILITIES, AND WE ARE
ADMINISTERING A NEW SMALL AND
RURAL HOSPITAL RELIEF PROGRAM TO
PROVIDE GRANTS TO SMALL, RURAL
AND CRITICAL ACCESS HOSPITALS.
FOR SEISMIC SAFETY COMPLIANCE.
WE HAVE A RANGE OF HEALTH
WORKFORCE PROGRAMS THAT SEEK TO
BUILD A WORKFORCE IN CALIFORNIA
THAT REFLECTS CALIFORNIA'S
RACIAL AND LINGUISTIC DIVERSITY
, SERVES MEDICALLY UNDERSERVED
AREAS AND ALSO SERVES MEDICAL
MEMBERS. AND I KNOW WE HAVE A
ITEMS LATER THAT WILL THAT WILL
DELVE INTO OUR WORKFORCE
PROGRAMS. UM WE HAVE BEEN IN THE
LAST YEAR, PROVIDING SUPPORT TO
PROGRAMS TO ENSURE CALIFORNIANS
HAVE ACCESS TO REACH
REPRODUCTIVE HEALTH CARE
SERVICES, INCLUDING ABORTION
SERVICES, AND ALL OF THOSE
INITIATIVES ARE UNDERWAY TO MAKE
SURE WE HAVE SUFFICIENT
PROVIDERS IN CALIFORNIA TO
PROVIDE REPRODUCTIVE HEALTHCARE
SERVICES TO PROVIDE CAPITAL
INFRASTRUCTURE, BOTH THE CLINICS
AND PROVIDERS BOTH DIGITAL
INFRASTRUCTURE, AS WELL AS AS
PHYSICAL. SAFETY INFRASTRUCTURE
AND THEN WE'RE ALSO OVERSEEING
UNCOMPENSATED CARE AND ABORTION
, PRACTICAL SUPPORT FUNDS TO
SUPPORT ACCESS TO THOSE SERVICES
. HK I ADDED IN THE LAST YEAR
FIFTH PROGRAM AREA, ADVANCING
HEALTH CARE AFFORDABILITY IN THE
STATE AND I'LL TALK IN THE NEXT
AGENDA ITEM ABOUT THAT WORK,
WHICH INCLUDES THE OFFICE OF
HEALTH CARE AFFORDABILITY. THE
HEALTHCARE PAYMENTS DATA PROGRAM
CALERA X IN THE HOSPITAL FAIR
BUILDING PROGRAM. I WAS ASKED TO
GIVE A BRIEF UPDATE ON OUR
RECAST FROM THE OFFICE OF
STATEWIDE HEALTH PLANNING AND
DEVELOPMENT OR ASH POD TO H. CHI
UM, SO THAT RECAST WAS DONE IN
THE 21 22 BUDGET AND WE FORMALLY
BECAME HK. I IN 2021. THIS
TRANSITION WAS IN LIGHT OF OUR
GROWING RESPONSIBILITIES AND
EXPANDING PORTFOLIO, WHICH MADE
IT TIME TO RECAST AND MODERNIZE
. SOME OF THE RECAST CHANGES
INCLUDED A NEW CALIFORNIA HEALTH
WITH WORKFORCE EDUCATION AND
TRAINING COUNCIL. TO PROVIDE
GUIDANCE ON STATEWIDE HEALTH,
WORKFORCE, EDUCATION AND
TRAINING NEEDS RELATED TO
PRIMARY CARE, BEHAVIORAL HEALTH
AND ORAL HEALTH. THE COUNCIL HAS
BEEN MEETING FOR MORE THAN A
YEAR NOW AND VERY PLEASED WITH
THE PROGRESS THAT THAT COUNCIL
IS MAKING. IT'S FULFILLING ONE
OF THE RECOMMENDATIONS OF THE
FUTURE WORKFORCE COMMISSION
REPORT. WE ALSO CREATED A NEW
CALIFORNIA HEALTH WORKFORCE
RESEARCH DATA CENTER TO BE THE
STATE'S CENTRAL HUB OF HEALTH
WORKFORCE DATA WITH NEW
STATUTORY AUTHORITY TO COLLECT
ADDITIONAL WORKFORCE DATA, SO WE
HAD TERRIFIC COLLABORATION WITH
THE DEPARTMENT OF CONSUMER
AFFAIRS TO COLLECT THAT NEW DATA
. WE HAVE PUBLISHED OUR FIRST
RESEARCH DATA CENTER REPORT AND
WAS VERY PLEASED THAT THE AGENDA
INCLUDES ACTUALLY SEVERAL PAGES
OF FINDINGS FROM THAT REPORT.
THE DEMOGRAPHIC INFORMATION,
GEOGRAPHIC INFORMATION AND THE
LIKE. UM ALSO, AS PART OF THE
RECAST WE, UH, DECOMMISSIONED
THE HEALTH PROFESSIONS EDUCATION
EDUCATION FOUNDATION WHILE
REMAINING WHILE CONTINUING THOSE
PROGRAMS AND WE INTEGRATED THE
STATE OFFICE OF RURAL HEALTH AND
THE J ONE WAIVER PROGRAM FROM
THE DEPARTMENT OF HEALTH CARE
SERVICES OVER TO H CHI, AND
WE'RE ADMINISTERING THAT PROGRAM
. WE MADE SOME CHANGES TO OUR
DATA PROGRAMS, INCLUDING GREATER
FLEXIBILITY WITH THE OUTCOMES
REPORTING ON SURGICAL CARDIAC
PROCEDURES AND IMPROVED ACCESS
TO BIRTH AND DEATH DAY. DATA. SO
THAT'S MY OVERVIEW UNLESS THERE
ANY QUESTIONS. DEPARTMENT OF
FINANCE. JOSEPH DONALDSON
DEPARTMENT FINANCE NO ADDITIONAL
COMMENTS. THANK YOU. HELLO. GOOD
AFTERNOON COMMITTEE. JASON
CONSTANT CARILLO, CELIO. NOTHING
TO ADD ON THIS ITEM. BRING IT UP
TO THE DIOCESE, SEE IF ANY
MEMBERS HAVE QUESTIONS. SEEING
NONE. WE WILL THANKS VERY MUCH
THIS PANEL AND MOVE ON TO ISSUE
THREE. WONDERFUL SO I'M PLEASED
TO PRESENT ABOUT HK'S
AFFORDABILITY PROGRAMS, STARTING
WITH THE OFFICE OF HEALTH CARE
AFFORDABILITY, WHICH WAS CREATED
BY LAST YEAR'S BUDGET. SO WE'RE
CALLING THE OFFICE OF HEALTH
CARE AFFORDABILITY, OKA, UM, AND
THIS PROGRAM WILL ANALYZE
CALIFORNIA'S HEALTHCARE MARKET
FOR COST TRENDS AND DRIVERS OF
SPENDING. IT WILL ENFORCE
HEALTHCARE SPENDING TARGETS AND
CONDUCT COST AND MARKET IMPACT
REVIEWS OF PROPOSED HEALTHCARE
CONSOLIDATIONS, AND I WANT TO
RECOGNIZE ASSEMBLYMEMBER'S WOULD
AS BEING THE LEGISLATIVE
CHAMPION. IN WORKING WITH US SO
CLOSELY. TO GET THIS LANGUAGE
OVER THE FINISH LINE. TO DRIVE
TOWARDS HIGH VALUE SYSTEM. IN
ADDITION TO THE SPENDING GROWTH
TARGETS, OKA WILL MEASURE AND
PUBLICLY REPORT ON QUALITY AND
EQUITY MEASURES. ADOPTION OF
ALTERNATIVE PAYMENT MODELS WILL
SET BENCHMARKS FOR INVESTMENT IN
PRIMARY CARE, SPEND AND
BEHAVIORAL HEALTHCARE SPEND AND
WILL SET MEASURES AROUND
WORKFORCE STABILITY. GIVEN THE
ROLE THAT MARKET CONSOLIDATION
PLAYS IN DRIVING UP HEALTHCARE
COSTS WILL HAVE NEW AUTHORITY TO
REVIEW PROPOSED MERGERS AND
ACQUISITIONS OF HEALTHCARE
ENTITIES IN THE STATE. SO I AM
PLEASED TO GIVE A HIGH LEVEL
UPDATE ON WHERE WE ARE WITH
IMPLEMENTATION OF OCHA. WE'VE
HIRED OUR DEPUTY DIRECTOR WHO,
IN TURN, HAS HIRED HIS THREE
ASSISTANT DEPUTY DIRECTORS. IN
HIS LEADERSHIP TEAM, AND SO THUS
FAR WE HAVE FILLED 25 OF OUR 59
POSITIONS AUTHORIZED FOR THE
CURRENT YEAR AND ARE
AGGRESSIVELY RECRUITING TO FILL
OUR REMAINING POSITIONS. STAFF
AND HIRED CONTRACTORS ARE
WORKING DILIGENTLY TO PREPARE
FOR THE HEALTH CARE
AFFORDABILITY BOARD MEETINGS AND
THE ADVISORY COMMITTEE,
PARTICULARLY AROUND SETTING THAT
SPENDING GROWTH TARGET. UM AND
PREPARING FOR THE COST AND
MARKET IMPACT REVIEWS, WHICH
START IN 2024. WE'RE PLEASED
THAT OKA WILL HOLD THE FIRST
MEETING OF THE HEALTH CARE
AFFORDABILITY BOARD NEXT WEEK.
ON MARCH 21ST. THE BOARD'S
RESPONSIBILITIES INCLUDE SETTING
THE SPENDING TARGET APPROVING
KEY BENCHMARKS, SUCH AS
STATEWIDE GOALS FOR THE ADOPTION
OF ALTERNATIVE PAYMENT MODELS
AND SPENDING FOR PRIMARY CARE
AND BEHAVIORAL HEALTH. THE BOARD
WILL ALSO APPOINT AN ADVISORY
COMMITTEE. UM WE HAVE MADE A
CALL FOR INTEREST FROM
INDIVIDUALS WHO WISH TO SERVE ON
THE ADVISORY COMMITTEE, WHICH
DOES HAVE TO INCLUDE
REPRESENTATIVES FROM CONSUMER
GROUPS, PAYERS. HOSPITALS
ORGANIZED LABOR, HEALTHCARE
WORKERS, MEDICAL GROUPS,
PHYSICIANS AND PURCHASERS. SO
MUCH OF 2023 WILL BE A SERIES OF
DESIGN DECISIONS FOR MEASURING
TOTAL HEALTHCARE EXPENDITURES.
HOW DOES THE STATE WANTED TO
FIND THE PARAMETERS AROUND
MEASURING TOTAL HEALTH CARE
COSTS AND EXPENDITURES IN THE
STATE, SO WE'LL DO SO WITH INPUT
FROM THE ADVISORY COMMITTEE
TECHNICAL WORK GROUPS WHICH WE
HAVE STARTED TO PUT TOGETHER. UM
AND WE'VE HAD WONDERFUL
COLLABORATION WITH OUR SIBLING
DEPARTMENTS, INCLUDING
DEPARTMENT OF HEALTH CARE
SERVICES AND DEPARTMENT OF
MANAGED HEALTH CARE, AS WELL AS
OTHER STAKEHOLDERS TO SUPPORT A
ROLE MAKING PACKAGE FOR DATA
COLLECTION. ONCE THOSE
PARAMETERS ARE LAID OUT PAIRS
WILL FIRST REPORT TOTAL HEALTH
CARE EXPENDITURE DATA FOR A
BASELINE REPORT WITH DATA FROM
2022 2023. WE ARE EXPECTED TO
COMPLETE DATA. UH HAVE THAT DATA
COLLECTION COMPLETED BY
SEPTEMBER 2024 FOR OUR FIRST
REPORT IN THE SUMMER OF 2025. IN
LATE 23 LOCAL WILL THEN ENGAGE
THE BOARD ON THE METHODOLOGY FOR
SETTING THE SPENDING TARGETS.
THE FIRST SPENDING TARGET HAS TO
BE PROPOSED BY MARCH 1ST OF 2024
FOR THE 2025 SPENDING YEAR THAT
1ST 2025 TARGET IS A IS NOT AN
ENFORCEABLE TARGET. IT'S A
BASELINE TARGET. THEIR FIRST
ENFORCEABLE TARGET WILL BE FOR
CALENDAR YEAR, 2026. WE'RE ALSO
FOCUSED ON THE COST AND MARKET
IMPACT REVIEW PIECE OF THE
OFFICE BECAUSE THE OFFICE HAS
NEW AUTHORITY TO ANALYZE
HEALTHCARE, ENTITY, MERGERS AND
ACQUISITIONS LIKELY TO IMPACT
COMPETITION, PRICE ACCESS,
QUALITY AND EQUITY, SO WE ARE
ALREADY BEGINNING WORK TO
DETERMINE THE REQUIREMENTS FOR
NOTICES BECAUSE THOSE NOTICES DO
NEED TO START IN JANUARY OF 2024
. SO WE'LL PREPARE A RULEMAKING
PACKAGE IN THIS THIS FALL OF
2023 SPECIFIC TIMELINES AND
FACTORS. TO DECIDE WHICH WHICH,
UM, PROPOSED MERGERS AND
ACQUISITIONS HAVE TO GO THROUGH
THIS NEW PROCESS. WE'RE ALSO
STARTING WORK TO SET THE GOALS
FOR PRIMARY CARE AND THE
ALTERNATIVE PAYMENT MODEL, UM,
WORK, WHICH IS WHICH IS VERY
IMPORTANT. IF THERE ARE NO OTHER
QUESTIONS ON, OKAY, I'M HAPPY TO
MOVE TO HPD. WHAT'S NEXT YEAR
FROM BETH COUPLE WITH HEALTH
ACCESS. EXCUSE ME? NOPE I GO
THROUGH THE REST OF THE ITEMS.
OKAY, SO I WAS ALSO ASKED TO
GIVE AN UPDATE ON THE ON THE
HEALTH CARE PAYMENTS DATA
PROGRAM OF REFERRED TO IT IN
OTHER STATES, AS ALL PAIRS
CLAIMED DATABASE. UM SO THIS THE
INFORMATION FOR HPD IS INTENDED
TO SUPPORT GREATER HEALTH COST
TRANSPARENCY AND TO INFORM
POLICY DECISIONS. UM, AND I'M
REALLY HAPPY TO GIVE A REPORT
HERE THAT WE'RE MAKING WONDERFUL
PROGRESS IN MEETING THE
REQUIREMENT OF SUBSTANTIAL
COMPLETION BY THIS NUMBER OF
2023. SO WE HAVE BEEN
COLLECTING, UM, LITERALLY
BILLIONS OF UM, MEDICAL CLAIMS
AND ENCOUNTER. DATA ELEMENTS AND
WE'RE ON TRACK AND MAKING
PROGRESS TO IMPLEMENT THE HPD.
SO WE'VE COLLECTED HISTORICAL
FILES FROM THE WE'RE GETTING THE
DATA FROM COMMERCIAL PAIRS. UM
AND INSURERS DIRECTLY FROM THEM
. WE'RE GETTING THE DATA ON
MEDICAL FEE FOR SERVICE FROM THE
DEPARTMENT OF HEALTH CARE
SERVICES AND THE MEDICARE DATA
WE ARE GETTING FROM THE CENTERS
FOR MEDICARE AND MEDICAID
SERVICES. WE'VE DEVELOPED
INITIAL ANALYTIC DATA SET
OUTPUTS TO BE USED FOR PUBLIC
REPORTING AND ARE EXCITED TO
START ISSUING THOSE FIRST SET OF
REPORTS THIS SUMMER. WE HAVE
ALSO DEVELOPED DATA RELEASE
REGULATIONS FOR ACCESS TO
NONPUBLIC DATA SUCH AS RESEARCH
DATA, AND WE'VE BEEN CONDUCTING
ONGOING ADVISORY COMMITTEE
MEETINGS AND RECENTLY FORMED A
NEW DATA RELEASED COMMITTEE THAT
STARTED MEETING IN DECEMBER. WE
ALSO SUBMITTED A REPORT WITH
LONG TERM FUNDING OPTIONS FOR
HPD, UH, FOR THE HPD PROGRAM TO
THE LEGISLATURE JUST IN THE LAST
TWO WEEKS. ON CALORIE REX.
ANOTHER IMPORTANT AFFORDABILITY
PROGRAM. LAST YEAR'S BUDGET
INCLUDED $100 MILLION INVESTMENT
FOR THE CALORIE X BIOSIMILAR
INSULIN INITIATIVE, SO THAT
INCLUDED $50 MILLION FOR DRUG
DEVELOPMENT. AND $50 MILLION FOR
A SECOND PHASE AROUND ME AND A
MANUFACTURING FACILITY, SO WE
HAVE SELECTED A PARTNER TO
DEVELOP, MANUFACTURE AND
DISTRIBUTE LOWER COST
TRANSPARENTLY PRICED VERSIONS OF
INSULIN. THREE DIFFERENT TYPES
OF LARGE JEAN GASPARD AND LIST,
BRO AND WE HOPE TO NAME THE
PARTNER VERY SHORTLY IN THE NEXT
COUPLE OF WEEKS. WE WILL BE
INVOLVED IN THE GOVERNANCE OF
THE CONTRACTING PARTNER TO
ENSURE THAT WE HAVE APPROPRIATE
MONITORING AND OVERSIGHT OF OUR
INVESTMENT, SO THERE WILL BE A
NEW JOINT STEERING COMMITTEE
WITH EQUAL REPRESENTATION FROM H
. CHI AND THE CONTRACTING
PARTNER TO OVERSEE THE
DEVELOPMENT, MANUFACTURE AND
COMMERCIALIZATION OF THE INSULIN
PRODUCTS. THE FIRST INSULIN PLOT
PRODUCT ALLERGY AND SHOULD BE IN
THE PROCESS FOR FDA APPROVAL
SOMETIME IN 2024, WITH PUBLIC
AVAILABILITY THEREAFTER, AND THE
OTHER TWO PRODUCTS ASKED PART
AND LIST BOROUGH FOLLOWING. THE
LAST PROGRAM I WAS ASKED TO GIVE
AN UPDATE ON WAS THE HOSPITAL
FAIR BUILDING PROGRAM, WHICH WAS
ESTABLISHED BY 10. MAYBE 10 20
BY ASSEMBLYMEMBER'S FRIEDMAN. IT
EXPANDS CURRENT REPORTING AND
REQUIREMENTS AND REQUIRES
QUALIFYING HOSPITALS TO SUBMIT
TO HK I THE HOSPITAL DEBT
COLLECTION POLICY, UM SO H CHI
IS TAKING OVER. ENFORCEMENT OF
THE HOSPITAL FAIR PRICING ACT,
WHICH PREVIOUSLY WAS ENFORCED BY
THE DEPARTMENT OF PUBLIC HEALTH
, AND WE WILL HAVE OUR FIRST
CONSUMER FACING PROGRAM WITH
CONSUMERS WHO FEEL THEY WERE
IMPROPERLY BILLED BY A HOSPITAL
ABLE TO FILE A COMPLAINT WITH H.
CHI. SO THOSE ARE MY OVERVIEW OF
THE FOUR PROGRAMS. THANK YOU.
NEXT WE WILL HEAR FROM BETH
PEOPLE WITH HEALTH ACCESS, AND I
MAY ASK US TO CREATE SOME SPACE
FROM THAT LEDGE WITH S E I U
WHO'S NEXT? THAT'S FIRST, OF
COURSE, BASKETBALL WITH HEALTH
ACCESS CALIFORNIA UM. HAPPY TO
CREATE SPACE, BUT UM. THANK YOU,
MR CHAIR AND MEMBERS FOR
OVERSIGHT ON THE OFFICE OF
HEALTH CARE AFFORDABILITY. UM
AND FOR THE OTHER PROGRAMS THAT
HK IS TASKED WITH IMPLEMENTING
IT IS VERY APPROPRIATE THAT YOU
BEGIN THIS TASK. THIS IS AS YOU
HEARD. FROM THE DIRECTOR, THE
BEGINNING OF A PROCESS TO TRY
AND BEND THE COST CURVE IN
CALIFORNIA AND BECAUSE I THINK
YOU WERE THE BEGINNING OF A
DECADE OF OVERSIGHT AND SOME OF
YOU MAY QUAIL OR SOME OF YOU WHO
ARE NEW TO THIS MAY THINK
THERE'S MY CAREER AHEAD OF ME.
UM BUT I THINK IT'S A DECADE OF
OVERSIGHT. I WANT TO STEP BACK
ON BEHALF OF CONSUMERS AND SAY
WHY WE WERE THE MOST STEADFAST
SUPPORTERS OF THIS PROPOSAL.
OVER THE LAST 20 YEARS, HEALTH
INSURANCE PREMIUMS IN CALIFORNIA
HAVE DOUBLED. WAGES ARE FLAT.
THESE ARE RELATED FACTS. THE
FACT IS, COMPENSATION INCLUDES
BOTH WAGES AND HEALTH BENEFITS.
AND IF YOU HAVE SOMEONE WHO'S
LIVING ON 20 OR 30 OR 40 $57,000
A YEAR, ASKING THAT THE EMPLOYER
FUND $25,000 IN FAMILY HEALTH
COVERAGE IS A LOT OF MONEY. IT'S
NOT SO MUCH IF YOU HAVE A FAMILY
LIVING OUT A COUPLE $100,000 A
YEAR IS A PERCENTAGE. THAT
REALITY HAS WORSENED INCOME IN
RICK QUALITY. IT WORSENS ALL OF
THE INCOME RELATED SOCIAL
DETERMINANTS OF HEALTH, HOUSING
, INSECURE HOUSING, INSTABILITY
, FOOD INSECURITY, INABILITY TO
AFFORD UTILITIES. EVEN FOR
MIDDLE CLASS FAMILIES. IT MEANS
IT'S HARDER TO AFFORD THE KID'S
COLLEGE EDUCATION, RETIREMENT.
ALL OF THE THINGS THAT MATTER TO
CALIFORNIA FAMILIES. WE'RE GOING
TO ARGUE A LOT OVER WHAT ARE THE
ECONOMIC AND POPULATION
INDICATORS SHOULD IT BE C P I W
OR C P? I YOU AND NO, I CAN'T
TELL YOU THE DIFFERENCE BETWEEN
THE TWO AT THE MOMENT, BUT I'M
SURE WE'LL KNOW IN SIX MONTHS.
THE DIFFERENCE BETWEEN
HEALTHCARE COSTS GROWING AT 3%
AS MANY STATES ARE PROPOSED, AND
FOUR OR FIVE OR SEVEN OR 8% ARE
TREND HAS BEEN SEVEN OR 8. IS
THE DIFFERENCE BETWEEN WORSENING
INCOME IN QUALITY AND WORSENING
INCOME RELATED SOCIAL
DETERMINANTS OF HEALTH. I WOULD
ALSO SAY IT GOES DIRECTLY TO THE
JURISDICTION OF THIS COMMITTEE.
MR CHAIR. I KNOW. YOU KNOW, I
THINK OTHER MEMBERS OF THIS
COMMITTEE MAY KNOW THE UNITED
STATES HAS THE MOST EXPENSIVE
HEALTH CARE SYSTEM IN THE WORLD.
YEAH AND WE DON'T GET MORE FOR
IT. WE DON'T GET MORE DOCTOR
VISITS. WE DON'T GET MORE
HOSPITAL DAYS. WE DON'T GET
BETTER OUTCOMES WERE NOT
HEALTHIER. WE PAY MORE AND GET
LESS. UM. AT THE SAME TIME,
OTHER COUNTRIES SPEND FAR MORE
THAN WE DO ON HUMAN SERVICES AND
ON HOUSING SUPPORT. THAT MONEY
THAT GOES THE TREND AND
COMMERCIAL COVERAGE THAT HAS
BEEN AT SEVEN OR 8% OF COVER OF
COSTS HAS DRIVEN UP HEALTH CARE
COSTS ACROSS THE BUDGET, AS WELL
AS FOR COMMERCIAL INSURANCE.
YOU'RE GOING TO HEAR YOU HAVE
ALREADY HEARD A LOT FROM
HOSPITALS ABOUT HOW TOUGH IT IS
TO DEAL WITH MEDICAL WE HAVE
HOSPITALS IN CALIFORNIA. THEY'RE
GETTING PAID 300 OR 400, OR 450%
OF MEDICARE AND THE HOSPITALS
THAT GET PAID THE MOST DO THE
LEAST MEDICAL. SO THIS WORK THAT
IS BEFORE THE FIRST OF HEALTH
CARE AFFORDABILITY IS AMONG THE
MOST IMPORTANT WORK IN TERMS OF
TRANSFORMING HEALTHCARE. THE
REASON THAT THE OFFICE OF HEALTH
CARE AFFORDABILITY AND WE WERE
INSTRUMENTAL ALONG WITH SEE YOU
AND OTHERS INCLUDES ALL THOSE
OTHER PROVISIONS IS THE REALLY
THE CHEAPEST THING IN HEALTH
CARE IS NOT TO GIVE ANYBODY CARE
. BUT THAT'S NOT THE INTENTION.
THE INTENTION IS THE TRIPLE AIM.
OF DOING SMARTER CARE BETTER OF
MAKING SURE THAT WE IMPROVE
OUTCOMES. WE REDUCED DISPARITIES
AND WE CONTROL HEALTH CARE
COSTS. AND IN CASE ANY OF YOU
WONDER HOW THAT CAN BE DONE. I'M
GOING TO QUOTE SOMETHING THAT DR
ARAMBULA IS FATHER USED TO SAY
TO ME. KIDS ENDING UP IN THE
EMERGENCY ROOM WITH ASTHMA IS
STUPID. THEY SHOULD HAVE THEIR
INHALERS. THEY SHOULD HAVE THEIR
ASTHMA MEANT MANAGED. HE SHOULD
NOT BE SEEING THEM IN THE
EMERGENCY ROOM, AND THAT'S JUST
ONE EXAMPLE OF HOW DOING CARE
BETTER CAN IMPROVE, HAVING
ADEQUATE ACCESS TO PRIMARY CARE,
AND THIS COMMITTEE WILL HEAR A
LITANY OF EXAMPLES WITH REGARD
TO BEHAVIORAL HEALTH. AND YOU'RE
YOU HAVE DONE A LOT ON MEDICAL
ON CALLUM AND YOU'LL HEAR MORE
ABOUT THAT. BUT THAT ISN'T THE
FUNDAMENTAL REBALANCING THAT I
SPOKE TO BETWEEN HEALTH AND
HUMAN SERVICES AND HEALTH AND
HOUSING, AND THAT'S THE PATH
THAT WE'RE HOPED THAT THE OFFICE
OF HEALTH CARE AFFORDABILITY
WILL PUT US ON. WE ALSO NEED THE
ABILITY TO LOOK AT THOSE
HOSPITALS. THEY'RE CHARGING 400
, OR 450% OF MEDICARE. IN
MASSACHUSETTS, MASSACHUSETTS
GENERAL EXCEEDED THEIR COST
TARGET BY $293 MILLION. THE ONLY
THING THEY COULD DO WAS IMPOSED
OF $500,000 FINE. FOR, UM.
FAILING TO FILL FILL OUT OF
PERFORMANCE IMPROVEMENT PLAN. UM
I'D SAY THAT'S THE EQUIVALENT OF
WORKING TICKET EXCEPT THE LAST
TIME I SAW PARKING TICKET FELT A
LOT MORE PAINFUL THAN THAT. SO
IN THE LAW THAT YOU PASSED. NOW
ALLOWS PENALTIES AS GREAT AS THE
AMOUNT THAT THE TARGET WAS
EXCEEDED, CAN MEASURE IT AND
ESCALATING. WE HOPE WE NEVER USE
THEM. THEY CERTAINLY WON'T USE
THEM ANY TIME SOON, BUT IT'S
THERE AND IT'S THERE FOR A
REASON. IT'S THERE TO SEND THE
MESSAGE THAT THE STATE OF
CALIFORNIA IS SERIOUS ABOUT
HEALTH CARE COSTS, AND THAT'S
WHY THE WORK OF THE HEALTHCARE
PAYMENT DATABASE IS SO IMPORTANT
, SO WE'LL KNOW THAT THEY HAVE
ACTUALLY MET OR EXCEEDED THE
TARGETS. UM AND A FINAL MENTION
ON TWO THINGS THAT ARE FAVORITES
THAT HEALTH ACCESS KELLER X. WE
THINK IT'S TERRIFIC THAT THE
STATE OF CALIFORNIA HAS GOTTEN
IN THIS BUSINESS ARE PLEASED TO
HEAR ABOUT THE PROJECT PROGRESS
THAT'S BEING MADE AND THEN THE
HOSPITAL FAIR PRICING ACT, WHICH
WHEN CALIFORNIA HAD SEVEN OR
EIGHT MILLION UNINSURED PRICE
GOUGING OF THE POOR BY HOSPITALS
WAS. UNCONSCIONABLE AND ROUTINE.
AND SO IT IS. VERY IMPORTANT
THAT CALIFORNIA ACTED IT'S EVEN
MORE IMPORTANT THAT WE HAVE
FOLLOWED THE PATH TO EXPAND
COVERAGE. SO MOST PEOPLE HAVE
INSURANCE. THANK YOU. NEXT WE'LL
HEAR FROM THAT LEDGE WITH CI.
YOU GOOD AFTERNOON CHAIR AND
MEMBERS OF THE COMMITTEE. THANK
YOU FOR THE OPPORTUNITY TO SPEAK
TODAY ON THIS IMPORTANT ISSUE. I
WANT TO JUST BRIEFLY TALK ABOUT
BOTH HEALTHCARE PAYMENTS
DATABASE AND THEN ALSO OUR
EXCITEMENT THAT WE SHARE WITH
HEALTH ACCESS AROUND THE OFFICE
OF HEALTH CARE. AFFORDABILITY
UM, FIRST JUST WANT TO THANK THE
DEPARTMENT FOR THEIR TIRELESS
EFFORTS AROUND CONVENING
STAKEHOLDERS AND PRODUCING THE
RECENT REPORT. ON THE OFFICE OR
ON THE HEALTH CARE PAYMENTS
DATABASE. FROM OUR VIEW, AS
MENTIONED BY HEALTH ACCESS. WE
SEE THIS AS A CRITICAL PIECE OF
THE FOUNDATION OF THE OFFICE OF
HEALTH CARE AFFORDABILITY,
LEADING TO A BETTER
UNDERSTANDING OF THE DRIVERS OF
HEALTH CARE COSTS AND
UTILIZATION THAT HPD WILL INFORM
BOTH THE MINISTRATIONS
LEGISLATURE AND RESEARCHERS ON
SPENDING UTILIZATION AND
PERFORMANCE ACROSS A RANGE OF
PROVIDERS. SUCH AS HOSPITALS,
PHYSICIANS AND OTHER SITES OF
CARE. THIS DATA WILL MAKE
CALIFORNIA ENABLE CALIFORNIA
MAKE BETTER INVESTMENTS IN HIGH
VALUE CARE, WHICH IS CRITICAL.
AS OF JANUARY BUDGET SHOWS
GENERAL FUND REVENUES IN
CALIFORNIA UNPREDICTABLE AND WE
ENCOURAGE THE LEGISLATURE TO
MOVE FORWARD WITH THE
SUSTAINABLE FUNDING STREAM THAT
SUPPORTS ROBUST IMPLEMENTATION
OF THE HPD AS DISCUSSED IN THE
DEPARTMENT'S RECENT REPORT ON
FUNDING OPTIONS FOR THE H P D A
REASONABLE AND SIT IN STEADY
FUNDING STREAM WOULD BE AN
ASSESSMENT ON HEALTH PLANS WERE
MANDATORY SUBMITTERS. TO THE HPD
ASSESSMENT ON MANDATORY
SUBMITTERS WOULD PROVIDE ONGOING
FUNDING STREAM FOR THE H B P D,
WHICH IS NOT OVERLY DEPENDENT ON
REVENUE GENERATED BY REQUESTS TO
ACCESS THE DATA COLLECTED BY THE
, UM, DATABASE. ANY REVENUE FROM
DATA ACCESS REQUESTS FROM SUCH
FROM LIKE. RESEARCHERS IS LIKELY
TO BE VARIABLE AND UNPREDICTABLE
AND KEEPING DATA ACCESS FEES.
REASONABLE WON'T COURAGE. THE
USE OF THE HPD BY RESEARCHERS
WHO WOULD BE DETERRED BY HIGH
USAGE FEES. ON THE OFFICE OF
HEALTH CARE AFFORDABILITY. THIS
IS PART OF A 10 YEAR CAMPAIGN.
THAT S C I U HEALTH ACCESS AND
OTHERS HAVE WORKED ON TO TRY TO
ADDRESS THE KEY DRIVERS OF
HEALTH CARE, ONE OF THE KEY
ISSUES AT THE BARGAINING TABLE.
OVER THE LAST 20 YEARS,
HEALTHCARE COSTS HAVE RISEN MUCH
FASTER THAN INFLATION, EQUALING
ALMOST AN ADDITIONAL $20,000
THAT SHOULD BE IN WORKERS'
POCKETS. THAT IS NOT THAT IS
ROUGHLY ABOUT $10, AN HOUR THAT
FAMILIES COULD USE TO ADDRESS
PRESSING NEEDS, SUCH AS HOUSING
COSTS AND FUTURE FOOD SECURITY.
THE RISING COST OF HEALTH CARE
IS ACUTELY FELT, PARTICULARLY BY
LOW WAGE WORKERS RATES OF JOB
BASED COVERAGE OR SNIFFING LEE
LOWER FOR LOW INCOME. BLACK
LATINO IMMIGRANT AND YOUNG ADULT
WICKER WORKERS THAN THEY ARE FOR
CALIFORNIANS. OVERALL THIS MEANS
THAT LOW WAGE WORKERS ARE ON THE
HOOK FOR MORE OF THE INCREASE IN
HEALTH CARE COSTS COMPARED TO
THEIR HIGH WAGE COUNTERPARTS.
THROUGH THE OFFICE OF HEALTH
CARE AFFORDABILITY. WE HAVE
OPPORTUNITY TO ADDRESS THIS
RISING COST OF CARE, AND WE
SHOULD MEASURE OUR SUCCESS FOR
THE OFFICE OF HEALTH CARE
AFFORDABILITY ON THE IMPACT ON
LOW WAGE WORKERS, SUCH AS THE
PERCENT OF WORKER PAY THAT GOES
INTO HEALTHCARE. AND THE WORKERS
TOTAL TAKE HOME PAY SO THAT
WORKERS ARE SEEING IMPROVEMENTS
IN THERE, STAYING OR LIVING IN
HEALTH CARE SAVINGS ARE SHARED
WITH THESE WORKERS. THE OFFICE
HAS SOME IN CRITICAL
IMPLEMENTATION STEPS IN THE
COMING YEAR. THESE INCLUDE
DEFINING TOTAL HEALTHCARE
EXPENDITURE, ISSUING REGULATIONS
AROUND DATA TO BE COLLECTED FROM
REGULATED ENTITIES AND SETTING
UP SAFEGUARDS TO ENSURE THAT
ONGOING STABILITY OF THE
HEALTHCARE WORKFORCE, COLLECTING
THE DATA FROM PAYERS PROVIDERS
AND INTEGRATED DELIVERY SYSTEMS
THAT WILL BE NEEDED TO CARRY OUT
THE MISSION OF THE OFFICE WILL
BE A SUBSTANTIAL UNDERTAKING AND
WE ENCOURAGE THE LEGISLATURE TO
ENSURE THAT DATA COLLECTED IS
MADE PUBLIC AND IN SUCH A WAY
HAS TO ALLOW PURCHASERS AND
OTHER STAKEHOLDERS TO FULLY
PARTICIPATE IN THE PUBLIC
PROCESS. HEALTHCARE WORKFORCE.
STABILITY FROM OUR VIEW IS A
CRITICAL ISSUE, ESPECIALLY RIGHT
NOW WHEN WE ARE ALREADY IN THE
MIDDLE OF A HEALTHCARE WORKFORCE
CRISIS, WHERE WORKERS
PARTICULARLY LOW WAGE HEALTHCARE
WORKERS ARE LEAVING THE INDUSTRY
AS WE HAVE SEEN FROM THE RECENT
SPIKE AND SPENDING ON CONTRACT
AND TRAVEL STAFF. HEALTHCARE
WORKFORCE SHORTAGES ARE ALREADY
IMPACTING THE ABILITY OF THE
SYSTEM TO PROVIDE TIMELY ACCESS
OF CARE AND CONTROL COSTS. AS
THE OFFICE UNDERTAKES ITS
MISSION. WE ENCOURAGE THE
LEGISLATURE TO LAYOUT TO STAY
ACTIVELY INVOLVED IN THE
PROCESS. ASSESS IN ORDER TO
GUARANTEE THAT COST GOES,
TARGETS ARE CONSTRUCTED. SO AS
TO ENSURE THAT THE HEALTHCARE
FACILITY ARE ADEQUATELY STAFFED
AND COST CONTAINMENT EFFORT.
EFFORTS ARE NOT BORN ON THE
BACKS OF LOW WAGE HEALTHCARE
WORKERS. WE LOOK FORWARD TO
WORKING WITH THE ADMINISTRATION
LEGISLATURE ON THESE KEY ISSUES.
THANK YOU. DEPARTMENT OF
FINANCE. NO ADDITIONAL COMMENT.
THANK YOU, LEO. ALSO NO COMMENT
BUT AVAILABLE FOR QUESTIONS.
WE'LL BRING IT UP TO THE
DIASPORA. ANY MEMBERS QUESTIONS.
I'LL KEEP IT HERE IF I CAN. UM
MS KAPIL AND MR LEDGE. BOTH
STATED THAT THIS WAS THE
BEGINNING OF A PROCESS AND THAT
IT WOULD REQUIRE A DECADE OF
OVERSIGHT. AND YET WHAT I'D LIKE
TO UNDERSTAND OR ANY
IMPLEMENTATION CHALLENGES OR
REMAINING GAPS THAT WE HAVE TO
ADDRESS AS WE'RE GOING THROUGH
THIS PROCESS. UM. SINCE THE, UH
, BOARD OF THE OFFICES ONLY
MEETING FOR THE FIRST TIME NEXT
WEEK, AND THEY'RE JUST STAFFING
UP. I WOULD COMMEND THE H CHI
FOR HAVING PUT OUT PRELIMINARY
TIMELINE OF WHAT NEEDS TO HAPPEN
WHEN AND WE KNOW ALSO IN OUR
CONVERSATIONS WITH THEM THAT
THEY'RE VERY FOCUSED AS YOU
HEARD TODAY. OR ON WHAT NEEDS TO
HAPPEN WHEN TO MEET THE
TIMELINES THAT WERE LAID OUT IN
THE LEGISLATION. A LOT OF
THOUGHT WAS GIVEN TO THAT AND UM
. WELL TO THE POINT WHERE I
SUSPECT WE MAY HAVE A CLEAN UP
BILL OR TWO, BUT WE A LOT OF
THOUGHT WAS GIVEN TO WHAT WHEN
AND HOW TO MAKE THAT WORK. AND
THE OTHER THING I WOULD SAY IS
THAT BETWEEN THE LEGISLATIVE
APPOINTEES AND THE GOVERNOR'S
APPOINTEES, IT'S A VERY
DISTINGUISHED BOARD THAT WE ARE
STARTING WITH. UM AND SOME OF
WHOM ALL OF WHOM WERE KNOWN TO
US IN OUR WORK. UM THINK OF DR
CARLYLE, WHO HEADS CHARLES DREW
MEDICAL SCHOOL WHO WAS A
PREVIOUS HEAD OF ASH PAD AND
VERY DISTINGUISHED ON THE ISSUE
OF HEALTH EQUITY SOMEONE WE'VE
WORKED WITH IN THE PAST CHRONIC
WHO STAFFED, UM THE HEALTH CARE
FOR ALL COMMISSION, AND BEFORE
THAT WAS WORKED IN HIS VERY
SENIOR LEVEL, AND, UM, THE OBAMA
ADMINISTRATION AND IMPLEMENTING
THE A AND THINGS LIKE RISK
ADJUSTMENT. UM ELIZABETH
MITCHELL WITH THE PACIFIC
BUSINESS GROUP ON HEALTH OF
LARGE PURCHASER PERSPECTIVE,
WHERE WE FOUND OURSELVES, OFTEN
THE LINED WITH THEIR CONCERNS
FOR THE REASONS THE METHODOLOGY
AND I TALKED ABOUT TODAY. SO YOU
HAVE IN LOUIS. THE SPEAKERS
APPOINTMENT WHO HAS LONG
EXPERIENCE WITH HEALTHCARE, BOTH
AS A PURCHASER AND REPRESENTING
HEALTHCARE WORKER UNIONS. THAT
UNIQUE COMBINATION. SO REALLY,
IT'S AN IMPRESSIVE, UM, GROUP OF
LEADERS THAT THEY WILL BE ABLE
TO RELY ON FOR THESE DECISIONS.
UH HUH. WE DO EXPECT THEM TO
LISTEN TO US. WE DON'T EXPECT
ALWAYS AGREE WITH THEM, JUST AS
WE DON'T ALWAYS AGREE WITH
ANYONE, BUT IT'S A NOTABLE GROUP
AND WHICH IS GOOD BECAUSE
THERE'S A LOT OF HEAVY LIFTING
IN THESE EARLY YEARS. AND I
THINK I WOULD POINT THIS
COMMITTEE TO DOCTOR WOULD HAS
PENDING LEGISLATION THIS YEAR TO
CLOSE SOME OF THE GAPS IN MERGER
OVERSIGHT THAT STILL REMAIN AND
WE NEED TO. THERE'S MORE WORK TO
DO IN THAT AREA. THE HK WILL
HAVE WILL DO STUDIES BUT THEY
CAN'T SAY YES OR NO. THEY CAN
ONLY STUDY THE IMPACTS. AND SO
IT WILL BE IMPORTANT THAT
PENDING LEGISLATION IS VERY
IMPORTANT FROM OUR PERSPECTIVE,
BUT THAT'S YOUR JOB, NOT THEIR
JOB TO DO. UM WE HAVE DONE OUR
BEST TO REALLY STAY IN THE
FRAMEWORK OF THE TRIPLE AIM. BUT
LIKE EVERYONE I'M TEMPTED TO SAY
, OH, THIS IS JUST ABOUT CUTTING
COSTS AND ALL THAT, BUT REALLY,
IT SHOULD BE ABOUT IMPROVING
CARE AT THE SAME TIME THAT WE'RE
TRYING TO MAKE THE RATE OF
GROWTH MORE REASONABLE THAN WHAT
I SHOWED YOU. ANY COMMENTS THAT
YOU CAN PROVIDE ON THE TIMELINE
EITHER FROM BETH COUPLE OR
MENTAL IT? DIRECTOR LANDSBERG.
YOU CAN COMMENT. IT SEEMED THAT
IT WAS MARCH 1ST 2024 FOR THE
FIRST BASELINE TARGET AND THEN
SUMMER OF 25 FOR THE REPORT. UM
CAN WE COMMENT ON WHAT THAT
TIMELINE WOULD MEAN? IF THAT'S
AN APPROPRIATE TIMELINE OR
ABSOLUTELY ABSOLUTELY, MR CHAIR
, SO WE DID THINK VERY CAREFULLY
ABOUT THE TIME FRAMES AND THEY
ARE AGGRESSIVE, BUT WE THINK
VERY MUCH DOABLE. WE REALLY DO
NEED TO FOCUS THE NEXT FEW
MONTHS ON UNDERSTANDING WHAT
TOTAL HEALTH CARE EXPENDITURE
IS, BUT THEN WE BELIEVE WE HAVE
ENOUGH TIME. TO HAVE
CONVERSATIONS ABOUT THE VARIOUS
ECONOMIC INDICATORS WE COULD USE
FOR THE SPENDING TARGETS. UM
THERE WERE THE NINTH STATE TO
HAVE A PROGRAM LIKE THIS.
MASSACHUSETTS HAS BEEN DOING IT
FOR MORE THAN A DECADE. OUR
NEIGHBOR TO THE NORTH HAS BEEN
DOING IT AND SO WILL WANT WILL
LOOK TO SOME OF OUR, UM OTHER
STATES THAT HAVE DONE THIS, BUT
WE THINK IT'S DOABLE. ALSO
STARTING THE MERGER ACQUISITION
NOTICE REQUIREMENT IN JANUARY OF
2024 IS AGGRESSIVE, BUT WE THINK
WE CAN DO IT. BUT I DO JUST WANT
TO HIGHLIGHT THAT. THIS IS NOT
JUST ABOUT COST. IT REALLY IS
ABOUT DRIVING TO A HIGH VALUE
SYSTEM. SO WE THINK THE FOCUS ON
INVESTING IN PRIMARY CARE AND
BEHAVIORAL HEALTH INVESTING
EARLY HAVING EARLY INTERVENTION
, UM WILL REALLY HELP US ACHIEVE
BOTH COST SAVINGS AS WELL AS
INCREASING HEALTHCARE. WITH THAT
I WILL THANKS VERY MUCH THIS
PANEL AND WE WILL MOVE ON TO
ISSUE FORTH. ISSUE FOR IS ON THE
EDUCATION AND TRAINING COUNCIL.
BUDGET CHANGE PROPOSAL TO BE
PRESENTED BY KAREN RUSSELL,
DEPUTY DIRECTOR OF HEALTH
WORKFORCE DEVELOPMENT AT EACH
GUY. MISS RIZZO. GOOD AFTERNOON.
SO, UM. I WILL PROVIDE AN
OVERVIEW OF THE BUDGET CHANGE
PROPOSAL FOR THE HEALTH
WORKFORCE, EDUCATION AND
TRAINING COUNCIL. SO THIS BUDGET
CHANGE PROPOSAL REQUEST TO
POSITIONS IN FISCAL YEAR 23 24
TO SUPPORT THE WORK OF THE
COUNCIL. UM AS DIRECTOR
LANDSBERG MENTIONED, THE COUNCIL
BEGAN MEETING IN 2022 HAS BEEN
DISCUSSING INNOVATIVE APPROACHES
AND STRATEGIES TO MEET THE
STATE'S NEEDS FOR NURSING,
BEHAVIORAL HEALTH AND GRADUATE
MEDICAL EDUCATION TRAINING SO
FAR. THE COUNCIL MEETS 4 TO 6
TIMES A YEAR, USUALLY OVER TWO
DAYS, AND SO TO SUPPORT THE
COUNCIL. THESE POSITIONS ARE
NEEDED TO SUPPORT THE
LOGISTICAL, THE ADMINISTRATIVE
THE DATA ANALYSIS. BUT ALSO THE
POLICY ANALYSIS NEEDS TO SUPPORT
THE WORK OF THE COUNCIL. IF
YOU'D LIKE. I CAN MOVE TO ANSWER
THE SPECIFIC QUESTIONS. OKAY
PLEASE DO PLEASE EXPLAIN THE
REASONS THAT THE BCP STATES THAT
A CHINESE FOUR PERMANENT
POSITIONS TO SUPPORT THE WORK OF
THE COUNCIL YET THIS REQUEST IS
ONLY FOR TWO POSITIONS. I
RECEIVED TWO POSITIONS FOR THE
COUNCIL THROUGH LAST YEAR'S
FISCAL YEAR. 22 23 HEALTH
WORKFORCE AND CENTRAL SERVICES
BCP. THAT'S THE FY 23 24
PROPOSAL REQUEST TWO MORE
POSITIONS TO BRING THE TOTAL
SUPPORT FOR THE WORK OF THE
COUNCIL TO FOUR POSITIONS. THE
FORECAST OF THESE POSITIONS. WE
ANTICIPATE THAT THE TOTAL COST
OF THE TWO POSITIONS REQUESTED
IN THIS PROPOSAL WILL BE
APPROXIMATELY 340,000 PER YEAR.
THE FUND SOURCE FOR THESE WILL
BE EXISTING STATE OPERATIONS
RESOURCES. THESE INCLUDES FUNDS
FROM CHILDREN, YOUTH BEHAVIORAL
HEALTH INITIATIVE AND OTHER
FUNDS, SUCH AS THE DATA FUND.
AND THE LAST QUESTION IS H. CHI
PLANNING TO USE CHILDREN AND
YOUTH BEHAVIORAL HEALTH
INITIATIVE FUNDING. IF SO,
PLEASE JUSTIFY THIS, GIVEN THAT
THE COUNCIL'S WORK COVERS BOTH
CHILDREN AND ADULTS. TO THE
EXTENT THAT THE COUNCIL SUPPORTS
TBH I WORKFORCE WORK COST
ASSOCIATED WITH THAT SUPPORT
WILL BE ALLOCATED TO C Y B H I
FUNDS. THE COUNCIL HAS BEEN BUSY
DELVING INTO BEHAVIORAL HEALTH
WORKFORCE POSITIONS AND
STRATEGIES TO DIVERSIFY OUR
WORKFORCE. AND H CHI HAS USED
THIS INFORMATION TO INFORM
PROGRAM DEVELOPMENT AND
IMPLEMENTATION. SO IN GENERAL H
. CHI WILL ALLOCATE THE COST OF
THESE POSITIONS, DO PROGRAMS AND
RELATED FUNDING THE COUNCIL
SUPPORTS THANK YOU HAPPY TO
ANSWER ANY QUESTIONS. DEPARTMENT
OF FINANCE. JOSEPH DONALDSON
DEPARTMENT FINANCE NO ADDITIONAL
COMMENTS AT THIS TIME. THANK
YOU, LEO. JASON. CONSTANT
CARILLO, CELIO. WE'VE BEEN
WORKING WITH THE DEPARTMENT ON
GETTING MORE CLARITY ON THIS
PROPOSAL, AND WITH THAT
ADDITIONAL INFORMATION, WE
UNDERSTAND THE RATIONALE A
LITTLE BETTER AT THIS TIME, ARE
RAISING CONCERNS BUT ARE
AVAILABLE FOR QUESTIONS.
EXCELLENT BRING IT UP TO THE
DIOCESE FOR ANY MEMBERS.
QUESTIONS ASSEMBLYMEMBER'S
RUBIO. THANK YOU. UM WHAT? UH
WHAT ARE THE OUTCOMES? I GUESS.
UM I DON'T UNDERSTAND IT
COMPLETELY. JUST. GOT TO READING
ABOUT IT, BUT, UM, WHAT OUTCOMES
ARE YOU HOPING TO ACHIEVE WITH
TWO ADDITIONAL FOLKS AND YOU GOT
TO LAST YEAR TO THIS YEAR? ARE
WE LOOKING AT TWO MORE NEXT YEAR
IN THE FOLLOWING YEAR, AND THE
FUNDS THAT YOU'RE USING OUR
BEHAVIORAL CHILDREN? BEHAVIORAL
HEALTH FUNDS IS WHAT YOU JUST
SAID. PART OF IT IS COMING FROM
THAT. SO LET ME LET ME RAISE MY
QUESTIONS AGAIN. SO THE FIRST
ONE WOULD OUTCOMES ARE YOU
HOPING TO ACHIEVE WITH THIS TO
ADDITION OF PEOPLE, THEN THE
SECOND PART WILL BE AS THE FUNDS
ARE COMING FROM BEHAVIORAL
CHILDREN, BEHAVIORAL HEALTH. AH
FUNDS. HOW DOES THOSE? HOW DO
THOSE TWO POSITIONS SUPPORT
CHILDREN'S BEHAVIORAL HEALTH
PROGRAMS, ETCETERA. SO THE
COUNCIL UM THROUGH THE LAST YEAR
HAS AS HAS MENTIONED HAS REALLY
BEEN DIGGING INTO UNDERSTANDING
. UM WHAT, UH, INNOVATIVE
STRATEGIES AND PROGRAMS CAN
REALLY EXPAND AND DIVERSIFY THE
WORKFORCE. UM AND SO THAT THEY
HAVE BEEN DEVELOPING
RECOMMENDATIONS, FOR EXAMPLE, AT
THE LAST MEETING BECAME FORWARD
WITH A GROUP A SET OF
RECOMMENDATIONS TO DO THAT FOR
BEHAVIORAL HEALTH, FOR EXAMPLE.
AND SO, UM, THAT THE WORK TO
SUPPORT DEVELOPING THESE
RECOMMENDATIONS DOING THE POLICY
WORK THE ANALYSIS WORK. UM IS
THE REASON FOR THE ADDITIONAL
TWO POSITIONS BECAUSE THERE'S
MORE WORK THAT WE'RE DOING TO
SUPPORT THE COUNCIL AND HELPED
THE COUNCIL, UM BE SUCCESSFUL IN
DEVELOPING RECOMMENDATIONS AND
PROVIDING GUIDANCE TO H CHI ON,
UM, THE OUR PROGRAMS. SO WE
EXPECT THAT THESE FOUR POSITIONS
ARE SUFFICIENT FOR NOW TO BE
ABLE TO SUPPORT THE WORK OF THE
COUNCIL. YES BUT WHAT OUTCOMES?
UM YOU SAID WE YOU HAD TWO
POSITIONS LAST YEAR. WHAT WERE
THE OUTCOMES OF THOSE ADDITIONAL
FOLKS? RECOMMENDATIONS HAVE ANY
OF THOSE BEEN IMPLEMENTED? HOW
IS THAT GOING TO HELP THE
PROGRAMS BECAUSE, YOU KNOW,
RECOMMENDATIONS ARE ONE THING.
OUTCOMES ARE DIFFERENT. SO UM,
AND AGAIN, THE COUNCIL JUST
STARTED MEETING LAST YEAR, AND
SO THE POSITIONS WERE HELPING TO
GET THE COUNCIL UP AND RUNNING.
UM AND BE ABLE TO SUPPORT THE
WORK OF THE COUNCIL AND THEN
WORK. THE WORK OF THE COUNCIL
HAS GROWN CONSIDERABLY IN THE
LAST YEAR. AND SO, FOR EXAMPLE,
THE RECOMMENDATIONS SO WITH
THESE RECOMMENDATIONS, THEN WE
WILL GO BACK AND USE THOSE
RECOMMENDATIONS TO SUPPORT THE
WORK THAT WE'RE DOING. FOR
EXAMPLE, UM, TO BE ABLE TO, UH
SUPPORT TRAINING AND COMMUNITY
HEALTH SETTINGS. SO WE'RE
LOOKING AT WHAT ARE THE PROGRAMS
THAT WE CAN IMPLEMENT THAT WILL
THAT WILL INCREASE TRAINING AND
COMMUNITY HEALTH CYNICS, UM, FOR
EXAMPLE, SO SOME OF THOSE
OUTCOMES ARE ACTUAL
RECOMMENDATIONS FOR WAYS WE CAN
IMPROVE OUR PROGRAMS. AND AGAIN
I CAN APPRECIATE ALL THAT. MY
QUESTION, THOUGH, IS WHAT, UH.
TANGIBLE IF YOU WILL OUTCOMES
HAVE YOU GOTTEN FROM THE TWO
PEOPLE THAT THAT YOU HIRED LAST
YEAR? WHAT CAN WHAT EXAMPLE? CAN
YOU GIVE ME A THINGS ANY PROGRAM
THAT'S BEEN IMPLEMENTED BASED ON
THE RECOMMENDATIONS, ETCETERA,
ETCETERA, BECAUSE I JUST I WAS A
TEACHER FOR A VERY LONG TIME,
AND WE HAD A LOT OF
RECOMMENDATIONS THAT NEVER GOT
IMPLEMENTED. AND SO MY
FRUSTRATION HAS ALWAYS BEEN IS
THAT WE KEEP DOING HAVING
CONVERSATIONS AND
RECOMMENDATIONS, BUT THERE IS NO
ACTUAL TANGIBLE OUTCOMES FROM
THIS SO IT CAN GIVE ME EXAMPLES
OF THE OUTCOMES THAT OR ANYTHING
TANGIBLE THAT CAME OUT OF THE
LAST TWO POSITIONS. THEREFORE
YOU NEED TWO MORE POSITIONS
BECAUSE THIS OUTCOME WHATEVER IT
MAY BE WAS SO SUCCESSFUL THAT WE
CAN DO MORE OF THAT. SO UM I
WOULD SAY THAT SOME OF THE SO
AGAIN SOME OF THE POSITIONS ARE
NEEDED JUST TO SUPPORT THE WORK
OF THE COUNCIL. THEY LEAD THE
JUST TICKLE THE ADMINISTRATIVE
TO BE ABLE TO DOUBT DEVELOP
THOSE RECOMMENDATIONS FOR THE
COUNCIL TO BE ABLE TO RUN A
COUNCIL MEETING. SO THOSE ARE
YOU KNOW, JUST THE UNDERLYING
WORK OF THE COUNCIL THAT WE NEED
TO SUPPORT WITH POSITIONS BEFORE
AGAIN. I'M JUST LEARNING A
LITTLE BIT MORE ABOUT THIS. SO
HOW MANY COUNCIL MEMBERS? DO YOU
HAVE 18 18, SO IT'S GOING TO
REQUIRE FORMAL FOR PEOPLE TO
SUPPORT THE COUNCIL? IS WHAT I'M
UNDERSTANDING. YES IT RECORDED
WOULD REQUIRES FOUR PEOPLE THERE
IS THERE ARE SIGNIFICANT POLICY
DEVELOPMENT PROPOSALS, FOR
EXAMPLE, THAT THE THAT THE STAFF
DOES TO SUPPORT THE WORK OF THE
COUNCIL TO PREPARE TO DO
RESEARCH. THE RESEARCH DATA
CENTER, AS WAS MENTIONED EARLIER
THAT WORKED SUPPORTS OF THE WORK
OF THE COUNCIL, DEVELOPING
GATHERING DATA AND SHARING THAT
BACK WITH THE COUNCIL TO HELP
INFORM THEM AS THEY AS THEY
CONSIDER QUESTIONS AND MAKE
RECOMMENDATIONS. SO WHAT I'M
HEARING THIS IS STRICTLY
ADMINISTRATIVE POSITIONS.
NOTHING TO DO WITH, YOU KNOW,
ACTUALLY, UH, DEVELOPING
PROGRAMS. THIS IS MORE OF
ADMINISTRATIVE SUPPORT FOR THE
COUNCIL. CORRECT. OKAY? AND THEN
THE SECOND PART OF THE QUESTION
IS FOR HOW DOES THIS HELP THE
CHILDREN IF THE MONEY IS COMING
FROM THERE THAN WHAT? UH WHAT
TANGIBLES DO WE EXPECT TO
PROVIDE FOR THE CHILDREN'S
MENTAL HELP? WELL AS I MENTIONED
EARLIER, SO THE FUNDING IS
PARTIALLY FROM THAT, BECAUSE
MANY OF THE PROGRAMS THAT THAT
HAVE BEEN RECOMMENDED AND
IMPLEMENTED, UM ALSO MAY SERVE
TO FAMILIES AND ADULTS BUT ALSO
SERVED CHILDREN AND YOUTH. FOR
EXAMPLE, AS I MENTIONED BEING
ABLE TO LOOK AT OUR OWN AND
LEARN PROGRAMS, HOW WE'RE
BUILDING A WORKFORCE WITH
APPRENTICESHIP PROGRAMS IS ONE
OF THE THINGS THAT WE'RE LOOKING
AT. IMPLEMENTING IS EXPANDING
THE KIND OF WORK WE DO WITH OUR
TRAINING PROGRAMS TO FOCUS ON,
UM BURN AND LEARNING
APPRENTICESHIP PROGRAMS IS ONE
EXAMPLE. UM THAT SUPPORTS THE
BEHAVIORAL, THE CHILDREN WITH
BEHAVIORAL INITIATIVE AS WELL AS
MANY OF OUR OTHER PROGRAMS.
THANK YOU. SO WHEN WE COME BACK
NEXT YEAR, AND WE ASKED THE SAME
QUESTION THAN WHAT? UH WHAT CAN
WE EXPECT AS AN ANSWER? WHAT
WE'RE HOPING TO SEE IS AND AGAIN
THE COUNCIL AGAIN. THEIR FIRST
SET OF RECOMMENDATIONS WERE
BEHAVIORAL HEALTH THERE WERE
THERE WORKING ON A SET OF
RECOMMENDATIONS FOR THE NURSING
WORKFORCE. UM AND THEY'LL BE
SAID, ALSO LOOKING AT SOME
RECOMMENDATIONS FOR PRIMARY CARE
AND GRADUATE MEDICAL EDUCATION.
SO WHAT WE'LL SEE WILL CONTINUE
TO SEE THROUGH THE WORK OF THE
COUNCIL IS A SET OF
RECOMMENDATIONS THAT DRIVE AND
INFORM UM AND SO WHAT? WE'RE
WHAT FOR THE WORK THAT WE'RE
DOING ACROSS ALL OF OUR PROGRAMS
. THANK YOU. AND THE REASON THAT
I'M AGAIN I'M ASKING ALL OF
THESE QUESTIONS IS BECAUSE I WAS
A TEACHER. WE GOT A WHOLE BUNCH
OF RECOMMENDATIONS THAT WERE
NEVER IMPLEMENTED, AND MY
CONCERN IS THAT WE HAVE SUCH A
CRISIS AND MENTAL HEALTH. UM UH
, CRISIS AND A LOT OF ISSUES BY
MENTAL HEALTH IS ONE OF THE
ISSUES THAT WE DO HAVE A CRISIS
AND SO IF WE'RE GOING TO INVEST
THESE FUNDS IN ADDITIONAL
SUPPORT, THEN I WANT TO SEE
OUTCOMES, UM, THAT THAT ARE
ACTUALLY SUPPORTING PEOPLE
INSTEAD OF, YOU KNOW, HOPING AND
PRAYING THAT YOU KNOW THESE
THESE RECOMMENDATIONS SOMEDAY
GET GET IMPLEMENTED. AND YOU
KNOW IF THEY DON'T WELL, TOO BAD
WE GOT THE SUPPORT. UH WE
SUPPORTED THE COUNCIL. AND SO
THAT'S WHY I'M ASKING THESE
QUESTIONS. I'M A LITTLE BIT. UM
UH UM. I DON'T REALLY KNOW WHAT
THE WORD I'M LOOKING FOR. BUT
AGAIN, WE'VE SAID HERE AND WE
TALK ABOUT HOPING AND PRAYING
THAT THINGS CHANGE BY INVESTING
AND THEN REALLY, WE DON'T REALLY
SEE ANY TANGIBLE OUTCOMES FROM
THE INVESTMENTS THAT WE'RE
MAKING. IN A IN A YEAR WHERE OUR
BUDGET IS GOING TO BE, UM,
HOPEFULLY NOT AS BAD AS AS FOLKS
ARE SAYING, UM, INVESTING MORE
MONEY AND HAVING ZERO OUTCOMES
TAKES AWAY FROM ACTUALLY
PROGRAMS THAT ARE IMPLEMENTED TO
SUPPORT MENTAL HEALTH SERVICES
EITHER FOR CHILDREN AND FOR
ADULTS, SO THAT'S WHY I'M
PRESSING ON ON THAT SO AGAIN, I
APPRECIATE THAT YOU'RE GOING TO
BE THE COUNCIL IS GOING TO BE
SUPPORTED, HOWEVER, ARE WE
TAKING AWAY MONEY FROM ACTUAL
PROGRAMS BECAUSE YOU KNOW THESE
POSITIONS MAY OR MAY NOT HELP
AND INFORMING, UM YOU KNOW WHAT
YOU'RE GOING TO DO LATER WITHOUT
ANY ACTUAL TANGIBLES AT THE END.
I'LL BRING IT BACK TO THE CHAIR
FOR A SECOND. IF I CAN.
ORIGINALLY THIS WAS CREATED IN A
B 1 33, WHICH ALLOWED US TO HAVE
A STATEWIDE APPROACH TO
DEVELOPING HEALTH WORKFORCE
POLICY RECOMMENDATIONS OUT OF
THAT CAME THE 1.5 BILLION THAT
WE INVESTED LAST YEAR. UM IN THE
NEXT ISSUE, WE'LL HEAR ABOUT
DELAYS BECAUSE OF THOSE DELAYS
DOES THAT CHANGE THE COUNCIL'S
WORK AND THEIR WORKLOAD? SHOULD
WE CONTINUE TO FUND IT AT FOUR
POSITIONS OR SINCE THERE'S A
SIGNIFICANT DECREASE? IN THE
NEXT TWO BUDGET YEARS. DOES IT
CHANGE THE COUNCIL'S OVERALL
INITIATIVE? WE HAVE A FULL
AGENDA FOR THE NEXT. UH ACTUALLY
, SEVERAL MEETINGS OF THE
COUNCIL, UM, IN TERMS OF IN
TERMS OF WORK TO DISCUSS,
BECAUSE ONE OF THE THINGS THAT
IT'S DOING IS THE COUNCIL'S
HELPING TO AS WE PLAN AS WE PLAN
TO BUILD THE NURSING WORKFORCE
AS WE PLAN TO BUILD THE
BEHAVIORAL HEALTH WORKFORCE THE
GRADUATE MIDDLE EDUCATION
WORKFORCE THERE CAN STARE. THERE
IS A LOT OF WORK THAT THEY'RE
CONTINUING TO DO, UM, THROUGHOUT
THE YEAR. UM I WILL HOLD THIS
ISSUE OPEN AS WE MOVED. ISSUE
FIVE. BUT LET'S REMEMBER THE
WORK OF THE COUNCIL AND THE
DEDICATION AND RECOMMENDATIONS
THAT CAME FORWARD AS WE'RE ABOUT
TO HEAR ABOUT DELAYS WITHIN
HEALTHCARE WORKFORCE. WE WILL
NOW MOVE ON TO ISSUE FIVE, WHICH
IS ON THE PROPOSED HEALTHCARE
WORKFORCE DELAYS TRAILER BIT
BILL. WHICH WILL BE PRESENTED BY
THE DEPARTMENT OF FINANCE. CAN
YOU PLEASE BEGIN? THANK YOU.
HONORABLE CHAIR COMMITTEE
MEMBERS. JOSEPH DAWSON.
DEPARTMENT OF FINANCE. UH SO DUE
TO DECLINING STATE REVENUES, THE
BUDGET PROPOSES DELAYING 68
MILLION IN CURRENT YEAR AND
329.4 MILLION IN BUDGET YEAR FOR
A TOTAL OF 397.4 MILLION FOR
VARIOUS HEALTH CARE WORKFORCE
PROGRAMS, INCLUDING THE 2022
BUDGET ACT. UNDERAGE CAIS
ADMINISTRATION MECHANISM TO GET
A LITTLE CLOSER TO THE MIC.
WE'RE HAVING A HARD TIME
CAPTURING YOU. IS THAT BETTER?
ALRIGHT SORRY ABOUT THAT. THE
MECHANISM TO IMPLEMENT THIS
PROPOSAL IS TBL, WHICH IS
CURRENTLY POSTED ON THE
DEPARTMENT OF FINANCE IS WEBSITE
FOR REVIEW. AND WHILE THE BUDGET
PROPOSES THESE DELAYS, THE
MINISTRATIONS STILL VERY MUCH
COMMITTED TO INCREASING THE
CAPACITY OF THE STATE'S
HEALTHCARE WORKFORCE. THESE
PROGRAMS WILL REMAIN FULLY
FUNDED, BUT THE FUNDS WOULD GO
OUT LATER THAN ORIGINALLY
PLANNED. NOW THESE REPAYMENTS
WOULD FOR THESE DELAYS WOULD GO
OUT AND 24 25 25 26. AMOUNT OF
198.7 MILLION IN EACH OF THOSE
SPECIFIED YEARS. NOW WE
ACKNOWLEDGE THAT THESE ARE
DIFFICULT DECISIONS TO CONSIDER
AND ACT UPON, HOWEVER, THE
ADMINISTRATION BELIEVES THAT
THESE ARE NECESSARY ACTIONS TO
ADDRESS THE CURRENT REVENUE
SHORTFALL, WHILE ALSO MAINTAIN
OUR COMMITMENT TO OUR STATES.
HEALTHCARE WORKFORCE CAN EITHER
POSITIVE QUESTIONS OR I CAN GO
THROUGH THE QUESTION SHINS
AROUND THE AGENDA, I WOULD GO
THROUGH THE QUESTIONS AND THE
AGENDA. NO PROBLEM, SO FIRST
QUESTION WAS, PLEASE DESCRIBE IT
MORE DETAILED ADMINISTRATIONS,
REASONING BEHIND CHOOSING A
SPECIFIC WORKFORCE PROGRAMS THAT
WERE CHOSEN FOR DELAYED FUNDING
FOR THOSE THAT WERE NOT SO FOR
CURRENT YEAR DELAYS. WE WORKED
WITH OUR COUNTERPARTS AT H CHI
TO IDENTIFY PROGRAMS WHOSE FUNDS
HAD NOT ALREADY BEEN HAD NOT
ALREADY GONE OUT OR
SUBSTANTIALLY IN FLIGHT FOR WITH
THE ULTIMATE GOAL OF TRYING TO
MINIMIZE PROGRAM DISRUPTION TO
THE GREATEST EXTENT POSSIBLE.
FOR BUDGET YEAR, THE
ADMINISTRATION IDENTIFIED AREAS
WITH RELATIVELY LARGE
INVESTMENTS. THIS IS WHERE THE
MOST SUBSTANTIAL SAVINGS COULD
BE OBTAINED. AND JUST TO
REITERATE WE UNDERSTAND THAT
THESE ARE VERY DIFFICULT
DECISIONS TO CONSIDER
ADMINISTRATION HAD TO AIM
BALANCING BOTH ADDRESSING
REVENUE SHORTFALLS, WHILE SO
MAINTAIN OUR COMMITMENT TO
INVESTING IN OUR STATE'S
WORKFORCE, AND WE BELIEVE THAT
THIS WAS THE BEST COMPROMISE OF
TRYING TO BALANCE THOSE
DIFFICULT PRIORITIES. THE NEXT
QUESTION WAS, WHAT WILL HAPPEN
TO THIS FUNDING AND THESE
PROGRAMS? SHOULD IT TURN OUT
THAT CALIFORNIA IS THAT A
PROTRACTED MULTIYEAR RECESSION?
UM AT THIS TIME, MINISTRATIONS
IS HOPEFUL THAT THE ECONOMY WILL
BOUNCE BACK AND THAT THESE
PROPOSED BUDGET SOLUTIONS ARE
SUFFICIENT TO ADDRESS THE
CURRENT SHORTFALL IF A FINANCIAL
LANDSCAPE OR ECONOMIC CONDITIONS
CHANGE WILL REASSESS OUR PLAN AS
PART OF THE ANNUAL BUDGET
PROCESS AND CONSIDER ALL OPTIONS
AT THAT TIME, BUT JUST TO
REITERATE CURRENTLY RIGHT NOW
THE PROPOSED BUDGET SOCIAL ONLY
DELAYS FUNDING FOR CURRENT YEAR
AND BUDGET YOUR INVESTMENTS FROM
THE 2022 BUDGET ACTS. AND A
POSITIVE AND ANSWER ANY
QUESTIONS YOU MAY HAVE. JASON
KANSEN TOURO, CELIO. BEFORE I
DELVE INTO OUR ASSESSMENT. I
JUST WANTED TO 0.2 PAGES IN CASE
THAT WAS HELPFUL FOR THE
MEMBERS. PAGE 18 OF YOUR AGENDA
SUMMARIZES THE SPECIFIC DELAYS
IN THE GOVERNOR'S BUDGET. SO YOU
CAN SEE THE LIST THERE AND THEN
ON PAGE 19, YOU'LL SEE ANOTHER
TABLE THAT PROVIDES A FULLER
SUMMARY OF THE INITIATIVES THAT
WERE ADOPTED LAST YEAR AND THE
REVISED EXPENDITURE PLAN FOR
THEM BOTH ONES THAT ARE PROPOSED
FOR DELAY IN ONES THAT ARE NOT
PROPOSED FOR DELAY. OUR OFFICE
RELEASED A POST ON THE PROPOSED
HEALTH WORKFORCE BUDGET
SOLUTIONS, BOTH IN H. CHI AND IN
THE DEPARTMENT OF PUBLIC HEALTH,
WHICH I UNDERSTAND THE COMMITTEE
HEARD PREVIOUS HEARING. YOU CAN
SEE OUR RECOMMENDATION TO THE
COMMITTEE ON PAGE 20. BUT RATHER
THAN GOING POINT BY POINT, I
THOUGHT IT WOULD BE HELPFUL TO
GO RIGHT TO THE STAFF QUESTIONS
FOR OUR OFFICE ON PAGE 21. THE
FIRST QUESTION IS, DO WE THINK
THAT THE STATE CAN AFFORD THE
PROPOSAL LAYS IN THE OUT YEARS
GIVEN THAT YOU KNOW THE FUNDS
ARE DELAYED IN THE BUDGET YEAR,
BUT WOULD YOU KNOW RESULT IN
HIGHER LEVELS OF SPENDING AND 24
25 25 26. OR OFFICE HAS RELEASED
A MULTIYEAR ASSESSMENT OF THE
GOVERNOR'S BUDGET. AND THAT
ASSESSMENT HAD TO CONCLUSIONS
FIRST THAT THE BUDGET PROBLEM IS
LIKELY BIGGER THAN WHAT'S
ASSUMED IN THE GOVERNOR'S BUDGET
WITHIN THE BUDGET WINDOW, SO
THAT'S IN 22 23 23 24. AND THEN
SECOND THAT THAT DEFICIT WOULD
PERSIST INTO THE OUT YEARS IN 24
25 25 26. THIS SUGGESTS THAT THE
LEGISLATURE WERE TO ADOPT THE
GOVERNOR'S BUDGET AND ITS
ENTIRETY LIKELY WOULD FACE
PRESSURE IN FUTURE YEARS TO TAKE
FURTHER ACTIONS SUCH AS
POTENTIALLY POSTPONING, UM, THE
RESUMPTION OF FUNDS THAT ARE
DELAYED, INCLUDING THOSE IN THE
HEALTH WORKFORCE AREA. THE
SECOND QUESTION TO OUR OFFICE IS
REALLY AROUND OUR RECOMMENDATION
. YOU KNOW, WE RECOMMEND THE
LEGISLATURE WAY THIS APPROACH
AGAINST OTHER POTENTIAL OPTIONS
, AND THE STAFF QUESTION TO US
IS, CAN WE BE A LITTLE MORE
SPECIFIC ON WHAT WE'RE SAYING?
THERE? SO IN A REPORT WE OFFERED
A COUPLE WE OFFER THREE
DIFFERENT WAYS TO SORT OF THINK
ABOUT THIS. UM THE FIRST WAY WE
SORT OF RECOMMEND HERE IS TO
TAKE A FAIR, FAIRLY DIFFERENT
APPROACH THAN WHAT THE
GOVERNOR'S PROPOSING AND TWO
NOTABLY SCALE BACK THE, UH,
PROPOSED THE WORKFORCE PACKAGE
THAT WAS ADOPTED LAST YEAR.
FOCUSING ON AREAS THAT ARE SORT
OF THE HIGHEST LEGISLATIVE
PRIORITY AND INITIATIVES THAT
THAT ADDRESS THAT PRIORITY ARE
THINKING THERE IS DOING THAT NOW
WOULD, UM, SORT OF AVOID THESE
SORT OF BIGGER DELAYS AND SORT
OF ADDRESSED THE ISSUE NOW
RATHER THAN SORT OF FACING THIS
ISSUE IN THE OUT YEARS. ANOTHER
WAY TO WE PROPOSE THINKING ABOUT
IT IS TO LOOK AT INITIATIVES AND
SEE WHICH INITIATIVES ARE AS THE
ADMINISTRATION NOTES MATERIALLY
IN FLIGHT OR ARE CURRENTLY UNDER
IMPLEMENTATION. AND THE AND LOOK
AT OTHER INITIATIVES THAT, UM,
HAVE NOT YET BEEN FULLY
IMPLEMENTED YET. AND WE KNOW
THAT THERE ARE A COUPLE OF
INITIATIVES THAT THE, UM
GOVERNOR'S BUDGET DOES NOT
PROPOSED DELAYING OR RESCINDING
AND THE INITIATIVES HAVE NOT YET
BEEN IMPLEMENTED. IF YOU TURN
BACK TO PAGE 19 OF YOUR AGENDA,
YOU'LL SEE THREE INITIATIVES
FOCUSED ON PSYCHIATRIC
WORKFORCE. THESE ARE INITIATIVES
THAT AS WE UNDERSTAND IT ARE THE
GRANT PROGRAMS WILL WILL RESUME
THIS SUMMER. AND SO, UM,
INEFFECTIVELY HAVEN'T STARTED
YET AND COULD BE DELAYED OR
REDUCED WITHOUT MAJOR
PROGRAMMATIC DELAY. NOW THIS
WILL ULTIMATELY DEPEND ON THE
LEGISLATURE'S PRIORITY OF
PSYCHIATRIC WORKFORCE IS AMONG
THE LAKERS TOP LEGISLATURE'S TOP
PRIORITIES. THIS THIS APPROACH
MIGHT NOT MAKE AS MUCH SENSE.
THE THIRD FACTOR WE RECOMMEND
THE LEGISLATURE CONSIDERS AREAS
WHERE DELAYS COULD HAVE A HAVE
SOME IMPACT ON SORT OF BROADER
STATEWIDE HEALTH REFORM EFFORTS.
UM THE GOVERNOR'S BUDGET DOESN'T
IMPACT ONGOING FUNDING FOR A LOT
OF THE MAJOR SORT OF HEALTH
CHANGE HEALTH POLICY CHANGES
THAT WERE ENACTED IN PREVIOUS
YEARS. BUT SOME OF THESE
WORKFORCE INITIATIVES COULD HAVE
SOME INDIRECT IMPACT TO THAT ONE
INITIATIVE. OUR OFFICE HEARD A
BIT FROM STAKEHOLDERS ON WAS THE
COMMUNITY HEALTH. UH, WORKERS
INITIATIVE, GIVEN ITS CONNECTION
TO THE COMMUNITY, HEALTH WORKER
BENEFIT AND MEDICAL THAT'S
THAT'S CURRENTLY BEING
IMPLEMENTED. SO WE THINK THAT'S
ANOTHER FACTOR THE LEGISLATURE
COULD CONSIDER WHEN DECIDING
WHICH INITIATIVES ARE TO DELAY
OR REDUCE. I'M HAPPY TO ANSWER
ANY QUESTIONS. I'LL BRING IT UP
TO THE DIASPORA MEMBERS
QUESTIONS DOCTOR WOULD AND THEN
DR JACKSON YES. GO FOR IT DIDN'T
MEAN DOUBT DRAW YOU THERE,
DOCTOR. JACKSON. UM AYE. YOU
KNOW, I GUESS I'M JUST AND I
RECOGNIZE WERE ENOUGH. WE WERE
IN TIGHT BUDGET TIMES. HERE, UM
THE NURSING NURSING INITIATIVE
IS TROUBLING, UH TO ME, UM. I
HEAR WHAT I HEAR FROM HOSPITALS
, IN PARTICULAR IS THE SHORTAGE
OF NURSES. UM THE FACT THAT
HAVING TO USE REGISTRY NURSES
FROM OUT OF STATE PAYING
EXORBITANT AMOUNTS OF MONEY AND
AFTER COVID JUST THE BURNOUT
AMONG NURSES AND NUTRITION IN
THE PROFESSION, SO THE IDEA THAT
WE WOULD SOMEHOW WANT TO REDUCE,
UM, AN INITIATIVE TO CREATE MORE
NURSES. IS REALLY
COUNTERINTUITIVE. I DON'T
UNDERSTAND THAT AT ALL. UM AND
THEN WHEN YOU GO TO RURAL
COMMUNITIES OR OTHER UNDER OR
UNDERSERVED COMMUNITIES AND
URBAN AREAS IT'S EVEN WORSE.
IT'S EVEN WORSE. WE STRUGGLE ON
A GOOD DAY WHEN THERE'S PLENTY
OF MONEY TO GET PEOPLE TO THESE
COMMUNITIES, AND I THINK IT'S
WRONG. UM. BEHAVIORAL HEALTH
WORKFORCE AT A TIME WHEN, UM THE
MENTAL HEALTH ISSUES LEADING TO
HOMELESSNESS ARE A BIG CHALLENGE
. AND AS WE TRY TO GET OUR ARMS
AROUND HOMELESSNESS, WHY, WHY
WOULD WE WANT TO REDUCE PROGRAMS
AND BEHAVIORAL HEALTH JUST ONCE
AGAIN, IT IT JUST FEELS
COMPLETELY COUNTERINTUITIVE. I
GOT A LIST OF AGENCIES AND
THINGS I WOULD LOVE TO TAKE
MONEY FROM AND PUT IT BACK IN
HERE, BUT WE'RE NOT. WE DON'T
AND THEY DON'T FIT IN THIS
COMMUNITY AND THIS COMMITTEE,
UNFORTUNATELY, BUT I GOT A LIST
THEN, BUT IT'S BUT IT IS. IT IS
FRUSTRATING. IT IS FRUSTRATING
THAT WE KNOW WE HAVE A SHIRT
SHORTAGE OF NURSES NOW. AND
WE'RE GONNA AND WE'RE GOING TO
DELAY THIS. WE KNOW THAT WE HAVE
CHALLENGES IN OUR BEHAVIORAL
WORKFORCE. THEY GO BACK TO SET
ON THE WORKFORCE COMMISSION IN
2017 WITH THE CALIFORNIA
HEALTHCARE FOUNDATION. WE HAVE
PROFESSIONALS FROM ALL OVER THE
STATE IDENTIFIED $3 BILLION AND
NECESSARY WORKFORCE. UH
INVESTMENTS. UM AND YOU KNOW, WE
BEGAN TO MAKE SOME PROGRESS
THERE, BUT UM IS IT IMPORTANT OR
NOT IT? YOU KNOW, I MEAN, WE
DON'T KNOW THE NEXT COVID IS
AROUND THE CORNER. WE DON'T
KNOW, BUT WE KNOW WE HAVE A
DEPLETED WORKFORCE AND
BEHAVIORAL HEALTH. AND NURSING.
AND WE'RE GONNA PUSH THIS DOWN.
PUSH THE KICK THIS DOWN THE
HIGHWAY A LITTLE BIT. I JUST YOU
KNOW, THERE'S THERE HAVE TO BE
OTHER WAYS OF DOING THIS.
THEY'RE REALLY DO. SO IT WASN'T
QUESTION IT WAS ANOTHER ONE OF
MY EDITORIAL COMMENTS. DR
JACKSON. WELL THE EDITORIAL
CONTINUES. UM. UM, I MEAN,
OBVIOUSLY, WE'VE SPENT HOURS
TALKING ABOUT JUST HOW DIRE ARE
THE PUBLIC HEALTH OF CALIFORNIA
IS. AND ALL OF THESE ARE
DESIGNED RIGHT TO HELP TO DEAL
WITH THAT OVER THE LONG TERM.
AND SIMILAR TO HOUSING. I DON'T
THINK WE CAN AFFORD TO THAT. PUT
THE BRAKES ON MANY OF THESE
PROGRAMS. AND SO I WOULD JUST
ENCOURAGE US TO LOOK AT OTHER
AVENUES ON IF THERE NEEDS TO BE
CUTS IN THE OVERALL BUDGET.
WHERE CAN WE? WHERE ELSE CAN WE
FIND THOSE? UM. I'M NOT ONE TO
JUST, UH, PASSED THE BUCK AT I'M
LOOKING AT A AH AH! TAX
EXPENDITURE RIGHT NOW WE'RE SO
WE'RE NOT TAXING SUBSCRIPTIONS
OF PERIODIC ALS. RIGHT? WE HAVE
A LOT OF THINGS IN OUR BUDGET.
THAT WE'RE CHOOSING NOT TO TAX.
BECAUSE OF GIVING THE REASONS A
LOT OF THEM HAVE BEEN ON AUTO
FOR DECADES WAY BEFORE ANY OF US
GOT HERE. THAT WE CAN FIND.
WE'RE SUBSIDIZING ALL KINDS OF
THINGS IN CALIFORNIA. ONCE
AGAIN, IT'S NOT ABOUT WHETHER
IT'S A GOOD OR BAD. WE DON'T
HAVE THAT LUXURY. IT'S ABOUT
PRIORITIES. AND SO I WOULD LOOK
AT THINGS THAT WE'RE CURRENTLY
SUBSIDIZING IN OUR BUDGET. UH
THINGS WERE CHOOSING NOT TO TAX
AND OUR BUDGET. AH UM AND PLAIN
OLD, FLASHY THINGS IN OUR BUDGET
THAT REALLY DOESN'T HAVE TO DO
WITH THE HEALTH AND WELFARE OF
CALIFORNIA THAT'S CURRENTLY
STILL IN OUR BUDGET. SO UM, I
STILL WOULDN'T BELIEVE THAT THIS
IS A UM, BAD BUDGET YEAR. I
THINK THIS IS A PRIORITY BUDGET
YEAR. AND, UM I WOULD JUST SAY
THAT WHEN IT COME, WE I WOULD
HATE TO BE HERE 5 10 YEARS FROM
NOW AND SAY, YOU KNOW UH OH. WHY
DO WE STILL NOT HAVE THE
WORKFORCE? HOW HOW MUCH
WORKLOADS ARE IN OUR HOSPITALS.
AND I HATE THIS. COME BACK HERE
TO, YOU KNOW, REMEMBER THIS TIME
AND SAY. WELL YOU KNOW, WE AGREE
BECAUSE WE WEREN'T READY. WE
WEREN'T WILLING TO MAKE TOUGHER
DECISIONS. RIGHT? UM THIS IS
SIMPLY, UH, ANYTHING THAT HAS TO
DO WITH OUR WORKFORCE,
ESPECIALLY WHERE WE'RE IN DIRE
STRAYS. WHETHER IT'S NURSES,
DOCTORS, SOCIAL WORKERS, I MEAN,
WE CAN GO ON AND ON UM, WE THIS
IS NOT DEFINITELY SOMETHING THAT
CERTAINLY I'M NOT WILLING TO
SUPPORT. THANK YOU, MR CHAIR.
ASSEMBLYMEMBER'S RUBIO. THANK
YOU JUST WANTED TO CONTINUE THE
COMMENTARY, UM, TO DR WOODS
POINT. I WANTED TO OFFER THAT I
DID DO SOME WORK IN TERMS OF
TRYING TO GET MORE NURSES IN
2019 BEFORE THE PANDEMIC. AND
THE CONVERSATION THAT WAS HAD AT
THAT TIME WAS THAT I SHOULDN'T
WORRY ABOUT IT BECAUSE I'M FROM
L. A COUNTY AND THEY HAVE PLENTY
OF NURSES THERE, WHICH COOL.
IT'S GREAT THAT L. A COUNTY
DOES, BUT DOCTOR WOULD AND A LOT
OF OTHER MEMBERS HERE HAVE RURAL
COMMUNITIES THAT DON'T HAVE THAT
WORKFORCE. AND WHAT I SEE
HAPPENING IS A LOT OF TIMES WE
LOOK AT AN AVERAGE OF NURSES IN
THE STATE, AS OPPOSED TO REGION
BY REGION, AND LIKE I SAID, FOR
ME, IT'S TIME. WE'RE GOOD. WE'RE
GRAVY IN VALLEY COUNTY HAS
PLENTY OF NURSES, BUT MY
COLLEAGUES HERE YOU KNOW, MY
PRIORITY IS ABSOLUTELY MY
DISTRICT. BUT CALIFORNIA HAS TO
BE A PRIORITY FOR ALL OF US. UM
WE CAN'T AFFORD NOT TO HEAL, YOU
KNOW, HAVE THE WORKFORCE FOR
THOSE RURAL COMMUNITIES BECAUSE
AT THE END OF THE DAY, WE'RE ALL
VERY GONNA END UP EITHER IN L, A
COUNTY OR WHEREVER THEY END UP.
WE WANT TO MAKE SURE THAT
EVERYBODY SUPPORTED AND SO TO
THE POINT OF DOCTOR WOULD AND DR
RANDALL IN. I THINK YOU HAVE
SOME RURAL COMMUNITIES AS WELL.
UM WE NEED TO LOOK AT THE
REGIONS NOT JUST, UH, SOME LINE
ITEM. AH THAT SAYS, HEY, WE'RE
GOING TO CUT THIS BECAUSE IT'S A
BUDGET ITEM. HOW ABOUT LOOKING
TAKING A REGIONAL APPROACH TO
SOME OF THESE PROGRAMS? I MAYBE
, YOU KNOW, THAT MAY BE WHAT YOU
ARE DOING. HOWEVER WE DON'T SEE
IT. I DON'T SEE HOW WE'RE REALLY
TARGETING THOSE AREAS THAT HAVE
A BIGGER NEED THAN THE ONES THAT
DON'T SO I WANTED TO ADD ON AND
OFFER SUPPORT TO MY RURAL
COMMUNITY COLLEAGUES THAT THEY
DON'T HAVE THE BENEFITS THAT
THOSE OF US AND ALI COUNTY IF WE
ACTUALLY DO AGAIN, THEY'RE ALL
JUST NUMBERS ON A ON A NUMBER
LINE, AS OPPOSED TO ARE ON A
BUDGET AS OPPOSED TO, ACTUALLY,
YOU KNOW, LOOKING AT THOSE
REGIONS TO SEE IF THOSE
COMMUNITIES ARE BEING SUPPORTED.
I'LL BRING IT UP TO THE CHAIR IN
THE NEXT ITEM. WE'LL HEAR ABOUT
MANY OF THOSE GEOGRAPHIC
DISPARITIES AND RACIAL
DISPARITIES AND WORKFORCE THAT I
LIKE TO GET A SENSE IF ANY OF
THESE INVESTMENTS THAT WE'RE
TALKING ABOUT DELAYING IF THEY
COULD BE MODIFIED TO ALLOW US TO
ADDRESS SOME OF THOSE
DISPARITIES. THE
ADMINISTRATION'S POSITION THAT
WE HAVE TO DELAY THESE AS YOU
SAY, AND WILL REMAIN FULLY
FUNDED. AND IF SO, HOW CAN WE
GUARANTEE THAT THE FUNDING WILL
BE AVAILABLE IN THOSE OUT YEARS,
AS THE LAO HAS INDICATED? THAT
MAY BE UNLIKELY DUE TO THE, UM
FORECASTED BUDGET. YEAH THANK
YOU FOR THE QUESTION. SO WE ARE
TO YOUR FIRST QUESTION ABOUT
ENSURING THE REPAYMENTS YOU WERE
TRACKING THE TWO PAYMENTS IN 24
25 25 26 OF THE 198.7 MILLION IN
OUR LONG TERM FORECAST AS
SOMETHING WE'RE COMMITTED TO
REPAYING. THAT'S SOMETHING THAT
WE'RE TRACKING THROUGH OUR
BUDGET PROCESS. I ALSO NOTE THAT
WHILE. WHILE THESE DELAYS ARE
DEFINITELY A HARD PILL TO
SWALLOW, BASED ON THE
CIRCUMSTANCES, WE WOULDN'T KNOW
WHAT THAT WHILE FUNDING IS BEING
DELAYED, INCURRING YOUR BUDGET,
OR THERE'S ALSO STILL
SUBSTANTIAL INVESTMENTS GOING
OUT AND CURRENTLY CURRENTLY, SO
JUST STILL WANT TO REITERATE
THAT WE REALLY TRY TO TAKE THAT
BALANCE OF WELL. THERE ARE
DELAYS WITHIN THIS PROPOSAL. WE
STILL WANT TO MAKE SURE WE COULD
GET OUT DOLLARS THAT WE COULD
BECAUSE WE DO UNDERSTAND THIS
IMMEDIATELY TO ADDRESS THE
WORKFORCE, SO UM, I WOULD. I
WOULD DEFER TO MY CRIB TOYS FROM
OUR DETAILED BUT FOR THE CURRENT
YEAR HK ISOLATED TO IMPLEMENT
100 AND $82 MILLION OF THIS
INVESTMENT FROM 2022 BUDGET ACTS
SO JUST REALLY WANTED TO READ,
REALLY TRY TO FIND THAT BALANCE.
WE UNDERSTAND THAT THIS IS A
HARD DECISION. THAT'S WHY THESE
ARE DELAYS AND NOT CUTS AND WE
ENSURE THAT FUNNY THAT WAS IN
THE CURRENT YEAR THAT WAS
ALREADY IN FIGHT. WE DID NOT
WANT TO INTERRUPT THAT PROCESS
SIMPLY BECAUSE OF THIS IMMEDIATE
NEED. I'LL ELEVATE IF I CAN, AS
WE WILL DELAY THE CONVERSATION
ON BEHAVIORAL HEALTH WORKFORCE
UNTIL APRIL 17TH THE NURSING
INITIATIVE AND THE STRUGGLE THAT
MANY OF OUR LOCAL HOSPITALS HAVE
AND HAVING NURSING STAFF
AVAILABLE AND NOT HAVING TO PAY
TRAVELING NURSES, WHICH THEN
CREATES COST PRESSURES ON
INSTITUTIONS. WE'VE SEEN ONE
HOSPITAL CLOTHES AND MY REGION
DUE TO THOSE PRESSURES AND THUS
WANT TO MAKE SURE WE'RE
PROVIDING IMMEDIATE ATTENTION
AND RESOURCES TO TRAINING THE
WORKFORCE, SO WE DON'T CONTINUE
TO EXACERBATE THE INSTITUTIONS
THAT ARE IN REGIONS THAT FEEL
UNDER RESOURCED AND HENCE WHY
YOU SEE THE REAL, UM UNANIMOUS.
POSITION OF ALL OF US
LEGISLATORS IS FEELING THAT, UM
, CRY FROM THOSE WHO ARE ON THE
FRONT LINES TODAY TO MAKE SURE
THAT WE'RE WORKING ON
REINFORCEMENTS FOR TOMORROW.
THUS WHILE I APPRECIATE THE
DELAYS AND THE PROMISES THAT WE
WILL FULLY FUND THIS MANY OF US
ARE LOOKING FOR THE GUARANTEES
OF GETTING THESE DOLLARS OUT SO
WE CAN START TRAINING THE
PROVIDERS IMMEDIATELY AND WILL
LOOK TO CONTINUE TO HAVE
CONVERSATIONS WITH THE
ADMINISTRATION AS WE GO FORWARD.
WITH THAT WE WILL HOLD ISSUE
FIVE OPEN AND NOW MOVE ON TO
ISSUE SIX. SIXTH ISSUE IS AN
OVERSIGHT ISSUE ON HEALTH CARE
WORKFORCE. OUR FIRST SPEAKER IS
KAREN RUSSELL WITH H TIE. PLEASE
BEGIN WHEN YOU'RE READY. GREAT.
GOOD AFTERNOON. UM SO I'VE BEEN
ASKED TO PROVIDE AN OVERVIEW OF
HK'S HEALTH WORKFORCE PROGRAMS.
UM SO H GUYS. HEALTH WORKFORCE
PROGRAMS HAVE THREE MAIN GOALS.
WE ARE SEEKING TO DEVELOP A
HEALTH WORKFORCE THAT SERVES
MEDICALLY UNDERSERVED AREAS.
THAT REPRESENTS THE CALIFORNIA
IT SERVES RACIAL AND LANGUAGE,
DIVERSITY AND SERVES MEDICAL
MEMBERS. AND SO IT TO ACHIEVE
THAT GOAL. WE'RE WORKING ACROSS
THE CONTINUUM TO DEVELOP
PROGRAMS. UM THAT SUPPORT
PIPELINE. WE RECOGNIZE THE NEED
TO BUILD THE WORKFORCE OF
TOMORROW. TO INCREASE THE NUMBER
OF PROFESSIONALS TRAINED AND THE
NUMBER OF STUDENTS TO SUPPORT
STUDENTS TRAINING TO BE HEALTH
PROFESSIONALS AS WELL AS
PROVIDERS WHO ARE SERVING AN
UNDERSERVED AREAS. SO IN THE FOR
EXAMPLE, IN OUR PIPELINE
PROGRAMS, WE OFFER SEVERAL
PROGRAMS UNDER OUR HEALTH
PROFESSIONS CAREER OPPORTUNITY
PROGRAM SUITE OF PROGRAMS ARE
HEALTH CAREERS EXPLORATION
PROGRAM PROVIDES STUDENTS
OPPORTUNITIES TO HEALTH CAREERS
, EXPLORATION, HEALTH CAREER
CONFERENCES. OUR HEALTH
PROFESSIONS PATHWAYS PROGRAM
THAT WE JUST LAUNCHED THIS LAST
YEAR ANNOUNCED MORE THAN 40
MILLION IN GRANTS TO SUPPORT
ORGANIZATIONS SUPPORTING AND
ENCOURAGING STUDENTS FROM
UNDERREPRESENTED REGIONS TWO AND
BACKGROUNDS TO PURSUE HEALTHCARE
CAREERS. WE ALSO AS I MENTIONED
TRAINING, WE LOOK AT WHAT ARE WE
DOING TO EXPAND THE CAPACITY OF
OUR TRAINING INSTITUTIONS TO
TRAIN? OUR SONG BROWN PROGRAM, A
LONGSTANDING PROGRAM THAT WE
HAVE TRAINS, PRIMARY CARE
PROVIDERS AND NURSES, PHYSICIANS
ASSISTANCE, UM AND FAMILY NURSE
PRACTITIONERS, AND THIS YEAR WE
ADDED LICENSE AND CERTIFIED
MIDWIVES. WE JUST ANNOUNCED
ALMOST 50 MILLION TO SUPPORT 54
PRIMARY CARE RESIDENCY PROGRAMS
, INCLUDING 17 NEW AND EXPANDING
PROGRAMS. AND WE MADE ANNOUNCED
17 MILLION TO SUPPORT 32 NURSING
PROGRAMS AND INCREASE FROM THE
PREVIOUS YEAR. AND THEN 3.4
MILLION TO SUPPORT 21 FAMILY
NURSE PRACTITIONER AND PHYSICIAN
IS ASSISTANT PROGRAMS AS I
MENTIONED SUPPORTING MIDWIFERY
PROGRAMS IN CALIFORNIA. WE ALSO
HAVE SEVERAL PROGRAMS THAT
SUPPORT BEHAVIORAL HEALTH,
EXPANDING THE CAPACITY TO TRAIN
PSYCHIATRISTS, PSYCHIATRIC
MENTAL HEALTH, NURSE
PRACTITIONERS, SOCIAL WORKERS
HERE PERSONNEL AS MENTIONED. WE
ALSO HAVE OUR SUPPORT FOR
INDIVIDUALS AND WE HAVE 11
REPAYMENT AND SCHOLARSHIP
PROGRAMS THAT WE OPERATE, WHICH
ALL REQUIRE A SERVICE OBLIGATION
TO SERVE IN AN UNDERSERVED AREA
OR FACILITY. THESE PROGRAMS
INCLUDE OUR LOAN REPAYMENT
PROGRAMS SUCH AS STEPHEN
THOMPSON STATE LOAN REPAYMENT.
OUR SCHOLARSHIP PROGRAMS. UM AND
WE HAVE SEVERAL PROGRAMS, FOR
EXAMPLE, THAT SUPPORT THE
NURSING PROFESSION. WE ARE
GETTING READY TO RELAUNCH OUR
STIPEND PROGRAM TO SUPPORT
SOCIAL SOCIAL WORKERS. UM, AND
AS I MENTIONED EARLIER, LOOKING
AT WAYS TO SUPPORT STUDENTS WITH
EARN AND LEARNING APPRENTICESHIP
PROGRAMS WITH OUR SUBSTANCE USE
DISORDER PROGRAM. NEXT, I WILL
PROVIDE A BRIEF OVERVIEW OF THE
RESEARCH DATA CENTER. SO AS WAS
MENTIONED STATUTE ESTABLISHED
THE HEALTH WORKFORCE RESEARCH
DATA CENTER AS THE STATE CENTRAL
SOURCE OF HEALTHCARE WORKFORCE
AND EDUCATION DATA. SO WITH THAT
WE'RE RESPONSIBLE FOR COLLECTING
, ANALYZING AND DISTRIBUTING
INFORMATION ON EDUCATIONAL AND
PLACEMENT, TRANS HEALTHCARE
OCCUPATIONS AND DISTRIBUTION.
THROUGH OUR COLLECTION AND
REPORTING OF DATA. WE FOCUS ON
ANALYZING SUPPLY AND DEMAND AND
DESCRIBING PROGRAM OUTCOMES. WE
DEVELOPED A PARTNERSHIP WITH
DEPARTMENT OF CONSUMER AFFAIRS
TO COLLECT THE DATA FROM ALL 18
HEALING ARTS SPORTS NECESSARY TO
PROVIDE THIS INFORMATION. AND AS
YOU SAW IN OUR FIRST REPORT TO
THE LEGISLATURE, WE WERE ABLE TO
TAKE THAT AND SHARE SOME OF THE
DATA THAT WE'VE BEEN COLLECTING.
WELL NEW DATA COLLECTION EFFORTS
ARE IN PROGRESS. OUR GOAL THIS
LAST YEAR WAS TO DEVELOP THE
INFRASTRUCTURE AND THE BASELINE
FOR COLLECT THE DATA AND THEN BE
ABLE TO SUMMARIZE THE DATA WE'VE
COLLECTED AND AS WE BUILD MORE
DATA WILL BE ABLE TO SHARE MORE
DATA ON THE ON THE WORK THAT
WE'RE DOING. SO WHAT TYPE OF
DATA WILL UH, HK I HAVE WITH
REGARDS TO HEALTH WORKFORCE IN
THE FUTURE. SO WE WILL HAVE A
VARIETY OF DATA AND INFORMATION
AVAILABLE TO ASSIST IN
ESTIMATING SUPPLY DEMAND AND
DEMOGRAPHIC MAKEUP. THIS
INCLUDES BREAKDOWNS BY
PROFESSION AGAIN FROM THE
LICENSED AND CERTIFIED FROM THE
HEALING ART BOARDS. DIFFERENT
GEOGRAPHY IS DEMOGRAPHIC
CHARACTERS, CHARACTERISTICS,
RACE AND ETHNICITY, AGE, SEXUAL
ORIENTATION, GENDER IDENTITY AND
SHORTAGES WHERE OTHER SHORTAGES
IN CALIFORNIA. THROUGH THE
PARTNERSHIP AS I MENTIONED
BEFORE WE HAVE BEEN COLLECTING
THIS DATA, UM WITH DEPARTMENT OF
CONSUMER AFFAIRS THROUGH
LICENSING SURVEYS, UM, AND IS
FEATURED IN OUR REPORT. WE'RE
EXPANDING THE NUMBER OF
PARTNERSHIPS WITH DIFFERENT
STATE ENTITIES TO ADD DIFFERENT
DATA SETS TO THE RESEARCH DATA
CENTER. WE ARE ALSO PARTNERING
WITH EACH OF THE HIGHER
EDUCATION SYSTEMS TO SHARE DATA
AND MEASURE THINGS LIKE
EDUCATIONAL THROUGHPUT PUT BY
DISCIPLINE, FOR EXAMPLE. SO IF
YOU LIKE I CAN GO INTO THE
SECOND QUESTION LAST QUESTION,
WHICH IS WHETHER CALIFORNIA'S
MOST URGENT HEALTHCARE WORKFORCE
SHORTAGES AND NEEDS SO OUR
PROGRAMS AS I MENTIONED FOCUS ON
CREATING ACCESS AND UNDERSERVED
AREAS AND UNDERSERVED
POPULATIONS, AND INCREASING THE
DIVERSITY AND CULTURAL
CONCORDANCE. LATER IN 2023, THE
RESEARCH DATA OR DATA CENTER
EXPECTS TO HAVE DATA TO BEGIN
DEVELOPING DEMAND ESTIMATES THAT
WILL HELP US TO START TO MAKE
ESTIMATES A NUMBER OF PROVIDERS
NEEDED BUT TODAY I WILL FOCUS ON
THE SHORTAGES WE SEE
GEOGRAPHICALLY AND
DEMOGRAPHICALLY AS FAR AS ACCESS
TO HEALTHCARE. WE SEE THE
MALDISTRIBUTION OF THE
WORKFORCE, WHICH CREATES
SHORTAGES IN AREAS THROUGHOUT
THE STATE. WE CONTINUE TO SEE
THE INLAND EMPIRE IN SAN JOAQUIN
VALLEY, BUT NOT ENOUGH
PHYSICIANS ORGANIZED, WHICH ALSO
APPLIES FOR BEHAVIORAL HEALTH
PROVIDERS, WILDEST DISTRIBUTED
WITH SHORTAGES AND IMPLEMENT
EMPIRE AND SAMUEL KEENE VALLEY
AS WELL AS WELL AS THE NORTHERN
SIERRA REGIONS OF THE STATE.
ALSO SUPPORT DISPROPORTIONATELY
EXPERIENCED THE SMALLEST SHARES.
OF THE PHYSICIAN, DENTAL AND THE
ALLIED HEALTH WORKFORCE. OUR
PROGRAMS HAVE ATTEMPTED TO
MITIGATE SOME OF THESE
MALDISTRIBUTION BY FUNDING
TRAINING PROGRAMS THAT BUILD OR
EXPAND IN THESE AREAS. FOR
EXAMPLE, WE FUNDED A NEW
PSYCHIATRIC RESIDENCY PROGRAM
AND COUNTY AND EXPANDED A
PROGRAM AND KERN WE MISS
RECENTLY MADE WORDS EXPAND
SOCIAL WORK TRAINING IN HUMBOLDT
IN SAN BERNARDINO. FOR OUR SONG
GROUND PROGRAM ALL OF THE RECENT
AWARDS TO SUPPORT EXPANDING
PROGRAMS OR DO PROGRAMS IN HIGH
NEED COUNTIES, INCLUDING SAN
BERNARDINO, SHASTA BUTTE, SAN
JOAQUIN AND KERN. OUR FUNDING
ALSO SUPPORTED PROGRAMS STARTING
NEW PRIMARY CARE RESIDENCIES IN
KINGS TO LARRY BEAUTY, SHASTA
AND SAN BERNARDINO COUNTIES.
SINCE CALIFORNIA SUCH A DIVERSE
STATE OF PROGRAMS INTEND TO
BUILD A WORKFORCE THAT
REPRESENTS THE CALIFORNIA IT
SERVES. AND WE KNOW THAT IT'S
SHORTAGE OF THE WORKFORCE THAT
IS DIVERSE, AFFECT SELF
OUTCOMES. SOME OF THE THINGS WE
ARE SEEING, INCLUDING THAT
ALTHOUGH THERE'S BEEN AN
INCREASE IN THE NUMBER OF
HISPANIC AND LATINO PHYSICIANS,
THERE IS STILL MUCH PROGRESS TO
BE MADE WITH PARITY WITH THE
POPULATION. WE DO SEE THE NUMBER
OF BLACK PHYSICIANS GROWING AND
COMING CLOSER TO PARITY WITH THE
POPULATION WITH SOME RECENT
DATA. SOME OF THE NURSING
WORKFORCES DIVERSE, SUCH AS
LICENSE, OCCASIONAL NURSES, AND
ALTHOUGH WE ARE SEEING A
MOVEMENT IN THE RIGHT DIRECTION,
THERE REMAINS A SEVERE SHORTAGE
OF HISPANIC LATINO REGISTERED
NURSING AND NURSES IN
CALIFORNIA. IN BEHAVIORAL HEALTH
. WE'RE ALSO SEEING THESE. WE'RE
SEEING TRENDS IN THE POSITIVE
DIRECTION. BUT WE ALSO SEE
SHORTAGES OF BOTH ASIAN AND
LATINO PROFESSIONALS ACROSS
PROFESSIONS SUPPORTING
BEHAVIORAL HEALTH. WITH THE
LICENSING DATA THAT WE'RE
RECEIVING, WERE ALSO ABLE TO
LOOK AT LANGUAGE. RECENT CENSUS
DATA, FOR EXAMPLE, SHOWS THAT
SPANISH IS SPANISH, IS A
LANGUAGE SPOKEN IN 28% OF
CALIFORNIA HOMES. BUT NONE OF
THE PROFESSIONS HAVE PROVIDERS
THAT MATCH THE PERCENTAGE. FOR
EXAMPLE, LESS THAN 15% OF
REGISTERED NURSES SPEAK SPANISH.
WE ARE NOW SEEING ALSO THAT
THERE ARE FEWER FEWER BEHAVIORAL
HEALTH PROFESSIONALS SPEAKING
SPANISH AND ASIAN PACIFIC
ISLANDER LANGUAGES. THEN THERE
ARE IN THE GENERAL POPULATION
AND SPANISH UNDERREPRESENTED IN
MOST PROFESSIONS. OUR PROGRAMS
DO PRIORITIZE ORGANIZATIONS AND
INDIVIDUALS THAT CAN PROVIDE
CARE IN MEDICAL THRESHOLD
LANGUAGES. FOR EXAMPLE, IN OUR
RECENT ROUND OF LOAN REPAYMENT
AND SCHOLARSHIP CYCLES WE
AWARDED OVER 600 INDIVIDUALS
THAT SPEAK A MEDICAL THRESHOLD
LANGUAGE OR ALMOST 35% OF OUR
AWARDS WERE THE STUDENTS OR
PROVIDERS WHO SPEAK THESE
ADDITIONAL MEDICAL THRESHOLD
LANGUAGES. THANK YOU. CAN WE
CREATE A LITTLE SPACE WITH
DEPARTMENT OF FINANCE, AND SO WE
HAVE A NUMBER OF PANELISTS. NEXT
WE WILL HAVE GARRETT CHAN,
PRESIDENT AND CEO OF HEALTH
IMPACT WITH THE CALIFORNIA
HOSPITAL ASSOCIATION, FOLLOWED
BY MATT PLEDGE WITH S E I U.
THANK YOU. CHAIR ARAMBULA AND
MEMBERS. UH MY NAME'S GARRETT
CHAN AND I AM THE CEO OF HEALTH
IMPACT, WHICH IS THE CALIFORNIA
NURSING WORKFORCE AND POLICY
CENTER. I'M ALSO A NURSING
CURRENTLY IN PRACTICE. WELL
CALIFORNIA HAS APPROXIMATELY 495
100,000 LICENSEES. WE KNOW THAT
ONLY ABOUT 375 100,000 OR 75%
ARE IN SOME TYPE OF PRACTICE. AS
THERE ARE NURSES WHO HAVE
RETIRED TO TELL HEALTH NURSES
FROM OUTSIDE OF CALIFORNIA
TRAVELER OR AGENCY NURSES, UM AS
ACCORDING TO THE UCSF HEALTH
WORKFORCE CENTER, AND DR JOANNE
SPITZ'S STUDY. THE STUDY THAT DR
SPITZ DID ALSO FOUND THAT
CALIFORNIA IS ALREADY SHORT,
40,567 REGISTERED NURSES, AND
IT'S LIKELY TO BE THAT DEFICIT
BETWEEN NOW AND 2026. OF NOTE
AND THAT SURVEY 24% OF
RESPONDENTS SAID THAT THEY WERE
QUOTE REASONABLY LIKELY THAT
THEY WOULD LEAVE THEIR POSITION
WITHIN THE NEXT TWO YEARS AND
ALMOST 15% SAID THAT THEY WERE
DEFINITELY LEAVING. HEALTHCARE
AND HOSPITAL SYSTEMS ARE THE
LARGEST EMPLOYER OF NURSES IN A
SURVEY OF SIX HOSPITALS IN
COUNTIES IN SOUTHERN CALIFORNIA
. ASSEMBLYMEMBER'S RUBIO, YOUR
COUNTY IS REPRESENTED IN THIS
NUMBER. UM THEY HAD A DEFICIT OF
OR THEY HAD 6394 R AND VACANCIES
POSTED. UM. AND IT ALSO TOOK AN
AVERAGE OF 67 DAYS TO ACTUALLY
FILL THOSE POSITIONS. THERE ARE
OVER 400 HOSPITALS IN CALIFORNIA
AND NUMEROUS OTHER COMMUNITY AND
PUBLIC HEALTH ENTITIES OTHER
THAN HOSPITALS AT HIGHER RNS,
FOR WHICH WE DO NOT HAVE
AGGREGATED DATA, SO WE KNOW THAT
THE WORKFORCE SHORTAGES MASSIVE.
IN NOVEMBER. AS THE COMMITTEE
KNOWS, CAN WE HEALTH AND VISALIA
REPORTED THAT THE EXPERIENCE TO
$29 MILLION LOSS AND OPERATING
REVENUE COULD WE HAVE HEALTH HAS
240 VACANT POSITIONS THAT ARE
FILLED BY TRAVELER NURSES. KOREA
IS PAYING ANYWHERE BETWEEN 180
TO $200 AN HOUR AND SINCE THE
START OF THE PANDEMIC, KOREA HAS
PAID $81 MILLION FOR CONTRACT
NURSES THAT DOESN'T INCLUDE
SHIFT BONUSES AND OVERTIME FOR
KOREA EMPLOYED NURSES. HOSPITALS
ACROSS THE STATE HAVE SEEN
NEARLY 20% RISE IN LABOR COST
SINCE THE PANDEMIC, CONTRIBUTING
TO THE OVERALL FINANCIAL
INSTABILITY IN THE HOSPITAL
FIELD. WELL WE CAN UNDERSTAND
THE NUMBERS OF THE IMPACTS OF
THE WORKFORCE SHORTAGE HAS ON
THE FINANCIAL VIABILITY OF
HEALTHCARE ORGANIZATIONS. WE
ALSO NEED TO UNDERSTAND HOW THE
WORKFORCE SHORTAGE HAS AN IMPACT
ON ACCESS TO CARE. WE'RE
BALANCING THE WORKFORCE SHORTAGE
WITH IMPORTANT POLICY
INITIATIVES. IN CALIFORNIA, FOR
EXAMPLE, THE GOVERNOR HAS
PROMISED TO ADVANCE UNIVERSAL
HEALTH, HEALTHCARE ACCESS
THROUGH MEDICAL, AND IN OCTOBER
OF LAST YEAR, HE ANNOUNCED THAT
ROUGHLY 286 100,000 OLDER ADULT
CALIFORNIANS WERE RECEIVING FULL
SCOPE MEDICAL AS A RESULT OF
THIS EXPANSION. WE ARE SEEING
WAIT TIMES FOR NEEDED SURGERIES
AND CLINICAL APPOINTMENTS RISE
EMERGENCY DEPARTMENTS OVER ARE
OVERWHELMED WITH PATIENTS
AWAITING INPATIENT BEDS. THE
WORKFORCE CRISIS IS NOT LIMITED
TO HOSPITALS, HOWEVER. HOME CARE
AGENCIES, COMMUNITY HEALTH
CLINICS, PUBLIC HEALTH
DEPARTMENTS WILL NURSES WHO
PROVIDE MUCH NEEDED CARE AND
SUPPORT TO PEOPLE IN THE
COMMUNITY COMMUNITY ARE ALL IN
NEED OF MORE WORKFORCE SUPPORT
AS THE HEALTHCARE NEEDS OF
CALIFORNIANS IS GROWING.
PERSONALLY I ALSO SEE THAT THERE
ARE SO MANY PATIENTS WHO NEED
CARE IN THE CLINIC WHERE I WORK.
EVEN IF I WORK AS FAST,
EFFICIENTLY EFFICIENTLY AND
PROVIDE HIGH QUALITY AND SAFE
PATIENT CARE. I STILL FEEL LIKE
I CANNOT DO ENOUGH. IT TAKES A
TOLL ON ME AS A NURSE WHO HAS
TAKEN AN OATH TO PROVIDE THE
BEST CARE TO THE MOST NUMBER OF
PEOPLE, AND IT CAN BE
DEMORALIZING. MY EXPERIENCE IS
NOT UNIQUE. WE ARE SEEING
THROUGH RESEARCH AND ANECDOTAL
REPORTS THAT BURNOUT AND MORAL
INJURY IS ON THE RISE FOR ALL
HEALTH PROFESSIONALS. THE
BURNOUT AND MORAL INJURY ARE
DERIVING NURSES OUT OF DIRECT
CARE PRACTICES AND NUMBERS WE
HAVE NEVER SEEN BEFORE. IT ALSO
HAS AN EFFECT ON THE WILLINGNESS
OF BEING A RECEPTOR. HAVING A
STUDENT CAN BE VERY REWARDING,
AND IT'S VERY TIME CONSUMING TO
DO WELL. YET MOST NURSES ARE NOT
EDUCATED IN THE PRACTICE ARE NOT
EDUCATED IN THE PRACTICE OF
TEACHING. ALSO PRECEPT NG IS AN
UNFUNDED OR NON COMPENSATED
ACTIVITY. MY PATIENT LOAD DOES
NOT CHANGE. WHEN I HAVE A
STUDENT. I AM STILL EXPECTED TO
DELIVER CARE AT THE SAME RATE.
SO HOW DO I CREATE A MEANINGFUL
LEARNING EXPERIENCE WHEN I WHEN
WE'RE SHORT STAFFED AND ALREADY
AND NOW WE'RE TRYING TO TEACH ON
THE FLY. ADDITIONALLY THE TIME
HORIZON FOR EDUCATING NURSES IS
ON AVERAGE FOUR YEARS, AND THE
GREATEST NUMBER OF PROFESSIONALS
WHO LEAVE THE PROFESSION WILL DO
SO WITHIN THE FIRST TWO YEARS OF
PRACTICE. SO WE NEED TO HELP
INCREASE THE NUMBER OF
TRANSITION OF PRACTICE OR
POSTGRADUATE APPRENTICESHIP
PROGRAMS TO KEEP THESE HIGHLY
EDUCATED PROFESSIONALS IN THE
PROFESSION. THE HEALTHCARE
WORKFORCE SHORTAGE CRISIS IS
CAUSED BY MANY FACTORS WHILE
ADDRESSING SINGLE FACTORS SUCH
AS ADDRESSING FACULTY SALARIES
AND CLINICAL PLACEMENT SHORTAGES
WILL HELP THEY WILL HAVE A
LIMITED IMPACT ON THE OVERALL
WORKFORCE SHORTAGE CRISIS.
DELAYING FUNDING FOR HEALTHCARE
WORKFORCE PROGRAMS WILL PROLONG
THE WORKFORCE SHORTAGE CRISIS
THAT WE FIND OURSELVES IN TODAY.
ON BEHALF OF HEALTH IMPACT. I
WOULD URGE THE LEGISLATURE AND
THE GOVERNOR TO NOT DELAY OR
INCLUDE TRIGGER CUTS IN THESE
CRITICAL WORKFORCE INVESTMENTS.
INVESTING IN THE HEALTH CARE
WORKFORCE IN AREAS SUCH AS
FACILITATING MORE K THROUGH 12,
ALLIED HEALTH PROVIDERS SUCH AS
DOULAS AND PARAMEDICS AND OTHER
PRE NURSING INDIVIDUALS,
ESPECIALLY PEOPLE OF COLOR TO
PURSUE A CAREER IN NURSING.
STRENGTHENS THE NURSING PIPELINE
STRENGTHENS THE NURSING
EDUCATION AND EXPANDS MEANINGFUL
AND EVIDENCE BASED INTERVENTIONS
TO SUPPORT AND RETAIN NURSES IN
DIRECT ROLES, WHERE WELL BEING
AND MENTAL HEALTH INITIATIVES
AND POSTGRADUATE TRANSITION
PROGRAMS ARE NECESSARY. WE WANT
TO THANK EACH CHI FOR THEIR
SIGNIFICANT WORK WITH US. WE ARE
THANKFUL FOR ALL THE WORK THAT
THEY'RE DOING, AND WE JUST HOPE
THAT WE CAN CONTINUE TO DO MORE.
NEXT WE WILL HEAR FROM MATTLAGE,
A WITH THE EU. UH GOOD AFTERNOON
. THANK YOU FOR HAVING ME UP
AGAIN ON THE THIS IMPORTANT
ISSUE. HEALTHCARE WORKFORCE IS
SOMETHING I'VE SPENT A NUMBER OF
YEARS WORKING ON AND WE ARE
REALLY AT A CRISIS POINT. UM
THERE'S BEEN A LOT OF TALK OF
NURSES AND ABSOLUTELY WHERE HAVE
A SHORTAGE NURSES, BUT I WOULD
SAY THAT THE WORKFORCE SHORTER'S
GO ACROSS THE SPECTRUM ACROSS
ALLIED HEALTH CARE PROFESSIONALS
UP AND DOWN RESIDENT PHYSICIANS
AND SO FORTH. SO REALLY NEED A
HOLISTIC SOLUTION TO TRY TO
ADDRESS OUR HEALTHCARE WORKFORCE
NEEDS, ALTHOUGH I YOU KNOW, ECHO
THE COMMENTS AROUND NURSING
WHERE WE ARE HAVING ACUTE
SHORTAGE RIGHT NOW, UM AS WELL,
UM, YOU KNOW IT'S BEEN SPOKEN
ABOUT, BUT THE TRAUMA THAT
HEALTHCARE WORKERS HAVE FACED
OVER THE LAST THREE YEARS IS
CRITICAL. AND IT IS, UM YOU
KNOW, NOT. I MEAN, IT'S SPOKEN
ABOUT A LOT BUT CAN'T BE SPOKEN
ABOUT ENOUGH. BECAUSE HEALTHCARE
WORKERS REALLY ARE LEAVING THE
PROFESSION AND AN INCREDIBLY
HIGH RATE, ACCORDING TO ONE
SURVEY AT A RATE OF ALMOST 30%
WHICH YOU KNOW IF WE'RE NOT
RETAINING OUR HEALTHCARE
WORKFORCE. IT TAKES SO LONG TO
TRY TO RE CHAINED TO TRAIN NEW
WORKERS. WE HAVE TO DO BOTH, AND
WE APPRECIATE THE INVESTMENTS
LAST YEAR BY THE LEGISLATURE AND
GOVERNOR ON RETENTION. IN THOSE
FUNDS ARE GOING TO GET OUT, BUT
JUST REALLY NEED TO MAKE SURE
THAT WE'RE DOING EVERYTHING WE
CAN TO TRY TO RETAIN OUR
EXISTING WORKFORCE AND TRAIN NEW
WORKERS. UM WITH THAT BEING SAID
IN A RECENT SURVEY OF HEALTHCARE
WORKERS, JUST THAT, YOU KNOW,
STRESS, THE 0.83% OF HEALTHCARE
WORKERS REPORTED THAT THEIR
DEPARTMENTS ARE UNDERSTAFFED. UM
AND THAT'S A SURVEY OF CTU
MEMBERS AND, YOU KNOW, REALLY,
WE ARE NOT ABLE TO DELIVER ON
OUR GOALS OF PROVIDING TIMELY
ACCESS TO CARE IF WE DO NOT HAVE
THE WORKERS TO DO THAT, IN THE
GOES FROM THE PERSON GREETING
YOU AT THE FRONT DESK. SO THE
MEDICAL ASSISTANT WHO'S GETTING
YOU READY FOR THE APPOINTMENT.
TO THE PHYSICIAN OR NURSE
PRACTITIONER. WHATEVER PROVIDER
TO BROUGHT IN CARE, UM, DURING
YOUR VISIT. UM. PROGRAMS LIKE
REGISTERED NURSES, RESTORATION
THERAPISTS, UH AND ROUTE
RADIOLOGIC TECHNOLOGISTS WHO
TAKE X RAYS. THOSE ARE TYPICALLY
AT A MINIMUM TWO YEARS IN
LENGTH, SO IT DOES TAKE SOME
TIME. AND SO WE ARE CONCERNED,
AND EVEN THOUGH WE ARE ABOUT ANY
DELAYS IN FUNDING, EVEN THOUGH
WE ARE APPRECIATE THAT WE'RE IN
A VERY DIFFICULT BUDGET TIME, I
WOULD JUST ECHO THE COMMENTS
THAT THE COMMITTEE MADE TODAY
AROUND YOU KNOW, THIS CAN'T
WAIT. THIS IS SOMETHING THAT'S
ABSOLUTELY NECESSARY,
PARTICULARLY, UM, IF WE'RE
THINKING ABOUT HOW THE GOVERNOR
COULD MEET GOALS OF ENSURING
500,000 APPRENTICES, I WOULD
ARGUE THAT YOU KNOW, HEALTH CARE
IS THE RIGHT FIELD TO INVEST IN
THE RIGHT FIELD TO MAKE THAT
HAPPEN. UM SO FOR THAT WE WOULD
JUST, YOU KNOW, ENCOURAGE THE
LEGISLATURE TWO. YOU KNOW, BOTH
THINK ABOUT THE DELAYS BUT ALSO
LOOK AT THIS AS A POTENTIAL
OPPORTUNITY TO LOOK AT THE TYPES
OF FUNDING THAT WE COULD PROVIDE
FOCUS ON PROGRAMS THAT ARE JOINT
PROGRAMS BETWEEN LABOR AND
MANAGEMENT SO WE CAN BRAID AND
COBBLED TOGETHER RESOURCES SO
THAT OUR DOLLARS ARE LIMITED
DOLLARS IN THE STATE BUDGET CAN
GO FURTHER. AND SO WITH THAT, UH
, JUST ALSO WANT TO FOCUS ON
CAREER LADDERS. HOW DO WE HELP
EXISTING HEALTHCARE WORKERS
ADVANCE IN THEIR CAREER? TAKE
THE NEXT STEP BECAUSE WE KNOW
THAT IF YOU HAVE SURVIVED
THROUGH THE PANDEMIC AND YOUR
CONTINUING TO WORK IN HEALTH
CARE, YOU'RE GOING TO WANT TO
STAY IN HEALTHCARE, WHICH WOULD
PROMOTE RETENTION. UM SO ONCE
AGAIN APPRECIATE THE, UM THE
BUDGET IN THE SITUATION THAT
WE'RE CURRENTLY IN, BUT JUST
ECHOED ALL THE COMMENTS OF THE
COMMITTEE MADE TODAY OF REALLY
NEEDING TO MAKE INVESTMENTS NOW
AND NOT DELAY. SO THANK YOU.
NEXT WE WILL HEAR FROM NATALIE
DIAZ, WHO'S THE DIRECTOR OF
HEALTH CENTER OPERATIONS WITH
THE CALIFORNIA PRIMARY CARE
ASSOCIATION. THANK YOU, CHAIRMAN
AND COMMITTEE MEMBERS FOR THE
OPPORTUNITY TO WEIGH IN. I'M
NATALIE DÍAS DIRECTOR PAUL
CENTER OPERATIONS AT THE
CALIFORNIA PRIMARY CARE
ASSOCIATION. WE REPRESENT
APPROXIMATELY 1300 NOT FOR
PROFIT COMMUNITY HEALTH CENTERS
WHO PROVIDE COMPREHENSIVE
QUALITY HEALTH CARE,
PARTICULARLY FOR LOW INCOME,
UNINSURED AND UNDERSERVED
CALIFORNIANS WHO MIGHT NOT
OTHERWISE HAVE ACCESS TO
HEALTHCARE. COLLECTIVELY HEALTH
CENTERS PROVIDE CARE TO MORE
THAN 7.7 MILLION PATIENTS AND A
SIGNIFICANT PORTION OF THE
MEDICAL POPULATION. HEALTHCARE
EMPLOYERS, INCLUDING HEALTH
CENTERS ARE CURRENTLY OPERATING
IN THE MOST CHALLENGING LABOR
MARKET AND DECADES. INFLATION
REMAINS HIGH AND UNEMPLOYMENT IS
NEAR HISTORIC LOWS. THE SIZE OF
THE LABOR MARKET HAS SHRUNK AND
HAS NOT RECOVERED SINCE PRE
PANDEMIC LEVELS. ACROSS
INDUSTRIES, EMPLOYERS ARE
RAISING SALARIES WHILE ALSO
EXPERIENCING RISING TURNOVER.
THE AVERAGE 12 MONTH TURNOVER
REPORT BY HOUSE OWNERS IN 2022
WAS 31.4. THIS TURNOVER RATE IS
MORE THAN THREE TIMES HIGHER
THAN IN 2020. AND NEARLY TWICE
AS HIGH THAN IN 2021. THE
POSITIONS WITH THE HIGHEST
TURNOVER, INCLUDING MEDICAL
ASSISTANCE. PHYSICIANS. DENTAL
ASSISTANCE. DENTISTS NURSE
PRACTITIONERS AND PHYSICIAN
ASSISTANCE RESPECTIVELY. THE
MAJORITY OF HEALTH CENTERS
IMPLEMENTED SALARY INCREASES IN
2022 IN RESPONSE TO HIGH
INFLATION AND THE COMPETITIVE
LABOR MARKET. HOWEVER IT'S
CHALLENGING FOR HEALTH CENTERS
TO KEEP UP WITH THE CURRENT RATE
OF SALARY INCREASES. HEALTH
CENTERS DO NOT HAVE THE
FLEXIBILITY TO INCREASE THEIR
PRICING STRUCTURES, THEREFORE,
SIGNIFICANT INCREASES TO
REIMBURSEMENT RATES FOR CLINICS
ARE NEEDED TO KEEP UP WITH THE
RISING LABOR COSTS. IN ADDITION
, STRATEGIC INVESTMENTS INTO
HEALTHCARE PATHWAY PROGRAMS AND
TOTAL REWARDS ARE CRUCIAL. NOW
MORE THAN EVER. FOR THESE
REASONS, THE WORKFORCE PROGRAMS
UNDER AGE CHI HAVE BECOME
INCREDIBLY IMPORTANT TO DEVELOP
IN THE HEALTH CENTER WORKFORCE.
WE CONTINUE TO WORK SITE ALONG.
WE CONTINUE TO WORK ALONGSIDE H
CHI STAFF AND PARTNERS LIKE C M
A C A P AS A S E A U AND OTHERS
TO ENSURE THAT GRADUATE MEDICAL
EDUCATION PROGRAMS LIKE THE SONG
BROWN PRIMARY CARE TRAINING
PROGRAM CONTINUE TO HAVE ROBUST
FUNDING AVAILABLE. THE TEACHING
HEALTH CENTER PROGRAM, WHICH
SHIFTS THE MODEL FROM TRAINING
POSITIONS IN THE HOSPITAL TO THE
COMMUNITY BASED SETTING HAS
DOUBLED IN THE LAST SEVEN YEARS.
AND THAT'S REALLY WHAT THE
SUPPORT, UH FOR NEW EXPANDING
EXISTING AND TEACHING HEALTH
CENTER FUNDING AVAILABLE THROUGH
THE SONG GROUND PROGRAM. NOW THE
CHALLENGE IN FRONT OF US IS
SUSTAINING THE TEACHING HEALTH
CENTER FUNDING, GIVEN THE
SIGNIFICANT EXPANSION AND
INCREASED COST OF TEACHING
HEALTH CENTER TRAINING, WHICH IS
NOW AT $209,000 PER RESIDENT PER
YEAR, ACCORDING TO HER SAVANNAH.
LAST YEAR, ADDITIONAL FUNDS WERE
INVESTED INTO THE SONG BROWN
PRIMARY CARE RESIDENCY FUNDING
PROGRAM THROUGH THE STATE BUDGET
PROCESS, BUT ADDITIONAL AND
SUSTAINABLE FUNDS ARE NEEDED TO
ENSURE TOO ARE NEEDED TO ENSURE
THAT WE DON'T LOSE GROUND. IN
ADDITION, CALIFORNIA INVESTED
FOR THE FIRST TIME LAST YEAR IN
NEW NURSE PRACTITIONER AND
PHYSICIAN ASSISTANT POST
GRADUATE TRAINING PROGRAMS. THIS
WAS A ONE TIME INVESTMENT SO
ADDITIONAL WORK WILL BE NEEDED
TO SUSTAIN THIS PROGRAM. OVERALL
THIS HIGHLIGHTS HOW H CHI
THROUGH COLLABORATION WITH THE
LEGISLATURE, GOVERNOR AND
STAKEHOLDERS HAS SIGNIFICANTLY
EXPANDED HEALTH PROFESSIONS
TRAINING PROGRAMS. SIMILAR
EXAMPLES INCLUDE THE CALIFORNIA
MEDICINE SCHOLARS PROGRAM AND
THE HEALTH PROFESSIONS CAREER
OPPORTUNITY PROGRAM, WHICH HELP
US REACH OUT TO STUDENTS EARLIER
IN THEIR TRAINING AND EXPOSE
THEM TO HEALTH CAREERS IN
COMMUNITY HEALTH CENTERS. WE'RE
DELIGHTED BY THIS AND WE WOULD
LIKE TO SEE HK I WORKFORCE
FUNDING PROGRAMS CONTINUE TO
PRIORITIZE COMMUNITY BASED
TRAINING PROGRAMS, SITES AND
RECEPTORS. THIS IS SOMETHING
THAT HAS BEEN SIGNIFICANTLY
DISCUSSED IN THE CALIFORNIA
HEALTH WORKFORCE, EDUCATION AND
TRAINING COUNCIL MEETINGS. SO
WELCOME ADDITIONAL CONVERSATIONS
ON HOW WE CAN MAKE THIS HAPPEN.
THE HK LOAN REPAYMENT AND
SCHOLARSHIP PROGRAMS HAVE BUILD
GAPS THAT EXIST WITH THE FEDERAL
HERSELF PROGRAMS. THE NATIONAL
HEALTH SERVICE CORE FUNDING
EXPIRES THIS FALL. WHICH MEANS
THAT LIMITED OR NON EXPANDED
FUNDING WILL ONLY FUND UH
PROVIDERS AND ENTITIES. THAT
HAVE A CERTAIN HIPS THE
THRESHOLD. STATE PROGRAMS LIKE
THE STATE LOAN REPAYMENT PROGRAM
WILL HAVE A HIP HAVE A HIPSTER
REQUIREMENT, BUT THEY DON'T HAVE
A HIPS OF THRESHOLD. THIS MEANS
THAT PROVIDERS WORKING IN
UNDERSERVED AREAS WITH
RELATIVELY HIGH HIPS OF SCORES
WILL CONTINUE TO BE ABLE TO
LEVERAGE THE STATE LOAN
REPAYMENT PROGRAMS, WHICH IS
CRITICAL. WELL THIS IS GREAT. I
DO WANT TO FLAG FOR YOUR
CHALLENGE THAT IS ON THE
HORIZON. THE INCREASED FEDERAL
FUNDING AND THE STATE LOAN
REPAYMENT PROGRAM IN THE PAST 2
TO 3 YEARS REMOVED THE EMPLOYER
MATCH REQUIREMENT. WHICH PAIR IS
YOU POSED CHALLENGES FOR SMALLER
HEALTH CENTERS WHO CANNOT
PROVIDE THE BATCH. UNLESS
INCREASED FUNDING IS DEDICATED
TO THIS PROGRAM. THAT MATCH
REQUIREMENT MAY BE REINSTATED.
WHICH CREATES RECREATES THE
CHALLENGE FOR ALL ELIGIBLE
HEALTHCARE PROVIDERS AND
ENTITIES TO PARTICIPATE. LASTLY
WE ARE AWARE THAT THE GOVERNOR'S
PROPOSED BUDGET INCLUDED
DEFERRED FUNDS FOR SEVERAL
WORKFORCE INITIATIVES, AS HAS
BEEN DISCUSSED AN EXAMPLE OF
THAT IS A COMMUNITY HEALTH
WORKERS. AND WE KNOW THAT IN OUR
SETTING COMMUNITY HEALTH WORKERS
ARE CRITICAL TO CONNECTING OUR
PATIENTS TO SOCIAL AND OUTREACH
SERVICES. SO WE DO. LIKE OTHERS
HAVE STATED ENCOURAGE THE
LEGISLATURE TO REVISIT THIS
PROPOSAL AND EXPLORE WAYS THAT
THE FUNDING COULD BE REINSTATED.
LIKE MANY IN THIS ROOM, WE ARE
COMMITTED TO ENSURING THAT ARE
UNDERSERVED COMMUNITIES HAVE
ACCESS TO HIGH QUALITY
HEALTHCARE, INVESTING IN THE
DEVELOPMENT OF A DIVERSE AND
INCLUSIVE WORKFORCE IS A
SIGNIFICANT ANSWER TO ACHIEVING
THAT GOAL. THANK YOU. FINALLY WE
HAVE ONE MORE SPEAKER WHO SO
KINDLY ACCEPTED OR VERY LEAD
INVITATION. LUPE ALONSO DIAZ WAS
THE PRESIDENT AND CEO OF
POSITIONS FOR A HEALTHY
CALIFORNIA MISS ALONSO DIAZ.
THANK YOU. THANK YOU. CHAIR
MEMBERS LOOP. ALONSO DÍAS,
PRESIDENT AND CEO FOR PHYSICIANS
FOR HEALTHY CALIFORNIA NOT
RELATED TO NATALEE DS, UM I
WANTED YOU FIRST AND FOREMOST,
THANK YOU FOR YOUR LEADERSHIP IN
THIS SPACE AS A FORMER RECIPIENT
OF MEDICAL AND WIC AND FOOD
STAMPS AND OTHER SERVICES
AVAILABLE FOR LOW INCOME WORKING
POOR FAMILIES HAVING THIS
CONVERSATION ABOUT THE
OPPORTUNITIES TO ADDRESS HEALTH
CARE, WORKFORCE CHALLENGES IS
REALLY PERSONAL. FOR ME. IT
CONTINUES TO BE PERSONAL FOR ME.
MY MOM IS ON MEDICARE. AND SHE
RELIES ON THAT FOR EVERY SINGLE
SERVICE THAT'S AVAILABLE TO HER
. AND SO AGAIN. THIS IS PERSONAL
FOR ME, AND I APPRECIATE BOTH
THE LEADERSHIP HERE IN THIS
COMMITTEE AS WELL AS THE
LEADERSHIP BY THE DEPARTMENT IN
THE SPACE I WANTED TO SHARE TO,
UM TO BEST PRACTICES AND I WANT
TO ALSO JUST RECOGNIZED TIME AND
KEEP MY COMMENTS BRIEF. WE KNOW
AS AS HAS BEEN NOTED ALREADY. WE
KNOW THAT ADDRESSING DEVELOPING
DEPLOYING PHYSICIAN TRAINING
PROGRAMS IN UNDERSERVED AREAS
WORK IT'S A WIN WIN. IT'S AN
ECONOMIC DEVELOPMENT
OPPORTUNITY. IT WORKS FOR THAT
COMMUNITY. IT INCREASES ACCESS
TO PHYSICIANS AND ALLIED HEALTH
PROFESSIONALS IN THAT COMMUNITY.
IT INCREASES ACCESS TO CARE. IT
ALSO ENSURES IDEALLY THAT THOSE
PHYSICIANS ARE STAYING IN THOSE
COMMUNITIES. THEY BECOME THE PT
LEADERS. THEY BECOME THE
INDIVIDUALS LOOKING FOR
EMPLOYMENT. THEY'RE ALSO LOOKING
TO BUY HOUSING AND MAKE A HOME
IN THAT COMMUNITY, AND THAT IS A
BUSINESS DEVELOPMENT
OPPORTUNITY. THAT IS A WIN WIN
FOR THAT COMMUNITY. PHC
ADMINISTERS THE CALL METAPHORS
PROGRAM. WE HAVE A CONTRACT WITH
THE UNIVERSITY OF CALIFORNIA. IT
IS FUNDED BY PROPOSITION 56.
IT'S AN ANNUAL APPROPRIATION OF
40 MILLION IN THE LAST FOUR OR
FIVE YEARS. SINCE 2018. WE HAVE
RECEIVED A REQUEST FOR MORE THAN
2482 RESIDENCY POSITIONS. SO
AGAIN, 2482 RESIDENT POSITIONS
THAT HAVE BEEN REQUESTED FOR
SUPPORT AND WE'VE BEEN ABLE TO
AWARD SLIGHTLY MORE THAN 965.
AND OF THOSE 386 ARE NEW AND
EXPANDING RESIDENCY SLOTS. THOSE
ARE 386 NEW AND EXPANDING
RESIDENCY SLOTS. THAT WOULDN'T
BE THERE. WITHOUT THE JOINT
SUPPORT OF THE PROPERTY, SIX
FUNDS AS WELL AS OTHER FUNDS
SUCH AS SONG BROWN. WE ALSO KNOW
THAT PHYSICIANS TEND TO PRACTICE
WHERE THEY TRAIN SO TO HAVING
PHYSICIAN TRAINING PROGRAMS THAT
ARE EXPOSED TO MIGRANT
FARMWORKER CLINICS, STREET
MEDICINE, OTHER COMMUNITIES
FOSTER CHILDREN, LGBTQ. PLUS IT
HELPS. IT'S A WIN WIN. FOR THAT
REASON WE AGAIN WANT TO
ACKNOWLEDGE AND APPRECIATE YOUR
LEADERSHIP IN THE SPACE. THE
OTHER PROGRAM THAT WE ADMINISTER
. ALSO FUNDED BY PROPOSITION 50
SIXES. KELL HEALTHCARE'S THAT
KELLY HEALTHCARE'S LOAN
REPAYMENT PROGRAM. THIS PROGRAM
FOCUSES ON WHO PHYSICIANS AND
DENTISTS SERVE RATHER THAN WHERE
THEY SERVE. WE'VE ALREADY HEARD
DATA WITH RESPECT TO MEDICAL
COMMUNITIES. THIS PARTICULAR
PROGRAM IS A ONE TIME
APPROPRIATION OF PROFIT. SIX
FUNDS FOR 340 MILLION WE HAVE
RECEIVED A REQUEST FOR MORE THAN
3585. PHYSICIANS AND DENTISTS.
SINCE 2019 THAT WOULD LIKE TO
INCREASE THEIR ACCESS AND THEIR
PARTICIPATION IN MEDICAL THE
AVERAGE PAYER MIX FOR OUR
AWARDEES IS 65 TO 70% MEDICAL,
SO WE ARE LOOKING FOR YOUNG
PHYSICIANS AND DENTISTS THAT
WANT TO PRACTICE WITH MEDICAL
COMMUNITIES. OF THOSE AWARDS
THAT WE HAVE FUNDED. IT'S BEEN A
LITTLE BIT MORE THAN 1130. THEIR
EDUCATIONAL DEBT IS MORE THAN
1.1 BILLION. AND WHAT WE HAVE
AVAILABLE TO DATE IS 350 WOULD
LIKE TO REPEAT THAT AGAIN. THE
REQUESTS IN THE LAST FOUR YEARS
HAS TOTALED MORE THAN 1.1
BILLION, AND I'M SURE BOTH OF
THE GOOD DOCTOR'S HERE KNOWN
THAT AVERAGE EDUCATIONAL DEBT
FOR A PHYSICIAN IS ABOUT
350,000. IT HAS A LOT OF MONEY.
AFTER 20 TO 30 YEARS OF
SERVICING THAT DEBT, IT'S CLOSER
TO 600,000. SO IN ADDITION TO
REIMBURSEMENT RATES, HAVING
THOSE OPPORTUNITIES TO PROVIDE
BOTH LOAN REPAYMENTS IN REAL
TIME ACADEMIC SUPPORT, BOTH
ACADEMIC AND FINANCIAL SUPPORT
BY MEANS OF SCHOLARSHIPS IS
CRITICALLY IMPORTANT IF WE WANT
TO DIVERSIFY THE PHYSICIAN
WORKFORCE HONESTLY, WE HAVE TO
START AT THE WOMB. WE HAVE TO
START WITH MATERNAL HEALTH. BUT
RECOGNIZING THAT THE PURPOSE OF
THIS COMMITTEE IS FOCUSED ON
ADDRESSING HEALTHCARE WORKFORCE,
WE HAVE TO FIND THOSE
OPPORTUNITIES TO ENSURE THAT
THAT FINANCIAL BARRIERS AND
ACADEMIC AND BARRIERS DON'T
LIMIT HOW WE DIVERSIFY OUR
PHYSICIAN WORKFORCE. OF OUR CAL
HEALTHCARE'S AWARDEES. ALMOST
80% SPEAK ANOTHER LANGUAGE OTHER
THAN ENGLISH AND AGAIN 65 TO 70%
OF THEM PRACTICE WITH MEDICAL
COMMUNITIES AGAIN. I WANT TO
RECOGNIZE ANY THINK THIS
COMMITTEE YEAR LEADERSHIP IN
THIS SPACE AS WELL AS THE
DEPARTMENT FOR ALL OF THE
WONDERFUL WORK THAT YOU'VE DONE
TODAY AND RECOGNIZING ALSO ALL
OF THE WONDERFUL WORK THAT SHALL
HAPPEN AGAIN APPRECIATE YOUR
SUPPORT. DEPARTMENT OF FINANCE.
FOLLOWED BY ELIO. JOSEPH NELSON
. APARTMENT FINANCE. NO
ADDITIONAL COMMENTS AT THIS
TIME. THANK YOU. JULIO JASON,
CONSTANT, CARILLO, CELIO ALSO
AVAILABLE FOR QUESTIONS BRING IT
UP TO THE DIOCESE WILL BEGIN
WITH ASSEMBLYMEMBER'S RUBIO
FOLLOWED BY DOCTOR WOULD THANK.
YOU APPRECIATE ALL OF THE
INFORMATION AND I AM LOOKING
THROUGH OUR PACKET AND I SEE ALL
OF THE DEFICITS IN THE WORKFORCE
. UM I THINK, UH, DIRECTOR WAS L
TALKED ABOUT ALL OF THE
INVESTMENTS ON, UM PROGRAMS TO
HELP DEVELOP THE WORKFORCE. I
DON'T SEE ANY DATA AS TO HOW
THOSE ARE WORKING. UM YOU KNOW,
INVESTING IN THOSE PROGRAMS IS
ONE THING, BUT ARE THEY ACTUALLY
WORKING? BECAUSE UM, I KNOW THAT
PRIOR TO THE PANDEMIC, WE HAD A
SHORTAGE. UH HEALTHCARE
WORKFORCE SHORTAGE. THE PANDEMIC
HAPPENED, AND IT DOESN'T SEEM TO
BE GETTING BETTER. SO IF THERE'S
ANY DATA THAT YOU CAN PROVIDE,
AND ALL THE INVESTMENTS THAT YOU
TALKED ABOUT EARLIER, UM WHAT
WAS IT THE. THE DOCTORS. THE UM
INVESTMENTS IN IN MINORITY
COMMUNITIES, UM, BEING PROVIDERS
IN SOME OF THESE THESE WORKFORCE
AGAIN. I DON'T SEE THAT HERE AND
SO TO ME IS AGAIN. WE'RE
INVESTING IN THESE PROGRAMS. BUT
ARE THEY ACTUALLY MAKING A
DIFFERENCE IN THE WORKFORCE? AND
THAT IS THE FIRST QUESTION IF
YOU OBVIOUSLY IF YOU DON'T HAVE
IT. UM TODAY. I WOULD LIKE TO
SEE THAT DATA BECAUSE WE CAN'T
HELP UNLESS WE SEE. HEY THIS
PROGRAM IS WORKING. LET'S PUT
MORE MONEY INTO THIS PARTICULAR
PROGRAM. UM WHAT I ALSO HEAR IS
YOU YOU WE TALK ABOUT THE
SHORTAGE OF WORKERS. SO HOW ARE
YOU, RECRUITING? UM FOLKS FOR
THESE PROGRAMS, FOR EXAMPLE,
BECAUSE WE CAN HAVE GREAT
PROGRAMS, BUT IF YOU HAVE EMPTY
CHAIRS OBVIOUSLY NOTHING IS
HAPPENING, AND SO IF WE ARE
HAVING A HARD TIME RECRUITING
ACTUAL EMPLOYEES, HOW ARE YOU
EVEN RECRUITING? UM FOLKS TO
PARTICIPATE IN SOME OF THESE
PROGRAMS THAT WERE INVESTING IN
SO THAT THEY CAN TRAIN AND
PROVIDE? AH THAT WORK FOR THAT
WE SO DESPERATELY NEED AND
AGAIN. THE QUESTION IS, WE HAD,
UM A SHORTAGE OF HEALTHCARE
WORKERS PRIOR TO THE PANDEMIC.
HOW ARE WE DOING NOW? I GUESS
IT'S RHETORICAL, BUT BUT WE
REALLY NEED TO ADDRESS THOSE
ISSUES BEFORE WE CONTINUE. OUR
THE INVESTMENTS THAT WE'RE
MAKING ARE SOME PROGRAMS BETTER
THAN OTHERS ARE. YOU KNOW THAT'S
I THINK THE DATA THAT I WOULD
LIKE TO SEE SO THAT WHEN WE'RE
UP HERE, MAKING THIS DECISIONS
WE CAN SAY TO THE POINT OF THE
OF OUR BUDGET, RIGHT? DO WE CUT
THIS FUNDING? UM AND THEN PUT
THAT MONEY IN HERE OR YOU
UNDERSTAND WHAT I'M SAYING?
BECAUSE IF WE'RE IN A IN A TOUGH
BUDGET, UM, SITUATION, THEN WE
HAVE TO MAKE THOSE TOUGH
DECISIONS AND ACTUALLY INVEST IN
PROGRAMS THAT ARE WORKING. UM
WELL, THANK YOU FOR THAT
QUESTION. AND SO I CAN, UM, YOU
KNOW, I THINK THAT, UM THEY ARE
WORKING, FOR EXAMPLE, THAT WITH
THE INCREASED SPENDING WITH SONG
BROWN, FOR EXAMPLE, THAT THE
NUMBER OF PROGRAMS THAT WE'VE
BEEN ABLE TO SUPPORT YOU KNOW
SOME OF THESE ARE THIS IS A
LONGER TERM, BUT WE HAVE BEEN
ABLE TO SIGNIFICANTLY EXPAND THE
NUMBER OF PROGRAMS THAT ARE THAT
ARE BEING BUILT TO TRAIN, FOR
EXAMPLE, WITH OUR PSYCHIATRIC
MENTAL HEALTH NURSE PRACTITIONER
PROGRAM. I THINK WE'RE ABLE TO
FUND OVER 700. YOU KNOW, NEW, UM
, PSYCHIATRIC MENTAL HEALTH
NURSE PRACTITIONERS, FOR EXAMPLE
, UM, THAT WE ARE, UM AND SO,
WITH OUR WITH OUR LOAN REPAYMENT
PROGRAMS, WE'VE BEEN ABLE TO
AWARD OVER 1000. AWARDS WITH
THESE INCREASED DOLLARS FOR
PROVIDERS TO BE ABLE TO SERVE IN
THOSE UNDER SERVED AREAS.
SIGNIFICANT INCREASE. SO WE HAVE
WE HAVE DEMAND FOR THE PROGRAMS
, PEOPLE WHO ARE APPLYING WE
HAVE WE DO SIGNIFICANT OUTREACH
TO REACH OUT AND WORK WITH OUR
STAKEHOLDERS, OUR COMMUNITIES,
UM, TO MAKE SURE THERE ARE
PROGRAMS ARE, UM WE'RE
COMMUNICATING AS MUCH AS WE CAN
. AND WE'RE SEEING INCREASED
DEMAND FOR THE PROGRAMS. UM BUT
THAT'S EXACTLY WHAT I NEED. UM
THOSE NUMBERS. YOU LISTED A
WHOLE RANGE OF PROGRAMS EARLIER
IF I CAN HAVE OR WE CAN HAVE
THAT CHILD. I'M SURE YOU HAVE OF
HOW HOW MUCH INVESTMENTS AND HOW
MANY HOW MANY PEOPLE HAVE BEEN
TRAINED AND THE RETENTION TOO,
BECAUSE IT'S YOU KNOW, AS WE
KNOW WITH EVEN WITH
UNIVERSITIES. AH THE ENROLLMENT
IS VERY DIFFERENT THAN THE
GRADUATION RIGHT? AND SO WHETHER
, IF YOU BRING IN FOLKS FOR
TRAINING, HOW MANY OF OUR
ACTUALLY A GRADUATING OR
CONTINUING AND HOW MANY ARE
ACTUALLY GOING INTO THE
PROFESSION? BECAUSE YOU MAY BE
INVESTING, BUT IF YOU DON'T HAVE
THEM, AND YOU KNOW IN THE HOT
SEAT THEN THEN THOSE INVESTMENTS
ARE BASICALLY BEING WASTED. AND
WHAT ARE WE DOING TO MAKE SURE
THAT WE RETAIN THOSE? DOCTOR
WOULD. THANK YOU. UM AND THANK
YOU FOR THE REPORT ON THE ENTIRE
PANEL HERE. UM I'M CURIOUS. SO
HOW HOW GRANULAR IS YOUR DATA AS
I LOOK AT YOUR REPORT? UM AND
I'LL JUST GIVE YOU AN EXAMPLE OF
A QUESTION HERE. UNITS IN ON
PAGE EIGHT, AND THE REPORT
ITSELF. SAYS RELATIVE TO THE
POPULATION, THE EXISTING NURSING
WORKFORCE IS WELL DISTRIBUTED
THROUGHOUT THE STATE. SO WHAT I
SEE YOUR CHART OR YOUR NUMBERS
SAYS THERE'S IN THE NORTHERN
CALIFORNIA IT'S 3.6% OF THE
POPULATION AND THREE POINT
WHATEVER. SO THE NUMBERS LINE
UP, BUT THAT DOESN'T TELL THE
WHOLE STORY FROM MY PERSPECTIVE.
UM AND, UM, BUT IT SAYS
ADDITIONAL RESOURCE RESEARCH IS
NECESSARY TO DETERMINE IF THE
EXISTING WORKFORCE IS
SUFFICIENT. AND THAT'S WHAT YOUR
WORK. YOU'RE WORKING OFF AT 2020
NUMBERS THAT SHOWED DECLINE AND
EXITS FROM THE PROFESSION. WE
DON'T REALLY KNOW. BUT YET,
ANECDOTALLY WHAT WE HEAR IS THAT
, UM HOSPITALS, FEDERALLY
QUALIFIED HEALTH CENTERS ARE
SEEING SHORTAGES AND IN NURSES
THAT CORRESPONDS TO, YOU KNOW,
DOCTOR SHORTAGE OF DOCTORS IN
SOME AREAS NOTED THAT SMALL
DISTRIBUTED ALLIED HOUSE
PROFESSIONALS ARE KIND OF WANNA
AREN'T ABLE TO WORK IN AREAS.
WHERE THERE AREN'T DOCTORS. AND
SO YOU KNOW, THERE'S A LOT.
THERE'S A LOT GOING ON HERE. AND
SO HOW GRANULAR IS YOUR DATA? UM
BECAUSE IF EVEN FROM 2020, WE
KNOW THERE ARE EXITS. THAT ARE
THAT ARE EXCEEDING THE NUMBER OF
NEW LICENSES IN THE NURSING AND
THE NURSING PIECE YET ON THE
OTHER HAND, WE'RE BEING TOLD WE
NEED TO PUSH BACK ON OUR NURSING
INITIATIVE BECAUSE WE DON'T HAVE
THE RESOURCES TO DO IT. OUR
HEALTH CARE. MORE YOU KNOW, IT
SEEMS THESE THINGS ARE GOING IN
THE WRONG DIRECTION FROM MY FROM
MY PERCENT AND LOOK, I RECOGNIZE
YOUR IN A DIFFICULT POSITION. I
CAN SAY A LOT MORE, PROBABLY AT
TIMES, THEN AS A LEGISLATOR, I'M
NOT. BUT IT'S BUT WHERE IS HOW
GRANULAR IS YOUR DATA? WHEN WILL
YOU HAVE MORE CURRENT DATA? UM
BECAUSE WHAT WE'RE HEARING FROM
HOSPITALS IS THAT STORIES OF
NURSES AND ALLIED HEALTH
PROFESSIONALS, ABSOLUTELY
KILLING THEM. SO UM, AND WHAT WE
WHAT WE WERE ABLE TO PRODUCE IN
THE REPORT BEGINNING TO COLLECT
THE DATA FROM THE LICENSING
BOARDS. AND SO IT WILL. IT WILL
BE, UH, OVER THE YEAR, RIGHT?
THAT WILL GET THAT FULL SET OF
DATA RIGHT THAT WE'RE GETTING
FROM THE LICENSING BOARD. UM,
AND SO WHAT? WHAT WE WHAT WE'RE
ABLE TO DO IS TO TAKE SOME OF
THE NEW DATA AS WELL AS DATA
THAT WE HAVE. THAT WAS FROM
2020. AND THEN THERE ARE NEXT
STEPS AS I MENTIONED EARLIER FOR
THE TEAM TO TAKE THAT DATA AND
START DOING AND UNDERSTANDING
THE EXITS AND DOING THAT
GRANULAR WORK, UM THAT WHAT WE
HAVE HERE WAS JUST KIND OF A
REPRESENT REPRESENTATION OF THE
DATA THAT WE HAVE SO FAR. OUR
NEXT STEPS ARE TO TAKE THAT AND
ACTUALLY, YOU KNOW, BECOME MORE
GRANULAR AND UNDERSTANDING THE
EXITS. UM AND HOW THAT IMPACTS
YOU KNOW THE SHORTAGES,
ETCETERA. OKAY SO YOU AND THAT
WHEN YOU ANALYZE THAT DATA, IS
IT? IS IT BASICALLY LOOKING AT
ADDRESSES WHERE PEOPLE LIVE OR
WHERE THEY'RE WHERE THEY'RE
ADDRESS WHERE THEY PROVIDE THAT
, IN THEIR LICENSING IN SURVEY
IS WHERE THEY WHERE THEY LIVE,
OR, UM, YOU KNOW WHERE THEY
PRACTICE, BUT IT DOESN'T TELL
YOU HOW MANY HOURS A WEEK THEY
MIGHT PRACTICE DOESN'T TELL YOU
THEY'RE EVEN PRACTICING. THERE
ARE SOME OF THAT WE'RE LOOKING
AT IN TERMS OF NUMBER OF HOURS.
UM AND, UM WHAT? WHAT KINDS OF
WORK THAT THEY'RE DOING. FOR
EXAMPLE. SO WE'RE GETTING WE'RE
ONE OF THE THINGS AND WHAT WERE
WE DOING AS WELL AS WE GET THIS
DATA IS WE'RE GOING TO BE WHERE
WE PUBLISHING IT ON OUR WEBSITE,
SO WE'RE TAKING THIS DATA AND
DEVELOPING IT AND WE'LL MAKE IT
AVAILABLE PUBLICLY, UM,
REGULARLY. YOU KNOW, I GUESS I
GUESS I WOULD JUST AND I THANK
YOU. I GUESS I WOULD JUST LOOK
AT YOU KNOW, JUST, YOU KNOW,
STAGES SEVEN AND EIGHT. THE KEY
FINDINGS. IT DOESN'T SHOW
HEALTHCARE WORKFORCE THAT'S
FIRING ON ALL CYLINDERS. NOT
EVEN CLOSE POSITIONS. ARM AL
DISTRIBUTED DENTAL PROFESSIONALS
OR AMOUNT DISTRIBUTED. UM
BEHAVIORAL HEALTH IS NOW
DISTRIBUTED. UM ALLIED WORKFORCE
IS NOW DISTRIBUTED. NURSES SEEM
TO BE DISTRIBUTED WELL, BUT THE
NUMBERS ARE DECLINING. WE HAVE A
WORKFORCE. CRISIS FROM MY
PERSPECTIVE. UM. BUT WE'RE BEING
TOLD WE NEED TO CUT BACK ON THE
INVESTMENTS. FOLLOW UP IF I CAN
. EARLIER WE HEARD FROM THAT
LEDGE A ABOUT THIS CRISIS POINT
THAT WE'RE REFERENCING TODAY AND
THE 3% OF FRONTLINE WORKERS OR
FEELING UNDERSTAFFED. WE ALSO
HEARD THAT OUR DECISIONS WILL
PROLONG THE WORKFORCE SHORTAGE
CRISIS THAT WE HAVE AS WELL AS
US HAVING A 31% TURNOVER RATE,
WHICH IS THREE TIMES HIGHER THAN
WE HAD IN 2020. HOW DOES IT THEN
MAKE SENSE FOR US TO BE
DECREASING INVESTMENTS INTO A
NURSING INITIATIVE? KNOWING AS
WAS STATED BY MR CHAN THAT WE'RE
CURRENTLY SHORT 40,000 NURSES?
HOW CAN WE NOT ADDRESS THIS
CRISIS HEAD ON BY CONTINUING THE
INVESTMENTS THAT WE MADE? YEAH
THANK YOU FOR THE QUESTION AND
DEFINITELY VERY MUCH COGNIZANT
AND KNOWLEDGE OF THOSE CONCERNS
. WE WOULD ADMINISTRATION WOULD
NOTE THAT SPECIFICALLY
INVESTMENTS IN NURSING WITHIN
THAT INITIAL 2022 BUDGET ACT
INVESTMENTS. SOME OF THOSE
INVESTMENTS HAVE STILL BEEN
RETAINED. WE UNDERSTAND THAT
THERE ARE DELAYS FOR SOME OF
THOSE, UM THOSE INVESTMENTS IN
THE OTHER YEARS. THAT WOULD BE
REPAID WITHOUT YEARS. BUT. IT'S
A TOUGH DECISION TO TRY TO
BALANCE BOTH THE IMMEDIATE NEED
TO ADDRESS A BUDGET PROBLEM, AND
IT WAS WELL STRENGTH, TRYING TO
STAY COMMITTED TO A LONG TERM
COMMITMENT TO HEALTH CARE
WORKFORCE, SO WE TRIED TO DO THE
BEST BALANCING ACT POSSIBLE,
WHILE TRAIN IS STILL RETAIN AS
MANY AS INVESTMENTS AS WE COULD
, BUT ALSO UNDERSTANDING WE HAVE
AN IMMEDIATE BUDGET PROBLEM AT
OUR HANDS. SO UM, LIKE WE SAID,
IT'S A HARD DECISION, BUT WE TRY
TO BEST TO BALANCE THOSE VERY
COMPETING PRIORITIES MAY
CONTEXTUALIZE IT AND REMIND US
OF WHAT AGAIN MR CHAN HAD STATED
REGARDING KOREA THAT THERE ARE
240 VACANCIES. AND THAT HAD COST
THEM $81 MILLION IN CONTRACT
NURSES. I WANT TO SCALE THAT TO
WHAT CALIFORNIA IS LOOKING TO
INVEST FOR THE STATE. IN TERMS
OF A NURSING INITIATIVE, AND
THAT'S ONE OF THE 400 HOSPITALS
. THAT'S LOOKING TO ADDRESS IT
THAT I WANT TO MAKE SURE WE'RE
ADDRESSING THE SCALE OF THE
PROBLEM AND THE 40,000 NURSES
WHO WE ARE SHORT AND THE AMOUNT
TO ARE TURNING OVER AND BURNED
OUT AND LEAVING THE PROFESSION
THAT WE'RE MAKING INVESTMENTS TO
TRAIN THOSE PROVIDERS TODAY, UM
I FEEL LIKE I'VE COMMUNICATED MY
POINT, BUT I WANT TO MAKE SURE
YOU'RE HEARING THE PRIORITIES
FROM THE LEGISLATURE FOR US TO
ALSO WE MAKING THOSE INVESTMENTS
TO TRAIN THE PROVIDERS OF
TOMORROW? I'D LIKE TO TURN A
LITTLE BIT OF Ó. I WILL TURN
JUST FOR A SECOND AND THEN COME
BACK TO DOCTOR WOULD IF I CAN. I
WANTED TO TALK ABOUT HOW WE
PRIORITIZED THRESHOLD LANGUAGES
WITHIN MEDICAL AND I AM VERY
SUPPORTIVE OF THIS, AS I BELIEVE
IT'S IMPORTANT TO BUILD TRUST
AND TO DO IT IN A LANGUAGE WHICH
PATIENTS ARE MOST COMFORTABLE IN
, BUT I WANT TO MAKE SURE THAT
THIS IS SOLID GROUND FOR US TO
DO IT ON BECAUSE WHY AREN'T WE
FOCUSING ON LANGUAGE MORE. WHY
DON'T WE USE THIS WITHIN OUR UM
, WORKFORCE PACKAGES TO
PRIORITIZE SO WE CAN ADDRESS
MANY OF THESE THRESHOLD
LANGUAGES. IS THAT
CONSTITUTIONALLY FEASIBLE FOR US
TO BE USING LANGUAGE? TO
PRIORITIZE FOR ACCEPTANCE. YES
MR CHAIR THAT WE DO BELIEVE IT'S
PERMISSIBLE TO LOOK AT LANGUAGE
SPECIFICALLY BECAUSE IT IS IT IS
RELATED TO THE WORK THAT'S BEING
DONE AND WE THINK IT'S
CRITICALLY IMPORTANT TO INCREASE
THE LINGUISTIC CAPACITY OF THE
WORKFORCE. RECENTLY WE WERE AT A
LATINO CAUCUS POLICY RETREAT
WHERE WE DISCUSSED PRIORITIZING
LANGUAGE. I WOULD LIKE TO BE
ABLE TO WORK WITH THE
ADMINISTRATION TO FOLLOW UP AND
FIGURE OUT IF THAT'S A WAY IN
WHICH WE CAN HELP TO DIVERSIFY
OUR WORKFORCE AS WE'RE SEEING
THE POSITIONS AND PROVIDERS WHO
ARE SHORT OF FOCUS ON LANGUAGE
MAY ALLOW US TO MAKE INROADS
INTO THOSE DISPARITIES AGREE MY
FINAL QUESTION IF I CAN HAVE, UM
MR ALONSO DIAZ, COME BACK UP.
NOW ON THE CAL MED FORCE. THE
NUMBERS I WROTE DOWN, UM THERE
WERE 24 82 POSITIONS FOR SUPPORT
PLACEMENTS, PEOPLE WHO HAD ASKED
FOR SUPPORT YOU HAD FUNDED 965.
BUT THE NUMBER THAT STUCK OUT TO
ME WAS 386 OR LESS THAN HALF
WHICH WERE NEW AND EXPANDING
RESIDENCY SLOTS. SO ARE WE TO
SAY THAT THE REMAINDER BETWEEN
THE 3 86 AND 9 65. WE'RE
BACKFILLING SLOTS THAT HOSPITALS
WERE CURRENTLY PAYING FOR
BEFORE. AND HOW DOES THAT MAKE
SOUND. FISCAL SENSE FOR US TO BE
MAKING INROADS. ESPECIALLY
HEARING SOME OF THE GEOGRAPHICAL
DISPARITIES. WE HEARD ABOUT
GREAT QUESTION IF I MAY CLARIFY
THAT CAL METAPHORS FUNDS, GM
PHYSICIAN TRAINING PROGRAMS,
THEY ARE NOT ALL HOSPITAL BASED
GROUP. SO THESE ARE GM PHYSICIAN
TRAINING PROGRAMS. SOME ARE IN
HOSPITALS THERE'S MIGHT BE IN
COMMUNITY HEALTH CENTERS, AS
WELL AS OTHER NON HOSPITAL AREAS
, AND SO WE'RE FOCUSED ON
SUPPORTING THOSE TRAINING
PROGRAMS THAT HAVE A LARGE PAYER
MIXED WITH MEDICAL AND, UM YES,
YOU ARE CORRECT THAT WE HAVE
FUNDED 967 RESIDENT POSITIONS
SINCE 18 2386 ARE BOTH NEW AND
EXPANDING THE STATUTE FOR PROP
56 SPECIFIC TO G M E
SPECIFICALLY FOCUSES ON
SUSTAINING, RETAINING AND
EXPANDING AND IT WAS THAT
RETENTION PIECES CRITICAL. I
WOULDN'T I WOULDN'T DESCRIBE IT
AS BACKFILLING. I WOULD DESCRIBE
IT OUT. SUPPORTING EXISTING GM
PHYSICIAN TRAINING PROGRAMS THAT
WOULD LIKELY WORE IN DIRE
FINANCIAL STRAITS AND OR NEEDED
ADDITIONAL SUPPORT IN ORDER TO
KEEP THE RESIDENT POSITIONS THAT
THEY HAVE WHAT WE HAVE SEEN IN
THE PAST, AS YOU KNOW, IS A
NUMBER OF EITHER PHYSICIAN
TRAINING PROGRAMS THAT HAVE
CLOSED OR THEY HAVE STARTED TO
REDUCE THE NUMBER OF RESIDENTS
POSITIONS THAT THEY HAVE,
BECAUSE THEY SIMPLY CAN'T
SUSTAIN THEM. THIS IS ONGOING
FUNDING IS THAT CORRECT? THIS IS
YES. THIS IS ANNUAL AND ANNUAL
APPROPRIATION OF 40 MILLION. NOW
I GUESS WHAT I'M TRYING TO FOCUS
ON IT IS WHETHER OR NOT IT MAKES
SENSE FOR US TO INVEST INTO
THOSE SPECIFIC EXAMPLES YOU GAVE
RATHER THAN IN NEW OR EXPANDING
RESIDENCY SLOTS. EARLIER YOU HAD
STATED THE IMPORTANCE OF THE
ECONOMIC DEVELOPMENT OPPORTUNITY
AND INCREASE ACCESS TO CARE THAT
ONLY HAPPENS WHEN YOU'RE
CREATING NEW AND EXPANDING
SLOTS, NOT SUSTAINING SLOTS.
THAT'S BASELINE. SO WHY ARE
DOLLARS GOING TOWARDS BASELINE?
EXCUSE ME, RATHER THAN EXPANDING
THE ECONOMIC OPPORTUNITIES AND
INCREASING ACCESS TO CARE, WHICH
WAS THE INTENT OF THE DOLLARS DO
WE NEED TO WORK ON THE
PRIORITIZATION AND LANGUAGE
WITHIN UM, OUR SIDE SO WE CAN
REFOCUS AND MAKE SURE WE'RE
PRIORITIZING NEW AND. EXPANDING
THOUGHTS. IS THAT WHAT I'M
HEARING FROM YOU SINCE THAT'S
WHERE WE FUNDED THUS FAR. IT'S A
DELICATE BALANCE OF RETAINING
AND SUPPORTING THE EXPANSION OF
PHYSICIAN TRAINING PROGRAMS. THE
PROGRAM HELMET FIRST, CURRENTLY
PRIORITIZES NEW AND EXPANDING
POSITIONS, AND WE CAN WE TAKE
INTO ACCOUNT A NUMBER OF
DIFFERENT CRITERIA THAT INCLUDES
PAYER MIX AS WELL AS GRADUATE
OUTCOMES, SO WE'RE FOCUSED ON
PRIORITIZING THOSE PHYSICIAN
TRAINING PROGRAMS THAT ARE IN
THOSE UNDER SERVED COMMUNITIES
AND THAT HAVE A HIGH MEDICAL
PAYER MIX. FOLLOW UP OFFLINE IF
I CAN, BUT I WILL ELEVATE THAT,
UM, LOCALLY, WE HAD 15
EXPANSIONS WITHIN ONE FACILITY.
I THOUGHT IT WAS 15 EXPANSIONS,
BUT IT ENDED UP BEING ZERO MORE
PROVIDERS. WHO WERE THERE
AVAILABLE TO HELP US DURING THE
PANDEMIC OF THE CENTURY. AND I
GUESS FOR MANY OF US, WE HAD
EXPECTED THAT TO TRANSLATE WITH
MORE DOLLARS GOING TO FACILITIES
TO MORE PROVIDERS DURING THE
PANDEMIC. AND IT'S A BIT
FRUSTRATING TO HEAR THAT IT'S
GOING TOWARDS SUPPLANTING OR
TOWARDS EXISTING SLOTS RATHER
THAN TOWARDS NEW AND EXPANDING
SLOTS. AND SO I LOOK FORWARD TO
MAKING SURE THAT THE LEGISLATIVE
INTENT IS PRESENT INTO THOSE
DOLLARS AS WE GO FORWARD ME,
PLEASE. IF I MAY OFFER
ADDITIONAL INFORMATION, AND I
APPRECIATE YOUR INTEREST IN THE
COMMENT FORCE PROGRAM AND HAPPY
TO TALK TO YOU OFFLINE ABOUT IT
OR TO ANYBODY ELSE, YOU KNOW IF
I MAY OFFER AN ADDITIONAL
PERSPECTIVE, WITH RESPECT TO THE
CHALLENGES OF BOTH NEW AND
EXPANDING PROGRAMS, THERE IS
ABSOLUTELY VALUE AND SUPPORTING
BOTH EXISTING AND EXPANDING
PROGRAMS BACK TO THE CORE FOCUS
OF INSURING NET NEW AS WELL AS
SUPPORTING INCREASED
OPPORTUNITIES FOR PHYSICIANS TO
TRAIN IN THOSE AREAS. NEW
PHYSICIANS NEW SLOTS IN THOSE
AREAS. I WOULD ALSO JUST OFFER
AS AN AS AN ADDITIONAL
OPPORTUNITY IS ENSURING THAT
WHAT WE CALL JAMIE KNIGHT HEALTH
SYSTEMS. IT'S A TERRIBLE NAME,
BUT IT'S A HEALTH SYSTEMS THAT
DON'T HAVE A GMD PROGRAM. AT
THEIR BIGGEST CHALLENGE IS THE
PROCESS THAT JOURNEY AS YOU KNOW
, BECOMING ACCREDITED, AND
TYPICALLY FOR THOSE GM UNITED
HEALTH SYSTEMS. IT TAKES 1 TO 2
YEARS AND TYPICALLY ABOUT $2
MILLION. SO IF I MAY JUST OFFER
THAT AS AN ADDITIONAL
PERSPECTIVE IN TERMS OF IF WE IF
WE I THINK WE ALL HAVE NOT. I
THINK I KNOW THAT WE ALL HAVE
THE SAME GOAL, WHICH IS TO
CONTINUE TO SUPPORT IN IT. NEW
THAT'S ALSO A DIFFERENT
PERSPECTIVE THAT I WANTED TO ADD
IN TERMS OF LOOKING AT THE
ECOSYSTEM AS A WHOLE JUST
COUNTER. IF I CAN. THERE WERE
TWO FACILITIES IN MY REGION,
WHICH RECEIVED DOLLARS. ONE
STARTED A BRAND NEW RESIDENCY
PROGRAM THAT I'VE NOW BEEN TO
THEIR GRADUATION AND SEEN
PROVIDERS WHO ARE PRACTICING IN
OUR COMMUNITIES. ANOTHER IS
SENDING MONEY TO A HOSPITAL THAT
ISN'T TRAINING AND GIVING US
MORE PROVIDERS. AND I THINK WHEN
I LOOK AT THOSE TWO INVESTMENTS
I THINK THERE'S A LOGICAL
RATIONALE FOR US TO INCREASE
ACCESS TO CARE AND TO WORK ON
ECONOMIC DEVELOPMENT FOR THOSE
REGIONS RATHER THAN TO SUPPLANT
FUNDING THAT WAS ALREADY BEING
SPENT IN THOSE PLACES, AND SO I
LOOK FORWARD TO THOSE
CONVERSATIONS AND HOW WE CAN
TIGHTEN LANGUAGE DOCTOR WOULD
THANK YOU AND JUST JUST KIND OF
A GENERAL COMMENT IN THE IN THE
IN THE WORKFORCE RELATED AREAS
AND CATS LIKE I CAN'T GET MY
MIND OFF THE NURSING PIECE OF IT
BECAUSE IT'S IN FRONT OF ME AND
I DON'T HAVE ONE FOR ALLIED
HEALTH. I DON'T HAVE WITH
OTHERS, BUT BUT, UM YOU KNOW
WHEN YOU PUSH BACK THESE
INITIATIVES, UM THERE IS A
WORKFORCE ASSOCIATED WITH THE
INITIATIVES. AND SO THERE'S NO
GUARANTEE A YEAR FROM NOW. FOR
TWO YEARS FROM NOW, WHEN THE
MONEY IS RESTORED THAT THAT THE
PEOPLE THAT SUPPORT THESE
INITIATIVES ARE GOING TO BE
AROUND BECAUSE THEY NEED TO WORK
SOMEWHERE ELSE. SO YOU KNOW,
PUSHING NOT NOT HAVING A
CONSISTENT STREAM OF FUNDING FOR
THESE KINDS OF PROGRAMS IN
IMPERILS. THE ABILITY TO
INCREASE THE WORKFORCE. UM AT A
TOTALLY DIFFERENT LEVEL, YOU CAN
GET TO A POINT WHERE SUDDENLY
HAVE THE MONEY YOU DON'T HAVE
THE WORKFORCE TO TRAIN THE
WORKFORCE. AND SO, YOU KNOW, BE
AWARE OF THE UNINTENDED
CONSEQUENCES. I KNOW WE BUDGET
FROM YEAR TO YEAR. WE HAVE TO
FOCUS ON THIS YEAR TO YEAR THING
. BUT THERE YOU KNOW, THE
REALITY IS THAT THESE ARE
INVESTMENTS AND YOU DON'T ALWAYS
SEE THE RETURN ON THE INVESTMENT
FOR YEARS TO COME. AND WE DO A
REALLY WE DON'T REALLY DO A VERY
GOOD JOB IN CALIFORNIA INVESTING
IN OUR IN THESE KINDS OF
INITIATIVES BECAUSE THEY ALWAYS
LOOK THEY'RE ALWAYS LINE ITEMS
AND, UM, PEOPLE ARE NOT LYING
ITEMS AND, UM AND HEALTHCARE IS
HAS BIG LINE ITEMS,
UNFORTUNATELY, BUT I JUST YOU
KNOW, CAUTION. YOU THINK WHEN
YOU'RE MAKING CUTS TO PROGRAMS
LIKE THIS THE WORKFORCE IS
SUPPORTING THESE WORKFORCE
PROGRAMS. MAY GO AWAY BECAUSE
THEY DON'T HAVE THE ABILITY TO
MOVE ON. AND NOW WE HAVE FURTHER
EXACERBATED THE CHALLENGE GOING
FORWARD. SO IN THE NURSING
INITIATIVE WHEN YOU GO FROM
25,000,001 DOWN TO 10 IN ONE
YEAR 55 TO 0. AND THEN THEN WE
DROPPED IN 141 175. THE
FOLLOWING YEAR YOUR IS YOU DON'T
GO FROM 0 TO 175 AND EXPECT
MIRACULOUS RESULTS. FROM OUR
PERSPECTIVE, IT'S REALLY
DIFFICULT, WHICH TECHNICALLY
WOULD MEAN THE END OF THAT
THERE'LL BE UNUSED FOR MONEY
THAT WILL GET CLAWED BACK AND
NEVER USED AND, YOU KNOW. I HAVE
TO THINK SOMEWHERE IS THERE ARE
SOME MACHIAVELLIAN PROCESS THAT
THINKS ABOUT THESE THINGS. AND
YOU KNOW, WE LINE IT UP THIS
WAY. MAYBE THAT SOME OF THAT
MONEY WON'T EVER GET USED TO GET
IT BACK. SO, UM, ANYWAY. I THINK
I MUST HAVE LOW BLOOD SUGAR OR
SOMETHING TODAY. BUT BUT BUT IT
IS IT IS IT IS. I JUST WISH WE
COULD THINK ABOUT THE BIG
PICTURE SOMETIMES, AND WE OFTEN
JUST THINKING ABOUT THE LINE OUT
OF MISS ROSELLE. I MAY BRING YOU
UP IF I CAN. EARLIER WE HEARD
ABOUT THE COUNCIL AND HOW THEY
CAN HELP US TO CREATE SOME
INNOVATIVE APPROACHES. WE REALLY
HAD A STUBBORN DISPARITY IN THE
GEOGRAPHIC DISPARITIES AND
WONDERING HOW THE COUNCIL CAN
HELP US TO ADDRESS THIS AND COME
UP WITH SOME SOLUTIONS. HOPING
YOU COULD PROVIDE SOME INSIGHTS
TODAY THAT MAY ALLOW US TO
ADDRESS THE GEOGRAPHIC
DISPARITIES. UM. WELL I THINK
THAT IT'S A PERFECTLY
APPROPRIATE THING FOR THE
COUNCIL MEETING. DISCUSSING IS
THEY'RE DISCUSSING DISPARITIES.
UM AND WE'VE BEEN HEARING FROM
PEOPLE WHO ARE AT THE COUNCIL IN
TERMS OF STAKEHOLDERS AND
TALKING ABOUT THE, UM. THE
GEOGRAPHIC DISPARITIES. UM AND
SO. UM YOU KNOW, ONE OF THE
THINGS THAT WE'RE DOING WITH THE
COUNCIL IS HELPING US TO
UNDERSTAND A LITTLE BIT MORE
ABOUT WHERE THOSE DISPARITIES
ARE AND THEN IT HELPS US TO THEN
PRIORITIZE AN ORGANIZED OUR
PROGRAMS. TO BE ABLE TO REACH TO
REACH THOSE AREAS, SO IT THAT
WE'RE DEFINITELY HEARING FROM
THE COUNCIL. UH AS TO YOU KNOW
WHAT KINDS OF SHORTAGES AND
WHERE THESE SHORTAGES ARE. MR
CHEN. THANK YOU. I JUST WANNA
REALLY, REALLY REITERATE MY
APPRECIATION FOR H CHI, AND THIS
IS THE INTERSECTION BETWEEN
NONPROFIT COMMUNITY BASED
ORGANIZATIONS LIKE MINE WHO
WORKED VERY CLOSELY WITH THE
COUNCIL AND WITH H CHI TO
ACTUALLY PROVIDE THE PROGRAMS
AND SO WE'RE DOING A LOT OF
THINGS THAT ARE INNOVATIVE AND
YET ARE, YOU KNOW, DON'T REQUIRE
A LOT OF GEOGRAPHY. UM YOU KNOW
PEOPLE TO BE CLOSE IN
GEOGRAPHICAL AREAS AND SO
DISTANCE LEARNING IS REALLY BIG
AND WE'RE USING NEW PEDAGOGY IS
TO TEACH PEOPLE ABOUT THIS, SO I
THINK IT'S THE RELATIONSHIP
BETWEEN COMMUNITIES BASED
ORGANIZATIONS AND GOVERNMENTAL
AGENCIES TO ACTUALLY DO THE WORK
AND WE RELY ON THE COUNCIL FOR
THEIR SUPPORT AND THEIR VISION
AND GUIDANCE. I WANT TO MAKE
SURE AND AGAIN WE CAN FOLLOW UP
OFFLINE IF NEEDED. UM BUT HYPER
LOCALLY. I KNOW WE HAVE AN
IMPACT SHIN AT OUR LOCAL CSU
SYSTEM THAT DOESN'T ALLOW US TO
TRAIN THE NUMBER OF NURSES THAT
ARE NEEDED. IS THE COUNCIL.
FOCUSING AND LOOKING AT SOME OF
THOSE IMPACT SHINS AS CAUSES OF
THE GEOGRAPHICAL DISPARITIES
THAT ARE SO PREVALENT. I'LL JUST
GIVE YOU AN EXAMPLE OF PRESIDENT
STATE. I GOT 60 SLOTS. WE HAD
100 AND 29 STUDENTS WHO APPLIED
WITH OVER A FOUR OH, NOW, JUST
TO BE FAIR. I DON'T HAVE A FOUR.
OH, AND GOT INTO MEDICAL SCHOOL
, AND I THOUGHT I DID JUST FINE
THAT I THINK WE HAVE TO MAKE
SURE WE'RE PROVIDING THOSE
OPPORTUNITIES AND TO COMMUNITIES
THAT ARE SUFFERING THOSE
DISPARITIES THAT I JUST WANT TO
MAKE SURE WE'RE ASKING THOSE
TYPES OF QUESTIONS SO WE CAN
START SOLVING THE PROBLEM AT ITS
ROOT CAUSES. YEAH, ABSOLUTELY. I
THINK SOME OF THE CONVERSATIONS
WE'VE HAD WITH THE COUNCIL OR WE
DON'T HAVE ENOUGH FACULTY AND IT
YOU KNOW, PEOPLE MAKE MORE MONEY
PRACTICING THAN THEY DO AS
TEACHERS. SO HOW DO WE HAVE
RETENTION PROGRAMS, RECRUITMENT
PROGRAMS FOR FACULTY. CLINICAL
PLACEMENTS ARE REAL STRUGGLE. SO
HOW DO WE INCREASE THE CLINICAL
PLACE PLACEMENT AND MAKE SURE
THAT THEY'RE IN IN IN THESE
RURAL AREAS AND THAT WE HAVE
GOOD? COORDINATION PIPELINE. HOW
ARE WE THINKING CREATIVELY ABOUT
ABOUT RECRUITING FOLKS WHO HAVE
EMOTIONAL INTELLIGENCE. WE HAVE
THIS ONE. THERE'S A WONDERFUL
PROGRAM. WE HEARD ABOUT IT. ONE
OF THE PRESENTATIONS OF THE
COUNCIL CALLED THE BARISTAS,
BARBERS, BARTENDERS. UM, YOU
KNOW, THERE ARE FOLKS WHO ARE
WORKING IN RETAIL WHO ARE REALLY
GOOD WITH PEOPLE WHO HAVE LIVED
EXPERIENCE WHO HAVE A LOT TO
OFFER HIS BEHAVIORAL HEALTH
FOLKS. HOW ARE WE REACHING OUT
TO THEM TO BE YOUR TO BE PEER
SUPPORT SPECIALIST? SO WE'RE WE
ARE HEARING PRESENTATIONS FROM
UM, YOU KNOW, FROM THE CLINICAL
PLACEMENT, UM FOLKS FROM THE, UM
, FROM THE SCHOOLS ABOUT WHAT DO
THEY NEED? THEY'RE TELLING US
THEY NEED FACULTIES. SO WE'RE
LOOKING AT HOW DO WE NEXT YEAR?
MAKE SURE THAT OUR CYCLES
INCLUDE FUNDING FOR FACULTY
POSITIONS IN THE LIKES AND WE
KNOW WE NEED TO INCREASE LOTS.
WE NEED TO INCREASE LOTS OF
SOCIAL WORKERS FOR NURSES AND
ALL THE POINTS YOU ALL ARE
MAKING DOCTOR WOULD UM THE
MALDISTRIBUTION CHALLENGES. UM
AND THIS IS, YOU KNOW, AND I AND
ALSO STATE PROGRAM AND I KNOW
THAT I'M CAREFUL HOW I WORD
THIS, BUT. YOU KNOW THE LOTTERY
SYSTEMS IN SOME OF OUR NURSING
PROGRAMS AND DENTAL HYGIENE
PROGRAMS. UM AH, MAKE IT.
DIFFICULT FOR PEOPLE IN A
COMMUNITY. WHO WANT TO GO TO
THEIR LOCAL COMMUNITY COLLEGE IN
A NURSING PROGRAM TO GET THERE,
BECAUSE THEY'RE GOING TO BE IN A
LOTTERY AND SOMEWHERE ELSE IN
THE STATE, AND SO IF THEY GET IF
THEY GET IN AT ALL, AND SO THAT
MEANS THEY MAY HAVE TO MOVE.
THEY MAY NOT BE ABLE TO AFFORD
TO MOVE, BUT THEY ARE AT HOME
AND IN THEIR OWN COMMUNITY. AND
HAVE A HARD TIME GETTING INTO
PROGRAMS IN THEIR OWN COMMUNITY.
AND THEN WE WONDER WHY WE HAVE,
UM AL DISTRIBUTION BECAUSE I
THINK WE'RE AND SAME WITH THE
SAME WITHOUT ALL THE ALLIED
HEALTH PROGRAMS AS WELL. SO I
UNDERSTAND WHY THE LOTTERY
EXISTS IN THEORY. BUT MAYBE SOME
OF THE UNINTENDED CONSEQUENCES
IS THAT THE PEOPLE WANT TO BE IN
THE COMMUNITIES THAT THEY GREW
UP IN, UM AND CAN FORWARD TO
LIVE THERE BECAUSE MAYBE THEY
CAN LIVE AT HOME AND GO TO THESE
PROGRAMS CAN'T GET INTO THE
PROGRAMS IN THEIR COMMUNITY
MIGHT GET YOU KNOW, SOMEONE IN
HUMBOLDT COUNTY MIGHT GET INTO
SOMETHING IN THE INLAND EMPIRE.
AND HOW DOES THAT WORK AND THAT
JUST FEELS LIKE IT COULD FURTHER
EXACERBATE OUR PROBLEMS. AND
THEN WHEN PEOPLE GO AWAY, THEY
MIGHT DECIDE THEY WANT TO STAY.
BUT CERTAINLY PEOPLE COMING TO
FROM A LARGE URBAN AREA TO IN
RURAL AREA FOR A PROGRAM. THEY
DON'T ALWAYS STAY. THEY GO BACK
TO WHERE THEY CAME FROM. SO I
JUST, YOU KNOW, AS WE START
LOOKING AT SOME OF THE NOW
DISTRIBUTION ISSUES, CAN WE
START LOOKING AT SOME OF THESE
OTHER ISSUES AS WELL? AND I, YOU
KNOW I DON'T AND WE DO HAVE
REPRESENTATIVES OF THE COMMUNITY
COLLEGE SYSTEM, THE CSU SYSTEM
AND THE UC SYSTEM ON OUR
COUNCIL, WHICH I THINK IS VERY
MEANINGFUL, BUT I THINK THE
NOTION OF GROWING YOUR OWN IS
VERY IMPORTANT. SO WE'RE ONE OF
THE PSYCHIATRIC MENTAL HEALTH
NURSE PRACTITIONER PROGRAMS.
WE'RE NEVER GOING TO TRAIN
ENOUGH PSYCHIATRISTS WE GOT TO
HAVE, YOU KNOW, SO WE'RE EXCITED
ABOUT THIS. THE PSYCHIATRIC
MENTAL HEALTH NURSE
PRACTITIONERS, BUT THEY HAVE A
MOSTLY ONLINE SYSTEM SO THAT
SOMEONE CAN START OUT IN
HUMBOLDT COUNTY CAN HAVE A
COUPLE OF IN PERSON SESSIONS BUT
CAN HAVE THEIR CLINICAL
PLACEMENT AT HOME. HOME, SO
THEY'RE THEY'RE EDUCATED, BEING
EDUCATED THERE. THEY DON'T HAVE
TO MOVE AND THEY CAN STAY WHERE
THEY ARE AND PROVIDE THE
VALUABLE SERVICES WHERE THEY
ARE. SO WE ARE DEFINITELY
LOOKING AT INNOVATIVE SOLUTIONS
LIKE THAT. THIS FEELS LIKE THE
NATURAL PLACE FOR ME TO ELEVATE
THAT THERE IS A èC THAT DOESN'T
HAVE A MEDICAL SCHOOL THAT WOULD
ALLOW US TO ADDRESS MANY OF THE
GEOGRAPHIC DISPARITIES IN THE
CENTRAL VALLEY. AND SO AS WE'RE
LOOKING TOWARDS HOW WE ADDRESS
THEM, HOPEFULLY U. C. MERCED IS
THOUGHT OF AND INCLUDED AS PART
OF THAT SOLUTION. WITH THAT. I
WOULD LIKE TO THANK VERY MUCH
ALL THE SPEAKERS ON THIS PANEL.
WE WILL NOW MOVE ON TO ISSUE
SEVEN. I WANT TO WELCOME THE
DEPARTMENT OF MANAGED HEALTH
CARE. WE WILL BEGIN WITH AN
OVERVIEW OF YOUR DEPARTMENT
BUDGET. OUR FIRST SPEAKER IS THE
MHC DIRECTOR MARY WATANABE. YOU
CAN PLEASE BEGIN WHEN YOU'RE
READY. ONE SECOND HERE TO GET
SETTLED. ALL RIGHT. GOOD
AFTERNOON. MARY WATSON. AH, BE
DIRECTOR OF THE DEPARTMENT OF
MANAGED HEALTH CARE WITH ME. I
HAVE DAN SOUTHERNER, CHIEF
DEPUTY DIRECTOR. UM THE
DEPARTMENT'S MISSION IS TO
PROTECT CONSUMERS HEALTHCARE
RIGHTS AND ENSURE A STABLE
HEALTHCARE DELIVERY SYSTEM. THE
DMH C LICENSE AND REGULATES 140
HEALTH PLANS THAT PROVIDE HEALTH
COVERAGE TO OVER 28 MILLION
CALIFORNIANS. WE REGULATE MORE
THAN 90% 6% OF STATE REGULATED
COMMERCIAL AND GOVERNMENT HEALTH
PLAN. ENROLLMENT IN THE STATE.
OR TOTAL PROPOSED FISCAL YEAR.
23 24 BUDGET IS 157 MILLION AND
685 AUTHORIZED POSITIONS. THE
DEPARTMENT, ESPECIALLY FUNDED BY
ANNUAL ASSESSMENTS ON HEALTH
PLANS AND RECEIVES NO GENERAL
FUND MONEY. THE DM AGENCY
REGULATES HEALTH PLANS IN A
NUMBER OF WAYS WE LICENSE AND
APPROVED PLANNED PRODUCTS FOR
FULL SERVICE, BEHAVIORAL,
HEALTH, VISION, DENTAL AND
CHIROPRACTIC PLANS. WE ENSURE
BASIC HEALTHCARE SERVICES AND
MANDATED BENEFITS ARE PROVIDED.
WE REVIEW HEALTH PLAN NETWORKS
UPON INITIAL LICENSURE AND ON AN
ANNUAL BASIS AND WOULD HELP
PLANS EXPAND OR CONTRACT THEIR
SERVICE AREA. WE ALSO REVIEW
HEALTH PLAN, TIMELY ACCESS
COMPLIANCE COMPLIANCE, REPORT
FILINGS AND PREPARING ANNUAL
TIMELY ACCESS REPORT. WE REVIEW
CONSUMER AND PROVIDER COMPLAINTS
. AND SINCE 2000 THE GMHC HAS
ASSISTED OVER 2.6 MILLION
CONSUMERS THAT OUR HELP CENTER
AND RECOVERED OVER 177 MILLION
FOR PROVIDERS, WE ADMINISTER THE
INDEPENDENT MEDICAL REVIEW
PROCESS. WE CONDUCT ROUTINE
HEALTH PLAN, MEDICAL SURVEYS AND
FINANCIAL EXAMS. WE MONITOR THE
FINANCIAL SOLVENCY AND REVIEW
HEALTH PLAN RATE FILINGS. AND
OUR PROGRAM FOR RATE REVIEW HAS
SAVED CONSUMERS OVER 296 MILLION
SINCE WE STARTED OVER 10 YEARS
AGO. WE ALSO PROSECUTE
NONCOMPLIANT HEALTH PLANS. WE
HAVE FINES, PENALTIES AND OR
CORRECTIVE ACTION PLANS. THAT
CONCLUDES MY OVERVIEW. I'LL MOVE
ON TO YOUR QUESTIONS IF THAT'S
OKAY. THE FIRST QUESTION IS, IS
THERE ANY EVIDENCE THAT GMHC IS
RISING COSTS MEASURABLY DRIVE UP
OVERALL HEALTH CARE COSTS IN
CALIFORNIA, AS I MENTIONED WERE
FUNDED THROUGH ASSESSMENTS ON
HEALTH PLANS, AND SO THE COST OF
INCREASED ASSESSMENTS RELATED TO
EITHER NEW LEGISLATION OR
WORKLOAD OR BE OTHER POLICY BCPS
ARE LIKELY PASSED ON TO
CONSUMERS THROUGH INCREASED
PREMIUMS. HOWEVER I WILL NOTE
THAT THE TOTAL COST OF OUR 23 24
BCPS IS APPROXIMATELY 24
MILLION. WHICH WILL RESULT IN AN
INCREASE IN ASSESSMENTS FOR FULL
SERVICE PLANS OF A PROP
APPROXIMATELY 48 CENTS PER
ENROLLEE PER YEAR. UM WHICH IS
ABOUT I WANT TO SAY, A FOUR CENT
PER MONTH PREMIUM INCREASE. IT'S
WORTH NOTING THAT THE OTHER
COSTS THAT GET PASSED ON
CONSUMERS IN THE FORM OF
PREMIUMS IS THE ACTUAL
REQUIREMENTS OF NEW LEGISLATION
IN PARTICULAR. AND THE OTHER
QUESTION WAS, WHAT'S THE
JUSTIFICATION FOR THE PROPOSED
WORKLOAD BUDGET REQUESTS? DAN'S
GOING TO COVER A COUPLE OF THOSE
IN MORE DETAIL LATER ON, BUT AT
A HIGH LEVEL WHERE REQUESTING
ADDITIONAL RESOURCES FOR OFFICE
OF FINANCIAL REVIEW TO CONDUCT
MORE FREQUENT FINANCIAL
EXAMINATIONS OF HEALTH PLANS AND
RISK BEING ORGANIZATIONS AND TO
ADDRESS THE ADDITIONAL WORKLOAD
ASSOCIATED WITH THE INCREASED
NUMBER OF HEALTH PLANS LICENSED
BY THE GMHC. TO GIVE YOU SOME
SENSE. I THINK. JUST THREE YEARS
AGO WE HAD ABOUT 25 MILLION
CONSUMERS AND THE PLANTS WE
REGULATE. WE'RE UP TO ABOUT 28 A
HALF WE HAD ABOUT 125 127 HEALTH
PLANS AND WE'RE UP TO 140. SO
JUST WITH OUR GROWTH UM, THAT'S
LED TO ADDITIONAL WORKLOAD. IN
ADDITION, WE'RE REQUESTING
ADDITIONAL RESOURCES TO COMPLY
WITH SOME OF THE NEW SECURITY
AND PRIVACY REQUIREMENTS TO RE
MEDIATE AUDIT FINDINGS AND TO
MAKE SECURITY AND MONITORING
ENHANCEMENT ENHANCEMENTS TO
COMPLY WITH THE CAL SECURE FIVE
YEAR PLAN. THAT CONCLUDES OUR
OVER EMAIL. MR SOUTHERN. UM HE'S
ACTUALLY GONNA COVER THEM IN
MORE DETAILED OR A DIFFERENT
ISSUE. NEXT FOR OUR OVERVIEW
DEPARTMENT OF FINANCE. JUST
DONALD DEPARTMENT FINANCE. NO
ADDITIONAL COMMENTS. THANK YOU.
JASON KANSEN CARILLO. CELIO JUST
WANTED TO POINT OUT A FEW
ADDITIONAL ASPECTS OF THE
DEPARTMENT'S BUDGET ON PAGE 27.
YOU CAN. YOU CAN SEE THE
DEPARTMENT'S BUDGET AND, UH, THE
GROWTH OF THE DEPARTMENT'S
BUDGET YEAR OVER YEAR. I ALSO
WANTED TO PROVIDE A LITTLE MORE
INFORMATION. UM DEPARTMENT NOTED
THAT THE INCREASE IN THE IN THE
PROPOSED BUDGET RESULTS IN A
ABOUT A 48 CENTS. UM IT'S SORT
OF INCREASE IN THE FULL SERVICE
RATE. IN ACTUAL LEVELS IN THE
BUDGET HERE, BASED ON
INFORMATION THE DEPARTMENT
PROVIDED US WE ESTIMATE THAT BE
ABOUT JUST A LITTLE OVER $3 AND
IN THE TOTAL FULL SERVICE, RIGHT
? SO WHILE THE GROWTH IS 48
CENTS THAT RESULTS IN THIS WHOLE
LEVEL OF JUST OVER $3, AND
THAT'S AN ANNUAL CHARGE THAT YOU
DIVIDE THAT BY 12 TO GET THE
MONTHLY IMPACTED THAT PER MONTH.
UM ONE FINAL POINT. WE WANTED TO
EMPHASIZE SEVERAL OF THE ISSUES
THAT YOU'RE ABOUT TO HEAR. WE
WERE ASKED IF WE REVIEWED THE
PROPOSALS AND FOUND THEM
REASONABLE AND WARRANTED AND
WHICH ONE EMPHASIZED. WE DID
REVIEW THE PROPOSALS AND ART,
RAISING CONCERNS WITH THE
PROPOSALS. WE ALSO WANT TO
EMPHASIZE THAT WE SHARE THE
STAFF INTEREST IN THE
DEPARTMENT'S GROWTH OVER TIME
AND ARE AVAILABLE TO THE
COMMITTEE TO ASSIST ON ANY
ISSUES. DON'T BRING IT UP TO THE
DIOCESE. SEE IF ANY MEMBERS HAVE
QUESTIONS. I'LL KEEP IT HERE
JUST FOR A SECOND IF I CAN.
USING YOUR NUMBERS 25 MILLION
ENROLLEES TO 28 A HALF AND 100
AND 27 HEALTH PLANS TO 140.
THOSE ARE ABOUT 10% INCREASES,
GIVE OR TAKE. AND YET WE'RE
TALKING ABOUT A 44% INCREASE IN
YOUR BUDGET. AND STAFFING IN THE
LAST TWO YEARS. AND SO I'M JUST
TRYING TO FIGURE OUT HOW THOSE
WORK TOGETHER TO HAVE A
TEMPERATURE. IT SEEMS LIKE IT'S
10% WORKLOAD INCREASE. AND YET
WE'RE HAVING A 44% STAFFING
INCREASE, HOPING YOU CAN.
COMMENT ON THAT I'LL GIVE YOU A
LITTLE BIT OF PERSPECTIVE ON
THAT. I THINK SOME OF IT IS JUST
WITH THERE'S A LOT OF INTEREST
IN HEALTHCARE RELATED
LEGISLATION. AND SO AS WE'VE HAD
A LOT OF NEW LEGISLATION PASSED,
IT'S ADDED TO JUST OUR WORKLOAD
AND SO A LOT OF JUST OUR CORE
FUNCTIONS LIKE OUR FINANCIAL
EXAMINATIONS ARE MEDICAL SURVEYS
EVEN HELP CENTERS TO OUR
COMPLAINTS, COMPLAINTS TO OUR
HELP CENTER. A LOT OF THE
FUNCTIONS THAT WE DO HAVE
INCREASED. UM I WILL ALSO JUST
NOTE THAT, UM WE HISTORICALLY
HAVE BEEN VERY CONSERVATIVE IN
OUR FISCAL REQUESTS ASSOCIATED
WITH LEGISLATION, AND WE TEND TO
GET ANALYSTS AND WHAT WE
NOTICED, PARTICULARLY LAST YEAR,
WE HAD A BIG WORKLOAD. BCP
REQUEST WAS THAT WHILE WE HAD A
LOT OF WORKER BEES, WE DIDN'T
HAVE THE SUPERVISORS TO OVERSEE
THEM. AND SO WE REALLY NEED TO
DO TO DO KIND OF SOME
RECONCILIATION. TO SHORE UP
OPERATIONS TO MAKE SURE WE HAD
THE APPROPRIATE NUMBER OF STAFF
REPORTING TO SUPERVISORS. AND SO
I THINK WHAT WE NOTICED, TOO, IS
JUST WITH OUR ONGOING GROWTH. WE
NEEDED TO REQUEST SOME
ADDITIONAL RESOURCES. SO YOU SAW
SOME OF THAT LAST YEAR AND WE
GOT ONE MORE WITH OUR OFFICE OF
FINANCIAL REVIEW THIS YEAR, DAN
I DON'T KNOW IF YOU'D ADD
ANYTHING ELSE ON THAT. THAT WILL
BRING IT BACK THEN. UNDER YOUR
OFFICE OF PLANNING LICENSING,
YOU SAID YOU EVALUATE PROVIDER
NETWORKS AND NETWORK ADEQUACY ON
AN ANNUAL BASIS AS WELL AS, UM,
VALUING MENTAL HEALTH PARODY IS
WHAT'S LISTED WITHIN THE AGENDA
. CAN YOU PROVIDE SOME COMMENTS
OR TELL US SOME OF YOUR FINDINGS
SO WE CAN HELP AND TRACK AND
TREND HOW THIS IS PROGRESSING
AND CAN YOU HELP TO ELABORATE?
WHAT ROLE DID HCS HAS VERSUS DMH
SEE AND DETERMINE NETWORK
ADEQUACY, AS WELL AS MENTAL
HEALTH PARITY THAT SO MANY OF US
ARE PUSHING FOR SURE IT ALL
STALL STARTING. THIS IS DAN'S OF
EXPERTISE SO HE CAN ADD AS WELL.
SO IT'S ACTUALLY OUR OFFICE OF
PLANNED MONITORING THAT LOOKS AT
BOTH NETWORK ADEQUACY, TIMELY
ACCESS. WE'VE DONE A VERY LARGE
MENTAL HEALTH PARITY REVIEW AT
THE DEPARTMENT OVER SEVERAL
YEARS. WE'VE NOW INCORPORATED
THAT INTO OUR ONGOING SURVEY
PROCESS. SO WE'RE LOOKING AT YOU
KNOW IT WHEN WE DO EVERY THREE
YEARS WE GOTTA LOOK AT HEALTH
PLAN OPERATIONS FOR COMPLIANCE
WITH ALL ASPECTS OF THE LAW.
WE'RE LOOKING AT PARITY THERE.
UM WE DO AN ANNUAL REVIEW OF
NETWORK ADEQUACY TO MAKE SURE
THE PLANS HAVE BOTH INADEQUATE
NETWORK TO PROVIDE ALL THE
SERVICES THAT ARE REQUIRED TO
COVER. UM AS WELL AS GEOGRAPHIC
ACCESSES AND THE RATIOS THAT ARE
IN THE STATUTE. UM SO WE DO THAT
ON A REGULAR BASIS AND THEN
ANNUALLY, THE PLANS NEED TO
CONNECT A SURVEY OF THEIR
PROVIDERS TO ASSESS THEIR
COMPLIANCE WITH THE TIMELY
ACCESS STANDARDS IN THE LAW. AH,
THEY REPORT THAT TO THE
DEPARTMENT. WE RELEASED A REPORT
WHICH WE DID. I THINK EARLIER
THIS YEAR UM WE'LL ALSO HAVE A
RATE OF COMPLIANCE THAT WE WILL
BE ENFORCING, STARTING WITH
MEASUREMENT YEAR 2023 THAT WILL
BE REPORTED IN 2024. SO THERE'S
A LOT OF STEPS THAT WE ARE
TAKING THEIR JUST TO ENSURE
COMPLIANCE WITH THE LAW. I WILL
JUST MENTION ON THE NOTE ABOUT
MENTAL HEALTH PARITY. WE ALSO
HAVE BEHAVIORAL HEALTH
INVESTIGATIONS THAT WERE
CONDUCTING THIS IS FIVE PER YEAR
ON THE COMMERCIAL HEALTH PLAN
SIDE AND WE SHOULD HAVE OUR
FIRST FINDING REPORTS FROM THOSE
INVESTIGATIONS IN THE NEXT
PROBABLY MONTH OR TWO, UM, IN
TERMS OF DHC SD HCS IS THAT YOU
KNOW THE PURCHASER. THEY
ADMINISTER THE MEDICAL PROGRAM.
UM MOST OF THE MEDICAL MANAGED
CARE PLANS HAVE TO HAVE A KNOX
KEENE LICENSE. AND WE DON'T
REGULATE THE COUNTY ORGANIZED
HEALTH SYSTEMS. UM, BUT SO WE
WORKED VERY CLOSELY WITH THE HCS
. THERE'S A LOT OF OVERLAP IN
THE FUNCTIONS THAT WE HAVE IN
THE WORK THAT WE DO,
PARTICULARLY AS IT PERTAINS TO
TIMELY ACCESS AND NETWORK
ADEQUACY. MISS ANYTHING,
SOMETHING? I'M SURE THAT A
COUPLE OF OTHER TOUCHING POINTS
HERE. SO WITH RESPECT TO
REVIEWING NETWORKS ANYTIME A
HEALTH PLAN CONTRACTS OR EXPANDS
THEIR SERVICE AREA, THEY MUST
FILE THAT NEW NETWORK PUTS THE
DEPARTMENT FOR APPROVAL BEFORE
THEY CAN GO IN TO THE NEXT
EXPANSION OR CONTRACTION. IN
ADDITION, ANYTIME THERE'S A
CONTRACT TERMINATION BETWEEN THE
HOSPITAL OR PROVIDE A GROUP OF
RB OH, AND A HEALTH PLAN. THAT
IMPACTS 2001 ENROLLEES HEALTH
PLAN MUST NEEDS TO FILE THAT
WITH US INCLUDES THE ENROLLING
NOTICE THAT THEY NEED TO SEND
ENROLLEES TO INFORM THEM OF THAT
CHANGE. WE REVIEW THOSE BLOCK
TRANSFERS TO ENSURE WHEREVER THE
HEALTH PLAN IS TRYING TO
TRANSFER BLOCK TRANSFER THE
ENROLLEES TO THEY HAVE THE
CAPACITY TO TAKE ON THAT
ENROLLMENT. I THINK THERE ARE A
NUMBER OF WORKGROUPS TO BETWEEN
OUR NETWORKS AND OUR SURVEYS
DIVISIONS THAT WORK DIRECTLY
WITH DHS ON THESE TOPICS WOULD
LOVE TO UNDERSTAND CAL AIM AND
ITS INTERFACE AND WHAT WILL
OCCUR. HOW ARE WE GOING TO BE
ABLE TO MONITOR AS WE ENTER INTO
JANUARY 1ST 2024 THAT MAY BE
MORE APPROPRIATE FOR DEEDS CS
BUT WANTED TO ASK. YOUR OPINION
AND HOW YOUR POSITIONING OH, I
THINK THAT'S PROBABLY MORE
APPROPRIATE FOR DHC S. I WILL
SAY ONE OF THE THINGS WE'RE
CONSTANTLY REMINDING THE HEALTH
PLANS ABOUT IS OFTEN THE CHANGES
THEY NEED TO MAKE TO COMPLY WITH
THE REQUIREMENTS AND DHS HAS
CONTRACT IMPACT THEIR KNOCK SKIN
LICENSE, AND SO WE'RE WORKING
VERY CLOSELY TO MAKE SURE
THEY'RE FILING ANY OF THOSE
CHANGES WITH US IF IT IMPACTS
THEIR NETWORK THEIR CONTRACTS.
OFTEN THEY HAVE DELEGATION
AGREEMENTS. THOSE NEED TO BE
FILED WITH THE DEPARTMENT. SO I
THINK MY OVERARCHING RESPONSE
WOULD BE. WE'RE WORKING CLOSELY
BOTH WITH THE HEALTH PLANS BUT
ALSO WITH OUR STREET AGENCY, THE
DEPARTMENT OF HEALTH CARE
SERVICES. I'M ASKING BECAUSE OF
THAT SUBCONTRACT. AND SINCE WE
HAVE FOCUSED ON THE PRIME
CONTRACT BEFORE FOR ADEQUACY, WE
DIDN'T HAVE A REAL ABILITY TO
VIEW AND DETERMINE IF THE
SUBCONTRACTS HAD BEEN MEETING
WHAT THEY WERE ABLE TO STATE
THEY WERE GOING TO DO, AND
THAT'S WHY I'M WANTING TO
GUARANTEE YOU WILL HAVE THAT
ABILITY. IN ADDITION TO THE HCR
POST, CAL AIMS IMPLEMENTATION SO
WE CAN TRULY DIG IN AND MAKE
SURE THAT ALL PLANS ARE
DELIVERING THE NETWORKS THAT
THEY CLAIM THEY CAN. ARE THERE
ANY OTHER FLEXIBILITIES OR
IMPROVEMENTS? WE COULD DO THAT
WOULD BETTER EMPOWER YOU TO MAKE
SURE YOU WERE AWARE OF UM, THEIR
NETWORKS. YOU KNOW, I DON'T KNOW
THAT THERE'S ANYTHING ELSE THAT
WE NEED. AT THE END OF THE DAY
WE HOLD THE WHAT WE CALL THE
PARENT PLAN THAT HOLDS THE KNOCK
SKIN LICENSE ACCOUNTABLE, AND IF
THEY SUB DELEGATE THOSE
FUNCTIONS THEY NEED TO REPORT
THAT FILED A CONTRACT WITH US
AND MAKE SURE THAT THEY HAVE THE
APPROPRIATE REQUIREMENTS IN
THOSE CONTRACTS AND THE
APPROPRIATE OVERSIGHT. UM SO I
THINK THAT'S A PEACEFUL BE
MONITORING VERY CLOSELY IS THE
HEALTH PLAN OVERSIGHT THE PARENT
PLANT OVERSIGHT OF THEIR
DELEGATES. WE HEARD EARLIER
ABOUT HOW THE NEXT DECADE WILL
BE FOCUSED ON HEALTH CARE
AFFORDABILITY. I ALSO BELIEVE IT
WILL BE ON NETWORK ADEQUACY AND
TIMELY ACCESS TO CARE TO MAKE
SURE AS WE'RE INCREASING ACCESS
OVERALL THAT PEOPLE ARE THEN
ABLE TO SEE PROVIDERS WITH THAT
I WILL THANKS VERY MUCH THIS
PANEL AND WE WILL MOVE ON TO
ISSUE EIGHT. OKAY YES, YOU ATE
IS ME AGAIN. THIS IS GENDER
AFFIRMING CARE. SO SP 9 23
REQUIRES THE COUNTY, CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY
TO CONVENE A TRANSGENDER, GENDER
, DIVERSE OR INTERSEX WORKING
GROUP FOR THE PURPOSES OF
DEVELOPING EQUALITY STANDARD FOR
PATIENT EXPERIENCE TO MEASURE
CULTURAL COMPETENCY COMPETENCY
RELATED TO THE T G COMMUNITY AND
TO RECOMMEND A TRAINING
CURRICULUM TO PROVIDE TRANS
INCLUSIVE HEALTH CARE. THE
WORKING GROUP WILL BE IN WILL BE
MADE UP OF AT LEAST THREE T G
SERVING ORGANIZATIONS. AT LEAST
THREE INDIVIDUAL CALIFORNIA
RESIDENTS WHO IDENTIFY AS T G
AND HEALTH CARE PROVIDERS AND
REPRESENTATIVES OF STATE
AGENCIES, THE WORKING GROUP WILL
CONDUCT AT LEAST FOUR LISTENING
SESSIONS ACROSS THE STATE WITH
PATIENTS OF THE T G COMMUNITY.
THE QUALITY STANDARD OF
RECOMMENDATIONS FOR THE TRAINING
CURRICULUM WILL BE DEVELOPED NO
LATER THAN MARCH. 1ST OF 2020
FOR THE CALIFORNIA HEALTH AND
HUMAN SERVICES AGENCY HAS
DELEGATED THE CONVENING AND
COORDINATION OF THE T G WORKING
GROUP REQUIREMENTS TO THE D. M.
H C. SB 9 23 REQUIRES HEALTH
PLANS IN THEIR DELEGATES STAFF
WHO ARE IN DIRECT CONTRACT WITH
THE CONTACT WITH ENROLLEES TO
COMPLETE EVIDENCE BASED CULTURAL
COMPETENCY TRAINING SO THEY CAN
PROVIDE PROFICIENTLY PROVIDE
TRANSOM INCLUSIVE HEALTHCARE. SP
9 23 ALSO REQUIRES THE CULTURAL
COMPETENCY TRAINING TO BE
FACILITATED BY A T G SERVING
ORGANIZATION. AND THE TRAINING
CURRICULUM WOULD BE SUBJECT TO
GMHC S APPROVAL FOLLOWING
ENGAGEMENT WITH T G SERVING
ORGANIZATIONS. THE BILL
STIPULATES THAT ANY HEALTH PLAN
STAFF WHO MAY HAVE BEEN FOUND TO
HAVE FAILED AND PROVIDING TRANS
INCLUSIVE HEALTH CARE WOULD BE
REQUIRED TO COMPLETE A REFRESHER
COURSE ON THE TOPIC. THE GMHC
WILL REVIEW INDIVIDUAL CASE
COMPLAINTS THE DEPARTMENT
RECEIVES ALLEGING DISCRIMINATION
BASED ON GENDER IDENTITY AND
REFER THOSE COMPLAINTS TO THE
CIVIL RIGHTS DEPARTMENT WILL
REVIEW THE COMPLAINTS THAT WE
RECEIVE INVOLVING IMPROVED
IMPROPER TO DIALS TO DETERMINE
WHETHER ANY ENFORCEMENT ACTIONS,
INCLUDING SANCTIONS MAY BE
APPROPRIATE. WILL REVIEW AND
APPROVE THE HEALTH PLANS. USE OF
CULTURAL COMPETENCY TRAINING
CURRICULUM WILL MODIFY OUR
EXISTING SURVEY METHOD,
METHODOLOGIES AND TOOLS TO
INCLUDE A REVIEW OF POLICIES AND
PROCEDURES FOR 9 23 COMPLIANCE
WILL PROVIDE A STATUS REPORT TO
THE LEGISLATURE SEMI ANNUALLY
UNTIL WE ADOPT REGULATIONS AND
WILL ISSUE GUIDANCE TO ENSURE
HEALTH PLANS ARE FOLLOWING THESE
NEW REQUIREMENTS. UM AND
ANNUALLY REVIEW HEALTH PLAN
DOCUMENTS TO ENSURE COMPLIANCE
WITH THE PROVISIONS OF SB 9 23.
THE CALIFORNIA HEALTH AND HUMAN
SERVICES AGENCIES REQUESTING
EXPENDITURE AUTHORITY OF 400,023
24 FROM THE GENERAL FUND TO
REIMBURSE THE GMHC FOR
CONSULTANT SERVICES TO PLAN
ORGANIZE AND FACILITATE THE T G
WORKGROUP. THE DM HCS REQUESTION
EXPENDITURE AUTHORITY OF 4.5
POSITIONS AND 1.2 MILLION AND 23
24 INCREASING TO 2.2 MILLION AND
27 28 ANNUALLY THEREAFTER. UM
THAT CONCLUDES MY OVERVIEW. YOU
HAD QUESTIONS ABOUT THE REPORT
TO THE LEGISLATURE WERE
ANTICIPATED PAINTING RIGHT NOW
THAT THE FIRST REPORT WOULD BE
SUBMITTED LIKELY BY JULY, 1ST
2025. EVERY SIX MONTHS AFTER
THAT, UNTIL WE PROMULGATE
REGULATIONS THAT WILL GIVE US
ENOUGH TIME SO THE FIRST REPORT
CAN INCLUDE AN UPDATE ON THE
WORKING GROUP AND IMPLEMENTATION
OF THE QUALITY STANDARDS AND
TRAINING REQUIREMENTS. SO
GETTING CLOSE AND THEN HOW WILL
THE ADMINISTRATION ENGAGED THE T
G COMMUNITY ON IMPLEMENTATION OF
SB? 9 23. WE'VE ALREADY HAD SOME
ENGAGEMENT WITH THE AUTHOR'S
OFFICE AND SPONSORS. UM AND
WE'LL ALSO BE LOOKING TO GET
INPUT FROM THE WORKING GROUP
ISSUED A SOLICITATION A FEW
MONTHS AGO FOR MEMBERS AND WE'RE
REALLY PLEASED WITH THE RESPONSE
WE RECEIVED. UM SO THE WORKING
GROUP WAS PRIMARILY GOING TO BE
MADE UP OF MEMBERS OF THE G
COMMUNITY OR THOSE THAT WORK
WITH THE T G COMMUNITY. ALSO
THOSE ADDITIONAL FOR LISTENING
SESSIONS WE INTEND TO CONDUCT
ACROSS THE STATE WILL BE A GOOD
OPPORTUNITY FOR US TO HEAR
DIRECTLY FROM THE T G COMMUNITY.
MAD I THINK ANSWERS THOSE
QUESTIONS. I HAD MR SOUTHERN ON
MY LIST. BUT IF YOU HAVE NOTHING
ELSE TO ADD, WILL GO TO THE
DEPARTMENT OF FINANCE. NO
ADDITIONAL COMMENTS AT THIS
TIME. THANK YOU, LEO. NO
CONCERNS BRING IT UP TO THE
HIGHEST TO SEE IF ANY MEMBERS
HAVE QUESTIONS SEEING. NO, NO,
THANK YOU. AND WE WILL MOVE ON
TO ISSUE NIGHT. OKAY IS SHE NINE
HEALTHCARE COVERAGE FOR ABORTION
SERVICES AND COST SHARING FOR A
SPEECH TO 45? SP 2 45 REQUIRES
FULL SERVICE HEALTH PLANS TO
COVER ABORTION AND ABORTION
RELATED SERVICES, INCLUDING PRE
ABORTION AND ABORTION, FOLLOW UP
SERVICES WITHOUT A COPAYMENT
DEDUCTIBLE OR ANY TYPE OF COST
SHARING. SP 2 45 REQUIRES A D
MHC TO INTERPRET AND IMPLEMENT
PROVISIONS OF SB 2 45 IN
CONSULTATION WITH THE DEPARTMENT
OF HEALTH CARE SERVICES AND THE
CALIFORNIA DEPARTMENT OF
INSURANCE, BY MEANS OF ALL
PLANNED LETTERS OR SIMILAR
GUIDANCE WILL ADOPT REGULATIONS
BY JANUARY. 1ST OF 2026 ANNUALLY
REVIEW HEALTH PLAN DOCUMENTS,
INCLUDING EVIDENCE OF COVERAGE
AND DISCLOSURE FORMS.
UTILIZATION, MANAGEMENT, DATA
AND HEALTH PLANS. SURVEY DATA TO
ENSURE COMPLIANCE. WE'RE
REQUESTING LIMITED TERM
EXPENDITURE AUTHORITY OF 499,023
24 483,024 25 THROUGH 27 28
DEVELOPED LEGAL MEMORANDA AND
REGULATIONS. UM I THINK YOU HAVE
A QUESTION HERE ABOUT WHY THE
COSTS WERE HIGHER THAN WHAT WAS
PROVIDED TO THE APPROPRIATIONS
COMMITTEE LAST YEAR. OUR
UNDERSTANDING IS THE BILL WAS
LAST HEARD IN THE ASSEMBLY
APPROPRIATIONS COMMITTEE ON JULY
5TH. I BELIEVE OF 20 AND 21. THE
BILL WAS AMENDED ON THE FLOOR
SEVEN MONTHS AFTER IT WAS HEARD
IN THE SECOND HALF. THIS WILL
COMMITTEE SO THE LAST FISCAL
ANALYSIS AND DOES NOT REFLECT
THE FEBRUARY 14TH 22 AMENDMENTS
. WE BELIEVE ALSO, THE INCREASED
FISCAL WAS THE RESULT OF
POTENTIAL LITIGATION, WHILE THE
SUBSTANCE OF THE BUILDING CHANGE
GREATLY GIVEN THE FEDERAL
ABORTION LITIGATION. WE WANT TO
DO IN CLOCK INCLUDE COSTS FOR
THE LIKELIHOOD THAT GMHC WILL BE
CHALLENGED IN OUR POSITION. UM
IN THE 2021 FISCAL. WE
ANTICIPATED TWO MEMOS AND IN OUR
UPDATED FISCAL WE'RE
ANTICIPATING ABOUT 14 MEMOS. UM
AND ADDITIONAL COORDINATION WITH
THE ATTORNEY GENERAL'S OFFICE
DURING LITIGATION. DEPARTMENT OF
FINANCE. NO ADDITIONAL COMMENTS
AT THIS TIME. THANK YOU. HELLO
NO CONCERNS. BRING IT UP TO THE
DIASPORA MEMBERS. QUESTIONS
SEEING NO, NO, THANK THIS PANEL,
AND WE WILL MOVE ON TO ISSUE 10.
CLEAR. THIS IS RELATED TO S P 58
58 REVISED THE ADMINISTRATOR,
MINISTRATIONS AND CIVIL PENALTY
PROVISIONS OF THE LOCKS KEENE
ACT AND INCREASED VARIOUS
SPECIFIED PENALTY AMOUNTS
ASSESSED FOR VIOLATIONS OF THE
LAW. THIS BILL PROVIDES THE GMHC
WAS SPECIFIC AUTHORITY TO IMPOSE
CORRECTIVE ACTION PLANS ON
HEALTH PLANS FOR VIOLATION OF
THE KNOX KEENE ACT. IT ALSO
INCREASED THE CIVIL PENALTY
AMOUNT FOR VIOLATIONS FROM 2500
TO NO MORE THAN 25,000.
ADDITIONALLY SB 8 58 UPDATES
VARIOUS SPECIFIC DOLLAR AMOUNT
PENALTIES THROUGHOUT THE KNOX
KEENE ACT APPLICABLE TO CIVIL
PENALTIES, CRIMINAL PENALTIES
AND VARIOUS ADMINISTRATIVE
PENALTIES. 58 REQUIRES THE GMHC
TO CONDUCT ANNUAL RATE CHANGE
ANALYSIS TO ANALYZE, CALCULATE
AND COMBINE THE AVERAGE RATE
CHANGE INFORMATION FOR THE
INDIVIDUAL AND SMALL GROUP
MARKETS. WE'LL ASSESS THE
FINANCIAL IMPACT OF INCREASED
PENALTIES ON HEALTH PLANS,
CONDUCT FINANCIAL MONITORING OF
CORRECTIVE ACTION PLANS. UM FOR
HEALTH PLANS AND RISK VERY OR
ORGANIZATIONS. WELL DEVELOPED
COMPREHENSIVE HEALTH PLANS.
SURVEY CORRECTIVE ACTION PLANS
REVIEW HEALTH PLAN FILINGS AND,
AS WE ALWAYS DO, WE'LL MODIFY
OUR EXISTING SURVEY METHODOLOGY
AND TOOLS. WE ALSO IN ORDER TO
COMPLY WILL BE ESTABLISHED,
ESTABLISHING A COMPLIANCE TEAM
THAT WILL BE HOUSED IN OUR
OFFICE OF ENFORCEMENT TO MONITOR
AND FORCED HEALTH PLAN
COMPLIANCE WITH CORRECTIVE
ACTION PLANS. WELL BILL ALSO
LEAD THE REVIEW AND ASSESSMENT
OF THE SEVERITY OF ISSUES THAT
COME TO DMH SEES ATTENTION
WHETHER FROM INTERNAL OFFICE'S
EXTERNAL STAKEHOLDERS, IMMEDIATE
ETCETERA. WE'RE REQUESTING 40.5
POSITIONS AND 12.6 MILLION AND
23 24 DECREASING THE 9.7 MILLION
IN 27 28 ANNUALLY THEREAFTER. SO
YOU HAD A QUESTION ABOUT THE
40.5 NEW POSITIONS WERE
REQUESTING, WHICH IS 7%
EXPANSION TO THE DEPARTMENT
STAFF. IT IS SIGNIFICANT. UM AND
SOME OF THE JUSTIFICATION FOR
THAT IS REALLY THIS IS THIS IS A
SIGNIFICANT INCREASE IN OUR
OVERSIGHT AUTHORITY ON OUR
ENFORCEMENT OFFICE. IT'S NOT
JUST AN INCREASE TO THE
POTENTIAL PENALTY AMOUNTS, BUT
ALSO THE ABILITY TO REQUIRE A
CORRECTIVE ACTION PLAN.
HISTORICALLY CORRECTIVE ACTION
PLANS HAVE BEEN SOMETHING WE HAD
TO NEGOTIATE, AND OFTEN THE
PLANS DIDN'T AGREE TO. UM GIVEN
THE INCREASED PENALTY AMOUNTS
AND THE ABILITY FOR US TO
REQUIRE CORRECTIVE ACTION PLANS.
WE'RE ALSO ANTICIPATING THE
PROBLEM OR CHALLENGES FROM THE
PLANS, WHICH WILL LEAD TO
LITIGATION, WHICH IS WHY YOU SEE
SUCH AN INCREASE IN THE NUMBER
OF ATTORNEYS AT THE DEPARTMENT.
UM AND I WILL JUST NOTE THAT
THERE'S A SIGNIFICANT AMOUNT OF
WORK NOT ONLY IN THE DEVELOPMENT
OF CORRECTIVE ACTION PLANS, BUT
WE REALLY WANT TO MAKE SURE THAT
WE'RE FOLLOWING UP AND
MONITORING THAT THOSE CORRECTIVE
ACTION PLANS ARE COMPLIED WITH
BECAUSE OUR ENFORCEMENT ACTIONS
WHILE THE PENALTIES AND THE
FINES MAKE THE BIG HEADLINE,
IT'S REALLY CORRECTING
OPERATIONS AND PLANT BEHAVIOR.
THAT'S THE GOAL HERE. AND I
THINK THAT WAS IT FOR THAT
QUESTION. DEPARTMENT OPPONENTS
NO ADDITIONAL COMMENT. THANK
YOU. WE DON'T HAVE CONCERNS WITH
THIS PROPOSAL THAT THE STAFF
QUESTIONS DID YOU KNOW DOESN'T
NOTE THAT THIS IS A SIGNIFICANT
INCREASE IN THE NUMBER OF STAFF
AND JUST WANTED TO SHARE A
RATIONALE. WHY WE DIDN'T HAVE
CONCERNS. ONE IS A IS, THE
DEPARTMENT NOTED, IS THAT THE
BILL DOES NOTABLY CHANGE THE
SCOPE OF THE EXISTING WORK THAT
ITS UNDERTAKING AND SO THAT THE
ADDED PROGRAMMATIC STAFF. MADE
SENSE TO US AS WE WERE REVIEWING
THE PROPOSAL. THE PROPOSAL ALSO
INCLUDES SOME ADDITIONAL
ADMINISTRATIVE AND TECHNOLOGY
STAFF, WHICH WE UNDERSTOOD TO BE
REASONABLE, GIVEN THE SORT OF
PROGRAMMATIC IMPACT TO THE
DEPARTMENT AND THEN WE ALSO
WANTED TO NOTE THAT THE FISCAL
IMPACT OF THIS PROPOSAL
GENERALLY ALIGNED WITH WHAT WE
SAW IN THE APPROPRIATIONS
COMMITTEE. SO IT WAS. WE'VE
UNDERSTOOD THAT IT WAS
UNDERSTOOD THAT THIS BILL WOULD
ENTAIL SUBSTANTIAL INCREASE IN
THE DEPARTMENT'S WORKLOAD. THANK
YOU. BRING IT UP TO THE DIOCESE
FOR ANY MEMBERS. QUESTIONS
SEEING NONE. I WILL. THANKS VERY
MUCH. THIS PANEL WE WILL MOVE ON
TO ISSUE 11. GOOD AFTERNOON, MR
CHAIR, MEMBERS OF SUBCOMMITTEE.
THE VCS OFFICE OF FINANCIAL
REVIEW WORKS TO ENSURE STABILITY
IN CALIFORNIA'S HEALTH CARE
DELIVERY SYSTEM BY ACTIVELY
MONITORING THE FINANCIAL STATUS
OF HEALTH PLANS AND PROVIDERS
GROUPS KNOWN AS RISK VERY
ORGANIZATIONS SO THEY CAN MEET
THE FINANCIAL OBLIGATIONS TO
CONSUMERS, PROVIDERS AND
PURCHASERS. THE DEMON SEES
OFFICE OF FINANCIAL VIEW
CONDUCTS THAT OVERSIGHT TO
ROUTINE AND NON ROUTINE
FINANCIAL EXAMINATIONS OF EACH
HEALTH PLAN AND R B O IS VERY
INDICATED EARLIER, THE NUMBER OF
DBC LICENSED HEALTH PLANS UNDER
THE DEMON SHE'S JURISDICTION HAS
STEADILY INCREASED FROM 121
LICENSED HEALTH PLANS 2015 TO
140 LICENSED HEALTH PLANS IN
2021. IN ADDITION TO ADDRESSING
THE WORKLOAD ASSOCIATED WITH
INCREASED NUMBER OF LICENSED
HEALTH PLANS. THE DAMAGES
DETERMINED THAT IT'S IN THE BEST
INTERESTS OF ENROLLEES AND
STAKEHOLDERS. TO TRANSITION TO A
SCHEDULE WHERE EVERY LICENSED
HEALTH PLAN IS EXAMINED AT LEAST
EVERY ONCE EVERY THREE YEARS.
INSTEAD OF THE CURRENT ONCE
EVERY FIVE YEARS AND MOVING THE
R B O OR MEDICAL GROUP REVIEWS
FROM ONCE EVERY EIGHT YEARS TO
ONCE EVERY FIVE YEARS. LESS
FREQUENT EXAMINATION. HEALTH MAY
RESULT IN AN INCREASE IN THE
NUMBER OF HEALTH PLANS AND RBS
THAT ARE FINANCIALLY INSOLVENT
AND ARE NON COMPLIANT WITH THE
KNOX KEENE ACT. TO ADDRESS THIS
WORKLOAD. GMHC IS REQUESTING
EXPENDITURE AUTHORITY OF 14.5
POSITIONS AND $2.68 MILLION
FISCAL YEAR 23 24. AND $2.55
MILLION IN FISCAL YEAR 24 25
ANNUALLY THEREAFTER TO CONDUCT
THE MORE FREQUENT FINANCIAL
EXAMINATIONS AND ADDRESS THE
WORKLOAD ASSOCIATED WITH THE
INCREASE IN THE NUMBER OF HEALTH
PLANS PLACES BY THE DBC. I DON'T
BELIEVE THERE ARE ANY SPECIFIC
FOLLOW QUESTIONS AND WEREN'T
HAPPY TO ADDRESS YOU NOW.
DEPARTMENT OF FINANCE NO
ADDITIONAL COMMENT AT THIS TIME.
THANK YOU, LEO. WOW ALSO NO
CONCERNS WITH THIS PROPOSAL, BUT
WANTED TO EMPHASIZE TWO KEY
POINTS. THE FIRST IS THAT THIS
IS A DISCRETIONARY PROPOSAL, SO
IT'S NOT BEING TRIGGERED BY
ENACTED LEGISLATION OR ANY
FEDERAL REQUIREMENTS AND THAT
SECOND THAT YOU KNOW,
FUNDAMENTAL GOAL OF THIS
PROPOSAL IS TO INCREASE THE
FREQUENCY IN WHICH, UM, RISK
BEARING ORGANIZATIONS AND HEALTH
PLANS ARE REVIEWED FOR FINANCIAL
SOLVENCY, AND SO THAT'S REALLY
THE ISSUE BEFORE THE LEGISLATURE
. DOES IT DOES IT IS THAT A
PRIORITY OF THE LEGISLATURE?
BRING IT UP TO THE DÍAS. DR
JACKSON. UM IS THERE HAVE THERE
? IS THERE ANY DATA YOU'RE
SAYING OR ANYTHING THAT HAS
TRIGGERED AND LEAD TO BE ABLE
TO, UM REVIEW THEM MORE
FREQUENTLY. YES I THINK WITH THE
INCREASE IN PRIVATE EQUITY TO
CONSOLIDATIONS AND MERGERS AND
ACTIVITY AROUND HEALTHCARE
ENTITIES. WE HAVE A GROWING
CONCERN OF WHETHER INTERESTS AND
ALSO IN ADDITION TO THAT WE'RE
SEEING, UH, MORE FREQUENT
INSOLVENCY OR CONCERNS WITH
TANGIBLE NET EQUITY AT THE
HEALTH PLAN AND RUBIO LEVEL,
WHICH IS OUR JUSTIFICATION
REQUESTING MORE FREQUENT, UM,
EXAMINATIONS OF THOSE TWO
ENTITIES. OKAY, THANK YOU. AND
JUST TO CONFIRM THESE ARE
THROUGH THE MANAGED CARE FUND
AND LUST DON'T HAVE A GENERAL
FUND OBLIGATION CORRECT. WITH
THAT WE WILL. THANKS VERY MUCH
THIS PANEL AND MOVE ON TO ISSUE
12. DUE TO AN INCREASE IN THE
SECRETARY REQUIREMENTS ON HEALTH
PLANS, COVERAGE OF ABORTION AND
MENTAL HEALTH SERVICES AND
CHANGES DUE TO COVID 19
REQUIREMENTS. GMHC HAS BEEN A
DEFENDANT IN 2 TO 3 LEGAL
ACTIONS PER YEAR SINCE 2019
GIVEN THE HIGH LEVEL OF
COMPLEXITY AND SIGNIFICANCE OF
THESE MATTERS. SUCH AS
PERSONNEL. I'M SORRY. SORRY THE
DVC UTILIZES THE ATTORNEY
GENERAL'S OFFICE FOR LEGAL
GUIDANCE AND TO PREPARE THESE
CASES FOR HEARINGS. THE DVC IS
REQUESTING ADDITIONAL
EXPENDITURE AUTHORITY TO ADDRESS
THE ATTORNEY GENERAL'S OFFICE
LEGAL FEES. AND THE DEMONS. SHE
HAS NOT HAD SUFFICIENT RESOURCES
TO ADDRESS THESE ASSOCIATED
COSTS. HISTORICALLY THE GMHC HAS
WE ALLOCATED MONEY. FROM SALARY
SEEMS TO COVER EXCESS ATTORNEY
GENERAL FEES, WHICH IS NOT A
VIABLE LONG TERM SOLUTION. TO
ADDRESS THIS THE DEMONS HE'S
REQUESTING EXPENDITURE AUTHORITY
$400,000 IN FISCAL YEAR 23 24
ONGOING TO SUPPORT LEGAL
REPRESENTATION BY THE ATTORNEY
GENERAL'S OFFICE IN LITIGATION
TO WHICH THE DEPARTMENT IS PART
IS CALLED, WHEREAS I WITNESS
THAT CONCLUDES MY OVERVIEW OR
HAPPY TO ADDRESS ANY QUESTIONS.
DEPARTMENT OF FINANCE. NO
ADDITIONAL COMMENTS. THANK YOU.
HELLO AND NO CONCERNS WITH THIS
PROPOSAL. BRING IT UP TO THE
DIOCESE. THERE'S ANY MEMBERS
QUESTIONS SEEING NONE. I WILL
THANK THIS PANEL AND WE WILL
MOVE ON TO OUR LAST ISSUE OF THE
DAY ISSUE. 13 ALRIGHT? THE D. V
C S OFFICE OF TECHNOLOGY AND
INNOVATION IS TASKED WITH
PROVIDING PROJECT MANAGEMENT
REENGINEERING AND AUTOMATING
CRITICAL BUSINESS PROCESSES TO
MITIGATE SECURITY
VULNERABILITIES. IN 2021, THE
CALIFORNIA MILITARY DEPARTMENT.
INDEPENDENT SECURITY AUDIT
IDENTIFIED THE DVC IS LACKING
ADEQUATE INFORMATION SECURITY
RESOURCES TO CAPTURE DATA
PERFORM CRITICAL DATA SECURITY
PRACTICES AND DOCUMENT SECURITY
PROCEDURES. IT WAS DETERMINED
THAT THE D MHC NEEDS TO ADAPT.
38 NEW INFORMATION SECURITY
POLICIES, 12 INFORMATION
SECURITY AND PRIVACY PLANS AND
AT A MINIMUM 87 PROCEDURES THAT
NEED TO BE CREATED AND MAINTAIN.
THE DEMON SEE CURRENTLY LACKS
SUFFICIENT RESOURCES TO
IMPLEMENT OPERATIONALIZED AND
MAINTAIN THE REQUIRED SECURITY
CONTROLS AND ADDRESS ONGOING
GROWING SECURITY THREATS
IDENTIFIED IN THIS SECURITY
ASSESSMENTS. THE DEMONS USED
REQUESTING EXPENDITURE
AUTHORITY. PRIVACY $3.5 MILLION
IN FISCAL YEAR 23 24 INCREASING
TO $30.6 MILLION IN FISCAL YEAR
27 28 ANNUALLY THEREAFTER TO
FUND THE REQUESTED FIVE
POSITIONS. THIS REQUEST ALSO
INCLUDES CONSULTING FUNDING OF
$100,000 ANNUALLY THROUGH 25 26
TO ASSIST THE DMC WITH THE
DEVELOPMENT OF ITS POLICIES,
PLANS AND PROCEDURES AND
CONSULTING FUNDING OF $775,000
ANNUALLY. FISCAL YEAR. 24 25 FOR
GAP ANALYSIS CONSULTANTS AND ONE
TIME FUNDING OF $90,000. TWO FOR
AN IDENTITY LIFE CONSULTANT,
LIFESTYLE OR LIFE CYCLE
CONSULTANT. THAT CONCLUDES MY
REVIEW WEREN'T HAPPENING.
ANSWERING QUESTIONS. DEPARTMENT
OF FINANCE NO ADDITIONAL
COMMENTS. THANK YOU. HELLO. NO
CONCERNS WITH THIS PROPOSAL WILL
BRING IT UP TO THE DIOCESE FOR
ANY MEMBERS. QUESTIONS SEEING.
NONE WILL THANK YOU VERY MUCH AS
I WILL THANK ALL OF OUR
PANELISTS WITH PARTICIPATED IN
TODAY'S HEARING. NOW WE WILL BE
MOVING TO PUBLIC COMMENT. AS I
STATED AT THE START, WE WELCOME
PUBLIC COMMENT ON ALL OF THE
ISSUES THAT ARE ON TODAY'S
AGENDA. BUT ASK YOU TO PLEASE
KEEP YOUR COMMENTS TO ONLY THESE
ISSUES. WE WILL BEGIN PUBLIC
COMMENT WITH INDIVIDUALS WHO ARE
HERE IN THE HEARING ROOM, AND
THEN WE WILL GO TO THE PHONE
LINES. HMM. LET US BEGIN WITH
PUBLIC COMING. GOOD EVENING,
LINDA WAY WITH WESTERN CENTER ON
LAW AND POVERTY. WE SHARE THE
CHAIR AND COMMITTEES CONCERNED
REGARDING THE PROPOSAL TO SWEEP
COVERED CALIFORNIA AFFORDABILITY
INTO THE GENERAL FUND WHEN THE
INDIVIDUAL MANDATE PENALTY WAS
PROPOSED IN 2019, WE HAD RAISED
CONCERNS CONSIDERING THE VERY
LARGE NUMBER OF LOW INCOME
INDIVIDUALS WHO ARE PAYING THE
PENALTY AND MORE RECENT DATA
BEARS THAT OUT, AND SO WE
RECOMMEND THAT WE URGED THE
COMMITTEE TO REJECT THIS
PROPOSAL. AS THIS FUNDING SHOULD
BE USED TO, UM, FOR
AFFORDABILITY ASSISTANCE. IN
ADDITION AS CO SPONSORS OF SP 9
TO 3 RELATED TO ACCESS TO GENDER
FIRMING CARE, WE DO SUPPORT
THAT, UM, PCP AS WELL AS, UH, SB
858 RELATED TO HEALTHCARE
PENALTIES. THANK YOU. THANK YOU.
GOOD AFTERNOON. MATT LOGY FROM
CTU, CALIFORNIA ALSO AN ISSUE
ONE JUST WANTED TO SHARE
CONCERNS WITH HEALTH ACCESS AND
WESTERN CENTER AROUND THE
SWEEPING OF THE FUNDS FOR
COVERED CALIFORNIA, DEEPLY
CONCERNED WITH THE POTENTIAL
IMPLICATIONS FOR AFFORDABILITY
AND PREMIUM SUBSIDY PROGRAMS
SUCH AS AND A B 25 30, WHICH WE
WERE CO SPONSOR OF WHICH WOULD
GUARANTEE WORKERS ARE NOT
PUNISHED WHEN THEY STRIKE BY
REMOVING THEIR HEALTHCARE
COVERAGE FOR THIS POLICY BE
SUCCESSFUL. WE DO NEED FUNDS
AVAILABLE TO OFFER THE ENHANCED
SUBSIDIES FOR STRIKING WORKERS.
A FUN WE HOPE WE NEVER HAVE TO
USE. SO THANK YOU SO MUCH. ALSO
JUST SPEAKING OF SUPPORT OTHER
THAN THAT, HER BUT THE BCP ON A
B 18 82 ALSO IN SUPPORT. THANK
YOU. THANK YOU. HI. AND UH,
THANK YOU. MEMBERS OF THE BUDGET
COMMITTEE. MY NAME IS ROBERT
BOYKIN, UM, REPRESENTING
CALIFORNIA ASSOCIATION OF HEALTH
PLANS, WHOSE MEMBERS DELIVER
HEALTHCARE COVERAGE TO
APPROXIMATELY 1.7 MILLION
INDIVIDUALS AND FAMILIES TO
COVER CALIFORNIA. WE ARE
CONCERNED AND DISAPPOINTED THAT
THE ADMINISTRATION HAS STARTED
TO SWEEP AWAY MONEY FROM THE
HEALTHCARE REFERRED ABILITIES
ARE FUN TO THE GENERAL FUND. THE
FUNDS. WHO'S THE FUNDS? WHOLE
PURPOSE AND UNCERTAIN TIMES. IT
IS SUPPORT INCREASED
AFFORDABILITY MEASURES FOR
PEOPLE PURCHASING COVERAGE
THROUGH THE COVERED CALIFORNIA
EXCHANGE. WE BELIEVE THIS MONEY
, ALONG WITH THE FEDERAL
SUBSIDIES IS IMPORTANT TO HELP
REDUCE THE COST OF HEALTH CARE
AND INCREASE ACCESS FOR COVERED
CALIFORNIA INDIVIDUALS AND
FAMILIES. THANK YOU FOR YOUR
TIME. THANK YOU. GOOD AFTERNOON
CHAIR AND COMMITTEE MEMBERS. MY
NAME IS RONA ROBLES, AND I AM
THE EXECUTIVE DIRECTOR OF THE
CALIFORNIA MEDICINE SCHOLARS
PROGRAM. THIS PROGRAM WAS FUNDED
IN 2021 AS A PILOT. THANK YOU,
DOCTOR ARAMBULA FOR SUPPORTING
THIS CURRENT ASKED TO CONTINUE
PROGRAM FUNDING UM, AS I SAID,
THIS PROGRAM WAS FUNDED AS A
PILOT IN THE GOVERNOR'S BUDGET
OF 2021. WE HAVE SINCE LAUNCHED
AND RECRUITED AND ENROLLED 140
STUDENTS THROUGHOUT THE STATE.
WE ARE WELL ON OUR WAY TO REACH
OUR TARGET OF 200 STUDENTS BY
JUNE 2023 WITH RECRUITMENT OF
THE SECOND COHORT BEGINNING
IMMEDIATELY IN JULY, 2023 I'D
LIKE TO EMPHASIZE THREE THINGS
ABOUT THE CALIFORNIA MEDICINE
SCHOLARS PROGRAM, WHICH IS A PRE
MED PATHWAY PROGRAM FROM
COMMUNITY COLLEGE TO MEDICAL
SCHOOL. ONE POSITIONS FROM
BACKGROUNDS UNDERREPRESENTED IN
MEDICINE ARE MORE LIKELY TO
PRACTICE IN RURAL AND LOW INCOME
AREAS WHERE THE PHYSICIAN
SHORTAGES MOST ACUTE, SO THIS
PROGRAM ALSO ADDRESSES A HEALTH
EQUITY AND HEALTH CARE ACCESS
ISSUE. NUMBER TWO STUDENTS FROM
COMMUNITY COLLEGES HAVE BEEN
FOUND TO BE MORE COMMITTED TO
THEIR COMMUNITIES AND ARE MORE
LIKELY TO RETURN TO LIVE AND
WORK AND BE OF SERVICE TO THESE
COMMUNITIES. LASTLY NUMBER
THREE, THE STUDENTS ALREADY
ENROLLED IN THE CURRENT
INAUGURAL COHORT REQUIRE
CONTINUED PROGRAM FUNDING TO BE
SUPPORTED IN THEIR PATHWAY AND
JOURNEY TO MEDICAL SCHOOL. THIS
BUDGET ASKED WOULD SUPPORT 600
STUDENTS FROM THE CURRENT PILOT
FROM COMMUNITY COLLEGE TO
ENROLLING IN MEDICAL SCHOOL.
THANK YOU. GOOD AFTERNOON CHAIR
AND MEMBERS OF THE COMMITTEE. MY
NAME IS VINCE RICHARDSON. I'M
JUST SOCIAL DIRECTOR OF THE
CALIFORNIA MEDICINE SCHOLARS
PROGRAM, WHICH IS A PIPELINE
FROM COMMUNITY COLLEGE TO
COMMUNITY RESIDENCY. I WANT TO
ACKNOWLEDGE THAT THE COMMITTEE
HOW VITAL THIS PROGRAM IS TO
ADDRESSING THE PHYSICIAN
SHORTAGE CRISIS IN OUR STATE. BY
INCREASING DIVERSIFYING. THE
HEALTHCARE WORKFORCE IN THE
MEDICAL FIELD. THIS PROGRAM
WOULD ALSO HAVE A POSITIVE
IMPACT ON CHANGING THE LIVES OF
OUR CHILDREN, YOUTH AND FAMILIES
, ESPECIALLY VULNERABLE URBAN
AND RURAL COMMUNITIES. THANK YOU
FOR YOUR SUPPORT. THANK YOU.
HELLO CHAIRMAN AND COMMITTEE
MEMBERS. MY NAME IS CAITLIN
JACKSON, THE ASSOCIATE DIRECTOR
FOR CALIFORNIA MEDICINE SCHOLARS
PROGRAM. I'M HERE TO SUPPORT THE
CALIFORNIA MEDICINE SCHOLARS
PROGRAM, WHICH WAS NOT INCLUDED
IN THE GOVERNOR'S JANUARY BUDGET
PROPOSAL. CMS P HAS ALREADY
LAUNCHED AND ENROLLED ITS FIRST
COHORT OF STUDENTS TO PROTECT
OUR PROGRESS. PLEASE HELP ENSURE
THE PATHWAY IS COMPLETED FROM
COMMUNITY COLLEGE TO MEDICAL
SCHOOL. AS ORIGINALLY INTENDED
BY THE LEGISLATION. THANK YOU.
THANK YOU. I WILL TAKE THAT AS
THE CONCLUSION OF IN PERSON.
PUBLIC COMMENT AS A REMINDER THE
PHONE NUMBER AND ACCESS CODE OR
ON THE FIRST PAGE OF OUR AGENDA
AND SHOULD BE ON THE
SUBCOMMITTEE'S WEBSITE. IT
SHOULD ALSO BE APPEARING ON YOUR
SCREEN IF YOU ARE WATCHING OVER
THE LIVESTREAM, THE PHONE NUMBER
AGAIN IS 877692. THE ACCESS CODE
IS 13151 OPERATOR. LET'S BEGIN.
DO YOU FOR PUBLIC COMMENT? YOU
MAY PRESS ONE THAN ZERO. AGAIN,
THAT'S ONE AND THEN ZERO FOR
PUBLIC COMMENT. WHO GO TO LINE
SIX. YOUR LINE IS OPEN. YOUR
LINE IS OPEN. PLEASE GO AHEAD.
YOU JUST TOOK YOURSELF OUT OF
CUTE. OH, THERE YOU GO. GO AHEAD
. HELLO CHAIR REMEMBERS. MY NAME
IS KEVIN GILBERT AND I AM A FULL
FEW MEDICAL STUDENT AT THE
UNIVERSITY OF CALIFORNIA, SAN
DIEGO SCHOOL OF MEDICINE, AND
I'M ONE OF THE CITIZEN DIRECTORS
OF THE CALIFORNIA MEDICINES
COLLEGE PROGRAM AT THE SAN DIEGO
HUB. I'M CALLING IN SUPPORT OF
THE CALIFORNIA MEDICINE SCHOLARS
PROGRAM, WHICH IS NOT INCLUDED
IN THE GOVERNOR'S JANUARY BUDGET
PROPOSAL. THE SCHOLARS PROGRAM
IS A VITAL PIPELINE PROGRAM
REPORTS STUDENTS FROM DIVERSE
BACKGROUNDS FROM COMMUNITY
COLLEGE ALL THE WAY TO MED
SCHOOL. I AM A PRODUCT OF THE
CALIFORNIA TO REALLY CALL SYSTEM
MYSELF AND CAN TESTIFY TO THE
NEED OF THIS PROGRAM. UM IT HAS
ALREADY LAUNCHED AND ENROLLED
ITS FIRST COHORT OF STUDENTS AND
IN THE SPIRIT OF PROTECTING OUR
PROGRESS. PLEASE HELP ENSURE
THAT THESE STUDENTS MAKE IT TO
MEDICAL SCHOOL, AS WAS
ORIGINALLY INTENDED BY THE
LEGISLATURE. THANK YOU. THANK
YOU. NEXT CALLER, PLEASE. THANK
YOU. AND NEXT YEAR WE'LL GO TO
LINE OF 15. YOUR LINE IS OPEN.
PLEASE GO AHEAD. THANK YOU, MR
CHAIR, AND DARBY KERNAN,
REPRESENTING LEADING H
CALIFORNIA WERE REQUESTING THAT
THE ADMINISTRATION LEGISLATURE
PRESERVE THE HEALTH CARE
WORKFORCE SPENDING THAT WAS
APPROPRIATED IN THE 2022 23
BUDGET. THE GOVERNOR'S JANUARY
PROPOSAL INCLUDED THE DEFERRAL
OF FUNDING TO NUMEROUS WORKFORCE
PROGRAMS OVER THE NEXT THREE
YEARS, INCLUDING THE 125 MILLION
FOR THE NURSING INITIATIVE
THROUGH 2026. AS A FUNDING IS
VITAL TO GROWING THE HEALTHCARE
WORKFORCE LEADING AGENT STRONGLY
ADVOCATING FOR THE FUNDING TO BE
PRESERVED. THANK YOU. THANK YOU.
NEXT CALLER, PLEASE. THANK YOU.
WE'LL GO TO LINE 17 YEAR LINE IS
OPEN. HELLO. MY NAME IS
STEPHANIE. UM I'M CALLING
BECAUSE THEY LISTEN TO YOUR
COMMITTEE AND YOU KNOW I HEARD
YOU TALKED ABOUT I THINK WAS SP
944, AND I DEFINITELY THINK IT
WAS A B 25 30. I THINK I GOT
THAT ONE CORRECT WHERE IT WAS
MENTIONED THAT UNION MEDICAL
WILL BE 84 WHEN THEY STRIKE. I
MEAN, OUR TAX DOLLARS PAY FOR
THAT. THAT'S COMPLETELY
LUDICROUS. FIRST OF ALL OUR
STATUS FACING $25 BILLION
DEFICIT. AND I'D LIKE TO MOVE TO
ITEMS TEND BECAUSE I DIDN'T CARE
ABOUT ITEMS EIGHT. AND I'M LIKE
THIS CLEAR ON THAT, UM I AM
UNDER THE OPINION, WHICH I KNOW
FOR THE LAST 50 YEARS MEDICAL
PAID FOR ABORTIONS. I KNOW THAT
FOR A FACT. YOU KNOW, AS A 15,
YEAR OLD AND HAVING SEX
EDUCATION WAY BACK IN 1969. IT
WAS TOLD THAT IT WAS A FEMALE
HAS THE ADMINISTRATION. YOU
CAN'T OR WILL GET PREGNANT IF
YOU HAVE SEX WITHOUT PROTECTION
. I THINK WE AS A SOCIETY AND
ESPECIALLY CALIFORNIANS. SHOULD
PROTECT THE CHILDREN, AND IT
SHOULD BE THE PARENTS
RESPONSIBILITY DID NOT. IT
SHOULD GO BACK TO THE BASIC
EDUCATION AND NOT FORCING PEOPLE
OR HAVING ABORTIONS OR GIVING
THEM AN EASY WAY OUT. NOW, IF
IT'S DIRT RATE OR ANYTHING OF
THAT NATURE, YES, I SUPPORT IT
NOT FULL TERM OR AFTER. I DO NOT
. AND HERE WE ARE. WE'RE TALKING
ABOUT HIS SHORT NURSES AND
DOCTORS. I REALLY WANT TO TALK
ABOUT THIS FOR ONE SECOND, YOU
KNOW? MOST OF THEM LEFT BECAUSE
THE BEST THING THAT IS HONESTLY
CLEAR. WE ALL KNOW THAT SO LET'S
NOT FOOL OURSELVES. THE OTHER
ONES ARE SO EXHAUSTED. I AM
FULLY COVERED. BEND FULLY MET
COVERED. I AM WITH CEDRIC
HEALTHCARE, AND I CAN GO TO INDY
CENTER HOSPITAL NOW AND YOU HAVE
TO WAIT. TO GO INTO AN EMERGENCY
. I AM ALREADY SENIOR. IT IS SO
FILLED WITH HOMELESS PEOPLE, IT
IS COMPLETELY LUDICROUS. THIS IS
NEEDS TO STOP. WHY DON'T WE
TALKING ABOUT BUILDING YOU KNOW
MENTAL HEALTH HOSPITALS NEEDED.
I REALLY NEED TO GET BACK TO THE
BASICS HERE. THAT'S ALL I NEED
TO SAY, BECAUSE I THINK YOU GUYS
ARE ALL OFF THE TARGET. THANK
YOU. NEXT COLOR, PLEASE. NEXT
ABOUT THE LINE 18 YOUR LINE IS
OPEN. GOOD AFTERNOON, MR CARON
MEMBERS NICOLE WARD ULLMAN ON
BEHALF OF THE CHILDREN'S
PARTNERSHIP, REQUESTING THAT THE
FUNDING ALLOCATED TO THE
TRAINING AND CERTIFICATION OF
COMMUNITY HEALTH WORKERS IN LAST
YEAR'S ENACTED BUDGET NOT BE
DELAYED. DELAYING THIS
INVESTMENT WILL CAUSE
DISRUPTIONS TO CALIFORNIA'S
BROADER EFFORTS TO ACHIEVE
SIGNIFICANT IMPROVEMENTS IN
MEDICAL, CLINICAL AND HEALTH
EQUITY OUTCOMES THAT THE STATE
HAS COMMITTED TO ACHIEVING BY
2025 THROUGH THE DHC S
COMPREHENSIVE QUALITY STRATEGY.
PUBLISHED LAST YEAR. THE
STRATEGY OUTLINES THE HCS BOLD
COSTS 50 BY 2025 INITIATIVES
WITH SPECIFIC STRATEGIES MEANT
TO ADDRESS HEALTH INEQUITIES
IMPACTING CHILDREN AND FAMILIES
ENROLLED IN MEDICAL THAT WERE
HIGHLIGHTED BY THE CALIFORNIA BY
THE CALIFORNIA STATE AUDITOR IN
2018 AND 2022. DELAYING THIS
INVESTMENT WILL COUNTER
CALIFORNIA'S BROADER EFFORT TO
ACHIEVING HEALTH, EQUITY AND
MEDICAL AS SUCH, WE URGED THE
LEGISLATURE AND ADMINISTRATION
TO MOVE FORWARD WITH THE
INVESTMENT WITHOUT DELAY, AND
INSTEAD CONSIDER ALTERNATIVES
RECENTLY LAID OUT IN AN L A
REPORT. THANK YOU. THANK YOU.
NEXT CALLER, PLEASE. THANK YOU.
NEXT WE'LL GO TO LINE 21. YOUR
LINE IS OPEN. GOOD AFTERNOON
CHAIR REMEMBERS. MY NAME IS TO
WATCH AND I'M CALLING ON BEHALF
OF THE CALIFORNIA ACADEMY OF
FAMILY PHYSICIANS, THE LARGEST
PRIMARY CARE MEDICAL SOCIETY IN
CALIFORNIA, REPRESENTING OVER
10,000 FAMILIES, POSITIONS,
RESIDENTS AND MEDICAL STUDENTS.
I WANT TO PROVIDE COMMENTS ON
ISSUES COMPLAINING TO THE
HEALTHCARE WORKFORCE AND ACCESS
. WE WANT TO EXTEND OUR
APPRECIATION AS FAR PRINTER AND
THE ACCESS TO HEALTHCARE REMAINS
A CENTRAL GOAL IN CALIFORNIA
STATE BUDGET RESTRAINING FROM
MAKING DRASTIC HEALTHCARE CUTS,
IT'S CRITICAL TO MEETING
CALIFORNIANS, ESPECIALLY AS
RECOVERED FROM THE COLD IN 1910.
TEMIC WHICH HAS HAD DEVASTATING
HOPE IN CATASTROPHIC ECONOMIC
IMPACT ON THE MOST VULNERABLE
RESIDENTS OF OUR STATES. AS A
BUDGET CYCLE PROGRESSES, WE ASK
THAT YOU PRIORITIZE IMPROVING
INVESTMENTS IN PRIMARY
CHARACTERS, SUCH AS THE PRIMARY
CARE RATE INCREASE IN THE BUDGET
AND CONTINUE TO INVEST AND
MAINTAIN FUNDING AND THE SONG
BROWN PRIMARY CARE PHYSICIAN
TRAINING PROGRAM. THESE
INVESTMENTS WILL IMPROVE ACCESS
TO PRIMARY CARE AND ADDRESS
CALIFORNIA'S PRIMARY CARE,
PHYSICIAN WORKFORCE SHORTAGE.
LASTLY WE ASK THAT YOU CONTINUE
TO MAINTAIN THE GENERAL FUND
EXPENDITURE TO EXPAND ACCESS TO
HEALTH CARE, SUCH AS MEDICAL
ELIGIBILITY TO ALL INCOME
ELIGIBLE ADULTS AGES 26 TO 49,
REGARDLESS OF IMMIGRATION STATUS
, AS THIS WILL ENSURE THAT
VULNERABLE POPULATIONS YOU SEE
THE CRITICAL CABIN THERAPY.
THANK YOU FOR YOUR CLIMATE
CONSIDERATION, AND HE LOOKS
FORWARD TO WORKING WITH THE
ADMINISTRATION AND THE
LEGISLATURE TO ENSURE CALIFORNIA
CAME TO GO. THE PRIMARY CARE
CONDITION WORK FOR IT. THANK
YOU. NEXT CALLER, PLEASE. THANK
YOU NEXT TO GO TO LINE 26, THE
AIRLINE IS OPEN. 26 YOUR LINE IS
OPEN. WE WILL MOVE ON TO LINE
28. YOUR LINE IS OPEN. HELLO UH
, DR ARAMBULA AND MEMBERS
FORMALLY WITH THE AMERICAN
FEDERATION OF STATE COUNTY AND
EMPLOYEES ACCESS AND JUST WANTED
TO UM FIRST MY APPRECIATION OR
OUR APPRECIATION FOR COMMENTS
MADE BY DR WOOD AND DR ARAMBULA.
UH UM CONCERNS AROUND THE DELAY
AND, UM, SUPPORTING THE
HEALTHCARE WORKFORCE. THE
LEGISLATURE AND THE GOVERNOR
MADE SIGNIFICANT ASSESSMENTS. IN
THE WORKFORCE. UM AND IN HEALTH
CARE, AFFORDABILITY AND ACCESS,
SO JUST AGAIN WANTED TO AS WELL.
UM GO COMMENTS MADE BY MATTLAGE
FROM FBI. YOU UH, WAS A CO
SPONSOR OF HB 25 30 BY DOCTOR
WOULD THAT WOULD SUPPORT UM,
ACCESS TO HEALTHCARE FOR
STRIKING WORKERS? UM AND WE
REALLY NEED TO MAKE SURE THAT,
UM, THAT IS FUNDED AS WELL AS
PROVIDING ASSISTANCE TO THOSE
WHO CANNOT AFFORD HEALTH
INSURANCE. UM AND WE NEED TO
ENSURE THAT, UM, THAT THE FUNDS
PROVIDED BY THE FEDERAL
GOVERNMENT SUPPORT HEALTH CARE
AFFORDABILITY DOES NOT GET SWEPT
UP INTO THE GENERAL FUND. THANK
YOU. THANK YOU. NEXT CALLER,
PLEASE. THANK YOU. THANK YOU.
NEXT WE'LL GO TO LUNCH. 30. YOUR
LINE IS OPEN. THANK YOU, MR
CHAIR AND MEMBERS. THAT'S THE
KATINA ON BEHALF OF THE ONLY
COME FROM NATURE ISSUES SET
CONFIRMATION STATEWIDE
ORGANIZATION DEDICATED TO
IMPROVING COMMUNITY WELL BEING,
EVEN PLEASED WITH HIS WORK ON
THE ROLLOUT OF CERTIFICATION
TRAINING FOR COMMUNITY HEALTH
WORKERS, INCLUDING ROMA TORA
SALUD, AS ENVISIONED LAST YEAR'S
BUDGET AND RELATED TO THIS,
WE'VE ALSO BEEN MONITORING THE
ROLLOUT OF THE COMMUNITY HEALTH
WORKER BENEFITS THROUGH MEDICAL
IT'S IMPORTANT TO REMEMBER THAT
THERE IS A DISTINCTION BETWEEN
CHW INFLAMMATORY. AFTER
PRIMARILY WOMEN FROM THE
COMMUNITY WHO ARE DEEPLY
ENTRUSTED BY PEOPLE WHO HAVE
BEEN OTHERWISE NEGLECTED OR
LOOTED BY THE HEALTH CARE
SYSTEM. THE SUBCOMMITTEE SHOULD
BE PROUD OF THE WORK THAT WE'VE
ALL DONE ON HELP FOR ALL AS WELL
AS OTHER WAYS TO IMPROVE HEALTH
EQUITY FOR UNDERSERVED
COMMUNITIES. THAT IN MIND. WE
BELIEVE HK HERE'S OUR POINTS ON
INCLUSION AND FROM A TORRES AND
HIS MULTIPLE IMPLEMENTATIONS AND
HAVING IT IS UNDER A BENEFIT AND
MEDICAL NEEDS TO REACH THE
WORKFORCES CAN REACH THE
UNDERSERVED COMMUNITIES. SUCH WE
ARE WORKING WITH
ASSEMBLYMEMBER'S AYESHA CURRY ON
A BUDGET REFLECTS INCREASED
TRAINING CAPACITY FOR CBS THAT
HAVE THOSE BEST PRACTICES ON
WORKING WITH SOME OF BORDERS. WE
REALLY APPRECIATE THE WORK THAT
THE SUBCOMMITTEE HAS DONE,
PARTICULARLY THE CHAIRMAN ON
GETTING CLOSER TO A HEALTHY
CALIFORNIA FOR ALL AND LOOK
FORWARD TO WORKING TOGETHER.
THANK YOU. THANK YOU. NEXT
CALLER, PLEASE. THANK YOU NEXT
TO THE LINE 31. YOUR LINE IS
OPEN. ANDREA RIVERA, CALIFORNIA
PANASONIC HEALTH NETWORK HERE TO
COMMENT ON ITEM 4800 AND 8 41 44
ITEM 4800 UNCOVERED CALIFORNIA
AFFORDABILITY REMAINS A
SIGNIFICANT BARRIER TO
CALIFORNIANS ACCESSING THE
HEALTH PRODUCT THEY NEED WHEN
THEY NEED IT, AND WITH
DEDUCTIBLES OF ALMOST $5000 IN
COPAYS FOR PRIMARY CARE VISITS
AT ABOUT $50 MANY LOW INCOME AND
MIDDLE INCOME CALIFORNIANS ARE
OPTING TO DELAY CARE SIMPLY DUE
TO COSTS. WE DO URGE THE
LEGISLATURE TO RESPECT THE
DIRECTION OF THE INDIVIDUAL
MANDATE PENALTY REVENUE TO THE
GENERAL FUND. AND INSTEAD
CONTINUED TO USE THOSE FUNDS TO
PROVIDE CRITICAL AFFORDABILITY
ASSISTANCE TO COMMUNITIES OF
COLOR FOR ITEM. 41 40 ON
WORKFORCE DELAYS PALACE
DISAPPOINTED BY THE GOVERNOR'S
PROPOSAL TO DELAY THE ALLOCATION
OF FUNDS TO RECRUIT, TRAIN AND
CERTIFIED 25,000 NEW CHW. TO
THIS CLEAR 2020 25 TO 2026 URGED
YOU TO REJECT THIS PROPOSAL AS
WELL. THESE FUNDS ARE CRITICAL
TO BUILD A ROBUST, CULTURALLY
AND LINGUISTICALLY RESPONSIVE
WORKFORCE THAT CAN MEET THE
NEEDS OF CALIFORNIA'S FIRST
POPULATIONS, INCLUDING THE
MEDICAL BENEFICIARIES WHO ARE
NOW ABLE TO ACCESS THE NEW
COMMUNITY HEALTH WORKER OR CHW
BENEFIT IN THE PROGRAM. AND AS
WE HEARD TODAY, CALIFORNIA IS
FACING A CITY OR HEALTHCARE
WORKFORCE. SHORTAGE AND CHW ARE
ESSENTIAL. ANY DELAY OF FUNDS IS
APPROVED. WE WOULD URGE THAT A
PERCENTAGE OF THE FUNDS SET
ASIDE FOR FISCAL YEAR 2023 TO
2024 SO THAT WE CAN SO THAT WE
CAN INCLUDE A PUBLIC PLANNING
PROCESS. THAT INCLUDES THE W TO
DETERMINE HOW THESE FUNDS SHOULD
BE SPENT IN FUTURE BUDGET YEARS.
THANK YOU. THANK YOU. NEXT
COLOR, PLEASE. SO GO TO LINE 13.
YOUR LINE IS OPEN. GOOD EVENING,
MR CARON. SUBCOMMITTEE MEMBERS.
MY NAME IS LINDA GARB. ASIO AND
I'M CALLING ON BEHALF OF BLUE
SHIELD OF CALIFORNIA WHO SHIELD
OPPOSES ISSUE ONE THAT WAS HURT
TODAY ON THE CANCER OF THE
HEALTH CARE AFFORDABILITY.
RESERVE GUN BALANCE. IT IS
CRITICAL THAT FUNDS REMAIN
WITHIN COVER CALIFORNIA FOR
PURPOSES OF ASSURING
AFFORDABILITY FOR MEMBERS IN
CALIFORNIA, TRANSFERRING FUNDS
TO THE CHANNEL FUNDS PICNICS
THIS PURPOSE. THANK YOU FOR YOUR
TIME. THANK YOU. NEXT CALLER,
PLEASE. THANK YOU. WE'LL GO TO
LINE 33. YOUR LINE IS OPEN.
HELLO CHAIR MEMBERS. MY NAME IS
JESSICA GARCIA AND I AM A HIGH
PATIENT PRACTITIONERS HERE IN
CALIFORNIA. I ABSOLUTELY.
CALIFORNIA PROGRAM, WHICH WAS
ROOTED IN THE GOVERNOR'S JANUARY
BUDGET PROPOSAL. THE PROGRAM HAS
ALREADY LAUNCHED AND ENROLLED
FOR A COURT OF STUDENTS. SO IN
THE SPIRIT OF PROTECTING OUR
PROGRESS, UM PLEASE HELP US TO
ENSURE THAT THIS ISN'T MAKING
MEDICAL SCHOOL. THE PROGRAM IS A
VITAL PATHWAY THAT SUPPORT
STUDENTS FROM DIVERSE
BACKGROUNDS COMMUNITY COLLEGE
ALL THE WAY TO MEDICAL SCHOOL
RESIDENCY AND THE CAUSE WE'RE
NOT WORKFORCE BY PROVIDING A
PUBLIC FOR UNDERWEAR. STUDENTS
PURSUE CAREERS IN MEDICINE. THE
PROGRAM NOT ONLY HELPS SUGGEST
THE CRITICAL SHORTAGE OF
PHYSICIANS IN CALIFORNIA BUT
ALSO BRINGS MUCH NEEDED
DIVERSITY TO THE MEDICAL
PROFESSION. CALIFORNIA HAS A
GROWING HEALTH WORKFORCE
SHORTAGE ACROSS THE STATE, AND
ESPECIALLY IN THE CENTRAL VALLEY
. THE CALIFORNIA MEDICINE OFFER
HAS BEGUN ADDRESSING THIS
QUESTION, BUT IN ORDER TO
CONTINUE TACKLING IT, I ASK THAT
YOU INCLUDE THE CALIFORNIA
MEDICINE SCHOLARS PROGRAM IN THE
2023 BUDGET BECAUSE IT HAS HAD
AND WILL CONTINUE TO HAVE A
SIGNIFICANT IMPACT ON THE LIVES
OF MANY STUDENTS. THANK YOU.
THANK YOU. NEXT CALLER, PLEASE.
THANK YOU. NEXT WE'LL GO TO LINE
38. YOUR LINE IS OPEN. GOOD
EVENING, MR CHAIR AND MEMBERS.
THIS IS REBECCA GONZALES WITH
THE NATIONAL ASSOCIATION OF
SOCIAL WORKERS. CALIFORNIA
CHAPTER HERE ON A FEW ISSUES.
FIRST OF ALL ISSUE NUMBER FIVE
ABOUT THE DELAYS IN THE WORK
FORCE. UM PROGRAMS WERE
ESPECIALLY CONCERNED ABOUT THE
30 MILLION THAT WAS SLATED TO BE
ALLOCATED FOR SCHOOLS OF SOCIAL
WORK TO INCREASE THEIR SLOTS AND
ALSO CONCERNED ABOUT OTHER
SOCIAL WORK INVESTMENTS WE HAVE
RECENTLY ALONG WITH OUR PARTNERS
WHO PROMOTED THE NSW. BUDGET
PROPOSAL LAST YEAR WE'VE MET
WITH H KIND. WE ASKED THEM
QUESTIONS, BUT WE STILL HAVE A
LOT MORE QUESTIONS. UM WE'RE
GOING TO CONTINUE TO MEET WITH
THEM TO GET MORE CLARITY. BUT AT
THIS POINT WE'RE VERY CONCERNED
ABOUT THE DELAYS SINCE YOU'VE
HEARD ABOUT ALL THE ISSUES WITH
THE WORKFORCE. I ALSO WANT TO
JOIN OTHERS ON ISSUE ONE ABOUT
BEING OPPOSED TO THE TRANSFER AS
A HEALTH CARE. AFFORDABILITY
RESERVE FUND INTO THE GENERAL
FUND. WE NEED TO KEEP HEALTH
CARE AFFORDABLE. UM AND LASTLY,
WE WANTED TO SUPPORT THE BUDGET
PROPOSAL ON GENDER AFFIRMING
CARE. THANK YOU. THANK YOU. NEXT
CALLER, PLEASE. THANK YOU. NEXT
WE GO TO LINE 41. YOUR LINE IS
OPEN. DR ARAMBULA MEMBERS OF THE
COMMITTEE. I'M TONY TRIGUEROS,
SPEAKING ON BEHALF OF THE
CALIFORNIA TEACHERS ASSOCIATION
, WE AGAIN WOULD LIKE TO ADDRESS
ISSUES AROUND EIGHT GUYS WERE
FORCED INVESTMENTS, FUNDING
STUDENT SCHOLARSHIPS, LONELY
PAYMENTS AND GRANTS TO MENTOR
AND SUPPORT A FUTURE WORKFORCE
MADE AVAILABLE IN PART FROM $1.4
BILLION. FROM THE WORKFORCE FOR
A HEALTHY CALIFORNIA FOR ALL
INITIATIVES. AS WELL AS THE
TOPICS BEING EXPLORED BY THE
EDUCATIONAL AND TRAINING
COUNCIL. THESE SEPARATE DO NOT
INCLUDE PUBLIC. PUPIL SERVICES
PERSONNEL LIKE CREDENTIAL SCHOOL
NURSES IN SCHOOL PSYCHOLOGISTS
WHO ARE LICENSED MEDICAL
PERSONNEL WHO ARE ALSO EARNING
THEIR NECESSARY CREDENTIALS
ISSUED BY THE COMMISSION ON
TEACHING CREDENTIAL INTO WORK IN
SCHOOLS. FROM THE NORTH STAR OF
THE HEALTHY CALIFORNIA FOR ALL I
QUOTE. WHERE ALL OF OUR CHILDREN
CAN PLAY AND LEARN AND WHERE WE
ARE CONFIDENT THAT WE HAVE DONE
ALL WE CAN TO PASS TO THEM, A
STATE THAT CAN LEAD INTO THE
FUTURE END QUOTE. GOING FORWARD
. WE HOPE THIS GOAL ENCOMPASSES
ALL BEHAVIORAL HEALTH WORKERS,
NOT JUST A SLIP OF YOU. THANK
YOU VERY MUCH. THANK YOU. NEXT
CALLER, PLEASE. THANK YOU. OUR
NEXT LINE IS 42. YOUR LINE IS
OPEN. HELLO SHERIFF. REMEMBER
MICHELLE PATTERSON AND I'M, A
COMMUNITY COLLEGE STUDENT
INVOLVED IN THE CALIFORNIA
MEDICINE SCHOLARS PROGRAM. I'M
CALLING IN SUPPORT OF THE
CALIFORNIA MEDICAL COLLEGE
PROGRAM, WHICH WAS NOT INCLUDED
IN THE GOVERNOR'S JANUARY BUDGET
PROPOSAL. CALIFORNIA MEDICINE
SCHOLARS PROGRAM IS VITAL TO
ADDRESS IN CALIFORNIA PHYSICIAN
SHORTAGE AS WELL AS INCREASING
INCREASING DIVERSITY IN THE
MEDICAL FIELD. THANK YOU. THANK
YOU. NEXT CALLER, PLEASE. THANK
YOU. OUR NEXT LINE IS GOING TO
BE 46. YOUR LINE IS OPEN. HELLO.
OKAY REMEMBER, MY NAME IS
ALEJANDRO NAVARRO, AND I AM A
MARKETING COMMUNICATIONS
PROFESSIONAL WHO HAS WORKED IN
BOTH THE CENTRAL VALLEY AND IN
SOUTHERN CALIFORNIA, CALLING ON
ITEMS 41 40 HEALTHCARE WORKFORCE
AND ITS SUPPORT OF CALIFORNIA
MEDICINE SCHOLARS PROGRAM. WHICH
WAS NOT INCLUDED IN THE
GOVERNOR'S JANUARY PROPOSAL.
ACADEMIC PATHWAY PROGRAM GUIDING
STUDENTS FROM COMMUNITY COLLEGE
TO MEDICAL SCHOOL IS CRITICAL TO
RESPOND TO CALIFORNIA'S
POSITIONS SORTED CRISIS, AND
IT'S ALSO VITAL TO INCREASE
UNIVERSITY IN THE MEDICAL
PROFESSION, BOTH OF WHICH ARE
NECESSARY TO ENSURE THAT ALL
CALIFORNIA COMMUNITIES HAVE
EQUITABLE ACCESS TO QUALITY
HEALTHCARE, CALIFORNIA MEDICINE
SCHOLARS PROGRAM HAS BEGUN
ADDRESSING THIS CRISIS WITH ITS
FIRST STUDENTS AND I SUPPORT
STATE FUNDING TO CONTINUE THIS
IMPORTANT WORK. THANK YOU. THANK
YOU. NEXT CALLER, PLEASE. 27
YOUR LINE IS OPEN. GOOD EVENING
WITH KELLY BROOKS. I'M
TESTIFYING TONIGHT ON BEHALF OF
TWO CLAIMS REGARDING THE
WORKFORCE FUNDING BELIEF. FIRST
TIME YOU HEARD ABOUT THE
CALIFORNIA ASSOCIATION OF PUBLIC
HOSPITALS AND HEALTH SYSTEMS.
PUBLIC HEALTH CARE SYSTEMS
CONTINUE TO FACE EXTREME
WORKFORCE CHALLENGES, WHICH WERE
EXACERBATED AND COMPOUNDED BY
THE PANDEMIC DISPENSER
STRUGGLING TO RETAIN WORKERS AND
POSITIONS ACROSS THE DELIVERY
SYSTEM, INCLUDING REGISTERED
NURSES, CERTIFIED NURSING
ASSISTANTS AND MEDICAL
ASSISTANCE, CLINICAL LAB
TECHNICIANS, RESPIRATORY
THERAPISTS. BEHAVIORAL HEALTH
PROVIDERS AND OTHERS AS BOTH
EMPLOYERS AND HEALTH CARE
WORKERS AND MAJOR PROVIDERS OF
TRAINING TO THE HEALTHCARE
WORKFORCE AND ESSENTIAL TAKING
THAT SYSTEM WERE VERY
SUPPORTIVE. OF THE FUNDING
INCLUDED IN THE CURRENT YEAR TO
SUPPORT AND REBUILD CALIFORNIA'S
HEALTH CARE WORKFORCE. WE HOPE
THAT THE ADMINISTRATION ON
LEGISLATURE CONTINUE TO
PRIORITIZE INVESTMENTS IN HEALTH
WORKFORCE AND EAGLETS REDUCTIONS
ARE TRIGGER CUTS TO WORKFORCE
DEVELOPMENT WILL NEGATIVELY
IMPACT THEM FURTHER DELAY
RESOLUTION TO OUR ONGOING HEALTH
CARE. THE WORKFORCE CRISIS. THE
SECOND ON BEHALF OF THE URBAN
COUNTIES OF CALIFORNIA.
WORKFORCE FROM ANTI POP PRIORITY
COUNTIES ARE STRUGGLING TO
COMPETE WITH PRIVATE SECTOR
EMPLOYERS TO ATTRACT NUMBER SEEN
WORKERS, ESPECIALLY FOR THE MOST
CRITICAL SERVICES THAT COUNTIES
PROVIDE COMING. HOSPITALS AND
CLINICS SYSTEM, PUBLIC HEALTH
DEPARTMENT, BEHAVIORAL HEALTH
AGENCIES IN HIM AND SERVICES
AGENCIES WERE VERY CONCERNED
THAT THE PROPOSAL TO USE AND
WORKFORCE BONDING WELL. CAMPER
OF THE PAIN PLANE FOR THAT VARY
ESSENTIAL WORKFORCE. THANK YOU.
THANK YOU. NEXT CALLER, PLEASE.
NEXT WE GO TO LINE 29. YOUR LINE
IS OPEN. UM ALIGN 29 YOUR LINE
IS OPEN. DON'T SHARE. REMEMBER
THE NAME IS MARIA VON. UM I
ATTEND COMMUNITY COLLEGE, MOUNT
SAN ANTONIO. I'M CALLING IN
SUPPORT OF THE CALIFORNIA
MEDICINE SCHOLARS PROGRAM, WHICH
WAS NOT INCLUDED IN THE
GOVERNOR'S JANUARY BUDGET
PROPOSAL. UM MEDICINE SCHOLARS
VITAL PIPELINE PROGRAM THAT
SUPPORTS STUDENTS. FROM DIVERSE
BACKGROUNDS. FROM COMMUNITY
COLLEGE ALL THE WAY TO MEDICAL
SCHOOL RESIDENCY AND CALIFORNIA
WORKFORCE. IT IS PARAMOUNT THAT
THIS PROGRAM IS INCLUDED IN THE
2023 FINALS BUDGET. THANK YOU
FOR YOUR TIME. THANK YOU. NEXT
CALLER, PLEASE. NEXT WE'LL GO
FLYING AT 36. YOUR LINE IS OPEN.
GOOD EVENING, MR CHAIR AND
MEMBERS. MY NAME IS LUCY.
QUESTION L I'M SPEAKING TO THEM
BEHALF OF MATERNAL AND CHILD
HEALTH ACCESS COMMUNITY
ORGANIZATION IN LOS ANGELES,
WITH NUMBER 50 EMPLOYEES SERVING
LOW INCOME FAMILIES ON A VARIETY
OF HEALTH AND OTHER SOCIAL
ISSUES. UM, WE OPPOSE THE
TRANSFER OF HEALTH CARE
AFFORDABILITY RESERVE FUND
BALANCES TO THE GENERAL SUND
COVERED. CALIFORNIA IS AN
EXTREMELY EXPENSIVE PROGRAM FOR
LOW LINCOLN CONSUMERS. BECAUSE
OF THE OUT OF POCKET COSTS. WE
TEND TO THINK IN CALIFORNIA THAT
PREGNANT PEOPLE ARE COVERED FOR
LABOR AND DELIVERY AT LITTLE OR
NO COST. BUT THAT IS CERTAINLY
NOT THE CASE FOR INPATIENT
HOSPITAL, LABOR AND DELIVERY
SERVICES UNDERCOVERED CALIFORNIA
, WHICH CAN RUN IN THE THOUSANDS
OF DOLLARS SIMILARLY INPATIENT
TREATMENT FOR DISEASES LIKE
BREAST AND CERVICAL CANCER, AND
MANY OTHER SERIOUS CONDITIONS
REQUIRING SURGERY ARE SUBJECT TO
THIS VERY HIGH COST SHARING. WE
URGE YOU TO REJECT THE PROPOSAL
AND TO KEEP OR MAKE COVERED
CALIFORNIA AFFORDABLE. THANK YOU
SO MUCH FOR YOUR ATTENTION TO
THIS MATTER. THANK YOU. NEXT
CALLER, PLEASE. THANK YOU. I'M
45. YOUR LINE IS OPEN. GOOD
EVENING. THANK YOU. MY NAME IS
DR JOHN GRANITO. I'M AN
EMERGENCY PHYSICIAN BY TRAINING.
AND I AM THE MEDICAL SCHOOL DEAN
AT CALIFORNIA HEALTH SCIENCES
UNIVERSITY AND CLOVIS, OUR
STATE'S NEWEST MEDICAL SCHOOL.
I'M CALLING TO ASK FUNDING
SUPPORT FOR THE CALIFORNIA
MEDICINE SCHOLARS PROGRAM BE
CONTINUED. I KNOW FIRSTHAND THE
NEED TO TRAIN OUR LOCAL STUDENTS
FOR THEIR MEDICAL CAREERS. AND
IN JUST A FEW SHORT MONTHS, WE
AT CHS, YOU WILL HAVE AN
ENROLLMENT THAT EXCEEDS 500
MEDICAL STUDENTS. WITH ABOUT 100
OR MORE BEING FROM DIVERSE
BACKGROUNDS SUCH AS FIRST
GENERATION COLLEGE STUDENTS AND
PERSONS OF COLOR. WE ARE PROUD
TO ASSURE THAT ALL OF OUR
STUDENTS ACTUALLY HAVE REQUIRED
MEDICAL SPANISH AS PART OF THEIR
CURRICULUM. AS YOU ALL KNOW,
CALIFORNIA'S PHYSICIAN,
WORKFORCE SHORTAGES
DISPROPORTIONATELY AND REALLY DO
TO MORALE. DISTRIBUTION OCCURS
IN AREAS OUTSIDE IN THE THREE OR
FOUR MAJOR METROPOLITAN AREAS,
AND IT'S HARDEST HIT IN AREAS
LIKE THE CENTRAL VALLEY. AND SO
I ASKED THE CALIFORNIA MEDICINE
SCHOLARS PROGRAM, WHICH HAS
BEGUN ADDRESSING THIS BY
PROVIDING MORE CLEAR PATHWAYS TO
OUR YOUNG, DIVERSE YOUNG PEOPLE
TO MAKE A PATH FOR MEDICAL
SCHOOL MORE CLEAR AND ASKED FOR
FUNDING. BE CONTINUED. THANK
YOU. THANK YOU. NEXT CALLER,
PLEASE. THANK YOU, LIKE 25 IS
OPEN. THANK YOU, DOCTOR.
AMBULANCE COMMITTEE MEMBERS AND
ANALYSTS AND HEARING MY NAME IS
JOHN ROBBINS, SENIOR ADVOCATE
WITH TBH, A THE CALIFORNIA
COUNCIL COMMUNITY BEHAVIORAL
HEALTH AGENCIES. WE REPRESENT
MENTAL HEALTH AND SUBSTANCE.
THESE COMMUNITY BASED
ORGANIZATIONS ACROSS THE STATE
CERTAIN NUMBER ONE MILLION
CALIFORNIANS JUST WANTED TO SAY
WE REALLY APPRECIATE THE AGENDA
OF THIS HEARING, ESPECIALLY
CONSIDERATION FOR EXPANDING
WORKFORCE RESOURCES AND SUPPORT.
AS HAS BEEN MENTIONED FOR THEIR
CITIZENS. BEHAVIORAL HEALTH
WORKFORCE SHORTAGE THERE'S
IMPACTING TIMELY ACCESS TO CARE,
DRIVEN IN PART, ISN'T INSTANT BY
NUMEROUS TRYING TO SPEND
INADEQUATE COMPENSATION FOR
BEHAVIORAL HEALTH CARE WORKERS.
I WANTED TO SAY WE ALSO
APPRECIATE THE FOCUS ON
IMPROVING ACCESS TO GENDER FROM
CARE WHILE AWAITING TRANS IN
LGBT. Q I PLUS VOICES AND
DECISION MAKING, GENDER
AFFIRMING CARRIES SHOWN TO
IMPROVE THE BEHAVIORAL HEALTH OF
FRIENDS IDENTIFYING PEOPLE WHO
OFTEN EXPERIENCE HIGHER RATES OF
DEPRESSION AND SUICIDALITY AS A
RESULT OF CULTURAL SOCIAL AND
FAMILY, CIGNA. OUR MEMBERS
PROVIDE CRITICAL BEHAVIORAL
HEALTH SERVICES THESE
POPULATIONS AND KNOW FIRSTHAND
THE POSITIVE IMPACT ACCESS TO
AFFORDABLE GENDER FIRMING CARE
HASN'T CLAIMED WELL BEING. WE
STAND BY THE LEGISLATURE AND THE
COMMITMENT TO SERVE THE HEALTH
AND BEHAVIORAL HEALTH NEEDS AND
L G B T Q. I PLUS CALIFORNIA AND
THANK YOU FOR YOUR LEADERSHIP ON
THESE ISSUES AND THANK YOU FOR
YOUR TIME. THANK YOU. NEXT
CALLER, PLEASE. THANK YOU.
NATURAL BUTTER LINE. 50 LINE IS
OPEN. GOOD AFTERNOON. DR
RAMBLING COMMITTEE MEMBERS. MY
NAME IS AMELIA SWEENEY. AND I'M
A NURSING. NOW I'D HELP
COUNSELOR AT COLLEGE OF THE
SEQUOIAS COMMUNITY COLLEGE. I'M
CALLING IN SUPPORT OF THE
CALIFORNIA MEDICINE SCHOLARS
PROGRAM. AND ONCE IT WOULD
REQUEST THAT IT BE CONTINUED.
THE MEDICINE SCHOLARS
PROGRAMMING THE VITAL PIPELINE
PROGRAM FOR COMMUNITY COLLEGE
STUDENTS WANTING TO ENTER THE
MEDICAL BILL. THE MAJORITY OF
OUR STUDENTS HERE AT COLLEGES
QUIET STUDENTS OF COLOR, WITH
MANY OF THEM BEING FIRST
GENERATION COLLEGE STUDENTS.
THIS PROGRAM IS CRUCIAL TO
PROVIDE THEM WITH THE RESOURCES
AND MENTORSHIP THEY NEED TO
PURSUE MEDICAL SCHOOL AND
RESIDENCY. INVESTMENT IN THIS
PROGRAM WILL POSITIVELY IMPACT
THE CALIFORNIA WORKFORCE AND
FILL THE NEED FOR PHYSICIANS IN
OUR AREA. WE CONSIDER RENEWING
THIS PROGRAM? THANK YOU FOR YOUR
MIND. THANK YOU. NEXT CALLER,
PLEASE. THANK YOU. OUR NEXT ONE
WILL COME FROM A LINE OF 57.
YOUR LINE IS OPEN. HI IS THAT ME
AND THE BUDGETS OF ONE
COMMITTEE? OUR BUT THE
CALIFORNIA STATE LEGISLATURE.
WELL EXCELLENT. UM I KNOW YOU
FOLKS PROBABLY ARE HANKERING TO
GO TO DINNER, WHICH I UNDERSTAND
ABOUT THAT. OUR UM AND I WASN'T
PLANNING TO COMMENT TODAY. BUT I
COULDN'T HELP BUT CALL IN
BECAUSE I WAS HEARING ABOUT THIS
NURSING SHORTAGE. AND CONSISTENT
WITH THE TEACHER SHORTAGE AND
ALL THESE OTHER SHORTAGES IN
CALIFORNIA, INCLUDING A SHORTAGE
OF PEOPLE BECAUSE PEOPLE KEEP
LEAVING THIS STATE, AND THEY
KEEP MOVING TO PLACES LIKE
FLORIDA THEY KEEP LEAVING FOR
FREE STATE. AND, YES, I DO MEAN
THAT PRE STATES BECAUSE HUMAN
BEINGS HAVE A RIGHT TO EXIST
APART FROM PHARMACEUTICAL
PRODUCTS. THEY HAVE A RIGHT NOT
TO BE STRONG, ARMED AND BULLIED
BY THEIR ELECTED OFFICIALS ABOUT
UNREGULATED, UNTESTED, GENOCIDAL
MEDICAL PRODUCTS. SO AT SOME
POINT, I THINK YOU LAWMAKERS MAY
BE ABLE TO CONNECT SOME OF THE
DOTS ON THIS. MAYBE THESE
SHORTAGES HAVE TO DO WITH THE
FACT THAT PEOPLE ARE LEAVING
THIS PHARMA FASCIST HELL,
COMPLETE WITH THIS SHOT.
PROPONENT SURGEON GENERAL WHO
WAS JUST CONFIRMED IN THE SENATE
TODAY. ONE OF GOVERNOR NEWSOM'S
UH, CRONIES WHO IS GOING TO
CONTINUE THE LIES HERE IN
CALIFORNIA? WELL YOU PEOPLE SIT
UP THERE CONTINUING TO GREASE
YOUR PALMS WITH PHARMA BLOOD
MONEY. PARENTS ARE SICK OF IT.
THEY'RE SICK OF YOUR MANDATE,
AND THEY'RE LEAVING. THEY'RE
LEAVING THE STATE. THEY'RE
LEAVING THESE PROFESSIONS AND
IT'S SOME POINT YOU PEOPLE ARE
NOT GOING TO BE ABLE TO IGNORE
THE ELEPHANT IN THE ROOM ANY
LONGER. SO THANKS FOR LETTING ME
SPEAK. AT LEAST THE FIRST
AMENDMENT STILL MATTERED IN THIS
MOMENT. WHO KNOWS ABOUT THE NEXT
HEARING? IF JIM WOOD HAS
ANYTHING TO DO WITH IT, HE WON'T
HAVE COMMENTS TIME AT ALL. SO GO
ENJOY YOUR DINNER. BUT LET ME
LEAVE YOU WITH THIS. THERE'S A
LITTLE BIT OF POETRY IN MY
KINDERGARTEN PASSED THE SIXTH
BEST DOCTORS ANYWHERE AND NO ONE
CAN DENY IT ARE SUNSHINE, WATER
, REST AND AIR EXERCISE AND DIET
. THESE SIX WILL GLADLY YOU
ATTEND. IF ONLY YOU ARE WILLING
YOUR MIND. THEY'LL EASE YOUR
WILL. THEY'LL MEND AND CHARGE
YOU NOT ONE CHILLING. NO MATTER
WHAT YOU FOLKS DO. WE ARE NEVER
TAKING YOUR COVID POISON. THANK
YOU. NEXT CALLER, PLEASE. NEXT
ONE WILL BE MIND 40. YOUR LINE
IS OPEN. HI THERE. IS THAT ME?
YES, MA'AM. HI THERE. MY NAME IS
THE UNCLE BLANK. KRISTEN POLICY
DIRECTOR FOR SMALL BUSINESS
MAJORITY. I'M CALLING TODAY TO
SPEAK IN SUPPORT OF USING THE
HEALTH CARE AFFORDABILITY
RESERVE FUNDS TO CONTINUE TO
MAKE HEALTH CARE MORE AFFORDABLE
FOR SMALL BUSINESS OWNERS IN
CALIFORNIA. UM HERE ARE PROBABLY
ALREADY AWARE. DEDUCTIBLES ARE
REACHING ALMOST $5000 AND CODE
FOR PRIMARY CARE VISITS AROUND
$50 FOR SMALL BUSINESS OWNERS IN
CALIFORNIA, MANY MOST OF WHOM
ARE MIDDLE INCOME. AS YOU KNOW,
THE ADMINISTRATION COLLECTS
HUNDREDS OF MILLION DOLLARS
ALREADY EASIER FROM AN INSURED
CALIFORNIANS THAT PENALTY MONEY
WOULD BE USED TO HELP THEM
AFFORD COVERAGE AND CARE. THANK
YOU SO MUCH FOR YOUR TIME, AND I
APPRECIATE YOU HANGING IN THERE
. THANK YOU. NEXT CALLER,
PLEASE. THANK YOU NEXT TO GO TO
BLIND 58. YOUR LINE IS OPEN.
HELLO CHAIR AND MEMBERS. MY NAME
IS JEFF OXEN DIÆN AND WITH THE
CALIFORNIA HEALTH PROFESSIONS
CONSORTIUM, HEALTHCARE
CONNECTION AND èC BERKELEY
SCHOOL OF PUBLIC HEALTH. I'M
CALLING IN SUPPORT OF THE
CALIFORNIA MINUTES AND SCHOLARS
PROGRAM, WHICH WAS NOT INCLUDED
IN THE GOVERNOR'S JANUARY BUDGET
. UM IT'S REALLY VITAL THAT WE
SUPPORT THE CALIFORNIA MEDICINE
SCHOLARS PROGRAM AS A STRATEGY
TO ADDRESS THE POSITION SHORTAGE
IN CALIFORNIA AND INCREASING
DIVERSITY IN THE MEDICAL FIELD,
WHICH IS REALLY CRITICAL TO
ACCESS AND HEALTH EQUITY FOR
ALL. THANK YOU VERY MUCH. THANK
YOU. NEXT CALLER, PLEASE. IF
PEOPLE THANK YOU, MR CHAIR. WE
HAVE NO FURTHER PUBLIC COMMENT.
QUÊ THANK YOU. OPERATOR I WILL
TAKE THAT AS THE CONCLUSION OF
PUBLIC COMMENT FOR TODAY. BEFORE
WE ADJOURNED FOR THE NIGHT. I'LL
TAKE A MOMENT AND THANK THE
ADMINISTRATION, THE DEPARTMENT
OF FINANCE THE L. A. OH
STAKEHOLDERS AND ALL OF THE
PANELISTS WHO PARTICIPATED I
WILL APPRECIATE MY STAFF, THE
BUDGET STAFF THE SERGEANTS AND
THE TECH FOR HELPING TO
DISTRIBUTE AND TO KEEP US SAFE.
BUT MOST IMPORTANTLY, I WANTED
TO THANK THE PUBLIC FOR
PARTICIPATING AND IMPROVING OUR
PROCESS AND MAKING THIS THE
PEOPLE'S HOUSE. WITH THAT WE ARE
ADJOURNED FOR THE NIGHT. HAVE A
GOOD NIGHT.