GOOD AFTERNOON. THIS IS THE
ASSEMBLY BUDGET SUBCOMMITTEE
NUMBER ONE ON HEALTH AND HUMAN
SERVICES. TODAY'S HEARING IS
FOCUSED ON SENIORS AND ON HEALTH
EQUITY. IN ADDITION, WE WILL
HAVE A SPECIAL ORDER OF BUSINESS
AT FIVE P.M. TODAY TO HEAR THE
GOVERNOR'S MENTAL HEALTH
MODERNIZATION PROPOSAL. GIVEN
THE LENGTH OF TODAY'S AGENDA. I
WOULD LIKE TO REQUEST THAT ALL
OUR SPEAKERS BE AS BRIEF AS
POSSIBLE. WE WILL HAVE PANEL
PRESENTATIONS ON THE 1ST 19
ISSUES ON TODAY'S AGENDA WHILE
THE REMAINING 20 ARE NON
PRESENTATION ITEMS. SINCE WE
HAVE A SPECIAL ORDER OF BUSINESS
AT FIVE PM FOR THE MENTAL HEALTH
MODERNIZATION PROPOSAL. WE WILL
BEGIN ISSUE NUMBER 15 AT FIVE PM
EVEN IF WE HAVE NOT YET FINISHED
WITH THE 1ST 14 ISSUES ON THE
AGENDA. WE WILL THEN FINISH THE
PRIOR ISSUES ON THE AGENDA AFTER
ISSUE 19 IN THIS CASE. MEMBERS
ARE WELCOME TO ASK QUESTIONS ON
ALL ISSUES IN THE AGENDA,
INCLUDING ON NON PRESENTATION
ITEMS, AND WE WELCOME PUBLIC
COMMENT ON THEM AT THE END OF
THE HEARING, SHOULD THERE BE ANY
. WE ARE LOCATED TODAY IN ROOM 4
37 IN OUR STATE CAPITAL. WITH
THAT WE WILL BEGIN. LET US HAVE
OUR FIRST PANEL WITH DR RITA
KRISHNA, PLEASE COME FORWARD.
GOOD AFTERNOON CHAIR, ARAMBULA
AND ALL MEMBERS OF THE ASSEMBLY
SUBCOMMITTEE. MY NAME IS DR
ROHAN RATHER KRISHNA HAVE THE
HONOR OF SERVING AS THE CHIEF
EQUITY OFFICER AT THE CALIFORNIA
DEPARTMENT OF PUBLIC HEALTH
WHERE I LEAVE THE OFFICE OF
HEALTH EQUITY, AND I'M HERE.
ALSO ON BEHALF OF OUR CAL HEALTH
AND HUMAN SERVICES AGENCY.
PROVIDE A BRIEF OVER YOU AND
ANSWER THE THREE QUESTIONS
PROVIDED BY THE STAFF IF THAT'S
ALL RIGHT. SO ISSUE NUMBER ONE.
THIS BUDGET ITEM IS A TECHNICAL
TRANSFER OF ONE POSITION FROM
OUR AGENCY TO OUR DEPARTMENT.
WITH THIS ITEM, THE OFFICE OF
HEALTH EQUITY THAT I LEAD WILL
HIRE A POSITION AND TAKE LEAD ON
COORDINATING THE RETROSPECTIVE
ANALYSIS ON EQUITY FROM COVID 19
WITH INTERNAL AND EXTERNAL
STAKEHOLDERS, INCLUDING BUT NOT
LIMITED TO LOCAL GOVERNMENT.
ACADEMIA OTHER STATES AND
NATIONAL ENTITIES AND COMMUNITY
BASED GROUPS. WE ALREADY HAVE
LIVE DASHBOARDS FROM AN EQUITY
LENS SHOWING THE RELATIONSHIPS
BETWEEN COVID OUTCOMES AND
CERTAIN SOCIAL DRIVERS OF HEALTH
LIKE INCOME, CROWDED HOUSING AND
ACCESS TO HEALTH INSURANCE, AND
WE HAVE ALREADY RELEASED AN
EARLY REPORT IN JULY OF 2022.
THAT MY OFFICE COMMISSIONED
FOCUSED ON SUPPORTING
COMMUNITIES AND LOCAL PUBLIC
HEALTH DEPARTMENTS DURING COVID,
19 AND BEYOND. IT'S TITLED A
ROADMAP FOR EQUITABLE AND
TRANSFORMATIVE CHANGE. IT
ENCOMPASSES THE FIRST YEAR OF
THE PANDEMIC, BUT IT IS NOT A
RETROSPECTIVE ANALYSIS.
NEVERTHELESS THE 208 PAGE REPORT
DOES HAVE VERY MANY RELEVANT
CHAPTERS AND RECOMMENDATIONS. WE
HAVEN'T YET COMPLETED A
RETROSPECTIVE ANALYSIS BECAUSE
THE PANDEMIC LASTED LONGER THAN
WE ALL IMAGINED BACK IN 2021
WHEN THIS ITEM WAS ORIGINALLY
CRAFTED. CAL HHS AND CD PH HAVE
BEEN ACTIVELY IN RESPONSE MODE
FOR THE PAST THREE YEARS, COMING
FROM A LOCAL HEALTH DEPARTMENT
IN THE MIDDLE OF THE PANDEMIC TO
JOIN STATE SERVICE. PERSONALLY
I'M FAMILIAR WITH BOTH LEVELS
AND PERSPECTIVES. COVID IS STILL
WITH US. IT'S NOT YET FULLY IN
THE REAR VIEW MIRROR. HENCE A
RETROSPECTIVE EQUITY ANALYSIS
HAS NOT YET BEEN COMPLETED. JUST
LIKE NO AFTER ACTION REPORTS
HAVE BEEN COMPLETED. THE
PROPOSED RETROSPECTIVE ANALYSIS
WILL LOOK AT THE INTERSECTION OF
THE COVID 19 PANDEMIC AND THE
HEALTH DISPARITIES AND
INEQUITIES THAT WERE FURTHER
PERPETUATED DUE TO THE PANDEMIC.
THE PURPOSE OF THIS ANALYSIS AS
ARTICULATED ON PAGE 10 IS TO
BETTER UNDERSTAND HOW THESE
UNDERLYING DISPARITIES AND
INEQUITIES FUELED THE PANDEMIC
AND WHAT CAN BE DONE TO PREPARE
FOR FUTURE CRISES. HOW WE BOUNCE
FORWARD AS OPPOSED TO GOING
BACK. AND NOW ANSWER THE THREE
QUESTIONS PROPOSED BY STAFF.
FIRST THE TIMELINE FOR THIS
ANALYSIS. IF THIS BUDGET CHANGE
PROPOSAL IS ACCEPTED, WE WILL
TRANSFER THE POSITION FROM
AGENCY TO OUR DEPARTMENT TO HIRE
THIS LEAD COORDINATOR THIS
SUMMER, WHO WILL BEGIN WORK WITH
MANY INTERNAL AND EXTERNAL
PARTNERS CONDUCTING AFTER ACTION
REVIEWS. PRELIMINARY MAPPING HAS
ALREADY BEGUN AND WILL CONTINUE
THROUGHOUT 2023. WE ANTICIPATE
COMPLETING THE ANALYSIS IN 2024
OR 25. QUESTION TWO. HOW WILL
SEE DPH SHARE THE FINAL ANALYSIS
? WE PLAN TO POST IT PUBLICLY ON
OUR WEBSITE FOR CONSUMPTION BY
ALL. AND QUESTION NUMBER THREE
FROM ASSEMBLYMEMBER'S CALDERON
WITH A LETTER PROPOSING AN
AMENDMENT. IN RESPONSE TO THIS
LETTER, I WOULD LIKE TO EXCLAIM
THE IMPORTANCE OF THE ISSUE AND
APPRECIATE WHAT ASSEMBLYMEMBER'S
CALDERON RAISED IN THEIR LETTER
REGARDING THE ECONOMIC IMPACT OF
LONG COVID ON WOMEN. WE ARE
HAPPY TO SHARE OUR CURRENT AND
ONGOING WORK RELATED TO LONG
COVID WITH THIS COMMITTEE AND
DIRECTLY WITH ASSEMBLYMEMBER'S
CALDERON. WHILE CD PHS CENTER
FOR INFECTIOUS DISEASE HAS
CREATED A COVID 19 CONTROL
BRANCH TO CONTINUE WORKING ON
THE IMPACTS OF COVID, INCLUDING
LONG COVID. IT IS AND WILL
CONTINUE EXAMINING THE IMPACT OF
LONG COVID ON CALIFORNIANS.
HOWEVER A SPECIFIC ECONOMIC
IMPACT ON LONG COVID ON WOMEN IS
BEYOND THE SCOPE AND EXPERTISE
OF THE MUCH BROADER EQUITY
RETROSPECTIVE ANALYSIS AND THIS
BUDGET CHANGE PROPOSAL, WHICH IS
A MINOR TECHNICAL TRANSFER OF
ONE G P STAFF FROM THE FAMILY OF
THE AGENCY TO OUR DEPARTMENT,
CONDUCTING A TRUE ECONOMIC
IMPACT WOULD REQUIRE ADDITIONAL
FUNDING AND A HEALTH ECONOMIST
I'LL BRIEFLY SUMMARIZE WHAT WE
ARE DOING IN REGARDS TO LONG
COVID CD PH IS ENGAGED IN
MULTIPLE ACTIVITIES TO ASSESS
COMMUNICATE AND COORDINATE
AROUND LONG COVID IN CALIFORNIA.
THESE EFFORTS INCLUDE
COLLABORATING WITH FEDERAL AND
ACADEMIC PARTNERS TO ASSESS
INCIDENTS RISK FACTORS MEASURING
BURDEN IN THE STATE, USING
DIFFERENT SURVEY TOOLS,
DEVELOPING COMMUNICATION
MATERIALS FOR PATIENTS AND
PROVIDERS AND FACILITATING INTER
AGENCY COORDINATION FOR POST
COVID PUBLIC HEALTH ACTION.
THROUGH THESE EFFORTS, CPH AIMS
TO CHARACTERIZE THE PROPORTION
OF COVID 19 PATIENTS THAT HAVE
ONGOING HEALTH EFFECTS. THE
DURATION, THE SEVERITY OF THOSE
EFFECTS AND PATIENTS AT GREATEST
RISK, INCLUDING CHARACTERIZING
THE BURDEN BASED ON DIFFERENT
DEMOGRAPHIC DISPARITIES,
INCLUDING GENDER AND WOMEN. THE
HOPE IS THAT THIS DATA WILL
INFORM PUBLIC HEALTH PROGRAMMING
TO ASSIST CALIFORNIANS MOST
IMPACTED BY LONG, COVID.
FURTHERMORE I'LL GUIDE YOU TO
CDP HS OCCUPATIONAL HEALTH
BRANCH, WHICH ALREADY HAS LIVE
ON ITS WEBSITE. INFORMATION ON
LONG COVID AND WORKERS EMPLOYEES
IN THE WORKFORCE. THIS INCLUDES
TOOLS FOR WORKERS AND
ACCOMMODATIONS FOR EMPLOYEES
UNDER THE AMERICANS WITH
DISABILITY ACT. SO AS MENTIONED
, WE'RE HAPPY TO SHARE A CURRENT
AND ONGOING WORK RELATED TO LONG
COVID WITH ASSEMBLYMEMBER'S
CALDERON. THANK YOU. ELIO. OH
WILL OWENS? ELIO, WE HAVE NO
CONCERNS WITH THIS PROPOSAL.
DEPARTMENT OF FINANCE DEPARTMENT
OF FINANCE NOTHING FURTHER TO
ADD THAT AVAILABLE TO ANSWER
QUESTIONS. BRING IT UP TO THE
DIOCESE FOR ANY MEMBERS.
QUESTIONS WILL BEGIN WITH DR
JACKSON. THANK YOU VERY MUCH, MR
CHAIR, AND, UM THIS ITEM IS
ACTUALLY VERY IMPORTANT. THAT WE
DO A THOROUGH RECAP. UH UM, ON
OUR STRENGTHS AND WEAKNESSES
THAT WE'VE ENCOUNTERED. UH HOW
WE HAVE, UM, I UM BEFORE I CAME
HERE I WAS ON RIVERSIDE COUNTY'S
EQUITY TASK FORCE FOR COVID 19.
AND ONE OF THE GREATEST THINGS
THAT I THINK IS NOW INFORMS MY
WORK. IS THAT EFFICIENT DOESN'T
MEAN THE BEST CHOICE. AND
BECAUSE WE START TO DO THE MOST
EFFICIENT THINGS WE BEGAN TO
CREATE DISPARITIES. RIGHT WHICH
MEANS WE HAD TO THEN ENGAGE MORE
COMMUNITY BASED ORGANIZATIONS TO
TRULY ACHIEVE EQUITY IN THE
DISTRIBUTION OF RESOURCES.
WHETHER IT'S PPE, WHETHER IT'S
UM BEING ABLE TO EDUCATE PEOPLE
ON THE VACCINE AND THOSE TYPE OF
THINGS. THE ONLY THING THAT I
WOULD THAT I WOULD REQUEST IN
THIS ITEM MR CHAIR IS THAT WE
ALSO INCLUDES SOME LEVEL OF
RECOMMENDATIONS TO THE
LEGISLATURE. UM THERE ARE THINGS
THAT WE PROVEN THAT WE COULD
HAVE, WE COULD DO. THAT ARE NOW
SUNSETTING. UM BUT WE'RE HEARING
THROUGHOUT THE SYSTEMS THAT
THOSE ARE STILL GOOD TO HAVE.
AND BECAUSE THERE'S SO MANY OF
THEM THAT WERE CREATED THAT ARE
NOW SUNSETTING. IT WOULD BE
GREAT FOR THE LEGISLATURE TO BE
ABLE TO RE LOOK AT THOSE SO THAT
WE CAN MAKE SURE THAT WE ARE
PREPARED FOR THE NEXT PANDEMIC
THE NEXT WHATEVER THAT MIGHT, UM
LAND THESE TYPE OF THINGS TO US
. SO EVEN THOUGH IT'S GREAT THAT
IT WILL BE FOR THE PUBLIC TO SEE
I WOULD LIKE TO MAKE SURE IF WE
ARE GOING TO BE APPROVING THIS
THAT WE GET SOME STUFF OUT OF IT
FROM A MORE PRACTICAL THINGS OF
HOW WE CAN BETTER DO OUR JOB.
AND UM, PREPARING FOR THE NEXT
THING. MY GREATEST FEAR IS THAT,
UH, AND WHICH IS ALREADY
HAPPENING. WE'RE MOVING ON TO
THE NEXT THING. RIGHT AND WE
STILL HAVEN'T FIXED SOME OF THE
. OPPORTUNITIES I SEE THE SWAT
ANALYSIS IN HERE, SO I'LL JUST
SAY OPPORTUNITIES. AH TO BE ABLE
TO FILL IN SOME GAPS THAT STILL
EXIST. RIGHT THAT WE SAW WHERE
SOME OF OUR WEAKNESSES AND OUR
SOCIETY AND I WANT TO MAKE SURE
THAT WE CAN CONTINUE TO DO THAT
WORK. UM AND THIS DOCUMENT COULD
ACTUALLY HELP US TO DO IT MORE
EFFICIENTLY OR EFFECTIVELY.
THANK YOU. THANK YOU ALL. BRING
IT TO THE CHAIR IF I CAN. I WAS,
UM, REALLY DRAWN TO YOUR
COMMENTS ABOUT WHAT FUELED THE
PANDEMIC, AND OFTEN TIMES IT WAS
THOSE SOCIAL DRIVERS OF HEALTHY
SPOKE ABOUT INCOME, CROWDED
HOUSING AND ACCESS TO
HEALTHCARE. THAT I ALSO LIKE TO
UNDERSTAND THE ROLE THAT CAL AIM
WILL PLAY AS WE ARE REBOUNDING
OUT OF THIS PANDEMIC AND THE
SUPPORTIVE SERVICES OR ENHANCED
CASE MANAGEMENT. IT WOULD BE
IMPORTANT WITH THIS POSITION
THAT THOSE RECOMMENDATION
ALLOWED US TO SEE HOW WE COULD
IMPACT THOSE SOCIAL DRIVERS OF
HEALTH BEYOND THE THREE THAT YOU
LISTED BUT WOULD LOVE TO GET
MORE CLARITY AS YOU DIG INTO IT.
AND DO YOUR ANALYSIS WANTED TO
GIVE YOU AN OPPORTUNITY TO
PROVIDE SOME COMMENTS. THANK YOU
FIRST. DR JACKSON. THANKS FOR
YOUR WORK IN RIVERSIDE. THEY
WERE ONE OF 68 KEY INFORMANTS
THAT WENT INTO OUR PRELIMINARY
REPORT, AND IT DOES HAVE POLICY.
RECOMMENDATIONS FOR DIFFERENT
LEVELS OF JURISDICTION. SOME
HAVE BEEN IMPLEMENTED. SOME ARE
OPPORTUNITIES FOR THE LONG TERM
, SO WE'LL KEEP THAT IN MIND AND
TO DIRECTLY ANSWER YOUR QUESTION
, DOCTOR ARAMBULA, WE WILL
CONTINUE TO COORDINATE WITH THE
DEPARTMENT OF HEALTH CARE
SERVICES AND THEIR CALLUM
INITIATIVE. THEY HAVE AN EQUITY
ROADMAP, WHICH WILL BE PRESENTED
IN JUNE AT THE QUARTERLY OFFICE
OF HEALTH EQUITY PUBLIC ADVISORY
COMMITTEE. SO WE HAVE A 26
MEMBER ADVISORY BOARD AND WE
TACKLE DIFFERENT TOPICS AND BY
STATUTE. WE WORK AND PARTNER
WITH THE DEPARTMENT OF HEALTH
CARE SERVICES. THEY HAVE A NEW
CHIEF EQUITY OFFICER AS WELL, SO
WE'LL DEFINITELY REACH OUT TO
THEM AS WELL AS MANY CALLOW YES
, LOCAL JURISDICTIONS, OTHERS
WITHIN OUR AGENCY FAMILY IN
CONDUCTING THIS RETROSPECTIVE
ANALYSIS. ABSOLUTELY. IT'S
IDENTIFYING THOSE DRIVERS THAT
WILL ALLOW US TO FOCUS OUR
LIMITED RESOURCES ON PROVIDING
SOLUTIONS IN REAL TIME, AND SO
WE'RE GRATEFUL THAT YOU'RE DOING
THIS RETROSPECTIVE ANALYSIS, BUT
WE HAVE TO LOOK AT SOME OF THE
LESSONS THAT WE LEARNED DURING
THIS PANDEMIC OF THE CENTURY AND
TO FIGURE OUT HOW TO DO IT
BETTER. AND I BELIEVE IT'S
IMPORTANT FOR US TO DO THIS WORK
WERE SUPPORTIVE OF THE BCP. UM
BUT FOR MANY OF US, IT'S JUST
TAKING SO LONG. TO GET TO THE
PLACE WHERE WE'RE AT NOW THAT WE
DON'T ACCEPT THE RESULTS THAT
HAPPENED DURING THE PANDEMIC AND
ARE LOOKING FORWARD TO THE
OPPORTUNITY TO CREATE A SYSTEM
THAT DOESN'T HAVE THE
DISPARITIES THAT WE SEE WITHIN
IT WITH THAT WE WILL. THANKS
VERY MUCH THIS PANEL AND MOVE ON
TO ISSUE TOO. GOOD AFTERNOON.
NICK MILLS DEPARTMENT OF
FINANCE. UH THE BUDGET REDUCES
$25 MILLION GENERAL FUND. QUITE
CHANGED EQUITY SECTION CHIEF OF
C P A YES, I AFTERNOON. THIS IS
LINDA HELEN WITH THE OFFICE OF
HEALTH EQUITY CLIMATE HELP
EQUITY SECTION AND WILL DEFER TO
THE DEPARTMENT OF FINANCE SUIT
PRESENT THE ISSUE IN QUESTION.
CREASE HERE WE GO. ALL RIGHT.
THE BUDGET REDUCES $25 MILLION
GENERAL FUND IN 22 23 FOR
CLIMATE AND HEALTH ðILIENCE,
PLANNING GRANTS IF THERE'S
SUFFICIENT GENERAL FOUND IN
JANUARY 2024. THIS REDUCTION
WILL BE RESTORED. UM THIS
REDUCTION IS CONSISTENT WITH THE
ADMINISTRATION'S OVERALL
APPROACH TO ADDRESSING THE
BUDGETARY PROBLEM THROUGH DELAYS
OR REDUCTIONS OF SOME SPENDING
IN THE NEAR TERM. WHERE
FEASIBLE, THE BUDGET PRIORITIZES
ONGOING COMMITMENTS INCLUDED IN
PREVIOUS BUDGETS. IN CLIMATE
HEALTH THAT INCLUDES 10 MILLION
GENERAL FANS ONGOING FOR D P. H
S CLIMATE AND HEALTH
SURVEILLANCE PROGRAM TO PROVIDE
NEAR REAL TIME NOTIFICATION FOR
PUBLIC HEALTH DEPARTMENTS FOR
SYSTEM MONITORS IN THE COMMUNITY
FOR EMERGING CLIMATE SENSITIVE
DISEASES. UM WILL NOW ANSWER
QUESTION NUMBER THREE IN THE
AGENDA REGARDING THE TRIGGER,
AND THEN WE'LL TURN IT OVER TO
THE DEPARTMENT FOR THE OTHER TWO
QUESTIONS. THE POTENTIAL
RESTORATION OF THIS PROPOSAL,
WHICH IS CONTINGENT UPON CERTAIN
GENERAL FUND REVENUE CRITERIA
BEING MET IS OPERATIONALIZED IN
CONTROL SECTION 3.94 IN THE
GOVERNOR'S BUDGET AND A B 2 21.
THIS CONTROL SECTION IDENTIFIES
THAT HONOR BEFORE JANUARY 10TH
2020 FOR THE DIRECTOR OF FINANCE
, SELL DETERMINE WHETHER THE
STATE HAS ACCESS GENERAL FUND.
FOR THE 2024 25 FISCAL YEAR THAT
IS SUFFICIENT TO SUPPORT THE
RESTORATION OF ALL THE REVERSION
ZIN REDUCTIONS IDENTIFIED IN THE
SECTION AND EXCESS GENERAL FUND
IS DEFINED TO BE THE TOTAL
GENERAL FUND AVAILABLE FOR
ALLOCATION IF THE STATE FULLY
FUNDS BASELINE OBLIGATIONS,
ENROLLMENT CASELOAD AND
POPULATION ADJUSTMENTS. AS
DETERMINED BY THE DEPARTMENT OF
FINANCE AT THE RELEASE OF THE
GOVERNOR'S BUDGET FOR FISCAL
YEAR 24 25, PLUS VARIOUS
CONSTITUTIONAL OBLIGATIONS, SUCH
AS PROP 98 THE BUDGET
STABILIZATION ACCOUNT IN THE
PUBLIC SCHOOL SYSTEM
STABILIZATION ACCOUNTS. UM, IF
THERE IS SUFFICIENT GENERAL FUND
REVENUE FINANCE WILL NOTIFY THE
JOINT LEGISLATIVE BUDGET
COMMITTEE OF THIS DETERMINATION.
AND WILL PROVIDE THE CONTROLLER
WITH THE SCHEDULE OF
APPROPRIATIONS IN FISCAL YEAR 23
24 TO BE AUGMENTED THROUGH AN
EXECUTIVE ORDER. AND I'LL TURN
OVER HIS IT DEPARTMENT FOR THE
OTHER TWO QUESTIONS. THANKS GOOD
AFTERNOON SHARE. ARAMBULA
ASSEMBLYMEMBER'S I'M LINDA HELEN
, WITH THE OPPOSITE OF HEALTH
EQUITY IN CALIFORNIA DEPARTMENT
OF PUBLIC HEALTH. I WILL ADDRESS
THE SECOND PERSON. SECOND
QUESTION HOW THIS CD PH PLAN TO
DISTRIBUTE THESE FUNDS 25
MILLION AND WAS INTENDED TO BE A
GRANT PROGRAM FOR LOCAL HEALTH
JURISDICTIONS AND TRIBAL HEALTH
PROGRAMS. I WILL ANSWER
QUESTIONS TO FIRST. YES THIS WAS
INTENDED TO BE A GRANT PROGRAM
FOR LOCAL HEALTH DEPARTMENTS,
TRIBES AND COMMUNITY BASED
ORGANIZATIONS TO DEVELOP CLIMATE
AND HEALTH RESILIENCE PLAN. OF
THE TOTAL AWARD OF 22,500,000
ADMINISTRATION AND STUFF AND
COSTS ONE MILLION WAS PLANNED
FOR CONSULTANTS, LEAVING 21 A
HALF MILLION LOCAL ASSISTANCE.
OF THAT 64% OR 13,800,000, WAS
PLANNED TO BE FOR LOCAL HEALTH
DEPARTMENT AND ABOUT 18% OF THAT
, OR 3.85 MILLION FOR COMMUNITY
BASED ORGANIZATIONS, AND
SIMILARLY ABOUT 18% OR 3.85
MILLION FOR TRIBES. AND BECAUSE
COMPETITIVE GRANTS TEND TO BE
INHERENTLY INEQUITABLE AS THE
MOST RESOURCE JURISDICTIONS WITH
THE MOST MONEY FOR CONSULTANTS
AND GREAT WRITERS, OR THE MOST
FREE TIME TO WRITE GOOD GRANT
APPLICATIONS TEND TO BE REWARDED
WITH FURTHER FUNDING. WE WANTED
TO ALLOCATE THE FUNDING THROUGH
AN EQUITY FRAMEWORK TO LOCAL
HEALTH DEPARTMENTS AND TRIBES.
AND WE'RE IN THE PROCESS OF
ENGAGEMENT WITH THEM WHEN WELL
INSTRUCTED TO SELF WORK ON THIS
PROGRAM IN DECEMBER, AND FOR
CBOS, WE WOULD LIKELY HAVE HAD
TO RELEASE THE COMPETITIVE
SOLICITATION BUT ONE OF THE
APPLICATION TO BE FAIRLY SIMPLE
AND MAKE AWARDS BASED ON
DEMONSTRATION OF NEED, I WILL
STOP THERE AND TAKE QUESTIONS
ARE COMING. HELLO? WILL OWENS
ELIO, GIVEN THE STATE'S CURRENT
BUDGET SITUATION, WE GENERALLY
FIND THAT THIS SOLUTION, MISS
SOME OF THE CRITERIA THAT WE HAD
LAID OUT EARLIER IN THE YEAR ON
, UM SOLUTIONS THAT WOULD YOU
KNOW, DISRUPT SERVICES BE FAIRLY
RECENT. AND SO WE HAVE NO
CONCERNS WITH THE PROS AT THIS
TIME. BRING IT UP TO THE DIOCESE
FOR ANY MEMBERS, QUESTIONS.
SAYING NO, AND I'LL KEEP IT HERE
AT THE CHAIR. UM, FIRST, I WAS
STRUCK. WE'VE BOTH HAD DESCRIBED
THAT THIS IS THE MOST
SIGNIFICANT PUBLIC HEALTH THREAT
THAT WE FACE TODAY. THAT I'D
LIKE TO UNDERSTAND HOW WE CAN
EXPLAIN WHEN ONLY A COUPLE OF
OUR LOCAL HEALTH DEPARTMENTS ARE
MAKING SIGNIFICANT INVESTMENTS.
REGARDING THIS ISSUE. SHOULD WE
BE EXPECTING? MORE. GIVEN THE
GREATER INVESTMENTS THAT WE'VE
DONE TO LOCAL HEALTH DEPARTMENTS
THAT 200 MILLION ONGOING THAT WE
GAVE HIM LAST YEAR. WHAT IS OUR
EXPECTATIONS? I FEEL LIKE ME AND
TRY TO ANSWER THAT. PLEASE. AH
SOME LOCAL HEALTH DEPARTMENTS
ARE USING SOME OF THOSE 2200
MILLION TO ADDRESS CLIMATE
CHANGE. UM, A FEW OF THEM HAVE
PROPOSED AND ACTUALLY ARE
ADDRESSING THE HEALTH IMPACTS OF
CLIMATE CHANGE THROUGH THEIR
FUTURE OF PUBLIC HEALTH OR
CALIFORNIA PUBLIC HEALTH
INITIATIVE FUNDING. UM PREVIOUS
TO THAT THERE WERE ABOUT FOUR
FUNDED HEALTH DEPARTMENT THROUGH
THEIR OWN FUNDING OR THROUGH
CDC. CLIMATE MESELF PROGRAM
FUNDING. THIS WOULD HAVE BEEN
THE FIRST DEDICATED STATE
FUNDING TO LOCAL HEALTH
DEPARTMENTS TO ADDRESS THIS
ISSUE. WE'RE GOING TO FINANCE
CAPITAL DEPARTMENT OF FINANCE. I
WOULD JUST LIKE TO ADD THAT
ALTHOUGH THIS IS ONE REDUCTION
CONTAINED IN THE CLIMATE, HEALTH
INVESTMENT, THE BUDGET DOES
MAINTAIN 321 MILLION TO CONTINUE
. OTHER INVESTMENTS SUCH AS AS
MY COLLEAGUE NOTED THE 10
MILLION ONGOING FOR SURVEILLANCE
, AS WELL AS AN ADDITIONAL I
APOLOGIZE, UM APPROXIMATELY 280
MILLION FOR COMMUNITY HEALTH
WORKERS, SOME OF WHICH WILL BE
ENGAGED IN CLIMATE HEALTH WORK.
WE'LL JUST STATE THIS IS NOT
INHERENTLY REGARDING THE
REVERSION OR THE RESTORATION.
BUT A COMMENTARY ON THE LACK OF
INVESTMENTS THAT HAVE BEEN
OCCURRING FROM OUR LOCAL HEALTH
DEPARTMENTS. THE AGENDA
HIGHLIGHTS THAT THERE'S ONLY TWO
DEPARTMENTS THAT CURRENTLY HAVE
FULL TIME STAFF DEDICATED TO
ADDRESSING THE HEALTH IMPACTS OF
CLIMATE CHANGE. AND KNOWING THAT
THESE IMPACTS DISPROPORTIONATELY
AFFECT OUR COMMUNITIES OF COLOR
. IT'S IMPERATIVE THAT OUR LOCAL
HEALTH DEPARTMENTS ARE WORKING
TO COME UP WITH SOLUTIONS THAT
MEET THE NEEDS OF ALL OF OUR
COMMUNITIES. AND HENCE WHY WE'RE
ASKING. FOLLOW UP IF I CAN. THE
AGENDA ALSO MENTIONS THE
DISPROPORTIONATE IMPACT THAT
OCCURS FOR MANY OF OUR TRIBAL
NATIONS. AND HOW THEY ARE NOT
GIVEN SIGNIFICANT ACCESS TO
GOVERNMENTAL PLANNING EFFORTS.
UM THAT I WANT TO KIND OF
UNDERSTAND OUR TRIBAL NATIONS
REPRESENTED ON OUR QUALITY
MANAGEMENT DISTRICTS AS AN
EXAMPLE SHOULD THEY BE THEIR
BORDERS LIKE I WITHIN. AIR
BASINS, BUT THEIR SOVEREIGN
NATIONS ALSO REQUIRE AN
OPPORTUNITY TO HAVE A SEAT ON
THOSE DECISION MAKING THAT I'D
LIKE TO UNDERSTAND OR WE
PLANNING TO START TO WORK ON
THAT TO MAKE SURE THAT THEY HAVE
A SEAT AT THE TABLE.
THAT'S FOR THE DEPARTMENT. IF
YOU CAN. FOR US TRIBAL NATIONS
SEATS ON AIR QUALITY MANAGEMENT
DISTRICT. I THINK THAT IS,
UNFORTUNATELY, A QUESTION THAT I
CANNOT ANSWER. UM, NOT BEING IN
CHARGE OF OUR QUALITY MANAGEMENT
DISTRICT, BUT I WILL. TELL YOU
THAT WE DO HAVE ONE STAFF PERSON
WORKING ON A DEDICATED BASIS
WITH TRIBES TO SUPPORT THEM,
TOO. ADDRESS THE HEALTH AND LIKE
WHAT THE IMPACTS OF CLIMATE
CHANGE ON THE TRIBES. UM AND
THEY'RE DEFINITELY WORKING VERY
HARD AND FACING OF IMPACTS ON A
DAILY BASIS, UM AND WANT TO DO
MORE. AND SO WE ARE SUPPORTING
THEM. TO THE EXTENT WE CANNOT
TECHNICAL SYSTEMS AND DATA AND
TOOLS WITH ONE STAFF PERSON.
THERE WILL BE MORE CONVERSATIONS
ABOUT SOME POTENTIAL WAYS TO BE
INCLUSIVE AND TO MAKE SURE THAT
AND ALL VOICES ARE ABLE TO BE
HEARD. BUT WE'LL COME BACK TO
THAT AT A LATER TIME. I WILL
BRIEFLY BRING UP ISSUE NUMBER 34
, WHICH IS CURRENTLY ON THE NON
PRESENTATION ITEM, BUT HAS A
CORRELATION HERE AS IT'S RELATED
TO EXTREME HEAT AND THE MAYBE 20
TO 38 B C P SINCE WE WON'T BE
DISCUSSING IT LATER. I'M REALLY
TRYING TO UNDERSTAND THE EXTREME
HEAT RANKING SYSTEM. AND WAYS IN
WHICH IT WILL BE COORDINATED.
HAPPY TO FOLLOW UP OFFLINE IF
YOU DON'T HAVE ANY ANSWERS TODAY
, BUT THERE WAS A DELEGATION
THAT WENT TO FRANCE TO LEARN
FROM THAT COUNTRY ABOUT EXTREME
HEAT, AND THEY'RE WANTING SYSTEM
THAT I'D LIKE TO BE ABLE TO WORK
WITH THE DEPARTMENT AND
UNDERSTAND IF THERE ARE UM,
LESSONS THAT WE CAN BRING OVER
FROM THAT COUNTRY. AS WELL AS
WHETHER OR NOT THERE ARE OTHER
EXAMPLES WITHIN OUR CURRENT
GOVERNMENT, SUCH AS UM, PS PS IS
THE PUBLIC SAFETY POWER. SHUT
OFF, SO THE NOTIFICATIONS THAT
WE'RE DOING FOR OUR ELDERLY
POPULATION WHEN WE'RE GOING TO
TURN POWER OFF. THAT I'D LIKE TO
UNDERSTAND HOW YOU'RE GOING TO
BE IMPLEMENTING THIS, AND I
WOULD LIKE TO BE ABLE TO WORK
WITH YOU GOING FORWARD. ANSWER
THAT. OR WOULD YOU LIKE ME TO
ANSWER THAT AT A DIFFERENT TIME?
YOU CAN FOLLOW UP WITH OUR
OFFICE IF THAT'S OKAY. UM I
WILL. THANKS VERY MUCH. THIS
ENTIRE PANEL AND WE WILL NOW
MOVE ON TO ISSUE THREE.
WE WILL BEGIN WITH MR CHO WHEN
YOU'RE READY. GOOD AFTERNOON.
MARIA OCHOA, ONE OF THE
ASSISTANT DEPUTY DIRECTORS
WITHIN THE CENTER FOR HEALTHY
COMMUNITIES AND CD PH, AND TODAY
I'LL BE PROVIDING A BRIEF
OVERVIEW OF ONE OF OUR SPRING
FINANCE LETTERS FOR PROTECTING
CHILDREN FROM THE DAMAGING
EFFECTS OF LEAD EXPOSURE. SO LET
US ONE OF THE MOST COMMON
ENVIRONMENTAL ILLNESSES IN
CALIFORNIA CAN HAVE HARMFUL
EFFECTS ON A CHILD'S BODY, WHICH
MAY LEAD TO LIFELONG LEARNING,
BEHAVIORAL, REPRODUCTIVE,
CARDIOVASCULAR AND OTHER HEALTH
PROBLEMS. WITHIN C D PH. THE
CHILDHOOD LEAD PREVENTION BRANCH
LEADS THESE EFFORTS AND IS
SUPPORTED BY FEES ASSESSED AND
COLLECTED ANNUALLY FROM LEAD
POLLUTERS. MOST OF THE FUNDS ARE
DISTRIBUTED TO 48 LOCAL HEALTH
JURISDICTIONS THAT CONDUCT LESS
LEAD POISONING PREVENTION AND
BASIC CASE MANAGEMENT. CD PH IS
REQUESTING TO POSITIONS AND 9.7
MILLION FROM THE CHILDHOOD LEAD
POISONING PREVENTION FUND AND
FISCAL YEAR 2023 THROUGH 2026
6.1 MILLION ONGOING FOR
ADDITIONAL CASE MANAGEMENT
ACTIVITIES THAT HAVE INCREASED
AS A RESULT OF THE 2021 CENTER
FOR DISEASE CONTROL AND
PREVENTION. UPDATED BLED LEAD
REFERENCE VALUE FROM FIVE
ISOLATORS TO 3.5. AND TO ALSO
ADDRESS THE FINDING OF A 2019
AUDIT BY THE CALIFORNIA STATE
AUDITOR THAT RECOMMENDS CD PH.
CLIP PROGRAM TO FOCUS MORE ON
PRIMARY PREVENTION OF CHILDHOOD
LEAD POISONING. OF THE NINE
POINT 7,000,005 9.0.9 WILL BE
ALLOCATED FOR BASIC CASE
MANAGEMENT SERVICES TO BE
PERFORMED BY STATE AND LOCAL
STAFF. 3.6 WILL BE ALLOCATED TO
DEVELOP AN ENHANCED LOCAL
GENERAL PREVENTION MEASURES
OUTLINED IN THE 2023 THROUGH
2026 SCOPE OF WORK PROPOSED BY
CONTRACTED L HJ. 214,000 WILL BE
ALLOCATED IN STATE OPERATIONS TO
ESTABLISH TWO POSITIONS TO
PROVIDE DIRECT SERVICES PROVIDED
BY STATE AND LOCAL PUBLIC HEALTH
NURSES, COMMUNITY CARE WORKERS
AND ENVIRONMENTAL PROFESSIONALS
THAT PERFORM CASE MANAGEMENT
CARE, COORDINATION AND
ENVIRONMENTAL INVESTIGATIONS TO
IDENTIFY AND REMOVE LEAD
SOURCES. AND THERE WERE A COUPLE
OF QUESTIONS WITHIN THE AGENDA.
SO THE FIRST ONE WAS DCD PH HAVE
AUTHORITY TO INCREASE THE FEES
IS NECESSARY TO COVER THE
INCREASING COST OF THE PROGRAM.
CITY PH HAS THE AUTHORITY TO
INCREASE THE CHILDHOOD LEAD
POISONING PREVENTION FEES FOR
PROGRAM COSTS AND HEALTH AND
SAFETY CODE ONE. OH 5310 G,
WHICH SETS A FEE CAP, ADJUSTED
FOR INFLATION PURSUANT TO
SUBDIVISION B. CD PH WILL
CONTINUE TO MONITOR EXPENDITURES
AND REVENUE PROJECTIONS AND PLAN
FOR FEE ADJUSTMENTS AS
NECESSARY. AND THE SECOND
QUESTION WAS HE DOES CDP H HAVE
ANY WAY TO MEASURE OUTCOMES AND
OR AND, YES, CD PH CONTINUALLY
MEASURES EFFECTIVENESS AND
PROGRAM OUTCOMES THROUGH
SURVEILLANCE DATA SITE VISITS
AND PROGRESS REPORT TRACKERS.
THESE MEASURES OCCUR AT BOTH THE
STATE AND LOCAL LEVEL. CITY PH
POST DATA ANNUALLY AND REPORTS
BY ANNUALLY, WHICH PROVIDES
INFORMATION ON THE RATES OF
CHILDHOOD. LEAD POISONING,
AFFECTS TO INCREASE SCREENING
AND EFFORTS TO REDUCE
SURVEILLANCE OF CHILDHOOD LEAD
POISONING. PCP IS IN RESPONSE TO
CD PH HAS PASSED WORK MEASURING
THE EFFECTIVENESS OF THIS
PROGRAM AND HAS THE GOAL OF
INCREASING SCREENING RATES AND
PRIMARY PREVENTION. THANK YOU.
NEXT WE WILL HEAR FROM MS
GIBBONS, EXECUTIVE DIRECTOR OF
JACK. THANK YOU. GOOD AFTERNOON
SHARE MEMBERS. MY NAME IS
MICHELLE GIBBONS. I'M AT THE
COUNTY HEALTH EXECUTIVES
ASSOCIATION OF CALIFORNIA,
REPRESENTING LOCAL HEALTH
DEPARTMENTS THROUGHOUT THE STATE
WERE SUPPORTIVE OF THE
ADMINISTRATION'S REQUEST FOR
ADDITIONAL FUNDING FOR THE
CALIFORNIA LEAD PREVENTION
PROGRAM. I'M JUST GONNA REFER TO
IT AS CLIP. HOWEVER WE BELIEVE
THAT LOCAL HEALTH DEPARTMENTS
WILL NEED ADDITIONAL FUNDING
BEYOND WHAT HAS BEEN REQUESTED
TO FULFILL THE REQUIREMENTS OF
THE SCOPE OF WORK RELATIVE TO
THE NEXT THREE YEARS. LOCAL
HEALTH DEPARTMENTS CONTRACT WITH
SEED PH TO ADMINISTER VARIOUS
ASPECTS OF THE CLIP PROGRAM. THE
PROGRAM ORIGINALLY REQUIRED
LOCAL HEALTH DEPARTMENTS TO
PROVIDE PROVIDER EDUCATION AND
CASE MANAGEMENT FOR CHILDREN
WITH ELEVATED BLOOD LEAD LEVELS
, WHICH WERE PREVIOUSLY VALUED
AT FIVE MICROGRAMS PER DECILITER
AND THEN TO REMEDIATE THE
SOURCES OF LEAD FOR THOSE
CHILDREN THAT WERE BEING CASE
MANAGED. THE NEWS COUPLE OF WORK
INCREASES THE WORKLOAD FOR LOCAL
HEALTH DEPARTMENTS IN TWO WAYS.
FIRST IT LOWERS THE BLOOD LEAD
LEVEL REFERENCE VALUE. UH 23.5
VERSUS THE FIVE TO ALIGN WITH
THE CENTERS FOR DISEASE CONTROL
AND PREVENTION. THIS RESULTS IN
INCREASED NUMBERS OF CHILDREN
REQUIRING CASE MANAGEMENT AND,
UH IT RESULTS IN A LONGER
DURATION FOR CASE MANAGEMENT
BECAUSE YOU HAVE TO GET KIDS
DOWN TO BELOW THE 3.5 LEVEL NOW.
THIS COUPLE WORK ALSO ADDS NEW
PRIMARY PREVENTION ACTIVITIES
THAT INCLUDES ROUGHLY 100 TASKS
ARE UP TO 100 TASKS THAT LOCAL
HEALTH DEPARTMENTS ARE
RESPONSIBLE FOR COMPLETING MANY
OF THOSE TASKS ARE ENTIRELY NEW
REQUIREMENTS FOR LOCAL HEALTH
DEPARTMENTS. IT'S UNCLEAR TO US
HOW THE STATE ESTIMATED THE FTS
AND SALARIES NEEDED TO COMPLETE
THIS WORK GIVEN LOCAL HEALTH
DEPARTMENTS DO NOT REPORT IN
THAT MANNER TO BETTER UNDERSTAND
WHAT THE ACTUAL COSTS WERE WITH
IMPLEMENTING THESE NEW
REQUIREMENTS. SHE BEGAN TO
OUTREACH TO OUR MEMBERS. WHILE
THIS PROCESS IS STILL UNDERWAY,
WE KNOW THAT WITH JUST 11
JURISDICTIONS RANGING FROM VERY
LARGE TO SMALL COUNTIES, THEY
NEED ROUGHLY 19 MILLION TO FULLY
IMPLEMENT THE SCOPE OF WORK
REQUIREMENTS, THE CURRENT
ALLOCATION FOR THOSE SAME
JURISDICTIONS ARE IS ROUGHLY 7.6
MILLION. WE'RE CONCERNED THAT
LOCALS WILL HAVE INCREASED
RESPONSIBILITIES WITHOUT
SUFFICIENT FUNDING TO CARRY OUT
THOSE DUTIES, AND IN THAT CASE,
HE'D PH SHOULD EXPECT LOCALS TO
RESPOND TO THE SCOPE OF WORK
IDENTIFYING WHAT WORK THEY CAN
CARRY OUT WITH THE LIMITED
LIMITED FUNDING, BUT NOT ALL. WE
HOPE THAT THE ADMINISTRATION WE
HOPE WE CAN WORK WITH THE
ADMINISTRATION AND LEGISLATURE
TO FINE TUNE THE FUNDING REQUEST
TO SUPPORT LOCAL HEALTH
DEPARTMENTS AND CARRYING OUT
BOTH CASE MANAGEMENT AND PRIMARY
PREVENTION. AND I WOULD JUST
NOTE THAT THERE IS A FUN
BALANCE, HOWEVER, IF FULLY
FUNDING LOCAL HEALTH
JURISDICTIONS WOULD EXCEED THE
FUND BALANCE, THEN WE WOULD
RECOMMEND INCREASING THE FEED TO
COMPENSATE FOR THAT. THANK YOU
FOR THE OPPORTUNITY PROVIDER
MARKS AND I'M HAPPY TO ANSWER
QUESTIONS WHEN APPROPRIATE.
PERMANENT FINANCE. AH NICK MILLS
DEPARTMENT OF FINANCE. UH,
NOTHING FURTHER TO ADD THE
AVAILABLE TO ANSWER QUESTIONS,
ELIO WILL OWNS A LEO. WE HAVE NO
COMMENT AT THIS TIME. BRING IT
UP TO THE DIOCESE FOR ANY
MEMBERS, QUESTIONS. I'LL KEEP IT
HERE JUST FOR A SECOND. I WANT
TO GIVE THE ADMINISTRATION A
CHANCE TO RESPOND TO JACK. IT
SEEMS THAT WITH THE DECREASE
FROM 5 TO 3.5 THAT THERE'S
SIGNIFICANT INCREASE IN WORKLOAD
, BOTH FOR PRIMARY PREVENTION
AND FOR CASE MANAGEMENT. AND IN
LIGHT OF THE REQUEST, DOESN'T IT
MAKE SENSE FOR US TO CONSIDER
THOSE FEES AND TO EVALUATE SINCE
YOU HAVE THE STATUTORY
AUTHORITY? WE ARE CONTINUING. WE
DO CONTINUE TO ASSESS THIS
ANNUALLY AND WE ARE COMMITTED TO
WORKING WITH JACK AND HAVE THEIR
CONCERNS AND BUILDING THAT
PARTNERSHIP. WELL, THE SOONER
YOU DO IT THE BETTER AS THERE'S
NO AMOUNT OF LEAD THAT'S SAFE
FOR OUR CHILDREN. AND I'M
APPRECIATIVE THAT WE'RE MOVING
IN THE RIGHT DIRECTION, BUT IT
THEN REQUIRES US TO BE UM,
STAFFING. AND PROVIDING THE
RESOURCES TO ADDRESS THE ISSUE.
HEAD ON. UM I WOULD ENCOURAGE
YOU TO GET THERE AS QUICKLY AS
YOU CAN. WITH THAT I WILL THANK
VERY MUCH. PANEL THREE AND WANDA
ISSUE FOR.
ISSUE FOUR IS ON MISSUS
DIVERSITY, EQUITY AND INCLUSION
. STRATEGIC PLAN DEVELOPMENT BCP
. WE WILL BEGIN WITH KIM LOU,
WHO IS THE CHIEF OF PERSONNEL
FOR IMSA. PLEASE BEGIN WHEN YOU
ARE READY.
GOOD AFTERNOON. THANK YOU FOR
THE INVITATION TO COME AND SPEAK
WITH YOU TODAY. MY NAME IS KIM
LOU. I AM THE AMS AUTHORITY,
KNOWN AS MEMES AS DIVISION CHIEF
OVER THE M S PERSONNEL DIVISION.
TO THE LEFT OF ME IS RICK
TRUSSELL. HE IS OUR DIVISION
CHIEF OVER OUR ADMINISTRATION
DIVISION. AS REQUESTED. I AM
HERE TO PRESENT THE DIVERSITY
EQUITY AND INCLUSION STRATEGIC
PLAN DEVELOPMENT BUDGET PROPOSAL
CURRENTLY UNDER CONSIDERATION.
AND WE'LL ALSO RESPOND TO ANY
QUESTIONS RAISED AT THE END OF
MY PRESENTATION. EXCUSE ME.
DIVERSITY EQUITY AND INCLUSION.
IT'S SOMETHING THAT WE HAVE NOT
HAD MUCH OF AN OPPORTUNITY TO
LOOK INTO WITHIN OUR DEPARTMENT
AS SUCH, WE ARE ASKING THROUGH
THIS PROPOSAL OR REQUESTING
$100,000 IN GENERAL FUND FOR THE
2023 24 YEAR TO CONTRACT WITH A
CONSULTANT TO ASSIST IN THE
DEVELOPMENT OF A DIVERSITY
EQUITY AND INCLUSION STRATEGIC
PLAN. THAT ALIGNS WITH THE
CALIFORNIA HEALTH AND HUMAN
SERVICES INITIATIVES THAT YOU
HAD HEARD EARLIER TODAY. UM THIS
WILL HELP TO REDUCE HEALTH
INEQUITIES AND DISPARITIES AND
TO SUPPORT THE AMS AUTHORITIES
STRATEGIC PRIORITIES. AS WE'VE
HEARD, HEALTH EQUITY HAS BEEN A
KEY FOCUS OF THE ADMINISTRATION
AND THE COVID 19 PANDEMIC HAS
ACCELERATED THAT NEED FOR
ADDITIONAL ACTION. IT IS
CRITICAL THAT CALIFORNIANS OF
ALL AGES, ABILITIES AND
BACKGROUNDS HAVE EQUITABLE
ACCESS TO THE CONDITIONS THAT
OPTIMIZE THEIR HEALTH. THIS
WOULD INCLUDE PRE HOSPITAL MÁS.
THIS IS ESPECIALLY CRITICAL FOR
COMMUNITIES THAT HAVE
EXPERIENCED SOCIAL, ECONOMIC
DISADVANTAGES, HISTORICAL
INJUSTICES AND OTHER AVOIDABLE
SYSTEMIC INEQUITIES. TO DO THIS
. THE M S AUTHORITY MUST
COORDINATE WITH CAL H S. SO THAT
ITS POLICIES AND PROGRAMS ARE
STRATEGICALLY ALIGNED TO FURTHER
STATEWIDE EQUITY CALLS. AHH
JUSTICE GUIDING PRINCIPLES
INCLUDE A FOCUS ON EQUITY AND
EMPHASIS. THAT MUST BE THE BUST
SUPPORT AGENT DOES THIS AS A
LEADER IN THE FIGHT FOR EQUITY
AND STRIVE TO CREATE PROGRAMS
THAT ADDRESS PERSISTENT AND
SYSTEMATIC INEQUITIES. TO CREATE
A STATE WHERE CITIZENS CAN HAVE
THE OPPORTUNITY TO THRIVE. THIS
ALSO INCLUDES REMOVING FIRST OF
ALL IDENTIFYING AND REMOVING
BARRIERS THAT IMPEDE CERTAIN
GROUPS AND INDIVIDUALS FROM
ACHIEVING OPTIMUM HEALTH AND
WELLNESS BECAUSE OF THE COLOR OF
THEIR SKIN, GENDER IDENTITY,
SEXUAL ORIENTATION, AGE OR
DISABILITY. HEALTH EQUITY
WORKFORCE. DIVERSITY AND
INCLUSION ARE CRITICAL ELEMENTS
OF THIS MISSION AND OUR HAVE
LONGSTANDING BARRIERS TO HEALTH
AND WELLNESS OF THE DIVERSE
POPULATION THROUGHOUT
CALIFORNIA. BY APPROVING THIS
REQUEST. IT WILL ALLOW THE E M S
AUTHORITY TO CANADIANS SUPPORT
ITS MISSIONS AND ITS GOALS
IMPROVE THE SUSTAINABILITY OF
PRE HOSPITAL MÁS EQUITY AND
SOCIAL JUSTICE EFFORTS WITHIN
THE STATE, LOCAL PRIVATE AND
COMMUNITY BASED ORGANIZATIONS IT
WILL HELP TO IMPROVE THE M S
PATIENT OUTCOMES IN
DISADVANTAGED AND DISPARATE
COMMUNITIES ACROSS THE STATE. IT
ALSO ALIGNS WITH CALAIS J
JUSTICE MISSION OF CREATING
PATIENT FOCUS PROGRAMS.
ADDRESSING ACCESS TREATMENT AND
WORK STREAM TO COMBAT MÁS
HEALTHCARE DISPARITIES AND
WORKFORCE INITIATIVES. UM, AND
INEQUALITY. SOME OF THIS MONEY
WILL GO TOWARDS THE IMMENSE
AUTHORITY, MAXIMIZING COMMUNITY
PARTNERSHIPS AND STAKEHOLDER
COLLABORATIONS. WE WILL
INCORPORATE HEALTH EQUITY
CONCEPTS AND MEASURES INTO THE
AMS AUTHORITIES PROGRAMS AND
POLICIES. WE WILL CONDUCT A SWAT
STRENGTH, WEAKNESS,
OPPORTUNITIES AND THREATS,
ANALYSIS AND HELPING TO PLAN FOR
OUR FUTURE INITIATIVES. WE WILL
ALSO INCLUDE A VISION, OBJECTIVE
, STRATEGIC ALS AND TASKS ALONG
WITH ACTION ITEMS USING KEY
PERFORMANCE INDICATORS AND
BASELINE METRICS. WE WANT TO
DEVELOP MECHANISMS TO COLLECT
DETAILED E M S PERSONNEL
WORKFORCE DATA AS WELL. WE HAVE
IDENTIFIED THAT THERE IS SOME
DISPARITIES AND SOME CONCERNS
AMONG THE POP OUR POPULATION AND
JUST EVEN BEING COMFORTABLE. UM
HAVING E M S PERSONAL COME OUT,
PARTICULARLY IF THEY DON'T LOOK
LIKE OR SPEAK LIKE WHAT THEY'RE
USED TO IN THEIR OWN FAMILIES
AND BUSINESSES. SO WE'D LIKE TO
INVEST SOME OF THIS FUNDING INTO
LOOKING AT THE WORKFORCE AND
INCLUDING THE DIVERSITY THERE AS
WELL. WE ALSO WANT TO SECURE
TRAINING AND HOST FORUMS FOR
EMS, A STAFF. UM AND OUR
PARTNERS AND CREATE A WORKFORCE
TO ASSESS THE IMPACT OF UM S
WORKFORCE AND CULTURAL
COMPETENCY TRAINING FOR THOSE
VMS PERSONNEL AREN'T PATIENT
HEALTH OUTCOMES. AND THEN WE
WILL ALSO CONDUCT METRICS AND
PERFORMANCE INDICATORS TO
DETERMINE HOW THAT MIGHT LOOK
AND WHAT WE MIGHT WANT TO
ESTABLISH BENCHMARKS MOVING
FORWARD. SO THIS IS A
PRELIMINARY EFFORT TO DO AN
ASSESSMENT OF OUR DEPARTMENTS,
UM, AND THE SERVICES THAT WE
PROVIDE THROUGH THE WORKFORCE
AND WITH PATIENT OUTCOMES. THANK
YOU. MR TRUSSELL COMMENT. THANK
YOU. DEPARTMENT OF FINANCE.
SELENA AND RALEIGH DEPARTMENT OF
FINANCE. NOTHING FURTHER. TAD
WILL OWNS A LEO. WE HAVE NO
CONCERNS WITH THIS PROPOSAL.
BRING IT UP TO THE DIESS, DR
JACKSON. THANK YOU VERY MUCH FOR
THIS ITEM. OBVIOUSLY VERY
IMPORTANT. AND THANK YOU FOR
BEING PROACTIVE IN DOING SO. MY
ONLY QUESTION REGARD IS IN
REGARDS TO THE UMBRAGE DIVERSITY
THAT. EXIST IN CALIFORNIA,
RIGHT? OF COURSE. FARMER AMS
WORKER AND I'M IN THE SAN JOSE
AREA, TOTALLY DIFFERENT
POPULATION AND CULTURES THAT
COME WITH THAT. LIKE IF YOU'RE
TRYING TO SAVE LIVES, YOU HAVE
TO UNDERSTAND THE CULTURES ARE
VERY FEW PEOPLE. DIFFERENT FROM
L, A COUNTY DIFFERENT FROM
COACHELLA FARMWORKER AREA, RIGHT
? HOW ARE YOU GOING TO, UM.
DESIGNED IN A WAY THAT ALLOWS
PEOPLE TO REALLY UNDERSTAND THAT
THERE'S STILL SOME UNIQUENESS,
DEPENDING ON THE POPULATIONS
THEY SERVE IN THE DIFFERENT
GEOGRAPHIC AREAS OF CALIFORNIA.
GREAT QUESTION. THANK YOU. YEAH,
I. WE ARE SMALL DEPARTMENT, BUT
WE UNDERSTAND THE IMPACT THAT
THIS IS GOING TO BE OR COULD BE
. SO OUR INTENTION OF HAVING A
CONSULTANT COME IN IS TO LOOK AT
WHAT WE SHOULD AND TO DO. AN
ASSESSMENT ACROSS THE STATE,
WHICH WOULD INCLUDE HAVING THAT
CONSULTANT ALONG WITH SOME OF
THE STAFF THAT I CURRENTLY HAVE
, ALONG WITH THE LOCAL EMS
AGENCIES AND COMMUNITY BASED
ORGANIZATIONS GETTING TOGETHER
TO HAVE THAT VERY DISCUSSION.
AND WHAT THAT MIGHT LOOK LIKE
FOUR OR M S PERSONNEL IN
REQUIRED TRAINING, CONTINUING
EDUCATION, CULTURAL COMPETENCIES
, AS WELL AS EMPLOYERS IN HIRING
PRACTICES FOR DIVERSE
INDIVIDUALS, AND WE WANT TO TALK
TO ON THE OTHER SIDE OF THAT THE
COMMUNITY BASED ORGANIZATIONS OF
THOSE DISPARATE FAMILIES AND THE
BUSINESSES IN THOSE COMMUNITIES
, SO WE HAVE TO START SOMEWHERE
AND THAT'S PART OF THIS INITIAL
ASSESSMENT. IT WILL COME LATER
DOWN THE ROAD ONCE WE'VE
IDENTIFIED OUR DEFICIENCIES.
THANK YOU. YOU'RE WELCOME. I
WILL. THANKS VERY MUCH. THIS
PANEL WE WILL NOW MOVE ON TO
ISSUE FIVE. THANK YOU. THANK
YOU. ISSUE FIVE IS ON THE
DEPARTMENT OF HEALTH CARE
SERVICES. CALIFORNIA CANCER
EQUITY ACT, BCP. LORIE WALKER,
THE DEPUTY DIRECTOR AND CHIEF
FINANCIAL OFFICER WITH THE HCS
IS GOING TO START WHEN YOU'RE
READY. GOOD AFTERNOON. I'M LAURA
WALKER. I'M THE DEPARTMENT'S
CHIEF FINANCIAL OFFICER. THE
DEPARTMENTS REQUESTING THREE
PERMANENT POSITIONS, ONE LT
POSITION CONTRACT RESOURCES AND
EXPENDITURE AUTHORITY OF
APPROXIMATELY $1.1 MILLION.
RESOURCES ARE NEEDED TO DEVELOP
AND IMPLEMENT GOOD FAITH EFFORT
CONTRACTING REQUIREMENTS FOR
MEDICAL MANAGED CARE HEALTH
PLANS, DEVELOP AND IMPLEMENT A
CANCER CENTER REFERRAL PROGRAM
FOR ENROLLEES WITH A COMPLEX
CANCER DIAGNOSIS. DEVELOP A
PROCESS IN CONSULTATION WITH
APPROPRIATE STAKEHOLDERS TO
CONTINUALLY UPDATE AND FURTHER
DEFINE COMPLEX CANCER DIAGNOSIS
FOR PURPOSES OF THE REFERRAL
PROGRAM. AND CONDUCT ONGOING
MONITORING AND OVERSIGHT OF
MANAGED CARE PLANS AND TAKE
CORRECTIVE ACTION WHEN NECESSARY
. THE BILL REQUIRES MANAGED CARE
PLANS TO MAKE GOOD FAITH EFFORTS
TO INCLUDE AT LEAST ONE NATIONAL
CANCER INSTITUTE DESIGNATED
CANCER CENTER OR QUALIFYING,
ACADEMIC CANCER CENTER WITHIN
THEIR CONTRACTED AND
SUBCONTRACTED PROVIDER NETWORKS
WITHIN EACH COUNTY IN WHICH THEY
OPERATE. FOR THE PROVISION OF
MEDICALLY NECESSARY SERVICES TO
MEMBERS DIAGNOSED WITH A COMPLEX
CANCER DIAGNOSIS. ELIGIBLE
MEMBERS HAVE THE RIGHT TO
REQUEST REFERRALS TO THESE IN
NETWORK CANCER CENTERS AND
INSTANCES WHERE AN M C P IS
UNSUCCESSFUL, AND IT'S GOOD
FAITH CONTRACTING EFFORTS,
MEMBERS CAN STILL REQUEST
REFERRAL TO AN OUT OF NETWORK
CANCER CENTER. HOWEVER, THE
ACCESS IS LIMITED TO WHEN THE M
C P AND THE OUT OF NETWORK
CANCER CENTER ARE ABLE TO COME
TO AGREEMENT IN TERMS OF
PAYMENT. THE REQUESTED RESOURCES
WILL WORK TO DEVELOP A
DEFINITION OF A COMPLEX CANCER
DIAGNOSIS AND A STAKEHOLDER
PROCESS FOR UPDATING AND
DEFINING THE DIAGNOSIS ON A
PERIODIC BASIS. THERE'S NO
STANDARD DEFINITION OF A COMPLEX
CANCER DIAGNOSIS AT THIS TIME,
AND THIS WOULD REQUIRE EXTENSIVE
CLINICAL EXPERTISE AND A PROCESS
TO COME TO CONSISTENT ON SUCH A
DEFINITION. SUBJECT MATTER.
EXPERTS NEEDED TO DIFFERENTIATE
WHAT COULD WHAT SHOULD BE
INCLUDED IN THE DEFINITION OF A
COMPLEX CANCER DIAGNOSIS AND TO
CONDUCT ONGOING REVIEW AND
MAINTENANCE OF THE LIST OF
ELIGIBLE DIAGNOSIS. CURRENTLY
DHC S DOES NOT HAVE A SUBJECT
MATTER EXPERT WITH AN ONCOLOGY
BACKGROUND WHO CAN MANAGE THE
BILL'S REQUIREMENTS. HAPPY TO
TAKE YOUR QUESTIONS. DEPARTMENT
OF FINANCE UH, INTRODUCTION
FINANCE NOTHING FURTHER. JASON
KANSEN, TOURO, CELIO. WE HAVE
NOT RAISED CONCERNS WITH THIS
PROPOSAL. BRING IT UP TO THE
DIOCESE TO SEE IF THERE ARE ANY
MEMBERS QUESTIONS SEEING NONE. I
WILL. THANKS VERY MUCH. THIS
PANEL WE WILL MOVE ON TO ISSUE
SIX. ISSUE SIX IS ON THE $1
PREMIUM SUBSIDY AUGMENTATION
PROPOSAL THAT COVERED CALIFORNIA
, WHICH WILL BE PRESENTED BY THE
DEPARTMENT OF FINANCE. I BELIEVE
IT'S JOSEPH DONALDSON.
ALL RIGHT. GOOD AFTERNOON CHAIR
COMMITTEE MEMBERS, JOSEPH
DONALDSON DEPARTMENT OF FINANCE.
UNDER THE FEDERAL AFFORDABLE
CARE ACT, FEDERAL DOLLARS ARE
NOT ALLOWED TO BE USED TO
PROVIDE ABORTION SERVICES WHEN
THE WAS PASSED PLANS THAT
COVERED ABORTION SERVICES WOULD
CHARGE CONSUMERS A FLAT PREMIUM
OF NO LESS THAN $1 PER MONTH TO
NOT VIOLATE FEDERAL POLICY.
BECAUSE CALIFORNIA LAW MANDATES
ALL PLANS TO COVER ABORTION
SERVICES. ALL CONSUMERS WERE
IMPACTED IN THUS REQUIRED TO
PLAY THIS $1 MONTHLY PREMIUM. AS
A RESULT, THE 2021 BUDGET ACT
INCLUDED A 20 MILLION GENERAL
FUND ONGOING APPROPRIATION FOR
COVERED CALIFORNIA TO MAKE THESE
PAYMENTS ON BEHALF OF
INDIVIDUALS IMPLANTS THROUGH THE
EXCHANGE EQUAL TO THE COST OF
THESE MONTHLY PREMIUMS. THIS
PROGRAM WOULD BE CALLED THE $1
PREMIUM SUBSIDY SUBSIDY PROGRAM.
NOW DUE TO INCREASED ENROLLMENT
COVERED CALIFORNIA'S REQUESTING
AN AUGMENTATION OF 350,000,
ONGOING TO ITS ORIGINAL
APPROPRIATION. THE CURRENT
APPROPRIATION IS NOT SUFFICIENT
, PROVIDED THE SOURCE IS, UM AT
THIS TIME AND THIS INCREASED
EXPENDITURE AUTHORITY WILL SERVE
AN ESTIMATED 29,000 ADDITIONAL
ENROLLEES. NOW IT'S IMPORTANT TO
NOTE THAT THIS PROPOSAL IS FOR
23 24 ONGOING UM, HOWEVER,
DEPARTMENT FINANCE IN
COLLABORATION WITH COVER,
CALIFORNIA SUBMITTED AND
APPROVED JAIL. BC LETTER UM
INCREASING THIS APPROPRIATION
FOR THE CURRENT YEAR PURSUANT TO
CURRENT LAW COMMUNITY HAD A
QUESTION RELATED. TO THIS
PROPOSAL, ASKING IF THERE'S A
WAY TO FUND THIS BASED ON
ENROLMENT ESTIMATES. AT THIS
TIME, THE ADMINISTRATION DOES
NOT BELIEVE IT IS NECESSARY TO
APPROACH THE PROGRAM IN THIS
MANNER AS THIS PROGRAM HAS BEEN
FULLY FUNDED TO MEET ANTICIPATED
DEMAND THROUGH THE BUDGET
PROCESS, THESE REPRODUCTIVE
HEALTH SERVICES ARE AND CONTINUE
TO BE A HIGH PRIORITY, AND THE
DEPARTMENT FINANCE HAS WORKED
WITH COVER CALIFORNIA TO STAY
PRICE OF ANY BUDGET NEEDS.
ADDITIONALLY WE HAVE THE
NECESSARY MECHANISMS THROUGH
CURRENT LAW TO MAKE ADJUSTMENTS
AS NEEDED. AND AS SUCH, UM,
APPROACHING THE PROGRAM IN THIS
MANNER WOULD NOT BE NEEDED AND
HAPPY TO ANSWER ANY QUESTIONS
YOU MAY HAVE. MR. OH, GILERA, IF
YOU HAVE ANY COMMENTS I HAVE
NOTHING TO ADD ELIO LUCAS MOURA
WITH THE LEGISLATIVE ANALYST'S
OFFICE. UM AS THE ADMINISTRATION
NOTED, ENROLLMENT AND COVERED,
CALIFORNIA HAS INCREASED
SUBSTANTIALLY IN RECENT YEARS,
AND AS SUCH, WE DO FIND IT
REASONABLE TO MAKE AN
AUGMENTATION, UM, TO ACCOUNT FOR
THE ENROLLMENT TRENDS THAT SUCH
AS WHAT THE ADMINISTRATION IS
PROPOSING. HOWEVER RATHER THAN
MAKING AN ONGOING ARGUMENTATION
OF $350,000, THE LEGISLATURE
COULD CONSIDER DIRECTED
ADMINISTRATION TO ADJUST THE
APPROPRIATION BASED ON
FORECASTED ENROLMENT. WE NOTE
THAT COVERED CALIFORNIA ALREADY
DOES FORECASTS, UM OF THEIR
ENROLLMENT. AND, UM THERE ARE
SIMILAR TYPES OF ADJUSTMENTS
MADE IN OTHER PARTS OF THE
BUDGET, INCLUDING IN THE
DEPARTMENT OF HEALTH CARE
SERVICES BUDGET AND THE
CALIFORNIA DEPARTMENT OF
CORRECTIONS AND REHABILITATION.
UM A POPULATION BASED ADJUSTMENT
WOULD HELP ENSURE THE PROGRAM IS
APPROPRIATELY FUNDED, BASED ON
THE NUMBER OF INDIVIDUALS
ENROLLED IN COVERED CALIFORNIA
PLANNED IN A GIVEN YEAR, AND WE
NOTE THAT OVER THE NEXT FEW
YEARS, ENROLLMENT AND COVERED
CALIFORNIA PLANS COULD FLUCTUATE
CONSIDERABLY DUE TO A NUMBER OF
FACTORS, INCLUDING THE END OF
THE CONTINUOUS COVERAGE
REQUIREMENT IN MEDICAL WHICH
WILL RESULT IN A DECLINE IN
MEDICAL ENROLLMENT AND
POTENTIALLY RESULTING IN AN
INCREASE IN PEOPLE SHIFTING TO
COVERED CALIFORNIA, IN ADDITION
, ENHANCED FEDERAL PREMIUM
SUBSIDIES AND COVERED CALIFORNIA
ARE EXPECTED TO, UH AND AT THE
END OF CALENDAR YOUR 2025, WHICH
COULD RESULT IN A REDUCTION IN
COVERED CALIFORNIA ENROLLMENT,
AND THEY'RE ALSO POTENTIAL
CHANGES THE STATE MAY MAKE IN
TERMS OF FINANCIAL ASSISTANCE
PROVIDED BY THE STATE TO COVERED
CALIFORNIA. FRAWLEY'S SO DOING A
ADJUSTMENT BASED OFF OF
ENROLLMENT COULD ENSURE THAT THE
AMOUNT OF FUNDING AVAILABLE
REMAINS APPROPRIATE FOR THE
POPULATION TO ADDRESS THESE
ISSUES. THANK YOU. THANK YOU
BRING IT UP TO THE DIOCESE FOR
ANY MEMBERS QUESTIONS. I'LL KEEP
IT HERE AT THE CHAIR. FIRST I
JUST WANT TO ST HOW SUPPORTIVE I
AM OF THE PROPOSAL OVERALL, BUT
WOULD LIKE TO FOLLOW UP ON WHAT
THE L. A IS COMMENTING REGARDING
ENROLLMENT TRENDS AND WHY WE
AREN'T DOING POPULATION BASED
ADJUSTMENTS AS WE DO WITH
ANOTHER TH CS PROGRAMS. YOUR
ANSWER EARLIER WAS YOU DON'T YOU
DON'T BELIEVE IT'S NEEDED. BUT
SHOULDN'T WE BASE IT ON
POPULATION SO WE CAN GET
ADEQUATE. UM PROJECTIONS SO WE
CAN BUILD THE BUDGET OUT OR WHY
ARE WE NOT LOOKING AT NUMBER OF
PEOPLE SERVED IN ARE SIMPLY
LOOKING AT A FLAT NUMBER.
MEDICAL CARE FOR FINANCE. UM YOU
KNOW, THERE ARE SEVERAL
ENTITLEMENTS IN THE STATE. AS
YOU KNOW, THERE'S ALSO OTHER
PROGRAMS THAT ARE JUST FUNDED
SUBJECT TO THE FUNDS PROVIDED
AND I THINK IN THIS CASE, IT
FALLS UNDER THE LATTER CATEGORY.
HOWEVER YOU KNOW, MANY OF THOSE
PROGRAMS ARE TREATED LIKE AN
ENTITLEMENT IN THAT IS THERE IS
THERE ENROLLMENT CHANGES YOU
KNOW, THROUGH OUR NORMAL BUDGET
PROCESS. WE'RE ADDRESSING THAT.
THROUGH OUR NORMAL BUDGET
PROCESS, SO THAT'S THAT'S WHERE
WE'VE BEEN HANDLING THIS
PROGRAM. IT, IS IT. IF IT'S NOT
AN ENTITLEMENT. DOESN'T THAT
THEN MEAN WE'RE ONLY COVERING IT
FOR SOME PEOPLE. AND HAVEN'T WE
BEEN PRETTY CLEAR ABOUT WHO WE
ARE AS A STATE OF CALIFORNIA?
AND ENSURING THAT ALL WHO WISH
TO ACCESS REPRODUCTIVE SERVICES
ARE GOING TO BE GIVEN THAT
OPPORTUNITY, SO IT SEEMS
CONTRARY TO ME A BIT AND REALLY
I WOULD LIKE TO EVALUATE THESE
POPULATION BASED ADJUSTMENTS AS
A WAY TO ENSURE THEY WERE RIGHT.
SIZING THE PROPOSAL GOING
FORWARD. WITH THAT I WILL.
THANKS VERY MUCH. THIS PANEL
ALONG THE BOND ISSUE SEVEN.
ISSUE. SEVEN IS CD PHS
FACILITATING PROJECTS TO BENEFIT
NURSING HOME RESIDENTS, BCP. WE
WILL HAVE MICHELLE BELL OFFICE
OF INTERNAL OPERATIONS CHIEF. IN
THE CENTER FOR HEALTH CARE
QUALITY AT CD PH, WHO WILL BEGIN
HELLO THERE. I ALSO HAVE CAN YOU
HEAR ME? OK ALSO HAVE CHELSEA
DRISCOLL ARE PUBLIC POLICY,
PUBLIC POLICY AND PREVENTION
DIVISION CHIEF WITH ME TODAY.
OKAY? MUCH BETTER. QUÊ IS
REQUESTING AN INCREASE IN LOCAL
ASSISTANCE EXPENDITURE AUTHORITY
OF FIVE MILLION IN 23 24. FIVE
MILLION IN 24 25 3 MILLION IN 25
26 FOR THE FEDERAL HEALTH
FACILITIES CITATION PENALTIES
ACCOUNT. CD PH ALSO REQUEST
PROVISIONAL LANGUAGE TO EXTEND
THE EXPENDITURE AND ENCUMBRANCE
AUTHORITY THROUGH JUNE 30TH
2027. CIVIL MONEY PENALTY, OR
RCMP FUNDS ARE PENALTIES THAT
ARE COLLECTED FROM NURSING HOMES
THAT ARE NOT IN COMPLIANCE WITH
FEDERAL REGULATIONS. THESE FUNDS
ARE REINVESTED Tð. SUPPORT CMS
APPROVED PROJECTS THAT PROTECT
OR IMPROVE THE QUALITY OF LIFE
OF NURSING HOME RESIDENTS. THESE
FUNDS WILL ALLOW SIRI PH TO
EXECUTE CONTRACTS FOR CURRENT
AND MULTI YEAR PROJECTS IN A
TIMELY MANNER. IS THAT IS THAT
THE CONCLUSION OF YOUR
DEPARTMENT OF FINANCE? NICK
MILLS DEPARTMENT OF HAVE
ANNOUNCED NOTHING FURTHER TO ADD
ELIO WILLOW AND DELAY SO WE HAVE
NO CONCERNS WITH THIS PROPOSAL
WILL BRING IT UP TO THE DIOCESE
. SEE IF THERE'S ANY MEMBERS
QUESTIONS I WILL JUST UPLIFT HOW
IMPORTANT IT IS TO PERSON
CENTERED CARE. ONE OF THE
EXAMPLES THAT CAME FROM THIS WAS
LIFE BIOS, WHICH TOOK TIME TO
TELL THE LIFE STORIES OF NURSING
HOME RESIDENTS SO THAT THOSE WHO
ARE WORKING AT THE NURSING HOME
UM, UNDERSTOOD A LITTLE BIT MORE
ABOUT SEEING THEM AND LISTENING
TO THEIR STORIES I THINK IS VERY
IMPORTANT INVESTMENT, AND I'M
GRATEFUL THAT THE ADMINISTRATION
HAS THIS PROPOSAL. WITH THAT I
WILL. THANKS VERY MUCH THIS
PANEL AND WE WILL MOVE ON TO
ISSUE EIGHT. ISSUE EIGHT IS THE
INTERNAL DEPARTMENT QUALITY
IMPROVEMENT ACCOUNT. PROVISIONAL
LANGUAGE PROPOSAL. MISS BELL
WHEN YOU ARE READY FOR ANY
POTENTIAL PROJECTS THAT MAY
EXCEED THE EXISTING ACCOUNT
EXPENDITURE AUTHORITY. CITY PH
IS REQUESTING PROVISIONAL
LANGUAGE BE INCLUDED IN THE
BUDGET ACT THAT ALLOWS US TO
REQUEST FROM DUFF. THE ABILITY
TO INCREASE THAT EXPENDITURE
AUTHORITY FROM THE ACCOUNT AFTER
REVIEWING A REQUEST THAT WE
SUBMIT DEMONSTRATING NEED FOR
THAT ADDITIONAL AUTHORITY. THIS
LANGUAGE WELL, NEW ALLOW CHC QUÊ
TO IDENTIFY QUALITY IMPROVEMENT
ACTIVITIES THEY WOULD LIKE TO
FUND THROUGH THIS ACCOUNT AND TO
REQUEST EXPENDITURE AUTHORITY IN
THE CURRENT YEAR. DEPARTMENT OF
FINANCE DEPARTMENT OF HIGHLIGHTS
NOTHING FURTHER TO ADD ELIO WILL
OWENS. HELLO WE HAVEN'T RAISED
CONCERNS WITH THE PROPOSAL AT
THIS TIME. BRING IT UP TO THE
DIOCESE. DR JACKSON. WHAT WOULD
YOU USUALLY DO? UM, IF YOU
NEEDED TO MAKE A CHANGE WITH
THIS BE BUDGET CHANGE PROPOSAL
USUALLY CORRECT AND ARE
CONCERNED WITH THAT WOULD BE IT
WOULD CREATE UNNECESSARY DELAYS
IN THE PROCESS WE DO. WE'VE BEEN
MAKING A LOT OF INVESTMENTS IN
TERMS OF OUR PROGRAMS,
TECHNOLOGY AND EFFICIENCY IN
RECENT YEARS, AND WE DO HAVE
PROJECTS ON THE HORIZON, BUT AS
OF THIS POINT, THEY WEREN'T
NECESSARILY FAR ENOUGH ALONG IN
THE PAL PROCESS TO REQUEST FUNDS
AT THIS TIME. OKAY, UM. OKAY CAN
YOU GIVE ME AN EXAMPLE OF WHAT
WILL MAKE SOMETHING URGENT THAT
WITH NECESSITATE SOMETHING
FASTER THAN A BUNCH OF CHANGE
PROPOSAL. IS THERE SOMETHING
LIKE I'M JUST TRYING TO BE A NEW
? I'M A NEW KID HERE, SO YOU'RE
GONNA HAVE TO HELP ME VISUALIZE
IT? ABSOLUTELY UM SO WE
CERTAINLY WOULD SUBMIT A BUDGET
FRENCH PROPOSAL FOR A MAJOR
TECHNOLOGY ENHANCEMENTS. SO FOR
EXAMPLE, UM, WE'RE WE'RE HOPING
TO PROCURE AN ONLINE APPLICATION
SYSTEM FOR ALL OF OUR
APPLICATIONS, BUT PARTICULARLY
FOR SMALLER PROJECTS. UM. LET'S
SEE. ONE THAT WE MIGHT HAVE
COMING UP IS WHERE WE'RE LOOKING
TO, UM, PROCURE A WAY FOR US TO
SECURELY GET, UM AH
INVESTIGATION DOCUMENTS FROM
HEALTHCARE FACILITIES AND TO
REDUCE OUR STAFFS. RELIANCE ON
PAPER. UM THINGS LIKE THAT.
THEY'RE THEY'RE SMALL. UM, THEY
MIGHT NOT NECESSARILY UM. IT
HELPS US TO HAVE SOME
FLEXIBILITY THERE. I'M ALWAYS
FOR FLEXIBILITY. I'M JUST
CONCERNED THAT THIS IS A LITTLE
BIT TOO BROAD AND THAT SPECIFIC
MEANING? AT WORK, TOO. UM, AT
WHAT POINT AT WHAT NUMBER DOLLAR
NUMBER? WOULD YOU REQUEST TO BCP
RIGHT, LIKE THERE'S NO CEILING
HERE WHEN IT COMES TO AND EVEN
THOUGH ONE PROJECT MAYBE LITTLE
WHAT IF THERE'S MULTIPLE THINGS
THAT NEED TO HAPPEN, RIGHT? SO
I'M TRYING TO WE MIGHT JUST NEED
TO TIGHTEN UP THE LANGUAGE A
LITTLE BIT TO MAKING SURE THAT
WE'RE NOT JUST DOING A BLANK
CHECK KIND OF THING. UM BUT
CERTAINLY WANT TO FIND THAT
SWEET SPOT. FOR FLEXIBILITY, BUT
YET MAKING SURE THAT WE'RE DOING
OUR JOB IN TERMS OF
ACCOUNTABILITY AS WELL. THANK
YOU, MR CHAIR. DOCTOR WOULD.
THANK YOU, MR CHAIR. I JUST DID
I HEAR YOU SAY THAT COMPLAINTS
ARE BEING FILED ON PAPER STILL.
UM NO. SO WE HAVE, UM, WE'VE
USED THESE FUNDS TO IMPLEMENT IN
PAST YEARS. A UM, AN ONLINE
SYSTEM THAT ALLOWS OUR STAFF TO
DO COMPLAINT INVESTIGATIONS. UM
BUT NOT ALL OF THE ELEMENTS OF
THE PROCESS OF FULLY ELECTRONIC
SO, FOR EXAMPLE, WE STILL HAVE
HEALTH FACILITIES THAT MAY WANT
TO HAND US PAPER. AS PART OF AN
INVESTIGATION AND WHAT I WAS
REFERRING TO WAS THE NEED TO
HAVE A SECURE ELEKTRONIK WAY TO
COLLECT DOCUMENTS SUCH AS THAT.
THANK YOU. I'M SORRY WITH IT. I
WILL SHARE MY CONCERNS OF DR
JACKSON AND LOOK FORWARD TO THE
DISCUSSIONS AS WE MOVE FORWARD.
THANK VERY MUCH PANEL EIGHT AND
MOVE ON TO ISSUE NINE. ISSUE
NINE AS A PROPOSED TRAILER BILL
ON THE REMOVAL OF THE FEDERAL
HEALTH FACILITIES. CITATION
PENALTIES ACCOUNT AWARD LIMIT WE
WILL BEGIN WITH MISS BELL. OKAY
SO IN 2007 A B 13 97 CREATED
SEPARATE PENALTY ACCOUNTS FOR
STATE AND FEDERAL CIVIL
PENALTIES AND ESTABLISHED A
$130,000 ANNUAL CAP ON THE
AMOUNT OF MONEY FROM THE F H F C
P ACCOUNT THAT CD PH ME SPEND
EACH YEAR PER PROJECT. THIS
AMOUNT HAS NOT INCREASED IN THE
15 YEARS SINCE THAT BILL'S
PASSAGE. THIS LIMIT CONFLICTS
WITH THE MANDATE THAT WE HAVE
FROM CMS TO SPEND DOWN THE
BALANCE OF THIS FUND ON PROJECTS
THAT IMPROVE THE LIVES OF
NURSING HOME RESIDENTS. ALTHOUGH
CMS DOES PROHIBIT COSTS THAT
APPEAR EXCESSIVE OR UNREASONABLE
. CMS DOES NOT SPECIFY A CEILING
AMOUNT FOR THESE PROJECTS.
ADDITIONALLY CMS HAS ALREADY
APPROVED MULTIPLE PROJECTS THAT
EXCEED THE CURRENT LIMIT. THIS
PROPOSAL WOULD ALIGN STATE LAW
WITH FEDERAL GUIDELINES. AT THE
END OF FISCAL YEAR. 21 22. THE
BALANCE OF THIS ACCOUNT WAS
APPROXIMATELY 13.9 MILLION. AND
IN CONSULTATION WITH CMS CD PHÐ
ALWAYS KEEPS 2 TO $3 MILLION
FUND RESERVE IN THE EVENT OF AN
ANTICIPATED EXPENDITURES OR
ADDITIONAL FUNDING FOR TEMPORARY
MANAGERS, PATIENT RELOCATION
EXPENSES, ETCETERA. REMOVING THE
SPENDING CAP IS NECESSARY TO
ALLOW CD PH TO FUND ASSUMING
SUFFICIENT NUMBER OF PROJECTS,
THEREBY IMPROVING THE LIVES OF
LONG TERM CARE FACILITY.
RESIDENTS AND SATISFYING CMS IS
GUIDANCE REGARDING SPENDING DOWN
THESE PENALTY FUNDS. DEPARTMENT
OF FINANCE MILLS DEPARTMENT OF
FINANCE NOTHING FURTHER TO ADD
HELIO LOANS. ELIO WE HAVE NO
CONCERNS WITH THIS PROPOSAL.
BRING IT UP TO THE DIOCESE FOR
ANY MEMBERS, QUESTIONS. I'LL
KEEP IT HERE AT THE CHAIR. I'M
VERY SUPPORTIVE OF THIS PROPOSAL
AS WE NEED TO UPDATE MORE OFTEN
THAN EVERY 15 YEARS ON A HARD
CAP. ESPECIALLY IN LIGHT OF THE
FACT THAT CMS HAS ALREADY
APPROVED SOME OF THE
APPLICATIONS THAT EXCEED THAT
CAP. IT'S TIME FOR THE STATES TO
MAKE THE CHANGE. WITH THAT. I
WILL THANK VERY MUCH PANEL NINE.
WE WILL MOVE ON TO ISSUE 10.
ISSUE 10 IS ALSO PROPOSED
TRAILER BILL ON THE RADIOLOGIC
HEALTH BRANCH LICENSING AND
CERTIFICATION. THIS PROPOSAL IS
BEING PRESENTED BY MYRON KLEIN,
DIRECTOR FOR THE CENTER FOR
ENVIRONMENTAL HELP AT C D. PH
PLEASE BEGIN WHEN YOU'RE READY.
SURE. GOOD AFTERNOON. SO THIS
PROPOSAL WILL MAKE CHANGES TO
LICENSE CHAIR, DENIAL,
SUSPENSION OR REVOCATION
PROCEDURES FOR MEDICAL, EXTREME
MACHINE AND RADIOACTIVE MATERIAL
USERS. CURRENTLY, CITY PH IS
ONLY ABLE TO TAKE DISCIPLINARY
ACTIONS ON LICENSES FOR CRIMES
SPECIFICALLY COMMITTED. DURING
THE PERFORMANCE OF AN X RAY
DUTY. CURRENT LAW PREVENTS CITY
PH FROM TAKING DISCIPLINARY
ACTION ON A LICENSEE WHO HAS
BEEN CONVICTED OF A CRIME THAT
IS SUBSTANTIALLY RELATED TO
THEIR DUTIES. THESE PROPOSED
CHANGES WILL BRING THE
DEPARTMENT LICENSING PROGRAM
INTO ALIGNMENT WITH EXISTING
STANDARDS FOR SIMILAR LICENSES
THAT ARE ALREADY ISSUED BY OTHER
STATE ENTITIES SUCH AS THE
CALIFORNIA PODIATRIC MEDICINE
BOARD, THE PHARMACY BOARD AND
THE PHYSICAL THERAPY BOARD. THE
PROPOSAL ALSO EXPERIENCE THE
CIVIL PENALTY AUTHORITY THAT THE
DEPARTMENT CURRENTLY HAS TO
COVER ALL THE STATUTORY AND
REGULATORY VIOLATIONS RELATED TO
MEDICAL, RADIOACTIVE MATERIAL
AND EXTRA MACHINE USE. HAPPY TO
ANSWER ANY QUESTIONS IF YOU HAVE
DEPARTMENT OF FINANCE SELENA
NARROWLY DEPARTMENT OF FINANCE
NOTHING FURTHER TO ADD LOHAN'S
ELIO, WE HAVE NO CONCERNS WITH
THIS PROPOSAL. BRING IT UP TO
THE DIOCESE FOR ANY MEMBERS,
QUESTIONS. I'LL KEEP IT HERE AT
THE CHAIR. I JUST WANT TO
CLARIFY. SO CURRENTLY YOU'RE
ONLY ABLE TO CHARGE IF IT'S
REGARDING A MAMMOGRAPHY
PROCEDURE. IS THAT CORRECT?
CORRECT SO THE CIVIL PENALTY
AUTHORITY THAT WE CURRENTLY HAVE
THAT TOOL WE CAN ONLY USE IF AN
X RAY TECHNICIAN IS PERFORMING
ON MAMMOGRAPHY, X RAY, BUT ANY
OTHER X RAY? WE DON'T HAVE THE
AUTHORITY TO BE ABLE TO USE THAT
TOOL. SO THIS PROPOSAL WILL
EXPAND THAT. WHERE DID THE
ORIGIN OF THAT COME FROM? HOW
DID WE EXPANDED TO MAMMOGRAPHY
ONLY UM. I THINK IT'S BACK A FEW
DECADES AGO WHEN THE STATE
ADOPTED THE FEDERAL MAMMOGRAPHY
STATUTES AND THERE WAS SOMETHING
THAT WAS MISSED AT THAT TIME.
AND SO WE FINALLY HAVE DECIDED
THAT IT'S TIME TO KIND OF TO
RESOLVE THAT ISSUE. AS WELL AS
TECHNOLOGIES HAVE EVOLVED, WHICH
ALSO ARE MORE INVASIVE AND
REQUIRE US TO MAKE SURE THAT THE
LAWS WERE FOLLOWING THEM.
APPRECIATIVE OF THIS PROPOSAL
WITH THAT, I WILL THANK PANEL 10
AND WE WILL MOVE ON TO ASSURE
LEVEL.
ISSUE 11 IS ON TH CSS BCP ON THE
MEDICAL SHORT TERM COMMUNITY
TRANSITIONS PROGRAM. FIRST WE
HAVE LORIE WALKER, PLEASE BEGIN
WHEN YOU ARE READY. THANK YOU.
THE DEPARTMENT IS REQUESTING
EXTENSION OF TWO EXISTING
LIMITED TERM POSITIONS AND
EXPENDITURE AUTHORITY OF
$286,000 BEGINNING IN FISCAL
YEAR. 24 25 EXTENSION OF THESE
LIMITED TERM POSITIONS IS
NECESSARY TO ENABLE THE
DEPARTMENT TO CONTINUE TO
IMPLEMENT AND MAINTAIN THE
WORKLOAD FOR THE SHORT TERM
COMMUNITY TRANSITIONS PROGRAM.
THIS PROGRAM CREATES AN
EXPEDITED PATH FOR RESIDENTS IN
LONG TERM CARE INSTITUTIONS TO
RECEIVE TRANSITION COORDINATION
SERVICES TO ASSIST THEM WITH
TRANSITIONING TO COMMUNITY BASED
SETTING AND CONNECT THEM A LONG
TERM SERVICES AND SUPPORTS THAT
WILL THEY WILL NEED, UM, SORRY
THEY WILL NEED TO REMAIN AT HOME
OR IN THE COMMUNITY, THEREBY
REDUCING THE RISK OF EXPOSURE TO
COVID 19. THE SHORT TERM
COMMUNITY TRANSITION PROGRAM WAS
EXTENDED BY THE LEGISLATURE IN
RESPONSE TO ONGOING COVID 19
PUBLIC HEALTH EMERGENCY. THE CTP
PROGRAM FUNDS TRANSITION
SERVICES FOR BENEFICIARIES THAT
HAVE BEEN RESIDENTS OF LONG TERM
INSTITUTIONS FOR UP TO 60 DAYS.
IF A BENEFICIARY HAS BEEN A
RESIDENT FOR OVER 60 DAYS, THE
SERVICES ARE PROVIDED THROUGH A
COMPANION PROGRAM CALLED THE
CALIFORNIA COMMUNITY TRANSITIONS
PROGRAM, WHICH IS FUN FUNDED
THROUGH THE FEDERAL MONEY
FOLLOWS THE PERSON GROUND.
APPROVAL OF THIS PROPOSAL WILL
ALLOW THE DEPARTMENT TO CONTINUE
TO TRANSITION ELIGIBLE
INDIVIDUALS AND FROM INPATIENT
FACILITIES TO THE COMMUNITY
SETTING OF THEIR CHOICE SOONER
THAN WHAT WAS ALLOWED UNDER THE
MEDICAL HOME AND COMMUNITY BASED
SERVICES PROGRAM. AND GENERATE
ONGOING LONG TERM SAVINGS FOR
PROVIDING SERVICES TO
INDIVIDUALS AND THE COMMUNITY
INSTEAD OF MEDICAL INPATIENT
FACILITIES. THE DEPARTMENT
ACKNOWLEDGES THAT PREVIOUS
UNCERTAINTY ABOUT THE CONTINUED
FEDERAL FUNDING FOR THE MONEY
FOLLOWS THE PERSON GRANT PROGRAM
DIRECTLY IMPACTED PROVIDER
PARTICIPATION IN THE CCT PROGRAM
AND SUPPORTS PERMANENT EXTENSION
OF THE MONEY FOLLOWS THE GRANT
PROGRAM. THERE IS MORE STABILITY
IN THE CCT PROGRAM OVER THE LAST
TWO YEARS AS THE CENTERS FOR
MEDICARE AND MEDICAID SERVICES
HAS APPROVED FUNDING ALLOCATIONS
THROUGH 2027, WITH THE
FLEXIBILITY FOR STATES TO DRAW
DOWN AND EXPAND THE YEAR OF
FUNDING, PLUS FOUR ADDITIONAL
YEARS GOING TO 2031. THE
DEPARTMENT AGREES WITH
STAKEHOLDER FEEDBACK THAT THE
SERVICE IS MADE POSSIBLE THROUGH
THE CCT PROGRAM ARE CRITICAL AND
ASSISTING INDIVIDUALS TO ASSESS
TO ACCESS SERVICES AND SETTINGS
OF THEIR CHOICE AND HAS WORKED
THROUGH KELLYANNE TO ESTABLISH
THE INFRASTRUCTURE TO CONTINUE
TRANSITIONAL CASE MANAGEMENT AND
TRANSITION SERVICES THROUGH
ENHANCED CARE MANAGEMENT. HE
SUPPORTS. THIS BENEFIT AVAILABLE
THROUGH MANAGED CARE PLANS
IMPLEMENTED A NEW POPULATION
FOCUS. JANUARY 1ST OF 2023 FOR
ADULTS NURSING FACILITY.
RESIDENTS TRANSITIONING TO THE
COMMUNITY THAT WAS SPECIFICALLY
BUILT USING THAT MONEY FOLLOWS
THE PERSON CCT PROGRAM AS A
MODEL. THAT ALSO APPLIES TO THE
COMMUNITY SERVICES, NURSING
FACILITY. TRANSITION TO A HOME
AND COMMUNITY SUPPORT BENEFIT
THAT MANAGED CARE PLANS CAN
ELECT TO MAKE AVAILABLE.
BUILDING AND EXPANDING THE
AVAILABILITY OF INSTITUTIONAL
TRANSITION SERVICES THROUGH THE
STATE'S MEDICAL MANAGED CARE
DELIVERY SYSTEM REMOVES RELIANCE
ON A NON PERMANENT FUNDING
SOURCE AND WILL ALSO DRIVE THE
DEVELOPMENT OF THESE SERVICES
AND SUPPORTS AND COMMUNITIES
ACROSS THE STATE, WHERE THE CCT
PROGRAMS NOT CURRENTLY
AVAILABLE. IN REGARDS TO THE
REPORTING. EAST BAY INNOVATIONS
IS REQUESTING FROM THE
DEPARTMENT. IT'S UNCLEAR AT THIS
TIME. IF THIS IS A ONE TIME DATA
REQUEST OR REQUEST FOR ONGOING
REPORTING, THE DEPARTMENT SHOULD
BE ABLE TO PROVIDE THE
INFORMATION REQUESTED, ALTHOUGH
NOTING THAT DEMOGRAPHIC DATA
WILL BE DEPENDENT UPON THE DATA
THAT THE DEPARTMENT HAS REQUIRED
COLLECTION OF HISTORICALLY. OUR
NEXT SPEAKER IS TOM HINES, WHO'S
JOINING US FROM MOTLEY. I THANK
YOU. UM MY NAME IS TOM HINES AND
THE EXECUTIVE DIRECTOR OF A
NONPROFIT CALLED EAST BAY
INNOVATIONS. THEY INNOVATIONS IS
A. CALIFORNIA COMMUNITY
TRANSITION SERVICE PROVIDER, UM
, HAS BEEN TO 1009 UM E B I IS
TRANSITIONED 300 PEOPLE,
APPROXIMATELY 300 PEOPLE. FROM
SKILLED NURSING FACILITIES BACK
INTO THEIR OWN HOMES. UM THE
HISTORY OF CCT GOES BACK TO 2007
. IT WAS STARTED, UM, WHEN
CALIFORNIA DECIDED TO
PARTICIPATE IN A FEDERAL
DEMONSTRATION MEDICAID
DEMONSTRATION PROJECT CALLED
MONEY FOLLOWS THE PERSON UM. CCT
ASSISTS PEOPLE WITH BEN WHO ARE
MEDICAL BENEFICIARIES. YOU KNOW
, BANNON, UM, SKILLED NURSING
FACILITIES FOR LONGER THAN 60
DAYS. S¼ CT ENABLES PROVIDERS
LIKE EAST BAY INNOVATIONS TO
PROVIDE INTENSIVE HOUSING
SEARCHES FOR PEOPLE WHO ARE IN
SKILLED NURSING FACILITIES TO
LOCATE AND SECURE A HOME. TO
HELP PAY FOR DEPOSITS. FIRST
MONTH'S RENT CUPCAKE FOR
ACCESSIBILITY MODIFICATIONS. TO
MAKE THEIR NEW HOME, UH,
SUITABLE TO MOVE IN, CONSIDERING
THEIR DISABILITY AND MOBILITY TO
CHOOSE. UM ALSO, IT HELPS TO PAY
FOR SYSTEM TECHNOLOGY. UM THINGS
LIKE, UM LIFTS AND YOUR LISTS
OVERHEAD LIFTS UM. DOWNWARD AIRS
ADAPTIVE EQUIPMENT TO HELP
PEOPLE BE SAFE IN THEIR OWN
HOMES. UM. E B. I ABOUT 75% OF
THE FOLKS THAT WE'VE SERVED
THROUGH THE CT ARE FOLKS FROM,
UM COMMUNITIES OF COLOR AND 72%
ARE PEOPLE WHO ARE OVER 55 YEARS
OF AGE. UM E B. I ALSO CONNECTS
PEOPLE TO LONG TERM SERVICES AND
SUPPORTS LIKE IN HOME SUPPORT
SERVICES. AS A CCT PROVIDER. WE
HELP PEOPLE ACCESS SITES FAST
AND THEN HIRE AND TRAIN I JUST
TEST WORKERS AS WELL AS APPLY TO
BE ON THE HELMET, COMMUNITY
BASED ALTERNATIVES TO LEVER. UM
. UNFORTUNATELY C C. T S FUNDING
RATES HAVE NOT CHANGED SINCE IT
WAS STARTED CALIFORNIA TO 1007.
THE RATES ARE STILL THE SAME AS
2007, EVEN THOUGH MEDICAL
FUNDING RATES FOR SKILLED
NURSING FACILITIES AND OTHER
INSTITUTIONS HAVE RISEN
SIGNIFICANTLY OVER THAT TIME.
THE PREVIOUS SPEAKER, ALLUDED TO
THE FEDERAL DEMONSTRATION
PROJECT. MONEY FOLLOWS THE
PERSON BEING UM, NOT EXTENDED IN
2018 AND THEN EXTENDED FLIES FOR
SHORT PERIODS OF TIME. THAT
UNCERTAINTY HAS LED TO MANY
AGENCIES THAT PROVIDE CCT
SERVICES LIKE MAYBE I THIS
CONTINUE PROVIDING THE SERVICE.
BUT JUST AS INSTRUMENTAL TO THE
INCREASE IN CCT PROVIDERS. IS
THE IN AN ADEQUATE RATES THAT
WE'VE BEEN LIVING WITH 1ST 16
YEARS. UM. IN 2020 14,000 PEOPLE
IN SKILLED NURSING FACILITIES
WHO ARE MEDICAL BENEFICIARIES.
EXPRESSED AN INTEREST IN HEARING
MORE ABOUT THE CPT PROGRAM. UM
BUT THERE'S NOT ENOUGH. THERE'S
ONLY 16 PROVIDERS PROVIDING
THESE TRANSITION SERVICES IN
CALIFORNIA RIGHT NOW, SO THERE'S
NO PROVIDERS LEFT IT TO MEET THE
NEEDS. EVEN THOUGH UM,
TRANSITION SERVICES. NO FOR
ALMOST ALL PARTIES WHO
TRANSITION IN A SIGNIFICANT COST
SAVINGS TO THE STATE OVER THEIR
INSTITUTIONAL FIRE. UM THE
PREVIOUS SPEAKER ALLUDED TO CAL
AIM BEING AS A VEHICLE TO
CONTINUE THESE TRANSITION
SERVICES. UNFORTUNATELY CAL AIM
WAS NOT DEVELOPED TO PARALLEL
THE FUNDING THAT'S AVAILABLE
THROUGH CCTV. SO EVEN PCTS RAIDS
HAVE NOT BEEN INCREASED IN 16
YEARS. MANY OF THE PALAIS NAMES
BENEFITS HELP PEOPLE TRANSITION
ARE ACTUALLY LESS THAN THE CCT
RESOURCES AVAILABLE. THAT'S
RIGHT. LESS. AND THEN THERE ARE
SOME SEVERAL TROUBLING LIFETIME
CAPS. IN THE CALENDAR PROGRAM
THAT DO NOT EXIST FOR THE CCT
PROGRAMS. THUS YOU KNOW, SERVING
TO LIMIT PEOPLE'S ACCESS EVEN
MORE. THIS IS, UM, AN INCREDIBLE
HEALTH EQUITY ISSUE AND ACCESS
ISSUE FOR LOW INCOME
COMMUNITIES. THAT HAVE NO CHANCE
OF TRANSITIONING INTO THEIR OWN
OWN HOME WITHOUT A SERVICE LIKE
CCTV. SO WE APPRECIATE
APPRECIATE THE OPPORTUNITY TO
SPEAK. UM AND IN QUESTIONS,
SURE. DEPARTMENT OF FINANCE HER
SCOOP THE DEPARTMENT OF FINANCE
NOTHING OUT AT THIS TIME
TOMORROW WITH THE LEGISLATIVE
ANALYST'S OFFICE. NO CONCERNS OF
THIS PROPOSAL. BRING IT UP TO
THE DIASPORA MEMBERS QUESTIONS.
I'LL KEEP IT HERE AT THE CHAIR.
JUST TO CONTEXTUALIZE. I BELIEVE
THERE'S 1000 NURSING HOMES. AND
IF WE HAVE 16 PROVIDERS FOR THE
C, C, T AND IN LIGHT OF US, NOT
INCREASING RATES FROM 2007. DOES
IT NECESSITATE US TO LOOK
TOWARDS IT? SINCE ULTIMATELY
WE'RE FINDING COST SAVINGS FROM
THESE TRANSITIONS AS A SYSTEM
AND, UM HOPING YOU CAN COMMENT
ON WHETHER WE HAVE AN ADEQUATE
NUMBER OF PROVIDERS CURRENTLY IN
THE STATE FOR THE NUMBER OF
NURSING HOMES. WE HAVE THANK
YOU. AND I'D LIKE TO TURN IT
OVER TO MY COLLEAGUE. GOOD
AFTERNOON. MY NAME IS SUSAN
PHILIP I'M DEPUTY DIRECTOR FOR
HEALTH CARE DELIVERY SYSTEMS OF
THE DEPARTMENT OF HEALTH CARE
SERVICES. CAN YOU HEAR ME? OK,
OKAY. UM SO IN TERMS OF THE
NUMBER OF PROVIDERS, I WILL SAY
THAT IS THE GOAL OF CALLUM. UM,
WITH ENHANCED CARE MANAGEMENT
GOING LIVE FOR THE POPULATION OF
FOCUS FOR ADULTS WHO ARE
CURRENTLY RESIDENTS OF NURSING
HOMES THAT WENT LIVE JANUARY OF
2023. SO JUST A FEW SHORT MONTHS
AGO, AND SO WE ARE LOOKING TO
SCALE E CN PROVIDERS THROUGH
CALLUM. SO UM, WE DO HAVE
PROVIDERS PARTICIPATING. WE DO
HAVE OPPORTUNITIES FOR CCT
PROVIDERS TO ALSO PARTICIPATE AS
PROVIDERS AND WE ARE LOOKING TO
SCALE UM E. C M THROUGH MANAGED
CARE AND IN REGARDS TO THE
QUESTION ABOUT RATE INCREASES AT
THIS POINT, WE ARE, UM WILLING
TO WORK AND UNDERSTAND THE
REQUEST AND RECEIVED THE DATA.
TO UNDERSTAND THE RATE INCREASE
REQUEST, LOOKING AT UTILIZATION
AND ALSO IN THE CONTEXT OF THE
COLUMN, AND THE, UM SPECIFIC UM,
UM, GOALS. I'M TRYING TO
UNDERSTAND. AND I THOUGHT YOU
HEARD THAT WE'RE SORRY FOR THE
PUN. WE'RE TRANSITIONING TO
SEEMS CALAIS NAMED. DOES THAT
MEAN WE'RE MOVING AWAY FROM CCT
? OR IS THIS A LONG? TERM
PROGRAM THAT WILL BE AROUND AND
THERE WILL BE SUSTAINABLE. OR IS
THIS A TEMPORARY PROGRAM THAT
WERE GOING TO, UM SUPPORT UNTIL
WE CAN TRANSITION TO KELLY
HOPING YOU CAN COMMENT. WELL WE
RECOGNIZE THE BENEFITS OF CCT,
WHICH IS REALLY THE PROGRAM AS
WELL AS COMMUNITY SUPPORTS THAT
FOCUS ON THIS POPULATION WAS
REALLY BUILT ON THE LESSONS
LEARNED FOR CCT, AND WE REALLY
DO WANT TO SKILLET STATEWIDE.
CCT AS WAS NOTED, IS LIMITED IN
TERMS OF THE PROVIDERS AND THEY
TAKE UP RIGHT NOW, UM 16, 17
PROVIDERS AND 43 COUNTIES, AND
THE GOAL OF CESIUM IS REALLY TO
BE STATEWIDE. UM SO, UH AND C C
T AS AS LAURIE, MY COLLEAGUE
MENTIONED, UM THE CMS HAS
APPROVED FUNDING THROUGH 2027
WILL ALLOW FOR EXPENDITURE OF
THAT FUNDING THROUGH 2031. I'LL
STOP. BUT IT SEEMS AS IF WHAT
YOU'RE SAYING IS THAT THEY'RE
NOT COMPLEMENTARY PROGRAMS THAT
IN MANY WAYS, THEY MAY BE
DUPLICATIVE THAT ULTIMATELY ECM
WILL TAKE THE PLACE OF CCT.
SOUNDS AS IF WHAT YOU'RE SAYING
AS A WAY FOR US TO SCALE AND TO
GROW IT NOW ULTIMATELY.
TRANSITIONING PEOPLE TO WHERE
THEY DO. THE BEST SHOULD BE THE
GOAL. AND IF WE CAN WORK WITH
BOTH CCT AND COWLING TO
ACCOMPLISH THAT GOAL, WE WILL
ULTIMATELY AS A STATE SEE THE
REWARDS AS WELL AS THE PATIENTS
WHO WILL BENEFIT FROM THAT, SO
I'M SUPPORTIVE, BUT JUST WANT TO
MAKE SURE THAT WE'RE NOT
DUPLICATING. PROCESSES THAT WERE
, UM COMPLEMENTING, AND IT
SOUNDS AS IF THE GOAL HERE IS
REALLY TO LOOK TOWARDS CALLE
AIM. SEEING NO FURTHER QUESTIONS
FROM THE DIETS. WE WILL THANK
VERY MUCH PANEL 11 AND MOVE ON
TO ISSUE 12. ISSUE. 12 IS THE
PEACE MONITORING AND PROGRAM
OPERATIONS BCP. WE WILL BEGIN
WITH MISS WALKER. THANK YOU. THE
PROPOSAL REQUEST EXPENDITURE
AUTHORITY FOR 10 NEW PERMANENT
POSITIONS THAT ARE NECESSARY FOR
THE DEPARTMENT TO MEET CURRENT
WORKLOAD DEMANDS TO COMPLY WITH
FEDERAL AND STATE REQUIREMENTS
RELATED TO THE ADMINISTRATION
OPERATION AND MONITORING OF THE
PROGRAM OF ALL INCLUSIVE CARE
FOR ELDERLY. OR PAVE THE
POSITIONS REQUESTED WILL ALLOW
THE DEPARTMENT TO ESTABLISH A
DEDICATED PACE MONITORING UNIT
AND INCREASE OPERATIONAL
CAPACITY TO MEET THE CONTINUOUS
INCREASING VOLUME OF PACE
NURSING FACILITY LEVEL OF CARE
DETERMINATIONS. IT MUST PERFORM
FOR EVERY NEW PARTICIPANTS AND
EVALUATED FOR ENROLLMENT AND
PACE AS WELL AS ANNUALLY AFTER
ENROLLMENT POSITIONS REQUESTED
ALSO INCLUDE LEGAL SUPPORT FOR
THE PROGRAM AND ITS CONTINUED
GROWTH. FEDERAL PACE REGULATIONS
REQUIRE THE STATE ADMINISTERING
AGENCIES CONDUCT ON SITE
PRODUCTS OF NEW PACE
ORGANIZATIONS ANNUALLY DURING
THE FIRST THREE YEARS OF
OPERATIONS, AND ADDITIONALLY,
THE DHC S CONTRACT WITH PEACE
ORGANIZATION REQUIRES. THE DHC S
WILL CONDUCT ON SITE AUDITS OF
MATURE PASTE ORGANIZATIONS
OUTSIDE OF THEIR TRIAL PERIOD AT
LEAST EVERY THREE YEARS OR AS
APPROPRIATE TO ADDRESS PROGRAM
COMPLIANCE. I'LL PASTE AUDITS
INCLUDE BOTH ON SITE AND DESK
REVIEW COMPONENTS AND THE
DEDICATED PACE MONITORING UNIT
ESTABLISHED WITH THESE POSITIONS
WILL ALSO BE RESPONSIBLE FOR
PACE QUALITY TO MONITORING
FUNCTIONS THAT WOULD INCLUDE A
REVIEW OF QUARTERLY PAYS
QUARTERLY REPORTING AND TAKE AN
INVESTIGATIVE COMPLAINTS.
MONITOR PACE ORGANIZATION
COMPLIANCE WITH LICENSING
REQUIREMENTS FOR PACE
ORGANIZATIONS THAT FALL UNDER
THE DHC S AUTHORITY. AND MONITOR
CORRECTIVE ACTION PLANS, AND
WE'RE HAPPY TO ADDRESS QUESTIONS
IN THE DEPARTMENT OF FINANCE
DEPARTMENT OF FINANCE. NOTHING
AT THIS TIME. NO CONCERNS AT
THIS TIME. BRING IT UP TO THE
DIOCESE FOR ANY MEMBERS.
QUESTIONS, DR JACKSON I
CERTAINLY UNDERSTAND THE NEED
FOR THIS. MY QUESTION IS FOR THE
LONG TERM. OBVIOUSLY UM THIS
SERVICE WILL PROBABLY BE NEEDED
MORE AND MORE AS WE GET DOWN THE
ROAD. DO WE HAVE A PROJECTED
GROWTH PLAN FOR THIS? AS WE KNOW
THAT THE AGING POPULATION WILL
INCREASE UH, THIS, UM. THINKING
ONE PLUS ONE EQUALS TWO. SO I'M
THINKING, YOU KNOW, THIS IS
PROBABLY GONNA WE'RE GOING TO
SEE CONTINUED BUDGET INCREASES
WHEN IT COMES TO THIS. AM I
CORRECT IN THAT? AND DO YOU
INTEND? DO WE HAVE HAVE ANY
ANTICIPATION WITH THE LONG TERM
GROWTH OF THIS PRO PROGRAM WOULD
LOOK LIKE LONG TERM GROWTH. SURE
SO WE DEFINITELY HAVE SEEN
GROWTH IN THE PEACE PROGRAM OVER
THE LAST FEW YEARS. UM UH, SO
JUST IN TERMS OF THE PROGRAM
GROWTH, THERE HAS BEEN A 75%
INCREASE. UM SINCE 2018 SO BACK
IN 2018 11 PACE ORGANIZATIONS,
AND NOW WE HAVE 23 PIECE
ORGANIZATIONS AND 25 COUNTIES.
UM AND CURRENTLY AT THE
DEPARTMENT, WE HAVE, UM SEVERAL
APPLICATIONS 28 NEW PEACE
ORGANIZATION APPLICATIONS AND
SERVICES AREA EXPANSION, SO JUST
CONCUR THAT IT IS. IN FACT
GROWING, WE ARE LOOKING TO BUILD
INFRASTRUCTURE TO ENSURE THAT WE
CAN CONDUCT APPROPRIATE
MONITORING AND OVERSIGHT THAT WE
CAN REVIEW THE APPLICATIONS
TIMELY. AND SO AT THIS POINT,
THIS IS OUR REQUEST, AND WE MAY
NEED TO ASSESS IN THE FUTURE.
RIGHT IN TERMS OF HOW AH! OF
COURSE, WE HAVE THE MASTER PLAN
FOR AGING. AND I'M WONDERING,
ARE YOU LOOKING AT THOSE GROWTH
PROJECTIONS WHEN IT COMES TO
THIS PROGRAM AS WELL? IN TERMS
OF BY 2030. WE'RE SUPPOSED TO
HAVE A VERY I MEAN, THERE SEEMS
TO BE A BIG INCREASE, BUT THE
BIG BIG ONE IS NOT THAT IS ABOUT
IT HASN'T HIT US YET, RIGHT? SO
I'M JUST WONDERING HOW HOW
CLOSELY ARE YOU ALIGNING WITH
THOSE GROWTH PROJECTIONS WHEN IT
COMES TO THIS PROGRAM? IS IT IN
ALIGNMENT? UM IN TERMS OF THE
INFRASTRUCTURE YOU'RE TRYING TO
BUILD OUT. OUR ASSESSMENT IT
THAT IT IS AN ALIGNMENT. UM, BUT
WE WILL DEFINITELY MONITOR THAT.
THANK YOU. I'LL ELEVATE IF I CAN
HAVING VISITED PACE PROGRAM IN
DOWNTOWN FRESNO, HOW CULTURALLY
AND LINGUISTICALLY COMPETENT
THEY CAN BE TO ADDRESS CERTAIN
SUB POPULATIONS. WE HAVE A LOCAL
MONK POPULATION THAT STRUGGLES
TO NOT BE SOCIALLY ISOLATED, AND
THE PACE CENTER CREATES A
OPPORTUNITY FOR THEM TO BE
TOGETHER TO HAVE THEIR HEALTH
NEEDS. MATT TO ADDRESS ANY
PSYCHOLOGICAL NEEDS THAT THEY
HAVE. AND REALLY, I'M IMPRESSED
WITH THIS MODEL AS A MEANS FOR
US TO ADDRESS SOME OF THE
INEQUITIES THAT HAVE BEEN
PRESENT WITHIN SYSTEMS. WITH IT.
I WILL THANK VERY MUCH THIS
PANEL. WE WILL MOVE ON TO ISSUE
13. ISSUE 13 AS A TRAILER BILL
PROPOSAL ON POST ELIGIBILITY
TREATMENT OF INCOME, MISS WALKER
, WHEN YOU ARE READY, THE
DEPARTMENT IS PROPOSING TRAILER
BUILD A CLEANUP LANGUAGE TO
ALLIANCE STATE STATUTE WITH
FEDERAL GUIDELINES. THE TRAILER
BILL ADDRESSES HOW THE
DEPARTMENT DESCRIBES THE COST
SHARING PROVISIONS FOR
INDIVIDUALS SUBJECT TO THE POST
ELIGIBILITY, TREATMENT OF INCOME
AND THE SPEND DOWN OF EXCESS
INCOME REQUIRED FOR INDIVIDUALS
TO BECOME ELIGIBLE FOR MEDICAL
THROUGH THE MEDICALLY NEEDY
PROGRAM. CALIFORNIA CURRENTLY
OPERATIONALIZE IS ITS LONG TERM
PROGRAM IN THE MEDICAL NEEDY
PROGRAM. INSTITUTIONALIZED
INDIVIDUALS ARE TRANSFERRED AND
ARE TRANSITIONED INTO THE
MEDICALLY NEEDY PROGRAM, WHERE
THE POST ENROLLMENT TREATMENT OF
INCOME RULES. ARE APPLIED FOR
EASE OF PROGRAM ADMINISTRATION.
THE SCOPE OF THE INDIVIDUALS
COVERAGE REMAINS THE SAME AS
THEIR ORIGINAL PROGRAM COVERAGE
PRIOR TO LONG TERM CARE
PLACEMENT. THE DEPARTMENT HAS
USED THE TERM SHARE OF COST TO
DESCRIBE THE POST ENROLLMENT
TREATMENT OF INCOME RULES FOR
MANY YEARS WHEN INDIVIDUALS MOVE
INTO LONG TERM CARE AND HAVE
APPLIED THE POST ELIGIBILITY
TREATMENT OF INCOME ROLES
CORRECTLY AND IN ACCORDANCE WITH
FEDERAL REGULATIONS. THE
DEPARTMENT USES THE SHARE OF
COST TERMINOLOGY INTERCHANGEABLY
, WITH BOTH TO EXPLAIN BOTH THE
POST ENROLLMENT TREATMENT OF
INCOME AND THE CONCEPT OF SPEND
DOWN OF EXCESS INCOME, CAUSING
CONFUSION FOR OUR CONSUMER
ADVOCATES AND OUR MEDICAL
MEMBERS. CENTERS FOR MEDICARE
AND MEDICAID SERVICES AND
CONSUMER ADVOCATES RAISE
CONCERNS DURING THE CONTINUOUS
COVERAGE PERIOD DURING THE
PUBLIC HEALTH EMERGENCY WITH THE
USE OF THE SHERIFF COST
TERMINOLOGY AND NOTICES OF
ACTION WHEN INDIVIDUALS MOVED
INTO LONG TERM CARE IN WHICH
THEY WERE NOW SUBJECT TO THE
POST RE POSTAL ENROLLMENT,
TREATMENT OF INCOME RULES AND
SHARE OF COST WHEN, PRIOR TO
THEIR PLACEMENT IN LONG TERM
CARE. THEY HAD NO COST MEDICAL
THIS APPEARED AS IF THE
DEPARTMENT WAS NOT BEING
CONSISTENT WITH THE FEDERAL
POLICIES ON CONTINUOUS COVERAGE
AND IMPOSING COST SHARING
INCORRECTLY. THE DEPARTMENT WAS
REQUESTED TO WRITE, REVISE AND
NOTICES OF ACTION TWO MORE
APPROPRIATELY COMMUNICATE WITH
BENEFICIARIES, THE POST
ENROLLMENT TREATMENT OF INCOME
RULES AND A CONSUMER FRIENDLY
WAY AND TO REMOVE THE SHARE OF
COST TERMINOLOGY AND TO ALIGN
OUR LONG TERM CARE NOTICES OF
ACTION WITH THE DEPARTMENT'S
OPERATIONAL PRACTICES. THE
DEPARTMENT IS PARTNERING WITH
THE CALIFORNIA HEALTHCARE
FOUNDATION TO DO FOCUS GROUP
TESTING TO MAKE SURE MEANINGFUL
CONSUMER FACING LANGUAGE IS USED
, AND THE TRAILER BILL DOES NOT
CHANGE THE WAY SHERIFF COST OR
POST ENROLLMENT. TREATMENT OF
INCOME IS CALCULATED OR
ADMINISTERED FOR THE MEDICALLY
NEEDY BENEFICIARIES. THE
DEPARTMENT OF FINANCE OR SCOOP
THE DEPARTMENT OF FINANCE
NOTHING FURTHER TO ADD ALOE
CONCERNS WITH THIS PROPOSAL,
BRINGING IT UP TO THE DIOCESE.
IT'S A MUCH NEEDED CHANGE. THANK
YOU VERY MUCH FOR PANEL 13 14.
HMM. ISSUE 14 IS AN OVERSIGHT
ISSUE ON DELAYED PAYMENTS TO
SKILLED NURSING FACILITIES.
FIRST WE WILL HEAR FROM JENNIFER
SNYDER, LEGISLATIVE ADVOCATE FOR
THE CALIFORNIA ASSOCIATION OF
HEALTH FACILITIES. PLEASE BEGIN
WHEN YOU ARE READY. GOOD
AFTERNOON, JENNIFER SNYDER WITH
CAPITAL ADVOCACY HERE TODAY ON
BEHALF OF CALIFORNIA ASSOCIATION
OF HEALTH FACILITIES. WE
APPRECIATE THE OPPORTUNITY TO
COMMENT ON THIS ITEM, WHICH IS
RELATIVE TO SKILLED NURSING
FACILITY. PAYMENT DELAYS. UM SO
EFFECTIVE JANUARY 1ST OF THIS
YEAR, ALL LONG TERM CARE
FACILITIES WERE INTEGRATED INTO
MEDICAL MANAGED CARE. UM THERE
WERE 31 COUNTIES WHERE THAT WAS
VERY NEW TO THEM, AND TO THE
NURSING FACILITIES THAT WORKED
WITHIN THESE TRANSITIONING
HEALTH PLANS IS WHAT WE CALL
THEM, UM THEIR LACK OF
EXPERIENCE AND KNOWLEDGE AS TO
HOW LONG TERM CARE IS FUNDED AND
COORDINATED IS HAVING A
SIGNIFICANT IMPACT ON
CONTRACTING AND TIMELY PAYMENTS
FOR OUR TRANSITIONING
POPULATIONS THAT EITHER ARE
CURRENTLY IN NURSING FACILITIES
WERE OBVIOUSLY BEING REFERRED TO
THEM. SO THE NURSING FACILITY
MEMBERS OF CALF ARE EXPERIENCED
A NUMBER OF KELLY MYTH
LIMITATION ISSUES, UM, THAT ARE
RELATIVE TO PLAN PAYMENT AND TO
CONTRACTING CONCERNS ARE TWOFOLD
. FIRST BECAUSE SOME MANAGED
CARE PLANS ARE NOT FOLLOWING
THROUGH WITH THEIR CONTRACTING
RESPONSIBILITIES. NURSING
FACILITIES ARE BEING FORCED TO
TAKE MEDICAL PATIENTS EITHER OUT
OF CONTRACT OR OUT OF NETWORK.
SOME PLANS ARE REFUSING TO
ACTUALLY CONTRACT INSTEAD
REQUIRING SOME TYPES OF LETTERS
OF AGREEMENT OAS OR WHAT WE CALL
THEM. SO WITHOUT CONTRACTS,
FACILITIES ARE DOING THEIR BEST
TO SECURE OUT OF NETWORK
PAYMENTS OR REQUEST A CONTRACT
AGREEMENT. BUT WITHOUT ANY
REQUIREMENT FOR A PLAN TO
CONTRACT MANY FACILITIES ARE
LEFT WITHOUT ANY GUARANTEE OF
PAYMENT FOR CURRENT MEDICAL
PATIENTS OR FUTURE REFERRALS.
CMS RULES REQUIRE THAT PROVIDERS
HAVE TO BE A NETWORK TO RECEIVE
ANY DIRECTED PAYMENTS AND
DIRECTED PAYMENTS CAN INCLUDE
ANY RATES THAT ARE DIRECTED FROM
STATE GOVERNMENT, AND THAT DOES
ALSO INCLUDE ANY MEDICAL PROGRAM
. UM RATE, UH, FACILITY RATES
THAT ARE ALSO WHAT WE TALK ABOUT
RELATED TO QUALITY PAYMENTS THAT
ARE UNDER KIND OF THE NEW RATE
SETTING SYSTEM FOR MAYBE 1 86
LAST YEAR AND INCLUDES QUALITY
PAYMENTS THAT FACILITIES ARE
INCENTIVIZED. SIZED THROUGH
MEETING CERTAIN QUALITY
STANDARDS. THE PROBLEM IS THAT
CMS REQUIRES THAT THESE
FACILITIES BEING NETWORK TO
QUALIFY FOR THOSE QUALITY
PAYMENTS. SO UNFORTUNATELY DUE
TO THE CMS RULES, SKILLED
NURSING FACILITIES THAT ARE NOT
CONTRACT IS, UM, AREN'T AREN'T
ELIGIBLE FOR THOSE PATIENT DAYS
THAT ARE NOT UNDER CONTRACT.
NOW, OF COURSE, THEY STILL HAVE
TO HERE AND MEET THE QUALITY
STANDARDS, BUT THEY CAN'T
ACTUALLY GET TO A POINT WHERE
THEY CAN BE QUALIFIED FOR THOSE,
UM, THOSE DAYS JUST BY THE FACT
THAT THEY'RE NOT CONTRACTING,
WHICH IN MANY CASES IS
COMPLETELY OUT OF THEIR CONTROL.
SO SECOND SINCE JANUARY 1ST MANY
, IF NOT MOST NURSING FACILITIES
HAVE EXPERIENCED SIGNIFICANT
PAYMENT DELAYS FOR SERVICES THEY
HAVE PROVIDED TO THEIR MEDICAL
RESIDENTS. NURSING FACILITIES AS
WE KNOW WE RELY HEAVILY ON STATE
MEDICAID FUNDS, WHICH ON THE
AVERAGE IS ABOUT 70% OF PATIENTS
THAT THEY SERVE. SO AS OF TODAY,
IT WILL BE FOUR MONTHS WITHOUT
SOME FACILITIES RECEIVING ANY
REIMBURSEMENT FOR SERVICES
PROVIDED PLANS ABILITY TO
PROCESSING TO PROCESS
TRANSITIONING MEDICAL
POPULATIONS, INCLUDING
RECOGNIZED NEWLY ENROLLED
BENEFICIARIES. AND RECOGNIZING
THE HCS PRIOR AUTHORIZATIONS
HAVE CAUSED SIGNIFICANT DELAYS
AND FACILITIES ABILITY TO SUBMIT
CLAIMS. THERE'S A REQUIREMENT IN
STATE LAW THAT HEALTH PLANS MUST
PAY PROVIDER WITHIN 30 DAYS AND
THEN AFTER 45 BUSINESS DAYS,
CERTAIN INTEREST STARTS APPLYING
. UNFORTUNATELY THERE ARE MANY,
MANY MANAGED CARE PLANS THAT ARE
NOT ADHERING TO THIS RULE. SO
DUE TO THE CIRCUMSTANCES WHERE
PLAN IS STILL NOT UNDERSTANDING
KIND OF THE LONG TERM CARE SPACE
, THEY'RE ISSUING AROMAS,
DELIGHT DENIALS FOR RATES THAT
ARE THAT ARE ALREADY SET BY THE
STATE. SO CATHERINE SUGGESTS TWO
AMENDMENTS TO THE CAL AIMED
TRAIN CALLUM TRAILER BILL THAT
THE DEPARTMENT OF HEALTH CARE
SERVICES HAS, UM HAS SUGGESTED
FIRST WE WOULD ASK THAT THE
TRAILER BILL LANGUAGE REQUIRE
MEDICAL MANAGED CARE PLANS TO
SIGN WHEN THEY DO SIGN CONTRACTS
TO SIGN THEM RETROACTIVELY. AND
THIS WILL, UM BE UTILIZED REALLY
, FOR THE PURPOSES OF DIRECTED
PAYMENTS. SO IN CASES WHERE
FACILITIES ARE ABLE TO SECURE A
CONTRACT, AND WE HOPE ALL OF
THEM WILL THAT THAT CAN BE
RETROACTIVE TO JANUARY 1ST SO
THEY CAN AT LEAST QUALIFY FOR
THE PATIENT DAYS THAT THEY'VE
SERVED MEDICAL PATIENTS. AND
THEN SECOND, WE WOULD ASK THAT
THAT THERE WILL BE A REQUIREMENT
FOR HEALTH PLANS TO REPORT THEIR
NETWORK. NETWORK UTILIZATION AND
TIMELY PAYMENTS. THERE'S
SPECIFIC TO LONG TERM CARE,
HEALTH FACILITIES AND THE SYSTEM
ISSUES THAT ARE SPECIFIC TO LONG
TERM CARE, HEALTH FACILITIES. UM
THIS WILL MAKE SURE THAT WE'RE
NOT SEEING A BROAD AVERAGING OF
HOW PAYMENTS ARE BEING, UM,
ADHERED TO TIMELINESS OF
PAYMENTS, BECAUSE RIGHT NOW
THOSE THOSE TYPES OF INFORMATION
IS AT LEAST FROM WHAT WE
UNDERSTAND IS AN AVERAGE AND
IT'S NOT SPECIFIC TO LONG TERM
CARE SO WE CAN HAVE A BETTER
SENSE AND THE DEPARTMENT COULD
HAVE A BETTER SENSE OF WHERE
WE'RE SEEING PROBLEMS RELATED TO
TIMELY PAYMENT, SO THESE TWO
REQUESTED AMENDMENTS WILL
STRENGTHEN WHAT WE BELIEVE ARE
THE CALLUM STATUTORY
REQUIREMENTS AND ENSURE THAT
MEDICAL BENEFICIARIES HAVE
STABLE ACCESS TO SNIFF SERVICES.
APPRECIATE YOUR TIME. THANK YOU.
NEXT WE HAVE PHDS DIRECTOR
MICHELLE BOSS. GOOD AFTERNOON,
MR CHAIR MEMBERS, UH, MICHELLE
BOSS, DIRECTOR OF THE DEPARTMENT
OF HEALTH CARE SERVICES. WE
CONTINUE TO KEEP COMMUNICATION
CHANNELS OPEN WITH OUR MANAGED
CARE PLANS AND OUR SKILLED
NURSING FACILITIES TO MONITOR
THE DELIVERY OF LONG TERM
SERVICES AT LONG TERM SKILLED
NURSING FACILITY BENEFIT TO
DIRECTLY INTERVENE IN PARTICULAR
SITUATIONS TO ADDRESS NON
COMPLIANCE AND TO BE INFORMED OF
ANY SYSTEMATIC ACTIONS NEEDED TO
CLARIFY POLICIES IN THE MARKET.
OVER THE LAST FEW MONTHS. WE'VE
BEEN MONITORING THE MARKET AND
TAKING SOME SYSTEMATIC ACTION TO
ADDRESS THE CONCERNS, AND WE'VE
IMPLEMENTED SOME ALL PLANNED
LETTERS AND HAVE IT ALL PLANNED
LETTER FORTHCOMING TO REMEDIATE
SOME OF THE CONCERNS WE'RE
HEARING, WE ISSUED AN A P L BACK
IN DECEMBER AND CLARIFIED IT IN
MARCH, ADDRESSED IN FACILITY
CONCERNS REGARDING THE ABILITY
FOR MANAGED CARE PLANS TO PAY
HIGHER RATES THAN THE FIFA
SERVICE PER DIEM FOR EXCLUSIVE
SERVICES, WHICH DHC S CLARIFIED
ARE NOT SUBJECT TO THE DIRECTED
PAYMENT POLICY. BIÂU THE A P L
LAID OUT EXISTING M C P OR
MANAGED CARE PLAN REQUIREMENTS
PERTAINING TO CONTINUITY OF CARE
FOR SKILLED NURSING FACILITY
RESIDENTS TO BE ABLE TO REMAIN
IN THEIR FACILITY AND HAVE
CONTINUED ACCESS TO THE OUT OF
NETWORK PROVIDER AND SERVICES,
INCLUDING THERAPY SERVICES AND
DURABLE MEDICAL EQUIPMENT. THE
ÁP ALSO CLARIFIED TRANSPORTATION
REQUIREMENTS THAT MANAGED CARE
PLANS ARE OBLIGATED TO PROVIDE
TO THEIR MEMBERS, PARTICULARLY
TRANSPORTATION TO APPOINTMENTS
LIKE DIALYSIS. THE A P L
INCLUDED NEW GUIDANCE TO ADDRESS
OPERATIONAL CONCERNS, FOR
EXAMPLE, REQUIRED THE MANAGED
CARE PLANS TO HAVE A LONG TERM
SERVICES AND SUPPORT LIAISON. SO
THAT SNIFFS HAVE A POINT OF
CONTACT AT THE PLAN TO SUPPORT
QUESTIONS THAT THEY MAY HAVE
ALSO REQUIRES A MANAGED CARE
PLANS TO TRAIN THEIR PROVIDERS
ON CLAIMS PROTOCOLS, SINCE MANY
MANAGED CARE PLANS HAVE THEIR
OWN PROCESSES AND SYSTEMS THAT
THEY USED TO REIMBURSE SERVICES.
TOO BROADLY ADDRESS THE CONCERNS
RELATED TO THE PROMPT PAYMENT OF
CLAIMS. WE ARE WORKING ON A
TIMELY PAYMENTS A PL THAT
REMINDS MANAGED CARE PLANS OF
THEIR EXISTING CONTRACTUAL
OBLIGATIONS TO PAY CLAIMS.
TIMELY MANAGED CARE PLANS ARE
CONSIDERED OUT OF COMPLIANCE IF
THEY DO NOT MEET CERTAIN
THRESHOLDS OF TIMELY PAYMENTS.
SPECIFICALLY THEY MUST PAY 90%
OF CLEAN CLAIMS IN 30 DAYS. AND
99% OF CLAIMS IN IN CLEAN CLAIMS
IN 90 DAYS, AND THIS WILL
CLARIFY WHEN THAT CLOCK STARTS
TO BE VERY CLEAR BOTH TO THE
PLANS AND PROVIDERS WE ARE
TARGETING TO ISSUE THIS A PL IN
JUNE OF THIS YEAR. ADDITIONALLY
ONE POINT OF CONFUSION FOR THE
MARKET WAS WHAT SERVICES WERE
CONSIDERED PART OF THE DIRECTED
PAYMENT FOR FACILITY RATE VERSUS
SERVICES FALLING OUTSIDE THAT
RATE, WHICH DIRECTED PAYMENTS DO
NOT APPLY A. WE CLARIFY WHAT
SERVICES ARE PART OF THE DEBATE
DIRECTED PAYMENT RATE AND WHAT
MAY BE FURTHER NEGOTIATED
BETWEEN THE PLANS AND THE
FACILITY. UM ALTHOUGH WE DO NOT
INTERVENE AND CONTRACTUAL
RELATIONSHIPS BETWEEN PLANS AND
PROVIDERS, WE HAVE FOLLOWED UP
WITH SPECIFIC PLANS WITH
CONCERNS THAT WE'VE HEARD FROM
SOME OF THE FACILITIES AND IT
DIRECTLY INTERVENED TO KIND OF
KEEP TABS ON THEIR PROMPT
PAYMENT. WE HAVE BROAD
ENFORCEMENT AUTHORITY TO IMPOSE
SANCTIONS FOR NON COMPLIANCE.
WITH REGARD TO THE WORKFORCE
QUALITY INCENTIVE PROGRAM AND
THE LETTERS OF AGREEMENT. UM WE
HAVE COMMUNICATED TO ALL PLANS
THAT THEY MUST TRANSITION FROM
MINIMUM CONTRACTING REQUIREMENTS
FOR NETWORK REDDICK NETWORK
ADEQUACY AND READINESS TO
ONGOING NETWORK CAPACITY
BUILDING TO ENSURE APPROPRIATE
ACCESS TO SKILLED NURSING
FACILITIES. THEY ARE AWARE THAT
THEIR LETTERS OF AGREEMENT ARE
NOT CONSIDERED NETWORK PROVIDER
AGREEMENTS. UM AND WE HAVE
ENCOURAGED ARE MANAGED CARE
PLANS TO RETROSPECTIVELY, UH,
RETROSPECTIVELY EFFECTIVE DATE
THEIR CONTRACT. AX TO THE
BEGINNING WHEN THE FIRST LETTER
OF AGREEMENT WAS ENTERED, KIND
OF TO ADDRESS THE FIRST ISSUE
THAT MS SNIDER RAISED, WE
CONTINUE TO MONITOR ARE MANAGED
CARE PLANS, EFFORTS TO BUILD ITS
NETWORK CAPACITY AND LOOK
FORWARD TO CONTINUING
CONVERSATIONS WITH THE NURSE
NURSING FACILITY INDUSTRY.
DEPARTMENT OF FINANCE HER SCRIPT
, THE DEPARTMENT OF FINANCE. WE
APPRECIATE HEARING FROM MISS
SNYDER AND WOULD BE HAPPY TO
WORK WITH THE RELEVANT PARTIES
AT THE APPROPRIATE TIME. HAD
ELIO ANDREW DUFFY ON. UH, I'M
WITH THAT. COLLINS. SO WE DON'T
HAVE SORRY. THANK YOU, UM, BRING
IT UP TO THE DIOCESE FOR ANY
MEMBERS. QUESTIONS DR. JACKSON
MS. SNIDER OBVIOUSLY, UM, I
SHARE YOUR CONCERNS IN TERMS OF
TIMELY PAYMENT. I COME FROM THE
NONPROFIT SECTOR. I KNOW WHAT IT
MEANS. BUT WHEN YOU GOT BILLS TO
BE PAID WHEN YOU GOT PEOPLE TO
PAY, AND YOU'RE NOT GETTING UH,
UM, PROPERLY COMPENSATED AS AS A
RARELY. PRACTICAL TIME, RIGHT?
YOU'RE YOU'RE NOT ACTING FOR
YOU'RE NOT ASKING FOR 24 HOURS.
YOU'RE NOT ASKING, RIGHT? UM
WHEN YOU WHEN YOU HEAR, UH, THE
RESPONSE TO BE ABLE TO RECTIFY
THIS ISSUE. AH ARE YOU UM.
HOPEFUL THAT THIS WILL HELP WITH
THE ISSUE. DEFINITELY PLEASED TO
HEAR THAT THE DEPARTMENT'S
ACTUALLY TAKING SOME REALLY GOOD
ACTION TO COMMUNICATE WITH PLANS
AND KEEP THEM A LITTLE BIT MORE
ACCOUNTABLE. DEFINITELY, UM
PLEASED TO HEAR THAT. I THINK I
MEAN, I HEARD AT LEAST TWO NEW
ÁP. LS, UM I THINK THE CONCERN
WILL CONTINUE TO BE THAT, UM,
THAT TO THE DEPARTMENT, TO SOME
EXTENT WILL DO ALL THEY CAN AND
YOU WILL STILL HAVE PLANS THAT
WILL NOT BE COMPLIANT. AND SO
YOU'LL HAVE FACILITIES THAT WILL
BE HARMED IN THEIR PATIENTS WILL
BE HARMED BECAUSE OF IT. SOME OF
THAT WILL REMEDY ITSELF AS WE
TRANSITION. MOST OF THIS IS
GOING TO BE IN THIS FIRST YEAR.
UM AND SO THAT'S REALLY WHY WE
WERE PUSHING. YOU KNOW, THE
FIRST PROPOSAL I TALKED ABOUT IS
TO FIND SOME WAY WHERE CONTRACTS
CAN BE RETROACTIVE OR REQUIRED
TO BE RETROACTIVE, AND WE ONLY
NEED THAT FOR A PERIOD OF TIME.
YOU KNOW, THIS WINDOW OF
OPPORTUNITY, I THINK IS THE
CONCERN IS THAT JUST DON'T BE
REMEDIED AND YOU HAVE FACILITIES
THAT REALLY DO RELY ON THOSE
QUALITY PAYMENTS WHEN THEY
QUALIFY, SO I WOULD SAY I FEEL
BETTER. I CAN'T SAY I'M 100%
100% BETTER SO UM AND, UM. ARE
YOU SAYING THIS IS THE BIG IS
THIS ALL YOU PLAN ON DOING OR IS
THIS SOME OTHER? SOLUTIONS
YOU'RE ALSO WORKING ON RIGHT
NOW. I MEAN, I THINK TO MISS
SNYDER'S POINT. THIS IS THE
TRANSITION PERIOD AND WHEN IF
THERE ARE PLANS THAT ARE NOT
SYSTEMATIC, SYSTEMATIC, KIND OF
NON COMPLIANT WITH THEIR TIMELY
PAYMENT, OR JUST IN GOOD FAITH
DISCUSSIONS WITH THE SKILLED
NURSING FACILITIES. WE ARE HAPPY
TO ENGAGE IN THOSE CONVERSATIONS
, BUT TO SYSTEMATICALLY REQUIRE
ACROSS THE BOARD PLANS TO HAVE
CERTAIN CONTRACTS. THAT'S NOT A
POSITION THAT THE DEPARTMENT
WOULD BE IN TO HAVE THIS KIND OF
BROAD BASED REQUIREMENT, BUT
HAPPY TO INTERVENE AS AS YOU
KNOW, AS DIFFERENT US.
SITUATIONS ARISE. AND THE
AUTHORITY THAT YOU HAVE IN TERMS
OF PENALTIES. ARE THEY
SUFFICIENT ENOUGH FOR THEM TO
ACTUALLY CARE? I MEAN, ARE YOU
KNOW COMPLAINTS DON'T WANT TO BE
SANCTIONED BY THE DOOR. YOU KNOW
THAT SOME SECTORS ARE LIKE,
WELL, WELL, RATHER ACCEPT THE
PENALTY RIGHT? AND SO, UM WELL,
DEFINITELY. I OBVIOUSLY LOOKING
FORWARD TO CONTINUE TO CLOSELY
MONITORING THIS BECAUSE WE
REALLY GOTTA MAKE SURE WE MAKE
PEOPLE WHOLE. YEAH IT'S VERY
IMPORTANT FOR US THAT OUR
PROVIDERS ARE PAID TIMELY.
THEY'RE PROVIDING A SERVICE AND
THEY SHOULD RECEIVE THAT PAYMENT
FOR THOSE SERVICES. ABSOLUTELY.
THANK YOU. BRING IT UP TO THE
CHAIR. MS SNIDER. I WANTED TO
GET THE DATA POINT. YOU SAID
THAT THERE WERE 31 COUNTIES WHO
HAVE NEW TRANSITION HEALTH PLANS
, AND I BELIEVE WITHIN THAT YOU
SAID 70% OF THE PATIENTS BEING
SEEN HAVE NOT HAD REIMBURSEMENT
THUS, PARK. CAN YOU CLARIFY THAT
70% I APOLOGIZE. SO IF I MADE
THAT IF I WAS A LITTLE BIT
CONFUSING ON THAT, THE 70% I
USED AS THE AVERAGE NUMBER OF
MEDICAL PATIENTS THAT ARE
NURSING FACILITY CARES FOR SO ON
AVERAGE NURSING FACILITY THERE.
EVERY NURSING FACILITIES ABOUT
70% OF THE POPULATION ARE
MEDICAL PATIENTS. IN SOME CASES
, IT CAN BE UPWARDS OF ALMOST
90% RIGHT AND OTHERS CAN BE A
LITTLE BIT LESS. UM SO I
APOLOGIZE FOR THAT. WE DON'T
KNOW EXACTLY HOW MANY HAVE
RECEIVED NON PAYMENT. UM WE
COULD TELL YOU. I MEAN, I WOULD
ONLY BE KIND OF COMING UP WITH A
VERY, VERY, VERY APPROXIMATE AND
IN MANY CASES, IT'S UM IT IS
LACK OF PAYMENT BASED ON A
NUMBER OF DIFFERENT ISSUES, AND
THEY COULD RECEIVE PAYMENT FOR
TWO OF THEIR PATIENTS BUT NOT
HAVE IT FOR YOU KNOW, THE 50
OTHERS THAT THEY HAVE OR
SOMETHING TO THAT EXTENT, SO
IT'S SAFE TO SAY, THOUGH IT'S
MORE THAN 10% SO THIS ALL
PLANNED LETTER THAT'S COMING OUT
REQUIRING 90% WITHIN 30 DAYS
WOULD OH, YES. NO IT'S YEAH. NO
I WOULD I. IT IS. IT'S GOT TO BE
AT LEAST 70% OF OUR PROVIDERS,
IF NOT MORE THAT ARE HAVING
PROBLEMS EASILY. YEAH, FOR
DIRECTOR, BOSS, IF I CAN. WHAT
WOULD IT TAKE? YOU SAID, WE HAVE
THE ABILITY TO IMPOSE SANCTIONS
FOR NONCOMPLIANCE. HAVING GONE
FOR MONTHS, NOT RECEIVING
PAYMENT, IT SEEMS THAT I WANT TO
MAKE SURE WE'RE DOING ALL THAT
WE CAN BUT WHAT WOULD IT TAKE?
WHAT TYPE OF NON RESPONSE WOULD
IT TAKE FROM THE MANAGED CARE
PLANS TO THEN? HOW LONG ARE WE
GOING TO WAIT? BEFORE WE INSIST
THAT OUR FACILITIES ARE GETTING
REIMBURSED. I THINK PART OF IT
IS KIND OF LEARNING THE PROCESS
BETWEEN WHAT PLANS REQUIRE FOR A
CLEAN CLAIM AND KIND OF THAT
BACK AND FORTH BETWEEN THE
PROVIDER, SO A LOT OF THIS IS
ALSO EDUCATION AND KIND OF THE
RELATIONSHIP BETWEEN THE PLAN
AND PROVIDER TO GET TO A POINT
WHERE THE CLAIM IS POSSIBLE
PROCESS A BLE UM AND, YOU KNOW,
THEY THINK THEY CAN PAY IT AND
SO WORKING WITH OUR PLANS ON HOW
TO DEFINE AND KIND OF DO MORE
PROVIDER EDUCATION AS WELL. EACH
PLAN IS RESPONSIBLE FOR
EDUCATING THE PROVIDERS ON WHAT
THAT PROCESS MIGHT LOOK. LIKE
AND SO THAT IS PART OF OUR KIND
OF THE APPEALS THAT WE ARE
WORKING ON. AND THIS YOU KNOW,
THIS GOES ACROSS BEYOND JUST
SKILLED NURSING FACILITIES. IT'S
REALLY THE RELATIONSHIP BETWEEN
THE PLAN AND THE PROVIDER TO
ENSURE PROPER PAYMENT. ARE WE
NOT REQUIRING THEM TO REPORT
NETWORK ADEQUACY EASE. RELATED
TO SNIFFS AS IT'S REPORTED BY
CAF WITHIN THE AGENDA, OR DO YOU
HAVE THAT? ABILITY TO OUR PLANS
ARE REQUIRED TO, UM, REFLECT
THEIR SKILLED NURSING FACILITY
NETWORK ADEQUACY AND KIND OF
THEIR PROVIDER NETWORKS. I'M NOT
QUITE SURE I UNDERSTAND THE
REQUEST THAT CALF HAS WITH
REGARD TO THE DATA MAY ASK MR
RYDER TO COMMENT. SURE NO
PROBLEM, SO OURS IS MORE AROUND
TIMELY PAYMENTS. IT'S OUR
UNDERSTANDING THAT, UM, AT LEAST
WHAT'S REPORTED BY THE PLANS TO
THE DEPARTMENT OF HEALTH CARE
SERVICES. IS THERE COMPLIANCE
OVERALL WITH TIMELY PAYMENTS
ACROSS THEIR ENTIRE PROVIDERS,
NOT JUST CERTAIN CATEGORIES OF
PROVIDERS. SO WHAT WE'RE HOPING
FOR IS THAT THERE IS A LITTLE
BIT MORE SPECIFICITY AS TO THEIR
TIMELY PAYMENTS RELATIVE TO LONG
TERM CARE FACILITIES SO WE CAN
SEE WHERE THERE ARE MORE
OUTLIERS. UM BECAUSE IF YOU'RE
LOOKING AT PROVIDER PAYMENTS AS
A WHOLE THEY'RE PROBABLY DOING
PRETTY WELL AT THIS POINT, UM,
WITH OTHER PROVIDERS THAT
THEY'VE BEEN CONTRACTING WITH
FOR A LONG TIME. SO IT'S MORE
SPECIFIC TO TIME TIMELY PAYMENTS
AS OPPOSED TO NETWORK ADEQUACY.
AWFULLY HARD TO THINK WE CAN
HAVE ADEQUATE NETWORKS IF PLANS
HAVEN'T CONTRACTED WITH HEALTH
FACILITIES THAT WE HAVE AND SO I
BELIEVE THAT SHOULD BE A MAJOR
MOTIVATION FOR MANY OF THESE
PLANS TO GET INTO COMPLIANCE
WITH NETWORK ADEQUACY AND THEN
WOULD PUSH ON HOW DO WE ENSURE
THAT WE ARE MEETING THAT NEED
FROM THE MEDICAL MANAGED CARE
PLANS? WITH THAT I WILL. THANKS
VERY MUCH THIS PANEL AND, UM WE
WANT.
WE ARE GOING TO DO SOMETHING A
BIT NONTRADITIONAL. WE ARE GOING
TO ACCEPT PUBLIC COMMENT ON
ISSUES ONE THROUGH 14 AT THE
MOMENT. AS WELL AS WE WILL TAKE
PUBLIC COMMENT AFTER THE
COMPLETION OF ALL THE ISSUES
TODAY, BUT WANTED TO GIVE THE
PUBLIC AN OPPORTUNITY TO
PARTICIPATE NOW. AND THIS WILL
BE STOPPED OR WE WILL TAKE A
BREAK PRIOR TO FIVE O'CLOCK SO
WE CAN BEGIN WITH THE ORDER OF
BUSINESS DIRECTLY AT FIVE
O'CLOCK. RIGHT NOW, THOUGH,
OPERATOR WE ARE READY TO
RECEIVE. WE WILL BEGIN WITH ANY
PUBLIC COMMENT IN THE HEARING
ROOM FIRST FOR ISSUES ONE
THROUGH 14, AND THEN WE WILL
TURN TO YOU, OPERATOR. THANK
YOU, MR. THANK YOU, MR CHAIRMAN
. MEMBERS TIFFANY WHITEN WITH
THE CIA. YOU CALIFORNIA. WE
SUPPORT THE EFFORTS TO HOLD
HOSPITALS ACCOUNTABLE AND ENSURE
NURSE TO PATIENT RATIOS ARE MET.
WE ALSO SUPPORT THE PROPOSAL BY
CAF TO AMEND THE COUNTY
IMPLEMENTATION TRAILER BILL IN
ORDER TO ADDRESS THE NEED FOR
OUR LONG TERM CARE FACILITIES.
WE DEFINITELY APPRECIATE THE
UPDATES FROM DIRECTOR BASS BOSS
AND LOOK FORWARD TO THE
COLLABORATION AS WE CONTINUE TO
FIGURE THESE THINGS OUT TO
ENSURE THAT THE PROBLEMS ARE
ADDRESSED ADEQUATELY. THANK YOU
SO MUCH. THANK YOU. JENNIFER
SNYDER WITH CAPITAL ADVOCACY ON
BEHALF OF FIRST ON BEHALF OF
CITY OF HOPE. I JUST WANTED TO
COMMENT HOW MUCH WE APPRECIATE
UNDER ISSUE FIVE. THE
DEPARTMENT'S REQUEST TO ADD
MONEY FOR THE IMPLEMENTATION OF
SP 987, WHICH IS A CANCER CURE
EQUITY ACT AND THEN SECOND ON
BEHALF OF WELL BEING HEALTH.
THEY'RE VERY SUPPORTIVE OF THE
DEPARTMENT'S BCP RELATIVE TO
INCREASING FUNDING FOR THE PACE
PROGRAM. THANK YOU. WE WILL TAKE
THAT AS THE END OF PUBLIC
COMMENT FOR NOW. OPERATOR. WE
WILL TURN TO ANY PUBLIC COMMENTS
THAT IS ON THE PHONE. THANK YOU
FRIDAY. PUBLIC COMMENT. YOU MAY
PRESS ONE AND THEN ZERO. WE'LL
GO TO LIKE 25. THANK YOU, MR
CHAIR AND MEMBERS SEEKING ON
BEHALF OF CAL TASTE, THE STATE
LED ASSOCIATION OF PROVIDERS
BEING IN SUPPORT OF ITEM 12 PHDS
AND PROPERLY SUPPORT PROGRAM
OVERSIGHT AND FUNCTIONS AND WE
REALLY APPRECIATE THE STAFF
RECOMMENDATION IN THE AGENDA. WE
ALSO APPRECIATE THE COMMITTEE'S
REMARKS TODAY WITH AN OUT OF THE
FUTURE FOR THE ELDERLY
CALIFORNIANS CAÑADA SAFELY IN
THEIR HOMES. COMMUNITIES
ESPECIALLY LINGUISTICALLY AND
CULTURALLY, UNDER 30 COMMUNITY
WAS TO REALLY APPRECIATE THE
DEPARTMENT PARTNERSHIP AND
MAKING THESE COMPLEX PROGRAMS
OPERATE PROPERLY AND
RESPECTFULLY ASK THAT THIS PCP
BE APPROVED AT THE APPROPRIATE
TIME. THANK YOU. THANK YOU. NEXT
CALLER, PLEASE. BLIND 26. HELLO
CHAIR MEMBERS AUTOMOBILE SMITH
WITH THE AMERICAN CANCER SOCIETY
CANCER ACTION NETWORK HERE TO
SUPPORT ITEM NUMBER FIVE. I'M A
CANCER CARE KOREA WHILE AMAZING
ADVANTAGES AND CANCER SCIENCE
AND ARE CREATING MORE EFFECTIVE
TREATMENT AND CARES FOR CANCER
PATIENTS. MANY PATIENTS WITH
COMPLEX DIAGNOSES AND NOT GIVEN
THE SAME OPPORTUNITIES TO
BENEFIT FROM THIS LEVEL OF CARE.
THE IMPACT OF CARE DISPARITIES
ARE GREATER PROVISION OR MEDICAL
BENEFICIARIES, ESPECIALLY THOSE
FROM UNDER RESOURCED
COMMUNITIES, RESULTING IN LESS
THAN FAVORABLE FIVE YEAR
OUTCOMES. SUPPORTING THIS BUDGET
REQUEST WILL ENSURE THAT
PATIENTS WOULD COMPLEX CANCER
DIAGNOSES RECEIVED THE CARE THAT
THEY NEED AND WE RESPECTFULLY
ASK THAT YOU SUPPORT THIS
MEASURE. THANK YOU. THANK YOU.
NEXT CALLER, PLEASE. THANK YOU
LADEN 14. GOOD AFTERNOON. DIANNA
DOUGLAS WITH HEALTH ACCESS
CALIFORNIA WE WOULD LIKE TO
EXPRESS SUPPORT FOR ISSUES SIX.
THE REQUESTED INCREASE IN
FUNDING TO SUPPORT THE COVERED
CALIFORNIA $1 PREMIUM PROGRAM
THAT IS IN TERMS EVERYONE CAN
ENROLL AS SEAMLESSLY AS POSSIBLE
. UM WITHOUT THE PREVIOUSLY
BURDEN, SOME EXTRA DOLLARS
CHARGE. THANK YOU VERY MUCH.
THANK YOU. THANK YOU ENLIGHTENED
16. THIS IS CATHERINE MCBRIDE.
UM EVERYONE, SORRY, BUT I'M
CALLING REGARDING ISSUE NUMBER
33 REGARDING GENDER FIRMING CARE
. P 107 NEVER SHOULD HAVE PASSED
AS IT TAKES AWAY PARENTAL RIGHTS
, ADDING 321,000 TO THE BUDGET
TO IMPLEMENT SPECIAL
INVESTIGATION DUE TO AN INCREASE
IN COMPLAINTS. REGARDING RELEASE
OF MEDICAL RECORDS WOULD BE A
WASTE OF TAXPAYER DOLLARS.
HEALTHCARE PROVIDERS SHOULD BE
ALLOWED TO RELEASE MEDICAL
INFORMATION WITH SUBPOENAS AND
AUTHORIZATION FROM PATIENT
REPRESENTATIVE ESPECIALLY
REGARDING MINORS. IF A MINOR IS
THAT CHANGED GENDER, THIS SHOULD
NEVER BE KEPT A SECRET FROM
PARENTS OR REPRESENTATIVES,
CONSIDERING THAT TELL THE
STORIES OF TRANSGENDER REGRET
AND HOW MANY CAN CONSIDERED
TREATY TRANSITIONING? SURPRISED
ANY PARENTS WOULD APPROVE A BILL
THAT SUPPORTS CAREGIVERS BEING
KEPT IN THE DARK REGARDING THIS
VERY SENSITIVE MATTER. PLEASE
VOTE NO ON ISSUE NUMBER 33
CONSIDER SPENDING THE MONEY ON
INCREASED MENTAL HEALTH CARE FOR
THOSE SUFFERING FROM GENDER
DYSPHORIA. THANK YOU VERY MUCH.
THANK YOU. NEXT CALLER, PLEASE.
LIKE 27. GOOD AFTERNOON, KELLY
BROOKS ON BEHALF OF THE CENTER
FOR OTHERS INDEPENDENCE PROGRAM
SERVING SENIORS AND ALAMEDA AND
CONTRA COSTA COUNTIES, CALLING
IN AND SUPPORT OF THE PEACE
BUDGET PROPOSAL. HCS NEEDS TO BE
ADEQUATELY FAST TO INCREASE
THEIR CAPACITY FOR CASE
ADMINISTRATION AND OVERSIGHT.
THE DEPARTMENT STAFF IS CRITICAL
TO OUR MISSION TO SERVE FRAIL
SENIOR. THANK YOU. THANK YOU.
NEXT CALLER, PLEASE. THANK YOU.
WE HAVE NO FURTHER PUBLIC
COMMENT AND KILL THANK YOU. I
WILL TAKE THAT AS THE CONCLUSION
FOR NOW WE WILL TAKE A BREAK
UNTIL FIVE O'CLOCK WHEN WE WILL
COME BACK TO OUR ORDER OF
BUSINESS ISSUES. 15 THROUGH 19.
WE ARE RECESSED UNTIL FIVE PM.
BECAUSE OF HOME TO YOU, RIGHT?
WE'RE GOING TO CALL THE MEETING
BACK INTO ORDER. I WOULD ASK,
UM, DR EWING COME FORWARD. WE
HAD BEEN WAITING ON DARRELL
STEINBERG, MAYOR OF SACRAMENTO,
AND HAVEN'T SEEN HIM LOG ON. SO
IF YOU'RE HAVING UH, ANY
TECHNOLOGY CHALLENGES. PLEASE
FEEL FREE TO REACH OUT TO THE
BUDGET OFFICE. BUT SINCE WE HAVE
NOT SEEN HIM ONLINE UP TO THIS
POINT, I BELIEVE WE'RE GOING TO
BEGIN WITH YOU, DR EWING, AND
WE'LL COME BACK AS NEEDED. THANK
YOU, MR CHAIR AND MEMBERS TOBY
EWING ON BEHALF OF THE STATE'S
MENTAL HEALTH COMMISSION. I
APPRECIATE THE OPPORTUNITY TO
JOIN YOU THIS EVENING. UM I WAS
HOPING TO GO SECOND. AND HERE,
MAYOR STEINBERG. SO I'M A LITTLE
CUT OFF, BUT BUT I REALLY
APPRECIATE THE CHANCE TO JOIN
YOU, AND WE PROVIDED SOME
WRITTEN COMMENTARY FOR PANEL ONE
OR ITEM ONE, WHICH IS REALLY
ASKING ABOUT SORT OF THE ORIGIN
STORY OF THE MHS A. AND SO, UM,
APOLOGIZE THAT IT'S A LITTLE
LENGTHY, BUT THERE THERE REALLY
ARE, UM A HANDFUL OF KEY
TAKEAWAYS FROM THE ORIGIN STORY
OF THE MENTAL HEALTH SERVICES
ACT THAT I THINK ARE VERY
RELEVANT TO THE GOVERNOR'S
MODERNIZATION PROPOSAL THAT IS
IN FRONT OF THE LEGISLATURE THAT
WILL BE IN FRONT OF THE
LEGISLATURE SHORTLY. AND ONE OF
THEM IS REALLY TO RECOGNIZE THAT
PROP 63 WAS BORN OUT OF A
MULTIYEAR CONSULTATION PROCESS,
REALLY BUILDING OFF OF WORK THAT
THE LITTLE HOOVER COMMISSION DID
OVER SEVERAL YEARS. AND THE
REASON THAT'S IMPORTANT IS
BECAUSE THE IMAGES SAY IS
CONSIDERED BY MANY IN THIS
COMMUNITY TO BE COMMUNITY OWNED
. IT WAS REALLY THE PRODUCT OF
HUNDREDS OF HOURS. HUNDREDS OF
MEETINGS HAVE CONSULTATIONS AND
ENGAGEMENT THAT STARTED WITH AN
UNDERSTANDING OF WHERE
CALIFORNIA'S MENTAL HEALTH
SYSTEM WAS AT THE TIME AND
THINKING ABOUT WHAT SHOULD THE
MENTAL HEALTH SYSTEM LOOK LIKE?
AND SO THE GOAL REALLY WAS TO
DRAFT VERY BROAD GOALS. WITH
SPECIFIC STRATEGIES, BUT ALSO
FLEXIBLE WITH FLEXIBILITY BUILT
IN TO THE MENTAL HEALTH SERVICES
ACT THAT WILL ALLOW LOCAL
AGENCIES TO MAKE DECISIONS THAT
ARE RESPONSIVE TO THEIR
COMMUNITIES IN WAYS THAT ARE
TAILORED TO THEIR GEOGRAPHY,
EASE TO THE POLITICAL REALITIES
OF THIS VERY DIVERSE STATE THAT
IS CALIFORNIA. AND IT WAS
DESIGNED TO BENEFIT FROM
EMERGING RESEARCH. RIGHT AND SO
AND I CAN GIVE YOU SOME EXAMPLES
DESIGNED TO REQUIRE COMMUNITY
CONSULTATION WITH A MANDATE FOR
PREVENTION AND EARLY
INTERVENTION THIS WHATEVER IT
TAKES APPROACH THAT IS INHERENT
IN THE FULL SERVICE PARTNERSHIP
PROGRAMS THAT ARE A MANDATORY
COMPONENT OF MENTAL HEALTH
SERVICES ACT. AND THAT, UM,
CALLS FOR INNOVATION THAT
RECOGNIZES THAT WE CAN DO
BETTER. AND SO I JUST I WANT TO
IT'S IMPORTANT TO REFLECT BACK
OF WHERE WE WERE 20 YEARS AGO
WHEN CALIFORNIA RATIONED ACCESS
TO CARE THROUGH MEDIC AL TO ONLY
THE MOST ILL THE MOST SICK
CALIFORNIANS. AND THERE WAS NO
PREVENTION AND THERE WAS NO
MECHANISM FOR CONTINUOUS
IMPROVEMENT. THE MHS SAY IS
REALLY DESIGNED AROUND A FUTURE
WHERE EVERYBODY WHO HAS MENTAL
HEALTH NEEDS HAS THOSE NEEDS
MET. AND WE'RE NOT THERE YET.
WE'RE FAR FROM IT. THE
CHALLENGES WE FACE. ACTUALLY I
WOULD ARGUE THROUGH THE
PERSPECTIVE OF THE WORK THAT WE
DO AT THE COMMISSION ARE MORE
ABOUT IMPLEMENTATION, THEN
POLICY. REMEMBER, JACKSON HAS
RAISED ISSUES AT AT THIS BUDGET
HEARINGS ABOUT WHETHER OR NOT
THERE'S A PROFOUND SENSE OF
URGENCY IN ADDRESSING THE
CHALLENGES THAT WE HAVE IN OUR
MENTAL HEALTH SYSTEM AND THAT'S
WHERE WE WERE 20 YEARS AGO IS
THAT WE DID NOT HAVE THAT
PROFOUND SENSE OF URGENCY. THE
COMMISSION WAS FORMED TO
ACTUALLY SUSTAIN AND AGGRESSIVE
AND ASSERTIVE VOICE FOR URGENCY
AROUND MENTAL HEALTH NEEDS
BROADLY DEFINED AND IT AND IF
YOU LOOK AT THE MEMBERSHIP OF
THE COMMISSION, WITH TWO MENTAL
HEALTH APPEARS TO FAMILY MEMBERS
TO PROVIDERS BUT ALSO EDUCATORS
TO PUBLIC SAFETY OFFICIALS TO
EMPLOYERS AND LABOR
REPRESENTATIVE. IT WAS REALLY
DESIGNED TO BE REFLECTIVE OF
DIVERSE VOICES ACROSS THE STATE
TO BRING THEM TOGETHER IN A WAY
INDEPENDENT OF WHO WAS IN THE
GOVERNOR'S OFFICE INDEPENDENT OF
LEGISLATIVE LEADERSHIP, BECAUSE
AT THE TIME WE DID NOT HAVE THE
SUPPORT OF THE GOVERNOR'S OFFICE
IN THE LEGISLATURE. IN FACT,
GRAY DAVIS VETOED LEGISLATION TO
CREATE A MENTAL HEALTH
COMMISSION AT THE TIME, WHICH
WAS PART OF THE REASON WHY, UM,
NOW MAYOR STEINBERG AND OTHERS
WENT TO THE BALLOT. IN TERMS OF
ACCOMPLISHMENTS, ONE OF THE
QUESTIONS THAT ARE OUTLINED IN
IN THE PACKET, UM THE PREVENTION
AND EARLY INTERVENTION COMPONENT
IN THE INNOVATION COMPONENT ARE
KEY FOUNDATIONAL PIECES. THEY
ARE FUNDING THAT IS UNAVAILABLE
IN NEARLY EVERY OTHER FUNDING
STREAM FOR MENTAL HEALTH. AGAIN
IF WE GO BACK 20 YEARS, AND I
WANT TO KEEP REFERENCING THIS
BECAUSE I WANT TO ALERT YOU TO
THE LIKELIHOOD THAT THAT SOME OF
THE REFORMS MAY RESULT IN
RETURNING TO HOW WE HAD
ORGANIZED AND FUND MENTAL HEALTH
SERVICES PRIOR TO THE A AND OVER
RELIANCE ON MEDICAL TO THE POINT
WHERE WE WERE RESTRICTING ACCESS
TO SERVICES DEPENDENT ON WHETHER
OR NOT MEDICAL WOULD PAY FOR IT.
THE MHS SAY DOES NOT HAVE
RESTRICTIONS THAT OTHER THAN NO
PSA PLANTATION, RIGHT. I ARGUE
THAT UNDER INNOVATION IF YOU CAN
CONVINCE THE MENTAL HEALTH
COMMISSION THAT FIELDING
POTHOLES IS GOOD FOR THE MENTAL
HEALTH OF THE COMMUNITY THAT
THAT IS AN ACCEPTABLE THERE'S NO
RESTRICTIONS BEYOND THE IDEA OF
ENGAGING THE COMMUNITY AND
HAVING FISCAL AND POLICY
DECISIONS AROUND LOCAL
BEHAVIORAL HEALTH STRATEGIES. TO
BE DRIVEN BY WHAT'S HAPPENING AT
HOME. THE DOLLARS ARE VERY
FUNGIBLE. P E. I IS IMPORTANT
NOT JUST AS A FUNDING STREAM.
IT'S MORE IMPORTANT AS AN
ATTITUDE THAT WE MANDATE
PREVENTION, EARLY INTERVENTION
IN WAYS THAT IS NOT TRUE IN ANY
OTHER FUNDING STREAM. IT IS A
FUNDING STREAM, BUT IT'S MOST
IMPORTANT VALUE IS IT FORCES US
TO HAVE COMMUNITY CONVERSATIONS
ABOUT WHAT DOES IT MEAN TO
PREVENT? WHAT DOES IT MEAN TO
INTERVENE EARLY? AND ARE WE
BEING SUCCESSFUL IN TERMS OF THE
EXPECTATIONS OF THE STATUTE, AND
GIVEN THAT IT WAS A STATUTE THAT
WAS DRIVEN BY VOTER INITIATIVE?
IT REALLY IS THE VOICE OF THE
PEOPLE WHO ARE SAYING PREVENTION
AND EARLY INTERVENTION IS KEY.
MORE THAN THAT. IT DEFINES
PREVENTION EARLY INTERVENTION IN
THE CONTEXT OF AVOIDING
HOMELESSNESS AND SCHOOL FAILURE
AND CRIMINAL JUSTICE INVOLVEMENT
. AVOIDING UNEMPLOYMENT AND
CHILD WELFARE INVOLVEMENT IF YOU
TAKE THE LANGUAGE OF PREVENTION
AND INTERVENTION IN THE NHS A
AND YOU TURN THOSE SEVEN
NEGATIVE OUTCOMES THAT ARE
DISCUSSED IT LINES UP VERY, VERY
NICELY, VERY CLOSE TO GLOBAL
DEFINITIONS OF WELL BEING. THE
MENTAL HEALTH SERVICES ACT IS
PUSHING OUR BEHAVIORAL HEALTH
SYSTEM TO BE A DRIVER OF WELL
BEING FOR ALL CALIFORNIANS. SO,
PES, SO HAVE WE BEEN SUCCESSFUL
? ABSOLUTELY WE'VE BEEN
SUCCESSFUL IN THAT WE'RE HAVING
THESE CONVERSATIONS AROUND
PREVENTION IN THE MENTAL HEALTH
SPACE AT A TIME WHERE THERE IS
NOT AGREEMENT OF WHAT THAT EVEN
MEANS. AND SO THE MHS SAY, IS
THIS CATALYST TO REALLY PUSH US
TO THINK DIFFERENTLY BEYOND WHAT
WE TRADITIONALLY PAY FOR AND TO
THINK ABOUT HOW WE DO UPSTREAM
INVESTMENTS TO REALLY SUPPORT
THE CALIFORNIANS WHO ARE AT
RISK. LOCAL COMMUNITIES HAVE
USED PE I DOLLARS AND INCREDIBLY
FLEXIBLE WAYS. I'LL GIVE YOU AN
EXAMPLE OF AN OUT OF THE BOX
STRATEGY THAT WAS ORIGINALLY
FUNDED WITH INNOVATION. GIVE YOU
TWO, UM IN IN THE IN FRESNO,
THEY FUNDED A COMMUNITY GARDEN
TO SERVE THEIR AMONG COMMUNITY.
REMEMBER CHAIR ARAMBULA. YOU MAY
BE FAMILIAR WITH THAT YOU MAY
HAVE VISITED TREMENDOUS
POLITICAL PUSHBACK IN OTHER
COMMUNITIES BECAUSE THEY FELT
THAT WAS A WASTE OF MONEY. THAT
PROPOSAL CAME OUT OF COMMUNITY
CONSULTATIONS AND WAS DESIGNED
TO RECOGNIZE THAT THE MONK
COMMUNITY DIDN'T HAVE THE
LANGUAGE AROUND MENTAL HEALTH,
AND THEY COULD ACTUALLY LEVERAGE
THESE CULTURAL PRACTICES OF
GARDENING. TO ENGAGE THAT
POPULATION AND THEY PUT SERVICES
NEXT DOOR. AND SO IT BECAME AN
ACT OF VERY CREATIVE, LOW COST
HIGHLY VISIBLE, HIGHLY VALUABLE
PREVENTION STRATEGY TO ENGAGE A
COMMUNITY THAT OTHERWISE WAS NOT
ACCESSING SERVICES. WE HAVE MORE
RECENTLY PARTNERED WITH SOLANO
COUNTY AND OTHER COUNTIES TO
LEVERAGE INNOVATION FUNDS TO
IMPROVE HOW WE CREATE ACCESS TO
SERVICES IN SOLANO COUNTY, THEY
SAW A 300% INCREASE IN ACCESS TO
CARE FOR THIS FOR THEIR
COMMUNITIES THAT WERE LEAST
LIKELY TO ACCESS BEHAVIOR HEALTH
SERVICES AGAIN THROUGH ROBUST
COMMUNITY CONSULTATION. EARLY
INTERVENTION AND PREVENTION WORK
. WE KNOW THAT BECAUSE OF THE
TESTIMONY THAT YOU HEARD AT YOUR
LAST HEARING, THE YOUNG WOMAN
WHOSE PARENTS HAD YOU KNOW, VERY
HIGH QUALITY HEALTH INSURANCE,
AND WE'RE NOT ABLE TO GET HER
INTO AN EARLY PSYCHOSIS PROGRAM
, AND THEY WERE ABLE TO GET INTO
AN EARLY INTERVENTION PROGRAM
WITH A GRANT. THAT PROGRAM TODAY
IS FUNDED WITH HS A DOLLARS THE
STRATEGIES THAT ARE AVAILABLE,
UM, THAT ARE NECESSARY THAT ARE
NOT AVAILABLE UNDER MEDICAL ARE
FUNDED WITH MHM S¼ SO PREVENTION
HAS BEEN ESSENTIAL P I HAS BEEN
ESSENTIAL. TO SHAPE HOW WE THINK
ABOUT MENTAL HEALTH
OPPORTUNITIES AND TO ENSURE THAT
WE CAN COVER THE DIFFERENCE
BETWEEN WHAT WHAT AN INDIVIDUAL
NEEDS OR WHAT A COMMUNITY NEEDS
AND WHAT MEDICAL IS, UM ABLE TO
PAY FOR UM, I ALSO WANT TO
RECOGNIZE THAT IN THIS IN THIS
QUESTION OF YOU KNOW, ARE WE
MAKING PROGRESS IN TERMS OF
PREVENTION, EARLY INTERVENTION
THAT IN THE TWO THOUSANDS WHEN
YOU KNOW BEFORE THE MENTAL
HEALTH SERVICES ACT WAS PASSED,
THE IDEA OF A SCHIZOPHRENIA
DIAGNOSIS WAS AKIN TO AN END OF
LIFE DIAGNOSIS. RIGHT THERE WAS
THIS JUST PROFOUND SENSE OF MY
LIFE IS OVER. THAT'S NOT TRUE
TODAY. THAT IS ABSOLUTELY NOT
TRUE. TODAY WE HAVE SEEN
PROGRESS IN SCHIZOPHRENIA
TREATMENT AND MENTAL HEALTH
TREATMENT AKIN TO THE KINDS OF
LEAPS THAT WE HAVE SEEN IN
CANCER OVER THE LAST 40 OR 50
YEARS WHERE CANCER DIAGNOSIS FOR
A GENERATION AHEAD OF US MAY
HAVE BEEN SEEN AS A DEATH
SENTENCE, AND NOW WE KNOW THAT
PREVENTION AND EARLY
INTERVENTION ABSOLUTELY WORK.
THE FRUSTRATION THAT I HAVE THAT
YOU MAY HEAR IN MY VOICE IS THAT
WE'RE EVEN HAVING THIS
CONVERSATION. WE DON'T NEED TO
HAVE A CONVERSATION ABOUT DOES
PREVENTION WORK OR DOES EARLY
INTERVENTION WORK IN TERMS OF,
UM AH, ALMOST ANY OTHER ASPECT
OF HEALTH CARE? AND SO, UM,
THESE TWO COMPONENTS ARE
ESSENTIAL IN THAT THEY HAVE
ACTUALLY PUSHED OUR COUNTY
BEHAVIORAL HEALTH PARTNERS TO
MOVE BEYOND THE TRADITIONAL
APPROACH. TO BEHAVIORAL HEALTH
CARE THAT IS FUNDING DRIVEN AND
INSTEAD PUT IN PLACE A STRATEGY
THAT IS NEED DRIVEN. BORN OUT OF
THAT COMMUNITY CONSULTATION BORN
OUT OF THOSE HONEST DISCUSSIONS
IN SOME PLACES, THEY'RE MORE
HONEST THAN OTHERS IN SOME
PLACES ACROSS THIS DIVERSE STATE
THAT THE LEVEL OF ENGAGEMENT
WITH THE COMMUNITY IS MORE
ROBUST THAN OTHERS. BUT IT IS
THIS IDEA THAT THE LAW REQUIRES
THE BEHAVIORAL HEALTH SYSTEM AT
THE LOCAL LEVEL TO SIT DOWN WITH
RESIDENTS AND HAVE A DISCUSSION
ON THESE TWO OPPORTUNITIES. ONE
ARE WE DOING EVERYTHING WE CAN
TO DO THE UPSTREAM WORK TO
ENGAGE PEOPLE EARLY AND TO
INVEST IN STRATEGIES THAT CAN
PREVENT NEEDS FROM CYCLING TO BE
MORE EXPENSIVE, PARTICULARLY IN
TERMS OF INCARCERATION,
HOSPITALIZATION AND HOMELESSNESS
AND SECOND ARE WE DOING
EVERYTHING WE CAN TO ENSURE THAT
THE SERVICES WE HAVE OUR BEST
AVAILABLE THAT INNOVATION PIECE
HAVING A PREVENTION MANDATE AND
HAVING AN INNOVATION MANDATE, I
WOULD ARGUE IS ESSENTIAL. IT'S
AT THE CORE OF THE ESA AND THOSE
PIECES REALLY WERE PUT IN INTO
THE NHS IN RESPONSE TO A
SCENARIO WHERE MENTAL HEALTH
SYSTEM WAS DRIVEN. PRIMARILY BY
MEDICAL PRIOR TO THE IMAGE OF
S¼. SO YOU KNOW, I WAS GOING TO
SAY THAT THREE YEARS AGO, I SAT
WITH THE MAYOR AND WE TALKED
ABOUT ACTUALLY WANTING TO CHANGE
THE FORMULA TO BE 80% PREVENTION
. EARLY INTERVENTION, WHICH IS
HOW WE SHOULD BE ALLOCATING
RESOURCES AND 20% RESPONSE TO
DEEPEN NEEDS. YOU KNOW, I'M I'M
I'M I'M CHALLENGED TO SEE HOW WE
FIND OURSELVES IN THIS PLACE
WHERE WE'VE LOST SIGHT OF THE
IDEA. THAT UPSTREAM IS NOT THE
PRIORITY AND THAT IN AND THAT
INSTEAD WHAT WE NEED TO DO IS
MAXIMIZE RESPONSIVENESS TO
DIAGNOSES. NOW I WANT TO
RECOGNIZE THAT THE GOVERNOR'S
PROPOSAL IS TACKLING SOME JUST
PHENOMENAL CHALLENGES, AND HE IS
SPOT ON IN TERMS OF THE EMPHASIS
ON HOMELESSNESS. THE EMPHASIS ON
ADDICTION AND SPOT ON IN TERMS
OF THE PUSHING MEDICAL TO BE
ABLE TO OFFER MORE UPSTREAM
SERVICES. RIGHT UM, THE MHS A
WAS ACTUALLY DESIGNED TO BE A
COUNTERPOINT TO WORK TOGETHER
WITH MEDICAL SO THAT MEDICAL
WITH THE MHS A WOULD ACTUALLY
GIVE OUR COMMUNITIES THE BEST
OPPORTUNITY. TO BE AS RESPONSIVE
AS POSSIBLE TO NEEDS THAT ARE
OCCURRING TODAY AND THAT ARE
EMERGENT AND I AND THE REASON I
SAY EMERGENT IS BECAUSE, UM, THE
FACT THAT MHS AIDALA ARE SO
FLEXIBLE, THEY ALLOW LOCAL
AGENCIES TO SPEND THOSE DOLLARS
ON ISSUES THAT WE DID NOT KNOW
ABOUT LAST YEAR. THAT THAT IT'S
NOT DRIVEN BY FEDERAL POLICY OR
EVEN STATE POLICY. THAT'S REALLY
THE FLEXIBLE THE MOST FLEXIBLE
RESOURCES THAT ALLOW OUR SYSTEMS
TO ACTUALLY BE RESPONSIVE. TO
NOT WHAT WE LEARNED LAST YEAR.
BUT WHAT WE'RE THINKING ABOUT IN
TERMS OF THE IMPACTS TODAY AND
TOMORROW. I'VE GOT A BUNCH OF
EXAMPLES BUT JUST AN INTEREST OF
TIME INTEREST SHAKING HER HEAD,
PLEASE. NO I WILL FINISH THERE
AND SAY, I REALLY LOOK FORWARD
TO HEARING MAYOR STEINBERG'S
COMMENTS HAPPY TO ANSWER ANY
QUESTIONS YOU MIGHT HAVE ABOUT
THE ORIGIN. I DID NOT COVER WHAT
WAS IN THE HANDOUT BECAUSE THEY
GAVE IT TO US A HANDOUT. BUT I
APPRECIATE YOUR TIME AND HAPPY
TO ANSWER ANY QUESTIONS YOU
MIGHT HAVE. THANK YOU, DR EWING.
FOR YOUR FLEXIBILITY. IT NOW IS
A PRIVILEGE AND TREAT TO WELCOME
THE SUB ONE. THE HONORABLE MAYOR
OF SACRAMENTO AND THE AUTHOR OF
THE MENTAL HEALTH SERVICES ACT
AND.
AH THAT'S BETTER. CAN YOU CAN
YOU? I'M SORRY. I THINK I WAS
UNDER YOUR THUMB. GOOD AFTERNOON
, MR CHAIRMAN, CHAIRMAN ARAMBULA
AND MEMBERS OF THE COMMITTEE.
THANK YOU FOR HAVING ME. I'M SO
SORRY. I CANNOT BE WITH YOU IN
PERSON. UH I TESTED POSITIVE
YESTERDAY FOR COVID AND MINOR
SYMPTOMS. I'M FINE, BUT OF
COURSE I SHOULDN'T AND CAN'T BE
THERE WITH YOU, BUT, UM
APPRECIATE THE TECHNOLOGY AND
THE OPPORTUNITY. TO ADDRESS YOU,
UM. SO LET ME BEGIN BY SAYING
I'VE HEARD MOST, UH DR EWING'S,
UH, TESTIMONY. LET ME BEGIN BY
SAYING THAT I'M NOT JUST AS A
PRIDE OF AUTHORSHIP. STATEMENT
BUT GENUINELY, I AM A BIG FAN OF
THE MENTAL HEALTH SERVICES ACT.
IT IS SAVED THE MENTAL HEALTH
SYSTEM IN CALIFORNIA LITERALLY
IT'S BILLIONS OF DOLLARS. HAVE
MADE UP FOR, UH, NO NUMEROUS
RECESSIONS OVER THE PAST. 20
PLUS YEARS AND HAD SERVED AS AS
DR EWING SAID, AS A SPUR FOR
INNOVATION AND POSITIVE CHANGE
IN THE SYSTEM. IF WE DID NOTHING
ELSE, UM, WE CHANGE NOTHING. UM
IT WOULD STILL BE A GOOD AND A
GREAT THING BY VIRTUE OF WHAT IT
IS DOING. AT THE SAME TIME. OVER
20 YEARS AFTER THE PASSAGE OF
ANY MAJOR LAW. IT IS NOT ONLY
FAIR, BUT I WOULD SAY IT IS
IMPERATIVE. THAT WE ALL TAKE A
LOOK AT ITS STRENGTHS. AND WHERE
IT CAN BE MORE EFFECTIVE,
FRANKLY, TO PUT IT IN A IN THE
MOST BASIC WAY. IT'S TOO MUCH
DARN MONEY. TO ALLOW US TO DO TO
ALLOW US TO JUST GO ON FOR
ANOTHER DECADE OR TWO WITHOUT
ASKING THE FUNDAMENTAL QUESTION.
ARE THE DOLLAR'S BEING USED FOR
THE HIGHEST AND BEST USE IS THE
MOST IMPORTANT NEEDS OF THE
PEOPLE OF CALIFORNIA WHEN IT
COMES TO MENTAL AND BEHAVIORAL
HEALTH. AND ON THAT QUESTION, I
ARGUED FORCEFULLY THAT IT IS
TIME FOR NOT, UM, REDOING IT FOR
THE SAKE OF REDOING IT, BUT FOR
MODERNIZING IT, AND HERE'S WHY
FIRST OF ALL. IT'S IMPORTANT.
YOU ASKED THE QUESTION. WHAT WAS
THE ORIGINAL INTENT OF THE
MENTAL HEALTH SERVICES ACT? THE
REGIONAL INTENT, AND I COULD SAY
THIS BECAUSE I CAMPAIGNED FOR I
WAS THE LEAD CAMPAIGNER FOR IT
WAS TO ALLEVIATE THE THEN
VERSION, CALIFORNIA'S HOMELESS
CRISIS. AND SIMPLE RUSTY. SEE
LICKS AND I, UM IN 1998 THE LATE
RESCUE FELIX AND I 1998 DID SOME
MATH ON THE BACK OF A NAPKIN.
AND SAID. WE ESTIMATE THERE ARE
50,000 HOMELESS, MENTALLY ILL
PEOPLE IN CALIFORNIA. WE
ESTIMATED THAT IT WOULD COST
THEN ABOUT $15,000 APIECE, UM
HALF FROM THE STATE AND HALF
FROM FEDERAL MATCHING FUNDS. TO
BE ABLE TO PROVIDE WRAPAROUND
SERVICES, WHICH BECAME FULL
SERVICE PARTNERSHIPS TO HELP
THEM AND IT WAS ROUGH MATH. BUT
IT LED TO IN THE YEARS PRIOR TO
THE MENTAL HEALTH SERVICES ACT
BY INTRODUCTION AS A FRESHMAN
ASSEMBLY MEMBER. UM A B 34,
MAYBE 2034, WHICH WERE THE
INTEGRATED SERVICES FOR THE
HOMELESS, MENTALLY ILL BILLS.
THAT LED TO 50 PLUS MILLION
DOLLARS A YEAR. TO HELP. PEOPLE
WHO ARE HOMELESS AND MENTALLY
ILL IN 30, PLUS COUNTIES IN
CALIFORNIA. IT WAS A GREAT
SUCCESS. WE SHOWED SIGNIFICANT
REDUCTIONS IN HOMELESSNESS IN
HOSPITALIZATION. ARE IN JAIL
TIME AND INCREASED. EMPLOYMENT
FOR PEOPLE WHO WERE THE
BENEFICIARIES OF THE WHATEVER IT
TAKES APPROACH. IT WAS SO GOOD.
THAT IT LED RUSTY AND I AND
OTHER MEMBERS OF THE MENTAL
HEALTH MOVEMENT TO SAY 50, PLUS
MILLION DOLLARS A YEAR IS NOT
ENOUGH. WE OUGHT TO FULFILL THE
PROMISE MADE BY THE STATE OF THE
19 SIXTIES AND SEVENTIES. WHEN
THEY SHUT THE STATE MENTAL
HOSPITALS TO BUILD A FULL SYSTEM
. UM MENTAL HELP FOR ALL
CALIFORNIA AND THAT LED TO THE
DEVELOPMENT OF AND EVENTUALLY
THE PASSAGE OF THE MENTAL HEALTH
SERVICES ACT. AND YES, WE WERE
DELIBERATE ABOUT SAYING THAT 20%
OF THE MONEY EVERY YEAR OUT OF
THE SPENT ON PREVENTION, EARLY
INTERVENTION AND 5% ON
INNOVATION, AND I WILL GET TO
THAT IN A MOMENT. BUT I THINK
WHAT'S MOST IMPORTANT IS
DIRECTING NYSE THAT THE
DEFINITION OF WHATEVER IT TAKES
AN A B 34 2034 HAS NOT
NECESSARILY BEEN THE WAY THAT 58
COUNTIES THROUGHOUT THE STATE
HAVE DEFINED THEIR OWN FULL
SERVICE PARTNERSHIPS, WHICH ARE
THAT WHICH IS THE COIN OF THE
REALM. WRAPAROUND SERVICES FOR
PEOPLE WITH SEVERE AND
PERSISTENT MENTAL ILLNESS. WHAT
DO I MEAN BY THAT? WELL, THE
HOMELESS CRISIS HAS HAS
MULTIPLIED IN CALIFORNIA. AND I
SAY THIS NOT ONLY AS AH SUBBAN
WITH A STATEWIDE SCOPE HERE, BUT
ALSO AS THE MAYOR OF A MAJOR
URBAN CITY. THE TRUTH OF THE
MATTER IS THAT NEITHER THE
ACCOUNTABILITY COMMISSION AND I
LOVE THE WORK THAT TOBY AND HIS
TEAM DO. BUT THE TRUTH IS THE
TRUTH. NEITHER THE
ACCOUNTABILITY COMMISSION OR ANY
OF THE COUNTIES. HAVE PRODUCED
ANY DATA TO SHOW THAT THE
MAJORITY OF THEIR FULL SERVICE
PARTNERSHIPS ARE ACTUALLY
FOCUSED ON PEOPLE IN THESE TENT
ENCAMPMENTS WHO ARE LIVING OR
LIVING IN THEIR VEHICLES. MANY
OF THEM WHO ARE SUFFERING FROM A
DIAGNOSABLE MENTAL ILLNESS AND
OR DRUG ADDICTION. AND WHAT'S
REALLY HAPPENING IN THE COUNTIES
IF WE'RE GOING TO TELL THE
TRUTH? IS THAT THEY ARE HELPING
A LOT OF PEOPLE. NO QUESTION
ABOUT IT. THE FULL SERVICE
PARTNERSHIPS ARE GOOD AND THEY
ARE WORKING. BUT BECAUSE
ADDRESSING THE PROBLEM OF STREET
HOMELESSNESS IS SO SIGNIFICANT
THEY ARE NOT FOCUSING ON THE
PEOPLE IN THE STREETS. NOW THERE
MAY BE INSTANCES WHERE THEY ARE
WHERE THE FULL SERVICE
PARTNERSHIP CONCEPT IS APPLIED
IS APPLIED, IN FACT TO PEOPLE
LIVING CHRONICALLY HOMELESS, BUT
THE MAJORITY OF THOSE F SPS ARE
NOT FOCUSED ON THAT POPULATION,
AND I THINK IF THERE'S ANYTHING
TO BE TAKEN FROM THE GOVERNOR'S
PROPOSAL THAT NEEDS TO BE
ADDRESSED. IT'S THAT A MAJORITY
OF THOSE F SPS MUST BE DIRECTED
TO PEOPLE WHO ARE IN THE MOST
VULNERABLE POSITIONS IN OUR IN
OUR STATE. WE REALLY WANT TO DO
SOMETHING ABOUT HOMELESSNESS
REALLY WANT TO SEE A RELIEF. FOR
THE THOUSANDS OF PEOPLE WHO ARE
SUFFERING IN FOR THE COMMUNITIES
BECAUSE THAT'S RELEVANT TO THEN
THIS MONEY, WHICH IS TOBY SAID
THAT SOME OF THE ONLY
DISCRETIONARY MONEY THAT THE
STATE HAS WHEN IT COMES TO
MENTAL HEALTH. MORE OF IT NEEDS
TO BE FOCUSED ON THE HOMELESS
POPULATION. AND IT JUST PLAIN
ISN'T NOW THAT THE COUNTIES WILL
PRODUCE SOME STATISTICS SAYING
THAT, UH, WITH A BROADER
DEFINITION OF HOMELESSNESS THAT
SAYS THAT A LOT OF MONEY IS
GOING TOWARDS HOMELESSNESS. NOT
ENOUGH AND NOT ENOUGH TOWARDS
THE PEOPLE ARE ACTUALLY LIVING
IN THE ENCAMPMENT, AND IT'S NOT
JUST THE SERVICES ASSERTIVE
COMMUNITY OUTREACH. THE MENTAL
HEALTH CLINICIANS OUT ON THE
STREET. IN THOSE ENCAMPMENTS.
THERE'S VERY LITTLE COORDINATION
BETWEEN CITIES AND COUNTIES. IN
OUR COUNTY AND THEN OUR CITY. WE
WORKED FOR FOUR DIFFICULT YEARS
WITH A LOT OF CONFLICT BEFORE WE
GOT TO A PLACE THAT WE WERE
FINALLY ABLE TO NEGOTIATE
ILLEGALLY BINDING PARTNERSHIP
AGREEMENT THAT REQUIRES THE
COUNTY TO ADD AS MANY F SPS AS
ARE NECESSARY TO MEET THE NEED
BASED UPON THE DIAGNOSIS IN THE
FIELD. THERE'S NO SUCH
PARTNERSHIP AGREEMENT THAT I
KNOW OF. IN ANY OTHER PART OF
THE STATE, SO THAT'S ONE
FUNDAMENTAL PROBLEM. LET ME TALK
ABOUT PREVENTION AND EARLY
INTERVENTION FOR A MOMENT,
BECAUSE WHILE TOBY IS CORRECT
THAT IT IS WAS A MAJOR TENANT IN
THE MENTAL HEALTH SERVICES ACT
AND OUGHT TO CONTINUE TO BE I'M
SORRY. THERE HAS NOT BEEN ANY
KIND OF A VALUED OF DATA. TO
SHOW THAT, UM, THE WIDE VARIETY
OF THINGS THAT ARE FUNDED TO
PREVENTION AND EARLY
INTERVENTION ARE ACTUALLY MAKING
A SYSTEMIC IMPACT. ON THE MOST
SERIOUS PROBLEMS AND CHALLENGES
WE FACE AS A STATE, NOT JUST
HOMELESS, BUT CRIMINAL JUSTICE,
RECIDIVISM REDUCTION. THE NUMBER
OF KIDS THAT ARE KEPT OUT OF
INSTITUTIONAL PLACEMENT. SUICIDE
REDUCTION. LET ME GIVE YOU 11
VERY PROMINENT EXAMPLE. WE KNOW
THAT. ONE OF THE BEST EVIDENCE
BASED PRACTICES IN PREVENTION
AND EARLY INTERVENTION IS EARLY
PSYCHOSIS, IDENTIFICATION AND
INTERVENTION. BECAUSE WE GIVE SO
MUCH DISCRETION TO THE COUNTIES.
AND BECAUSE THESE PRODUCTS THESE
KINDS OF PROGRAMS TAKE SOME TIME
TO DEVELOP AND MAYBE ARE MORE
EXPENSIVE THAN THE OTHER
APPROACHES. WE'VE GOT 30 EARLY
PSYCHOSIS IDENTIFICATION
INTERVENTION PROGRAMS THAT ARE
GOING ON IN THE STATE, I'M TOLD
BY THE EXPERTS THAT WE HAVE THE
CAPACITY TO RAISE THAT TENFOLD.
THAT WE COULD THAT WE COULD
EASILY SERVE. UH TEENAGERS AND
OTHERS WHO EITHER HAVE HAD A
FIRST BREAK. OR ARE JUST SHORT
OF THE FIRST BREAK. WE COULD WE
COULD HAVE 300 PROGRAMS. AND
MEET THE NEED INSTEAD. WE ONLY
HAVE 30. SO WHAT DOES THAT SAY
TO ME? NOT THAT THE IMAGE ESSAY
PREVENTION AND EARLY
INTERVENTION DOLLARS ARE BEING
WASTED. YOU KNOW, IT'S LIKE THE
F SPS ARE NOT BEING WASTED. THE
ARGUMENT IS DIFFERENT. MY
ARGUMENT IS THAT IT IS FAR PAST
TIME THAT WE SET MORE FOCUSED
PRIORITIES. EARLY PSYCHOSIS,
IDENTIFICATION AND INTERVENTION
IS THE KIND OF EARLY
INTERVENTION WE WANT TO SAY SEE
MORE OF THEN WE OUGHT TO SAY AS
A STATE TO OUR COUNTY PARTNERS.
YOU MUST FUND THIS. DO IT YOUR
WAY. WE WON'T TELL YOU HOW TO DO
IT. BUT YOU MUST FUND THIS. WHAT
WOULD BE WRONG WITH SAYING IN
THAT THIRD BUCKET, FOR EXAMPLE,
WHICH I KNOW IS THE MOST
CONTROVERSIAL PART OF IT. I
STRONGLY FAVOR A BILLION DOLLARS
SET ASIDE FOR HOUSING. I THINK
IT OUGHT TO BE TIED TO F SPS AS
MUCH AS POSSIBLE. I SUPPORT
ENHANCING F SPS IN THE SECOND
BUCKET. BUT MAKING SURE THAT
THAT A HIGH PERCENTAGE OF THOSE
F SPS ARE DEDICATED, INCLUDING
OUTREACH TO PEOPLE ON THE
STREETS IN THE THIRD BUCKET. I
WOULD SUPPORT A SET ASIDE FOR
EARLY INTERVENTION JUST AS THE
ORIGINAL ACTED, BUT I WOULD
REQUIRE BY THE STATE THAT WOULD
BE MUCH MORE FOCUSED. PICK THE.
FIVE EVIDENCE BASED PRACTICES
AROUND EARLY PSYCHOSIS AROUND
SUICIDE REDUCTION AROUND
WHATEVER ELSE, UM WHATEVER ELSE
IS GOING TO HELP SAVE LIVES FOR
PEOPLE WHO ARE WHO ARE THE
SICKEST OF THE SICK? HOW ABOUT F
SPS FOR TRANSITION AGE KIDS
BETWEEN THE AGES OF 16 AND 24
MAKE THAT ONE OF YOUR CATEGORIES
OF PREVENTION AND EARLY
INTERVENTION. IN OTHER WORDS.
WITHOUT STATE LEADERSHIP AND
STATE FOCUSED. ON OUTCOMES THAT
WE EXPECT FROM THESE DOLLARS
YOU'RE GONNA GET THE KINDS OF
EXAMPLES THAT TOBY JUST
DESCRIBED. I LOVE THE MONNING
STORY FROM FRESNO. I'VE TOLD
THAT STORY MANY TIMES THAT STORY
IS 15 YEARS OLD. WHAT DO WE HAVE
NOW TO SHOW FOR PREVENTION AND
EARLY INTERVENTION TO SCALE THAT
IS ACTUALLY GOING TO MAKE AH, A
REAL DIFFERENCE. UM AND SO
RATHER THAN AND ONE OTHER THING.
HAS CHANGED IN SOME WAYS FOR THE
BETTER. WE NEVER L. A. UM THE
GOVERNOR BECAUSE OF THE GOOD
BUDGET BECAUSE IF ITS LEADERSHIP
AND THE LEGISLATORS,
LEGISLATURES LEADERSHIP. THANK
YOU, CHAIR RAM. YOU AND YOUR
COLLEAGUES. YOU SET ASIDE $5
BILLION FOR YOUTH MENTAL HEALTH.
AS I SAID, YOU KNOW, HAVE CAL
AIM IT MAKES YOU SHOULD NEVER BE
SEEN AS JUST ONE PIECE OF THE
SYSTEM. OR JUST SEPARATE PART OF
THIS IS TO MAKE SHOULD BE SEEN
AS AN INTEGRATED PART OF THESE
OTHER MEASURES AND INITIATIVE.
AND IN THAT LIGHT, I THINK IT IS
WORTH ASKING. CAN SCHOOL BASED
SERVICES BE FUNDED THROUGH
CALAIS? UM THERE FOR OBVIATING
THE PRESSURE ON MH ESSAY TO DO
THAT? UM PREVENTION. EARLY
INTERVENTION IS ABSOLUTELY
RIGHT. BUT IT MUST BE FOCUSED
AND I'M SORRY. THERE'S NO
EVIDENCE THAT I'VE SEEN THAT
THERE IS ANY FOCUS STATEWIDE
PRIORITIES. THAT TO SCALE THAT,
UM, THAT THAT WOULD FULFILL THE
PROMISE OF WHAT WE SET OUT TO DO
20 YEARS AGO, SO ASIAN IN
CONCLUSION. F SPS OUGHT TO BE
BASED MORE ON THE ORIGINAL
INTENT OF A B 34. MAYBE 2034
OUGHT TO BE FOCUSED IN
COLLABORATION WITH CITIES. THE
MAJOR CITIES OF THE STATE ON
ADDRESSING AND GENUINELY
REDUCING THE NUMBERS OF PEOPLE
LIVING IN SQUALOR ON OUR
STREETS. IN THEIR VEHICLES OR IN
THESE TENTS, NUMBER TWO HOUSING
IS AN ABSOLUTE MUST, BECAUSE
WITHOUT AN ONGOING SOURCE OF
FUNDING YOU REMEMBER SEVERAL
YEARS AGO I PUSHED WITH THEN
PROTEST KEVIN DELEON THE IDEA OF
NO PLACE LIKE HOME THAT IS
WORKED. BUT IT WAS ONE TIME
MONEY AND FRANKLY, IF WE DO IT
AGAIN AND YOU DO THE BILLION, I
WOULD DIRECT AS MUCH OF IT AS
POSSIBLE. THE MANUFACTURED
HOUSING AND LOW COST HOUSING
THAT CAN BE BUILT TO SCALE AND
BUILT QUICKLY, BUT WE NEED THE
HOUSING MONEY. THE F S. P S
CONTINUE THEM, BUT IN THE HANDS
THEM AND MAKE THEM FOCUSED ON
THE PEOPLE WHO ARE LIVING ON OUR
STREETS AND ON PREVENTION AND
EARLY INTERVENTION RIGHT ON. I
THINK THERE'S A LOT OF ROOM TO
NEGOTIATE AND TO WORK OUT THAT
THIRD BUCKET BUT FOCUS IT ON 345
THINGS THAT WE CAN'T OTHERWISE
DO WHAT THE OTHER MONEY AND THAT
REPRESENT INTERVENTION FOR
PEOPLE WHO WITHOUT THAT INNER
WITHOUT THAT INTERVENTION ARE
GOING TO END UP ON OUR STREETS
OR IN OUR JAILS. I'M HAPPY TO
ANSWER YOUR QUESTIONS. I THINK
THIS IS THE TIME TO LEAN IN. I
SEE WHAT'S HAPPENING OUT THERE.
I SEE THAT THE STEINBERG
INSTITUTE, WHICH YOU KNOW, I'M
VERY PROUD OF THE LEADERSHIP OF
OUR ENTIRE TEAM ARE SORT OF ON
ONE SIDE SORT OF. RALLYING UH,
WITH A SIMILAR MESSAGE TO MINE.
I SEE. A LOT OF THE TRADITIONAL
STAKEHOLDERS WHO ARE OUR FRIENDS
WHO WE DID THIS WORK. MHM ESSAY
IN PARTNERSHIP WITH ARE SAYING.
DON'T TAKE THE MONEY THAT WE
HAVE AWAY FROM US, BECAUSE, UM,
WE'LL GET HURT AND OUR PROGRAMS
WILL GET HURT. I JUST ALL TO
COME TOGETHER HERE BECAUSE WHERE
YOU CAN SHOW THAT ANY GOOD
PROGRAM WILL SOMEHOW BE HURT BY
ANY MODERNIZATION. WE ARE NOT
GOING FORWARD UNTIL WE CAN
ADDRESS THAT. EDITH UM, H S A
THROUGH CALIFORNIA OR THROUGH
OTHER STORES OF FUNDING, BUT WE
HAVE TO. WE CAN'T HAVE THE USUAL
DEBATE HERE THAT THAT IS, YOU
KNOW. LOOK WHAT ACTION IS DOING
TO WHY WE HAVE AN OPPORTUNITY
WITH THIS LARGESSE. THIS GIFT
FROM THE PEOPLE TO SAVE MORE
LIVES. AND WHAT'S GOING ON ON
OUR STREETS AND WHAT'S GOING ON
WITH TEENAGERS AND KIDS WHO ARE
SUCH GREAT RISK IF YOU DON'T GET
INTENSIVE, IMMEDIATE HELP, IT'S
TOO BIG FOR US TO DO BUSINESS AS
USUAL. AND SO IF MY VOICE MEANS
ANYTHING IS THE ORIGINAL AUTHOR,
THIS ACT THIS DOES NOT NEED TO
BE FUNDAMENTALLY FIXED, ER, YOU
KNOW, REDONE. IT JUST NEEDS TO
BE MODERNIZED AND REFRESHED, THE
MOST URGENT NEEDS AT THE MOMENT
AND, UH I THINK IT'S A GREAT
OPPORTUNITY. HOPE IT SEEMED THAT
WAY, AND I HOPE THAT WE CAN ALL
COME TOGETHER AS PEOPLE WHO
REALLY CARE ABOUT ALL THOSE
SUFFERING NEEDLESSLY OUT THERE.
THANKS FOR HAVING ME. THANK YOU,
MAYOR STEINBERG. I WILL BRING IT
UP TO THE DIESS FOR MEMBERS
QUESTIONS AND WOULD REMIND
EVERYONE THAT WE HAVE FIVE
ISSUES. RELATED TO MENTAL HEALTH
THAT WILL BE FOLLOWING SO ANY
PARTICULAR QUESTIONS THAT YOU
MAY HAVE RELATED TO THE HISTORY
AND OVERVIEW. THIS WOULD NOW BE
AN APPROPRIATE TIME. SEEING
NONE. I WILL THEN KEEP IT HERE
AT THE CHAIR. I REALLY LIKED. UM
MAYOR STEINBERG. YOU SAID THIS
WAS A GIFT FROM OUR PEOPLE TO
SAVE LIVES THAT I'D LIKE TO ASK
MR EWING. IF I CAN. THERE WAS A
SUGGESTION REGARDING 3 TO 5
THINGS THAT WE COULD RECOMMEND
POTENTIALLY TWO COUNTIES THAT
WOULD FOCUS ON PREVENTION AND
EARLY INTERVENTION, AND I'M
HOPING YOU CAN COMMENT ON WHAT
YOU WOULD BELIEVE THOSE 3 TO 5.
THINGS WOULD BE THANK YOU, MR
CHAIR, AND I AND I AGREE WITH,
UM MAYOR STEINBERG AND IN FACT,
THE COMMISSION HAS BEEN BRINGING
THAT FOCUS, AT LEAST IN OUR OWN
WORK. AND IF WE START WITH THE
THREE MOST EXPENSIVE, MOST
NEGATIVE, YOU KNOW, DIFFICULT
OUTCOMES OF HOMELESSNESS,
INCARCERATION AND
HOSPITALIZATION, AND WE LOOK AT
JUST THE DOLLARS THAT WE'RE
SPENDING TO REACT TO THOSE THREE
PARTICULAR CHALLENGES. WE LOOK
UPSTREAM. FIRST IT THE STEP THAT
SHOULD SHOULD BE JUST BEFORE
THAT HAPPENS IS, AS THE MAYOR
POINTS OUT IS FULL SERVICE
PARTNERSHIPS. SO WITH WITH YOUR
SUPPORT. JUST LAST YEAR, THE
COMMISSION RECEIVED FUNDING TO
ACTUALLY DIG IN AND DO THE
ANALYSIS THAT THAT THE MAYOR HAS
CALLED FOR WHICH IS TO
UNDERSTAND WHAT IS WORKING. AND
IN FACT, LAST WEEK WE DID A SITE
VISIT ASSEMBLY HEALTH STAFF WORK
, PLANNING TO ATTEND BUT RAN
INTO SOME BARRIERS AND BUDGET
COMMITTEE STAFF ALSO WERE
PLANNING TO ATTEND. WE WILL DO
ANOTHER SITE VISIT TO F SPS TO
REALLY ENTERTAIN WHAT'S WORKING.
WHAT'S NOT WORKING? BUT THE STEP
UP FROM THAT IS, AS THE MAYOR
SAYS, EARLY PSYCHOSIS. WE HAVE
AN EVIDENCE BASED PRACTICES
AVAILABLE TO LESS THAN 10% OF
CALIFORNIANS. THE ESTIMATE IS
27,000 CALIFORNIANS WILL DEVELOP
PSYCHOSIS THIS YEAR AND
SOMEWHERE IN THE 20 TO 2500 WILL
RECEIVE CARE AND ABOUT HALF OF
THOSE WILL NOT ACTUALLY RECEIVE
EVIDENCE BASED, MOST EFFECTIVE
CARE. AND SO IF WE WANT TO KEEP
THOSE FOLKS WHO ARE MOST LIKELY
TO STRUGGLE AND NEED AN FSP FROM
NEEDING THAT EXPENSIVE
INTERVENTION, THE NEXT UPSTREAM
IS EARLY PSYCHOSIS. WE ARE
ARGUING THAT UPSTREAM FROM THAT
IS YOUTH DROP IN BECAUSE WE HAVE
TO CREATE THE TRUST AND
ENGAGEMENT WITH YOUNG PEOPLE
BEFORE THEY NEED THE SERVICE AND
CREATE UNIMPEDED ACCESS TO
SERVICES. YOU HAVE SUPPORTED THE
DEVELOPMENT OF YOUTH. ALL CODE
CENTERS AROUND THE STATE IS A
GLOBALLY RECOGNIZED PRACTICE
INVENTED DEVELOPED REALLY IN
AUSTRALIA THAT IS EXPANDING
ACROSS THE WORLD. AND WE HAVE
TWO SIDES OPEN. THREE MORE SITES
UNDERWAY. THE CHALLENGE WE HAVE
WITH YOU DROPPING IS THE FUNDING
ACTUALLY DOESN'T PAY FOR THE
SERVICES THAT THE YOUTH NEED
THROUGH THIS DROP IN MODEL
BECAUSE IT'S A IT'S A PAYER
BASED FINANCING MODEL, NOT A
NEED BASED RESPONSE. AND THEN
THEN THE YOU KNOW THE UPSTREAM
FROM THAT IS SCHOOL MENTAL
HEALTH, AND WE REALLY APPRECIATE
THE CHANCE FOR SOME OF THE
STUDENTS WHO ARE INVOLVED IN
MENTAL HEALTH STUDENT SERVICES
ACT FUNDED PROGRAMS IN IMPERIAL
COUNTY HAVING THE CHANCE TO TALK
WITH YOU TODAY, SO, UM, NOW THAT
LEAVES OFF JUSTICE INVOLVEMENT,
SUICIDE PREVENTION THE NEEDS OF
OLDER ADULTS STRATEGIES TO
PREVENT KIDS IN THE CHILD
WELFARE SYSTEM, BUT THOSE FOUR
RIGHT WOULD BE AT THE CORE. OF
REALLY PUTTING IN PLACE THE
PREVENTION, EARLY INTERVENTION
STRATEGY THAT IS RESPONSIVE TO
THOSE THREE PROFOUNDLY DIFFICULT
CHALLENGES THAT ARE BRINGING
THIS TOPIC TO THE TABLE TODAY.
HOMELESSNESS, INCARCERATION,
HOSPITALIZATION. I'M GOING TO
BRING UP A POINT THAT I ALSO
BELIEVE I HEARD. MAYOR STEINBERG
SAY THAT CURRENTLY A MAJORITY OF
F S. P S ARE NOT BEING FOCUSED
ON THOSE. WHO ARE LIVING IN
ENCAMPMENTS, AND I'D LIKE TO TRY
AND UNDERSTAND. WHY WE AREN'T
USING OR WHATEVER. IT TAKES
APPROACH FOR THOSE WHO WE NOW
HAVE GREAT NEEDS WHO ARE ON
HOUSED AND LIVING IN THE
ENCAMPMENTS. IS THIS AN
INDIVIDUAL COUNTY OR ARE WE ABLE
TO SAY THAT? UM IS THERE A FOCUS
WITHIN THE F SPS TO LOOK AT
THOSE WHO ARE WITHIN THE
ENCAMPMENTS? SO UNFORTUNATELY,
YOU KNOW WE SPENT AND I WAS
GOING TO RAISE THIS ISSUE IN THE
NEXT PANEL. WE SPENT SOME TIME
WORKING WITH THE DEPARTMENT OF
FINANCE IN ORDER TO SECURE THE
RESOURCES IN ORDER TO DO THE
ANALYSIS THAT THE MAYOR HAS
MENTIONING AND THAT YOU'RE
ASKING AND WE JUST GOT STARTED
WITH THIS WORK, AND SO WE
HAVEN'T HAD THE CHANCE TO
ACTUALLY ASK THOSE QUESTIONS. WE
CAN POINT OUT, THOUGH, THAT
THERE ARE REQUIREMENTS IN THE
LAW FOR A MAJORITY OF HSS SORRY
IMAGES. S¼ CSS FUNDS TO GO
TOWARDS FULL SERVICE
PARTNERSHIPS, AND WE'RE NOT
ACTUALLY REQUIRING COUNTIES TO
DEDICATE AND MAJORITY OF FUNDS
TO FSP. SO ALL I CANNOT SPEAK
SPECIFICALLY TO THE ISSUE OF WHO
GETS SELECTED FOR FSP SERVICES.
THAT'S SOMETHING WE'RE WORKING
TO EXPOSE. FLOOR. WE CAN AGREE
THAT FROM AN ANECDOTAL
PERSPECTIVE THAT THERE ARE MANY
PEOPLE WHO ARE LIVING ON THE
STREETS WHO SHOULD BE IN A FULL
SERVICE PARTNERSHIP WHO ARE
ELIGIBLE FOR A FULL SERVICE
PARTNERSHIP, AND WE KNOW THAT
THERE ARE FUNDS AVAILABLE OR
THAT'S SUPPOSED TO BE AVAILABLE
FOR THAT THAT ARE NOT BEING MADE
AVAILABLE. BUT THAT'S THE THAT'S
THE MOST. I CAN TELL YOU AT THIS
POINT IN TIME. UM I MEAN, YES,
MR MAYOR STEINBERG. JUST GONNA
SAY I MEAN, I THINK ANYONE WHO
IS LIVING THIS AT THE LOCAL
LEVEL, AND THIS IS NOT PUTTING
IT. PUTTING IT NEGATIVE ON THE
COUNTY BECAUSE, LIKE I SAY
CANADA. THE FULL SERVICE
PARTNERSHIPS I THINK ARE
EFFECTIVE. UM AND THE PEOPLE WHO
ARE THE RECIPIENT OF THEM ARE
GETTING HELP AND OFTEN
LIFESAVING HELP. ANYBODY WHO.
EXPERIENCE IS WHAT IS GOING ON
LOCALLY KNOWS THAT THERE IS NOT
A PRIMARY FOCUS ON PEOPLE LIVING
IN TENDING CAMERAS ARE LIVING IN
THEIR VEHICLES. THERE JUST ISN'T
THERE AREN'T THE THERE AREN'T
THE INTERDISCIPLINARY TEAMS
BETWEEN CITIES AND COUNTIES
GOING OUT IN THESE ENCAMPMENTS
THERE, THERE ISN'T THE OFFERING
OF F SPS TO LARGE NUMBERS OF
THESE PEOPLE, AND SO AND IF WE
REALLY WANT TO ASK WHY UM THE
ANSWER IS PRETTY CLEAR. IT'S
BECAUSE IT'S REALLY HARD. IT'S
REALLY HARD AND, UM, IT'S NOT
CREAMING BECAUSE THE PEOPLE THAT
THE COUNTIES ARE HELPING ARE IN
REAL NEED. BUT UM, BUT IT'S
PARTNER TO DO THAT CONSISTENT,
PERSISTENT WORK OUT THERE AND SO
THE QUESTION IS NOT JUST WHAT IS
THE COMMISSION'S POLICY HERE.
IT'S WHAT SHOULD BE THE STATE'S
POLICY AND WHAT I'M ASSERTING.
AND WHAT I THINK THE GOVERNOR IS
ASSERTING LOUD AND CLEAR IS THAT
MORE OF THE PRIORITY NEEDS TO BE
TOO NEEDS NEEDS TO BE APPLYING
THESE MENTAL HEALTH RESOURCES.
THESE PRECIOUS RESOURCES TO THE
PROBLEM OF CHRONIC AND
UNSHELTERED HOMELESSNESS. AND IF
WE CAN AGREE ON THAT, THEN WE
CAN AGREE ON THE FORMULA FOR HOW
TO MAKE THAT BETTER.
ASSEMBLYMEMBER'S RAMOS. THANK
YOU, MR CHAIRMAN, JUST A COUPLE
OF QUESTIONS ON THE MAYOR
BROUGHT UP COLLABORATION WITH
THE COUNTIES AND TAKEN SOME TIME
TO BE ABLE TO WORK THROUGH SOME
AGREEMENT. TO GET TO THAT POINT.
DO WE THINK THAT THAT IS
SOMETHING THAT'S HOLDING IT BACK
AND OTHER CITIES ALSO IN THE
STATE COLLABORATION WITH THE
COUNTY AND THE RESOURCES THAT
ARE THERE. YES. UM SO. YOU KNOW,
I HAVE BEEN OUT THERE FOR
SEVERAL YEARS NOW, SAYING THAT
PROVIDING HELP TO PEOPLE WHO ARE
HOMELESS. AUTOMOBILE A MANDATORY
LEGAL OBLIGATION OF CITIES AND
COUNTIES AND THE STATE FOR THAT
MATTER. AND TEAR COURT
CONTROVERSIAL AS IT IS WHERE
MOST OF THE ATTENTION WAS PAID.
WHETHER OR NOT THE INDIVIDUAL
SHOULD HAVE TO AH HAVE TO IN
VOLUNTARILY COMMIT TO SERVICES.
WE ALREADY TALKED ABOUT THE
OTHER HALF OF WHAT YOU DID,
WHICH I THOUGHT WAS EXEMPLARY.
AND THAT IS THAT A JUDGE CAN
ORDER THE GOVERNMENT THROUGH THE
COUNTY. TWO CAN REQUIRE THE
GOVERNMENT TO PROVIDE THE
SERVICES TO THE PEOPLE. YEAH. I
THINK THAT THE STATE SHOULD
REQUIRE IN SOME WAY. CITIES AND
COUNTIES TO DEVELOP SIMILAR
PARTNERSHIP AGREEMENTS TO WHAT
WE DID IN THE BACKGROUND AND BY
THE WAY EVERY PART OF THE STATE
MIGHT HAVE A DIFFERENT VERSION
OF THIS BUT I THINK IT OUGHT TO
BE REQUIRED THAT CITIES AND
COUNTIES HAVE LEGALLY BINDING
PARTNERSHIP AGREEMENTS. ASSIGN
ROLES AND RESPONSIBILITIES AND
REQUIRE CITIES AND COUNTIES TO
ACTUALLY GET OUT THERE IN A IN
AN INTENSIVE IN AN INTENSIVE,
ASSERTIVE WAY. AND TO DO
WHATEVER IT TAKES TO GET PEOPLE
OFF THE STREETS BECAUSE ABSENT
THAT SORT OF LEGAL PROD IT JUST
. IT'S JUST NOT GONNA HAPPEN AS
FAST AS YOU WANT IT TO, UM BE
BECAUSE IT'S JUST NOT GOING TO.
I CAN TELL YOU THE LAW MATTERS.
I SAID IT FOR YEARS, AND THE LAW
CURRENTLY SAYS THAT EVERYTHING
THAT CITIES AND COUNTIES DO IN
THIS AREA IS OPTIONAL AND
VOLUNTARY. AND IN SOME WAYS THE
RESULTS SPEAK FOR THE RESULTS.
SO HEARING THAT IN SOME AREAS IN
THE STATE, AND CERTAINLY HERE
YOU WERE ABLE TO WORK THROUGH AN
AGREEMENT WITH THE COUNTY. BUT
MAYBE OTHER CITIES AND OTHER
JURISDICTIONS AREN'T SO, UM THE
ABILITY TO WORK THROUGH SOME OF
THOSE CHALLENGES MIGHT NOT BE IN
FRONT OF THEM. AND SO ANOTHER
QUESTION THAT I'VE BEEN DEALING
WITH AND TRYING TO ADVOCATE
AROUND HIS DIRECT FUNDING TO THE
CITIES, CITIES THAT NOW, UM
AREN'T AFFORDED DIRECT FUNDING
BECAUSE OF THE POPULATION BASE
OF SOME CITIES. LARGEST CITY IN
MY DISTRICT AS 200,000 PLUS CITY
THAT DOESN'T GET DIRECT FUNNY
THAT STILL HAS TO WORK THROUGH
THE COUNTY. THROUGH SOME OF
THOSE THINGS. DO YOU THINK THAT
IF WE DID START TO LOOK AT THAT
DIRECT FUNDING AND WHO ACTUALLY
GETS IT WITH THAT BE SOMETHING
THAT WOULD BE A STEP IN THE
RIGHT DIRECTION? WELL I THINK IT
WOULD BE. I MEAN, BACK IN 2018.
I BELIEVE IT WAS THE BIG CITY
MAYORS WERE ABLE TO WORK WITH
THEM. CHAIR TING AND. AND THEN
GOVERNOR BROWN AND THE
LEGISLATURE TO GET THE FIRST
DIRECT ALLOCATION UNDER HEAP AND
HALF TO THE LARGEST CITIES IN
THE STATE. BUT THE LINE WAS
DRAWN AND SO MEDIUM SIZED CITIES
DID NOT GET THAT SAME BENEFIT. I
WOULD FAVOR MORE DIRECT
ALLOCATION TO THE CITIES, BUT
I'M NOT AH, I REALLY THE
COUNTIES ARE HEALTH AND HUMAN
SERVICES SUBDIVISIONS. I DO NOT
THINK CITIES. ARE EQUIPPED. MOST
CITIES ARE QUICKLY BECOME HEALTH
AND HUMAN SERVICE HEALTH
AGENCIES. I THINK THE COUNTIES
ARE THE APPROPRIATE BODY OF
GOVERNMENT TO DO THIS. I THINK
THEY DO A GOOD JOB. I THINK
THEY'RE GOOD PARTNERS. THIS IS
NOT A MATTER OF YOU KNOW YOU'RE
DOING GOOD JOB OR BAD JOB. IT'S
A MATTER OF PRIORITY. AND I
THINK THAT THE LAW THROUGH THE
STATE AUTO IN SOME WAY INDUCED
REQUIRE. THAT MORE FOCUSED BE
PAID TO THESE MOST SERIOUS
PROBLEMS AND NOT JUST
HOMELESSNESS. AND HERE'S YOUR
HERE'S YOUR OPPORTUNITY. THE MHS
A REFORM IS AN OPPORTUNITY
BECAUSE YOU KNOW, IT'S NOT. THE
STATE'S MONEY IS NOT THE
COUNTY'S MONEY IS THE PEOPLE'S
MONEY, AND HERE'S AN OPPORTUNITY
TO WORK TOGETHER TO ASK THE
PEOPLE. TO MODERNIZE IT AND MAKE
SURE THAT WE STATE THE
PRIORITIES THAT THE PEOPLE OF
THE STATE OR DEMANDING THANK
YOU, MAYOR. THANK YOU. MR CHAIR
WILL BEGIN WITH THE CHAIR OF
TING AND THEN DR JACKSON. MR
MAYOR. THANKS VERY MUCH FOR
JOINING US TODAY. JUST A QUICK
QUESTION WHEN YOU WHEN YOU WROTE
THE BALLOT MEASURE. UM NUMBER OF
YEARS AGO YOU CREATED AN
INDEPENDENT COMMISSION, WHICH UM
, DR EWING OVERSEAS, CAN YOU CAN
YOU WALK US THROUGH? WHY YOU
CREATED A INDEPENDENT COMMISSION
THAT WASN'T DIRECTLY TIED TO THE
ADMINISTRATION. IT WASN'T
DIRECTLY TIED TO THE
LEGISLATURE. I MEAN, YOU ARE A
LEGISLATOR BACK THEN. SO YOU
EASILY COULD HAVE HAD TO BE PART
OF THE LEGISLATIVE BODY. BUT IF
YOU COULD WALK US THROUGH THAT
THINKING, THAT'D BE GREAT,
RIGHT? I MEAN, ONE. IT WAS
ALWAYS TRANSPARENT AND HONEST.
NUMBER ONE. IT WAS A POLITICAL
CAMPAIGN, AND WE WANTED TO
CONVINCE THE VOTERS THAT THERE
WOULD BE TRUE INDEPENDENT
OVERSIGHT. AND IT ALSO WAS THE
RIGHT THING TO DO. TO ESTABLISH
A COMMISSION THAT WOULD BE
INDEPENDENT OF THE LEGISLATURE
AND THE ADMINISTRATION. JUST IN
THE VERY WAY YOU DESCRIBED IT.
UM THIS IS A TOUGHER QUESTION. I
STILL FAVOR INDEPENDENCE, BUT I
WOULD LIKE TO SEE A GREATER
ALIGNMENT. CERTAINLY WITH THE
ADMINISTRATION BECAUSE ONE THING
THAT IS AND IT. ONE THING THAT
IS REALLY BOTHERED ME OVER THE
YEARS AND I DON'T KNOW. I DON'T
KNOW WHERE TO PUT THE BLAME OR
THE FOCUS ON THIS, BUT IT'S JUST
BEEN A SOURCE OF GREAT
FRUSTRATION. AND THAT IS THAT
NEITHER THE STATE NORTHERN
COUNTIES NOR THE COMMISSION.
HAVE YOU EVER BEEN ABLE TO
FIGURE OUT HOW WE PRODUCE
REGULAR OUTCOME BASED DATA? FOR
WHAT? THIS GIFT FROM THE PEOPLE
IT'S ACTUALLY PRODUCING, AND IT
IS LED TO THE MOST SIGNIFICANT
CRITICISMS OF THE ACT. UM A
LITTLE HOOVER COMMISSION
REPORTS. UM IT AND I'M GETTING A
LOT OF FEEDBACK. I'M SORRY. CAN
YOU HEAR ME? COMING IN LOUDLY
AND CLEARLY ON OUR END, OKAY.
SOUNDS LIKE SOMEBODY'S LIKE
COUGHING, BUT MAYBE IT'S JUST MY
COMPUTER IS COUGHING. THAT'S
OKAY. OKAY JUST LIKE. OKAY UM
AND. AND I DON'T UNDERSTAND WHY
WE DO WHY WE DO NOT HAVE THE
TECHNOLOGY. TO BE ABLE TO ALLOW
THE PROGRAM PROVIDERS TO EASILY
INPUT BASIC DATA TO THE
COUNTIES. TO HAVE THE COUNTY'S
THEN BE ABLE TO PROVIDE BASIC
DATA. TO THE STATE, SO THAT
EVERY YEAR THE COMMISSION OR THE
ADMINISTRATION OR SOMEBODY CAN
PEOPLE DO SING THE SAME KIND OF
OUTCOME BASED DATA THAT WE DID.
WITH A B 34 2034 BACK IN 1999
AND 2000 IN THE YEARS AFTER THAT
, IT'S SO IT'S SO BASIC AND
IMPORTANT. BECAUSE UM. I KNOW
THAT THIS MONEY HAS BEEN WELL
SPENT. I KNOW THAT LOTS OF
PEOPLE ARE GETTING HELP, BUT THE
PUBLIC YOU KNOW, DOES IT RESULTS
AND SO, UM. I HOPE THAT WHATEVER
COMES OUT OF THIS IN TERMS OF
THE STATUS OF THE COMMISSION,
AND AGAIN, I THINK INDEPENDENCE
IS IMPORTANT. THAT WE ALSO
INVEST IN WHATEVER TECHNOLOGY
INFRASTRUCTURE. IT IS NECESSARY
TO BE ABLE TO DO THAT BASIC
OUTCOME BASED DATA WORK SO THAT
. REGULARLY KNOWS WHAT'S
WORKING. WHAT ISN'T AND IT MIGHT
ALSO GUIDE THESE KINDS OF
DEBATES IN A WAY THAT THAT WOULD
BE HELPFUL. SO SO I HEAR YOU
ABOUT TECHNOLOGY AND DATA. I
THINK THAT THE MIX OF MAKES A
LOT OF SENSE. UM IN YOUR MIND.
HOW DO YOU CREATE THIS GREATER
ALIGNMENT WITH THE
ADMINISTRATION YOU MENTIONED
WITHOUT LOSING THE INDEPENDENTS.
I DON'T KNOW. I MEAN SOMETHING.
I'M THINKING A LOT ABOUT AND
WE'RE THINKING A LOT ABOUT, UM
YOU KNOW, THE GOVERNOR DOES
APPOINT MOST OF THE MEMBERS OF
THE COMMISSION. I KNOW THE
ATTORNEY GENERAL AND THE
SUPERINTENDENT AND THE PRO TEM
AND THE SPEAKER. ALSO APPOINT
YOU KNOW, MIKE, I DON'T KNOW
THERE NEEDS TO BE. I THINK SOME
GREATER ENGAGEMENT FOR SURE. UM
BUT, UM. I THINK MAYBE THESE
MONTHS ARE AN OPPORTUNITY FOR
THE COMMISSION AND THE
ADMINISTRATION AND THE
LEGISLATION. FIGURE OUT HOW YOU
WORK FOR A CLOSELY TOGETHER.
GREAT THANK YOU, DR JACKSON.
THANK YOU VERY MUCH, UM I AGREE
WITH MAYOR STEINBERG IN TERMS
OF, UM SOME OF THE P E I
PROGRAMS UM, I ACTUALLY BEFORE I
GOT HERE ACTUALLY ADMINISTERED
ONE OF THE P I PROGRAMS FOR
RECITE COUNTY, ONE FOCUSING ON,
UM. EARLY INTERVENTION. AND
PREVENTION FOR MENTAL HEALTH. IN
REGARDS TO AFRICAN AMERICAN
YOUTH. AND ONE OF THE CRITICISMS
THAT WE HAD WHEN WE WERE
ADMINISTERING THE PROGRAM IS
NUMBER ONE. WHEN YOU CAN DO ALL
THE DATA, YOU DO ALL THE
APPROPRIATE TOOLS. IT WORKS, BUT
YOU CAN ONLY SERVE 15 YOUNG
PEOPLE PER YEAR. AND IT WAS NOT
SCALABLE. AND I THINK WE HAVE TO
START FOCUSING MORE ON
INTERVENTIONS. THAT CAN PRODUCE
THOSE TYPE OF RESULTS. YES IT
CAN ALSO BE SCALABLE SO THAT
OTHER COMMUNITY BASED
ORGANIZATIONS CAN IMPLEMENT IT.
AND IN A WAY THAT IS NOT AS UM.
CONVERSE UM, AN EXPENSIVE AS
SOME OF THE THINGS HAVE BEEN
RIGHT. BUT I ALSO THINK THAT WE
ALSO NEED TO CREATE A BETTER
STRUCTURE TO WORK CLOSER WITH
THE SCHOOLS. I THINK WE'RE
INTERESTED IN A PERFECT
OPPORTUNITY HERE IN SOCIETY
WHILE WE'RE TRYING TO RECREATE
OURSELVES. TO SAY THESE ARE WHAT
INSTITUTIONS HAVE BEEN HAVE DONE
IN THE PAST. BUT THAT DOESN'T
MEAN THAT THEY HAVE TO BE THAT
WAY IN THE FUTURE, AND THAT
INCLUDES OUR SCHOOLS. UM THE
ALCOVE ACTUALLY VISITED ONE OF
THEM. UM BEAUTIFUL. FANTASTIC.
AH, HOWEVER. AH THE ISSUE IS
THAT IT'S IF YOU CAN GET TO US.
HOPEFULLY WE CAN HELP YOU. UM
OUR SCHOOLS IS THE NUMBER ONE
WAY TO REACH OUR YOUNG PEOPLE IN
A CONSISTENT MANNER. AND WE HAVE
TO SAY FOR AT SOME POINT THAT
OUR SCHOOLS ARE NOT JUST FOR
EDUCATION IS TO MAKE THEM
HEALTHY. AND THEY'RE NOT
MUTUALLY EXCLUSIVE. AND YOU, YOU
KNOW. MY RANTS THAT YOU'VE BEEN
VICTIMS OF, UM I THINK WE MEET
TOMORROW SO YOU'LL HEAR IT AGAIN
AND THE IDEA THAT WE CAN'T GET
TO SCREENING OUR YOUNG PEOPLE IN
SCHOOLS. WHILE WE HAVE THOUSANDS
OF YOUNG PEOPLE SUFFERING WELL,
I CAN'T SAY RIGHT NOW THEY'RE
OUT OF SCHOOL NOW. SUFFERING
EVERY DAY. FOR THINGS THAT THEY
HAVEN'T EXHIBITED YET IN TERMS
OF BEHAVIOR. WE'RE WAITING FOR
THEM. TO GET UM, LESS HEALTHY IN
ORDER FOR US TO FIND SOMETHING
TO DO WITH THEM. SO IT'S MY HOPE
THAT AS WE ARE THINKING ABOUT
REINVENTING THE MENTAL HEALTH
SERVICES ACT THAT NUMBER ONE.
THEY REFLECT OUR CURRENT
PRIORITIES. BUT ALSO REFLECT THE
TYPE OF INNOVATION THAT WE NEED
TO HAVE. AH TWO AND THEY
RESEARCH BASED PRACTICES THAT WE
NEED TO HAVE. AH TO MAKING SURE
THAT WE CAN REALLY MEET THESE
NEEDS. SO I APPRECIATE THE
CURRENT DISCUSSION AND LOOKING
FORWARD TO MORE TO COME. THANK
YOU WITH THAT WE WILL THANKS
VERY MUCH THIS PANEL AND WANT TO
WISH MAYOR STEINBERG A SPEEDY
RECOVERY. THANK YOU FOR JOINING
US TODAY. THANK YOU VERY MUCH.
TOBY. WE WILL NOW MOVE ON TO
ISSUES 16, WHICH IS ON THE IMAGE
S OH, A C TRANSFER TO THE
ADMINISTRATION. WE WILL BEGIN
WITH STEPHANIE WELSH, DEPUTY
SECRETARY OF BEHAVIORAL HEALTH,
FOLLOWED BY, UM QUICKLY
QUESTIONS AND ANSWERS FROM CHAIR
TING PRIOR TO HIM NEEDING TO
LEAVE, AND THEN WE WILL WORK
THROUGH THE REMAINDER OF THE
ORDER AS NORMAL. WE WILL BEGIN
WITH MISS WELCH WHEN YOU WERE
READY. GOOD EVENING CHAIR
ARAMBULA AND OTHER MEMBERS. NICE
TO SEE EVERYONE, UM MY NAME IS
STEPHANIE WELCH ON THE DEPUTY
DEPUTY SECRETARY OF BEHAVIORAL
HEALTH FOR THE CALIFORNIA HEALTH
AND HUMAN SERVICES AGENCY. I'M
ALSO JOINED HERE BY MY COLLEAGUE
KIM CHIN, WHO WAS AN ASSISTANT
SECRETARY WITH THE AGENCY. I'M
HERE TONIGHT TO PROVIDE AN
OVERVIEW OF THE COMPONENT OF THE
MODERNIZATION PACKAGE PROPOSAL
THAT INCLUDES MOVING THE MENTAL
HEALTH SERVICES OVERSIGHT AND
ACCOUNTABILITY COMMISSION UNDER
THE CALIFORNIA HEALTH AND HUMAN
SERVICES AGENCY. WITH THIS
CHANGE, IT IS THE INTENT OF THE
ADMINISTRATION TO SEEK SUPPORT
TO SEEKS TO SUPPORT THEIR WORK
AND BEING INTEGRATED, CONNECTED
AND COORDINATED TO THE STATE'S
OVERALL BEHAVIORAL HEALTH AGENDA
AND SYSTEM. AND THE WORK THAT WE
HAVE UNDERWAY AND SEVERAL OF OUR
DEPARTMENTS, UM, AND THE WORK
THAT WE DO ACROSS AGENCIES, UM
AND, UH, AND THE ESSENTIAL GOAL
OF THAT WORK BEING TO IMPROVE
THE BEHAVIORAL HEALTH OF ALL
CALIFORNIANS. SPECIFICALLY THE
PROPOSAL WILL SUPPORT THE
COMMISSION'S, UH, FOCUS ON THE
CRITICAL NEED TO EXAMINE DATA
AND OUTCOMES. I REALLY WANT TO
UNDERSCORE SOME OF THE POINTS
THAT MAYOR STEINBERG MADE. UM
AND THAT WE ARE IN AGREEMENT
WITH, UM, REALLY WANTING TO HAVE
A CORE FOCUS ON DATAS AND
OUTCOMES TO DRIVE POLICY. UM AND
THAT IS ONE OF OUR INTENTS WITH
THIS PROPOSAL. UM WE FEEL THAT
THIS IS ALSO VERY CONSISTENT
WITH THE WORK THAT THEY'RE DOING
NOW AND PART OF THEIR CORE
MISSION AND THAT THAT AND THAT
THAT DATA WOULD REALLY DRIVE
POLICIES AND REALLY DRIVE WHERE
THE STATE SHOULD BE INVESTING IN
BEST PRACTICES AND HIGH QUALITY
PROGRAMS. THE COMMISSION WILL
CONTINUE TO ADMINISTER THE
PROGRAMS THAT ARE DIRECT. THEY
ARE DIRECTED TO ADMINISTER BY
THE LEGISLATURE AND THE
ADMINISTRATION. THE COMMISSION
WILL ALSO CONTINUE TO REPORT TO
THE LEGISLATURE. UM AS A MAYOR
STEINBERG OUTLINED THERE IS
REPRESENTATION OF THE
LEGISLATURE ON THE, UH, MENTAL
HEALTH SERVICES OVERSIGHT AND
ACCOUNTABILITY COMMISSION, WHICH
WE CALL ALWAYS FOR SHORT. I
APOLOGIZE IF I DO SHORTEN IT AT
SOME POINTS, UM AND THEY REALLY
PLAY, UH, A CRITICAL ROLE IN
STAKEHOLDER ENGAGEMENT WHEN WE
HAD THE DISILLUSION OF THE
DEPARTMENT OF MENTAL HEALTH OVER
A DECADE AGO. THEY TOOK ON SOME
REALLY AWESOME RESPONSIBILITIES
TO ENGAGE CONSUMERS AND,
FRANKLY, HAVE DONE A REALLY
EXCELLENT JOB GOING BEYOND JUST
THE SIMPLE CLASSIFICATIONS OF
PEERS AND FAMILY MEMBERS, BUT
REALLY LOOKING AT
UNDERREPRESENTED GROUPS. UH
VARIOUS CULTURAL GROUPS. OLDER
ADULTS, LGBT Q. PLUS, ETCETERA,
UM AND THEN LASTLY, WE WOULD BE
REQUIRING AS PART OF COMING INTO
THE HEALTH AND HUMAN SERVICES
AGENCY THAT THE COMMISSION
ITSELF BE LED AND MANAGED BY
GUBERNATORIAL APPOINTEE WHICH,
OF COURSE, WOULD BE SUBJECT TO
THE CHECKS AND BALANCES THAT
EXIST IN THE LEGISLATURE IN
APPROVING THOSE INDIVIDUALS. UM
WE REALLY FEEL THAT THIS IS A
GOOD MARRIAGE AND A GOOD
RELATIONSHIP BETWEEN THE
DEPARTMENT OF HEALTH CARE
SERVICES THAT CAN REALLY FOCUS
ON PROVIDING OVERSIGHT OF THE
FISCAL ALLOCATIONS AND THE
COUNTIES USE OF FUNDING,
INCLUDING ACCOUNTABILITY FOR
CONTRACTED SERVICES. I KNOW
YOU'RE GOING TO HEAR A LOT ABOUT
SOME OF THE STRENGTHEN
ACCOUNTABILITY MEASURES THAT
WE'RE PUTTING IN THIS AND IT
REALLY IS THE FOCUS ON DHC S
RESPONSIBILITY TO REGULATE WHO
THEY CONTRACT WITH THE COUNTIES
TO DELIVER THIS CARE AND FOR THE
A C TO REALLY FOCUS ON OUTCOMES,
HIGH QUALITY PROGRAMS, BEST
PRACTICES AND MAKING SURE THAT
WE CREATE A MARRIAGE BETWEEN US
AS PART OF OUR AGENCY. UM I WE
RECENTLY HAD THE OPPORTUNITY
JUST A FEW DAYS AGO. I THINK AT
THE END OF LAST WEEK TO MEET
WITH THE COMMISSIONERS, AND
WE'RE REALLY ABLE TO LISTEN AND
HEAR SOME OF THEIR CONCERNS
ABOUT THIS PARTICULAR PROPOSAL.
IT WAS VERY HELPFUL TO LISTEN TO
THEIR PERSPECTIVE. I WANT TO. WE
WANT TO ACKNOWLEDGE THAT WE
HEARD THOSE CONCERNS AND THAT WE
LOOK FORWARD TO CONTINUE
DISCUSSIONS. SIMILAR TO WHAT THE
MAYOR STEINBERG SUGGESTED THAT
WE NEED TO HAVE MORE
CONVERSATIONS AND WE ARE VERY
OPEN TO THAT. SO WITH THAT I
WILL CLOSE AND OPEN UP FOR ANY
QUESTIONS. AND THANK YOU FOR THE
FLEXIBILITY. WE WILL HAVE THE
REMAINDER OF THE PANEL COME UP
CHARTING, HAS ANOTHER ENGAGEMENT
AND WANTED AN OPPORTUNITY CHAIR
. TEEN THANK YOU, MR CHAIR.
JUST, UM MISS MISS WELCH. I WAS
JUST TRYING TO UNDERSTAND. THE
PROBLEM. THE ADMINISTRATION'S
TRYING TO SOLVED BY. MAKING THIS
COMMISSION PART OF THE
ADMINISTRATION RATHER THAN
LEAVING IT AS AN INDEPENDENT
BODY. AS I MENTIONED, I THINK
THAT I MEAN, THE I WOULDN'T
NECESSARILY FRAME IT AS A
PROBLEM AS WELL AS HOW WE CAN
MAKE IT A BETTER SUCCESS. UM UH,
I THINK IN BEING PART OF OUR
AGENCY, THERE CAN BE MORE
COLLABORATION AND INTEGRATION IN
REAL TIME. UM UH, MR EWING
TALKED ABOUT THE VALUE OF
IMPLEMENTATION. WE HAVE CRITICAL
ROLES IN IN SUPPORTING
IMPLEMENTATION, PROVIDING
OVERSIGHT TO IMPLEMENTATION IN
REAL TIME, AND I THINK IT COULD
BE VERY VALUABLE TO HAVE THAT
KIND OF, UH, COORDINATION
HAPPENED, UH, IN REAL TIME, UH,
TOGETHER AS PART OF OUR AGENCY.
HOW DOES UM THE COMMISSION THAT
BECOMES PART OF THE AGENCY.
MAINTAIN ITS INDEPENDENCE, AS,
UM WATCHDOG AND TO PROVIDE
OVERSIGHT OVER THE SPENDING. IF
I MAY, MR CHAIR, I THINK THAT
WE'VE WE'VE HEARD THAT, UM AS
ONE OF THE CONCERNS OF THIS
PARTICULAR PROPOSAL, AND WE HEAR
THAT LOUD AND CLEAR AND AS MISS
WELCH IN HAS MENTIONED, UM WE'RE
HAPPY TO CONTINUE ITERATING ON
THIS AND SEE IF THERE IS
SOMETHING WE CAN DO TO REACH
BOTH BOTH GOALS HERE RIGHT OF
OVERSIGHT AND BETTER INTEGRATION
AND ALIGNMENT. AND OF COURSE,
OUR GOAL IS ALWAYS TO IMPROVE
THE ACCESS OF CARE AND IMPROVE
ALIGNMENT. AND, UM HOWEVER, WHAT
I'M HEARING FROM FOLKS HERE IS
THAT YOUR GOALS ARE NOT BEING
MET HERE, AND WE'RE OPEN TO
HAVING FURTHER DISCUSSIONS ON
WHAT THAT MIGHT MEAN. UM. I
DON'T KNOW. IT'S KIND OF HARD TO
FIND THEM. A MIDDLE GROUND, I
GUESS, BECAUSE WHEN YOU WHEN YOU
KNOW WE HAVE A INDEPENDENT
ANALYSTS ARE LEGISLATIVE
ANALYST'S THEIR BIPARTISAN IF
THEY WORKED FOR OTHER, YOU KNOW,
SINCE WE'RE THE MAJORITY CAUCUS,
WE COULD SAY WELL, THEY'RE GOING
TO BE PART OF OUR CAUCUS. BUT I
THINK THE MINORITY CAUCUS WOULD
OBJECTED THAT EVEN THOUGH WE
WOULD SAY HEY, IT'S OKAY.
THEY'RE GOING TO BE WE'RE GOING
TO CONTINUE TO HAVE IT BE
BIPARTISAN. IT'S JUST GOING TO
BE OVERSEEN BY US SO HOW. I'LL
ASK IT AGAIN. I MEAN, HOW DO YOU
MAINTAIN INDEPENDENCE AND
OVERSIGHT? IF THEY ARE PART OF
YOUR AGENCY. I DON'T HAVE AN
ANSWER TO THAT TODAY, AND I'M
COMMITTING TO YOU THAT WE ARE
GOING TO DISCUSS THAT AND BRING
IT BACK TO FOLKS TO CONSIDER
THAT FURTHER. I DON'T HAVE AN
ANSWER TO THAT. TODAY DR. EWING
TALK ABOUT ONE OF THEIR MAIN
ISSUES. AND WHY HER MAYOR
STEINBERG, TALK ABOUT IT. TALKED
ABOUT A LOT OF IT WAS LACK OF
DATA COLLECTION A NEED FOR MORE
DATA COLLECTION. UM. THAT THAT
CAN BE DONE AS AN INDEPENDENT
COMMISSION, COULDN'T IT? IN SOME
WAYS, I THINK THAT YOU'LL HEAR
IN THE LATER PANELS OR YOUR
COLLEAGUES WILL HERE AND LATER
PANELS ABOUT THE EFFORTS THAT
ARE DEPARTMENT OF HEALTH CARE
SERVICES IS PROPOSING THAT WILL
HAVE AS PART OF THIS PROPOSAL TO
INCREASE OVERSIGHT AND
ACCOUNTABILITY. PART OF THAT
RIGHT NOW IS DIFFICULT TO SHARE
BECAUSE OF THE ROLE THE
DEPARTMENT PLAYS AS THE CONTRACT
HOLDER VERSUS THE ALWAYS BEING
INDEPENDENT ENTITY, SO THERE ARE
SOME PIECES OF FRICTION THERE. I
THINK PART OF HAVING POTENTIALLY
THE A C AS PART OF AGENCY IS, UM
, BECAUSE THEY ARE IN BROUGHT
INTO AGENCY. THERE'S A LITTLE
BIT MORE OF ABILITY TO SHARE
THAT INFORMATION IN THE LINE
THAT INFORMATION IN REAL TIME.
BUT BUT ME WELL, ONE OF THE MAIN
ROLES OF THIS COMMISSION IS A
FIDUCIARY RESPONSIBILITIES ARE
NOT HMM. IS THERE A FIDUCIARY
RESPONSIBILITY AS PART OF WHAT
THE VOTERS APPROVED? UM I DON'T
KNOW IF I CAN ANSWER THAT.
SPECIFICALLY YOU MIGHT HAVE TO
GET THAT ANSWER FROM D H. C S,
BUT, UM, TECHNICALLY, THE D, UM
THE DHC S HAS OVERSIGHT TO THE
CONTRACTS OF WHICH THE DOLLARS
FLOW. UM THE WAY THAT THE ALWAYS
THE MENTAL HEALTH SERVICES ACT
IS DESIGNED. NOW IT REALLY IS
DRIVEN BY THE LOCAL PROCESS. AND
SO, AS I SAY, WE TAKE FRESNO,
FOR EXAMPLE, I THINK THEY'LL BE
HERE LATER. THEY GET THEIR
ALLOCATION THAT COMES FROM THE
STATE. THEY DEVELOP THEIR STATE
LOCAL PROCESS. UM NOW THE ONE
COMPONENT THAT DOES GO TO THE
ATTACK FOR REVIEW IS CURRENTLY
THE INNOVATION COMPONENT. UM BUT
FOR THE MOST PART, THOSE ARE
REALLY DETERMINED AT THE LOCAL
LEVEL, SIGNED OFF BY THE BOARD
OF SUPERVISORS AND THEN COUNTIES
ARE HELD UP HELD RESPONSIBLE
THROUGH THE CONTRACTS THAT THEY
HAVE WITH THE HCS. LET'S TALK TO
YOU IN THAT QUESTION. I MEAN,
DOES IF YOU GET TO STAND BY THEM
AT THE MIC FOR ONE SECOND, DOES
THE COMMISSION HAVE A FIDUCIARY
RESPONSIBLE IS IT WAS DESIGNED
AS A FIDUCIARY RESPONSIBILITY.
YOU CAN JOIN US AT THE TABLE.
THANK YOU REMEMBER TING? SO THE
LAW ACTUALLY STATES THAT THE
COMMISSION HAS OVERSIGHT OVER
THE CHILDREN'S SYSTEM OF CARE,
THE ADULT SYSTEM OF CARE AND THE
OLDER ADULTS SYSTEM OF CARE
WHICH COLLECTIVELY MAKE UP THE
ENTIRE MENTAL HEALTH SYSTEM,
PUBLIC MENTAL HEALTH SYSTEM, BUT
BECAUSE THE P E I LANGUAGES EVEN
BROADER THAN THAT THE
COMMISSION'S PURVIEW IS
EXPANSIVE. AND SO OUR SCHOOL
MENTAL HEALTH WORK, FOR EXAMPLE.
BUT WHEN YOU THINK OF OVERSIGHT,
WHAT'S YOUR BECAUSE YOU'RE NOT
MANAGING IT? CORRECT? WHAT IS
OVERSIGHT, MEANING YOUR MIND? UM
WE ACTUALLY WORKED TO CREATE
TRUST ON THE PART OF POLICY
MAKERS AND THE PUBLIC, INCLUDING
SHARING FISCAL INFORMATION, SO
SOME OF THE VERY FIRST WORK THAT
WE DID WAS TO MONITOR AND
DOCUMENT WHETHER OR NOT THE
FISCAL RULES ARE BEING FOLLOWED.
AND INCLUDING. PUTTING ONLINE
WHAT WE CALL THIS. A FISCAL
TRANSPARENCY TOLD THAT ALLOWS
POLICYMAKERS AND THE PUBLIC TO
TRACK IMAGES SAY DOLLARS
SPENDING AND UNSPENT FUNDS AND
THAT RESULTED IN THE THERE WAS A
FOLLOW UP AUDIT WE FOUND ABOUT
192 $100 MILLION OF UNSPENT
TRANS THE AUDITOR FOUND ABOUT
350. SO YES, I WOULD ARGUE THAT
THE COMMISSION'S JURISDICTION
DOES INCLUDE A FIDUCIARY
RESPONSIBILITY. NOT TO ENSURE
THAT CONTRACTS ARE BEING
IMPLEMENTED IN A WAY THAT IS THE
WAY THAT THE DEPARTMENT OF
HEALTH CARE SERVICES IS BUT MORE
EXPANSIVELY, MUCH LIKE A GRAND
JURY IS AUTHORIZED TO LOOK AT
FISCAL ISSUES ACROSS GOVERNMENT
AGENCY. WHAT WOULD BE A BETTER
EXAMPLE? AND MISS WELCH? I DON'T
KNOW IF YOU'RE FAMILIAR WITH, UM
OFTENTIMES, WHEN YOU PASSED BOND
MEASURES YOU HAVE A CITIZEN'S
OVERSIGHT BOND COMMITTEE. I YOU
FAMILIAR WITH THAT MODEL? KIM
I'M NOT. I'M SORRY. HAVE YOU
HEARD OF THAT VOTE ON A BOND
MEASURE? IT'S VERY COMMON. YOU
KNOW, IF A SCHOOL BOND DO YOU
HAVE A CAR, YOU KNOW, COMMUNITY
COLLEGE BOND. THEY HAVE A
CITIZEN'S OVERSIGHT. COMMITTEE
YOU HAVE YOU? I GUESS YOU
HAVEN'T HEARD. I'M HEARING YOU
NOW, AND I UNDERSTAND WHAT YOU
MEAN COMMON AMONGST MEASURES ALL
ACROSS THE STATE OF CALIFORNIA
TO DO EXACTLY THE DOCTOR, EWING
SAID TO BUILD TRUST WITH THE
VOTERS BECAUSE VOTERS WANT TO
MAKE SURE THAT MONEY IS BEING
SPENT PROPERLY NOW THE DISTRICTS
PICK WHO'S YOU KNOW WHAT BUT THE
PROJECTS ARE. THEY OVERSEE THE
CONTRACTS THEY PICK WHICH
FACILITIES ARE BEING IMPROVED,
HOW THEY'RE BEING IMPROVED.
THAT'S NOT WHAT THE COMMISSION'S
JUST MAKING SURE THAT HEY,
DISTRICT. WHATEVER WE PROMISED
YOU, IT'S ACTUALLY BEING
DELIVERED. SO TOO. TO ME IF THE
SCHOOL DISTRICT PROPOSED TO THE
VOTERS, YOU KNOW WHAT? WE'RE NOT
GOING TO DO AN INDEPENDENT
OVERSIGHT COMMISSION. WE'RE JUST
GOING TO HAVE THAT. BOARD OF
TRUSTEES DO IT. HOW DO YOU THINK
THE VOTERS WOULD REACT TO THAT?
AND YOUR VOTER. I MEAN, JUST
DON'T HAVE TO HAVE YOU AS A
VOTER WOULD DIRECTOR IT THROUGH
THE CHAIR. I THINK THAT THAT'S A
REALLY IMPORTANT POINT THAT
YOU'RE RAISING. I THINK THAT, UM
WHAT UH, MR EWING IS TALKING
ABOUT IS A MUCH MORE EXPANSIVE
ROLE THAN THAT, AND I THINK WE
COULD PROBABLY HAVE A DISCUSSION
ABOUT, YOU KNOW A SPECIFIC
OVERSIGHT ROLE. HOW THEM YOU
KNOW OF THAT. THAT'S MORE AKIN
TO A BOND, I THINK AGAIN
REITERATING OUR OPENNESS TO HAVE
THIS DISCUSSION. I THINK THAT
SOME OF THE MORE PROGRAMMATIC
AND, UM AH, OVER OVERSIGHT. UH
RESPONSIBILITIES THAT THE
COMMISSION WORKS ON, WE THINK
COULD BE, UM, IMPROVED WITH
BETTER ALIGNMENT AND REAL TIME
DATA. IT'S A PROBLEM LIKE ARE
YOU AND THAT? THAT'S WHY I ASKED
WHAT THE PROBLEM WAS. I MEAN, IS
THE PROBLEM THAT ARE YOU SAYING
THAT THE COMMISSION'S MANAGING
THINGS AND YOUR AGENCIES
MANAGING THINGS, AND BECAUSE OF
THAT THERE ARE TOO MANY.
MANAGERS OF THESE PROGRAMS AND
WHAT I'M TRYING STILL TRYING.
I'M STILL TRYING TO UNDERSTAND
WHAT THE PROBLEM YOU'RE TRYING
TO SOLVE. UM I THINK HERE'S A
GOOD EXAMPLE WHERE WE'RE GOING
TO TALK A LITTLE BIT LATER ABOUT
THE ROLE THAT COMMERCIAL
INSURANCE PAYS IN COVERING THE
CARE FOR INDIVIDUALS, UH, IN
MANY WAYS, UM, MAJORITY OF
INDIVIDUALS HERE IN OUR IN OUR
STATE. WE HAVE A NUMBER OF
INITIATIVES UNDERWAY WHEN ONE OF
THE THINGS WE WANT TO DO IS
REALLY FOCUS ON WORKING THROUGH
THE COMMISSION. YOU'RE PROBABLY
GOING TO HEAR TODAY ABOUT MANY
OF THE GOOD WORKS THAT THEY DO,
AND WE REALLY WANT TO MAKE SURE
THAT THAT THE THINGS THAT WE'RE
WORKING ON AND THAT THAT WEIRD
PERSON DOING, INCLUDING JUST
THINGS THAT ARE ALREADY OUR
RESPONSIBILITY TO DO, FRANKLY,
NOT NECESSARILY NEW THINGS THAT
WE'RE DOING IN COORDINATION WITH
A GROUP THAT REALLY IS TRYING TO
DO GOOD WORK AND, YOU KNOW, DO
THINGS LIKE EARLY PSYCHOSIS AND
SUPPORT THE COUNTIES TO BE
SUCCESSFUL WITH THE
IMPLEMENTATION OF DIFFICULT
PROGRAMS UNDERSTAND THAT SO
WHAT'S THE WHAT'S THE ISSUE
THAT'S COMING UP YOU'RE TALKING
ABOUT IN THE FUTURE. WE HOPE TO
BE DOING THESE THINGS AND WE
WANT TO BRING THE COMMISSION IN
WHAT? WHAT'S THE ISSUE TODAY?
OUR GOAL WAS TO HAVE BETTER
ALIGNMENT. WE THINK THAT IT CAN
BE BETTER. YOU THINK THIS
MISALIGNMENT I'D LIKE SOME
EVIDENCE OF WHAT THAT
MISALIGNMENT IS? BECAUSE YOU
HAVEN'T, FOR INSTANCE,
ARTICULATED A SINGLE EXAMPLE.
SURE, FOR INSTANCE, REAL TIME
COLLECTING AND REPORTING OF
DATA. SO WE COULD TIME DATA BUT
PART OF WHAT I'VE BEEN HEARING
THE PROBLEM WITH THE REAL TIME
DATA IS THEIR LACK OF BUDGET.
HAVEN'T THEY HAVEN'T BEEN GIVEN
. WE'VE WE'VE ADVOCATED FOR
YEARS MORE BUDGET AUTHORITY THAT
CHALLENGES GETTING INTO SO THEY
FINALLY GOT BUDGET. AND THEN
FINALLY COLLECTING THE DATA.
OKAY SO WHAT ELSE? IT SEEMS LIKE
WE'RE MOVING AND SOLVING THAT
PROBLEM. WHAT ARE THE PROBLEMS
DO WE HAVE THAT'S MISALIGNMENT?
I THINK IT'S CLEAR THAT YOU'RE
POINTING OUT THE, UM CONCERNS
THAT THE LEGISLATURE AND OTHERS
HAVE WITH THE PROPOSAL. I'M
ASKING YOU TO TELL ME WHERE THE
MISALIGNMENT IS, AND YOU'VE
GIVEN ME NO EVIDENCE. SO WHAT? I
MEAN THIS. I'M LOOKING AT DATA.
GIVE ME DATA. SO YOU SAID
THERE'S MISALIGNMENT. HOW HAS IT
BEEN MISALIGNMENT? PLEASE TELL
ME. WE BELIEVE THAT THERE'S
MISALIGNMENT. GIVE ME GIVE ME
GIVE ME A FEW EXAMPLES. I MEAN,
YOU'RE YOU'RE YOU'RE TESTIFYING
TALKING ABOUT MISALIGNMENT, BUT
YOU HAVE NO EXAMPLES. I DON'T
HAVE ANYTHING RIGHT HERE TODAY.
BUT I MIGHT YOU HAVE MY
COMMITMENT TO COME BACK AND
SHARE WITH YOU THAT INFORMATION.
WHY DID YOU PROPOSE THIS?
BECAUSE CLEARLY YOU PROPOSED IT
BECAUSE THERE WAS EVIDENCE OR IT
MIGHT HAVE BEEN MY TO ASSUME
THAT YOU ACTUALLY DON'T HAVE ANY
EVIDENCE, AND THERE'S ANOTHER
MOTIVE AS TO WHY YOU PROPOSALS.
BECAUSE YOU'VE GIVEN THIS
COMMITTEE. NO EVIDENCE AS TO WHY
THIS WAS WAS PROPOSED AS OF
RIGHT NOW. WE HEAR YOU AND
UNDERSTAND YOUR CONCERN. SO WHAT
? WHAT ISSUE I IMAGINE WITH
MISALIGNMENT IS AROUND
COMMUNICATION. HOW OFTEN DO YOU
THAT YOUR AGENCY MEET WITH THE
COMMISSION COMMUNICATE WITH THE
COMMISSION. I CAN ONLY I WILL
LET D HCS SPEAK FOR THEMSELVES,
BUT FOR MYSELF, WE STARTED
MEETING WHEN I CAME INTO THIS
POSITION. I'VE BEEN IN THIS
POSITION FOR ABOUT THREE YEARS.
THEY MEET MONTHLY AND I COME AND
SPOKEN TO THE COMMISSION. I WAS
JUST THERE LAST THURSDAY. UM AND
SO I FEEL LIKE WE HAVE A GOOD
PARTNERSHIP. MY COLLEAGUE
MELISSA STAFFORD JONES, WHO WAS
LEADING THE CHILDREN AND YOUTH
BEHAVIOR HEALTH INITIATIVE ALSO
MEETS WITH TOBY AND HIS TEAM
REGULARLY MEET WITH DHS MONTHLY
MONTHLY COMMUNICATIONS. MONTHLY
TO THE COMMUNICATION IS GOOD.
I'M STILL TRYING TO UNDERSTAND,
AND WE HAVE A PARTNERSHIP WITH
THE DEPARTMENT OF AGING. WE
RELEASED $20 MILLION IN GRANT
FUNDS AND ABOUT SIX MONTHS THE
PARTNERSHIP WITH DEPARTMENT OF
AGING. WE HAVE A PARTNERSHIP
WITH THE HCS ARE AROUND
EXPANDING ACCESS TO EARLY
PSYCHOSIS CARE. THROUGH
RESHAPING AND I CAN GIVE THEIR
MULTIPLE EXAMPLES OF WHAT I'M
HEARING. WHAT I'VE HEARD THE
ONLY THING THAT I'VE HEARD RIGHT
THIS IS THIS IS JUST ME.
LISTENING. YOU'D LIKE TO GET THE
DATA FASTER. I'D LIKE TO GET THE
DATA FASTER, TOO, SO I'LL
TOTALLY COMPLETELY AGREE. IT
SEEMS LIKE YOU'RE STARTING TO
COLLECT THE DATA, SO I ASSUME AS
YOU AS SOON AS YOU GET THE DATA
YOU'LL BE HAPPILY TURNING IT
OVER TO D. H C S. IS THAT A FAIR
STATEMENT ACTUALLY GET THE DATA
FROM THEM. IN MOST INSTANCES, IT
OKAY, SO AS I DON'T KNOW WHAT
DATA ARE YOU LOOKING FOR? THAT
FITS YOUR DATA. WELL THAT'S THE
POINT IS THAT IF THEY WERE MORE
BROUGHT IN, WE COULD GET THAT
INFORMATION TO THEM FASTER AND
MORE REAL TIME. WHY LIKE IS IT
BECAUSE THE EMAIL IS NOT WORKING
OR THE SERVERS AREN'T WORKING OR
WHAT INTERNAL PROTOCOLS. IT'S A
PIECE OF PAPER OR SOMETHING. I
UNDERSTAND YOUR POINT, AND THEY
CAN BE THIS. THIS CAN SOUND LIKE
VERY BUREAUCRATIC BARRIERS TO
SHARING DATA AND WE CAN EXPLORE
WHAT THAT COULD MEAN. BUT I FEEL
LIKE YOUR WORDS, NOT MINE. SURE
I I'M ACKNOWLEDGING THE CONCERNS
THAT YOU'RE SHARING AND I HEAR
YOU AND WE WILL BRING IT BACK IN
OUR OPEN TO CONTINUE THE
DISCUSSION ON THIS PARTICULAR
PART OF THE PROPOSAL. I DON'T
HAVE ANY CONCERNS. I'M JUST
TRYING TO UNDERSTAND WHAT'S THE
ISSUE, SO I'M JUST LISTENING TO
WHAT YOU ARE ARTICULATING. YOU
PROPOSE SOMETHING? YOU'RE PROS.
ARE YOU TOLD? YOU TOLD THEM
YOU'RE TELLING THE COMMITTEE?
THERE'S MISALIGNMENT. THERE'S NO
EVIDENCE OF MISALIGNMENT. SO IF
THERE'S NO EVIDENCE OF
MISALIGNMENT, AND THERE'S
PERHAPS SOME OTHER REASON THIS
HAS HAPPENED. I HEAR THE
QUESTION, BUT BEFORE WE BEFORE
WE. TELL THE VOTERS THAT AN
INDEPENDENT COMMISSION THAT IS A
PRODUCER JERRY COMMISSION
OVERSEEING MONEY. BE TAKEN AWAY
. I WOULD HOPE THAT THERE'S SOME
ARTICULATION AS TO WHY THAT IS
AS A VOTER. IF SOMEONE TOLD ME
THAT A INDEPENDENT OVERSIGHT
COMMITTEE WAS ACTUALLY RUN BY
THE SCHOOL BOARD ON SCHOOL
BONDS. THAT TO ME IS NOT
INDEPENDENCE. SO. THAT WOULDN'T
GIVE ME AS A VOTER PERCENT OF
THE VOTE. I'M JUST JUST AND I
HAVE JUST ONE VOTE ON A BALLOT
MEASURE THAT WOULD GIVE ME
PAUSE. THANK YOU. ME PASS. AND
THE FACT THAT WE'RE HAVING
CHALLENGES REALLY UNDERSTANDING
WHERE THE MONEY'S GOING FROM
THIS REVENUE. HOW MUCH MONEY IS
IT A YEAR ROUGHLY. THE IMAGES S¼
. YEAH YEAH, I THINK IT'S
ROUGHLY AT THIS POINT IN TIME.
HOW DOES FLUCTUATE DRAMATICALLY
, SOMETIMES WITH OUR ECONOMY THE
WAY THAT IT IS, BUT IT'S AROUND
FOUR BILLION. THE FACT THAT WE
CAN'T REALLY ARTICULATE WERE $4
BILLION IS GOING. AS CONCERNING
. AS MAYOR, STEINBERG POINTED
OUT. ESTABLISHING THE COMMISSION
WAS EXPLICITLY TO SUPPORT THE
BALLOT MEASURE. I THINK ONE OF
THE COMMISSION'S CHALLENGES HAS
BEEN NOT HAVING THE BUDGET
AUTHORITY TO ACTUALLY GO GET THE
DATA, RIGHT? THAT'S WHY IS THAT
CORRECT PART OF IT? YEAH PART OF
IT. OKAY WELL, I MEAN, WE
APPRECIATE CONTINUING THIS.
DISCUSSION. HOPEFULLY, WE CAN
GET A LIST OF WHAT ISSUES WERE
TRYING TO SOLVE. SO WE CAN
DECIDE WHETHER WE AGREE WITH
THIS OR NOT. THANK YOU. THANK
YOU. WE WILL NOW CONTINUE WITH
THE REST OF THE PANEL ON ISSUES
16. WE ARE GOING TO BEGIN WITH
DAVE GORDON, SUPERINTENDENT OF
SACRAMENTO COUNTY OFFICE OF
EDUCATION, FOLLOWED BY BILL
BROWN. FOLLOWED BY ANDREA WAGNER
. AND THEN OUR STUDENTS. UM
STUDENTS WHO ARE HERE FROM
IMPERIAL COUNTY HIGH SCHOOL. MR
GORDON AND MR BROWN.
MR BROWN WHEN YOU'RE READY.
WELL, THANK YOU AND GOOD
AFTERNOON CHAIR, AMBULATORY AND
MEMBERS OF THE COMMITTEE. I AM
BILL BROWN, THE SHERIFF OF SANTA
BARBARA COUNTY, AND I HAVE
SERVED ON THE COMMISSION AS A
GOVERNOR'S. APPOINTEE
REPRESENTING THE STATE'S 58
SHERIFFS. SINCE 2010. IT'S BEEN
SUCH A PRIVILEGE TO SERVE
ALONGSIDE AN EXTRAORDINARILY
DEDICATED GROUP OF FELLOW
COMMISSIONERS WHO REPRESENT
CONSUMERS AND THEIR FAMILIES.
MENTAL HEALTH SERVICE PROVIDERS.
ENFORCEMENT. EDUCATORS
LEGISLATORS ADVOCATES AND
EMPLOYERS. EACH OF OUR DIVERSE
BACKGROUNDS IS WHAT MAKES THE
COMMISSION UNIQUE. AND RELEVANT.
AND OUR INDEPENDENCE HAS
PROVIDED US THE FREEDOM. TO
INTENSIFY ENGAGEMENT. THAT
INFLUENCES AND TOUCHES MENTAL
HEALTH. IN AREAS SUCH AS HOMES,
COMMUNITIES, SCHOOLS, WORKPLACES
AND THE JUSTICE SYSTEM. I WOULD
LIKE TO THANK THE GOVERNOR AND
THE ADMINISTRATION FOR THEIR
LEADERSHIP ON THIS IMPORTANT
ISSUE. I SHARE THE GOVERNMENT'S
COMMITMENT TO FOCUSING ON FULL
SERVICE PARTNERSHIPS AND ON
IMPROVING CALIFORNIA'S
BEHAVIORAL SALT HEALTH SYSTEM TO
BETTER ADDRESS MENTAL HEALTH,
SUBSTANCE USE DISORDERS AND
HOMELESSNESS. THESE ARE VEXING
ISSUES, WHICH I SEE EVERY DAY IN
MY COUNTY. AND I COULDN'T AGREE
MORE THAT MORE CAN AND MORE MUST
BE DONE. ENFORCEMENT OFFICERS
ARE OFTEN THE FIRST RESPONDERS
TO MENTAL HEALTH CRISIS. AND
JAILS AND PRISONS HAVE BECOME A
DEFAULT TREATMENT SYSTEM. AN
ESTIMATED 31% OF JUSTICE
INVOLVED. CALIFORNIANS HAVE
UNMET MENTAL HEALTH NEEDS. AND
THE PERCENTAGE OF STATE
PRISONERS WITH MENTAL HEALTH
CHALLENGES HAS INCREASED BY 77%
OVER THE PAST DECADE. THE
COMMISSION HAS BEEN WORKING
UPSTREAM TO PREVENT JUSTICE
INVOLVEMENT, REDUCE COSTS AND
IMPROVE OUTCOMES. WE DO THAT BY
PARTNERING WITH CRIMINAL JUSTICE
AND BEHAVIORAL HEALTH AGENCIES
AND PRACTITIONERS. WE HAVE HAD
MANY IMPORTANT ACCOMPLISHMENTS
IN THIS AREA. WE ESTABLISHED
DATA INFRASTRUCTURE TO TRACK
JUSTICE INVOLVEMENT. WE
DOCUMENTED A 69% REDUCTION IN
CRIMINAL JUSTICE INVOLVEMENT FOR
FULL SERVICE PARTNERSHIP
PARTICIPANTS. WE PARTNERED WITH
FEDERAL AGENCIES TO IDENTIFY AND
OBSERVE NATIONAL BEST PRACTICES.
TO BRING TO CALIFORNIA. AFTER
WHICH WE PUBLISHED A REPORT.
ENTITLED TOGETHER, WE CAN.
REDUCING CRIMINAL JUSTICE
INVOLVEMENT FOR PEOPLE WITH
MENTAL ILLNESS. THIS REPORT
HIGHLIGHTS EFFECTIVE WAYS THAT
COUNTIES CAN BETTER COLLABORATE
AND COMBINE THEIR RESOURCES.
PROVIDE BETTER CRISIS SERVICES
AND ALTERNATIVES TO CUSTODY FOR
MENTALLY ILL PEOPLE. AND EXPAND
BOTH JAIL AND COMMUNITY BASED
RESTORATIVE PROGRAMS FOR PERSONS
FOUND INCOMPETENT TO STAND
TRIAL. WE LAUNCHED AN INNOVATION
INCUBATOR TO REDUCE JUSTICE
INVOLVEMENT. WE'RE DEVELOPING
MULTI COUNTY LEARNING
COLLABORATIVE TO REDUCE JUSTICE
INVOLVEMENT. AND WE ARE
LEVERAGING INNOVATION ON A RANGE
OF PROJECTS, INCLUDING EXPANDING
THE USE OF PSYCHIATRIC ADVANCED
DIRECTIVES TO IMPROVE RESPONSE
TO MENTAL HEALTH CRISES.
LAUNCHING A CRISIS NOW ACADEMY
TO SCALE EVIDENCE BASED
PRACTICES ACROSS CALIFORNIA. AND
STRENGTHENING COUNTY CAPACITIES
TO MAP THE MENTAL HEALTH
CRIMINAL JUSTICE NEXUS. I
BELIEVE THAT WE ARE ABLE TO DO
MUCH OF THIS WORK BECAUSE OF THE
COMMISSION'S INDEPENDENCE.
BECAUSE OF OUR ABILITY TO WORK
OUTSIDE OF THE TRADITIONAL
BOUNDARIES OF MENTAL HEALTH. AS
I MENTIONED, GOVERNOR NEWSOM HAS
SHOWN TREMENDOUS LEADERSHIP IN
THIS FIELD, AND THAT HAS NOT
ALWAYS BEEN THE CASE WITH PRIOR
GOVERNORS. WHILE I APPLAUD HIS
GREAT INTEREST IN AND COMMITMENT
TO MENTAL HEALTH. I RESPECTFULLY
DISAGREE WITH THAT PART OF THE
ADMINISTRATION'S PROPOSED PLAN
THAT TAKES AWAY THE INDEPENDENCE
OF THE MENTAL HEALTH SERVICES
OVERSIGHT AND ACCOUNTABILITY
COMMISSION. AND PLACES IT UNDER
THE HEALTH AND HUMAN SERVICES
AGENCY. AS WELL AS HAVING THE
GOVERNOR APPOINT THE EXECUTIVE
DIRECTOR. THE COMMISSION'S STAFF
SHOULD WORK FOR THE COMMISSION.
AND THERE'S A REASON FOR THAT.
MY FELLOW SHERIFFS AND I HAVE
BEEN CHAMPIONING EFFORTS TO
DIVERT MENTAL HEALTH CLIENTS OUT
OF THE CRIMINAL JUSTICE SYSTEM.
AND TO DECRIMINALIZE MENTAL
ILLNESS FOR YEARS. AT TIMES
WE'VE HAD SUPPORT FOR THAT
EFFORT. AND AT OTHER TIMES WE
HAVE NOT HAD THAT SUPPORT. THE
COMMISSION WAS FORMED, IN PART
TO MAKE SURE THAT THERE IS A
CONSISTENT AND CONSTANT VOICE TO
TACKLE THIS CHALLENGE, AMONG
MANY OTHERS. IT IS ESSENTIAL
THAT MILLIONS OF CALIFORNIANS
WHO ARE STRUGGLING WITH MENTAL
HEALTH NEEDS CONTINUE TO HAVE AN
INDEPENDENT BODY AVAILABLE TO
HEAR THEM AND TO RECOMMEND WAYS
THAT WE CAN DO BETTER. MR
CHAIRMAN, I THANK YOU AND ALL
THE COMMITTEE MEMBERS FOR THE
OPPORTUNITY TO SPEAK BEFORE YOU
TODAY. NEXT WE WILL HAVE BILL
BROWN. EXCUSE ME. DAVE GORDON
SUPERINTENDENT, SACRAMENTO
COUNTY OFFICE OF EDUCATION. GOOD
EVENING CHAIR ARAMBULA ARAMBULA
AND MEMBERS OF THE COMMITTEE.
I'M DAVE GORDON, SUPERINTENDENT
OF THE SACRAMENTO COUNTY OFFICE
OF EDUCATION AND FORMER
SUPERINTENDENT OF THE ELK GROVE
UNIFIED SCHOOL DISTRICT, HAVE
SERVED ON THE COMMISSION SINCE
2013 AS THE REPRESENTATIVE OF
LOCAL SCHOOLS. WHAT YOU WILL
HEAR IN A FEW MOMENTS FROM THE
HIGH SCHOOL STUDENTS FROM
IMPERIAL COUNTY TODAY IS EXACTLY
WHAT THE COMMISSION HOPED TO
ACHIEVE. WHEN WE BEGAN
ADVOCATING THAT THE STATE MOVED
TOWARDS ENCOURAGING SCHOOL BASED
MENTAL HEALTH. COMMISSION
BELIEVED SCHOOL ENTITIES AND
HEALTH SYSTEMS COULD WORK
EFFECTIVELY TOGETHER. TO HELP
CHILDREN TO LIVE WORK AND THRIVE
BY PARTNERING TO MAKE SCHOOLS
INTO CENTERS OF WELLNESS AND
PREVENTION. AND BY JOINING WITH
SCHOOL LEADERS TO MEET STUDENTS
AND FAMILIES, WHERE THEY WHERE
THEY ARE, WHICH IS IN THE
COMMUNITY. I THANK AND APPLAUD
THE GOVERNOR AND HIS TEAM FOR
THEIR CONTINUED SUPPORT AND
CREATING VEHICLES TO BETTER MEET
THE BEHAVIORAL HEALTH NEEDS OF
CHILDREN AND YOUTH. THE
GOVERNOR'S HISTORIC COMMITMENT
TO THE CHILDREN AND YOUTH
BEHAVIORAL HEALTH INITIATIVES,
INDEED, EXTRAORDINARY AND THE
COMMISSION'S WORK ON SCHOOL
MENTAL HEALTH WAS A PRECURSOR TO
THAT EFFORT. WE HAVE BEEN URGING
OUR LOCAL AND STATE PARTNERS TO
RECOGNIZE SCHOOLS AS CENTERS,
WELLNESS AND PREVENTION SINCE
2016 AND THE GOVERNOR'S
INITIATIVE HAS THE POTENTIAL TO
EXPAND THOSE EARLY EFFORTS
STATEWIDE. THE PROGRAMS YOU WILL
HEAR THE STUDENTS SPEAK ABOUT
TODAY WERE DEVELOPED AS A RESULT
OF LEADERSHIP COMING OUT OF THE
STATE SUPERINTENDENTS
ASSOCIATION, THE CD AND THE
COMMISSION AMONG MANY OTHERS.
FACILITATING THESE STRONG
PARTNERSHIPS BETWEEN LOCAL
EDUCATION AND BEHAVIORAL HEALTH
LEADERS. THE MAKEUP OF THE
COMMISSION WITH BOTH ITS
BEHAVIORAL HEALTH AND EDUCATION
SEATS. AND I WANT TO RECOGNIZE
MY PUBLIC SAFETY COLLEAGUE
SHERIFF BROWN IN THAT REGARD HAS
ENABLED THE COMMISSION AND ITS
OVERSIGHT ROLE TO IDENTIFY AND
PURSUE OPPORTUNITIES FOR
INNOVATION. OFTENTIMES GO
UNADDRESSED IN THOSE TWO
IMPORTANT AREAS. THE COMMISSION
IS CURRENTLY DIRECTLY SUPPORTING
SCHOOL MENTAL HEALTH
PARTNERSHIPS IN MORE THAN 400
SCHOOL DISTRICTS AND 2000
SCHOOLS. WE ARE PARTNERING
DIRECTLY WITH 57 COUNTY
BEHAVIORAL HEALTH DEPARTMENTS
AND 50 COUNTY OFFICES OF
EDUCATION, ONE OF WHICH IS MY
OWN. OUR SCHOOL. MENTAL HEALTH
EFFORTS HAVE ENGAGED THE
DEPARTMENT OF HEALTH CARE
SERVICES, THE DEPARTMENT OF
EDUCATION THEME A COMMUNITY
BASED ORGANIZATIONS, UNIVERSITY
AND RESEARCH CENTERS, AMONG
OTHERS. I CANNOT OVEREMPHASIZE
HOW IMPORTANT THIS WORK IS
PARTICULARLY AS OUR SCHOOLS AND
COMMUNITIES ARE STRUGGLING IN
THE WAKE OF THE PANDEMIC TO
ADDRESS SUICIDE RISKS, ADDICTION
AND OVERDOSES. BULLYING AND THE
STRESS OF ANXIETY FROM THE
PANDEMIC AND THE ECONOMIC
REALITIES FACING FAR TOO MANY
CALIFORNIA FAMILIES THE
EXPANSIVE PERCENT PERSPECTIVE OF
THE COMMISSION, WHICH INCLUDES
SUICIDE, SUD SERVICES, HOUSING,
EMPLOYMENT, CHILD WELFARE
INVOLVEMENT, JUSTICE, JUSTICE
INVOLVEMENT AS OUTLINED IN THE
MENTAL HEALTH SERVICES ACT HAS
MADE THE COMMISSION'S EFFORT
EVEN MORE IMPACTFUL. THE WORK IS
ENHANCED BECAUSE THE COMMISSION
IS A SMALL INDEPENDENT
COMMISSION APPOINTED BY THE
GOVERNOR THAT WORKS ACROSS
MULTIPLE SECTORS IN DYNAMIC WAYS
WITH TREMENDOUS FLEXIBILITY AND
INDEPENDENCE. IN MY TENURE IN
PUBLIC SERVICE, WORKING WITH
MANY PUBLIC AGENCIES, ONE
CHARACTERISTIC OF THE COMMISSION
THAT STANDS OUT IS HOW NIMBLE IT
IS AND HOW ACCESSIBLE IT IS. TO
PROMOTING INNOVATIVE PRACTICES.
AND. THE ABILITY TO RESPOND
QUICKLY TO MOUNTING INNOVATIONS
TRYING THEM OUT. THEY MAY WORK,
THEY MAY NOT WORK AND GETTING
THE DATA TO FIGURE OUT WHAT HAS
HAPPENED AND IN AN AREA AS
IMPORTANT AS MENTAL HEALTH AND
PREVENTION. THAT'S AN ASPECT OF
THE COMMISSION THAT I FEEL WE
CANNOT LOSE. THANK YOU FOR THE
CHANCE TO SPEAK BEFORE YOU THIS
EVENING. I WANT TO THANK BOTH
THE SUPERINTENDENT IN SHERIFF.
WELL NOW HAVE ANDREA WAGNER,
EXECUTIVE DIRECTOR FOR THE
CALIFORNIA ASSOCIATION OF MENTAL
HEALTH, PEER RUN ORGANIZATIONS.
FOLLOWED BY IVAN ARELLANO CARLOS
GASTELUM. AND AIYANA HOFFMAN. IF
YOU CAN COME FORWARD, PLEASE. WE
WILL BEGIN WITH MISS WAGNER.
YEAH. YES, I'M FIRST. HI I'M
ANDREA WAGNER. AND I'M, THE
EXECUTIVE DIRECTOR FOR CAMPAÑA,
THE CALIFORNIA ASSOCIATION OF
MENTAL HEALTH, PEER RUN
ORGANIZATIONS AS YOU HEARD. WE
REPRESENT, UH SEVERAL DOZEN
INDEPENDENT PEER RUN
ORGANIZATIONS ACROSS THE STATE,
WHICH IN TURN REPRESENTS ABOUT
YOU KNOW, ROUGHLY 5000 PEER
CONSTITUENTS AROUND CALIFORNIA.
ONE OF OUR PROJECTS IS AND AN
IMAGE S O A C FUNDED STAKEHOLDER
GRANT, WHICH WE GO TO ALL FIVE
REGIONS EACH YEAR AND DO FOCUS
GROUPS AMONG INDIVIDUALS IN
THOSE COUNTIES AND PEOPLE WITH
LIVED EXPERIENCE, ASKING THEM
WHAT THEIR MENTAL HEALTH
PRIORITIES ARE AND WHAT WHAT'S
MISSING IN THEIR SYSTEMS OF
CARE. UM WE TALK A LOT. I'VE
HEARD A LOT IN THE LAST FEW
WEEKS FROM DIFFERENT MEETINGS IN
THE CAPITAL ABOUT DATA AND, UH,
I CAN TELL YOU FIRSTHAND. I'M
JUST ABOUT TO FINISH MY DEGREE
AND PUBLIC ADMINISTRATION FROM
USC AND I KNOW ALL KINDS OF WAYS
TO COLLECT AND GATHER GATHER
DATA, BUT, UM, ARE ORGANIZATIONS
CANNOT DO THAT INEFFECTIVE WAY
AND THAT IS THE DATA THAT IS
THAT STATES ASKING FOR SO WHEN I
HEAR STEINBERG SAYING THAT YOU
KNOW THERE ISN'T DATA. HOW DO
YOU HOW DO YOU COLLECT DATA ON
SUCCESS WHEN PEOPLE LIKE ME HAVE
GOTTEN THROUGH THE SYSTEM
THROUGH AN INNOVATION PROJECT
WHEN I GOT OUT OF THE HOSPITAL
THAT THAT KEPT ME OUT OF THE
SHELTER AND INTO HOUSING THROUGH
A, YOU KNOW, I'M NOT GOING TO
THE HOSPITAL ANYMORE, SO MY
NUMBER ISN'T COUNTED ANYMORE,
RIGHT? HOW DO YOU HOW DO YOU
MEASURE THAT? AND HOW DO YOU
QUANTIFY? TONS AND TONS OF
QUALITATIVE DATA THAT WE HEAR
EVERY DAY. WE HAVE THOUSANDS OF
PAGES OF NOTES OF WHAT PEOPLE
HAVE TOLD US AND WE DON'T KNOW
HOW TO GET THAT TO YOU ALL
BECAUSE WE DON'T HAVE MONEY TO
PAY FOR DATA ANALYSTS THE COMMON
MAKE FANCY INFOGRAPHICS SO WE
CAN SHOW YOU THE SUCCESS THAT
THAT THE VOLUNTARY PEER PROGRAMS
HAVE PROVIDED TO OUR
COMMUNITIES. UM, I'M SPEAKING
TODAY AS APPEAR AS A SISTER,
SOMEONE WITH SCHIZOPHRENIA AS AS
A MOTHER OF A CHILD THAT HAS
MENTAL HEALTH DIAGNOSIS. I'VE
WORKED IN CRISIS SERVICES FOR
FIVE YEARS. I'VE BEEN ON BOTH
SIDES OF THAT. THAT PSYCHIATRIC
HOSPITAL DOOR ALSO BEEN
INCARCERATED. I'VE ALSO BEEN
HOMELESS. UM I SAY ALL THAT TO
SAY THAT LIKE WHEN I FIRST READ
THE MENTAL HEALTH SERVICES ACT,
IT BROUGHT TEARS TO MY EYES.
BECAUSE IT WAS THE FIRST TIME I
SAW IN A LEGAL DOCUMENT, THE
THINGS THAT MADE ME WELL AND
THAT CHANGED MY LIFE AND THE
LIVES OF SO MANY PEOPLE THAT I
STARTED TO MEET YOUR WORK. I'M
CONCERNED ABOUT MOVING THE MH S
O A C BECAUSE OF SO MANY WAYS
THAT THE ALLOWS THAT OPEN DOOR
FOR ADVOCATES LIKE ME TO COME
AND TELL THESE STORIES. TO BE
ABLE TO TALK, AND I CAN SAY I'M
REALLY AFRAID OF IT GOING UNDER
KELLY JHS. BASED ON AND THE
DEMONSTRATED AN OUTRIGHT
DISMISSAL AND IGNORING OF THE
PEER COMMUNITY DURING THE CARE
COURT PUSH LAST YEAR. UM I HAVE
A REALLY LARGE FEAR THAT IF THIS
COMMISSION HAS MOVED ARE YOUR
VOICE WILL BE CREDIBLY SILENCED
AND DISENFRANCHISED. IT ALREADY
IS STRUGGLING. WE ALREADY FEEL
LIKE WITH THE GOVERNOR AND
STEINBERG AND THE BIG CITY
MAYORS COMING AFTER OUR RIGHTS
AND COMING AFTER OUR PROGRAMMING
AND OUR MONEY. AND WE HAVE NO
RECOURSE. WE ALREADY FEEL LIKE
YOU KNOW THAT GOLIATH IS TAKING
THE STONES AWAY FROM DAVID. IT
REALLY FEELS VERY, VERY MUCH
LIKE UM, AN UNWINNABLE BATTLE. I
REMEMBER A COUPLE OF YEARS AGO
IN THIS VERY COMMITTEE. WE HAD A
BUDGET HEARING ON THIS FIRST
IDEA THAT STEINBERG HAD
MODERNIZING IMAGES SAY IN THE
ENTIRE ROOM WAS PACKED. THANK
YOU FOR THEIR, UM AND THE PUBLIC
COMMENT WAS PUT OFF TILL THE
VERY END. I WAS THERE SEVEN
HOURS WITH TWO PEOPLE THAT HAD
PHYSICAL DISABILITIES. WE SAT
AND WE WAITED BECAUSE IT MEANT
SO MUCH TO US TO HOLD ONTO THE
MHS S¼. AND WE ALL STOOD UP AT
THE END, AND I THINK YOU WERE
THE ONLY THE ONLY MEMBER THAT
STAYED AND I RUN A THANK YOU FOR
THAT. AND HEARD ALL OF THE
PUBLIC COMMENTS THAT WENT ON FOR
QUITE A WHILE. AND I DON'T THINK
THAT ANYONE ELSE EVER PROBABLY
WATCHED THEM. AND THAT WAS
REALLY SAD. AND THAT'S JUST WHAT
WE SEE A LOT AND I FEEL LIKE IN
THE A C. ALTHOUGH WE THEY DON'T
ALWAYS DO WHAT WE ASK, AND THEY
DON'T ALWAYS HEAR EVERYTHING. WE
HAVE TO SAY IT IS ONE OF THE FEW
PLACES I FEEL LIKE THEY'RE
ACTUALLY ASKING TO HEAR US AND
THEY ACTUALLY WANT TO KNOW WHAT
WE HAVE TO SAY. UM I DON'T KNOW
HOW MUCH TIME I HAVE BEEN.
THAT'S THAT'S THE BOOK OF WHAT I
HAVE TO SAY. THANK YOU FOR THAT
, AND WE'LL SAY WE ARE ASKING TO
MAKE SURE THAT STUDENTS HAVE A
SEAT AT THE TABLE AND WE DO WANT
TO KNOW WHAT YOU SAY. AND SO I'M
LOOKING FORWARD TO THE STUDENTS
WHO WILL SHARE THEIR EXPERIENCES
NEXT. WILL BEGIN WITH IVAN
ARELLANO. ALL RIGHT. GOOD
AFTERNOON OR GOOD EVENING. UM
AND EVEN ARIANO, OBVIOUSLY AND
I'M HERE TODAY. AND TELLING YOU
GUYS THAT, UM ABOUT MY
EXPERIENCE WITH MENTAL HEALTH, I
GUESS, UM UM, I COME FROM, WELL
, I'M ADOPTED INTO A MEXICAN
FAMILY. WE'RE KNOWN FOR OUR
PRIDE, BUT ALSO WHAT MOST PEOPLE
DON'T KNOW. IS THAT NORMALLY UM
FEELINGS ARE HIDDEN. IN A
MEXICAN HOUSEHOLD. YOU CAN'T
REALLY EXPRESS YOURSELF. IN
FRONT OF CERTAIN SITUATIONS
BECAUSE YOU'LL BE SEEN AS WEAK.
WILL BE SEEN AS WELL LESSER THAN
THE REST. BYE. I'VE BEEN WHAT
THAT MENTALITY. TERMS LIKE I WAS
KIDDING. I WAS A LITTLE BECAUSE
I USED TO TRY TO EXPRESS MYSELF
OR I DIDN'T REALLY KNOW HOW SO
IT ALWAYS COMES OUT IN THE WRONG
WAY. AND THEN I FINALLY HIT HIGH
SCHOOL. AND PROBLEMS STARTED
GETTING WORSE. MY BEHAVIOR
STARTED GETTING MORE AGGRESSIVE
. I STARTED BEING MORE I DIDN'T
REALLY CARE WHAT ANYONE ELSE
THOUGHT OR FELT. I WAS, UM
DISRUPTIVE. I WAS DESTRUCTIVE
AND I WASN'T THE BEST PERSON.
I'M NOT. I WASN'T AS GOOD OF A
PERSON AS I AM NOW. AND I
FINALLY HIT MY JUNIOR YEAR I
MOVED TO I STARTED GOING TO I H
S AND I DIDN'T REALIZE THAT WE
HAD A MENTAL HEALTH. PERSON
THERE AND I FINALLY STARTED
SEEING HER THIS YEAR. AND SHE'S
BEEN HELPING ME THROUGH ALL THE
PROBLEMS, MY EMOTIONAL PROBLEMS
AND DISTRESSES THAT I'VE BEEN
HAVING THROUGHOUT THE ENTIRETY
OF MY LIFE. WE'VE BEEN SORTED
HIM OUT. AND NOW I ACTUALLY GET
ALONG WITH A LOT OF PEOPLE. I AM
UNDERSTANDING AND I EVEN TRY TO
HELP OTHERS WITH THEIR FEELINGS
AND THEIR EMOTIONS. AND I EVEN
HAVE A BETTER RELATIONSHIP WITH
MY MOM BECAUSE I AND MY DAD, OF
COURSE. BECAUSE THEY WEREN'T AS
UNDERSTANDING. DÍAS THEY? WELL,
THEY TRIED BUT I'VE FINALLY BEEN
ABLE TO PUT LIKE SOME SORT OF
UNDERSTANDING INTO THEM. AND NOW
WE CAN GET ALONG EMOTIONALLY. WE
HELP EACH OTHER WITH THROUGHOUT
PROBLEMS NOW. AND SO, UM ALL IN
ALL. UM. IT'S A VERY GOOD CAUSE
IN MY OPINION. AND I FEEL LIKE
THIS IS SOMETHING THAT'S VERY
MUCH NEEDED. THANK YOU, IVAN.
NEXT WE WILL HEAR FROM CARLOS.
GASTELUM HELLO. I AM CARLOS
GASTELUM AND I WOULD SAY IT'S
BECOME BEHALF OF THE STUDENTS
WITH EMOTIONAL AND AVAILABILITY
. VERY INDEPENDENT STUDENTS WHO
I'VE BEEN GOING TO SCHOOL BY
MYSELF WALKING MILES SINCE THE
SECOND GRADE BECAUSE MY MOM
MIDDLE CLASS HAD TO WORK. UM 5
TO 9 ALL THE TIME. I HAD TO TAKE
THE BUS ALWAYS ALONE, JUST NOT
ABLE TO WORK WITH MY OWN
EMOTIONS. SO IMAGINE COMING TO
HIGH SCHOOL WITH THE REALITY OF
ADULTHOOD BILLS GROWING UP, AND
I DON'T EVEN KNOW HOW TO DEAL
WITH MY OWN SADNESS. MY OWN
ANXIETY HAVE S A T S COMING UP.
HAVE TO GRADUATE. I HAVE TO DO
ALL OF THESE THINGS YET. I DON'T
EVEN KNOW WHAT TO DO WITH MY OWN
SELF. YEAH, I'M TOLD WHAT TO DO.
SO WITH MY EXPERIENCE HEADING
INTO HIGH SCHOOL, I SKIPPED
SCHOOL. I WAS A SKIPPER. I WAS
ONE OF THOSE KIDS WHO JUST I
DON'T LIKE SCHOOL. I DON'T WANT
SCHOOL. I CAN'T DO SCHOOL. I HAD
TO STAY HOME. THAT'S MY COMFORT,
SKIP SCHOOL ANY LITTLE WAY SO I
CAN HAVE COMFORT TILL I GOT
SCOUTED OUT BY THE SECURITY. AND
THEY HAD ASKED ME WHY? WHY WERE
YOU GONE FOR SO LONG MONTHS. AND
I HAD SAID, UM YOU KNOW WHAT. I
HAVEN'T TOLD YOU BECAUSE I HAVE
BEEN AFRAID THAT YOU'RE JUST
GOING TO TELL ME. YOU KNOW WHAT?
JUST DO YOUR WORK. JUST DO YOUR
WORK, AND YOU'RE GONNA BE FINE,
LIKE JUST DO YOUR WORK. UM, BUT
I M I WANT TO COMMIT SUICIDE.
AND RIGHT AWAY. EVERY SINGLE
RESOURCE THAT I COULD THINK OF
WAS GIVEN TO ME EVERY SINGLE
SUPPORT EVERY SINGLE RESOURCE
EVERYTHING. I HAVE PACKETS. I
HAD SO MANY PEOPLE EMAILING ME
TELLING ME THAT THEY COULD HELP
ME. SO MANY PEOPLE CALLING ME
TELLING ME. HEY I GOT EMAILS BY
THE COUNSELORS AT THE SCHOOL. I
GOT EMAILS BY THIS AND NOT I
WANT TO HELP YOU. HERE'S AN
APPOINTMENT. HERE'S YOUR MOM.
GIVE ME YOUR MOM'S PHONE NUMBER.
LET'S TALK BLAH, BLAH, BLAH,
BLAH. WITHIN. I WOULD SAY A YEAR
AND A HALF. MY GRADES HAVE
INCREASED MY RELATIONSHIPS WITH
MYSELF AND OTHERS HAVE JUST
SKYROCKETED. AND I REALLY FEEL
LIKE I'VE BECOME LIKE JUST THE
ARCHITECT OF MY OWN LIFE. JUST
THE MASTER OF MY OWN EMOTIONS
AND IMAGINE WHAT I COULD DO AT
30 YEARS OLD. IF I COULD DO THIS
NOW, SO IMAGINE EVERYBODY. IF
EVERY STUDENT WAS LIKE THAT,
THEN HOW CAN IT BE PASSED ON TO
THEIR KIDS? AND WHAT WOULD THAT
LOOK LIKE IN THE FUTURE? SO
YEAH. THANK YOU, CARLOS. NEXT
WE'LL HEAR FROM AYANA HOFFMAN.
MY NAME IS I, ANA HOFFMAN, AND I
AM A 17 YEAR OLD JUNIOR AT
IMPERIAL HIGH SCHOOL. ALTHOUGH I
AM NOT ORIGINALLY FROM
CALIFORNIA. I COME FROM MONTANA
. I WILL STILL BE ADVOCATING FOR
MENTAL HEALTH AWARENESS
PROGRAMS. IN EDUCATION SYSTEMS.
UM. CORRECT ME IF I'M WRONG, BUT
THERE WAS A STATISTIC IN DONE IN
2022 ON MENTAL HEALTH AWARENESS
AND MENTAL HEALTH SERVICES
THROUGHOUT THE STATES, AND IT
LISTED THE, UM THE AMOUNT OF HOW
MUCH. MENTAL HEALTH SERVICES
ESTATE CAN GET UM, NUMBER 17 WAS
MONTANA AND I STRUGGLED
IMMENSELY IN MONTANA. NUMBER 28
WAS CALIFORNIA. UM IN MONTANA. I
WAS BORN INTO A EXTREMELY
DRAMATIC, VERBALLY AND
PHYSICALLY ABUSIVE ENVIRONMENT.
UM, BY THE BY THIRD GRADE. I WAS
SELF HARMING. IF I'M NOT
MISTAKEN THAT IS AN EIGHT YEAR
OLD TO NINE YEAR OLD CHILD. UM I
SWITCHED FROM HOME TO HOME. BOTH
ENVIRONMENTS WERE INCREDIBLY
TRAUMATIC. AND BY 15. I WAS
KICKED OUT OF MY HOUSE WITH
NOWHERE TO GO. UM. BEFORE THAT.
I HAD BEEN MANAGING MY GRADES.
INCREDIBLY I WAS A 4.7 GPA
STUDENT. ALWAYS UM, MY
ATTENDANCE WAS PERFECT. I WAS
HEADING FOR VALEDICTORIAN OR
VALEDICTORIAN. APOLOGIES. UM.
AND I USED TO SCHOOLING AS A
WAY. TO ESCAPE FROM MY CURRENT
SITUATION. I DID ANY
EXTRACURRICULAR ACTIVITIES? I
COULD. I WAS AN ATHLETE. I WAS
GOOD AT WHAT I DID. I HAD
INCREDIBLE RELATIONSHIPS WITH
ALL OF MY TEACHERS. UM AND I WAS
WELL KNOWN AROUND THE SCHOOL.
FOR MY INTELLECTUAL ABILITIES.
ONE AND I GOT KICKED OUT. MY
GRADES DROPPED IMMEDIATELY. I
WAS SKIPPING CLASS. I WAS HAVING
MORE SUICIDAL TENDENCIES. UM. I
WAS HARMING MYSELF A LOT MORE. I
WOULD SKIP CLASS IF I DID ATTEND
SCHOOL TO HARM MYSELF. I WAS
CRYING EVERY SINGLE PERIOD.
BECAUSE I COULDN'T HANDLE MYSELF
AND MY EMOTIONS AND THE AMOUNT
OF ABANDONMENT AND TRAUMA THAT I
WENT THROUGH. WITH NO ONE TO
TALK TO I HAD NO ONE THERE WAS
NO MENTAL HEALTH. UM AWARENESS.
THERE WAS NO ON CAMPUS THERAPIST
THAT COULD CONNECT ME TO OTHER
RESOURCES FOR MY BENEFIT. AND I
WAS ALONE. UM, I TRIED
COMMITTING SUICIDE. CRITICAL
TIMES. I WAS SEXUALLY ASSAULTED
ON MULTIPLE ACCOUNTS. I WAS
ABUSING. DRUGS AND ALCOHOL. I
WAS MYSELF. WHEN I MOVED TO
CALIFORNIA, I HAD STARTED LIVING
WITH MY GRANDPARENTS, AND IT HAS
BEEN A LOT BETTER. BUT I WAS
STILL STRUGGLING WITH KEEPING UP
MY GRADES. I WAS STILL
STRUGGLING WITH GOING TO CLASS
AND MAINTAINING A POSITIVE
ATTITUDE. I WAS STILL CRYING. IT
WAS STILL HAVING ANGRY EPISODES
AND I WAS STILL HAVING INTRUSIVE
THOUGHTS. WHEN. I HEARD ABOUT
THE ON CAMPUS THERAPIST. WHEN I
HEARD ABOUT THE RESOURCES THAT
IT COULD PROVIDE ME UM. I WAS
SPEECHLESS. NEVER HAVE I EVER
EXPERIENCED ANYTHING LIKE THAT.
UM I'VE NEVER STAYED AT A SCHOOL
FOR MORE THAN TWO YEARS. PANTS
NO SCHOOL IN MONTANA. HAS EVER
PROVIDED MENTAL HEALTH SERVICES.
SINCE THEN. I HAVE NOT SELF
HARMED IN OVER A YEAR. I NO
LONGER ABUSE, DRUGS OR ALCOHOL.
UM I AM WORKING THROUGH MY
TRAUMA. I HAVE GOTTEN A
DIAGNOSIS CONFIRMATION. UM I WAS
DIAGNOSED WITH BORDERLINE
PERSONALITY DISORDER. AND I AM
CURRENTLY ON MEDICATION. AYE. MY
GRADES ARE STEADILY, UM,
IMPROVING AND. UM, MY
RELATIONSHIPS WITH PEOPLE. MY
RELATIONSHIPS WITH TEACHERS HAVE
EXPONENTIALLY. UM BECOME BETTER.
I'M MORE CONFIDENT IN MYSELF. I
CAN EXPRESS MYSELF. I AM OKAY
WITH SHOWING MY SKIN. I'M OKAY
WITH SMILING. I'M OKAY WITH
LAUGHING. UM AND I CAN FINALLY
SHOW PEOPLE THAT I AM A BRIGHT
YOUNG, CREATIVE, INTELLIGENT
MIND AND I HAVE POTENTIAL.
THANKS TO THE MENTAL HEALTH
SERVICES THAT CALIFORNIA
PROVIDES. I WANT TO THANK IVAN
AND CARLOS AND AYANNA FOR YOUR
TESTIMONY HERE TODAY. IT'S
IMPORTANT TO SHOW YOUR
VULNERABILITY, BUT WE SEE IT AS
STRENGTH. AND WE KNOW THAT
RESILIENCY THAT'S WITHIN YOU
WILL BE PASSED ON TO OTHER
STUDENTS WHO ARE SEEING YOU IN
THESE POSITIONS SPEAKING YOUR
TRUTH. BECAUSE YOU'RE SPEAKING
FOR SO MANY STUDENTS ACROSS
CALIFORNIA. I WANTED TO MAKE
SURE DO APPRECIATE YOUR TIME.
THANK YOU. WE WILL NEXT HEAR
FROM COLETTI, YOU BOZO. HELLO
GOOD EVENING CHAIR ARAMBULA AND
SIMPLY MEMBERS AND ALSO THANK
YOU SO MUCH FOR THE STUDENTS AND
WHO JUST SPOKE TO THEIR LIVED
EXPERIENCE. MY NAME IS COLECCHIA
BOZO. I AM A SUICIDE ATTEMPT.
SURVIVOR APPEAR SUPPORTER AND
SOMEONE WHO DEEPLY CARES ABOUT
THE AVAILABILITY AND
ACCESSIBILITY OF SELF DETERMINED
VOLUNTARY MENTAL HEALTH CARE FOR
EVERYONE. IN 2012. I MOVED TO
CALIFORNIA ACTUALLY BECAUSE OF
THE MENTAL HEALTH SERVICES ACT
AND THE CONSUMER MOVEMENT. I WAS
SOMEONE WHO CYCLED IN AND OUT OF
HOSPITALS AND EXPERIENCED
TRAUMATIZING CARE DURING FORCED
TREATMENT. AND I THOUGHT I WAS
ALONE, TOO. AND THEN I LEARNED
ABOUT PIERS. PEOPLE WITH LIVED
EXPERIENCE SUPPORTING ONE
ANOTHER, AND I HEARD ABOUT THIS
IMAGE OF STATE LEGISLATION THAT
NOT ONLY HONORED, LIVED,
EXPERIENCE FUNDED, LIVED
EXPERIENCE RECOVERY, INNOVATION
, CULTURAL HUMILITY, AND SO MUCH
MORE AND SO INSPIRED BY THIS
CONSUMER MOVEMENT AND IMAGES
SERI MY MOTHER, MY BIGGEST
SUPPORTER, AND I HACKED UP ALL
OF MY BELONGINGS AND MOVED ME
FROM STONE MOUNTAIN, GEORGIA TO
OAKLAND, CALIFORNIA TO WORK IN
THE MENTAL HEALTH FIELD. I HAVE
FACILITATED IMAGES. S¼ COMMUNITY
PLANNING PROCESSES CONDUCTED
BASE PAR FOR INNOVATION PROGRAMS
AND MUCH MORE, AND I'M REALLY,
REALLY SAD TO BE HERE AT THE
CORNER OF WHAT I BELIEVE IS GOOD
INTENT AND TRULY HARMFUL
CONSEQUENCES. AND IF YOU HEAR
NOTHING ELSE I SAY TODAY I WANT
YOU TO HEAR THREE THINGS ONE
ALWAYS SEE HAS TO BE A SEPARATE,
INDEPENDENT BODY. WE WILL LOSE
THE VOICE AND EXPERTISE HAVE
LIVED EXPERIENCE TO CHANGING THE
TARGET POPULATION OF THE ENTIRE
BEHAVIORAL HEALTH SYSTEM WILL
NEGATIVELY IMPACT THE MENTAL
HEALTH OF THOSE WHO NEED AND
DESERVE UPSTREAM CARE BEFORE
THEY HAVE MORE SEVERE AND ACUTE
MENTAL HEALTH CHALLENGES, AS
LITERALLY JUST DEMONSTRATED BY
THE STUDENTS YOU HEARD AND THREE
WE HAVE TO PRESERVE THE CURRENT
REQUIREMENTS FOR THE LOCAL
FUNDING A P I. COMPONENT OF
IMAGES SAY, WHICH IS ACTUALLY
THE MOST VIABLE FUNDING FOR
REDUCING DISPARITIES THROUGH
FUNDING COMMUNITY TO FIND
EVIDENCE BASED PRACTICES FOR
BIPAC AND LGBTQ, PLUS
COMMUNITIES. SO I WILL SAY IT'S
CALLED THE MENTAL HEALTH
SERVICES OVERSIGHT AND
ACCOUNTABILITY COMMISSION, NOT
THE MENTAL HEALTH SERVICES ACT
OVERSIGHT AND ACCOUNTABILITY
COMMISSION. AND THAT DISTINCTION
IS IMPORTANT BECAUSE THIS BODY
HAS OVERSIGHT ON ALL MIDDLE
SERVICES IN THE STATE, WHICH IS
NEEDED BECAUSE CALIFORNIA DOES
NOT HAVE A DEPARTMENT OF MENTAL
HEALTH. IT'S ALSO IMPORTANT FOR
THOSE OF US WITH EXPERIENCE,
WHICH DOES INCLUDE PEERS AND
FAMILY MEMBERS TO BE ABLE TO
VOICE OUR CONCERNS TO AN
INDEPENDENT BODY. I'LL GIVE YOU
AN EXAMPLE SINCE 2018 AND MORE
URGENTLY IN RESPONSE TO THE
DEVASTATING OUTCOMES THAT THE
PANDEMIC HAS HAD ON COMMUNITIES
OF COLOR IN PARTICULAR AND THE
ONGOING EFFORT TO REDUCE
DISPARITIES COMMUNITY
STAKEHOLDERS HAVE BEEN
ORGANIZING TO HAVE PREVENTION
AND EARLY INTERVENTION, E I.
PRIORITY POPULATIONS INCLUDE TÂM
. WE'RE NOT IN COLLEGE AND
COMMUNITY FIND EVIDENCE BASED
PRACTICES. OCCULT STATE UPS.
THIS ADVOCATING HAPPENED
EVERYWHERE AND ALSO AT THE A. C
AS ALWAYS SEE CREATES SPACE FOR
LIVED EXPERIENCE, NOT ONLY AS
PART OF THEIR LEADERSHIP BUT IN
DIALOGUE WITH THE COMMUNITY. SO
WHAT WAS THE OUTCOME? JUST LAST
WEEK, THE COMMISSION ADOPTED
THOSE TWO ADDITIONAL PRIORITIES
ALSO GIVE YOU ANOTHER EXAMPLE.
PRIOR TO THE SIGNING OF THE
GOVERNOR'S CARE COURT BILL
PEOPLE WITH LIVED EXPERIENCE WHO
MAY NOT BE IN AGREEMENT WITH
CARE COURT ASKED OVER AND OVER
AGAIN TO MEET WITH THE GOVERNOR
AND THE GOVERNOR'S OFFICE TO
DISCUSS CURRENT CERN'S OF COURT
ORDERED TREATMENT, INVOLUNTARY
TREATMENT WITH A NEGATIVE
ASSOCIATIONS WITH BLACK AND
BROWN PEOPLE. PIERS COLLECTIVELY
DID NOT MEET WITH THE GOVERNOR'S
OFFICE AND CARE COURT WAS ST
STEAMROLLED THROUGH RELATIONSHIP
BUILDING REQUIRES COMMUNICATION
AND BI DIRECTIONAL FEEDBACK. AND
HOW CAN WE TRUST THAT THE EC
UNDER THE GOVERNOR WHEN SHORT
LIVED EXPERIENCES ARE HEARD? WE
NEED AN INDEPENDENT BODY TO
LISTEN TO THE EXPERIENCE OF
PEERS AND FAMILY MEMBERS. AND,
YES, FAMILY MEMBERS AND PEERS
CONTINUE TO WRESTLE WITH BIG
CONVERSATIONS, BUT BOTH OF US
NEED TO BE HEARD, REGARDLESS OF
WHO IS DEEMED EASIER TO LISTEN
TO. WE NEED AN INDEPENDENT BODY
THAT HAS OVERSIGHT OVER THE
MENTAL SERVICES OF THE STATE NOT
TO BE UNDER THE GOVERNOR,
BECAUSE, FRANKLY, THAT IS A
CONFLICT OF INTEREST. WE KNOW IN
THAT, YOU SAY IS NOT PERFECT
WHEN WE FIRST STARTED WHEN
COUNTY'S FIRST STARTED WITH THE
IMAGES SAY IT WAS LIKE THE ICING
ON TOP OF THE CAKE, AND NOW IT'S
GROWN TO BE THE ENTIRE CASE AND
COUNTIES. LET'S BE REAL ARE
IMPACTED BY POLITICS. AND, YES,
WE WANT MORE SUPPORT FOR FOLKS
WHO RUN HOUSED, BUT LET'S
ACKNOWLEDGE THAT THE UNHEALTHY
POPULATION IS NOT THE RESULT OF
MENTAL ILLNESS. PEOPLE WITH
MENTAL HEALTH ISSUES ARE BEING
SCAPEGOATED AGAIN FOR ECONOMIC
AND SOCIAL PROBLEMS THAT
PERMEATE OUR SOCIETY. THE
PROBLEM IS LACK OF AFFORDABLE
HOUSING AND POLITICAL WILL NOT
PEOPLE DIAGNOSED WITH MENTAL
ILLNESS. WITH THAT SAID, IT IS
MY UNDERSTANDING THAT A
COMPREHENSIVE MULTI YEAR STUDY
ON THE CALIFORNIA REDUCING
DISPARITIES PROJECT WAS
COMPLETED AND SHOWED THAT SEA
DEPTHS ARE NOT ONLY EFFECTIVE
BUT HAVING IMPRESSIVE RETURN ON
INVESTMENT. SO ONE OF THE
UNINTENDED CONSEQUENCES OF
CHANGING THE PRIORITY
POPULATIONS TO FOCUS ON WHO IS
DEEMED THE MOST VULNERABLE AND
MOST RISK IS THAT WE ACTUALLY
DEEP PRIORITIZED UPSTREAM
PREVENTION AND EARLY
INTERVENTION SOLUTIONS. THAT
LARGELY FUND CULTURALLY SPECIFIC
AND RESPONSIVE PROGRAMMING. OUR
CHILDREN AND YOUTH PROGRAMS AND
OUR LGBTQ PLUS PROGRAMS. WE HAVE
TO REMEMBER TO SEE MENTAL HEALTH
AS A CONTINUUM THAT NEEDS MORE
THAN ONE TIME FUNDING EFFORTS,
AND WE NEED UPSTREAM SUPPORT TO
ENSURE THAT WE INTEGRATE
INTERRUPT INCREASE MENTAL HEALTH
NEEDS. MY COLLEAGUE CARES,
MYRICK SAYS. IT'S LIKE WE'RE
CONTINUALLY MOVING DECKCHAIRS ON
THE TITANIC. BUT WE'RE NOT
ADDRESSING THE ICEBERG. WE ARE
NOT BUILDING CAPACITY OR LOOKING
AT OUR STRUCTURAL EFFORTS. THIS
WILL HAVE AN UNINTENDED
CONSEQUENCE OF FARM WHICH I'M
SURE WHAT HE WANTS. AND THAT IS
NOT THE INTENT. THANK YOU SO
MUCH FOR LISTENING. THANK YOU.
NEXT TIME. WE'LL HAVE ROBERT
HARRIS COME FORWARD, FOLLOWED BY
TYLER RANDY. AND THEN TOBY. YOU
IN.
ROBERT HARRIS WITH THE C I U
CALIFORNIA ON BEHALF OF OUR
700,000 MEMBERS. WHO PAID ABOUT
A THIRD OF WHAT IT COSTS TO PASS
PROP 63 JUST TO BE CLEAR. SO WE
HAVE AN INTEREST IN MAKING SURE
IT WORKS, AND IT CONTINUES TO
WORK. WE DON'T HAVE A FORMAL
POSITION YET THE MOVEMENT BUT
WHEN I TALKED TO OUR MEMBER OF
THE OVERSIGHT PANEL YESTERDAY,
SHE DOESN'T WANT IT SO BUT WE
DON'T HAVE A FORMAL POSITION SO
THERE I WAS SURPRISED THAT
THEY'RE ALL WAS ACTUALLY
STRAIGHTFORWARD THAT IT WAS A
POLITICAL REASON. THAT THERE WAS
AN OVERSIGHT COMMISSION CREATED
BECAUSE IT WOULDN'T HAVE PASSED.
THE POLLING SHOWED. WHEN WE'RE
DRAFTING INITIATIVE, IT WOULDN'T
HAVE PASSED WITHOUT THE
OVERSIGHT COMMISSION. AND SO.
AND THAT'S WHAT CHAIRMAN TANG
WAS SAYING, TOO. IT'S LIKE
PEOPLE DON'T TRUST ELECTED
PEOPLE. I'M JUST TELLING YOU SO
. SO OKAY. OKAY SO, YEAH. SO NOW
NOW THEY PUBLIC MINIMAL CHANGE.
YOU KNOW, AND THEY MIGHT BE ABLE
TO PASS THIS REVISION. WHICH
WITH THE OVERSIGHT COMMISSION
GONE, BUT THEY MIGHT NOT BE ABLE
TO AND IT'S TRUE. WE HAVE A
FRAGMENTED SYSTEM WITH
CONFLICTING RULES, REGULATIONS,
OVERSIGHT AND COMPLEX
ADMINISTRATIVE FUNCTIONS. AROUND
THE SYSTEM OF CARE. AND SO WE
WASTE A LOT OF MONEY. SOMETIMES
JUSTIN DUPLICATIVE REPORTING.
BUT. WE SHOULD REMEMBER THAT
WHATEVER CHANGES ARE MADE. ARE
FOR THE FUTURE FOR TODAY AND THE
FUTURE OF PEOPLE. AND IT'S NOT
FOR WHO'S ON THE COMMISSION. NOW
IT'S NOT WHO THEY APPOINTED.
IT'S NOT FOR THE GOVERNOR.
THEY'LL ALL BE GONE. BUT
HOPEFULLY IF WE DO THIS, RIGHT
MHM ESSAY WILL LIVE BEYOND ALL
OF US, AND THAT'S OUR HOPE, AND
THAT'S HARD GOAL AND THAT'S WHAT
WE INTEND TO MAKE SURE IT
HAPPENS. THANK YOU. NEXT. WE
HAVE TYLER WINDY. GOOD EVENING
CARE ARAMBULA AND MEMBERS TYLER
WENDY WITH THE CALIFORNIA
ALLIANCE OF CHILD AND FAMILY
SERVICES, THE CALIFORNIA
ALLIANCE REPRESENTS OVER 160
DIFFERENT NONPROFIT COMMUNITY
BASED ORGANIZATIONS PROVIDING
SERVICES, THE CHILDREN, YOUTH
AND FAMILIES ACROSS MENTAL
HEALTH, CHILD WELFARE, JUVENILE
JUSTICE AND EDUCATION SYSTEMS.
REMEMBER AGENCIES ARE SERVING
INDIVIDUALS IN MARGINALIZED
COMMUNITIES THAT ARE HEAVILY
RELIANT ON SERVICES FUNDED BY
THE MENTAL HEALTH SERVICES ACT.
THE ALLIANCE VIEWS THE MENTAL
HEALTH SERVICES OVERSIGHT AND
ACCOUNTABILITY COMMISSION AS A
VITAL PARTNER AND OVERSIGHT
ENTITY OVERSEEING THE
IMPLEMENTATION OF THE MHS. A THE
COMMISSION PROVIDES OVERSIGHT ON
FISCAL TRANSPARENCY WITHIN THE
ACT, INCLUDING IF COUNTIES ARE
MEETING REQUIRED SPENDING
ALLOCATIONS, INCLUDING WITHIN
COMPONENTS, SUCH AS THE
REQUIREMENT TO SPEND A MAJORITY.
OF THE EYE FUNDING ON CHILDREN
AND YOUTH, 0 TO 25 ALSO RELEASES
REPORTS AND INITIATIVES
EXPLORING PREVENTION AND EARLY
INTERVENTION. CRIMINAL JUSTICE.
UM SCHOOL MENTAL HEALTH CRISIS
SERVICES FOR CHILDREN AND YOUNG
ADULTS AND SUICIDE PREVENTION AS
WELL AS APPROVES COUNTY
INNOVATION PLANS. THE
COMMISSION'S WORK ON SUICIDE
PREVENTION SET THE GROUNDWORK
FOR US TO WORK TOGETHER AND
SPONSORED LEGISLATION WITH
ASSEMBLYMEMBER'S RAMOS TO STAND
UP THE STATE'S FIRST OFFICE OF
SUICIDE PREVENTION AT THE CROWD.
WE FOUND A DEPARTMENT OF PUBLIC
HEALTH THE WORK OF THE
COMMISSION UPLIFTS SPECIFIC
NEEDS OF COMMUNITIES AND THE
INDEPENDENCE OF THE COMMISSION
ALLOWS THEM TO SPEAK WITH A FREE
VOICE AND ADVISE BOTH THE
LEGISLATURE AND ADMINISTRATION
ON ISSUES RELATED TO THE MHS S¼.
WE BELIEVE THAT THE WORK OF THE
COMMISSION HAS MADE SIGNIFICANT
PART POSITIVE PROGRESS TO OUR
MENTAL HEALTH SYSTEM IN
CALIFORNIA. THE VALUE OF THE
COMMISSION'S INDEPENDENCE IN
IMPORTANCE OF ITS OVERSIGHT
FUNCTION CANNOT BE OVERSTATED IS
INVALUABLE FOR THE FAMILIES AND
OUR CLIENTS THAT ARE MEMBERS
SERVE. WE RESPECTFULLY REQUEST
THAT THE LEGISLATURE REJECT THE
ADMINISTRATION'S PROPOSAL TO
MOVE THE COMMISSION UNDER THE
ADMINISTRATION AS AN ADVISORY
BODY, AND UM, AND INSTEAD TO
PRESERVE ITS CAPACITY AND
ABILITY FOR THE COMMISSION TO DO
OVERSIGHT AND TO HIGHLIGHT AREAS
THAT REQUIRE ATTENTION WITHIN
OUR MENTAL HEALTH SYSTEM AND NOT
BE PRESERVED. THANK YOU FOR THE
OPPORTUNITY TO SPEAK TODAY AND
HAPPY TO ANSWER ANY QUESTIONS.
DR EWING. THANK YOU, MR CHAIR
AND MEMBERS JUST IN LIGHT OF THE
HOUR. JUST REALLY KEEP MY
COMMENTS VERY BRIEF AND THEN
AVAILABLE TO ANSWER ANY
QUESTIONS. UM YOU KNOW, AS I AS
I STATED IN THAT IN THE WRITTEN
HAND OUT, THE ORIGIN STORY OF
THE IMAGES SAY IS TWOFOLD. IT'S
WELL, IT WASN'T QUITE SAID IT
THIS WAY. BUT IT'S REALLY BEEN
TO FOLD. IT IS AS DARRELL
STEINBERG SAID MEMBER TEAM
COMMENTED. IS THAT WHEN YOU PUT
A MEASURE ON THE BALLOT WITH THE
TAX INCREASE, YOU GET A 15 TO
20% BUMP IN SUPPORT, BECAUSE YOU
KNOW TAXPAYERS AND VOTERS DO
HAVE AN EXPECTATION THERE THAT
THERE WILL BE A SECOND SET OF
EYES PAYING ATTENTION, BUT IT
WAS ALSO TO HAVE A PERSISTENT
VOICE. ON THIS NEED TO
CONSTANTLY PUSH, PARTICULARLY IN
THE BROAD AREAS OF THE MHS A, AS
EVIDENCED BY THE SHERIFF AND THE
SUPERINTENDENT IT YOU KNOW. THE
MENTAL HEALTH SYSTEM ENDED THE
MHS A REALLY RECOGNIZES THE
INTERSECTION BETWEEN CRIMINAL
JUSTICE, HOUSING, EDUCATION,
CHILD WELFARE EMPLOYMENT. THOSE
ARE ALL OUTCOMES THAT ARE
IDENTIFIED AS KEY PRIORITIES
UNDER THE P E. I SECTION AND WE
ARE CURRENTLY PARTNERING WITH
AND HOPE TO CONTINUE TO PARTNER
WITH THE BOARD OF STATE
COMMUNITY CORRECTIONS, THE
COUNCIL AND CRIMINAL JUSTICE AND
BEHAVIORAL HEALTH DEPARTMENT OF
EDUCATION DEPARTMENT OF AGING.
HOUSING COMMUNITY DEVELOPMENT
DEPARTMENT OF PUBLIC HEALTH, TH
CS AND C. D S S AND YOU KNOW ONE
OF THE QUESTIONS WE HAVE FOR THE
ADMINISTRATION AS THEY THINK
ABOUT THIS ISSUE, PARTICULARLY
THE IDEA OF MOVING THE
COMMISSION UNDER AGENCY IS
EIGHT. THE HEALTH AND HUMAN
SERVICES AGENCY DOESN'T ACTUALLY
WORK IN SOME OF THOSE AREAS AND
SO WE'RE MORE THAN HAPPY TO
CONTINUE TO STRENGTHEN
OPPORTUNITIES TO PARTNER WITH
THE ADMINISTRATION. WE WELCOME
THAT AND AS, AS EVIDENCED BY THE
COMMENTS EARLIER, WE DO MEET
REGULARLY WITH A NUMBER OF
OFFICIALS FROM FROM THE
ADMINISTRATION. BUT WE ALSO
WOULD QUESTION IF IT IS
APPROPRIATE TO HOUSE THE
COMMISSION UNDER HEALTH AND
HUMAN SERVICES AGENCY,
RECOGNIZING THAT THE PERSPECTIVE
THAT THE COMMISSION BRINGS AS
EVIDENCE SIMPLY BY ITS MEMBERS.
IS BROADER THAN THAT, THEN THE
PURVIEW OF AGENCY SO THANK YOU
FOR THE CHANCE TO JOIN YOU
AGAIN. AND THANK YOU SO MUCH FOR
ALLOWING US TO SUPPORT THE
STUDENTS TO COME AND TALK ABOUT
THE IMPORTANCE OF THE MENTAL
HEALTH. STUDENT SERVICES ACT AND
THE COMMISSION'S WORK ON SCHOOL
MENTAL HEALTH BECAUSE THAT HAS
AS MANY OF YOU KNOW THAT HAS NOT
BEEN A TRADITIONAL AREA OF STATE
INVESTMENT IN THE PAST, AND
WHILE THIS ADMINISTRATION HAS
JUST MADE HISTORIC INVESTMENTS,
UM WE HOPE THAT CONTINUES IN THE
FUTURE AND WE WOULD WANT TO BE
IN A POSITION TO ADVOCATE FOR
THAT TO CONTINUE UNDER FUTURE
ADMINISTRATIONS IN IN THE EVENT
THAT THAT IS NOT A PRIORITY.
THANK YOU AGAIN. DEPARTMENT OF
FINANCE. DIANA VASQUEZ, THE
DEPARTMENT OF FINANCE NOTHING TO
VÚI.
YES I WILL. OWENS L A L SO, UM,
TO THE CHAIRS. WANNA KIND OF SET
THE TABLE, SO WE HAVE A NUMBER
OF INITIAL COMMENTS THROUGH THE
REMAINDER OF THE ISSUE ITEMS AS
IT RELATES TO THE MARS ATION
EFFORT, AND WE'RE HAPPY TO SHARE
THOSE TODAY. I JUST WANT TO
CLARIFY. THESE ARE ALL INITIAL
COMMENTS. AS YOU KNOW, THE
ACTUAL PROPOSAL HAS NOT BEEN PUT
FORWARD IN LANGUAGE. SO UM ARE
ANY CONCERNS WE RAISE OR
COMMENTS WILL CHANGE OVER TIME.
UM ALSO ONE THING TO NOTE JUST
FILL LEGISLATURE AND THE
COMMISSION OR, UM, THE COMMITTEE
AS I'M SURE YOU'RE AWARE, UH, TO
THE DEGREE THAT SOME OF THIS
PROPOSAL WILL BE PUT ON THE
NOVEMBER 2024 BALLOT. UM THERE
IS TIME FOR THOUGHTFUL
DELIBERATION AND ANALYSIS ON THE
PROPOSAL. THIS IS NOT SOMETHING
THAT NEEDS TO BE DONE
NECESSARILY, IMMEDIATELY. SO WE
JUST LIKE TO EMPHASIZE THAT AND
WE'RE HAPPY TO WORK WITH THE
COMMITTEE AS MORE INFORMATION IS
FORTHCOMING. AS IT RELATES TO
THE TRANSFER THE PROPOSED
TRANSFER OF THE COMMISSION TO
AGENCY. YOU'VE HEARD A LOT TODAY
FROM A NUMBER OF SPEAKERS ON THE
TRADE OFFS AND WE WOULD LIKE TO
HIGHLIGHT THOSE TRADE OFFS. UM,
ON ONE HAND, UM MOVING THEIR
COMMISSION UNDER AGENCY. COULD
HELP BETTER COORDINATE THE
STATE'S ADMINISTRATION OF ITS
NUMEROUS BEHAVIORAL HEALTH
INITIATIVES, ESPECIALLY THE
MAJOR INVESTMENTS. THAT HAPPENED
IN RECENT YEARS. UM HOWEVER, THE
COMMISSION'S EXISTING STRUCTURE
, UM WE ACKNOWLEDGE VERY MUCH
ENABLES THE COMMISSION TO HAVE A
STRONG INDEPENDENT ROLE IN BOTH
OVERSIGHT POLICY AND RESEARCH
AND ADVISEMENT TO THE
LEGISLATURE. AND THE
ADMINISTRATION. UM. THERE ARE
ALTERNATIVES TO THE
ADMINISTRATION'S CURRENT
PROPOSAL, WHICH IS TO MOVE THE
COMMISSION FULLY AS A ADVISORY
COMMITTEE UNDER THE AGENCY, AS
WELL AS THE CURRENT STRUCTURE
THAT THE LEGISLATURE COULD
CONSIDER OF AN EXAMPLE OF THIS
WOULD BE THE ENERGY COMMISSION
UNDER THE NATURAL RESOURCES
AGENCY. WHERE THE UM COMMISSION
WOULD STILL HAVE INDEPENDENCE
FOR ITS MEMBERS FOR ITS, UH FOR
THE COMMISSION MEMBERSHIP WHILE
STILL HOPEFULLY BEING WILL HAVE
BETTER COORDINATION WITH THE
ADMINISTRATION. UM THAT BEING
SAID WITH THE PROPOSAL AS IT'S
CURRENTLY STRUCTURED, UM WE
WOULD THINK THE LEGISLATURE WILL
WANT TO ASK THE MINISTRATIONS
FOR TO PROVIDE MORE INFORMATION
ON A NUMBER OF TOPICS, FOR
EXAMPLE. WE WOULD RECOMMEND THE
LEGISLATURE ASK HOW THE PROPOSAL
WOULD ACTUALLY IMPROVE
COORDINATION OF MENTAL HEALTH
EFFORTS WITH BOTH COUNTIES AND
STAKEHOLDERS. AND WHAT ARE THE
SPECIFIC OUTCOMES THAT THE
ADMINISTRATION HOPES TO
ACCOMPLISH BY TRANSITIONING THE
COMMISSION UNDER AGENCY.
ADDITIONALLY WE WOULD SEEK MORE
INFORMATION ON HOW THE TRANSFER
WOULD ACTUALLY IMPACT THE
COMMISSION'S ONGOING AND CURRENT
EFFORTS, PARTICULARLY IN TERMS
OF STAFFING, RESEARCH AND
DEVELOPMENT, DATA COLLECTION AND
SHARING AND WHAT THE ACTUAL
RESULT OF THAT TRANSFER WOULD BE
ON THOSE EFFORTS. HAPPY TO
ANSWER ANY MORE QUESTIONS. THANK
YOU. I WILL BRING IT UP TO THE
DÍAS FOR MEMBERS. QUESTIONS WE
WILL BEGIN WITH DR JACKSON. I
MAY ASK TO CREATE SOME SPACE FOR
MISS WELCH AND MR GENDER COME
FORWARD IF THAT'S OKAY. MR EWING
UNDERSTAND THERE. OKAY? DR
JACKSON. THANK YOU VERY MUCH, MR
SHERIFF. AND THANK YOU FOR
EVERYONE WHO'S CONTRIBUTED TO
THIS ITEM. PARTICULARLY OUR
YOUNG FOLKS, WE WANT TO THANK
YOU VERY MUCH FOR UH, YOUR
INSIGHTFUL WORDS. UM AND GIVING
US AN OPPORTUNITY TO UNDERSTAND
THAT THE THINGS THAT WE TALK
ABOUT REALLY AFFECTS REAL
PEOPLE. UM AND THINGS THAT
HAPPEN ON THE GROUND. UM AND
THERE IS NO DOUBT THAT YOU HAVE
PROBABLY HAD TO, UM YOU'VE BEEN
UP FOR A WHILE. AND UM, JUST
KNOW THAT THE TIME THAT YOU PUT
IN TODAY IS ABSOLUTELY WORTH IT.
I WOULD JUST SAY THAT, UM IT'S
IMPORTANT THAT BECAUSE THE THIS
ITEM. AND THE WAY WE'VE KIND OF
MADE SURE THAT WE'VE DELINEATE
THESE BY ISSUES. SO THAT WE ARE
NOT. ONE ISSUE IS NOT SPILLING
INTO THE OTHER. IN TERMS OF THE
MENTAL HEALTH SERVICES ACT. AND
THE COMMISSION. TWO SEPARATE
THINGS. AND I WOULD AGREE. THAT,
UM. THE IMPORTANCE OF KEEPING
THIS COMMISSION. UM INDEPENDENT,
I THINK IS VERY IMPORTANT. FOR A
FEW THINGS. UM, AS SOMEONE WHO
ACTUALLY ENJOYS THE SUBJECT
MATTER. MY ABILITY TO HAVE FRANK
AND OPEN CONVERSATIONS IS
IMPORTANT TO ME. AND I THINK
THAT, UM, BEING SOMEONE TO IS
APPOINTED BY THE GOVERNOR. THEIR
JOB IS NOT TO BE FRANK AND OPEN.
JUST THE NATURE OF THINGS. UM
AND SO I THINK THAT IT'S A
PUBLIC GOOD. FOR THIS COMMISSION
TO, UM BE INDEPENDENT. UM AGAIN
. HOW DO WE ENSURE THAT WE
STRIKE A GREATER BALANCE IN
TERMS OF MAKING SURE THAT THE
STATE DOES HAVE A SINGLE
COMPREHENSIVE AND STRATEGIC
MENTAL HEALTH PLAN. AND EVERYONE
IS MOVING IN THE SAME DIRECTION.
IT'S ALSO ESSENTIAL SO HOW DO WE
MAKE SURE THAT WE DO THAT IN A
WAY? AH THAT SATISFIES BOTH. UM
AND SO I WOULD JUST URGE IS TO
CONTINUE TO HAVE THESE
DISCUSSIONS. UM BUT TO ALSO
ENSURE THAT, UH, LIKE I SAID, WE
DON'T CONFUSE THE TWO THIS IS A
. COMPLICATED ISSUE, BUT THERE
IS NO DOUBT THAT. THE MENTAL
HEALTH SERVICES ACT WAS CREATED
IN A DIFFERENT TIME. POPULATIONS
ARE DIFFERENT. THE NEEDS HAVE
GROWN EXPONENTIALLY. UM AND WE
DEFINITELY NEED TO MAKE SURE
THAT UH UM EVERY DOLLAR IS USED
FOR WHAT IS BEST FOR THIS MOMENT
IN TIME. AND SO I LOOK FORWARD
TO THE CONTINUED CONVERSATIONS.
THANK YOU. THANK YOU AND I WON'T
BELABOR THE POINT. I THINK YOU
HAVE HEARD THE. INTEREST OF THE
LEGISLATURE AND EMBRACING THIS
PORTION OF THE PROPOSAL THAT I
LIKE TO MAKE SURE WE AT LEAST
ASK THE ALEJO'S QUESTIONS ABOUT
WHICH OUTCOMES WE WOULD EXPECT
TO SEE IMPROVED IF WE WERE TO DO
THIS PROPOSAL. I DILIGENTLY
WROTE DOWN HIS QUESTIONS BECAUSE
I DO THINK WE OWE YOU A MORE
THOROUGH RESPONSE TO BE FRANK
THAN WHAT I CAN SHARE WITH YOU
AT THIS VERY MOMENT. BUT WHAT?
BUT WHAT I CAN'T SAY IS THAT, UM
I THINK THAT WE DO BOTH AT THE
AGENCY LEVEL AS WELL AS OUR
DEPARTMENTS. WE REALLY DO.
LISTEN TO THE LEGISLATURE'S
PRIORITIES. TÔI BEEN DOING THIS
WORK FOR ALMOST 25 YEARS, AND
IT'S BEEN REALLY HELPFUL IN THE
LAST THREE YEARS TO REALLY THINK
ABOUT HAVING A SHARED AGENDA. UM
AND SO I THINK ONE OF THE ONE OF
THE OUTCOMES THAT I WOULD HOPE
TO SEE IS I THINK WE CAN DO MORE
TOGETHER, YOU KNOW, POTENTIALLY
FASTER WHEN WE HAVE A SHARED
AGENDA, AND WE'RE ALL WORKING
TOGETHER. SO UM, I KNOW THAT
THAT'S VERY BROAD. AND UH AND
NOT SUPER SPECIFIC. I THINK WE
WOULD LIKE THE OPPORTUNITY TO BE
ABLE TO DO SOME HOMEWORK TO COME
BACK AND GIVE YOU SPECIFICS, BUT
I THINK, UM, THE THERE IS SO
MUCH WORK GOING ON. UM YOU GUYS
KNOW THAT I'VE BEEN HEARING
OTHER HEARINGS TALKING ABOUT ALL
THE DIFFERENT THINGS GOING ON,
AND I REALLY WANT US TO BE
COORDINATED. WE WANT EVERYONE TO
COORDINATE AND FOCUS ON DOING
GREAT WORK WITH ALL THE
OPPORTUNITIES THAT WE HAVE TWO
AHEAD OF US. SO THAT WOULD BE
THE ONE MAJOR OUTCOME THAT I
WOULD WANT FOCUSED, WORKING
TOGETHER APPROACH TO GET GOOD
OUTCOMES FOR CALIFORNIANS. IF I
MAY, UM I WANT TO THANK THE L.
A. OH, FOR BRINGING UP DIFFERENT
EXAMPLES. I THINK THAT THOSE CAN
BE PART OF THE DISCUSSION. I
THINK I'M ALSO HEARING TWO
DIFFERENT, UH, PRIORITIES, ONE
IN THE DRIVING TOWARDS GOALS
THAT WE CAN ALL ACHIEVE, AND
THEN THE FIDUCIARY OVERSIGHT AND
YOU KNOW, IN STATUTE DEPARTMENT
OF HEALTH CARE SERVICES IS THE
ADMINISTRATOR OF THE OF THE
IMAGES A FUND. SO HOW DO WE
SQUARE THAT WITH WHAT THE ROLE
OF THE IS RIGHT. AND SO I THINK
THAT THERE'S A LOT OF
CONVERSATIONS THAT SHOULD BE HAD
THERE WHEN WE HAVE SORT OF A BY
STATUTE. SPLIT FUNCTION ALREADY
, RIGHT? HOW DO WE BRIDGE THOSE
TWO SO THAT WE'RE GETTING BOTH
THE FISCAL OVERSIGHT PIECES OF
IT AND THE, UM YOU KNOW,
OVERSIGHT THAT THE POLICY BROAD
AGENDA PIECES TO IT, BUT HERE
ALL OF THE COMMON STARTS
FRUSTRATIONS. HAVE OUR
COMMITMENT TO CONTINUE THE
CONVERSATION. I WILL ELEVATE
WHILE SITTING IN THIS CHAIR.
I'VE TRIED HARD EVERY CHANCE I
CAN TO MAKE SURE THE PUBLIC
PARTICIPATES IN IMPROVING THE
PROCESS, AND IT ISN'T ALWAYS
EASY TO HEAR THE CRITIQUES
TOWARDS PROPOSALS AND YET IT'S
AN IMPORTANT PART OF THE PROCESS
FOR US TO GET IT DONE, RIGHT?
AND I GUESS I'M TRYING TO
UNDERSTAND WHY WE WOULD WANT TO
DECREASE THAT PARTICIPATION
SINCE IT SEEMS THAT A NUMBER OF
PEERS AND ORGANIZATIONS FEEL
MORE COMFORTABLE COMING TO THE
MHS. ALWAYS AT LEAST THAT'S
ANECDOTALLY WHAT WE'RE RECEIVING
THAT I'M TRYING TO UNDERSTAND
WHY WE WOULD TAKE THAT AWAY AS I
THINK IT'S A VITAL CHECK AND
BALANCE FOR US THERE. THERE'S NO
INTENT TO TAKE THAT AWAY AND MY
AND MY COMMENTS I MENTIONED MANY
OF THE DUTIES OF THE A. C AS
THEY ARE TODAY WOULD REMAIN
INTACT AND THAT IS ONE OF THE
THINGS THAT THEY DO. THAT'S HIGH
VALUE. UM AND EXTREMELY HELPFUL.
I DID HEAR SOME OF THE COMMENTS
THAT SOME OF THE OTHER PAIRS
MADE THAT IS A RELATED TO THIS
PARTICULAR TOPIC, AND I THINK
WE'LL FOLLOW UP ON ON THAT AS
WELL. UM FOR DR EWING, IF I CAN
I'VE LOVED THE WORK THAT YOU'VE
DONE FOR THE MENTAL HEALTH
STUDENT SERVICES ACT. WE SEE THE
BENEFIT HERE WITH STUDENTS WHO
HAVE RECEIVED THAT THAT I'D LIKE
TO UNDERSTAND. DO YOU THINK THAT
PROPOSAL HAPPENS IF YOU HAVE
INDEPENDENCE OR IF YOU DON'T
HAVE INDEPENDENCE? FROM THE
ADMINISTRATION. DO YOU THINK
THAT GOES FORWARD OR DOES IT
ONLY OCCURRED BECAUSE OF YOUR
CONNECTION TO COMMUNITY AND
HEARING FROM THOSE WHO ARE AT
SCHOOLS ABOUT THE DIRE NEED THAT
OUR STUDENTS ARE FACING. THANK
YOU, MR CHAIR. UM I MEAN, AS WE
THOUGHT ABOUT THIS, AND WE'VE
ACTUALLY HAD CONVERSATIONS AMONG
COMMISSIONERS, AND I THINK THIS
WILL BE PART OF OUR NEW
STRATEGIC PLANNING PROCESS,
WHICH WERE UNDERTAKING THIS YEAR
IS THERE'S SORT OF A COUPLE OF
MODELS HERE. ONE IS THAT THE
COMMISSION CONTINUES TO HAVE THE
SORT OF PORTFOLIO THAT IT HAS
TODAY. AND IT IS APART FROM SOME
OF THE OTHER ASPECTS OF THE
ADMINISTRATION AND THERE'S SOME
. THERE'S A LOT OF VALUE IN THAT
BECAUSE WE'RE SMALL AND WE CAN
BE DYNAMIC AND MOVE QUICKLY,
RIGHT. BUT THE DOWNSIDE IS, I
THINK WHAT THE ADMINISTRATION IS
POINTING OUT IN TERMS OF THE
CONNECTEDNESS AND SO ONE EXAMPLE
IS THE WORK THAT WE DID ON
SUICIDE PREVENTION WHERE WITH
THIS SUBCOMMITTEE REALLY PUSHED
A PRIOR ADMINISTRATION THAT WAS
HESITANT. AND SO UPON THE
DIRECTION OF THE LEGISLATURE AND
THE GOVERNOR THAT WE UNDERTOOK
THE PROCESS OF DRAFTING A
STRATEGIC PLAN, WHICH WAS THEN
HANDED OVER TO IN COLLABORATION
WITH THE DEPARTMENT OF PUBLIC
HEALTH RESULTED IN THE
ESTABLISHMENT OF THE OPPOSITE
SUICIDE PREVENTION. SO THERE'S
AN EXAMPLE OF STRONG
CONNECTEDNESS WHERE IT WAS
IMPORTANT FOR THE COMMISSION TO
HAVE AN INDEPENDENT VOICE TO BE
ABLE TO MOVE OUTSIDE OF THE
DOMAIN OF WHAT GOVERNOR WAS
WILLING TO DO AT THAT TIME AND
TO ACTUALLY HAVE THAT STRONG
RELATIONSHIP SO THAT IT MADE
MORE SENSE TO PUT THAT OFFICE
WITHIN THE DEPARTMENT OF PUBLIC
HEALTH AND WITHIN THE COMMISSION
ITSELF. ON SCHOOL. MENTAL HEALTH
, YOU KNOW THAT WE HAVE ASKED
THE QUESTION OF WHO OWNS SCHOOL
MENTAL HEALTH MOVING FORWARD,
PARTICULARLY GIVEN THE
CONSTITUTIONAL SEPARATION
BETWEEN OUR DEPARTMENT OF
EDUCATION RUN BY A
SUPERINTENDENT AND OUR
DEPARTMENT OF HEALTH CARE
SERVICES THAT IS UNDER THE
GOVERNOR. UM, I DON'T THINK IT
IS A GOOD IDEA TO HAVE SCHOOL
MENTAL HEALTH OWNED SO TO SPEAK
BY THE COMMISSION BECAUSE WE
DON'T HAVE THE CAPACITY. TO
MANAGE AND GROW THAT SPACE THE
IN A WAY THAT IS COMPARABLE TO
THAT THE ADMINISTRATION, AS
EVIDENCED BY THE CHALLENGES
BEHAVIOR HEALTH INITIATIVE, BUT
THAT DOESN'T MEAN THAT THERE
SHOULD NOT BE A ROLE FOR THE
COMMISSION TO CONTINUE TO PUSH
IN THOSE SPACES THAT ARE NOT
BEING ADDRESSED WITHIN SCHOOL.
MENTAL HEALTH PUSH. THERE YOU GO
. THAT'S RIGHT. SO I THINK YOU
KNOW IT'S A VERY VALID
CONVERSATION TO ASK THIS
QUESTION ABOUT HOW CAN WE? HOW
CAN THE COMMISSION BE EFFECTIVE
AT DOING THINGS? THAT THE
ADMINISTRATION ISN'T DOING AND
HOW CAN WE NOT TRY TO DO THE
THINGS THAT THE ADMINISTRATION
REALLY NEEDS TO DO? AND THAT IS
A DYNAMIC? UH TOPIC RIGHT?
BECAUSE WHAT WE KNOW IT NEEDS TO
BE THE FOCUS OF SCHOOL. MENTAL
HEALTH TODAY MAY NOT BE THE
OPPORTUNITY THAT WE'RE LOOKING
FOR TOMORROW. RIGHT UM, YOU KNOW
, FIVE YEARS AGO, WE ADOPTED A
WHITE PAPER CALLING FOR PUBLIC
INVESTMENT IN DIGITAL MENTAL
HEALTH STRATEGIES. RECOGNIZING
THAT THIS WAS TAKING OFF IN THE
PRIVATE SECTOR, BUT WE DID NOT
WANT TO SUBSCRIPTION BASED,
MEANING A FEE BASED EAST
INDIVIDUAL FEE BASED MODEL FOR
DIGITAL MENTAL HEALTH BECAUSE WE
KNEW THAT WOULD LEAVE PEOPLE WHO
CANNOT AFFORD THAT FEE. RIGHT
RURAL PEOPLE, PEOPLE OF COLOR.
WE KNEW THAT THAT WOULD NOT BE
WHERE THE COMMERCIAL SECTOR
WOULD START. AND SO AND SO WE
ADOPTED A PLATFORM THAT SAID, WE
HAVE TO EMBRACE DIGITAL MENTAL
HEALTH AND, IN FACT, IN
PARTNERSHIP WITH THE HCS, WE
WORK TO ACTUALLY GET FEMA TO
FUND. SUPPORTS THROUGH SCHOOLS.
AND SO WHAT YOU SEE IS CAL HOPE
TODAY, LED BY THE ADMINISTRATION
ACTUALLY WAS BORN OUT OF THESE
EARLY EARLY CONVERSATIONS
BECAUSE WE WEREN'T CONSTRAINED
BY HAVING TO RUN A LARGE
BUREAUCRACY AND A SYSTEM. IT
ALLOWED US TO SORT OF LOOK
AROUND THE CORNER. SO I BELIEVE
THAT THAT THE STATE NEEDS TO
FIGURE OUT HOW IT CAN SUSTAIN
THE SCHOOL MENTAL HEALTH
INITIATIVE. CONSISTENT WITH THE
THREE, YOU KNOW, INCREDIBLY
COURAGEOUS VOICES THAT YOU HEARD
TOO. DAY. BUT ALSO BE THINKING
ABOUT HOW CAN WE CONTINUE TO DO
BETTER, AND THAT'S WHAT WE'RE
GOOD AT. OKAY? APPRECIATE IT
VERY MUCH THIS ENTIRE PANEL. WE
WILL NOW MOVE ON TO ISSUE 17.
ISSUE 17 IS ON THE MENTAL HEALTH
SERVICES ACT REFORM. WE WILL
BEGIN WITH DIRECTOR BOSS
WHENEVER YOU ARE READY. GOOD
AFTERNOON AGAIN, UH, MICHELLE
BOSS, DIRECTOR OF THE DEPARTMENT
OF HEALTH CARE SERVICES SINCE
2019, THE ADMINISTRATION AND THE
LEGISLATURE HAVE EMBARKED ON
MASSIVE INVESTMENTS AND POLICY
REFORMS TO RE ENVISION HOW THE
STATE TREATS MENTAL HEALTH AND
SUBSTANCE USE DISORDER SERVICES
. WE'VE INVESTED MORE THAN 10
BILLION YEARS, YOU'VE HEARD OVER
THE LAST FEW HEARINGS OF
INVESTMENTS. CHILDREN NEED
BEHAVIOR HEALTH INITIATIVE, CAL
AIM CARE ACT, THE EXPANSION OF
THE BEHAVIOR HEALTH CONTINUUM
INFRASTRUCTURE PROGRAM. UM, AND
THIS THIS INITIATIVE BUILDS UPON
WHAT WE'VE ALREADY PUT IN PLACE
AND CONTINUES THE TRANSFORMATION
ON HEALTH. CALIFORNIA TREATS
MENTAL HEALTH AND SUBSTANCE USE
DISORDERS. ONE OF THE KEY
INITIATIVES ARE KEY ELEMENTS OF
THIS INITIATIVE IS THE PROPOSAL
TO MODERNIZE THE MENTAL HEALTH
SERVICES ACT TODAY. IMAGES S¼
FUNDS 30% OF THE STATE'S MENTAL
HEALTH SYSTEM, BUT THE IMAGES
SAY HAS NEVER UNDERGONE A FULL
SCALE REFORM SINCE ITS INITIAL
PASSING IN 2004, THE AFFORDABLE
CARE ACT AND PARITY LAWS HAVE
SIGNIFICANTLY SHIFTED THE
LANDSCAPE AND NOW IS THE TIME TO
MODERNIZE THEM. HSCEI TO ACCOUNT
FOR EXPANDED COVERAGE UNDER
MEDICAL THE GOVERNOR'S PROPOSAL
INCLUDES SOME, UM REFORMS,
SPECIFICALLY REQUIRING COUNTIES
TO DEDICATE 30% ROUGHLY ABOUT A
BILLION DOLLARS A YEAR ON GOING
TO PAY FOR HOUSING. UM HOUSING
INTERVENTIONS AND TO PROVIDE AN
ONGOING SOURCE REALLY, THIS IS
AN ONGOING SOURCE FOR THOSE
INTERVENTIONS. FOCUS FUNDING ON
FULL SERVICE PARTNERSHIPS, AS
WAS DISCUSSED EARLIER BY
DEDICATING 35% OF THE LOCAL
DOLLARS TO FULL SERVICE
PARTNERSHIPS AND REALLY CREATING
A STANDARDIZED SYSTEM OF CARE
30% FOR COMMUNITIES SUPPORTS AND
SERVICES. THIS IS WHERE THE
PREVENTION AND EARLY
INTERVENTION DOLLARS WOULD ALSO
COME FROM WORKFORCE AND CAPITAL
INFRASTRUCTURE. BROADENING THE
TARGET POPULATION TO INCLUDE
MORE PEOPLE WHO NEED SUPPORT BY
ALLOWING PEOPLE WITH SUD
DISORDERS TO RECEIVE SERVICES
FUNDED BY AMATEURS, SAY AND THEN
IMPROVED COUNTY ACCOUNTABILITY
AND INCREASED TRANSPARENCY BY
UPDATING THE THREE YEAR COUNTY
PLANNING PROCESS TO REQUIRE
COUNTIES TO CREATE A REALLY MORE
COMPREHENSIVE PLAN, SO THIS PLAN
WOULD REALLY BRING TOGETHER SOME
OF OUR INDEPENDENT EFFORTS WITH
REGARD TO THE MEDICAL MANAGED
CARE. POPULATION NEEDS
ASSESSMENT WORK, LOCAL HEALTH
JURISDICTIONS, COMMUNITY AND
VESTMENT PLAN WORK, BRINGING ALL
OF THESE EFFORTS TOGETHER TO
REALLY WHAT IS COMMUNITY
BEHAVIORAL HEALTH AND A COUNTY
INSTEAD OF REALLY LOOKING AT ALL
OF THESE, THESE PLANNING
PROCESSES IN THESE EFFORTS AND
THESE PROGRAMS AND THESE FUNDING
IN SILOED APPROACHES, WHAT DOES
COMMUNITY MENTAL HEALTH MEAN AND
DEVELOPING A THREE YEAR PLAN TO
DO THIS? THIS WOULD CONTINUE TO
BUILD ON THE LOCAL STAKEHOLDER
ENGAGEMENT PROCESS THAT IS VERY
ROBUST UNDER THE THREE YEAR PLAN
UNDER IMAGES SAY, BUT THIS IS
ADDING NEW PLAYERS TO THAT
CONVERSATION, SO WE HAVE A MORE
COMPREHENSIVE PLAN TO ADDRESS
COMMUNITY BEHAVIORAL HEALTH.
UNDER THE PROPOSAL, DHC S
ANTICIPATES THAT COUNTIES WILL
CONTINUE TO INVEST IN PREVENTION
AND EARLY INTERVENTION. AND
REALLY THERE IS A DISTINCTION
BETWEEN PREVENTION AND EARLIER
INTERVENTION. IT REALLY
RECOGNIZING SOME OF THE
POPULATION HEALTH POPULATION
BASED PREVENTION EFFORTS THAT WE
WANT TO BE CONTINUED TO BE
FUNDED. WE THINK COUNTIES WILL
HAVE MORE FLEXIBILITY TO ADJUST
THEIR SPENDING AS NEEDED,
DEPENDING ON THEIR THREE YEAR
PLANNING PROCESS, AND WHAT THE
LOCAL PREVALENCE AND NEEDS OF
THE COMMUNITY MIGHT BE. THIS
PROVIDES COUNTIES THE ABILITY TO
FLEX A LITTLE BIT IN THAT 30%
35% BUCKET REALLY AGAIN TO
IDENTIFY WHAT ARE THE COMMUNITY
NEEDS AND HOW TO ADJUST. I DO
WANT TO NOTE A NUMBER OF
PREVENTION AND EARLY
INTERVENTION SERVICES ARE NOW
COVERED UNDER MEDICAL AND UNDER
, UH, THE NEWLY PROPOSED
CALIFORNIA BEHAVIORAL HEALTH
COMMUNITY BASED CONTINUUM CAN
YOU NEED PER PAYS THE 11 15
WAIVER THAT IS STILL IN DRAFT
CONCEPT AND ALSO UNDER THE
CALIFORNIA BEHAVIORAL HEALTH.
CHILDREN AND YOUTH BEHAVIORAL
HEALTH INITIATIVE. SO NOW
MEDICAL COVERS, UH, PEER SUPPORT
SPECIALISTS UNDER MEDICAL. THEY
WERE PREVIOUSLY NOT COVERED, YOU
KNOW, PRIOR TO THE LAST COUPLE
OF YEARS, THE COVERAGE OF
DIETETIC SERVICES, WHICH ALSO
WAS NOT PREVIOUSLY COVERED
MEDICAL BENEFIT, THE COMMUNITY
HEALTH WORKER BENEFIT AS WELL IS
NOW A COVERED BENEFIT IN MEDICAL
. UM AND THEN FINALLY, THE
CHILDREN AND YOUTH BEHAVIORAL
HEALTH INITIATIVE WILL ESTABLISH
A FEE SCHEDULE FOR SCHOOL BASED
BEHAVIORAL HEALTH SERVICES
ACROSS ALL PAIRS. UM IF THERE IS
A LOCAL PREVENTION OR EARLY
INTERVENTION SERVICE THAT IS
OFFERED BUT NOT CURRENTLY
COVERED BY MEDICAL. THIS IS
WHERE COUNTIES CAN CONTINUE TO
USE THEIR IMAGES SAY DOLLARS TO
FUND THOSE WE REALLY WANT TO
ENCOURAGE COUNTIES TO CONTINUE
REALLY REFINING THE COMMUNITY
DEFINED PRACTICES AND TESTING
INNOVATIVE MODELS TO BUILD THAT
EVIDENCE BASE TO TURN THEM
ACTUALLY INTO STATEWIDE BENEFITS
. IN THE LONG RUN, I THINK ABOUT
COMMUNITY HEALTH WORKERS, WHICH
WERE OFTEN FUNDED BEFORE WITH
INNOVATION DOLLARS. NOW THAT
PRACTICE HAS BEEN DEMONSTRATED.
WE HAVE EVIDENCE, AND NOW IT'S A
STATEWIDE BENEFITS THAT WANT TO
CONTINUE THAT PRACTICE. UM I
THINK ONE OF THE MAIN REASONS TO
GET TO SOME OF THE QUESTIONS IN
YOUR AGENDA OF WHITE COUNTIES
DON'T ALWAYS BUILD FOR MEDICAL.
IT DOES TAKE WORK TO BECOME A
MEDICAL PROVIDER, AND, YOU KNOW,
WANT TO PROVIDE THE ASSISTANCE
TO PROVIDE A PATH THERE. WE HAVE
STREAMLINED THE PROCESS FOR THIS
AS WELL WITH REGARDS SOME OF THE
CAL AIM DOCUMENTATION STANDARD
REVISIONS, SOME OF THE MEDICAL
NECESSITY CRITERIA ALSO FOR
RECEIVING SERVICES AND THEN VERY
IMPORTANTLY, THE BEHAVIORAL
HEALTH PAYMENT REFORM THAT WILL
GO LIVE IN JULY, WHICH ALSO WILL
SIMPLIFY FROM A PROVIDER
PERSPECTIVE PARTICIPATION IN THE
MEDICAL SPACE. UM I WAS SCOOT ON
TO, UM. AGAIN OUR GOAL HERE IS
TO REALLY MAXIMIZE THE DOLLARS
AVAILABLE IN IN THE IN OUR
COMMUNITY BEHAVIORAL HEALTH
SYSTEM, SO WANTING COUNTIES TO
BILL MEDICAL AND ALL
OPPORTUNITIES POSSIBLE SO THAT
WE'RE ABLE TO DRAW DOWN FEDERAL
DOLLARS AND STRETCH BOTH MHS S¼
ARE REALIGNMENT AND OUR VARIOUS
BLOCK GROUNDS TO THE TO THE
MAXIMUM, UH, ABILITY AS
POSSIBLE. AH THIS PROPOSAL DOES
NOT DE PRIORITIZED CHILDREN WITH
MILD TO MODERATE BEHAVIORAL
HEALTH NEEDS. MANY OF THESE
CHILDREN ARE ALREADY BEING
SERVED THROUGH MEDICAL, WHERE A
COMPREHENSIVE SET OF DON,
ESPECIALLY MENTAL HEALTH
SERVICES ARE PROVIDED THROUGH
MANAGED CARE AND FEED FOR
SERVICE SYSTEM. LAST YEAR, THE
DEPARTMENT WE RELEASED OUR
GUIDANCE TO MEDICAL MANAGED
CARES TO CLARIFY THE
RESPONSIBILITIES FOR NON
SPECIALLY MENTAL HEALTH SERVICES
, AND WE ALSO DEVELOPED A
STANDARDIZED SCREENING AND
TRANSITION CARE TOOLS BETWEEN
THE TWO SYSTEMS BETWEEN MANAGED
CARE AND ESPECIALLY MENTAL
HEALTH. ALSO THERE'S A
CONSISTENT WAY THAT CHILDREN AND
YOUTH ARE SCREENED AND ASSESSED
AND TRANSITION THROUGH THE
DIFFERENT DELIVERY SYSTEMS.
AGAIN IT'S CRITICAL THAT
COUNTIES MAXIMIZE ALL BEHAVIORAL
HEALTH FUNDING AND AVOID USING
MHS SAY TO PREPARE TO PICK PAY
FOR SERVICES THAT ARE ACTUALLY
REIMBURSABLE UNDER MEDICAL AND
REALLY MAXIMIZE OUR OPPORTUNITY
TO DRAW DOWN FEDERAL FUNDS. IN
ADDITION, THE PROPOSAL WILL
ALIGN COMMERCIAL COVERAGE OF
BEHAVIORAL HEALTHCARE WITH
MEDICAL. THIS WILL ENSURE THAT
INDIVIDUALS WITH BEHAVIORAL
HEALTH CONDITIONS CAN ACCESS
APPROPRIATE SERVICES THROUGH
THEIR COMMERCIAL HEALTH PLANS AS
WELL, INCLUDING CHILDREN AND
YOUTH WITH MILD TO MODERATE
BEHAVIORAL HEALTH CONDITIONS,
AND THEN FINALLY AGAIN TO
MENTION THE CHILDREN IN YOUTH
BEHAVIORAL HEALTH INITIATIVE
WILL IMPROVE ACCESS TO THESE
CRITICAL SERVICES AND THAT
PREVENTIVE UPSTREAM APPROACH
THROUGH THE VIRTUAL SERVICES
PLATFORM AND THE FEE SCHEDULE,
WHICH IS REALLY MAXIMIZING OUR
ABILITY TO MEET CHILDREN. THEY
ARE IN SCHOOLS AND PROVIDE
SERVICES AND AN ONGOING ONGOING
FUNDING SOURCE FOR THOSE
SERVICES. I DO WANT TO REITERATE
THIS IS A WORK IN PROGRESS AS
WE'VE ALREADY SPOKEN TO YOU AND
YOU KNOW, WE'VE HAD MANY
STAKEHOLDER CONVERSATIONS AND WE
KNOW WE WILL HAVE MANY MORE BUT
REALLY LOOK FORWARD TO THE
CONTINUING DISCUSSION AND REALLY
UNDERSTANDING KIND OF WHERE
THERE MIGHT FOLKS MIGHT FEEL
THERE IS A LOSS IN GETTING SOME
SPECIFIC EXAMPLES TO KIND OF
WORK THROUGH THOSE THANK YOU.
THANK YOU. NEXT WE'LL HAVE
ROBERT HARRIS WITH S E I U.
FIRST OF ALLAH. START WHAT'S UP
PERSONAL AND HARMONY AND REMARK
, WHICH IS THANK YOU SO MUCH AND
TO THE GOVERNOR FOR THE YOUTH
AND CHILD BEHAVIORAL HEALTH
THING. I'VE BEEN WORKING IN
WAITING MY WHOLE LIFE OR AT
LEAST 50 YEARS, SO THANK YOU FOR
THAT. AS LONG AS IT WORKS, WE'RE
GOOD. AH! I SEE I YOU NEVER SAID
A HOLISTIC COMPASSION. APPROACH
TO CARE THAT ENSURES CONSUMER
ACCESS. THE HIGH QUALITY THAT
CALIFORNIA THAT COUNT
CALIFORNIANS NEED TO DEAL WITH
THE RANGE OF BEHAVIORAL HEALTH
ISSUES. THIS INCLUDES HOUSING,
BEHAVIORAL HEALTH, HELP AND
SUPPORTERS. THE WHOLE SYSTEM OF
CARE THAT'S COORDINATED IS
RELIANT ON CASEWORKERS CASE.
SPAM MATT MANAGERS, NAVIGATORS,
PEERS AND COMMUNITY HEALTH
WORKERS. WHO ARE PAID A DECENT
LIVING SO THEY'LL ACTUALLY
PROVIDE CARE. OVER CONTINUITY.
AH! CLEARLY THERE WAS MISTAKEN
PROP 63 THAT WAS THAT. THEY ONLY
TALKED ABOUT SUBSTANCE ABUSE IN
TERMS OF CORKER EATING DISORDERS
, AND THAT WAS BECAUSE EVEN MR
STEINBERG AND NO ONE WANTED TO
DEAL WITH THE DOUBLE STIGMA. AND
IT'S STILL EXISTS. TODAY I WAS
HEARING AT A HEARING EARLIER
THIS WEEK WHERE THEY WERE
TALKING ABOUT. ALEX, RIGHT? MY
IT WAS JUST GRADING BECAUSE ITS
SUBSTANCE USE DISORDER. IT'S NOT
ADDICTS. IT'S NOT SUBSTANCE
ABUSE DISORDERS, SUBSTANCE USE
DISORDER. IT'S A DIFFERENT
THING. AND SO IF WE COULD USE
THAT, TO REFER TO IT, I'D FEEL
BETTER. UH, WE'RE HAPPY THAT YOU
DECIDED TO INCLUDE THAT. THE
ONLY THING THAT WE'RE WORRIED
ABOUT IS BECAUSE THE ODS IS
PRETTY MUCH NOT FUNDED RIGHT BY
THE COUNTIES AND THEN DOES NOT
TO HELP ALL THEIR OWN. THE
RIGHTS WERE TOO LOW. THEN. THEN,
UH, YOU'RE PUTTING IN ADDED BURN
ON THE MENTAL HEALTH SERVICES
ACT TO FUND SOMETHING THAT'S
ALREADY UNDERFUNDED. AND THAT
AND THAT'S WORRISOME BECAUSE
WILL THERE BE ENOUGH MONEY AND
SO WE'RE WAITING TO SEE THE
LANGUAGE? YOU KNOW THE DEVIL'S
IN THE DETAILS AND WE DON'T KNOW
THE DETAILS YET, ALTHOUGH WE'RE
HOPING WE'RE GETTING CLOSER, I
THINK AH! THE CENTER. WE SEE
THEM AND UNDERSTAND THEM AND CAN
DISCUSS ON THE BETTER WILL FEEL
AND I THINK THE SAME WAY GOES
FOR THE LEGISLATURE AND SO NOT
TO SPEAK FOR YOU, BUT YET TO
SPEAK YOU, BUT BUT ONCE WE SEE
HIM AND CAN WORK WITH YOU AND DO
THAT WE THINK WE CAN MAKE MAKE
YOUR SUGGESTIONS PROBABLY
IMPROVE THEM, WE THINK AND THAT
WILL GO FORWARD FROM THERE, BUT
IT'S GOTTA BE COOPERATION, AND
IT'S GOT TO BE LIKE ACTUALLY
TALKING ABOUT SUBSTANCE USE
DISORDER. SCHOOL CHILDREN. MOST
YOUNG PEOPLE ARE AFRAID TO TALK
ABOUT THAT GET KICKED OUT OF
SCHOOL TO TALK ABOUT IT TO ADMIT
THEY HAVE PROBLEMS AND THERE'S
GOTTA BE A WAY TO DEAL WITH
THAT. AND SO WE'VE GOT TO DEAL
WITH IT. WE'VE GOT TO RAISE THE
ISSUE. SO THAT'S PRETTY MUCH IT.
THANK YOU VERY MUCH. THANK YOU.
YOU HAVE ANY QUESTIONS? I'LL BE
BACK THERE. NEXT WE WILL HEAR
FROM AHMAD REZA BAHRAMI,
DIVISION MANAGER FOR THE PUBLIC
BEHAVIORAL HEALTH AND FRESNO
COUNTY WHO'S APPEARING REMOTELY.
UH GOOD EVENING, DR ARAMBULA.
HOPEFULLY EVERYONE IS ABLE TO
HEAR ME MY BRAHMI. I'M WITH THE
PRESIDENT COUNTY DEPARTMENT OF
BEHAVIORAL HEALTH. UM I HAVE A
TENDENCY FROM PEOPLE WHO ARE
PROBABLY ON THESE EARLIER PANELS
TO KNOW THAT I SPEAK QUICKLY, SO
THAT MIGHT BE A GOOD THING AT
THIS LATE HOUR. UM SO EARLIER IN
THE IN THE HEARING, MAYOR
STEINBERG NOTED THAT AMONG
COMMUNITY GARDENS FUNDED THROUGH
THE COUNTY STARTED ABOUT 15
YEARS AGO. WHILE THAT
PARTNERSHIP AND PROGRAM WAS
SUCCESSFUL, IT WAS EVENTUALLY
SUNSET IT A FEW YEARS AGO DUE TO
FEEDBACK WE GOT FROM TWO
DIFFERENT INDEPENDENT THIRD
PARTY EVALUATIONS AND THEIR
FUNDINGS AND OUTCOME ASSOCIATED
WITH THAT PROGRAM, SO I JUST
WANTED TO, YOU KNOW, KIND OF SO
I SET THE RECORD CORRECT ON THAT
ONE. WE WELCOME THE OPPORTUNITY
TONIGHT TO EXPAND ON HOW WE'RE
ENGAGING PRESENTS DIVERSE
COMMUNITIES. UM, THIS EVENING, I
WILL TOUCH ON A STAR STRONG
PARTNERSHIP WE HAVE WITH SOME OF
OUR LOCAL COMMUNITIES.
ORGANIZATIONS THAT ASSIST US
WITH YOU IN OUR OUTREACH AND
PROVIDING SERVICES IN A CULTURAL
RESPONSIVE MANNER TO ONE OF OUR
SPECIFICALLY TRADITIONALLY
UNDERSERVED COMMUNITIES HERE IN
THE CENTRAL VALLEY. AND THEY'RE
BEING OUR SOUTHEAST ASIAN,
SPECIFICALLY POPULATION
PRESIDENT COUNTIES PARTNERSHIP
WITH THE PRESIDENT STARTED WITH
THE PRESIDENT. SENATOR STARTED
ABOUT 15 YEARS AGO. TODAY THE
PRESIDENT CENTER PROVIDES AN
ARRAY OF COMMUNITY BASED
SERVICES TARGETING OUR SOUTHEAST
ASIAN IMMIGRANT COMMUNITIES. WE
FIND THIS CONTINUES SERVICES
ACTUALLY THREE THROUGHOUT
THROUGH THREE DIFFERENT
COMPONENTS OF THE MENTAL HEALTH
SERVICES ACT. THE FIRST ONE BUT
CULTURALLY BASED ACCESS AND
NAVIGATION SERVICES OR SEE BANDS
AS WE CALL THAT AN ACADEMIC
WORLD IS A PREVENTION EARLIER
MENTIONED FUNDED ACCESS AND
LINKAGE PROGRAM PRIMARILY
FOCUSED ON PROVIDING ACCESS AND
LINKAGES TO THOSE IN OUR
COMMUNITY CONNECTING THEM TO
THOSE BEHAVIOR. HEALTH SERVICES
. THE HOLISTIC WELLNESS CENTER
IS ANOTHER PREVENTION. EARLY
INTERVENTION PROGRAM FUNDED BY
THE DEPARTMENT WITH THE
PRESIDENT CENTER THAT USES
CULTURALLY RESPONSIVE APPROACHES
SUCH AS GARDENING DANCE
TRADITIONAL HEALERS AS A WAY TO
ENGAGE AND HAVE DISCUSSIONS
ABOUT MENTAL HEALTH IN A NON
STIGMATIZING WAY THAT IS MORE
EFFECTIVE IN ENGAGING THOSE
POPULATIONS HAVE NOT BEEN SERVED
EFFECTIVELY IN THE PAST BY THE
BEHAVIOR HEALTH SYSTEM. UM AS A
COMMUNITY TO FIND PRACTICE,
THESE SERVICES ARE NOT
NECESSARILY INSURANCE OR MEDICAL
REIMBURSABLE SERVICES, BUT THEY
ARE EFFECTIVE AT IMPROVING THE
EQUITY AND ACCESS FOR THOSE
POPULATIONS. PRESIDENT CENTER
ALSO OPERATES A FULL SERVICE
PARTNERSHIP. WE HEARD A LOT
ABOUT FULL SERVICE PARTNERSHIPS
EARLIER THIS EVENING. THE
PRESIDENT CENTER ALSO OPERATES A
FULL SERVICE PARTNERSHIP THAT'S
BEEN DESIGNED FOR OUR SOUTHEAST
ASIAN POPULATION. UM YES,
THERE'S ONE OF OUR OUR F SPS. WE
DO HAVE A NUMBER OF F SPS HERE.
PRESIDENT COUNTY, NUMEROUS ONES
THAT FOCUS ON YOUTH CHILDREN.
JUSTICE INVOLVED PERSONS.
INDIVIDUALS WITH CO OCCURRING
DISORDERS, SPECIFICALLY
SUBSTANCE ABUSE OR MISUSE
DISORDERS, AS WAS JUST NOTED BY
BY THE PREVIOUS PANELS, ALSO
CULTURAL SPECIFIC POPULATIONS.
AS I SAID, WITH OUR SOUTHEAST
ASIAN POPULATION SO I ALSO WANT
TO HIGHLIGHT ONE LAST PROGRAM IF
I CAN REAL QUICKLY, WHICH IS
FUNDED THROUGH OUR INNOVATION
PARTNERSHIP WITH THE FRESNO
CENTER. IT'S CALLED HELPING
HANDS. YOU KNOW, CHAIRMAN OF
AMBULANCE FAMILIAR WITH THAT
PROGRAM? THE MOM HELPING HANDS
PROJECT WAS ONE OF THE THREE
CALIFORNIA REDUCING DISPARITIES
PROJECTS THAT WAS ACTUALLY
SEATED BY STATEWIDE ESSAY
DOLLARS. OUR INNOVATION. PLAYING
CONTINUES TO SUPPORT AMONG
HELPING HAND AND TWO OTHER LOCAL
CRD PIECE HERE IN FRESNO COUNTY
WITH INNOVATION DOLLARS WITH OUR
INTENTION TO CONTINUE THOSE
PROJECTS AS PREVENTION, EARLY
INTERVENTION PROGRAMS. UM THE
POPULATION IN FRESNO COUNTY IS
MADE UP PRIMARILY OF REFUGEES
AND IMMIGRANTS WHO CAME TO
FRESNO IN THE LATE 80 AND LATE
19 SEVENTIES EARLY 19 EIGHTIES
AND THEY'RE TALKING ABOUT A
POPULATION THAT WENT IN, UH,
RESETTLED HERE IN THE CENTRAL
VALLEY THAT ARE EXPERIENCED
TRAUMA. THEY HAD A LOT OF
CHALLENGES AS FAR AS THEY
RELATED TO ACCULTURATION, UM AND
THEN JUST THAT'S NOT EVEN
COUNTING JUST A REGULAR MENTAL
HEALTH CHALLENGES THAT THE
POPULATION HAS THE SO BAD
REGULAR CHALLENGES AS WELL AS
THESE WOMEN SAID EXACTLY THIS
SITUATION. YEAH FROM THAT
COMMUNITY. PEOPLE DID NOT SEEK
MENTAL HEALTH SERVICES FOR
ALMOST THREE DECADES UNTIL WE
STARTED SEEING CULTURALLY
RESPONSIVE PROGRAMS BEGIN TO
EMERGE THROUGH IMAGE S A U R P E
I FEWER INNOVATION. THAT'S WHERE
WE FOR THE FIRST TIME HAD THIS
UNDERSERVED COMMUNITY ACTUALLY
RECON REACHING OUT AND ENGAGING
IN SERVICES. UM SO I JUST WANTED
TO, YOU KNOW, KIND OF HIGHLIGHT
THAT REAL QUICKLY AND THEN
AMONGST US HELPING HANDS PROJECT
I MEAN, WHAT IS IT WITH OUR
OLDER ADULT POPULATION WHO ARE
MANY OF THEM ARE ALONE? UM THEY
HAVE LANGUAGE BEARS A LOT OF
MORE MONOLINGUAL. THERE'S
CULTURAL BARRIERS. THEY HAVE
CHALLENGES FROM PAST TRAUMAS. I
MENTIONED CHALLENGE WITH
DISTANCE MALAYSIAN A LOT OF
TIMES THEY'RE STRUGGLING, NOT
JUST EMOTIONALLY BUT ALSO
FINANCIALLY. THEY'RE PHYSICALLY
ISOLATED. THAT'S ONE OF THE
BIGGEST THINGS WE DO HEAR A LOT
OF TIMES AND THAT HAS AN IMPACT
ON THE WELLNESS. AND LIKE I SAID
LANGUAGE IS A BARRIER BUT ALSO
TEXTS A LOT OF TIMES. WELL,
LET'S DO THIS OR SIGN UP THIS
WAY OR DO THAT. ATTACK ABOUT
LITERACY AND ACCESSIBILITY IS
REALLY LIMITED FOR THAT
POPULATION AS WELL, UM, I'M
GONNA WRAP UP HERE IN A SECOND.
IF YOU'LL BEAR WITH ME. I JUST
WANT TO KIND OF POINT OUT TO
REALLY THINGS THAT I THINK WERE
IMPORTANT FOR 44. YOU KNOW THE
COMMITTEE TO HERE IN 2019 WHEN
WE STARTED TO OUR MENTAL HEALTH
SERVICES COMMITTEE OF PLANNING
PROCESS. UM WE DID AN EVENT AND
WE HAD 80 INDIVIDUALS FROM OUR
OLDER AMONG COMMUNITY. THAT
SHOWED UP TO THAT EVENT, AND
THEY WERE SHARING WITH US JUST
THE STORIES OF THE DESPERATION.
THEY WERE FEELING THE FEELING OF
HOPELESSNESS AND NUMBER OF THE
PEOPLE IN THAT GROUP PROBABLY
WASN'T HALF BUT I WOULD SAY A
THIRD OF THEM HAD TALKED ABOUT
HAVING SUICIDAL IDEATION AND YOU
KNOW WHETHER IT'S FROM BRIEF
WHERE THERE WAS JUST FROM BEING
ALIENATED, OR JUST A LOT OF THEM
WAS HISTORICAL TRAUMA. THROUGH
THESE PROGRAMS ARE ABLE TO
CONNECT. WE MET AGAIN THIS PAST
NOVEMBER WITH OVER 100 MEMBERS
FROM OUR SOUTHEAST ASIAN
COMMUNITY AND A LARGE NUMBER
AGAIN SHARED STORIES ABOUT
HOPELESSNESS, SUICIDAL IDEATION
THINGS LIKE THAT THEY WERE
EXPERIENCING. UM BUT THEN HOW BY
GETTING ENGAGED IN THESE
PROGRAMS THEY STARTED TO FEEL
CONNECTED. THEY STARTED TO GET
HELP, AND THEY STARTED TO HAVE
HOPE. SURE THAT THEY DO NOT
NUMBER OF THEM. THIS IS NOT A
FEW. THESE ARE PROBABLY LARGE
NUMBERS. I CAN SAY MAYBE ABOUT A
THIRD. THEY DO NOT BELIEVE THAT
THEY WOULD HAVE BEEN THERE THAT
DAY, SHARING THEIR EXPERIENCES
WITH US. IF THEY HAD NOT HAD
THOSE PROGRAMS THAT WERE ABLE TO
SPEAK TO THEM IN THEIR
CULTURALLY APPROPRIATE IN THEIR
LANGUAGE WITH PEOPLE THAT WERE
FAMILIAR WITH THERE'S PEOPLE
THAT LITERALLY TOLD US. THEY
WOULD NOT HAVE BEEN HERE WITHOUT
THAT. SO WHEN WE GO TO TALK
ABOUT, YOU KNOW, PE I PROGRAMS
AND WHAT THEY DO. YOU KNOW, WE
FEEL P I PROGRAMS WORK. WE FEEL
THEY'RE SAVING LIVES AND THEY
ARE ENGAGING OR BIPAC OR BLACK,
INDIGENOUS AND PERSONS OF COLOR
AND IMMIGRANT COMMUNITIES. WE'RE
HEARING THE TESTIMONY FROM THEM.
UM IN FRESNO COUNTY. WE DO
REALLY TRY TO FOLLOW ALL OF THE
RAGS TO P E I RIGS AND WE
UTILIZE A NEUTRAL THIRD PARTY OF
THE RAND CORPORATION HAS
ACTUALLY EVALUATED A NUMBER OF
RP I PROGRAMS TO LOOK AT THOSE
PROGRAMS MEASURING OF YOU KNOW,
ARE THEY MEETING THOSE THOSE ARE
REDUCING THE SECOND SEVEN
NEGATIVE OUTCOMES. ARE THE
PROGRAMS HAVING THE DESIRED
OUTCOME? DO THEY NEED TO BE
CHANGED FOR SOME OF THEM? THE
SUNSET OF WHAT THE PROGRAM WAS
DESIGNED FOR IN THE PRIORITIES
IN THE COMMUNITY CHANGED THE WAY
WE EITHER NEED A ADAPT AND
ADJUST THE PROGRAMS ARE LOOKING
GOING IN DIFFERENT DIRECTIONS.
SO TO ASSEMBLYMEMBER'S JACKSON'S
POINT EARLIER IN THE PANEL LIKE
WE DO, LOOK AT DO THE NEEDS OF
THE COMMUNITY CHANGE AND DO THE
PROGRAMS CHANGE. WE NEED TO
CHANGE THE PROGRAMS TO REFLECT
THAT TO ADDRESS THAT WE DON'T
WANT TO KEEP THE SAME PROGRAM.
LET'S SAY FROM 15 YEARS AGO IF
IT'S NOT NEEDED TODAY, IF IT'S
NOT HAVING THE SAME IMPACT, BUT
WE GO THROUGH EVALUATION, DO IT.
THAT DOESN'T MEAN WE ELIMINATE
ACCESS TO THIS PROGRAM. IT JUST
MEANS WE HAVE TO RE PRIORITIZE
THOSE PREVENTION OPPORTUNITIES.
UM LASTLY, I JUST SAY, YOU KNOW
THAT WE DO. LOOK AT AT WHAT
NEEDS TO BE DONE WITH THE
OUTCOMES. WE'RE CONSTANTLY
LOOKING AT HOW WE CAN MAKE SURE
THAT OUR UNDERSERVED AND
VULNERABLE COMMUNITIES UH, ARE
GETTING CONNECTED THROUGH THESE
TYPES OF PROGRAMS INTO THOSE
MEDICAL ELIGIBLE SERVICES HAS A
LOT OF TIMES. IT'S HARD TO TAKE
THEM FROM POINT A TO B, SO WE
HAVE TO USE THESE PROGRAMS AS A
WAY TO BUILD UP THE REPORT. HELP
THEM UNDERSTAND, IMPROVE MENTAL
HEALTH LITERACY, REDUCE THE
STIGMA AND THEN CONNECT THEM TO
THOSE SERVICES. WITH THAT? I
THANK YOU. AND HOPEFULLY, IF YOU
HAVE ANY QUESTIONS, I'LL BE ABLE
TO ANSWER THIS. THANK YOU. NEXT
WE HAVE LASHAWN FRANCIS, THE
SENIOR DIRECTOR OF BEHAVIORAL
HEALTH AT CHILDREN NOW. FOLLOWED
BY TYLER WINDY. THANK YOU. CHAIR
MEMBERS, LASHAWN FRANCIS WITH
CHILDREN. NOW WE ARE STATEWIDE
RESEARCH POLICY AND ADVOCACY
ORGANIZATION. THE MAIN THING
THAT I REALLY WANT TO GET ACROSS
TODAY IS WE AGREE THAT THERE
SHOULD BE CHANGES THAT MUCH TO
SAY IT HAS BEEN 20 YEARS. WHAT
THOSE CHANGES ARE IS UP IS
WHAT'S UP FOR DEBATE. SO WHILE
WE DO LIKE THE IDEA OF INCLUDING
SUD MORE BROADLY INTO THE
PROPOSAL, WE ALSO UNDERSTAND AND
AGREE WITH. I THINK SOMEONE
ELSE'S, UH EARLIER COMMENT THAT
THE STATE SHOULD REALLY BE
ROBUSTLY FUNDING SUD SERVICES
AND SHOULDN'T BE USING IMAGESA
TO FILL THIS GAP. HOWEVER
OUTSIDE OF THAT, AS PROPOSED, WE
STRONGLY BELIEVE THAT THIS IS A
BAD IDEA FOR KIDS. I THINK
THAT'S VERY SIMPLY STATED SO
THAT WE'RE ALL CLEAR. THE
CURRENT CATEGORIES OF COMMUNITY
SUPPORTS AND SERVICES AND
PREVENTION, EARLY INTERVENTION
WORKFORCE IN CAPITAL
INFRASTRUCTURE ARE COLLAPSED
INTO THAT THIRD BUCKET OF 30. I
BELIEVE AND THE PLAN SO FAR IS
THAT COUNTIES CAN HAVE A
COMMUNITY PROCESS DETERMINING
HOW MUCH MONEY GOES INTO THOSE
CATEGORIES. THAT MEANS YOU COULD
HAVE A COUNTY OR SEVERAL
COUNTIES THAT DECIDED NOT TO PUT
ANY MONEY TOWARDS PREVENTION AND
ALL OF THEIR MONEY INTO
TECHNOLOGY. OR IF THEY DO PUT
MONEY INTO PREVENTION. IT
DOESN'T HAVE TO BE FOCUSED ON
CHILDREN. WE SEE THAT AS A
PROBLEM SOMEONE MENTIONED
EARLIER THAT CALLUM AND C Y B H.
I HAVE BEEN SOLID RESPONSES TO
CHILDREN'S MENTAL HEALTH, AND WE
DO AGREE WITH THAT, TOO. TO A
POINT RIGHT NOW, THE STATE'S
PLAN FOR CHILDREN'S MENTAL
HEALTH LIES LARGELY IN PROVIDING
SERVICES IN CLINICAL SETTINGS
AND SCHOOL SETTINGS. VERY
IMPORTANT. WE SUPPORT BOTH OF
THOSE INITIATIVES, BUT THERE'S
REALLY NO PLAN ON HOW TO SUPPORT
LONG TERM INVESTMENT IN
COMMUNITY DEFINED EVIDENCE BASED
PRACTICE MODELS. THIS PROPOSAL
DRASTICALLY REDUCES THE
POSSIBILITY FOR THOSE FUNDS. AND
HERE'S WHY THAT'S IMPORTANT. THE
REALITY IS NOT ALL CHILDREN ARE
IN SCHOOL. THIS IS TRUE FOR
THOSE UNDER FIVE. AND THOSE
TRANSITION AGE YOUTH THAT WE
TALKED ABOUT EARLIER. YOU'LL
NOTICE A NUMBER OF OUR
CARRINGTON CLASSES ARE ACTUALLY
FUNDED BY THE USA. YOU'LL NOTICE
THAT FOR SOME OF OUR TRANSITION
AGE YOUTH THEY ARE GOING TO SOME
COUNTIES ARE FUNDING ANTI GUN
VIOLENCE PROGRAMS NOT DIRECTLY
RELATED TO MENTAL HEALTH, BUT
DEFINITELY MENTAL HEALTH
ADJACENT THAT'S FUNDED BY THE
USA. I DO WANT TO NOTE THAT THE
IMAGES SAY IS STILL VALUABLE FOR
OUR SCHOOL AGED CHILDREN. AS
SOMEONE WHO HAS RUN SEVERAL
BILLS AND SUPPORTED EFFORTS TO
MAKE SCHOOLS MORE EMOTIONALLY
WELCOMING SPACE FOR ALL STUDENTS
, INCLUDING TRAINING FOR SCHOOL
STAFF AND RESORT. RESTORATIVE
JUSTICE APPROACHES. I CAN SAY
NOT ALL OF OUR SCHOOLS ALREADY.
NOT BECAUSE THE STAFF OUR
STUDENTS AREN'T READY, BUT
BECAUSE THE STATE HAS BALKED AT
THE PRICE TAG OF SCALING THESE
APPROACHES, OR THERE'S BEEN A
HESITANCY TO REQUIRE THESE
REPROACH APPROACHES. THERE'S A
PROGRAM IN SAN JOAQUIN COUNTY
RIGHT NOW, THAT'S TRAINING,
SCHOOL PERSONNEL AND SUICIDE
PREVENTION THAT'S FUNDED BY THE
NHS S¼. UNTIL WE'RE
FUNDAMENTALLY ADDRESSING NOT
JUST THE SERVICES WE OFFER ON
CAMPUS, BUT ALSO THE ENVIRONMENT
. WE'RE NOT READY TO REROUTE
IMAGES A FUNDS I DO WANT TO
FOCUS ON OUTCOMES. I DIDN'T COME
PREPARED TO TALK ABOUT THAT
TODAY, BUT CHILDREN NOW DID
WRITE A REPORT DETAILING ALL OF
THE DATA THAT THE STATE COLLECTS
AND PUBLICLY REPORTS ON
CHILDREN'S MENTAL HEALTH AND THE
POINT OF THE REPORT WAS WE
COLLECT A LOT OF DATA, AND WE
STILL DON'T KNOW MUCH. WE HAVE A
HEALTHCARE DATA PROBLEM THAT'S
NOT UNIQUE TO PROP 63 NO ONE
TRACKS GOOD OUTCOMES, AND WE
SHOULD A TRUE DATA
TRANSFORMATION WOULD INCORPORATE
ALL OF THE DIFFERENT DEPARTMENTS
AND AGREED UPON SET OF METRICS
FOR WHAT OUTCOMES YOU WOULD LIKE
TO SEE FROM KIDS. THE GOOD NEWS
IS WE DON'T NEED A BALLOT
INITIATIVE TO DO THIS. THERE'S A
NARRATIVE THAT WE DON'T KNOW IF
THE P E I PROGRAMS ARE WORKING.
THAT MAY BE TRUE, BUT ABSENCE OF
EVIDENCE ISN'T EVIDENCE OF
ABSENCE, WE COULD BE ASKING THE
WRONG QUESTIONS. WE COULD NOT BE
FUNDING THESE PROGRAMS WELL
ENOUGH TO SHOW EFFECTIVENESS. MY
POINT IS, THERE ARE A HOST OF
ISSUES THAT COULD BE EVIDENT
THAT DON'T MEAN SINCE. WE DON'T
KNOW IF IT WORKS, THEN IT MUST
NOT WORK. THAT CONCLUSION IS
GOING TO BE HARD PILL FOR
SWALLOW FOR PROGRAMS LIKE THE
ONE IN ALAMEDA COUNTY THAT
FOCUSES ON UNACCOMPANIED
IMMIGRANT YOUTH AND SUPPORTING
THEIR MENTAL HEALTH ONCE THEY
ARRIVE IN CALIFORNIA. HERE'S
WHAT WE'D LIKE TO SEE. IT'S A
FINE PERCENTAGE FOR P E I FOR
KIDS. A DEFINED PERCENTAGE FOR
CSS FOR KIDS. IT'S A FINE
PERCENTAGE OF FSP FOR KIDS. I
ACKNOWLEDGE THIS GOES BEYOND THE
CURRENT IMAGES SAY, BUT IF
SOMEONE MENTIONED EARLIER, A LOT
HAS CHANGED IN 20 YEARS, AND
THAT INCLUDES WHAT WE'RE DOING
FOR KIDS, SO WE SHOULD ACTUALLY
BE DOING A LOT MORE. I'M PLEASED
THIS COMMITTEE IS THINKING ABOUT
THE IMPACT THIS WILL HAVE ON
CHILDREN. AND I'M HAPPY TO
ANSWER ANY QUESTIONS YOU MAY
HAVE. THANK YOU. NEXT WE HAVE
TYLER WINDY, DEPUTY DIRECTOR OF
CHILD WELFARE POLICY AT THE
CALIFORNIA ALLIANCE OF CHILD AND
FAMILY SERVICES. GOOD EVENING
CHAIR AND MEMBERS TYLER REALLY
WITH THE CALIFORNIA ALLIANCE OF
CHILD AND FAMILY SERVICES. THE
GOVERNOR'S PROPOSAL IMPORT OPENS
UP AN IMPORTANT DIALOGUE AROUND
MODERNIZING THE MENTAL HEALTH
SERVICES ACT AND CALIFORNIA'S.
OUR HOUSE SYSTEM OFFERS AN
OPPORTUNITY TO PROVIDE BETTER
CARE FOR OUR COMMUNITIES. OUR
MEMBERS ARE ON THE FRONT LINES
CARRYING FOR COMMUNITIES AND ARE
EAGER TO ENGAGE IN A DIALOGUE
ABOUT HOW TO MODERNIZE THE
SYSTEM TO BE MOST EFFECTIVE TO
MEET THE NEEDS OF TODAY AND
FUTURE CALIFORNIANS. WHILE GREAT
PROGRESS HAS BEEN MADE, THERE IS
STILL A STRONG NEED IN
COMMUNITIES ACROSS THE STATE,
FOR EXAMPLE, DESPITE AN OVERALL
DECREASE IN THE SUICIDE RATE IN
CALIFORNIA IN 2020 DURING COVID
19 YOUTH, PARTICULARLY BLACK,
MODERN, X AND GIRLS ALL SHOW
DISPROPORTIONATE INCREASES IN
SUICIDE. SHOCKING 78% OF LGBT Q
PLUS YOUTH WHO ARE SURVEYED
SHARED THAT THEY HAD CONSIDERED
SUICIDE WITH THE MAJORITY OF
THOSE WHO HAD CONSIDERED SUICIDE
SHARED THEY HAD DONE SO IN THE
PAST YEAR, AND NEARLY A THIRD
HAD MADE AN ATTEMPT IN THE PAST
YEAR. UM THERE'S STILL A GREAT
AMOUNT OF DETAIL NEEDED TO
UNDERSTAND THE GOVERNOR'S
PROPOSAL, AND WE LOOK FORWARD TO
ENGAGING ONE FURTHER DETAILS ARE
AVAILABLE. HOWEVER WE HAVE
IDENTIFIED SEVERAL CONCERNS FROM
WHAT WE KNOW. NOW EXISTING MODEL
REQUIRES 20% OF MHS EXPENDITURES
AND ON PREVENTION AND EARLY
INTERVENTION. UM OR P I WITH 51%
OF PE I FUNDING TO BE SPENT ON
PROGRAMS AND SERVICES FOCUSED ON
CHILDREN AND YOUTH. THIS RESULTS
IN AT LEAST $360 MILLION
REQUIRED OF ANNUAL EXPECT
STATEWIDE EXPENDITURES FOR
CHILDREN AND YOUTH BASED ON
FISCAL YEAR 22 23 REVENUES. THE
GOVERNOR'S PROPOSAL WOULD
COLLAPSE. UM P I FOR CHILDREN
AND YOUTH, UM, INTO A BROADER
FUNDING CATEGORY OF 35% OF THE
ANNUAL REVENUES, INCLUDING
CAPITAL FACILITIES, WORKFORCE
AND EDUCATION, UM AND PRUDENT
RESERVE. WE VIEW THIS AS, UM,
PUTTING THE FUNDING THAT IS SET
ASIDE FOR CHILDREN AND YOUTH AT
RISK. UM AND THEN ANOTHER 35%
WOULD BE FOR FULL SERVICE
PARTNERSHIPS WITH THE EXPLICIT
REQUIREMENT TO LEVERAGE MEDICAID
FUNDING. THERE'S A LITTLE DILL
DETAIL ABOUT HOW CHILDREN AND
YOUTH WOULD BE PRIORITIZED
WITHIN THE FSP COMPONENT, AND WE
KNOW THAT HALF OF ALL MENTAL
ILLNESSES START BY AGE 14 AND
THREE QUARTERS OF BY AGE 25. UM
WITHOUT EXPLICIT LANGUAGE,
REQUIRING A CERTAIN PERCENTAGE
SPENT ON PREVENTION AND EARLIER
INTERVENTION. WE FEAR THAT
CHILDREN AND YOUTH WILL NOT
RECEIVE THE NECESSARY PREVENTION
AND EARLY INTERVENTION SERVICES
, AND WE'LL SEE MORE CASES AND
MENTAL ILLNESS AND THE
CONSEQUENCES ASSOCIATED WITH
UNTREATED MENTAL ILLNESS THAT
COULD HAVE BEEN PREVENTED OR
TREATED EARLIER. WE OFTEN DO NOT
SEE THE IMPACT OF PREVENTION
SERVICES, BUT WE WILL NOTICE
WHEN THEY ARE NOT THERE.
ADDITIONALLY CURRENT SUMMARIES
OF THE PROPOSAL NOTE THAT P I
DOLLARS FOR SCHOOLS SHOULD BE
FOCUSED ON SCHOOL WIDE, UM,
BEHAVIOR HOUSE SUPPORTS AND NOT
INDIVIDUAL SERVICES TO NOT
OVERLAP WITH THE CHILDREN AND
YOUTH BEHAVIORAL HEALTH
INITIATIVE. UM OR C Y B H I, BUT
IT'S UNCLEAR HOW MUCH COUNTIES
WILL INVEST IN SCHOOL BASED
SCHOOLWIDE PREVENTION SERVICES.
WITHOUT THE PRESERVING THE
EXISTING SET ASIDE. WE ALSO FEAR
AROUND. UM YOU KNOW THE IMPACTS
TO COMMUNITY TO FIND EVIDENCE
BASED PRACTICES AND LOSING AND A
KEY ONGOING REVENUE SOURCE FOR
THEM. WHILE THE GOVERNOR'S
PROPOSAL EMPHASIZES ALIGNMENT
WITH A AND B H I, WHICH INCLUDES
INVESTMENTS FOR SEA DEPTHS FOR
YOUTH, THE C Y B H I IS STRICTLY
ONE TIME FUNDING AND SEA DEPTHS
ARE THE UM, FOUNDATION OF
CULTURALLY RESPONSIVE HEALING
FOR COMMUNITIES OF COLOR,
INCLUDING YOUTH, AND THE STATE
HAS ALREADY MADE SIGNIFICANT, UM
, INVESTMENTS IN UPLIFTING AND
SCALING SEA DEPTHS THROUGH THE
CALIFORNIA REDUCING DISPARITIES
PROJECT, AND IT'S UNCLEAR OF HOW
THE HEALTH CARE SYSTEM AT LARGE
, INCLUDING MEDICAL MANAGED CARE
PLANS. COUNTY MENTAL HEALTH
PLANS CAN OR WILL EMBRACE SETUPS
AS MEDICALLY NECESSARY SERVICES
AND CONTINUE TO PAY FOR THEM.
HISTORICALLY THEY'VE BEEN FUNDED
THROUGH THE END OF INNOVATION
COMPONENT UNDER THE MENTAL
HEALTH SERVICES ACT. A STREAM
THAT WOULD BE ELIMINATED FROM
THE WITH THIS PROPOSAL. WE
UNDERSTAND AND APPRECIATE THE
FOCUS ON HOUSING AND
HOMELESSNESS AND THE SIGNIFICANT
CRISIS THAT CALIFORNIA IS IN OUR
THOUGHTS RELATE TO PRESERVING
WHAT WE BELIEVE MADE THE MHS A
UNIQUE AND ITS CAPACITY TO FOCUS
ON PREVENTION, EARLY
INTERVENTION, LOCAL COMMUNITY
PLANNING AND FUNDING OF
CULTURALLY RESPONSIVE SERVICES.
WE RECOMMEND IN ORDER TO
INCENTIVIZE INVESTMENTS IN
PUBLIC HEALTH APPROACH TO WELL
BEING AND TRUE UPSTREAM
PREVENTION THAT WE MUST PRESERVE
THE SET ASIDE FOR PREVENTION AND
EARLY INTERVENTION FOR CHILDREN
AND YOUTH, ESPECIALLY WE DO
AGREE THAT THERE COULD BE WAYS
TO STRENGTHEN THE ACT, INCLUDING
ADDITIONAL FOCUS ON YOUTH THAT
ARE NOT IN SCHOOL AND THE 0 TO 5
POPULATION. UM, THANK YOU FOR
THE OPPORTUNITY TO TESTIFY AND
HAPPY TO ANSWER ANY QUESTIONS.
NEXT. WE WILL HEAR FROM TOBY
EWING, EXECUTIVE DIRECTOR OF THE
O. E. C. I'LL INVITE FORWARD
MICHELLE CO. BUT WHEN SHE'S
READY AS WELL, THANK YOU, MR
CHAIR AND MEMBERS, UM YOU KNOW
TOBY EWING ON BEHALF OF THE
COMMISSION? UM I WANT TO SORT OF
, YOU KNOW, ADDRESSED THESE
QUESTIONS? UM THROUGH SOME OF
THE OTHER POLICY DECISIONS THAT
THE STATE HAS MADE JUST FOR
REFERENCE, INCLUDING 1991
REALIGNMENT. IN 91. UM AMONG
MANY CHALLENGES WE WERE TRYING
TO ADDRESS THROUGH REALIGNMENT
AND SOME OF US WERE HERE. I'LL
ADMIT PUBLICLY AND ON THE
RECORD. UM YOU KNOW WAS THIS
NOTION WAS THIS NOTION OF, UM BY
PROVIDING RESOURCES TO THE
COUNTIES AND GIVING THEM
RESPONSIBILITIES THAT CUT ACROSS
SERVICE DELIVERY SYSTEMS THAT IT
WOULD CREATE A NATURAL INCENTIVE
FOR PREVENTION TO OCCUR BECAUSE
COUNTIES COULD, UM INVESTMENTS
IN MENTAL HEALTH COULD REDUCE
JUVENILE JUSTICE COSTS AND COST
SAVINGS COULD RESULT WHICH WOULD
REMAIN WITH THE COUNTY'S PRIOR
TO REALIGNMENT. THERE WAS ALWAYS
THIS TENSION OVER WHO RETAINS
COST SAVINGS. IF THE STATE IS
MAKING AN INVESTMENT, IT REDUCES
LOCAL COSTS AND SO PART OF THAT
REALIGNMENT CONVERSATION WAS
REALLY TO BUNDLE. RIGHTS AND
RESPONSIBILITIES, AUTHORITY AND
RESPONSIBILITIES IN WAYS THAT
COULD CREATE THAT INCENTIVE FOR
PREVENTION. I WOULD SAY THE
RECORD IS NOT QUITE AS A FEW
SIEVE IN TERMS OF OUR ABILITY TO
HAVE ACHIEVED THAT PREVENTION
INCENTIVE. THROUGH THIS IDEA OF
A DISCRETIONARY FUNDING STREAM.
AND SO, YOU KNOW, GETTING AT THE
QUESTION IN THE COMMITTEE
ANALYSIS, AND I WANT TO SAY, I
THINK I THINK YOU'RE ASKING THE
RIGHT QUESTIONS, RIGHT? UM IS IT
IMPORTANT TO HAVE AN EXPLICIT
MANDATE FOR PREVENTION AND EARLY
INTERVENTION AND IS IT IMPORTANT
TO HAVE AN EXPLICIT MANDATE FOR
INNOVATION? I WOULD SAY
ABSOLUTELY, YES. THE NATURE OF
THE CHALLENGES IN FRONT OF YOU
AS POLICYMAKERS AND US AS PUBLIC
OFFICIALS AND WORKING TO ADDRESS
THESE, THESE ISSUES ARE BEYOND
WHAT WE CAN AFFORD TO SIMPLY PAY
OUR WAY OUT OF WE HAVE TO THINK
ABOUT HOW WE CAN PREVENT DO THE
UPSTREAM WORK THAT WILL ACTUALLY
REDUCE THOSE COSTS. AND AS I
MENTIONED MY TESTIMONY EARLIER,
SOME OF THE LARGEST INCREASES IN
EXPENDITURES ARE IN STATE
HOSPITALS. RIGHT AND THAT WE
KNOW A LOT ABOUT HOW TO ACTUALLY
PREVENT THAT FROM HAPPENING. THE
CHALLENGE ISN'T IN THE POLICY,
THE CHALLENGES IN THE PRACTICE
AND HOW MIGHT WE, UM, I WOULD
ASK YOU TO THINK ABOUT HOW CAN
WE ACTUALLY STRENGTHEN THE
SUPPORT FOR THE COUNTIES TO DO
PREVENTION WELL, AND TO DO IT
EFFECTIVELY THE SCALING THAT WAS
MENTIONED EARLIER IN TERMS OF
THE ABILITY FOR COUNTIES TO
LEARN FROM EACH OTHER TO LEARN
FROM RESEARCHERS AND ACADEMICS
TO LEARN FROM COMMUNITY MEMBERS,
THE FOLKS WHO ARE ACTUALLY BRING
IN THE LIVED EXPERIENCE OF THE
STUDENTS. OF OTHER REPRESENTED
THAT YOU'VE HAD TESTIFIED. AND
HOW CAN THE STATE ACTUALLY BACK
THEM UP? PARTICULARLY IN DOING
THE KIND OF ANALYSIS THAT SOME
COUNTIES COULD DO, LIKE LOS
ANGELES OR POSSIBLY SANTA CLARA,
SAN FRANCISCO, BUT OTHER
COUNTIES DO NOT HAVE THE STAFF
CAPACITY TO DO THAT KIND OF
WORK. AND SO, UM, UNDER THIS
PROPOSAL TO BE ANTICIPATE THAT
CONTINUES, COUNTIES WILL
CONTINUE TO INVEST IN PE AND
INNOVATION. I WOULD SAY IT'S
HIGHLY UNLIKELY BECAUSE OF THE
FISCAL INCENTIVES ARE TO SHIFT
RESOURCES, PARTICULARLY UNDER
THE METAL MEDICAL MAXIMIZATION
PROPOSAL, LIKE ONE OF THE
QUESTIONS THAT THAT THAT I WOULD
ASK, UM OF THE ADMINISTRATION.
IF WE TAKE, FOR EXAMPLE, THE
EARLY PSYCHOSIS PROGRAM THAT WAS
PART OF THE PRESENTATION SURE,
LAST HEARING AND THE EXPERTS AT
UC DAVIS POINTED OUT THAT ABOUT
80% OF THE SERVICES ARE FUNDED
BY MEDICAL AND ABOUT 20% ARE
THEN FUNDED THROUGH MHS. A TO
COVER THAT PORTION THAT MEDIC AL
CAN'T COVER. IF WE CHANGE THE
INCENTIVES TO REQUIRE A MUCH
STRONGER INVESTMENT IN MEDICAL
AND REQUIRE A MEDICAL BILLING
AND MEDICAL MATCH, DOES IT
CREATE AN INCENTIVE FOR COUNTIES
TO FUND THE 80? USING AMATEUR
SAY AS THE LOCALS THE FEDERAL
MATCH AT THE EXPENSE OF THE 20.
AND IF WE TAKE THAT 20% OF
SERVICE OFF THE TOP, DOES THE
SERVICE HAVE THE SAME LEVEL OF
EFFICACY? THAT IT WOULD HAVE
WITHOUT THE 20 WITHOUT THAT. 20%
ADD ON AS IT DOES RIGHT WITH THE
20% ADD ON AND SO, UM, FISCAL
INCENTIVES ARE A HUGE DRIVER OF
DECISION MAKING. UM NOT JUST THE
STATE LEVEL BUT AT THE LOCAL
LEVEL. UM. IN THIS ISSUE ABOUT
THE EXPANSION OF MEDICAL THROUGH
ITALIAN. SPECIFICALLY IT'S IT IS
A PHENOMENALLY IMPORTANT STEP
FOR THE STATE OF CALIFORNIA TO
OPEN THAT UP. AND, YES, THERE
ARE OPPORTUNITIES TO COVER SOME
OF THE SAME TYPES OF SERVICES
THAT P AS I P I IS COVERING. BUT
THE IMAGES SAY WAS REALLY
ENVISIONED AS THE BALANCE. TO
MEDICAL AND WHAT WE WOULD LIKE
TO SEE IS AMATEUR S¼ FUNDS THAT
ARE FREED UP BECAUSE MEDICAL IS
NOW COVERING MORE CAN THEN BE
USED FOR THOSE THINGS. THAT
MEDICAL STILL DOES NOT CONTINUE
TO COVER. IT REALLY SHOULD BE
PUSHING US. TO THINK UPSTREAM SO
THAT WE CAN CONTINUE TO EXPAND
OUR PREVENTION STRATEGY.
ADDITIONALLY, I HAVE TO
RECOGNIZE THAT, UM, IN ADDITION
TO DOING THE UPSTREAM WORK THAT
IS IMPORTANT TO REDUCE OUR COSTS
AND IMPROVE OUR OUTCOMES. WE
HAVE TO RECOGNIZE THAT A LOT OF
WHAT WE DO TODAY WAS DESIGNED IN
THE 19 FIFTIES OR SIXTIES OR
SEVENTIES. THAT THAT WERE NOT
NECESSARILY THE MOST DYNAMIC.
ASPECT OF YOU KNOW, THE PUBLIC
SECTOR IS NOT NECESSARILY THE
MOST DYNAMIC ASPECT OF OUR LIVES
AND LOOK HOW FAST SO MANY OTHER
AREAS OF OUR LIFE HAVE BEEN
EVOLVING. THE INNOVATION
COMPONENT IS THIS. IT'S ABOUT 1%
OF PUBLIC MENTAL HEALTH FUNDING
. IT'S 5% OF THE IMAGE TO SAY,
BUT IT'S ABOUT 1% AND HIS
MEDICAL GOES UP THAT PERCENTAGE
ACTUALLY GO DOWN. THAT IS
PROBABLY THE MOST EFFECTIVE TOOL
THE STATE HAS BECAUSE IT
REQUIRES OUR COUNTY PARTNERS TO
THINK DIFFERENTLY ABOUT HOW THEY
CANNOT JUST DO MORE PREVENTION
BUT HOW THEY CAN ACTUALLY
IMPROVE THEIR BASE. IT GIVES
THEM THE RESOURCE GIVES THEM THE
MANDATE. IT GIVES THEM THE
POLITICAL COVER TO SAY, WE THINK
WE CAN DO BETTER IN THIS SPACE.
SO UM, WE HAVE SEEN ACTUALLY
THROUGH THE HISTORY OF THE ESSAY
THAT LOCAL GOVERNMENTS AND STATE
GOVERNMENT I WILL SAY ARE NOT
GOOD AT INNOVATING ON OUR OWN.
AND SO HAVING THAT REQUIREMENT
FORCING THAT CONVERSATION,
PARTICULARLY A CONVERSATION THAT
STARTS WITH THE COMMUNITY
TALKING ABOUT WHAT IS NOT
WORKING AS WELL AS IT SHOULD BE
WORKING. AND HOW MIGHT WE DO
BETTER IS AS A MANDATE IS THE
ONLY WAY WE CAN CONTINUE TO HAVE
THIS PUSH TOWARDS NOT JUST MORE
UPSTREAM INVESTMENT BUT
IMPROVING HOW OUR BASE IS
FUNCTIONING. I'M I'M NOT GOING
TO COMMENT ON THE LACK OF
BUILDING OF MEDICAL LIFE. YOU'VE
GOT MUCH SMARTER PEOPLE IN THE
ROOM HERE THAN ME. ON YOUR LAST
QUESTION ABOUT THIS
PRIORITIZATION OF MILD TO
MODERATE VERSUS SEVERE AND
PERSISTENT. THE REALITY IS WE
SHOULD NOT BE FORCED INTO THIS
FALSE CHOICE. WE CAN'T. WE CAN'T
ALLOW OURSELVES TO SAY WE ARE
GOING TO INVEST IN CANCER
TREATMENT BUT NOT CANCER
PREVENTION. RIGHT BECAUSE WE DO
KNOW THAT IF WE INTERVENE EARLY
, THE OUTCOMES ARE BETTER. IF WE
DO PREVENTION, RIGHT, THE
OUTCOMES ARE BETTER, RIGHT? WE
REALLY HAVE TO DO BOTH. UM AND
IN THIS FOURTH QUESTION THIS
FOURTH QUESTION IN YOUR, UM,
DOCUMENT HERE. IS THAT? YES IF
WE CAN IF WE NEGLECT
OPPORTUNITIES TO INTERVENE EARLY
IN USE THE EXAMPLE OF THE LIVES
OF THE YOUNG PEOPLE WHO WERE
HERE TODAY, RIGHT? VERY POWERFUL
FOR THEM TO SIT IN FRONT OF YOU,
POWERFUL FOR YOU AND POWERFUL
FOR THEM AND TO RECOGNIZE THAT
THEY JUST SAID TO YOU. I WAS
FAILING IN SCHOOL. BUT FOR THE
OPPORTUNITY THAT WAS AFFORDED TO
ME BY MY COUNTY BEHAVIOR, HEALTH
DEPARTMENT IN PARTNERSHIP WITH
OUR SCHOOLS. ABSOLUTELY YES, IF
WE D PRIORITIZE TÌM
OPPORTUNITIES WE CAN ANTICIPATE
MUCH LONGER DOWNSTREAM LISTS AND
MUCH LARGER DOWNSTREAM BILLS.
THANK YOU FOR THE CHANCE TO JOIN
YOU TONIGHT. NEXT WE HAVE
MICHELLE CABARET TO EXECUTIVE
DIRECTOR FOR THE COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION. GOOD EVENING, MR
CHAIR AND MEMBERS MICHELE
CABALLERO WITH THE COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION OF CALIFORNIA, AND I
JUST WANT TO SAY THAT ON THIS
FIRST DAY OF MENTAL HEALTH
AWARENESS MONTH. I LIKE ANDREA
ALSO RECALL WHEN YOU CHAIR HELP
THE LAST OVERSIGHT HEARING ON
NHS REFORM IN LATE 2019 AND
REALLY WELCOME THE OPPORTUNITY
TO BE HERE AGAIN TO PROVIDE AN
UPDATED VIEW ON THE STATUS OF
PROPOSED REFORMS. UM LET ME
START OUT BY SAYING THE MHS A AS
YOU'VE HEARD LAID OUT TODAY IS
THE CAKE. IT IS THE LIFEBLOOD OF
ART COMMUNITY COUNTY MENTAL
HEALTH SAFETY NET, IT'S
TRANSFORMATIVE IMPACT LITERALLY
HIDES IN PLAIN SIGHT ALL AROUND
US SERVING TENS OF MILLIONS OF
CALIFORNIANS TODAY. IT'S ALLOWED
COUNTIES TO INVEST IN CULTURALLY
ALIGNED SERVICES LIKE THOSE
DESCRIBED HERE TODAY THAT ARE
NOT INSURANCE REIMBURSABLE. EVEN
UNDER MEDICAL. IT'S HELPED US TO
PROVIDE SEED FUNDING TO BUILD
OUT OUR STATE'S NETWORK OF
NATIONAL SUICIDE PREVENTION
LIFELINE CALL CENTERS AS WELL AS
MOBILE CRISIS SERVICES. BEFORE
988 WAS EVEN A THING. IN FACT,
THERE WAS A QUESTION EARLIER
ABOUT INDEPENDENT ANALYSIS OF
THE IMPACT OF THE NHS A AND
PREVENTION WORK. LAST YEAR, A
RESEARCHER FROM USC DIDN'T
WHOLLY INDEPENDENT ANALYSIS OF
THE MHS A. IT WAS A PRE PEER
REVIEWED STUDY AND FOUND THAT IN
HIS ESTIMATES. THE MH ESSAY BY
ITSELF RESULTED IN 5600 AVOIDED
DEATHS BY SUICIDE FROM 2012 TO
2019. THAT'S THE POWERFUL IMPACT
OF OUR MENTAL SERVICES ACT IN
CALIFORNIA. IT'S ALSO BUILT OUT
AND FUNDED COMMUNITY HEALTH
WORKERS AND PEER SUPPORT
SPECIALISTS BEFORE THESE
SERVICES COULD BE REIMBURSED BY
MEDICAL AND FUNDED ARE SCHOOL
BASED SERVICES TO A VERY
SIGNIFICANT DEGREE. IT'S ALLOWED
US TO MAKE INVESTMENTS IN
WORKFORCE AND HOUSING OVER
DECADES, AND IT COVERS THE FULL
RANGE OF NEEDS IN OUR COMMUNITY
FROM WELLNESS AND PREVENTION TO
CRISIS SERVICES. TO OUR MOST
ACUTE HIGH LEVELS OF FULL
SERVICE PARTNERSHIPS AND
ASSOCIATED WRAPAROUND AND
WHATEVER IT TAKES APPROACH FOR
BOTH CHILDREN AND ADULTS. AND
OVER TIME, IT'S BECOME A PILLAR
OF MEDICAL FUNDING. èC COUNTIES
DO NEED TO PROVIDE THE NON
FEDERAL SHARE OF SERVICES. AND
SO TODAY WE LEVERAGE
APPROXIMATELY HALF OF THE IMAGE
TO SAY AS A SOURCE OF NON
FEDERAL SHARE OVER A BILLION
DOLLARS THAT GENERATES TWO
BILLION IN MEDICAL HEALTH
FUNDING FOR OUR STATEWIDE SAFETY
NET AND WHILE THE STATE HAS BEEN
WORKING AGGRESSIVELY UNDER THIS
ADMINISTRATION TO REALLY EXPAND
THE ARRAY OF SERVICES THAT WE
CAN REIMBURSE WITH MEDICAL,
WHICH IS WONDERFUL. I HAVE TO
NOTE THAT NEEDS HAVE GONE UP
TREMENDOUSLY AS WELL. AND THE
MORE WE EXPAND THE NUMBER OF
SERVICES THAT WE CAN OR MUST
REIMBURSE WITH MEDICAL MORE WILL
BE SEARCHING FOR THAT DOLLAR TO
PUT UP AS NON FEDERAL SHARE. WE
DON'T HAVE KIND OF AN EXISTING
SET ASIDE, OR SORT OF ENDLESS
SUPPLY OF FUNDING TO PAY FOR OUR
MEDICAL ENTITLEMENT
RESPONSIBILITIES. AND SO THE
BIGGER THAT OBLIGATION YES. THE
MORE WILL NEED TO FUND OUR
MEDICAL SERVICES. AT THE SAME
TIME, THE MHS S¼ AS WILL LIKELY
GET INTO OVER THE COURSE OF THE
NEXT YEAR IS BY FAR OUR MOST
COMPLEX AND VOLATILE FUNDING
STREAM. UM THAT VOLUNTARILY T
HAS BEEN COMPOUNDED BY THE
CHALLENGES THAT WE FACE JUST
WITH PLANNING HOW WE'LL SPEND
OUR DOLLARS. UM THE STATE
ESTIMATES REVENUES, BUT THEN
THERE'S A LAG WITH THE
ADJUSTMENT AND TO EXPLAIN IT A
LITTLE BIT BETTER. WE NEED TO
BUILD OUT THREE YEAR PLANS AND
SPEND TO THOSE PLANS WITH OUR
COMMUNITIES. LATER FUNDING IS
ADJUSTED EITHER UPWARD OR DOWN,
AND THAT HAS TO DO WITH HOW TAX
RECEIPTS COME IN. THIS FISCAL
AND CERTAINTY IS THEN LAYERED
WITH VERY STRICT REQUIREMENTS TO
ENSURE THAT EVERY PENNY OF OUR
SPENDING IS APPROVED THROUGH THE
LOCAL COMMUNITY PLANNING PROCESS
AS WELL AS OUR BOARD OF
SUPERVISORS, THEN VALIDATED BY
THE STATE AND NO MATTER WHETHER
THE FLUCTUATIONS WITH THOSE
ADJUSTMENTS ARE UP OR DOWN,
WE'RE STILL EXPECTED TO SPEND
ACCORDING TO OUR CATEGORICAL
SPENDING REQUIREMENTS AS THEY
ARE TODAY. IT MAY NOT COME AS
ANY SURPRISE THAT WITH THE WILD
RIDE THAT IS THE MHS A. OUR
MEMBERS WELCOMED THE
CONVERSATION ABOUT FINDING A
BETTER WAY TO DO THIS. THERE
MUST BE ONE AND YET, AS WE WORK
TO STREAMLINE AND SIMPLIFY AND
ADD TRANSPARENCY, WE BELIEVE
IT'S ESSENTIAL FOR US TO
UNDERSTAND HOW THE STATE'S
PROPOSAL LINES UP WITH WHAT'S
IMPORTANT TO OUR LOCAL
COMMUNITIES. TO PUT IT A
DIFFERENT WAY. THERE WILL BE
TRADE OFFS ASSOCIATED WITH THIS
RE PRIORITIZATION, AND WE
BELIEVE THAT THE ADMINISTRATION
AS WELL AS THE LEGISLATURE AND
COMMUNITIES NEED TO BETTER
UNDERSTAND THOSE TRADE OFFS.
UNDOUBTEDLY THE HOMELESS CRISIS
IN CALIFORNIA IS THE BIGGEST
ISSUE FACING OUR STATE. WE WOULD
ARGUE THAT THE MHS A IS ALREADY
HARD AT WORK ADDRESSING THIS
CRISIS UP AND DOWN THE CONTINUUM
FROM PREVENTION AND OUTREACH
THROUGH TO THE MOST SEVERELY
IMPACTED INDIVIDUALS WHO ARE
SERIOUSLY AND PERSISTENTLY
MENTALLY ILL. WHO OFTEN ACTUALLY
AVOID ENCAMPMENT WHERE THEY CAN
BE AT RISK FOR VIOLENCE. OFTEN
TIMES ARE MOST MENTALLY ILL
CLIENTS ARE HIDING UNDER FREEWAY
OVERPASSES AND REALLY IN SCONCE
TEST. AND WE DEFINITELY GO AND
LOOK FOR THEM, CONNECT WITH THEM
AND SEEK TO BRING THEM INTO
SERVICES. WE HAVE FAR MORE
COUNTY BEHAVIORAL HEALTH CLIENTS
WHO ARE ON HOUSED AND WHO WANT
HOUSING. THEN WE HAVE AVAILABLE
SOURCES OF HOUSING TO CONNECT
THEM WITH. AND THE REASONS FOR
THAT ARE VARIED THERE. MANY THEY
INCLUDE A LACK OF HOUSING SUPPLY
TO BEGIN WITH, BUT THEY ALSO
INCLUDE ANTIQUATED RULES
CONNECTED OFTEN TO HUD FUNDING.
UM, THAT DEEP PRIORITIZE PEOPLE
WITH THE MOST SIGNIFICANT MENTAL
HEALTH NEEDS IF YOU CAN BELIEVE
THAT, IT'S REALLY UPSIDE DOWN.
AND SO IN THOSE COUNTIES WHERE
WE'VE REALLY TRIED TO PARTNER
WITH OUR COC S, WE FOUND IT
ACTUALLY, SOMETIMES DEEP
PRIORITIZES OR DE EMPHASIZES OUR
CLIENTS. WE WOULD ARGUE THAT
LOOKING AHEAD. WE NEED TO ENSURE
THAT WE'RE MINDFUL OF OUR
COMMUNITIES NEEDS NOT ONLY TO
ADDRESS THE CRISIS BEFORE US,
BUT TO DO IT IN WAYS THAT RETAIN
THE LOCAL WISDOM ABOUT HOW TO
FOSTER AND SUSTAIN RECOVERY AND
PREVENT HOMELESSNESS IN THE
FIRST PLACE. YES, UM, WE ALSO DO
NEED TO RETAIN MEDICAL MATCH
UNDER THE MHSC. CONTINUE TO
COMMIT TO P E I, AS IT IS ONE OF
THE ONLY AND CERTAINLY THE BEST
SOURCE OF PREVENTION AND EARLY
INTERVENTION FUNDING. WE NEED TO
UNDERSTAND THAT THE MHS A IS
ACTUALLY A DRIVER OF EQUITY
WITHIN OUR BEHAVIORAL HEALTH
SYSTEM, MEANING THAT THE YOU
KNOW IT IS THE SOURCE OF FUNDING
FOR COMMUNITY DEFINED PRACTICES
, AND IT CANNOT REPLACE A
BROADER AND ONGOING SUSTAINED
INVESTMENT IN WHAT WE WILL NEED
AS A STATE. NOT ONE BUT NEED TO
ADDRESS HOMELESSNESS CONSISTENT
WITH OUR COUNTIES AT HOME
PROPOSAL PUT FORWARD BY C SEC.
WE OFF WELCOME THE OPPORTUNITY
TO SHARE MORE INSIGHTS AND, UM,
TO LEARN MORE AS WE GO ALONG THE
WAY ABOUT WHAT THE MHS IS DOING
TODAY AND HOW WE CAN IMPROVE THE
PUBLIC'S CONFIDENCE IN THAT WORK
THROUGH BETTER TRANSPARENCY AND
, UM, REALLY A BETTER
UNDERSTANDING ABOUT HOW THE
IMAGES S¼ FUNCTIONS. THANK YOU.
NEXT WE WILL HEAR FROM THE
DEPARTMENT OF FINANCE. NEBRASKA
DEPARTMENT OF FINANCE NOTHING TO
ADD. BUT HERE FOR ANY QUESTIONS
NEXT WE WILL HEAR FROM THE L. A.
HELLO. UM SO. THERE ARE TWO
MAJOR COMPONENTS OF THE MENTAL
HEALTH MODERNIZATION PROPOSAL
THAT THE L WOULD LIKE TO BRING
UP FOR THE COMMITTEE. UM NOW, AS
MORE LANGUAGE, UM, AND MORE
INFORMATION ABOUT THE PROPOSAL
COMES TO LIGHT. YOU KNOW, WE
WILL, OF COURSE. UM HAVE MORE
RAISE MORE INFORMATION FOR THE
COMMITTEE TO CONSIDER. UM
HOWEVER, AT THIS TIME, WE WOULD
LIKE TO HIGHLIGHT TWO THINGS.
FIRST IS THE CHANGE IN THE LOCAL
CATEGORICAL FUNDING AMOUNTS. UM
AS YOU'VE HEARD, THERE'S A
NUMBER OF TRADE OFFS TO CONSIDER
WHEN EVALUATING HOW TO ALLOCATE
THE RESOURCES. AH PROVIDED BY
THE NHS A AND. THOSE CONCERNS,
YOU KNOW, WILL BE WILL BE WORKED
THERE AND HASHED OUT. WE JUST
WANT TO BRING BEFORE THE
LEGISLATURE THAT WE THINK IT IS
VERY REASONABLE FOR THE
LEGISLATURE TO RECONSIDER THE
PRIORITIES OF THIS FUNDING. UM
AS TIME GOES ON, AND EVOLVING
ISSUES TAKE PLACE IN THE STATE.
UM. THAT BEING SAID, TO THE
DEGREE THAT SOME OF THESE
CATEGORIES CHANGED. WE
ACKNOWLEDGE THAT COULD HAVE SOME
DISRUPTION TO THE CURRENT
SERVICES THAT ARE PROVIDED BY
COUNTIES HAD THE LOCAL LEVEL. UM
SO A COUPLE OF THINGS TO THE
LEGISLATURE COULD CONSIDER AS
THEY'RE VALUING THIS PROPOSAL.
IS TO THE DEGREE THAT THE
CATEGORIES ARE CHANGED AT
LEGISLATURE COULD CONSIDER
DELAYS IN IMPLEMENTATION. TO THE
CHANGING FUNDING CATEGORIES TO
REALLY ALLOW, UM TIME FOR BETTER
EVALUATION OF HOW THESE CHANGES
WILL IMPACT CURRENT SERVICE
LEVELS. SECONDLY THE TO HELP
ADDRESS THE EVOLVING POLICY
NEEDS OF THE STATE MOVING
FORWARD BEYOND THIS PROPOSAL, UM
, THE LEGISLATURE COULD CONSIDER
PROVISIONS THAT WOULD ALLOW
CHANGES IN THE ALLOCATION OF
FUNDING MOVING FORWARD WITHOUT
GOING BACK TO THE VOTERS FOR
ANOTHER BALLOT MEASURE. UM, SO
THAT'S SOMETHING TO CONSIDER
THERE. THE OTHER COMPONENT THAT
WE WOULD LIKE TO DRAW ATTENTION
TO IS THE REDUCTION IN THE
ALLOWABLE PRUDENT RESERVES FROM
33% TO THE 20 AND 25%
RESPECTIVELY, FOR A LARGE AND
SMALL COUNTIES. SO UM, AS WAS
STATED, THE MHS, A MAJOR, SAYS
FUNDING SOURCE, WHICH IS THE 1.
ON TAX ON INCOMES OVER A MILLION
DOLLARS, UM, IS AMONG THE MOST
VOLATILE IN THE STATE'S BUDGET.
UM FLUCTUATES. TO A LARGE DEGREE
YEAR OVER YEAR. AND GENERALLY,
REVENUE VOLATILITY IS MANAGED BY
TWO THINGS EITHER. THROUGH
RESERVES OR CHANGES IN THE
ACTUAL TAX STRUCTURE. UM SO MHM
CURRENTLY ALLOWS COUNTIES TO
MANAGE THE VOLATILITY BY KEEPING
A FAIRLY SIZABLE RESERVE AMOUNT
AND LOWERING THE RESERVE CAPS AS
THE ADMINISTRATION
ADMINISTRATION PROPOSES DOES
WEAKEN THIS TOOL. UM AND SHOULD
BE CONSIDERED CAUTIOUSLY. UM,
THAT BEING SAID, UM, AS AN
ALTERNATIVE OF THE LEGISLATURE
COULD CONSIDER, UM. FUNDING THE
NHS, A MOVING FORWARD WITH
PERHAPS A LESS VOLATILE REVENUE
STREAM ON NOT NECESSARILY THE
MILLIONAIRE'S TAX. UM, AND DOING
SO. WOULD NOT NECESSARILY
REQUIRE. CHANGES IN THE ACTUAL
TAX STRUCTURE, BUT RATHER HAVE A
JUST A MORE CONSISTENT FUNDING
FOR COUNTIES, UH, IN THE FUTURE.
THANK YOU. WE'LL BRING IT UP TO
THE DIOCESE FROM MEMBERS.
QUESTIONS WILL BEGIN WITH DR
JACKSON. THANK YOU VERY MUCH. MR
CHAIR. THIS IS UM, VERY, VERY
IMPORTANT AND, UM, REALLY
EXCITING DISCUSSIONS. EVEN AT
THIS TIME, I'M STILL EXCITED.
JUST WANT TO LET YOU KNOW. COULD
BE HAVE A LITTLE PEP. AH DO. UM
BUT A FEW THINGS THAT I WANT TO
HIGHLIGHT NUMBER ONE. LIKE I
SAID BEFORE I CAME HERE I WAS AN
ADMINISTRATOR OF A P E I PROGRAM
THROUGH THE IMAGE ESSAY. AND I
THINK THAT AS WE LOOK TO REFORM
THAT WE HAVE TO FOCUS ON
SCALABLE PROGRAMS. SOMETIMES WE
ARE. SO WE CREATE, UM LITTLE
NUGGETS OF EXCELLENCE. BUT IT
DOESN'T TRANSFORM. RIGHT WE
CAN'T IT CAN'T. UM A OTHER
COMMUNITY BASED ORGANIZATION
CAN'T TAKE THAT SAME MODEL. WITH
THE FUNDING THAT THEY HAVE. AND
IMPLEMENT THE SAME PROGRAM. AND
IN MANY CASES, COUNTIES WILL
WILL SAY THAT THIS IS ACTUALLY
PROPRIETARY INFORMATION. HOW CAN
WE BE CREATING PROGRAMS? THAT
ARE, UM BUT STILL HAVE GREAT
OUTCOMES. DON'T GET ME WRONG,
RIGHT? GREAT OUTCOMES. VERY
SMALL POPULATION. AND NO ONE CAN
LEARN FROM IT. THAT HAS GOT TO
CHANGE. RIGHT. THAT HAS GOT TO
CHANGE. SO I WOULD SAY IF WE'RE
GOING TO CONTINUE ON WITH PE I
IT NEEDS TO BE MORE SCALABLE. UH
WITH THE ABILITY FOR OTHER
ORGANIZATIONS THAT ARE IN THE
COMMUNITY. THAT CAN REPLICATE
IT. SO THAT WE CAN GET MORE. UM
BANG FOR OUR BUCK WHEN IT COMES
TO THOSE THINGS. SECONDLY, I DO
AGREE. WE GOT TO LET THE DATA
GUIDE US. AH! AT THE TOP OF THE
LIST IN TERMS OF MENTAL HEALTH
IS YOUTH MENTAL HEALTH. WHEN YOU
LOOK AT THIS PERCENTAGE AND HOW
WE WANT TO ALLOCATE DOLLARS.
THIS DOESN'T REFLECT THE DATA.
SO WE NEED TO MAKE SURE THAT WE
HAVE WE LITERALLY WE ACTUALLY DO
HAVE A SEPARATE PERCENTAGE FOR
YOUTH WHEN IT COMES TO MAKING
SURE THAT THE ARE ABLE TO, UM.
ARE BEING ABLE TO BE A SERVE TO
MEET THE MOMENT OF THIS CRISIS.
UM. I'LL NEVER STOP SAYING ABOUT
SCREENINGS IN SCHOOLS. WE NEED
TO FIND A WAY TO CONTINUE TO DO
THOSE THINGS SO THAT WE CAN
ACTUALLY DO SOME EXTRA
PREVENTION, UH SO THAT WE CAN
CATCH THEM EARLY. AND THEN WE
NEED TO ALSO THINK ABOUT.
THERE'S A LOT IN HERE ABOUT
INPATIENT SERVICES. FOR THE MOST
SEVERE MENTAL, MENTAL, MENTALLY
ILL. UM BUT THERE'S NOTHING
ABOUT OUTPATIENT EITHER. NOT
ONLY DO WE NEED INPATIENT
FACILITIES. WE ALSO NEED A LOT
OF OUTPATIENT FACILITIES AS WELL
SO THAT WE CAN PREVENT THEM FROM
GETTING INTO THE MORE EXPENSIVE
AND PATIENT SERVICES. THOSE
FACILITIES ARE EQUALLY AS
IMPORTANT. AND I SAY THAT AS
SOMEONE WHO ACTUALLY TOOK A
FAMILY MEMBER TO AN OUTPATIENT
FACILITY. IN MY COUNTY. UM. AND
THEN FINALLY, I WOULD JUST SAY
THAT OBVIOUSLY WE WERE GOING TO
HAVE TO HAVE SOME MORE. UM. NEW
ONES. CONVERSATIONS TO MAKING
SURE THAT ARE WE REALLY UM OR
EVEN SOME OF THESE CATEGORIES
FLEXIBLE ENOUGH TO MEET THE
LOCAL NEEDS A PARTICULAR
COUNTIES. SOME COUNTIES MIGHT
NEED MORE IMPATIENT. SOME
COUNTIES MIGHT NEED MORE
OUTPATIENT FACILITIES, RIGHT?
AND SO I'M I'M WORRIED THAT
WE'RE NOT. THAT WE HAVE TOO MUCH
OF A COOKIE CUTTER APPROACH WHEN
IT COMES TO SOME OF THESE
PERCENTAGES AND CATEGORIES, AND
WE CAN TALK ABOUT THE SPECIFIC
ONES LEFT LATER. UM BUT BESIDES
THAT, I MEAN, I THINK OBVIOUSLY
WE HAVE A LOT OF NEEDS THAT
WE'RE TRYING TO SERVE DURING
THIS. UM UH, WITH THIS REFORM.
UM, BUT OF COURSE. UM I THINK
THAT IT'S A GOOD START. GREAT
START. I LOVE THE GREAT
CONVERSATION AND LOOKING FORWARD
TO GETTING OUR HANDS DIRTY.
THANK YOU. OKAY I'LL BRING IT UP
TO THE CHAIR. IF I CAN. I'M
GOING TO BEGIN DIRECTOR BOSS
WITH WHERE YOU STARTED THAT THIS
IS A WORK IN PROGRESS AND
APPRECIATE THE OPPORTUNITY TO
GET INTO CONVERSATIONS THAT
SOMETIMES HAVE FRICTION, BUT WE
TRY AND WORK THROUGH IT. THAT
I'M TRYING TO UNDERSTAND REALLY
. THE COMMUNITY SUPPORTS AND
SERVICES THAT SEEMS TO BE A
FOCUS OF THE DISCUSSION HERE
TODAY. UM YOUR COMMENT WAS THAT
IT REALLY IS THERE AS A OVERALL
PERCENTAGE TO CREATE MORE
FLEXIBILITY. AND WHAT WE'RE
HEARING FROM. UM OUR COUNTY
PARTNERS IS THAT IT MAY DECREASE
FUNDING TOWARDS CERTAIN
POPULATIONS. SPECIFICALLY IF WE
LISTEN TO CHILDREN NOW IT WAS
DECREASING FUNDING TOWARDS
CHILDREN. AND I'M QUESTIONING
WHETHER. CREATING MORE
FLEXIBILITY IS DEEP,
PRIORITIZING OR NOT, AND YOU
WERE REALLY CLEAR WITH YOUR
STATEMENT THAT IT DOES NOT DEEP
, PRIORITIZED CHILDREN THAT I'M
TRYING TO FIGURE OUT HOW THAT
FLEXIBILITY SHOWS OUR
PRIORITIZATION THINK PART OF IT
IS REALLY CONSIDERING THE
CONTEXT OF ALL THE INITIATIVES
UNDERWAY WITHIN THE STATE AND SO
KIND OF THE STATEMENT THAT THE
ADMINISTRATION IS DE PRIORITIZED
MILD TO MODERATE AS DE
PRIORITIZE CHILDREN IS JUST NOT
NOT THE CASE. IT'S ONE OF OUR
CLINICAL FOCUS AREAS IN THE
MEDICAL SPACE. IT'S CLEARLY
DEMONSTRATED WITH THE CHILDREN
AND YOUTH BEHAVIORAL HEALTH
INITIATIVE AND ALL THE
PREVENTION UPSTREAM WORK THAT IS
HAPPENING THERE CAN INCLUDING
EVIDENCE BASED PRACTICES AND
COMMUNITY FIND PRACTICES AND
GRAHAM IT'S TO REALLY BUILD OUT
THE SCALE ABILITY THERE AND SO
BEING MY COMMENT IS DEFINITELY
ALSO WANTING TO BE TAKEN IN THE
CONTEXT OF EVERYTHING THAT IS
GOING ON IN THE STATE, AND THAT
THIS THIS BUCKET IS REALLY
INTENDED TO BE THE GROUT
INTENDED TO BE THE PLACES WHERE
MAYBE MEDICAL DOLLARS CAN'T BE
USED TO ALSO REALLY RECOGNIZE
THE POSSIBILITIES OF THOSE
DOLLARS AS WELL, NOT JUST TO BE
USED AS MATCH FOR MEDICAL AND
ALSO RECOGNIZING THAT WITH THE
ADDITION OF SOME OF THESE
BENEFITS, DIABETIC PIERS,
COMMUNITY HEALTH WORKERS. WE ARE
ALL NOW ABLE TO DRAW DOWN
FEDERAL DOLLARS AND WENT IN
TIMES WHEN WE WERE NOT ABLE TO
BEFORE AND SO REALLY THINKING
ABOUT THIS COMPREHENSIVELY AND
AS WE GET TO THE NEXT TOPIC
ABOUT ACCOUNTABILITY AND
TRANSPARENCY, OUR WHOLE GOAL AND
I CAN'T SAY THIS ENOUGH IS
REALLY ABOUT THINKING ABOUT THE
ENTIRE COMMUNITY BEHAVIORAL
HEALTH SYSTEM AND NOT JUST
IMAGES SAY IN ONE VEIN, CALIMA
AND ANOTHER VEIN OR OTHER
WAIVERS IN ANOTHER VEIN, IT'S
HOW DO YOU LOOK ABOUT THIS
COMPREHENSIVELY WITH OUR MANAGED
CARE PLANS OR LOCAL HEALTH
JURISDICTIONS AND SOME OF THEIR
PREVENTION DOLLARS THAT THEY GET
, AND THAT'S HOW THROUGH THE
COMMUNITY KIND OF CONVERSATION.
I THINK LOCALS WILL BE ABLE TO
DESIGN PROGRAMS AND KIND OF JUST
A COMPREHENSIVE APPROACH TO
COMMUNITY BEHAVIORAL HEALTH. AND
I WILL SAY WHEN THE GOVERNOR WAS
AT MCLEAN WITH ME LISTENING TO
STUDENTS, I DID NOT FEEL HE WAS
DEEP PRIORITIZING AND THE
OVERALL EMPHASIS OF THIS
ADMINISTRATION TO FOCUS UPSTREAM
IS NOTED BY THOSE OF US WHO ARE
SERVING HERE. I THINK WHAT WE'RE
REALLY TRYING TO GET OUT,
THOUGH, IS THE PERCENTAGES. MHM
AND, UM, I WAS STRUCK BY MISS
FRANCES, WHO SPOKE ABOUT THAT
OVER 50% DOLLARS ARE SPENT ON
THE CHILDREN. DOES THAT GO AWAY
AFTER WE NOW MOVE INTO COMMUNITY
SUPPORTS AND SERVICES? ARE WE
STILL GOING TO BE A PRIORITY? IT
SEEMS LIKE WE'RE GIVEN THAT
FLEXIBILITY, BUT WE'RE NOT AGAIN
FOCUSING TO ENSURE THOSE DOLLARS
ARE SPENT ON. THAT'S THE
BALANCE. YOU SET STRICT
PERCENTAGES. THEN YOU TAKE AWAY
SOME OF THE FLEXIBILITY AND
REALLY UNDERSTANDING WHAT THE
NEEDS OF THE COMMUNITY ARE. SO
AGAIN. WE'RE OPEN. WE YOU KNOW
THIS IS AN ONGOING CONVERSATION
AND REALLY ALSO THINKING ABOUT
PREVENTION. THE DIFFERENCE
BETWEEN PREVENTION FROM A
POPULATION BASED AND PUBLIC
HEALTH APPROACH REALLY MORE
BROAD BASED INTERVENTION VERSUS
PREVENTION, WHICH IS MORE
INDIVIDUAL BASED SERVICES, WHICH
YOU KNOW, WE NOW DO HAVE SOME
ADDITIONAL FUNDING SOURCES FOR
THAT TYPE OF WORK, SO YOU KNOW
LOTS TO CONTINUE TO DISCUSS AND
THINK THROUGH AS WE AS WE BUILD
THIS OUT. UM WHILE GIVING THEM
THE FLEXIBILITY. COULDN'T WE
ALSO BE ENCOURAGING THEM TO BE
SPENDING THOSE DOLLARS ON
CHILDREN? IF YOU'RE GOING TO
HAVE P E I DOLLARS THAT THE
COUNTY IS SPENDING TO ENSURE
THAT THEY SPEND OVER 50% OF
THOSE DOLLARS ON CHILDREN'S
SEEMS LIKE A LOGICAL THING FOR
US TO UM MOVE FROM THEM FORWARD
THAT I'M WONDERING WHY. I WILL
ALSO NOTE EARLY INTERVENTION SO
NOT THE PREVENTION SIDE OF THIS,
BUT THE EARLY INTERVENTION ARE
ARE SERVICES THAT ARE GENERALLY
MOSTLY ALL MEDICAL COVERED, AND
SO REGARDLESS OF IF WE SET UP A
CERTAIN PERCENTAGE RELATED TO
EARLY INTERVENTION, THESE ARE
ENTITLEMENT SERVICES ON THE
MEDICAL SIDE THAT HAVE TO BE
PAID FOR OR PROVIDED YOU THINK
ABOUT CRISIS SERVICES. THOSE ARE
MEDICAL SERVICES. AND SO THOSE
ARE ENTITLEMENTS. WE HEARD ABOUT
THE COMMUNITY DEFINED EVIDENCE
BASED PRACTICES ARE THOSE
SERVICES, WHICH ARE COVERED BY
MEDICARE CAL BECAUSE IT SEEMS AS
IF THAT THEY'VE BEEN INCREDIBLY
SUCCESSFUL AT DEALING WITH MANY
OF THE CULTURAL AND LINGUISTIC
NEEDS, BUT IT'S PART OF OUR KIND
OF OUR PROPOSAL. WE WOULD WANT
TO EMBED THAT IN ALL OF THE
DIFFERENT CATEGORIES, REALLY
PUSHING THE BOUNDARIES OR WHAT
ARE SOME OF THE COMMUNITY TO
FIND PRACTICES, BUILDING THE
EVIDENCE BASED SO THEN
EVENTUALLY THEY CAN TURN INTO
STATEWIDE STRATEGIES. BUT
CURRENTLY MEDICAL DOESN'T FUND
COME FROM THE COMMUNITY SUPPORTS
AND SERVICES, WHICH UM, AS WE
HEARD FROM THE PRESIDENT COUNTY
DIRECTOR REALLY HAS LED TOWARDS
GREAT RESULTS WITHIN THE MONNING
HELPING HANDS. I'LL ELEVATE THE
SWEET POTATO PROJECT THAT WE
HAVE FOR OUR AFRICAN AMERICAN
COMMUNITY IN SOUTHWEST FRESNO,
AS WELL AS JUST SOME GREAT
EXAMPLES OF AND I WOULD ALSO SAY
THERE'S COMPONENTS THERE FOR FSP
AS WELL. SO THERE ARE SOME FSP
PROBABLY IDEAS WITH COMMUNITY
FIND PRACTICES THAT CAN BE
INCORPORATED IN THAT BUCKET AND
LIKELY IN THE HOUSING BUCKET AS
WELL IS, I THINK, AS COUNTY IS
REALLY THINK ABOUT WHAT THESE
INTERVENTIONS MIGHT LOOK LIKE I
WANTED TO FOLLOW UP WITH THE AH
, YOU PIQUED MY INTEREST CHANGES
TO PERCENTAGES WITHOUT GOING TO
THE BALLOT MEASURE. I'M TRYING
TO UNDERSTAND WHAT THAT LOOKS
LIKE AND FEELS LIKE BECAUSE IF I
WOULD WANT TO ENSURE THAT AT THE
END OF THE DAY, THE PUBLIC THE
PARTNERS WHO ARE GOING TO BE
IMPLEMENTING HAVING ABILITY TO
ENSURE THAT THEIR VOICES ARE
SIMILARLY HEARD THAT I'M TRYING
TO UNDERSTAND WHAT YOU THINK
THAT WOULD LOOK LIKE ABSOLUTELY
. AND YOU KNOW, AS THIS PROPOSAL
TAKES SHAPE, OBVIOUSLY VERY
HAPPY TO WORK WITH THE COMMITTEE
ON THIS SPECIFIC LANGUAGE, UM,
OF THAT. BUT. HISTORICALLY THERE
HAVE BEEN CHANGES, UM, WITHIN
THE EITHER THE COMMUNITY
SERVICES SUPPORTS THE P E I,
THERE HAVE BEEN CHANGES WITH
WITHIN THOSE CATEGORIES. WHAT
COULD BE FUNDED THAT HAVE NOT
NEEDED TO GO TO THE VOTERS,
RIGHT? BUT THOSE OVERALL
CATEGORIES HAVE STILL EXISTED.
UM SO WHEN WE'RE TALKING ABOUT
FLEXIBILITY IN THE FUTURE TO
CHANGE THOSE WERE WE REALLY ARE
TALKING ABOUT CHANGES INTO OF
THOSE OVERALL CATEGORIES. SO UM
, WHEREAS YOU KNOW, CURRENTLY IT
IS THE 20% FOR P AND I WHAT THAT
20% COULD CHANGE. BUT IT'S 20%
FLAT FOR P I MOVING FORWARD. UM
WE THINK IT WOULD BE REASONABLE
FOR THE LEGISLATURE TO CONSIDER
, UM THROUGH SOME TYPE OF
PROCESS. UM YOU KNOW THE ABILITY
TO ALTER THAT PERCENT, WHETHER
THAT NEEDS TO BE INCREASED OR
DECREASED AND UNDER THE PROPOSAL
, FOR EXAMPLE, WITH THE 30% FOR
HOUSING AND RESIDENTIAL
SERVICES. DOES THAT NEED TO GET
SHIFTED UP OVER TIME SHIFTED
DOWN OVER TIME, DEPENDING ON THE
STATE'S ONGOING NEEDS SIMPLY AND
LIKE THAT, WE THINK THE
LEGISLATURE COULD VERY MUCH.
CONSIDER. WITHIN THAT
CONSIDERATION. WOULD THERE BE AN
OPPORTUNITY FOR US TO INSIST ON
A CERTAIN AMOUNTS WITHIN
COMMUNITY SUPPORTS AND SERVICES
TO BE SPENT ON P E. N I IF IT
WAS A PRIORITY OF THE
LEGISLATURE, ABSOLUTELY. I MEAN
, THAT'S CURRENTLY THE CASE NOW
WHERE THERE IS A SET ASIDE FOR P
E I. IT'S CERTAINLY REASONABLE,
UM, FOR LEGISLATIVE PRIORITIES
TO DECIDE THAT P I IS SOMETHING
THAT IS IMPORTANT, MOVING
FORWARD AND AGAIN, IT COULD BE
EXCEPT PERCENT. IT COULD BE WHAT
THAT FUNDING INCLUDES. IT'S
ABSOLUTELY WITHIN THE
LEGISLATURE'S PURVIEW, AND WE
THINK THAT GIVEN THE NATURE OF
POTENTIALLY BRINGING THIS UP IN
A BALLOT MEASURE COULD BE A
CHANCE FOR THE LEGISLATURE TO
INCLUDE SOME LANGUAGE TO GIVE IT
MORE FLEXIBILITY IN THE FUTURE
AS WELL. UM THIS NEXT QUESTION
IS FOR MR CABRERA. AND FOR TOBY
EWING, UM, WITHIN THAT COMMUNITY
SUPPORTS AND SERVICES. IF WE
TAKE CURRENT PERCENTAGES, ITS
20% FOR P AND I 5% FOR
INNOVATION. IT DOESN'T LEAVE
MUCH FOR THE REMAINING ITEMS
THAT YOU LISTED WHICH ARE
CAPITAL IMPROVEMENT. TECHNOLOGY
AND WORKFORCE INVESTMENTS CAN
CAN YOU SPEAK TO WHAT THEN
OCCURS IF WE CONTINUE OUR LEVELS
OF PE AND I AND IN A VACATION TO
THOSE OTHER CATEGORIES. UM WHAT
WOULD TRANSPIRE IF THEY WERE ALL
WITHIN ONE BUCKET? THANK YOU FOR
THIS QUESTION. CHAIR MICHELLE
CABRERA WITH THE COUNTY
BEHAVIORAL HEALTH DIRECTORS
ASSOCIATION. WE'VE ACTUALLY BEEN
WORKING WITH OUR MEMBERS TO TRY
AND UNDERSTAND WHAT HAPPENS IF
YOU HAVE A TABLE FOR FOUR AND
YOU'RE TRYING TO CREATE ROOM FOR
SEVEN. SO WE'RE DOING A LOT OF
ANALYSIS RIGHT NOW ABOUT NOT
JUST WHAT HAPPENS WITH C F T N
AND WENT AND SOME OF THESE OTHER
COMPONENTS, BUT WE'RE ASKING TO
ADD PULL UP A CHAIR FOR SUD ONLY
SERVICES, RIGHT, AND WE'RE
PULLING UP A COUPLE OF CHEERS
FOR HOUSING AND WE'RE LOOKING AT
OKAY. WHAT'S THE COLLECTIVE
IMPACT HERE? BECAUSE NOT ONLY DO
WE HAVE WHAT'S FUNDED, UM, UNDER
CSS WITH REGARD TO THOSE, UM,
POTENTIAL TRANSFERS FOR
WORKFORCE FUNDING FOR CAPITAL
AND TECHNOLOGY AND
INFRASTRUCTURE. THERE'S ALSO THE
REST OF CSS THAT IS NOT FULL
SERVICE PARTNERSHIPS, WHICH WE
HAVEN'T TALKED MUCH ABOUT TODAY
. BUT THAT TURNS OUT TO BE A
VERY IMPORTANT SEE AT THIS TABLE
AND A VERY IMPORTANT SET OF
SERVICES. WE'RE TALKING BREAD
AND BUTTER, OUTPATIENT CARE. AND
TO YOUR POINT, DR JACKSON. I
MEAN, WE'VE LOOKED AT SOME OF
OUR HIGHEST PERFORMING COUNTIES
, THEY ARE HIGH IN THE PERKS.
COST PER BENEFICIARY OUTPATIENT
MENTAL HEALTH SPENDING. VERY
HIGHLY INVESTED THERE, AND THE
RESULTS ARE VERY FEW PEOPLE
NEEDING VERY ACUTE INPATIENT OR
, YOU KNOW, KIND OF FORCED
TREATMENT, KINDS OF OPTIONS.
IT'S A FAIRLY SIMPLE RECIPE, BUT
IT DOES REQUIRE THAT DEEP
INVESTMENT IN OUTPATIENT AND
UPSTREAM SERVICES, UM SO WE
THINK IT'S CRUCIAL. TO NOT PUT
OUR SYSTEM IN OUR CLIENTS WHOSE
WHO ARE REAL PEOPLE WITH REAL
LIVES WHO COULD BE DESTABILIZED
AND THEN FACE VERY SIGNIFICANT
NEGATIVE OUTCOMES FOR US TO VERY
CAREFULLY CONSIDER HOW WE'RE
GOING TO MAKE THAT ALL YOU KNOW
, KIND OF WORK TOGETHER IN TURN
AROUND AND AGAIN. WHAT ARE THE
TRADE OFFS? WHAT ARE WE LOOKING
AT? POTENTIALLY PUTTING A LITTLE
BIT OF A SQUEEZE ON AS WE TRY TO
MAKE MORE SEATS AT THE TABLE. DO
YOU WANT? THANK YOU, MR CHAIR. I
CAN TELL YOU FROM EXPERIENCE YOU
SLICE THE TOMATO A LOT THINNER
WHEN YOU ADD THREE EXTRA SEATS
TO THE TABLE. UM SO THE WAY THE
FORMULA WORKS NOW 80% FOR CSS,
BUT YOU'RE REQUIRED TO DO A SET
ASIDE OF 5% FOR INNOVATION, SO
THAT'S SEVEN TO THAT 80 ACTUALLY
BECOMES ABOUT 76. UM I THINK
PART OF THE REASON WHY THEY'RE
COUNTIES HAVE BEEN CHALLENGED TO
DEDICATE THE MAJORITY TO F SPS
BECAUSE THAT WOULD SAY 38% OR SO
FOR F SPS AND ABOUT THE BALANCE
FOR EVERYTHING ELSE. AND THE LAW
ALLOWS COUNTIES TO SHIFT UP TO
20% OF CSS INTO WORKFORCE
TECHNOLOGY. PRUDENT RESERVE,
RIGHT AND THEY'RE REQUIRED TO
HAVE AT LEAST ONE WORKFORCE
EDUCATION AND TRAINING PROGRAM
EVERY GIVEN YEAR. SO THAT 38% IF
THEY'RE MAXIMIZING THAT WHICH IS
28% 20. IT LEAVES ME 18. FOR
EVERYTHING ELSE. THE BREAD AND
BUTTER RIGHT? THE CORE IT, YOU
KNOW, NOT NOT THE EXTENSION
THERE. UM UM, BUT THE WAY THE
LAW IS WRITTEN TODAY IS IT GIVES
THE COUNTIES THE FLEXIBILITY AND
I, I PERSONALLY AND I THINK FROM
THE PERSPECTIVE OF THE WORK THAT
WE HAVE SEEN, UM, ADDING,
SUSTAINING THAT FLEXIBILITY
PARTICULARLY IF WE SUPPORTED IT
WITH THE KIND OF TECHNICAL
ASSISTANCE AND CAPACITY BUILDING
AROUND SCALING SCALING HAPPENS
WHEN THINGS ARE EASY TO DO.
SCALING DOESN'T HAPPEN WHEN IT'S
HARD. AND A KEY COMPONENT OF
EASY TO DO IS SUSTAINABLE
FINANCING. CLEAR AND CONSISTENT,
AVAILABLE STAFFING. AND
CONFIDENCE THAT WE KNOW WHAT
WE'RE DOING, WHICH OFTEN COMES
WITH THAT KIND OF CAPACITY
BUILDING AND TRAINING THE
CALIFORNIA THE CHALLENGES
BEHAVIOR HEALTH INITIATIVE IS A
PHENOMENAL EXAMPLE THROUGH THE
EVIDENCE AND SEE THAT GRANTS
THAT THE DEPARTMENT IS MAKING
AVAILABLE AND THAT THE
COMMISSION IS PARTNERING WITH
THE DEPARTMENT TO MAKE
AVAILABLE. IS A TREMENDOUS
OPPORTUNITY FOR THE STATE TO
PROVIDE THAT LITTLE PUSH FOR
COUNTIES THAT HAVE NOT ALREADY
ADOPTED EVIDENCE BASED PRACTICE
TO EXPLORE AND LEARN WITH THEIR
COLLEAGUES. RIGHT, BUT WE
RECOGNIZE THAT MAYBE A CHAI IS
SHORT TERM. AND IT'S ONLY KIDS.
IT'S NOT OLDER ADULTS. IT'S
RIGHT. SO. I THINK IT WOULD BE
ONE WAY TO APPROACH THIS IS TO
HOW DO WE CREATE A SYSTEM THAT
IS GOING TO BE RESPONSIVE TO THE
COUNTIES, WHICH WORKED VERY HARD
TO CLARIFY THAT THESE FUNDS CAN
BE USED FOR HOUSING, BY THE WAY,
RIGHT? THAT THAT ABILITY IS
ALREADY THERE. HOW DO WE WORK?
HOW DO WE SUPPORT THEIR ABILITY
TO BE SUCCESSFUL? GIVEN THE FACT
THAT WE ONLY HAVE SO MANY SEATS
OR SO MANY SO MUCH FOOD AT THAT
TABLE TO MAKE SURE THAT IT IS
MOST EFFECTIVELY USED, UM AND TO
AND TO RECOGNIZE THAT WHAT'S
HAPPENING IN LOS ANGELES IS VERY
DIFFERENT THAN WHAT'S HAPPENING
IN MODOC AND MONO. RIGHT
PARTICULARLY AROUND THE PRUDENT
RESERVE. I DIDN'T SAY THIS
EARLIER. BUT YOU KNOW, ONE OF
THE CHALLENGES THAT WE HAVE HAD
IS THE NOTION THAT THE STATE
CONTROLS WHETHER OR NOT COUNTIES
CAN ACCESS THE PRUDENT RESERVE
AND IT'S ONLY DURING A DOWNTURN
IN THE ECONOMY DURING COVID, THE
ECONOMY DIDN'T TURN DOWN BUT
NEEDS SHOT UP AND A COUNTY THAT
WANTED TO ACCESS THEIR PRUDENT
RESERVE BECAUSE THEY FELT THAT
THEY HAD SET IT ASIDE AT A PRIOR
TIME WHEN THERE WAS ENOUGH EXTRA
BUT THEY NEEDED IT TODAY WOULD
NOT HAVE ACCESS TO THAT. SO YOU
KNOW, HOW DO WE FIND THE SWEET
SPOT BETWEEN THE FLEXIBILITY TO
ADAPT OUR FINANCES? THE ESSAY
BUT NOT JUST THE ESA REALIGNMENT
AND MEDICAL TO YOU KNOW TO
RESPOND TO REFLECT THE DIVERSE
GEOGRAPHY, DEMOGRAPHY AND
POLICIES AND PRACTICES AND
REALITIES OF FIFTH OF CALIFORNIA
FROM IMPERIAL TO DELL NORTH,
RIGHT? AND DO SO IN A WAY THAT
LEVERAGES THAT CONSISTENCY OF
EFFECTIVE INTERVENTIONS THAT
WE'RE LEARNING COLLECTIVELY.
RIGHT AND RECOGNIZES THAT
VOLATILITY ISN'T JUST IN THE MHS
A AND THIS HAS COME UP IN IN IN
THIS TOPIC OF BUILDING. UM, WE
HEAR MANY COUNTIES RAISED THE
ISSUE OF THE AUDIT RISK OVER A
FIVE YEAR TIMEFRAME AS CREATING
, UM, AN INCENTIVE FOR THEM TO
BE HESITANT. TO BE ASSERTIVE
ABOUT SPENDING MHS A AND TO BE
AGGRESSIVE ABOUT BUILDING AND SO
, UM, YOU KNOW, FINDING THAT
BALANCE AND YOU KNOW, ONE OF THE
QUESTIONS THAT WERE BEGINNING TO
THINK ABOUT IN THE CONTEXT OF A
MANDATORY MEDICAL BILLING IS
UNDER REALIGNMENT. WHAT WE DID
IS WE SHIFTED A LOT OF THE
FISCAL RISK ONTO THE COUNTIES.
FOR FEDERAL AUDIT EXCEPTIONS.
AND SO PART OF THE REASON WE SEE
VARIATION IN HOW COUNTIES BILL
MEDICAL IS BECAUSE THEIR LOCAL
TOLERANCE FOR RISK TAKING IN
TERMS OF BUILDING AND SO YOU
KNOW, WE'RE CHALLENGED BY THE
NOTION THAT THE STATE WILL SET
THE REQUIREMENTS OF THE BUILDING
THAT HAPPENS, BUT WILL THE STATE
SHARE THE FINANCIAL RISK? OF THE
AUDIT EXCEPTION. WHEN BUILDING
IS DONE IN A WAY THAT MAY OR MAY
NOT MEET FEDERAL RULES. THERE
WAS SOMETHING IN YOUR COMMENT
THERE THAT REALLY STRUCK ME AND
THAT WAS THAT COUNTIES ARE NOT
CURRENTLY INVESTING IN THE
HOUSING AND YET WE ALSO TO A
SIGNIFICANT EXTENT AS THE
PERCENTAGES THAT ARE BEING
PROPOSED. IN THE, UM REFORM THAT
WE'RE LOOKING AT THAT THAT I'M
TRYING TO UNDERSTAND WITH ALL OF
THIS HOUSING NEED THAT WE HAVE,
HOW WE KEEP PEOPLE HEALTHY IF
THEY ARE UNHAPPY, HOUSED. WHY IF
YOU HAVE THE FLEXIBILITY TO USE
THOSE DOLLARS ON HOUSING, HAVE
WE NOT? BEEN USING MORE OF THOSE
DOLLARS FOR HOUSING. MY ANSWER
WOULD WOULD BE THAT IN SOME
PLACES. THEY ARE RIGHT. IN SOME
PLACES. WE HAVE VERY STRONG
EXAMPLES. SO THE SITE VISIT THAT
WE HAD LAST WEEK WE HAD WE HEARD
FROM THREE PEOPLE AND THEY WERE
IN AN FSP PROGRAM, AND ONE OF
OUR COMMISSIONERS ASKED THIS
JUST DELIGHTFUL PERSON. HOW DID
YOU LAND HERE? AND SHE SAID,
WELL, I FELL ASLEEP IN THE WRONG
PLACE. AND AFTER SEVERAL LAW
ENFORCEMENT INTERACTIONS, THEY
BROUGHT ME HERE. ANOTHER
GENTLEMAN SAID. YOU KNOW, I I'VE
BEEN LIVING AT DISCOVERY PARK.
AND I HAD HAD A PROBLEM WITH
ALCOHOL, AND I GOT HERE THROUGH
SACRAMENTO COUNTY BEHAVIORAL
HEALTH PROGRAM, SO I THINK THERE
ARE PHENOMENAL EXAMPLES. I THINK
THE QUESTION IS, YOU KNOW, ARE
WE BRINGING THOSE COSTS DOWN?
ARE WE BRINGING THOSE SPIT SLOTS
UP? AND ARE WE MAKING, YOU KNOW
ARE ARE WE AS THOUGHTFUL AND
KNOWLEDGEABLE AS WE CAN TO
MAXIMIZE THOSE OPPORTUNITIES SO
THAT WE GET BETTER AT IT? I WANT
TO BRING IN THIS COVERING UP,
BUT I THINK I'M ALSO TRYING TO
ASK FOR THE RIGHT SIZING WHAT
WE'RE SPENDING TOWARDS HOUSING
AND THE NEEDS THAT WE HAVE, AND
I THINK THAT'S REALLY THE
QUESTION WE'RE TRYING TO PUT
BEFORE THE VOTERS WITH THIS
POTENTIAL REFORM IS, ARE WE ABLE
TO ENSURE THAT WE'RE SPENDING
ENOUGH ADEQUATELY TO ADDRESS THE
HOUSING SUPPLY ISSUE THAT WE
KNOW THE STATE IS FACING?
CERTAIN MICHELLE CABRERA WITH C
PH. D A. CERTAINLY NOT FOR THE
170,000 INDIVIDUALS WHO ARE
EXPERIENCING HOMELESSNESS IN
CALIFORNIA TODAY. SO WE HAVE TO
REMEMBER THAT EVEN FOR COUNTY
BEHAVIORAL HEALTH CLIENTS WHO
MAYBE REPRESENT HALF OF THAT
POPULATION WE'RE TALKING ABOUT.
YOU KNOW, IT'S YOU KNOW,
SEVERAL, UM. WHY AM I? WHY AM I
STRUGGLING WITH MATH? PROBABLY
BECAUSE IT'S LATE AT MATH NIGHT
. BUT ANYHOW, SO WE'RE LOOKING
AT A VERY THANK YOU. I NEED SOME
MOUNTAIN DEW. THANK YOU. I'M
LIKE I SHOULD KNOW THIS NUMBER.
WHY ISN'T IT COMING TO ME? MY
RECALL IS BAD. YEAH OKAY. THANK
YOU. OKAY 165,000 ROUGHLY RIGHT.
SO WE'RE TALKING 85,000 PEOPLE
WHO MIGHT, YOU KNOW, QUALIFY FOR
COUNTY BEHAVIORAL HEALTH
SERVICES. OBVIOUSLY. YOU KNOW,
100% OF PEOPLE WHO ARE ON HOUSED
LIVING ON THE STREET PROBABLY
NEED SOME MENTAL HEALTH
SOMETHING RIGHT? BUT NOT ALL OF
THOSE PEOPLE WILL QUALIFY FOR
COUNTY BEHAVIORAL HEALTH
SERVICES. UM AGAIN, PROBABLY
HALF OF THEM WOULD NOT QUALIFY,
THEY PROBABLY NEED SOME MILD TO
MODERATE MENTAL HEALTH SUPPORT
THAT KIND OF THING WHERE THEY
MIGHT HAVE SOME SUBSTANCE USE,
BUT IT'S NOT AT THE LEVEL OF A
DISORDER, RIGHT? THOSE THAT
POPULATION IS A PART OF OUR
HOMELESSNESS PROBLEM. MORE
BROADLY, RIGHT? AND WE HAVE
FOLKS WHO AGAIN QUALIFY BECAUSE
THEY HAVE SERIOUS MENTAL ILLNESS
OR THEY HAVE SOME SORT OF LIKE A
SIGNIFICANT ISSUE IS ARE TWO
DIFFERENT PROBLEMS AND TO THE
EARLIER COMMENTS, THE DRIVERS OF
HOMELESSNESS ARE PRIMARILY NOT
PEOPLE'S BEHAVIORAL HEALTH
CONDITIONS. THAT'S THE
AFFORDABILITY AND THE LACK OF
AFFORDABLE PLACES FOR PEOPLE TO
LIVE IN CALIFORNIA WHEN YOU HAVE
PEOPLE WHO ARE RICH BY MOST
PEOPLE'S STANDARDS, WHO HAVE A
VERY SOLIDLY MIDDLE CLASS LIFE
IN CALIFORNIA. YOU KNOW
SOMETHING'S UP, RIGHT? SO I JUST
I JUST WANT TO BE CLEAR. OUR
CLIENTS ARE DISPROPORTIONATELY
IMPACTED BECAUSE THEY'RE PEOPLE
WITH SIGNIFICANT DISABILITIES
WHO CAN'T COMPETE. AND WHO, WHEN
THEY'RE LIVING OFF OF SS I.
THERE'S JUST NO HOPE SO LET'S
TALK ABOUT WHAT IMAGES SAYS
DOING TODAY. FULL SERVICE
PARTNERSHIPS HELPED TO FUND
RENTAL SUBSIDIES FOR A LOT OF
FOLKS, BUT ONLY THE PEOPLE WHO
CAN GET IN AND WE CAN ONLY HOUSE
ABOUT HALF OF THE UNHAPPIEST
PEOPLE WHO WE BRING INTO F SPS
EVERY YEAR AND THEN ONCE THEY'RE
IN F SPS SOMETIMES BECAUSE OF
HOW IMAGES SAY FUNDING WORKS
THEIR HOUSING, IT'S TIED TO THAT
FSP, AND SO THEY MIGHT STAY IN
THAT FSP LONGER THAN THEY
ACTUALLY NEED TO BE AT THAT
HIGHER LEVEL OF CARE BECAUSE WE
DON'T WANT THEM TO BECOME
HOMELESS, OKAY? SO THERE'S
ACTUALLY POTENTIALLY SOME
BENEFIT TO LIKE, REALLY
REORDERING THIS AND LOOKING AT
ALL THE PUZZLE PIECES SO THAT WE
CAN SAY OKAY. HOUSING AND FSP
STATUS ARE ACTUALLY DIFFERENT
THINGS WE NEED TO, LIKE, HAVE A
CONVERSATION THERE, RIGHT? BUT
COUNTIES USING IMAGES A DOLLARS
ENOUGH TOWARDS HOUSING. WE WOULD
ARGUE WE HAVE BEEN WE HAVE BEEN
BREAKING OUR BACKS TO USE
IMAGES, SAFER HOUSING. WE'VE
BEEN PAYING FOR THE BONDS FOR NO
PLACE LIKE HOME BUILDING
PERMANENT SPORTS, SUPPORTIVE
HOUSING, AND THERE WAS THE IMAGE
OF A HOUSING PROGRAM BEFORE
THAT, SO WE'RE TALKING HUNDREDS
OF MILLIONS OF PLUS MHSC DOLLARS
ONGOING. WE PROBABLY THINK IT'S
CLOSE TO, YOU KNOW, A BILLION
TODAY THAT JUST GETS PUT TO BOTH
HOUSING AND SERVICES FOR PEOPLE
WHO ARE ON HOUSED. WE'RE WORKING
ON UPDATING THOSE NUMBERS AND
GETTING THEM MORE ACCURATE, BUT
WE'RE PAYING FOR BOARDING CARE
PATCHES THROUGH MHS A. WE'RE
BUILDING HOUSING. WHAT WE CAN'T
DO IS KEEP UP WITH THE DEGREE
AND THE PACE AT WHICH PEOPLE ARE
FALLING INTO HOMELESSNESS IN
CALIFORNIA, AND THE MORE TIME
THEY SPEND ON THE STREETS, THE
MORE LIKELY THEY ARE TO COME TO
COUNTY BEHAVIORAL HEALTH WITH
SOME KIND OF REALLY PROFOUND
NEED, RIGHT? BECAUSE LIFE ON THE
STREETS IF YOU DON'T COME WITH A
SIGNIFICANT BEHAVIORAL HEALTH
PROBLEM WILL HELP YOU DEVELOP
ONE. YES AND THAT THAT IS A
MATTER OF SURVIVAL AND DEALING
WITH THE TRAUMA OF BEING HOUSED
. AND SO WE REALLY THINK, AND
THAT'S WHY I MENTIONED THE C SAC
AT HOME PROPOSAL. WE NEED TO YOU
KNOW, IN ADDITION TO THIS
CONTINUE TO HAVE THAT
CONVERSATION ABOUT BROADER,
SUSTAINED EFFORTS TO CONTINUE TO
INVEST IN HOUSING BECAUSE WE CAN
DO A SLICE OF THE SLICE, BUT THE
BIGGER PROBLEM IS STILL THE
BIGGER PROBLEM. WILL ELEVATE, I,
UM. DON'T EXPECT OR ANTICIPATE
THE C B H D A TO BE ABLE TO
FULLY FUND THE HOUSING NEEDS. WE
HAVE AS A STATE, BUT JUST TO BE
A PARTNER TO HELP US TO BRAID
FUNDING AND SEE THE ADVANTAGE
TOWARDS AN ONGOING SOURCE OF
FUNDING TO ADDRESS THE SUPPLY
SIDE ISSUE OF HOUSING OVERALL.
WELL SAY, I FEEL LIKE WE'VE
TALKED ABOUT THIS ISSUE
SIGNIFICANTLY. UM AND YOU WANT
TO APPRECIATE EVERYONE, UH,
WE'LL HOLD THIS OPEN AND MOVE ON
THE ISSUE. 18. ISSUE 18 IS ON
THE ACCOUNTABILITY AND ACCESS
COMPONENTS OF THE GOVERNOR'S
PROPOSAL. WE WILL BEGIN WITH
DIRECTOR BOSS HELLO AGAIN.
REALLY THIS THIS PIECE OF THE
INITIATIVE REALLY IS REALLY
TRYING TO MAKE TODAY'S SYSTEM OF
CARE WORK BETTER FOR ALL OF
CALIFORNIANS, INCREASING OUR
TRANSPARENCY AND ACCOUNTABILITY
AND UNDERSTANDING OF HOW
COMMUNITY BEHAVIORAL HEALTH AND
ONE OF THE KEY PROPOSALS IS
REALLY WITH REGARD TO THE FISCAL
REPORTING AND FISCAL
TRANSPARENCY. UNDER THIS
PROPOSAL, WE WILL BE REQUIRING
COUNTIES TO REPORT TO THE
DEPARTMENT AND MITCHELL SAY
ALLOCATIONS REALIGNMENT. FEDERAL
BLOCK GRANTS HOW THEY USE THOSE
DOLLARS AS THE NON FEDERAL SHARE
FOR MATCHING OF MEDICAID.
FEDERAL DOLLARS. UM THEIR THEIR
THEIR SPEND ON NON FF NON
MEDICAID DOLLARS AS WELL,
UNSPENT MHS A REALIGNMENT AND
BLOCK GRANT FUNDING AND KIND OF
THE CUMULATIVE UNSPENT AND
RESERVES. AH HAVING A BETTER
UNDERSTANDING OF ADMINISTRATIVE
COST INFORMATION ON SERVICES NOT
PROVIDED TO PEOPLE NOT COVERED
BY MEDICAL SO WE CAN GET
UNDERSTANDING FOR THE DIFFERENT
PAIR SOURCES WHETHER IT'S
COMMERCIAL, UNINSURED MEDICAL,
FOR EXAMPLE, REALLY USING THIS
AS A BASIS TO KIND OF THINK
THROUGH BOTH PROCESS AND
PROGRAMMATIC OUTCOME, MEASURES
THAT WE WILL ALSO BE DEVELOPING
, SO OUR GOAL IS TO ESTABLISH
SOME STATEWIDE BEHAVIORAL HEALTH
METRICS THAT WE CAN TRACK ACROSS
THE STATE. RECOGNIZING THE
SIGNIFICANT INVESTMENT IN
DOLLARS FOR COMMUNITY BEHAVIORAL
HEALTH, AND THEN ALSO
RECOGNIZING THROUGH THE THREE
YEAR PLANNING PROCESS THAT WE
SPOKE TO IN THE PREVIOUS ITEM,
LOCALS WILL DEVELOP THEIR OWN
GOALS AS WELL TO KIND OF WITH
THEIR PLANNING PROCESS. WHAT DO
THEY EXPECT TO ACHIEVE WHAT
THEIR DOLLARS AT THE LOCAL
LEVEL? I'M REALLY AGAIN. I SAID
THIS IN THE PREVIOUS ITEM, BUT
REALLY THINKING ABOUT THIS MORE
COMPREHENSIVELY THAN JUST MHS A
REALLY THINKING ABOUT THIS AS
THE COMMUNITY BEHAVIORAL HEALTH
PLAN FOR A COUNTY OR REGION, AND
HOW DO WE COLLECT THE DATA? WE
NEED TO UNDERSTAND WHAT'S
HAPPENING AT THE LOCAL LEVEL.
AND HOW DO WE START BUILDING OUT
STATEWIDE METRICS AND LOCAL
GOALS WITH REGARD TO THOSE
DOLLARS? UH, ANOTHER PIECE OF,
UM THE KIND OF THE PROPOSAL IS,
AS YOU KNOW, IN 2024. WE WILL BE
GOING FORWARD WITH THE NEW
MEDICAL MANAGED CARE CONTRACT.
WE'VE INVESTED SIGNIFICANT WORK
WITH OUR STAKEHOLDERS. OUR PLANS
OUR COMMUNITY PARTNERS WITH
REGARD TO THAT CONTRACT AND WANT
TO TAKE SOME OF THOSE KEY
PROVISIONS AND RELATE THEM TO
OUR COUNTY BEHAVIORAL HEALTH
CONTRACT INFORMATION SUCH AS
COMPLIANCE AND MODERNITY OF
OVERSIGHT OF SUBCONTRACTORS,
POSTING NETWORK ADEQUACY FILINGS
ON WEBSITES A LOT MORE PUBLIC
TRANSPARENCY WITH REGARDING
UTILIZATION. REQUIRING KEY
ADMINISTRATIVE POSITIONS
REQUIRING, UM COUNTY BOARDS OF
SUPERVISORS TO ALSO ATTEST TO
MEETING THEIR OBLIGATIONS WITH
REGARD TO REALIGNMENT AND THEIR
OBLIGATIONS UNDER COMMUNITY
BEHAVIORAL HEALTH. UM AND THEN
ESTABLISHING AS I MENTIONED A
ROBUST SET OF QUALITY METRICS
THAT WE CAN BOTH KIND OF BE VERY
TRANSPARENT TO THE PUBLIC AND TO
OUR COMMUNITIES. WITH WHAT
REGARD WHAT WHERE WE'RE GOING
WITH OUR BEHAVIORAL HEALTH
SYSTEM. AND THEN LASTLY, THE
PROPOSAL, UM, WANTS TO ALIGN
BEHAVIORAL HEALTH BENEFITS
ACROSS ALL HEALTH PLANS IN
CALIFORNIA, SO NOT JUST MEDICAL
, RIGHT MEDICAL AND COMMERCIAL
PAIR, SO WORK WITH GMHC OR THE
DEPARTMENT OF HEALTH CARE,
MANAGED HEALTH CARE AND
DEPARTMENT OF HEALTH CARE
SERVICES TO DEVELOP STAKEHOLDER
INFORMED PLAN TO ACHIEVE PARITY
BETWEEN COMMERCIAL AND MEDICAL
COVERED MENTAL HEALTH AND
SUBSTANCE USE DISORDER BENEFITS.
HAPPY TO ANSWER ANY QUESTIONS.
NEXT WE'LL HAVE MARY WATANABE,
DIRECTOR OF THE DEPARTMENT OF
MANAGED HEALTH CARE. GOOD
EVENING. I THINK MICHELLE JUST
STOLE MY THUNDER ABOUT THE
MEDICAL AND COMMERCIAL PARODY. I
WILL JUST NOTE THAT I THINK YOU
KNOW, THROUGHOUT THE EVENING, I
HEARD MENTION OF WHATEVER IT
TAKES WRAPPER ON SERVICES, AND I
THINK THAT'S REALLY WHAT WE WANT
TO UNDERSTAND IS THERE IS
SOMETHING MORE THAT PEOPLE GET
WHEN THEY HAVE A BEHAVIORAL
NEEDING THERE IN THE MEDICAL
PROGRAM, UM SO WE'LL BE SPENDING
SOME TIME REALLY TRYING TO
UNDERSTAND WHAT THAT MEANS AND
TRY AND DO A BALANCE THE
ACCOUNTABILITY HOLDING OUR
COMMERCIAL HEALTH PLANS
ACCOUNTABLE. FOR THE SERVICES
THEY SHOULD BE PROVIDING.
THERE'S A LOT OF OVERLAP, BEING
MINDFUL OF THE PRESSURES AND OUR
WORKFORCE CHALLENGES AND ALSO
JUST THE COST OF HEALTHCARE. SO
ANYTHING WE DO TO EXPAND
COVERAGE IN THE COMMERCIAL
WORLD. ALSO LIKELY WILL DRIVE UP
PREMIUMS. SO WE WANT TO BE
REALLY THOUGHTFUL ABOUT THAT. SO
WE'LL BE HAVING THAT PLANNING
PROCESS THAT MICHELLE MENTIONED
WORKING VERY CLOSELY TOGETHER
AND ENGAGING BOTH WITH OUR
HEALTH PLANS ARE CONSUMER
ADVOCATE PARTNERS IN THE
COUNTIES IN THAT PROCESS, SO
MORE TO COME. I HAVE. MR
SOUTHERN ON MY LIST IS NOT JUST
ME. PERFECT. YEAH. DIRECTOR IT'S
JUST GREAT. YEAH UM, NEXT, WE
HAVE MICHELLE KARP BARRERA WITH
CB HD A CUP PEREIRA. MHM. BRERA.
OKAY, SORRY. UM MR CHAIR
MEMBERS, MICHELE CABRERA WITH
COUNTY BEHAVIORAL HEALTH
DIRECTORS ASSOCIATION, AND I
JUST WANT TO START OFF BY SAYING
, UM, THAT WE CERTAINLY CAN
APPRECIATE THE CONVERSATION
ABOUT BROADER SENSE BEHAVIORAL
HEALTH SYSTEM. ACCOUNTABILITY UM
, YOU YOU AUTHORED A BILL THAT
WE SPONSORED A B 6 86, WHICH
ATTEMPTED TO DO SOMETHING QUITE
SIMILAR, ACTUALLY. SO I WOULD
LIKE TO SAY THAT WE HAVE WE TAKE
SOME JOINT RESPONSIBILITY FOR
HELPING TO INTRODUCE THIS
CONVERSATION, WHICH IS SO OFTEN
, WE'VE HAD A CONVERSATION ABOUT
THAT SORT OF HYPER FOCUSED ON
MENTAL HEALTH SERVICES ACT AND
WE, AS COUNTY BEHAVIORAL HEALTH,
HAVE SAID. WAIT A MINUTE. THIS
IS OVER A THIRD OF OUR FUNDING
AND OFTEN INTRICATELY BRAIDED
WITH OUR 2011 REALIGNMENT AND
OUR 1991 REALIGNMENT WITH WHICH
I'M DR EWING SPOKE ABOUT EARLIER
AND SO ARE OUR COUNTY FOLKS
ACTUALLY INVITED SCRUTINY AROUND
OUTCOMES, WHICH I JUST WANT TO
POINT OUT. I THINK IT'S FAIRLY
UNPRECEDENTED IN THE HEALTHCARE
WORLD. IT'S CERTAINLY SETS US
APART. IN HEALTHCARE POLICY. WE
AS LASHAWN MENTIONED EARLIER. WE
DON'T REALLY DO OUTCOMES. UM AND
PARTIALLY BECAUSE THERE ARE SO
MANY DYNAMIC FACTORS THAT GO
INTO HELP SEEKING BEHAVIORS
WHETHER SOMEBODY COMES INTO
SERVICES WHETHER THEY ADHERE TO
THE DOCTOR'S PRESCRIPTION, RIGHT
WHAT THE SOCIAL DETERMINANTS OF
HEALTH ART, ETCETERA, ETCETERA,
SO I HAVE TO SAY AS A HEALTH
POLICY NERD, I WAS KIND OF BLOWN
AWAY WHEN THE COUNTY BE HERO,
HEALTH DIRECTORS SAID. WHAT DOES
ACCOUNTABLE FOR OUTCOMES AND SO
ARE YOU SURE YOU WANT TO DO
THAT? BECAUSE DOCTORS DON'T WANT
TO DO THAT IN THE HOSPITALS
DON'T REALLY WANT TO DO THAT. DO
YOU WANT TO DO THAT? THEY SAID
YES. SO I WAS PRETTY IMPRESSED
THAT THEY WERE SO COMMITTED TO
CHANGING PEOPLE'S LIVES THAT
THEY SAID YES. NOW THE ONE THING
I HAVE TO POINT OUT IS THAT
WE'RE NOT JUST REGULAR OLD
HEALTHCARE. WE ARE BEHAVIORAL
HEALTH. SO BIO PSYCHOSOCIAL,
RIGHT? AND OFTEN TIMES WHEN YOU
TALK TO OUR FOLKS ABOUT WHAT
MATTERS TO OUR CLIENTS AND OUR
COMMUNITIES, IT'S MORE THAN THE
MEDICAL. IT'S IT GOES BEYOND
THAT, RIGHT? IT GETS INTO SOME
OF THE SQUISHY STUFF LIKE
PURPOSE. IN CONNECTION RIGHT AND
WE THINK IT'S VERY IMPORTANT IN
AND OUTCOMES IN ACCOUNTABILITY
CONVERSATION TO MAKE SURE THAT
WE ARE PULLING IN EXPERTS SO
PEOPLE WHO KNOW HOW TO TIE DATA
ABOUT FUNDING PROGRAMS AND
OUTCOMES TO ENSURE THAT WE HAVE
A VERY GROUNDED CONVERSATION
ABOUT WHAT'S ACTUALLY MEASURABLE
AND APPROPRIATE TO MEASURE AND
THAT WE DO THIS IN A WAY AS WELL
. WHERE WE'RE MINDFUL OF THE
SIGNIFICANT DOCUMENTATION BURDEN
THAT WE HEAR SO MUCH FROM OUR
PROVIDERS ABOUT RIGHT BECAUSE WE
TODAY I WOULD ARGUE, HAVE
PROBABLY THE HIGHEST LEVEL OF UH
, SCRUTINY AROUND THE MHS A. AND
YET WE'RE STILL SCRATCHING OUR
HEADS. AND WHY IS THAT COUNTY IS
VERY DILIGENTLY REPORT UP TO THE
STATE WITH THE STATE ASKS BOTH
THE OASIS AS WELL AS D H C S, UM
, BUT WE DON'T HAVE THE KIND OF
DATA THAT KIND OF ANALYSIS THAT
WE ALL COLLECTIVELY REALLY
DESIRE. AND I HAVE TO SAY WE
SHARE IN YOUR FRUSTRATION. THAT
OF THE ADMINISTRATION AND THAT
OF OUR COMMUNITY STAKEHOLDERS.
MAYBE WE FEEL IT EVEN MORE
BECAUSE WE ARE WORKING SO HARD
TO PROVIDE THE INPUT AND TO
PROVIDE THE DATA AND TO HELP
INFORM THOSE ANALYSES. UM WE ARE
EXCITED ABOUT THE OPPORTUNITY
ALSO TO BE HELD SHOULDER TO
SHOULDER ACCOUNTABLE WITH
ALONGSIDE MANAGED CARE PLANS AND
COMMERCIAL PLANS, BECAUSE AS
WE'VE TALKED ABOUT WITH THE
DEPARTMENT BEFORE IF MILD TO
MODERATE SERVICES ARE NOT
GETTING TO UNDERSERVED
COMMUNITIES. THOSE FOLKS WILL
GET WORSE AND THEY WILL END UP
WITH MORE SIGNIFICANT NEEDS IN
OUR SYSTEM, AND WE DON'T WANT TO
SEE THAT FOR THEIR SAKE OR FOR
OURS, RIGHT. SO WE DO THINK THAT
WE NEED TO VERY CLOSELY LOOK AT
WHAT'S UPSTREAM OF US. WHETHER
IT'S THE MANAGED CARE PLANS
RESPONSIBILITY MEET WITHIN
MEDICAL BUT UNFORTUNATELY RIGHT
NOW, TODAY THE COMMERCIAL PLANS
AS WELL CONTRIBUTE TO FOLKS
FALLING INTO OUR SYSTEM WHEN
THEY ARE EXTREMELY SICK BECAUSE
THEY HAVE BEEN UNDERSERVED OR
INAPPROPRIATELY SERVED WITHIN
COMMERCIAL INSURANCE PLANS. AND
SO THOSE ARE REALITIES THAT YOU
KNOW, WE REALLY APPRECIATE THE
ADMINISTRATION'S, YOU KNOW,
FOCUS. I THINK THE NEW SOME
ADMINISTRATION HAS GONE HARD.
YOU KNOW, THE COMMERCIAL PARODY
ISSUES LIKE NO OTHER
ADMINISTRATION. NATION. AND YET
WE ARE VERY EARLY DAYS IN THAT
JOURNEY, AND THERE'S A LOT MORE
TO BE DONE TO REALIZE THAT THE
SORT OF DIRECTION THAT THEY'VE
SET FORWARD THERE IN THE
MEANTIME, WHEN I TALKED TO OUR
COUNTY BEHAVIORAL HEALTH
DIRECTOR IS ABOUT CAN YOU LET GO
? A LITTLE BIT OF WHAT YOU'RE
DOING FOR PEOPLE WITH COMMERCIAL
INSURANCE. THEY DON'T FEEL
ENTIRELY COMFORTABLE LETTING GO
OF THAT YET BECAUSE THE
CONSEQUENCE THE OUTCOME OF THAT
CAN BE OFTEN IS DEATH. OR OTHER
SORTS OF REALLY VERY BAD
OUTCOMES. AND SO YOU HAVE TO
UNDERSTAND THE SORT OF MORAL
QUANDARY. I THINK THAT COUNTY
BEHAVIOR HEALTH IS IN IN TRYING
TO HOLD ALL THE PIECES. I THINK
THERE WOULD BE A WILLINGNESS TO
LET GO OF IT. IF WE KNEW THAT
SOMEBODY ELSE WAS HOLDING IT,
AND SO MANY OF THE THINGS THAT
ARE LAID OUT IN THE, UM OUTCOMES
AND ACCOUNTABILITY PORTION OF
THIS ARE THINGS THAT YOU KNOW WE
FEEL ARTS TO SOME DEGREE ALREADY
BEING WORKED ON OR ALREADY BEING
ADDRESSED. FOR EXAMPLE, NETWORK
ADEQUACY FILINGS. EXTERNAL
QUALITY REVIEW THOSE SORTS OF
THINGS, SO WE THINK THAT THERE'S
SOME PLENTY OF GOOD DISCUSSION
TO BE HAD THERE. UM BUT AGAIN IF
WE COULD BRING SOME CLARITY AND
MORE CERTAINTY TO OUR PARTNERS
ABOUT THE FULL PICTURE, BOTH
ABOUT THE FISCAL PIECE AS WELL
AS THE OUTCOMES PIECE. WE THINK
IT WOULD BE A BENEFIT TO
EVERYONE BUT ESPECIALLY TESTS
AND OUR CLIENTS. THANK YOU. NEXT
WE HAVE TOBY EWING, EXECUTIVE
DIRECTOR OF O. E. C FOLLOWED BY
KIERAN SAVAGE. CHENGGUAN COME
FORWARD. EXECUTIVE DIRECTOR OF
CALIFORNIA PAN ETHNIC HEALTH. DR
EWING. THANK YOU VERY MUCH FOR
THE CHANCE TO JOIN YOU AGAIN.
YOU KNOW, I YOU KNOW, THE
COMMISSION HAS BEEN FOCUSED ON
OVERSIGHT AND ACCOUNTABILITY AND
DATA SINCE YOU KNOW, I JOINED
EIGHT PLUS YEARS AGO. UM AND I
THINK I WANT TO SORT OF POINT
OUT SOME QUESTIONS HERE FIRST
THAT ARE REALLY IMPORTANT AS WE
THINK ABOUT HOW TO DO
ACCOUNTABILITY. UM YEAH, BECAUSE
THE HSCEI HAS THIS COMMUNITY
CONSULTATION PIECE WE REALLY
START WITH WHO IS THE AUDIENCE
AND ASKING FOR THAT DATA AND
ASKING THE AUDIENCE WELL, WHAT
DATA WOULD BE HELPFUL? RIGHT UM,
WE CAN SPEND A LOT OF TIME
DEVELOPING LISTS OF THE KINDS OF
THINGS WE WANT TO KNOW. UM BUT
IT'S REALLY IMPORTANT TO
ACTUALLY WORK THROUGH A CLEAR
UNDERSTANDING OF THE DECISIONS
THAT WERE THAT ARE BEING MADE
AND HOW INFORMATION SUPPORTS
THOSE DECISIONS. WE CAN'T AFFORD
TO JUST MONITOR EVERYTHING. WE
NEED TO BE STRATEGIC IN ASKING
OURSELVES WHO'S AN INFORMATION
NEEDS? ARE WE TRYING TO ADDRESS
WHAT ASK THOSE FOLKS WHAT WOULD
BE HELPFUL AND? AND HOW DO WE
PRESENT THE INFORMATION THAT IS
HELPFUL IN TERMS OF THE
DECISIONS THAT ARE BEING MADE,
MEANING THE TIMING? RIGHT SO
HISTORICALLY, THE DATES THE
STATE'S DATA ON SUICIDE WAS
THREE YEARS OLD. WHICH IS REALLY
IMPORTANT FOR SEEING TRENDS. NOT
VERY IMPORTANT FOR RESPONDING
QUICKLY TO EMERGING NEEDS. UM SO
IN OUR WORK WE ACTUALLY ENGAGED
COMMUNITY MEMBERS AND ASKED,
WELL, WHAT ARE THE MOST
IMPORTANT THINGS WE WANT TO
UNDERSTAND? AND WE WANT TO
RECOGNIZE AS AS DIRECTOR BOSS
HAS SAID EARLIER. THERE ARE
POPULATION HEALTH KINDS OF
ISSUES THAT ARE IMPORTANT. AND
THEN THERE ARE PROGRAMS SPECIFIC
KINDS OF INTERVENTION. DOES THAT
PROGRAM WORK THAT AND IN THAT IN
THE BROAD HEALTHCARE SPACE, WE
HAVE BOTH RIGHT. WE CAN TALK
ABOUT THINGS LIKE, UM TEEN
PREGNANCY RATES, AND WE CAN TALK
ABOUT THE EFFICACY OF A GIVEN
INTERVENTION. RIGHT IN THE
MENTAL HEALTH SPACE. WE REALLY
DON'T HAVE EITHER. WE'RE WAY
BEHIND IN TERMS OF BUILDING OUT
THE SYSTEMS THAT ARE NECESSARY
TO BE RESPONSIVE TO OUR RANGE OF
DECISION MAKERS IN A WAY THAT IS
TIMELY AND SUPPORTIVE OF THE
DECISIONS THAT THEY'RE MAKING.
THE COMMISSION. WHEN WE BROUGHT
COMMUNITY MEMBERS TOGETHER AND
WITH COMMISSIONERS, THEY REALLY
IDENTIFIED THREE ISSUES THAT
THEY WANTED TO UNDERSTAND. FIRST
THEY WANTED TO UNDERSTAND
FINANCES. I'M STARTING WITH M H
S A BUT NOT LIMITED TO MHS A
RIGHT AND PART OF THAT WAS
BECAUSE THE MHS S¼ SAYS THEY'RE
SUPPOSED TO BE THIS COMMUNITY
ENGAGEMENT PROCESS, AND THEY
MADE THIS VERY SOUND ARGUMENT
THAT IT'S HARD FOR US TO ENGAGE
IN A DISCUSSION OF WHERE TO
INVEST IF WE DON'T HAVE AT LEAST
A BASIC UNDERSTANDING. OF HOW
MUCH MONEY IS COMING IN HOW MUCH
MONEY IS BEING SPENT AND HOW
MUCH MONEY YOU HAVE IN THE BANK,
AND WE'VE HAD OUR DIFFERENCES OF
OPINION WITH WITH THE DEPARTMENT
OF HEALTH CARE SERVICES AND THE
COUNTIES OVER HOW MUCH MONEY YOU
HAVE IN THE BANK. THE REASON WE
THINK OF HOW MUCH MONEY YOU HAVE
IN THE BANK BECAUSE THAT'S IN
ADDITION TO THE MONEY YOU HAVE
COMING IN THAT YOU CAN PLAN TO
SPEND. WE HAVE SOME SOME
LEFTOVER FROM LAST YEAR. PLUS
THIS YEAR'S REVENUES. THAT'S
REALLY IMPORTANT AS WE THINK
ABOUT WHAT'S THE RESOURCE BASE
FOR MAKING DECISIONS MOVING
FORWARD. UM IDEALLY, WE WOULD DO
THAT ACROSS ALL OF THE FUNDING,
BUT WE CERTAINLY STARTED WITH
THE IMAGES S¼. THE SECOND DOMAIN
WAS REALLY THE SERVICES. WHAT
ARE WE BUYING? WITH THE DOLLARS
THAT WE HAVE? RIGHT AND THEN THE
THIRD PIECE IS ONE OF THE
OUTCOMES THAT ARE BEING ACHIEVED
AND IT REALLY WAS AN ATTEMPT TO
YOU KNOW, WITHIN AT LEAST
STARTING WITH THE MHS A GET A
CLEAR SENSE TO WHAT DR JACKSON
WAS TALKING ABOUT. IN TERMS OF
WHERE DO WE SCALE RIGHT? SO WHAT
DO WE DO WITH THAT? WELL FIRST
WE BUILT THE FISCAL TRANSPARENCY
TOOL WITH THE DATA THAT WE HAVE,
WHICH IS PRIMARILY AMATEUR SAY
WE DO HAVE REVENUE DATA ON OTHER
FUNDING STREAMS. WE DON'T HAVE
EXPENDITURE DATA AND UNSPENT
FUND DATA ON REALIGNMENT AND THE
MEDICAL DATA DOESN'T COME IN THE
SAME TIME. THE TIMING IS OFF IN
TERMS OF THE MEDICAL DATA, SO
IT'S ACTUALLY REALLY HARD TO
CREATE A COMPREHENSIVE PICTURE.
OF A POINT IN TIME RESOURCES FOR
MENTAL HEALTH, IT'S EASIER TO DO
IN OTHER DOMAINS, BUT I WOULD
JUST REMIND US THAT WE DON'T
ACTUALLY DO THAT, IN MOST OTHER
AREAS OF THE BUDGET. WE DON'T
ACTUALLY HAVE GOOD INFORMATION
OF HOW MUCH MONEY IS SPENT ON
TRANSPORTATION. WHAT IT WAS
SPENT ON AND WHAT OUTCOMES WE
GOT. WE HAVE GOOD TRANSPORTATION
DATA AROUND THINGS LIKE, YOU
KNOW, VEHICLE MILES TRAVELED AND
AIR POLLUTION AND SO FORTH. BUT
TYING IT TO DOLLARS SPENT IS
ACTUALLY A LITTLE MORE
COMPLICATED THAN WE'RE ABLE TO
DO AT THE MOMENT. ON THE
SERVICES SIDE. WHAT THE
COMMUNITY WANTED TO UNDERSTAND
WAS HOW OUR LOCAL GOVERNMENTS
USING THESE DOLLARS WHAT
SERVICES ARE AVAILABLE, AND THEY
WANTED TO USE IT NOT JUST TO
UNDERSTAND HISTORICAL TRENDS.
THEY WANTED TO UNDERSTAND OUR
CHILDREN BEING PRIORITIZED ARE
CERTAIN PARTS OF A COUNTY BEING
PRIORITIZED OVER. OTHERS ARE
SOME COUNTIES INVESTING IN A
PROGRAM THAT WOULD BE BENEFICIAL
IN OUR COUNTY. BUT WE HAVEN'T
YET DONE THAT THEY REALLY WANTED
TO BE ABLE TO COMPARE AND
CONTRAST AND HAVE CONVERSATIONS
. WE ACTUALLY BUILT A PROGRAM
REPORTING TOOL THAT WAS WORD
SEARCHABLE THAT LISTED FUNDING
SOURCE THE AMOUNT OF FUNDING
TARGET POPULATION. ACTUALLY THE
POPULATION SERVED RELATIVELY THE
TARGET POPULATION. THE NATURE OF
THE SERVICES WHO GOT THE
CONTRACT HOW MUCH IT WAS
ACTUALLY PRETTY COMPREHENSIVE.
IT WAS AN INCREDIBLE LIFT TO
BUILD. IT WAS REALLY HELPFUL,
AND IT WAS OUT OF DATE ABOUT
THREE DAYS AFTER WE MET PUBLIC.
BECAUSE COUNTIES CHANGED THE
NAMES OF THEIR PROGRAMS.
SOMETHING STOP SOMETHING ENDS.
UM AND WE WERE ACTUALLY MANUALLY
TYPING IT UP. BECAUSE THE
REPORTS COME TO US IN PAPER
FORM. WE GET THEM FROM THE
COUNTIES OR FROM THE HCS, AND WE
REALLY HAD TO RECREATE. WE BUILT
THIS BEAUTIFUL THING. AND THIS
IS ALSO WHY NOBODY DOES PRINT
PHONE BOOKS ANYMORE, RIGHT? AND
SO WE DID NOT ACTUALLY HAVE WE
ACTUALLY EXPLORED WITH THE
COUNTIES AND WITH SOME OF OUR
STATE PARTNERS, THE IDEA OF
ACTUALLY BUILDING A DATA PORTAL.
THAT WOULD SATISFY THE THREE
YEAR PLAN REPORTING RULES,
ACTUALLY, HOW DO WE ACTUALLY
REDUCE THE COST FOR COUNTIES TO
SUBMIT DATA TO THE STATE OF
CALIFORNIA, INCLUDING ITS IMAGE
TO SAY, PLAN IN WAYS THAT WOULD
ALLOW US TO MINE THAT DATA TO
ANSWER THE KINDS OF QUESTIONS
THAT YOU'RE ASKING? YOU KNOW
WHAT'S WORKING WHERE AND WHAT
SCALABLE AND WHAT'S MISSING AND
HOW ARE DIFFERENT COUNTIES
ADDRESSING SHARED CHALLENGES.
THE THIRD PIECE, THE MOST
IMPORTANT PIECE, THE MOST
DIFFICULT PIECE IS THE OUTCOME.
PEACE AND SO ON OUR WEBSITE
TODAY, AS WAS MENTIONED BY A
COUPLE OF THE COMMISSIONERS. WE
HAVE BEEN ABLE TO DO SOME
INCREDIBLE DATA LINKING, UM,
CONSISTENT WITH SOME OF THE BEST
WORK IN THE COUNTRY. THAT'S
LINKING MENTAL HEALTH DATA WITH
CRIMINAL JUSTICE, DATA OR SCHOOL
DATA OR EMPLOYMENT DATA. UM TO
REALLY UNDERSTAND THESE HIGH
LEVEL OUTCOMES FOR CLIENTS. THAT
IS BOTH A COMBINATION OF BEING
ABLE TO TELL THE SYSTEMS OUTCOME
STORY AND A PROGRAMMATIC
OUTCOMES STORY. UM IT'S REALLY
HARD. THE DATA ARE MESSY. IT
WILL TAKE US. UP TO THREE YEARS
IN SOME CASES TO GET A DATA USE
AGREEMENT TO MEET ALL THE
STANDARDS WE HAVE HAD TO MEET
FBI STANDARDS IN ORDER TO ACCESS
, UH, JUSTICE DATA TO TRACK
CRIMINAL JUSTICE INVOLVEMENT, IN
PART BECAUSE WE WANT TO BE ABLE
TO ANSWER YOUR QUESTIONS ABOUT
DO F SPS RESULT IN LESS CRIMINAL
JUSTICE INVOLVEMENT, RIGHT? UM
SO THE SHORT ANSWER IS THAT WAS
PRETTY MUCH A LONG ANSWER. BUT
THE SHORT ANSWER IS THE STATE
HAS SOME INCREDIBLE DATA. WE
ACTUALLY HAVE THE TECHNOLOGY TO
ALLOW US TO LINK AND TO CONNECT
AND TO ANALYZE. THE ORIGINS OF
THE DATA ACTUALLY ARE NOT
DESIGNED TO FEED INTO THOSE
SYSTEMS IN WAYS THAT ARE
EFFICIENT OR EFFECTIVE, WERE
OFTEN SOME TRANSMITTING DATA IN
WAYS THAT ARE VERY OLD SCHOOL,
UM, THAT EVEN ON THE FISCAL DATA
, I THINK IT TAKES, UM IT CAN
TAKE UH, SIX MONTHS. TO
RECONCILE A COUNTY REPORT
BETWEEN THE COUNTIES AND PHDS ON
HOW MUCH MONEY THEY SPENT. SIX
MONTHS. UM, THAT'S A LONG TIME.
WHY DOES IT TAKE THAT LONG? UM
ALL KINDS OF APPROPRIATE REASONS
, BUT IT GETS IN THE WAY OF THE
ABILITY TO TAKE THAT DATA AND
TURN IT INTO SOMETHING USEFUL
FOR THE DECISIONS THAT YOU'RE
YOU'RE NEEDING TO MAKE OTHER
PUBLIC NEEDED TO MAKE. MY LAST
COMMENT, AND THIS IS WHERE I
THINK WE HAVE A TREMENDOUS
OPPORTUNITY. IS, UM, THAT. IT'S
INAPPROPRIATE TO SIMPLY TALK
ABOUT MORE REPORTING. WE HAVE TO
BE WILLING TO TALK ABOUT
ELIMINATING SOME OF THE DATA
REPORTING REQUIREMENTS THAT WE
PLACE THAT THE STATE PLACES ON
THE COUNTY'S HOW CAN WE ACTUALLY
GET MORE EFFICIENT, SPEND LESS
TIME AND MONEY ON DATA. BUT GET
BETTER DATA OUT OF IT. MOST OF
THE CONVERSATIONS ARE ABOUT MORE
REPORTING. AND I THINK OUR
PERSPECTIVE WOULD BE IF THE
COUNTY IS SUBMITTING DATA TO THE
STATE AND THE DATA DOESN'T USE
IT. STOP ASKING FOR IT. AND
INSTEAD START BACK TO THAT
QUESTION OF WHAT WHAT DECISIONS
DO YOU NEED TO INFORM WITH DATA
? LET'S MAKE SURE WE'RE ASKING
THE RIGHT QUESTIONS FOR THE
RIGHT AUDIENCE IN A TIMELY
MANNER AND SLOWLY BEGIN TO MOVE
AWAY FROM THESE LEGACY
REQUIREMENTS TOWARDS UP TO DATE
DATA SYSTEMS. AND I JUST HAVE TO
MAKE A PLUG FOR INNOVATION
BECAUSE THAT'S REALLY WHAT THE
OPPORTUNITY IS FOR US TO DRIVE
DOWN COSTS AND DRIVE UP VALUE
OVER TIME. THANK YOU. NEXT WE
HAVE KAREN SAVAGE THING. ONE
EXECUTIVE DIRECTOR OF SIPAN.
GREAT THANKS, CHAIR, ARAMBULA.
UM AND THANKS FOR HOLDING THIS
HEARING, AND I WILL TRY TO MAKE
IT BRIEF BECAUSE I KNOW WE'RE AT
THE TAIL END HERE. SO IN 2017 WE
AT SEA PEN PARTNERED WITH DR
ARAMBULA TO PASS HB 4 70, WHICH
REQUIRES THE PUBLIC REPORTING OF
MEDICAL MENTAL HEALTH
DISPARITIES, DATA. THAT
INFORMATION DEMONSTRATED WHAT WE
KNOW THROUGH LIVED EXPERIENCE TO
BE TRUE, WHICH IS THAT
COMMUNITIES OF COLOR FACE
SIGNIFICANT BARRIERS TO
ACCESSING MENTAL HEALTH SERVICES
AND SUFFER AS A RESULT OF A
BEHAVIORAL HEALTH SYSTEM NOT
DESIGNED TO ADDRESS OUR NEEDS.
OUR ANALYSIS OF MEDICAL DATA
DEMONSTRATED THAT ONLY A SMALL
FRACTION OF MEDICAL MEMBERS
RECEIVE NON SPECIALTY OR MILD TO
MODERATE BEHAVIORAL HEALTH
SERVICES FROM THEIR MANAGED CARE
PLAN. AND TUESDAY TO SHOWS THAT
COMMERCIALLY INSURED
CALIFORNIANS ARE UNABLE TO
ACCESS NEEDED BEHAVIORAL HEALTH
CARE AT A SIMILAR RATE.
UNSURPRISINGLY THE RATE OF UNMET
NEED ONLY GROWS WHEN THE DATA IS
ANALYZED BY RACE OR LANGUAGE. AT
SEA PEN. WE BELIEVE THAT EVERY
CALIBER THAT CALIFORNIA SHOULD
HAVE A NORTH STAR OF A
BEHAVIORAL HEALTH HOME FOR EVERY
RESIDENT OR A TRUSTED PROVIDER
THAT SERVES AS A CULTURALLY AND
LINGUISTICALLY APPROPRIATE
SOURCE OF BEHAVIORAL HEALTH
PREVENTION. EARLY INTERVENTION,
MILD TO MODERATE TREATMENT AND
REFERRAL TO MORE INTENSIVE
SERVICES AS NEEDED. IN PHYSICAL
HEALTH CARE. IT IS ACCEPTED THAT
A USUAL SOURCE OF PRIMARY CARE
IS A KEY ASPECT OF BOTH ACCESS
AND QUALITY OF CARE. THE SAME
SHOULD BE TRUE OF BEHAVIORAL
HEALTH CARE. WE SUPPORT THE
ADMINISTRATION'S PROPOSAL TO
EXPAND THE SCOPE OF BENEFITS IN
COMMERCIAL HEALTH PLANS TO
MIRROR THAT WHICH IS AVAILABLE
IN MEDICAL THIS SHOULD INCLUDE
CRISIS RESPONSE AND
STABILIZATION, DIETETIC SERVICES
, PEER SUPPORT SERVICES AND
COMMUNITY HEALTH WORKERS
SERVICES TO NAME A FEW. IN
ADDITION, IT IS IMPORTANT TO
RECOGNIZE THAT A PART OF WHAT
WORKS ABOUT THE SPECIALTY
BEHAVIORAL HEALTH SYSTEM IS THAT
IT DOES NOT SOLELY RELY ON A
MEDICAL MODEL OF CARE, BUT
RATHER ALSO INTEGRATES SOCIAL
SUPPORTS ANIMAL, MORE HOLISTIC
UNDERSTANDING OF THE DRIVERS OF
BEHAVIORAL HEALTH NEEDS AND THE
FACTORS THAT SUPPORT RECOVERY.
SHIFTING COMMERCIAL HEALTH
COVERAGE TO UNDERSTAND AND
SUPPORT. THIS APPROACH IS
CRITICAL. WE RECOMMEND THAT
MEDICAL LOOKED TO ADD THE
COMMUNITY TO FIND EVIDENCE BASED
PRACTICES OR SEA DEPTHS THAT
HAVE BEEN DISCUSSED TONIGHT. TO
THE PROGRAM AS EITHER A BENEFIT
OR AS AN IN LIEU OF SERVICES AND
THAT THE GMHC MIRROR THIS IN THE
COMMERCIAL MARKET, AN EXAMPLE OF
A COMMUNITY TO FIND EVIDENCE.
PRACTICE CURRENTLY UNDER REVIEW
BY CMS FOR INCORPORATION INTO
MEDICAL IS TRADITIONAL HEALERS
AND NATURAL HELPERS TO PROVIDE
SUBSTANCE USED TO SORT OF CARE
IN THE NATIVE AMERICAN
COMMUNITY. BUT EXPANDING
BENEFITS ALONE IS NOT
SUFFICIENT. UM OTHER IMPORTANT
ASPECT OF ACCOUNTABILITY FOR THE
BEHAVIORAL HEALTH SYSTEM IN ITS
ENTIRETY INCLUDE CONDUCT MORE
RIGOROUS OVERSIGHT OVER
DELEGATED BEHAVIORAL HEALTH
PLANS, WHICH SERVED MOST HEALTH
PLAN MEMBERS IN BOTH MEDICAL AND
THE COMMERCIAL MARKET. MARKET
PEN CONDUCTED SECRET SHOPPER
TESTING OF ACCESS TO MENTAL
HEALTH SERVICES IN MEDICAL
MANAGED CARE AND FOUND
CONSIDERABLE DIFFICULTY
NAVIGATING TO THESE SERVICES
THROUGH DELEGATED ENTITY,
PARTICULARLY IN LANGUAGES OTHER
THAN ENGLISH. WE NEED TO
IMPLEMENT EQUITY METRICS THAT
HOLD HEALTH PLANS ACCOUNTABLE
FOR CARE. THIS COMMITTEE DID
APPROVE TRAILER BILL LAST YEAR
TO REQUIRE THE GMHC TO DEVELOP
QUALITY AND EQUITY METRICS FOR
BOTH HEALTH, HEALTH PLANS AND
BEHAVIORAL HEALTH PLANS.
UNFORTUNATELY THE DEPARTMENT HAS
NOT YET BEEN ABLE TO DEVELOP
MEASURES SPECIFIC TO BEHAVIORAL
HEALTH PLANS. UM, AND THERE'S
ONLY ONE BEHAVIORAL HEALTH
MEASURE FOR HEALTH PLANS, WHICH
IS A SCREENING MEASURE BASED IN
PRIMARY CARE, SO WE HAVE A WAYS
TO GO THERE. WE ALSO THINK IT'S
IMPORTANT TO LOOK INTO THE
POSSIBILITY OF PROVIDING
STRONGER PROTECTIONS FOR
CONSUMERS WHO MUST SEEK THEIR
BEHAVIORAL HEALTHCARE OUT OF
NETWORK DO NOT ONLY TO THE LACK
OF AVAILABLE TIMELY APPOINTMENTS
, BUT ALSO DUE TO THE LACK OF
CULTURALLY AND LINGUISTICALLY
APPROPRIATE PROVIDERS IN
NETWORK. CONSUMERS OF COLOR
OFTEN REPORTED NEGATIVE
EXPERIENCES OF CARE WITH
PROVIDERS WHO ARE NOT CULTURALLY
OR LINGUISTICALLY COMPETENT AND
THEREFORE FOREGO NECESSARY CARE
IN THE FUTURE. UM AND ONE OTHER
ASPECT. WE THINK IT'S REALLY
IMPORTANT TO EVALUATE THE
EFFORTS OF BOTH HEALTH PLANS AND
BEHAVIORAL HEALTH PLANS TO BUILD
SUFFICIENT NETWORKS WITH A FOCUS
ON THE CULTURAL LINGUISTIC
DIVERSITY OF THOSE NETWORKS. IN
THE MOST RECENT GMHC REPORT,
ONLY ONE OF SIX BEHAVIORAL
HEALTH PLANS LICENSED BY THE
DEPARTMENT MET THE 70% BENCHMARK
FOR ACCESS TO TIMELY URGENT AND
NON URGENT APPOINTMENTS.
CONSUMERS SPEND DAYS CALLING
THROUGH BEHAVIORAL HEALTH
PROVIDER DIRECTORIES ONLY TO
DISCOVER THAT LARGE SWATHS OF
THE NETWORK ARE UNAVAILABLE. FOR
THOSE WHO SPEAK A LANGUAGE OTHER
THAN ENGLISH INAPPROPRIATE
PROVIDER NETWORK IS VIRTUALLY
NON EXISTENT. WITH REGARD TO THE
MENTAL HEALTH SERVICES ACT.
REFORMS ARE PERSPECTIVE IS THAT
THE MHSC IS BEST UTILIZED TO
FILL IN THE GAPS ON BOTH A LOCAL
AND STATEWIDE LEVEL. AND SO WE
URGED THE LEGISLATURE TO
CONSIDER WHETHER PRIORITIES LIKE
PREVENTION AND WORKFORCE ARE
REALLY BEST IMPLEMENTED COUNTY
BY COUNTY OR WHETHER SHIFTING A
LARGER PORTION OF THE FUNDING TO
STATEWIDE PRIORITIES VIA THE
PROPOSED BALLOT INITIATIVE WOULD
BE MORE EFFECTIVE AND ALLOW FOR
MORE SCALABILITY. WE URGE
CONSIDERATION OF AN ONGOING
STATE FUND FOR INVESTMENT IN
THESE PRACTICES IN ORDER TO
REDUCE AND ELIMINATE RACIAL
DISPARITIES. SOME OF OUR MOST
PROMISING INTERVENTIONS THAT
WERE DISCUSSED TONIGHT WERE
FUNDED BY A ONE TIME STATE SET
ASIDE OF MHS A FUNDS THEY DID
NOT NECESSARILY ORIGINATING
COUNTIES. AND SO WE BELIEVE THAT
THIS SHOULD BE AN ONGOING
INVESTMENT AND THAT WORKFORCE
INVESTMENTS SHOULD BE MADE IN A
SIMILAR STATEWIDE MANNER THAT
CAN ALLOW US TO PRIORITIZE THE
GREATEST NEEDS. ON THE REPORTING
SIDE. WE RECOMMEND SHIFTING THE
FOCUS OF COUNTY REPORTING AND
ACCOUNTABILITY FROM HOW THE
DOLLARS WERE SPENT TO WHAT WAS
ACHIEVED. COUNTY SHOULD BE
REQUIRED TO DEMONSTRATE NOT ONLY
THAT THEY SPENT DOLLARS ON
PREVENTION, FOR EXAMPLE, BUT
THAT THEY SERVED COMMUNITIES OF
COLOR ADEQUATELY WITH THESE
RESOURCES. TODAY LATINO, ASIAN
AND PACIFIC ISLANDER COMMUNITIES
REMAIN UNDERSERVED BY THE COUNTY
SYSTEM AND BLACK COMMUNITIES
REMAIN INAPPROPRIATELY SERVED
AND OVERREPRESENTED IN
INSTITUTIONAL SETTINGS. THE
STATE SHOULD SET BENCHMARKS FOR
UTILIZATION AND FOR OUTCOMES
WITH A FOCUS ON EQUITY AND
SHOULD HOLD COUNTIES TO MEETING
THESE BENCHMARKS THROUGH
FINANCIAL INCENTIVES AND
DISINCENTIVES. AND FINALLY
CONSUMER, FAMILY AND COMMUNITY
ENGAGEMENT IN THESE PROCESSES IS
CRITICAL COUNTIES DO CURRENTLY
UTILIZE THE PLANNING PROCESS. IT
IS NOT CLEAR THAT THE PLANNING
PROCESS IN MOST COUNTIES
APPROPRIATELY INCORPORATES THE
VOICES OF COMMUNITIES OF COLOR,
NOR THAT PROGRAM AND FUNDING
DECISIONS ARE FULLY BASED UPON
THIS PROCESS. AT THE STATE LEVEL
, SIMILAR CONCERNS DO EXIST AND
MUCH MORE CAN BE DONE TO
ACTIVELY ENGAGE THOSE WITH LIVED
EXPERIENCE IN DECISION MAKING.
WE RECOMMEND THAT COUNTY SUBMIT
ANNUAL PLANS TO THE STATE FOR
APPROVAL THAT INCLUDE METRICS
FOR COMMUNITY ENGAGEMENT. CROSS
SYSTEM COLLABORATION, THE USE OF
DATA TO IDENTIFY AND REDUCE
RACIAL DISPARITIES. EQUITABLE
RESOURCE ALLOCATION, PROGRAM
OUTCOMES, CONSUMER EXPERIENCE
AND TRANSPARENCY. THANK YOU SO
MUCH FOR YOUR TIME AND
LEADERSHIP. DEPARTMENT OF
PLANETS. KINDA VASQUEZ, THE
DEPARTMENT OF FINANCE NOTHING TO
ADD TO IT, DIRECTOR BOSS SHARON
BUT HERE FOR ANY QUESTIONS.
WELL. SO GENERALLY, WE FIND THE
ADMINISTRATION'S ACCOUNTABILITY
REPORTING AND PLANNING PROPOSAL
. UH APPEARS TO HAVE MERIT. UM
YOU KNOW, FOR EXAMPLE,
BROADENING THE COUNTY PLANNING
PROCESS TO ENCOURAGE MORE
REGIONAL COLLABORATION COULD
ABSOLUTELY YOU'LL BENEFITS, UM,
IN TERMS OF EXPECTED OUTCOMES.
THAT BEING SAID, WE WOULD LIKE
TO KIND OF REITERATE SOME OF THE
POINTS THAT WERE ALREADY BROUGHT
UP SPECIFICALLY AROUND DATA
REPORTING AND DATA COLLECTION IN
THAT. NOT NECESSARILY MORE DATA
REPORTING IS NEEDED. BUT MAYBE A
, UM MORE NARROWLY DEFINED FOCUS
FOR CURRENT DATA REPORTING
SPECIFICALLY AROUND AREAS THAT
WE BELIEVE WOULD HELP THE
LEGISLATURE MAKE DECISIONS. SO I
THINK IT WAS STATED THAT IF
WE'RE COLLECTING DATA, AND WE'RE
NOT USING THE DATA, IT PROBABLY
COULD BE THAT REPORTING
REQUIREMENT COULD BE ELIMINATED
SO WE WOULD DEFINITELY ENCOURAGE
THE LEGISLATURE TO REALLY? FOCUS
AND. COME UP WITH SPECIFIC
METRICS OUTCOMES THAT WOULD HELP
IT TO, UH BETTER SET LEGISLATIVE
PRIORITIES. UM SO WITH THAT, YOU
KNOW, HAPPY TO ANSWER ANY
QUESTIONS BRING IT UP TO THE
DIOCESE WILL BEGIN WITH DR
JACKSON. THANK YOU VERY MUCH,
MR. CHAIR. UM THIS QUESTION'S
FOR OUR DIRECTORS. ANY OF THESE,
UM. IMPROVEMENTS INCLUDE SAME
DAY BUILDING FOR BEHAVIORAL
HEALTH. YEAH THANK YOU FOR THE
QUESTION. THIS BROKEN RECORD? I
DON'T KNOW. I MEAN, I CAN DO
THIS ALL DAY. WELL, I'M I'M
DOING IT ALL DAY. THIS
PARTICULAR PROPOSAL THAT IS
BEFORE YOU DOES NOT TOUCH ON
SAME DAY BILLION FOR ANYTHING
THAT YOU DO ANYTHING YOU WILL
DO. INCLUDES SAME DAY BILLING.
TAKE NOTE OF YOUR COMMENT AND
THERE ARE PLENTY OF
OPPORTUNITIES TO HAVE FUTURE
DISCUSSIONS ON THAT. I WOULD
LIKE TO HAVE AS MANY
CONVERSATIONS AS NECESSARY
BECAUSE, OBVIOUSLY, UM IF THE
MENTAL HEALTH ISSUE IS INDEED A
CRISIS, AND SOMEONE GOES INTO A
CLINIC OR ANY ANY OTHER PLACE
AND THEY MIGHT BE GOING IN FOR
RASH. BUT THEN ALL OF A SUDDEN,
THEY ALSO HAVE A MENTAL HEALTH
CONCERN. AT THIS TIME, THEY
CAN'T BE SERVED ON THAT SAME DAY
AND BE FULLY, YOU KNOW, FULLY,
UM, TREATED, UM OR REIMBURSED
FOR IT. UM AND SO I WANT TO MAKE
SURE THAT WE ARE ELIMINATING ANY
AND EVERY BARRIER, EVEN IF IT IS
FOR A TEMPORARY BASIS. I KNOW
THIS IS NOT INCURRING
EVERYWHERE. OR IN EVERY SETTING
, BUT WE STILL HAVE SETTINGS AND
WHICH, UM, THEY HAVE TO SCHEDULE
A SEPARATE APPOINTMENT IN ORDER
TO TAKE CARE OF THEIR BEHAVIORAL
HEALTH NEEDS. AND IF THAT IS THE
CASE, MENTAL HEALTH DOES NOT
WORK THAT WAY. RIGHT AND THE
CHANCES OF THEM COMING BACK OR
SLIM AND SO WHATEVER WE CAN DO
FOR ANY PERIOD OF TIME. YOU KNOW
, I MEAN, I CAN WASH YOUR CAR,
YOU KNOW, TELL ME WHAT YOU NEED
TO MAKE THIS HAPPEN. I WOULD
NOTE THE DIABETIC BENEFIT THAT
HAS BEEN IMPLEMENTED DOES ALLOW
FOR THAT. SO IF A PARENT AND
CHILD COME IN FOR A WELL CHILD
VISIT FOR THE FOR THE CHILD, AND
THROUGH THAT VISIT, IT IS
IDENTIFIED THAT THE PARENT MAY
NEED SOME, UM, SOME ASSISTANCE
OR SOME BEHAVIORAL HEALTH
COUNSELING. THAT CAN HAPPEN SAME
DAY AND IT IS ABLE TO BUILD FOR
THE FOR THE FOR THE PARENT AND
THE CHILD SEPARATELY. AND SO WE
HAVE PROVIDED A MEANS TO DO THAT
KIND OF UNDER THE DIABETIC
BENEFIT, SO THAT THAT KIND OF
SAME DAY, ALTHOUGH IT'S FOR A
DIFFERENT PERSON, THE WAY WE'VE
IMPLEMENTED DOES ALLOW CLINIC TO
BUILD FOR THE MOTHER OF THE
PARENTS CARE. SO UH, LOVE THAT
EXAMPLE. I JUST WANT TO MAKE
SURE WE BEGIN TO DO IT MORE
UNIVERSALLY, SO WHATEVER WE CAN
DO TO CONTINUE TO HAVE THAT
DISCUSSION, UM, HAPPY TO HAVE
IT. THANK YOU. BRING IT BACK TO
THE CHAIR. I'M GONNA BEGIN WITH
DIRECTOR BOSS IF I CAN. I LIKED
THE L. A S COMMENT. IS THERE ANY
DATA REPORTING THAT WE CAN
ELIMINATE? IS THERE ANY DATA OR
COLLECTING THAT WE'RE NOT
UTILIZING PART OF THIS PROPOSAL
? WHAT? WE'RE ALSO ENVISIONING.
THERE ARE MULTIPLE SYSTEMS AT
THE COUNTY AND THE STATE USED TO
COLLECT THIS AND WE ARE GOAL IS
TO STREAMLINE THAT AND HAVE KIND
OF A STANDARDIZED SYSTEM. AND SO
YOU KNOW, THE KIND OF THE
EXAMPLE THAT YOU HAVE BEFORE
WITH ALL THE DIFFERENT DATA
ELEMENTS THE WAY WE CAPTURE SURE
IT IS NOT NECESSARILY THE MOST
STREAMLINED WAY OR THE EASIEST
WAY TO PRESENT THE PICTURE. SO
IT'S A MATTER OF COLLECTING THIS
DATA, BUT THEN ALSO MAKING IT
EASIER TO COLLECT AND PRESENT
AND USE. THAT IS PART OF THIS
PROPOSAL SO WE WOULD NOT BE
DUPLICATING ANYTHING. IT WOULD
BE REALLY A FRESH LOOK AT WHAT
WE'RE COLLECTING TODAY. AND HOW
DO WE PLAN TO COLLECT IT IN THE
FUTURE? DO WE NEED IT? SO IT IS
MORE OF A COMPREHENSIVE
PERSPECTIVE IN TERMS OF DATA
COLLECTION. YES I HEARD THERE
WAS GOING TO BE A PROCESS FOR US
TO CREATE WHAT THOSE STATEWIDE
BEHAVIORAL HEALTH METRICS WOULD
BE THAT I'D LIKE TO ASK THE
COMMISSIONED HELP US TO
SIMILARLY COME OUT WITH SOME
OUTCOME MEASURES AND WANT TO
KNOW IF THE ADMINISTRATION IS
AMENABLE TO THE COMMISSION
HELPING US YEAH. I MEAN, I THINK
IT'S AS FAR AS OUR PROPOSAL.
WE'RE NOT GOING TO BE SPECIFIC
IN TERMS OF WHAT THOSE STATEWIDE
METRICS WOULD BE, BUT
ESTABLISHING A PROCESS BY WHICH
WE WOULD DEFINE WHAT THOSE WILL
BE IN THE FUTURE. UM AND THEN
ALSO RECOGNIZING THAT AT THE
LOCAL LEVEL, THERE WILL BE LOCAL
GOALS OUT. COME BACK TO DIRECTOR
WANNABE IF I CAN, UM, WE TALKED
ABOUT PARITY BETWEEN THE SYSTEMS
, BUT I'M TRYING TO UNDERSTAND
WHAT THE PRIVATE PLANS CURRENTLY
ARE NOT PROVIDING. ARE THEY
PROVIDING DIETETIC SERVICES OR
ARE THEY PROVIDING CRISIS
SERVICES OR COMMUNITY? HEALTH WE
NOT PROBABLY NOT. UM YOU KNOW, I
AGAIN I THINK WHEN YOU THINK
ABOUT YOU KNOW, WE WE'D LUMP IT
INTO WRAPAROUND SERVICES. I
THINK IT IS. YOU KNOW, CRISIS
INTERVENTION OUTSIDE OF 988 MAY
NOT BE COVERED, UM, INTENSE CARE
MANAGEMENT CASE MANAGEMENT THAT
HELP NAVIGATING THE SYSTEM,
FAMILY COUNSELING THESE THINGS
WHERE YOU KNOW WHATEVER IT TAKES
TO SUPPORT THE FAMILY AND THE
PERSON THESE ARE NOT THINGS THAT
FALL INTO OUR MANAGED CARE
SYSTEM. AND IF YOU THINK ABOUT,
YOU KNOW, FOR THOSE OF US IN THE
ROOM WITH COMMERCIAL COVERAGE.
YOU GET A TREATMENT, THEY BUILD
A CERTAIN CODE, AND THEY'RE
REIMBURSED A CERTAIN AMOUNT.
THERE'S DELEGATION AND SO I
THINK WHAT WE'RE REALLY TRYING
TO UNDERSTAND IS YOU KNOW WE
HEARD AT THE HEARING A FEW WEEKS
AGO ABOUT A FAMILY THAT ACCESS
HAS GREAT COMMERCIAL COVERAGE OR
ACCESSING SERVICES THROUGH C.
DAVIS. WHY? EARLY PSYCHOSIS
SERVICES. THOSE SERVICES SHOULD
BE COVERED. THERE'S SOMETHING
ELSE THAT THAT FAMILY WAS
GETTING IN THAT INDIVIDUAL WAS
GETTING THAT THEY GET THROUGH
THE COUNTIES THEY GET THROUGH
MEDICAL. THAT IS NOT PART OF OUR
COMMERCIAL HEALTHCARE SYSTEM. SO
THAT'S I THINK REALLY WHAT WE
WANT TO TRY TO UNDERSTAND IT
AGAIN. BEING MINDFUL EVERY PIECE
YOU ADD ON INCREASES PREMIUMS
POTENTIALLY, AND WE NEED TO WORK
FORCE TO SUPPORT THAT ON THE
COMMERCIAL SIDE, SO THAT'S WHY
THIS IS A PLANNING PROCESS OVER
THE NEXT YEAR. BUT REALLY, I
THINK WE NEED TO HEAR FROM THOSE
THAT ARE ACCESSING SERVICES
THROUGH MEDICAL OR THROUGH THE
COUNTIES OR THROUGH WHOEVER THAT
HAVE COMMERCIAL COVERAGE THAT
ARE PAYING NEARLY $600 A MONTH
FOR THEIR HEALTH INSURANCE. WHAT
IS IT THAT YOU'RE NOT GETTING?
SO THAT'S THAT WILL BE THE
QUESTIONS TO ANSWER. UH PUSH
BACK JUST A BIT, THOUGH WE HEARD
FROM, UM, EXECUTIVE DIRECTOR
SAVAGE SAYING JUAN THAT 1/6 OF
COMMUNITY HAVE ADEQUATE NETWORKS
TO BE ABLE TO ACCESS AND SO HOW
HOW DO WE MAKE SURE WE'RE
PUSHING THOSE PLANS ENOUGH? THAT
THERE THEN NOT COST SHIFTING
ONTO PUBLIC SYSTEMS THAT THAT'S
REALLY THE CONCERN I HAVE IS.
ALL OF A SUDDEN WE'RE ASKING
MORE OF CB H D A AND THOSE
ORGANIZATIONS TO FUND THINGS
THROUGH, UM, HSCEI WHEN THEY'RE
PAYING PREMIUMS EVERY SINGLE
MONTH AND NOT THEN ABLE TO
ACCESS NETWORKS OR SEEK SERVICES
UNTIL THEY'RE ON GOVERNMENT.
PROGRAMS SEEMS CONTRARY TO THE
LOGIC FOR GETTING PRIVATE
INSURANCE IN THE FIRST PLACE
THAT UM I JUST WANT TO ENCOURAGE
US AS MUCH AS I CAN TO MAKE SURE
WE'RE HOLDING THOSE PLANS
ACCOUNTABLE. AND I DO BELIEVE WE
HAVE THAT OPPORTUNITY NOW THAT
WE ARE LOOKING AT THE
SUBCONTRACTS TWO, THEN MAKE SURE
THAT WE'RE HOLDING ALL MEDICAL
MANAGED CARE PLANS TO UM, WHAT
ARE ADEQUATE NETWORKS, BUT I'M
HEARING YOU ABOUT SOME OF THE
COST PRESSURES. BUT WE'RE
FEELING IT ON THE STATE SIDE AND
ARE WITNESSING WHEN SERVICES ARE
NOT ADMINISTERED WITH THE
HOMELESSNESS CRISIS THAT WE HAVE
BEFORE US. AND SO I'M UM, I KNOW
WE'RE PUSHING FOR PARODY, AND
THAT'S THE WORD WE NORMALLY USE.
I THINK IT'S FAIRNESS. THAT IF
WE'RE GOING TO HOLD OURSELVES
ACCOUNTABLE WITHIN THE PUBLIC
SYSTEM, THEY HAVE CERTAIN
BENEFITS THAT WE SHOULD IN
FAIRNESS REQUIRE OUR PRIVATE
PLANS TO SIMILARLY PARODY WITHIN
THAT. WITH THAT I THANK YOU VERY
MUCH. THIS PANEL AND WE WILL
MOVE ON TO ISSUE 19. OUR LAST
ISSUE OF TODAY'S HEARING. THIS
ISSUE IS ON THE PROPOSED GENERAL
OBLIGATION BONDS TO SUPPORT NEW
BEHAVIORAL HEALTH RESIDENTIAL
TREATMENT SETTINGS. WE WILL
BEGIN WITH DIRECTOR BOSS THERE'S
A DOCUMENTED NEED FOR ADDITIONAL
SUB ACUTE AND RESIDENTIAL
TREATMENT CAPACITY IN CALIFORNIA
. A RECENT RAND STUDY INDICATES
THAT THE STATE NEEDS ABOUT 6000
MORE SUB ACUTE AND RESIDENTIAL
BEDS TO SUPPORT CALIFORNIANS
LIVING WITH UH, S M I S T, D AND
N OR S U D, PARTICULARLY THOSE
EXPERIENCING HOMELESSNESS. THE
PROPOSED GENERAL OBLIGATION BOND
WOULD DEVELOP APPROPRIATE CARE
OPTIONS FOR CALIFORNIANS LIVING
WITH SEVERE MENTAL ILLNESS,
CONDITIONS AND SUBSTANCE USE
DISORDERS WHO NEED SHORT TERM
AND LONG TERM RESIDENTIAL
SUPPORT SERVICES. IT WOULD FUND
THE DEVELOPMENT OF AN ARRAY OF
UNLOCKED COMMUNITY BASED
TREATMENT AND RESIDENTIAL CARE
SETTINGS AND BUILD UPON THE
INFRASTRUCTURE INVESTMENTS THAT
BEGAN AS PART OF THE BEHAVIORAL
HEALTH CONTINUUM INFRASTRUCTURE
PROGRAM. SETTINGS WILL FOCUS ON
BUILDING RECOVERY SKILLS,
ENCOURAGING COMMUNITY
INVOLVEMENT, SUPPORTING
RETENTION IN BEHAVIORAL HEALTH
SERVICES AND LONG TERM RECOVERY.
AND ALSO PROVIDING TRANSITIONS
TO PERMANENT SUPPORTIVE HOUSING
PLACEMENTS OR WORKING TOWARDS
HOUSING STABILITY. THESE
SETTINGS REPRESENT CRITICAL SUB
LEVELS OF CARE THAT ARE
NECESSARY TO SUPPORT INDIVIDUALS
WITH THE MOST COMPLEX BEHAVIORAL
HEALTH CONDITIONS SUCCEED AS
THEY JOURNEY THROUGH CONTRITE
MINT CONTINUUM FROM INPATIENT
SETTINGS TO RESIDENTIAL SETTINGS
TO SUPPORTED HOUSING SETTINGS.
THANK YOU. OUR NEXT SPEAKER IS
NICOLE EBERHARD, A SENIOR
BEHAVIORAL SCIENTIST WITH THE
RAND CORPORATION. PLEASE BEGIN.
CAN YOU HEAR ME? OK CAN GREAT UM
, CHAIR ARAMBULA AND MEMBERS OF
THE CALIFORNIA STATE ASSEMBLY
COMMITTEE ON BUDGET SUBCOMMITTEE
ON HEALTH AND HUMAN SERVICES.
THANK YOU FOR THE OPPORTUNITY TO
SPEAK TODAY. MY NAME IS DR
NICOLE ABRA HEART, AND I'M, A
SENIOR BEHAVIORAL SCIENTIST AT
THE RAND CORPORATION. BRAND IS A
NONPROFIT, NONPARTISAN RESEARCH
ORGANIZATION HEADQUARTERED IN
SANTA MONICA, CALIFORNIA. RENT
HAS BEEN CONDUCTING INDEPENDENT
COUNTY FUNDED EVALUATIONS OF THE
IMAGESA FOR OVER A DECADE. WE
RECENTLY EXAMINED PSYCHIATRIC
BED CAPACITY NEED AND SHORTAGES
IN CALIFORNIA, INCLUDING A
STATEWIDE STUDY WHICH I WILL
DRAW ON TODAY, AND ADDITIONAL
STUDIES FOCUS ON SPECIFIC
COUNTIES OR REGIONS. BEFORE I GO
INTO OUR FINDINGS. I'D LIKE TO
PROVIDE SOME RELEVANT BACKGROUND
PSYCHIATRIC BEDS ARE ESSENTIAL
INFRASTRUCTURE FOR MEETING THE
NEEDS OF INDIVIDUALS WITH MENTAL
HEALTH CONDITIONS. THESE ARE
BEDS CONNECTED TO MEDICAL
MONITORING AND CARE WHERE PEOPLE
AT RISK OF HARM TO THEMSELVES OR
OTHERS, OR WHO NEED SUPPORT TO
CARE FOR THEMSELVES ARE GIVEN
ACCESS TO TREATMENTS IT
STABILIZE THEM, SUPPORT THEIR
MEDICAL NEEDS AND PUT THEM ON A
PATH TO RECOVERY. PAST
RESEARCHERS HAVE HAVE POINTED TO
THE LACK OF ACCESS TO
PSYCHIATRIC BEDS AS CONTRIBUTING
TO GROWING RATES OF HOMELESSNESS
AND MASS INCARCERATION.
CALIFORNIA LIKE MANY PARTS OF
THE UNITED STATES, IS
CONFRONTING A SHORTAGE OF
PSYCHIATRIC BEDS. THIS SHORTAGE
MANIFESTS ITSELF IN HIGH BED
OCCUPANCY RATES MEETING
FACILITIES ARE FULL AND LONG
WAITLIST REPLACEMENTS, RANDOM
RESEARCHERS ANALYZED THE SIZE OF
THE APPARENT SHORTAGES AND WHERE
THEY OCCUR WITH RESPECT TO BOTH
GEOGRAPHICAL REGION AND LEVEL OF
CARE. IN A RECENT STATEWIDE
STUDY ESTIMATED PSYCHIATRIC BED
CAPACITY NEED AND SHORTAGES FOR
ADULTS AT THREE LEVELS OF CARE.
ACUTE CARE IS DIRECTED TOWARD
THOSE WITH THE HIGHEST SECURITY
NEEDS IS TYPICALLY SHORTER TERM
DAYS TWO WEEKS AND IS INTENDED
TO STABILIZE PATIENTS. QUÊ CARE
IS DIRECTED TOWARD THOSE WHO IS
MODERATE TO HIGH ACUITY NEEDS
FOR A LONGER DURATION MULTIPLE
MONTHS. COMMUNITY RESIDENTIAL
SERVICES ARE INTENDED TO ADDRESS
LOWER ACUITY AND LONGER TERM
CARE, OFTEN MULTIPLE YEARS THAT
IS FOCUSED ON RECOVERY. WE
DEFINE THIS LEVEL OF CARE TO
INCLUDE ENHANCED OR AUGMENTED
BOARD AND CARE FACILITIES THAT
PROVIDE ADDITIONAL MENTAL HEALTH
SUPPORT SERVICES BEYOND THE
SERVICES IN GENERAL FACILITIES
THAT PROVIDE HOUSING ALONE. IN
THIS TESTIMONY. I WILL HIGHLIGHT
KEY FINDINGS FROM THE REPORT AND
I WILL DISCUSS RECOMMENDATIONS
TO ADDRESS PSYCHIATRIC BED
SHORTAGES BASED ON THESE
FINDINGS. OVERALL WE FOUND THAT
CALIFORNIA FACES SHORTAGES. THE
PSYCHIATRIC BEDS AT ALL THREE
MAJOR LEVELS OF ADULT INPATIENT
AND RESIDENTIAL CARE. I WEAR
ANALYSIS CONCLUDED THAT THE
STATE HAS A SHORTAGE OF CLOSE TO
8000 BEDS. ALMOST 2000 BEDS AT
THE ACUTE LEVEL A LITTLE UNDER
3000 BEDS AT THE SUB ACUTE LEVEL
, AND ALMOST 3000 BEDS OF THE
COMMUNITY RESIDENTIAL LEVEL
BOTTLENECKS IN THE SYSTEM OF
CARE CONTRIBUTE TO HEAD HIGH BED
OCCUPANCY RATES AND LENGTHY WAIT
LISTS. CUTE INPATIENT
PSYCHIATRIC FACILITIES
REPORTEDLY WOULD TRANSFER ON
AVERAGE ABOUT ONE IN 10 OF THEIR
PATIENTS TO SUB ACUTE FACILITIES
IF THERE WERE PLACEMENTS
AVAILABLE TO DO SO. WHILE
ADMINISTRATORS AT THE SUB ACUTE
LEVEL REPORTEDLY WOULD TRANSFER
MORE THAN ONE THIRD OF THEIR
PATIENTS IF THEY WERE ABLE TO DO
SO. A SERIOUS BOTTLENECKS CAUSED
BY THE LACK OF AVAILABILITY OF
COMMUNITY RESIDENTIAL CARE.
THESE SHORTAGES, MAYBE EVEN MORE
DIRE FOR CERTAIN HARD TO PLACE
POPULATIONS. WE FOUND THAT A
MAJORITY OF PSYCHIATRIC
FACILITIES AT ALL LEVELS OF CARE
REPORTING IN THE INABILITY TO
PLACE INDIVIDUALS WITH SERIOUS
CO OCCURRING PHYSICAL HEALTH
CONDITIONS. AND A MAJORITY OF
COMMUNITY RESIDENTIAL FACILITIES
WERE UNABLE TO PLACE INDIVIDUALS
INVOLVED IN THE CRIMINAL JUSTICE
SYSTEM. WITHOUT ACTION. THIS BED
SHORTAGE WILL GET WORSE OVER
TIME. OUR RESEARCH SHOWS THAT
CALIFORNIA FACES AN ESTIMATED
1.7% GROWTH AND ITS PSYCHIATRIC
BED NEED IN THE FIVE YEARS
FOLLOWING OUR 2021 ASSESSMENT.
USING THESE FINDINGS, WE
RECOMMEND PRIORITIZING,
INCREASING PSYCHIATRIC THAT
INFRASTRUCTURE AT THE SUB ACUTE
AND COMMUNITY RESIDENTIAL LEVELS
OF CARE WHERE WE FOUND THE
GREATEST SHORTAGES ON A
STATEWIDE LEVEL, ALTHOUGH THERE
WAS SIGNIFICANT VARIATION ACROSS
CALIFORNIA'S REGIONS AS DETAILED
IN OUR REPORT PRIORITIZING
INCREASING CAPACITY AT THE
COMMUNITY RESIDENTIAL LEVEL,
SUCH AS ENHANCED HER AUGMENTED
BOARDING CARE WOULD LIKELY EASE
THE BURDEN UPSTREAM AT HIGHER
LEVELS OF CARE AND ALLOW PEOPLE
TO BE IN THE MOST APPROPRIATE
AND LEAST RESTRICTIVE LEVEL OF
CARE. IT SHOULD ALSO CONSIDER A
BUILDING CAPACITY TO SERVE HARD
TO PLACE POPULATIONS WHO
CONTRIBUTE DISPROPORTIONATELY TO
BOTTLENECKS IN THE CURRENT
SYSTEM. MOST NOTABLY, IT IS
CHALLENGING TO TRANSFER PATIENTS
. THE CRIMINAL JUSTICE
INVOLVEMENT FROM THE SUB ACUTE
LEVEL OF CARE TO COMMUNITY
RESIDENTIAL SETTINGS. GIVEN
THIS, THE STATE MIGHT CONSIDER
ALTERNATIVE ARRANGEMENTS FOR
PLACING SUCH POPULATIONS. IN
CONCLUSION, OUR STUDY REVEALED
SIGNIFICANT SHORTAGES IN
PSYCHIATRIC BEDS ACROSS THE
STATE THAT ARE PROJECTED TO
WORSEN IF NOT ADDRESSED TO HELP
RESOLVE THESE CHALLENGES. WE
RECOMMEND PRIORITIZING,
INCREASING ITS PSYCHIATRIC THAT
INFRASTRUCTURE AT THE SUB ACUTE
AND COMMUNITY RESIDENTIAL LEVELS
OF CARE AND BUILDING CAPACITY TO
SERVE HARD TO PLACE POPULATIONS
TO ALLEVIATE BOTTLENECKS IN THE
CURRENT SYSTEM. THANK YOU AGAIN
FOR THE OPPORTUNITY TO TESTIFY,
AND I LOOK FORWARD TO YOUR
QUESTIONS OF FINANCE. EXACTLY
THE DEPARTMENT OF FINANCE. NO NO
FURTHER COMMENTS AT THIS TIME.
SURE SO WE HAVE SOME INITIAL
COMMENTS ON THIS PROPOSAL, AND
THEN WE'LL ALSO SPEAK TO THE
GENERAL COST OF BONDS, WHICH WE
WERE ASKED TO COMMENT ON BY
STAFF SO FIRST TO THE INITIAL
OVERALL COMMENTS. UM WE DO KNOW
THAT THE STATE IS CURRENTLY
SPENDING BILLIONS OF DOLLARS IN
RECENT INITIATIVES LIKE THE
BEHAVIORAL HEALTH CONTINUUM
INFRASTRUCTURE PROGRAM. UM ON
HOUSING AND INFRASTRUCTURE FOR
IN THE BEHAVIORAL HEALTH AREAS
SPECIFICALLY, UM, WHILE WE NOTE
THE RESEARCH ON THE SHORTAGE OF
BEDS GENERALLY, WE WOULD LIKE A
MORE IN DEPTH ANALYSIS FROM THE
ADMINISTRATION ON SPECIFICALLY
HOW THE BEDS THAT WOULD BE
CONSTRUCTED THROUGH THIS BAND
MEASURE WOULD FIT WITH ON
ONGOING INVESTMENTS THAT HAVE
HAPPENED IN RECENT YEARS. UM SO
SECOND AS TO THE COST OF A BOND
, SO AS WE UNDERSTAND IT
CURRENTLY THE ADMINISTRATION'S
PROPOSING GENERAL OBLIGATION
BOND, WHICH MEANS THAT GENERALLY
THE REPAYMENT IS GUARANTEED BY
THE STATE'S TAXING POWER, AND
THAT GENERAL OBLIGATION BONDS
ARE TYPICALLY REPAID THROUGH THE
GENERAL FUND. SO A LOT GOES INTO
THE ACTUAL ONGOING COSTS OF BOND
FINANCING, BUT ASSUMING
BORROWING TERMS THAT ARE TYPICAL
FOR GENERAL OBLIGATION BONDS FOR
EVERY BILLION DOLLARS BORROWED
THAT WOULD RESULT IN AN AVERAGE
OF 50 TO 60 MILLION IN ANNUAL
DEBT SERVICE. FOR AROUND 30
YEARS. SO ASSUMING $5 BILLION
BOND IS RAISED. UNDER THIS
PROPOSAL, THE AVERAGE ANNUAL
DEBT SERVICE COSTS WOULD AMOUNT
TO AROUND $275 MILLION. UM SO
THE TOTAL COSTS OF THE PRINCIPAL
AND THE INTEREST FOR A BOND IS
CLOSE TO $2 FOR EVERY $1
BORROWED, HOWEVER, AFTER
ACCOUNTING FOR INFLATION OVER
THE COURSE OF THE 30 YEARS, IT'S
A BIT CLOSER TO $1.40 FOR EVERY
DOLLAR BORROWED. SO FOR THE SAME
$5 BILLION BOND, THAT WOULD BE
ABOUT 275 MILLION ANNUAL DEBT
SERVICE. THE TOTAL COST
PRINCIPLE IN ISSUE INTEREST OF
THE BOND WOULD BE ABOUT $7
BILLION. SO ONE ISSUE TO
CONSIDER WHEN DISCUSSING ANY
TYPE OF NEW BOND FINANCING WOULD
BE HOW MUCH OVERALL DEBT WOULD
BE CONCERNED TOO MUCH FOR THE
STATE. SO WE TYPICALLY ASSESS
THIS BY COMPARING THE PERCENTAGE
OF THE GENERAL FUND REVENUE, UM
, THAT IS DEDICATED TO DEBT
SERVICE AND SO THE PERCENTAGE OF
GENERAL FUND REVENUE THAT ARE
USED FOR GENERAL OBLIGATION BOND
DEBT SERVICE IS CURRENTLY LOW
COMPARED TO THE RECENT
HISTORICAL AVERAGES. AND THE
BOND MEASURE BASED ON THE
INFORMATION PROVIDED AGAIN, YOU
KNOW, WITH CERTAIN ASSUMPTIONS,
UM, WOULD LIKELY HAVE A
NEGLIGIBLE IMPACT ON THIS
PERCENTAGE OF GENERAL FUND
REVENUES TO DEBT SERVICE. BRING
IT UP TO THE DIOCESE REMEMBERS
QUESTIONS WILL BEGIN WITH DR
JACKSON REALLY, JUST JUST ONE
QUESTION AND THAT IS, OBVIOUSLY
WE KNOW THAT THE VARIOUS
DIVERSITIES THAT WE NEED IN
TERMS OF THE DIFFERENT TYPE OF
BEDS THAT WE NEED. HOWEVER THIS
BOND IS FOR PARTICULARLY FOCUSED
ON HOMELESS VETERANS WITH MENTAL
OR SOME MENTAL ILLNESSES ARE
SUBSTANCE USE AND MY CORRECT IN
THAT PORTION OF THE BOND WOULD
BE AVAILABLE FOR VETERANS AND I
DON'T HAVE THE DETAILS ON THE
ALLOCATION BUT OF THE 3 TO $5
BILLION BOND THAT WE'RE TALKING
ABOUT. IT WOULD BE A SUBSET OF
THAT WOULD BE FOR VETERANS.
OKAY, SO WE ARE SO AS YOU ARE,
DO YOU ANTICIPATE? AND I KNOW
YOU'RE STILL WORKING OUT DETAILS
, BUT DO WE ANTICIPATE MAKING
SURE THAT WE DON'T JUST HAVE, UH
THAT WE HAVE. FUNDING FOR BEDS.
UM THAT COVER THE SPECTRUM OF
OUR NEEDS. UM OR DO YOU
ANTICIPATE FOCUSING ON ONE OR
TWO TYPE OF LEVELS OF NEED?
STILL THE THERE'S THE SPECIFIC
LEVELS WOULD BE THE SUB ACUTE
AND THE RESIDENTIAL CARE
FACILITIES RECOGNIZING I MEAN TO
THE TO THE RAN RESEARCHERS POINT
ABOUT KIND OF THE THROUGHPUT AND
WANTING TO ENSURE THAT WE HAVE
THE ENTIRE CONTINUUM TO ENSURE
THAT INDIVIDUALS CAN TRANSITION
THROUGH THESE SETTINGS. AND THIS
IS WHERE WE SEE THE BIGGEST NEED
. THANK YOU. UM SIMILARLY, I'D
LIKE TO ASK ABOUT SOME OF THE
GEOGRAPHICAL DISPARITIES. ARE WE
PLANNING TO PRIORITIZE SOME OF
THE FUNDING TO ADDRESS THE
DISPARITIES AND RESIDENTIAL.
FACILITIES ACROSS THE STATE.
THAT WILL DEFINITELY BE A
COMPONENT. THAT'S WHAT WE'RE
DOING WITH OUR BEHAVIORAL HEALTH
CONTINUUM INFRASTRUCTURE PROGRAM
AS WE GO THROUGH THE GRANT
ROUNDS, AND ONCE WE'VE ISSUED
THE AWARDS FOR GRANT AROUND
FIVE, THE ROUND SIX WILL BE
TAKING A LOOK AT WHERE HAVE WE
DEVELOPED OR MADE AWARDS? AND
WHERE DO WE KNOW WE NEED TO ADD
SOME MORE CAPACITY, SO THAT
WOULD BE PART OF THIS AS WELL? I
WILL ELEVATE THAT SINCE WE, UM
ARE LOW COMPARED TO OUR HISTORIC
PERCENTAGES FOR DEBT LIMIT AND
SEEING AS WE'RE FACING THE
HOMELESSNESS CRISIS THAT WE HAVE
BEFORE US SEEMS APPROPRIATE FOR
US TO BE CONSIDERING THIS TYPE
OF OBLIGATION BOND AND
APPRECIATE THE ADMINISTRATION
FOR BRINGING IT FORWARD. WITH
THAT? I WILL THANK OUR LAST
PANEL AND ALL OF OUR PANELISTS
AND TODAY'S HEARINGS. AND WE
WILL NOW TURN TO PUBLIC COMMENT
ON ALL 39 ISSUES THAT ARE ON
TODAY'S AGENDA. WE WILL BEGIN
PUBLIC COMMENT WITH INDIVIDUALS
WHO ARE HERE IN THE HEARING
ROOM, AND THEN WE WILL GO TO THE
PHONE LINES. GOOD EVENING, MR
CHAIR, AND DR JACKSON, JULIANA
DARE WITH A CALIFORNIA STATE
ASSOCIATION OF COUNTIES
REPRESENTING ALL 58 COUNTIES
JUST WANTED TO MAKE A FEW BRIEF
COMMENTS ON ISSUES 17 THROUGH 19
OF THE IMAGES A PROPOSAL
CALIFORNIA COUNTIES LOOK FORWARD
TO PARTNERING WITH THE GOVERNOR
, THE LEGISLATURE AND OTHER
STAKEHOLDERS ON REFORMS THAT
ALIGN WITH SAX AT HOME PLAN TO
MAKE REAL PROGRESS ON ADDRESSING
HOMELESSNESS WHILE ALSO
SUPPORTING LOCAL BEHAVIORAL
HEALTH SERVICES. CSX SUPPORTS
ACCOUNTABILITY INCREASED
FLEXIBILITY WITHIN THE ESSAY TO
MAKE THE FUNDING MORE EFFECTIVE
, AS WELL AS MORE BEHAVIORAL
HEALTH BASED, UH, HOUSING. I DID
WANT TO NOTE THAT PROPOSED
VERSIONS OF MHS A FUNDING
WARRANT CAUTION AS REDUCTIONS TO
CURRENT LOCAL BEHAVIORAL HEALTH
SERVICES MAY RESULT IN A
COMMENSURATE LOSS OF CRITICAL
FEDERAL MATCHING FUNDS AND CARE
FOR THOSE LIVING WITH BEHAVIORAL
HEALTH ALBUM SAYS. THAT BEING
SAID, WE DO LOOK FORWARD TO
COLLABORATING ON PROPOSED
CHANGES, DISCUSSING MORE DETAILS
OF THE PROPOSAL AND ARE OPEN TO
JOINTLY DEVELOPING MHSC REFORM
FOCUSED ON BEST SERVING THE
NEEDS OF VERNAL BORDER
CALIFORNIANS. THANK YOU. THANK
YOU. I DON'T KNOW IF I'M AWAKE
FOR AWAKE ENOUGH FOR THIS, BUT
I'M GONNA TRY ANDREA WAGNER WITH
CAM PRO CALIFORNIA ASSOCIATION
OF MENTAL HEALTH CARE RUN
ORGANIZATIONS, JUST A FEW, UM,
DISJOINTED COMMENTS. UM FIRST OF
ALL, JUST WANT TO EMPHASIZE THE
POINT THAT YOU KNOW, WE TALK
ABOUT THE THIS AS PART OF A
RESOLUTION ON HOMELESSNESS AND,
UM, YOU KNOW, IN IN CURRENT
STUDIES FROM THIS ADMINISTRATION
POINTED OUT THAT ONLY 25% OF THE
PEOPLE OUT ON THE STREETS HAVE A
SEVERE MENTAL ILLNESS. AND SO WE
CAN'T PUT ALL THE MONEY IN THE
BEHAVIORAL HEALTH POT AND EXPECT
THIS PROBLEM TO GO AWAY. UM AND
THEN I WOULD LIKE TO SAY THAT,
YOU KNOW, I THINK THE ARGUMENT
THAT THE BILL IS OLD IS A MOOT
POINT. I MEAN, ARE WE GOING TO
PULL OUT EVERY 20 YEAR OLD BILL
AND ANALYZE IT AND GO THROUGH
THIS? I DON'T THINK SO. THERE'S
OTHER REASONS FOR IT, AND I
THINK THAT'S POLITICAL SPIN, AND
WE SHOULD STOP BUYING IT. UM I
ALSO WANT TO SAY THAT WE'VE GOT
TO THINK, TOO ABOUT WHY PEOPLE
AREN'T TAKING THESE SERVICES.
IT'S NOT JUST THAT THE SERVICES
ARE OUT THERE AND PEOPLE DON'T
YOU KNOW THEY'RE JUST NOT
CAPABLE OF TAKING THEM. THERE'S
ALSO A FACTOR OF CHOICE, AND
PEOPLE DON'T LIKE THE SERVICES
THAT ARE AVAILABLE OR THEY
AREN'T AVAILABLE. I LIVE IN
BUTTE COUNTY, WHERE MEDIUM SIZED
COUNTY WE HAVE A HUGE PROBLEM
WITH PEOPLE LIVING ON THE
STREETS AND CAMPING. ON OUR BIKE
TRAILS AND AROUND OUR BEAUTIFUL
PARKS, BUT THE ONLY THING THAT'S
OFFERED AN ALTERNATIVE IS A
PALLET SHELTER. AND A WAREHOUSE
. HOMELESS SHELTER. I CAN TELL
YOU I WAS ONE OF THOSE PEOPLE
OUT THERE, AND I'D MUCH RATHER
SLEEP IN THE PARK. SO I THINK WE
HAVE TO RETHINK ABOUT NOT JUST
PROVIDING PLACES FOR PEOPLE TO
SLEEP, BUT PLACES THAT PEOPLE
WANT TO GO, NOT JUST PROVIDING
PROVIDING PSYCHIATRISTS, BUT AND
, YOU KNOW, ENTITIES THAT PEOPLE
WANT TO GET SERVICES AND UM
THANK YOU VERY MUCH FOR YOUR
TIME TODAY. THANK YOU. SEEN NO
FURTHER PUBLIC COMMENT IN THE
HEARING ROOM. 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 AND
SHOULD ALSO BE APPEARING ON YOUR
SCREEN. IF YOU ARE WATCHING ON
THE LIVESTREAM. THE PHONE NUMBER
AGAIN IS 877692. AND THE ACCESS
CODE IS 131. 5127 OPERATOR.
LET'S BEGIN PUBLIC COMMENT. MR
CHAIR. OUR FIRST PUBLIC COMMENT
IS FROM LINE 42. YOUR LINE IS
OPEN. COMMISSIONER ON THE MENTAL
HEALTH SERVICES OVERSIGHT AND
ACCOUNTABILITY COMMISSION, AS
THE ATTORNEY GENERAL SAID TO ME
SPEAKING TO ISSUES 17 ON BEHALF
OF TCP, I WANT TO START BY
RECOGNIZING THAT THE GOVERNOR'S
PROPOSAL OPENS AN IMPORTANT
CONVERSATION AROUND BENEATH AND
MODERNIZE THE MHS SAY IN
CALIFORNIA'S BEHAVIORAL HEALTH
SYSTEM TO BETTER CARE FOR OUR
COMMUNITY. WE URGE THE
LEGISLATURE AND ADMINISTRATION
TO INFER THAT DIALOGUE IF BASE
TO KEEP IN A TRUE UPSTREAM
PREVENTION AND A WHOLE CHILD,
WHOLE FAMILY OR COMMUNITY
APPROACHED THE MENTAL HEALTH
THAT IS AT THE CENTER OF THE
MENTAL HEALTH SERVICES BACK. AS
DETAILED AS SOLIDIFIED. WE
RECOGNIZE THE CONSIDERATION TO
BUILD ON THE GOVERNOR'S
LEADERSHIP ON MENTAL HEALTH AND
FURTHER SUPPORT, CHILD HEALTH
AND WELL BEING, INCLUDING
MAINTAIN PROTECTIONS FOR
EXISTENCE. SET ASIDE THAT AMOUNT
TO AT LEAST 10% OF TOTAL AMATEUR
RESOURCES FOR PROGRAMS AND
SERVICES SERVING CHILDREN AND
YOUTH 0 TO 25. PRIORITIZED
FAMILIES WERE A PARENT OR
CAREGIVER HAS SEVERE MENTAL
ILLNESS OR SUBSTANCE USE
DISORDER AND TRANSITIONAL OF
YOUTH FOR HOUSING SUPPORT. AND
ADVANCED UTILIZATION COMMUNITY
FIND EVIDENCE BASED PRACTICES
ACROSS THE AGE CONTINUUM AS A
COVERED BENEFIT IN BOTH MEDICAL
MANAGED CARE AND SPECIALTY
MENTAL HEALTH THROUGH A STATE
PLAN AMENDMENT IN ORDER TO
MAXIMIZE DRAWING DOWN THOSE
FEDERAL FUNDS AS A COMMISSIONER,
AND AS AN ADVOCATE. I LOOK
FORWARD TO THE CONTINUED WORK
TOGETHER. THANK YOU FOR THE
OPPORTUNITY TO COMMENT. THANK
YOU. NEXT CALLER, PLEASE. THANK
YOU. OUR NEXT COMMENT IS FROM
LINE 44. YOU MAY GO AHEAD. GOOD
EVENING, SHARING IT WITH THE
CORPORATION FOR SUPPORTIVE
HOUSING. I'M GOING TO SPEAK ON
ITEMS 17 AND 19. WE FULLY
SUPPORT THE GOVERNOR'S PROPOSAL
TO DEDICATE 30% OF MENTAL
SERVICES ACT DOLLARS TO FUND
HOUSING. STUDY AFTER STUDY SHOWS
HOUSING IS HEALTHCARE, AND THIS
IS EQUALLY TRUE FOR PEOPLE
EXPERIENCING HOMELESSNESS AND
SERIOUS MENTAL ILLNESS. STUDIES
SHOW PEOPLE'S CONDITIONS AS LONG
AS THEY EXPERIENCE HOMELESSNESS
, OFTEN RESULTING IN EARLY
MORTALITY. WE ALSO JUST, UM, IT
JUST SAY AS ASSERTIVE COMMUNITY
TREATMENT OR ACT SERVICES AS
ELIGIBLE. HE'S. FULL SERVICE
PARTNERSHIPS WERE ORIGINALLY
INTENDED TO MIMIC ACT SERVICES
AS ACT AS AN EVIDENCE BASED
MODEL FOR PEOPLE WITH SERIOUS
BEHAVIORAL HEALTH CONDITIONS AND
ARE FUNDED IN MULTIPLE STATES
STATES ACROSS THE COUNTRY BUT
NOT HEARING CALIFORNIA.
UNFORTUNATELY FULL SERVICE
PARTNERSHIPS DO NOT IN ANY WAY
PROVIDES FIDELITY TO ACT
EVIDENCE BASED PRACTICES.
OVERWHELMING EVIDENCE SHOWS THE
ACT MODELS AFFECT FOR PEOPLE
EXPERIENCING HOMELESSNESS WITH
SERIOUS BEHAVIORAL HEALTH
CONDITIONS. FINALLY WE URGE THE
LEGISLATURE ALLOWS THE BOND
FUNDS TO BE USED FOR SUPPORTIVE
HOUSING. AS THE GOVERNOR
INITIALLY INDICATED IN HIS
ANNOUNCEMENT AROUND THIS
PROPOSAL, RESIDENTIAL TREATMENT
JUST TO CLARIFY IS NOT HOUSING.
WE CANNOT EXPECT PEOPLE TO
TRANSITION TO HOUSING WHEN A
WHOLLY INSUFFICIENT SUPPLY OF
HOUSING EXISTS. WHEN THEY LEAVE,
UH, RESIDENTIAL TREATMENT.
RESIDENTIAL TREATMENT IS
TEMPORARY. IT'S NOT INTENDED TO
PROVIDE HOUSING IS INTENDED TO
PROVIDE A PLACE WHERE PEOPLE WHO
NEED IN PATIENT CARE OR LICENSE
ABILITY CAN RECEIVE THAT AND
THEN PEOPLE HAVE TO LEAVE AT
SOME POINT IN TIME. IF WE ARE
PRIORITIZING PEOPLE EXPERIENCING
HOMELESSNESS. THE NEED FOR
INCIDENT HOUSING WITH INTENSIVE
SERVICES IS FAR GREATER THAN THE
NEED FOR RESIDENTIAL TREATMENT
THAT SO WE'VE RECOGNIZED THAT
THERE IS A SHORT RESIDENTIAL
TREATMENT BUSINESS WELL WE DO
HAVE A SHORTAGE OF OVER 225,000
HOUSING IN ITS FOR HOUSEHOLDS
EXPERIENCING HOMELESSNESS, ABOUT
A THIRD OF WHOM HAVE BEHAVIORAL
HEALTH CONDITIONS. FOR THIS
REASON, WE STRONGLY RECOMMEND
ALLOWING THESE BOND FUNDS TO BE
USED TO CREATE MORE SUPPORTIVE
HOUSING. THANK YOU VERY MUCH.
THANK YOU. NEXT CALLER, PLEASE.
OUR NEXT PUBLIC COMMENT IS FROM
LINE 40 52, PLEASE GO AHEAD BY
52. COUNTIES OF CALIFORNIA ON
THE URBAN COUNTIES. I'M
COMMENTING ON ISSUES 17 THROUGH
19 REGARDING MANAGED TO SAY
PROPOSAL, URBAN COUNTIES ARE
OPEN TO THE MODERNIZATION
CONVERSATION THAT THE GOVERNOR
HAS HAS STARTED. HOWEVER AS MANY
DETAILS REMAIN A NO. WE WANT TO
MAKE SURE THAT PROPOSED CHANGES
DON'T HARM SERVICE DELIVERY OR
INFRASTRUCTURE. TO THAT END, WE
ARE IN THE PROCESS OF HAVING IN
DEPTH CONVERSATIONS WITH OUR
URBAN COUNTY IS ABOUT WHAT IS
HAPPENING ON THE GROUND. WE HAVE
TO ENGAGE THE ADMINISTRATION TO
BETTER UNDERSTAND THE PROPOSAL
AND ADDRESS UNANSWERED QUESTIONS
. BUT YOU'RE PARTICULARLY IN
REGARD TO THE HOUSING BUBBLE AND
THE IMAGE OF THE HOUSING
COMPONENTS. FOR EXAMPLE, THE UM
WHAT DO WE THINK THERE ARE WAYS
THAT YOU CAN HELP INCENTIVIZE
THE HOUSING, INCLUDING
ADDRESSING SOME OF THE LOCAL,
CITING ISSUES THAT HAVE BEEN
SIGNIFICANT BARRIERS TO CREATING
HOUSING AND LOOKING AT THE
EQUESTRIAN LINING. UM WE ALSO
WOULD URGE. UM THESE
CONVERSATIONS TO THINK ABOUT HOW
THE CHANGES THAT ARE GOING ON
AND BEHAVIORAL HEALTH FINANCING
REFORMS WILL OCCUR IN IN THIS
JULY MAY INTERACT WITH LOCAL
PLANS AND EXPENDITURES. THE
MEDICAL SERVICES ACT HAS
HISTORICALLY BEEN THE GLUE FOR
MENTAL HEALTH SYSTEMS AND MANY
COUNTIES. WE LOOK FORWARD TO
WORKING WITH THE LEGISLATURE ON
THE ADMINISTRATION ON THE
PROPOSAL, AND AS IT IS DEVELOPED
FURTHER, THANK YOU. THANK YOU
NEXT COMMENT, PLEASE. OUR NEXT
COMMENT IS FROM 9 53, PLEASE GO
AHEAD. GOOD EVENING, ERADICATE
ON BEHALF OF THE RURAL COUNTY
REPRESENTATIVES OF CALIFORNIA
AND I APPRECIATE THE DISCUSSION
THIS NEW THIS EVENING ON THE AND
JUST SAY MODERNIZATION AND WE
LOOK FORWARD TO DISCUSSING THE
PROPOSAL AND MORE DETAIL. THIS
IS A VERY IMPORTANT FUNDING
SOURCE THAT TOUCHES NUMEROUS
PROGRAMS AND ANY TYPE OF
REDIRECTING NEEDS TO BE, UM,
REALLY THOUGHTFUL, LOOKED AT
THOUGHTFULLY AND CAUTIOUSLY TO
AVOID ANY UNINTENDED
CONSEQUENCES. AND MORE WORK
NEEDS TO BE DONE IN DEVELOPING
THE DETAILS AROUND THIS PROPOSAL
WERE ALSO IN THE PROCESS OF
LOOKING AT ADDITIONAL
INFORMATION ON THE GROUND TO
SHARE AS THIS PROPOSAL TAKES
SHAPE, WERE SUPPORTIVE OF THE
FLEXIBILITY MENTIONED TONIGHT
AND OPEN TO ADDITIONAL
ACCOUNTABILITY. LASTLY, ON THE
BOND MEASURE, IT'S IMPORTANT
THAT THE DISTRIBUTION OF THESE
DOLLARS ARE DONE. EXCELLENT
EQUITABLY. AND THAT WHEN THEY'RE
DISTRIBUTED, THE FUNDS ARE GOING
TO AREAS THAT HAVE HISTORICALLY
HAVE WORSE ACCESS TO BEHAVIORAL
HEALTH SERVICES TO ENSURE THAT
THEY ARE NOT LEFT BEHIND.
ESPECIALLY RURAL CALIFORNIA.
THANK YOU. THANK YOU. NEXT
COMMENT, PLEASE. OUR NEXT
COMMENT IS FROM LINE. 54, PLEASE
GO AHEAD. GOOD EVENING. MY NAME
IS STACY HERO MOTO AND I'M, THE
DIRECTOR OF REMCO, THE RACIAL
AND ETHNIC MENTAL HEALTH
DISPARITIES POLISH IN I'VE BEEN
DEEPLY INVOLVED WITH THE MENTAL
HEALTH SERVICES ACCENTS GOING TO
WORK FOR RUSTY FELIX IN 2006.
I'D LIKE TO SPEAK TO ISSUES 16
AND 17. FIRST THANK YOU, CHAIR
ARAMBULA AND ASSEMBLING MEMBER
BOOKER FOR STAYING SO LONG AT
THIS HEARING TO HEAR WHAT THE
PUBLIC HAS TO SAY. I WILL NEVER
FORGET THAT HEARING THAT ONE OF
YOUR EARLIER PANELISTS. ANDREA
WAGNER TALKED ABOUT. IT WAS THE
HEARING OF DECEMBER OF 2019 THAT
YOUR STAFF MEMBER, ANOTHER
ANDREA, ORGANIZED CHAIR ARAMBULA
. YOU IMPRESSED US ALL BY
STAYING AND LISTENING TO ALL THE
PUBLIC COMMENTS SO LATE TONIGHT.
IT WAS ALSO THE HEARING THAT
DARRELL STEINBERG FIRST
INTRODUCED SOME OF HIS THINGS,
IDEAS ABOUT CHANGING THE FUNDING
. PRIORITIES OF THE IMAGES SAY
THAT, AS I RECALL WERE NOT
SUPPORTED BY A SINGLE MEMBER OF
THE PUBLIC THAT GAVE COMMENT
THAT DAY. WELL WE STILL WHAT WE
RESPECT HIS DERMOT DETERMINATION
. WE REMAIN STRONGLY OPPOSED TO
HIS PROPOSALS. WHAT IS MOST
IMPORTANT FOR REM CODE TO GET
ACROSS TONIGHT. IS THAT IT IS
PENNY WISE AND POUND FOOLISH TO
ALLOW DECREASES IN PREVENTION
AND EARLY INTERVENTION FUNDS AS
PROPOSED IN THE GOVERNOR'S PLAN
TO MODERNIZE THE IMAGE, JUST
SAY. HAS BEEN INVOLVED SINCE
2010 WITH THE CALIFORNIA
REDUCING DISPARITIES PROJECT,
WHICH WAS ORIGINALLY FUNDED WITH
PE I DOLLARS AND CONTINUES TO
THIS DAY. THE CALIFORNIA
REDUCING DISPARITIES PROJECT ONE
OF OUR STATES MOST IMPORTANT AND
DISTINGUISHED MENTAL HEALTH
PROJECTS IS INTERNATIONAL LEADER
IN IMPLEMENTING COMMUNITY
DEFINED EVIDENCE PRACTICES OR
SEA DEPTHS. THAT ARE HIGHLY
VALUED BY RACIAL, ETHNIC AND L G
B T Q. PLUS COMMUNITIES AS WELL
AS OTHERS AND ARE CERTAINLY ONE
OF THE MOST EFFECTIVE WAYS TO
REDUCE DISPARITIES, ONE OF THE
ONLY PLACES THAT FUNDING IS
AVAILABLE FOR SEA DEPTHS IS
THROUGH PE I FUNDING AT THE
COUNTY LEVEL. AS ANOTHER OF YOUR
STELLAR PANELISTS, LET YOU BOTH
HAVE STATED EARLIER. THERE IS A
STATEWIDE MULTIYEAR STUDY OF THE
CALIFORNIA REDUCING DISPARITIES
PROJECTS THAT WAS COMPLETED THAT
SHOWS THE EFFECTIVENESS AND THE
RETURN OF INVESTMENT OF
COMMUNITIES YOU FIND PRACTICES.
THIS STUDY WAS SUBMITTED TO THE
STATE BY A HIGHLY RESPECTED
RESEARCHERS AT LOYOLA MARYMOUNT
UNIVERSITY IN MAY OF LAST YEAR.
THIS STUDY HAS NOT BEEN ALLOWED
TO BE RELEASED TO THE PUBLIC.
WHEN IT IS IT WILL BE PROOF THAT
PREVENTION SERVICES ARE VALUABLE
NOT ONLY FOR THE ORGANIZATIONS
THAT CURRENTLY USUAL EYES THEM,
BUT FOR THOSE COUNTIES AND
ORGANIZATIONS THAT WANT TO ADOPT
THESE AS FOR THE IMAGE YOU SAY,
ALWAYS SEE. GOING UNDER AGENCY
OR C H. H S. ASSEMBLYMEMBER'S
KING DID A GREAT JOB OF ASKING
QUESTIONS. THE O A. C WOULD
DEFINITELY LOSE SOME
INDEPENDENCE IF IT WENT UNDER
AGENCY. THANK YOU SO MUCH FOR
ALLOWING ME TO SPEAK TONIGHT AND
LISTENING TO OUR CONCERNS. THANK
YOU NEXT COMMENT, PLEASE. OUR
NEXT COMMENT IS FROM LINE. 35,
PLEASE GO AHEAD. HI THIS IS
THERESA COME STOCK WITH THE
CALIFORNIA ASSOCIATION OF LOCAL
BEHAVIORAL HEALTH BOARDS AND
COMMISSIONS. WE SUPPORT THE WORK
OF CALIFORNIA'S 59 LOCAL, MENTAL
AND BEHAVIORAL HEALTH BOARDS AND
COMMISSIONS. UM PART OF THE
GOVERNOR'S PROPOSALS ALIGN WITH
OUR PRIORITIES, INCLUDING FOCUS
IN TWO KEY AREAS. PERFORMANCE
OUTCOME MEASURES AND ADDRESSING
THE NEED FOR ADULT RESIDENTIAL
FACILITIES. UM FIRST, WITH
PERFORMANCE MEASURES AND
OUTCOMES FOR MENTAL AND
BEHAVIORAL HEALTH PROGRAMS. WE
KNOW THEY ARE FUNDAMENTAL TO
MAKING INFORMED DECISIONS SO WE
REALLY SUPPORT INCREASED
STANDARDIZATION ANALYSIS AND
COMMUNICATIONS PERFORMANCE
OUTCOME DATA AND KNOW THAT THAT
WILL HELP ENSURE EFFECTIVE LOCAL
AND STATEWIDE REVIEW. AND
IMPLEMENTATION OF BEHAVIORAL
HEALTH PROGRAMS AND SERVICES, UM
, MEASURING PERFORMANCE RELATED
TO LIFE OUTCOMES IS KEY TO
UNDERSTANDING BEST PRACTICES
INFORMING IMPROVEMENT PLANS
JUSTIFYING LOCAL AND STATEWIDE
IMPLEMENTATION AND SUSTAINING
FUNDING AND IN TERMS OF ADULT
RESIDENTIAL FACILITIES. WE
STRONGLY SUPPORT EFFORTS TO
BOOST THIS ESSENTIAL PART OF THE
CARE AND HOUSING CONTINUUM. IT
IS TRUE THAT THERE HAS BEEN ONE
TIME FUNDING DIRECTED TOWARD
INFRASTRUCTURE. BUT WE KNOW THAT
ADULT RESIDENTIAL FACILITIES ARE
CONTINUING TO CLOSE DUE TO A
BROKEN FINANCIAL MODEL. THESE
FACILITIES ARE CLOSING BECAUSE
THEY CANNOT COVER OPERATING
EXPENSIVE SO WE DO LOOK FOR
EFFORTS TO BOOST THIS CRITICAL
RESOURCE, AND WE KNOW THAT THAT
SHOULD INCLUDE CONSIDERATION BY
THE ADMINISTRATION BY THE
DEPARTMENT OF HEALTH CARE
SERVICES AND OTHER DEPARTMENTS
TO PUT IN A MEDICAL WAIVER
DEMONSTRATION PROJECT LIKE HAS
BEEN DONE FOR PEOPLE WITH
DEVELOPMENTAL DISABILITIES. UM
AND THEN THAT MEDICAL FUNDING
COULD BE TIED WITH THE NHS
FUNDING. THANK YOU. THANK YOU.
NEXT COMMENT, PLEASE. OUR NEXT
COMMENT IS FROM LINE. 55, PLEASE
GO AHEAD. HELLO. MY NAME'S
ALLISON MONROE. I'M CO FOUNDER
OF AN ORGANIZATION CALLED
FAMILIES ADVOCATING FOR THE
SERIOUSLY MENTALLY ILL. I WAS
HOPING TO SEE MORE FAMILY
MEMBERS HERE TONIGHT FAMILY
MEMBERS OF THE MENTALLY ILL. AND
I WOULD LIKE TO SEE MHSC AND ITS
PROGRAMS FOCUSED ON SERIOUS
MENTAL ILLNESS ON PSYCHOTIC
DISORDERS LIKE SCHIZOPHRENIA AND
SCHIZOAFFECTIVE AND BIPOLAR.
PEOPLE WHO HAVE A PHYSICAL
ILLNESS OF THEIR BRAIN. THAT IS
NOT THEIR FAULT AND SOMETIMES
PUTS THEM AT GREATER RISK. ONLY
THE STATE AND THE COUNTY'S
WORKING TOGETHER CAN KEEP THESE
PEOPLE ALIVE. IT'S NOT SOMETHING
THAT A FAMILY CAN DO ON ITS OWN
. AND IT'S CERTAINLY NOT
SOMETHING THAT A CLIENT CAN DO
ON THEIR OWN. IT'S NOT SOMETHING
THAT AN INSURER IS GOING TO WANT
TO DO ON THEIR OWN. IT'S US OR
NO. BUT I'D LIKE TO PROPOSE A
TEST FOR THE TEST OF SPENDING.
THEY KEEP PEOPLE WITH SERIOUS
MENTAL ILLNESS ALIVE WELL AND
SAFE AND AWAY FROM ABUSERS AND
THE VIOLENCE AWAY FROM DRUGS OUT
OF JAIL OFF THE STREET, FREE OF
CHRONIC MEDICAL CONDITIONS. THIS
IS EASY TO EVALUATE. EVERY
COUNTY HAS A LIST OF SUCH PEOPLE
ARE COUNTY HAS AT LEAST 1000.
HIÂU DIALYZERS THAT IT'S
TRACKING. WHO ARE IN AND OUT OF
JAIL AND HOMELESSNESS. A
SPREADSHEET COULD VERY EASILY
EVALUATE. HOW THESE PEOPLE ARE
BEING PROTECTED AND MAINTAINED.
AND THAT'S DOABLE TEST OF THE
SUCCESS OF OUR MENTAL HEALTH
SYSTEM. I'D LIKE TO SEE THE
ORGANIZATIONS WHO SPEND MHSC
MONEY, UNDERSTAND AND ADMIT,
FINALLY, THAT SECURE BIDS AND
CONSERVATORSHIPS ARE PART OF A
WORKING SYSTEM. UM. MHM S¼ NEEDS
REFORM THE MAIN REASON IT NEEDS
TO REFORM. IS THAT WE HAVE. TO
CHANGE OUR MINDSET. THERE IS A
WILLINGNESS TO PURSUE HOPE AND
OPTIMISM AND OCCASIONAL SUCCESS
STORIES. AT THE EXPENSE OF THE
SERIOUSLY MENTALLY ILL. AND TO
MAKE PROGRESS. WE NEED TO
ABANDON THE ASSUMPTION THAT ALL
TREATMENTS TREATMENT MUST BE
VOLUNTARY, ALWAYS AND THAT WE
CAN KEEP REDUCING THE NUMBER OF
SECURE BEDS. THIS IS A
MISCONCEPTION. IT'S TIME WE
TURNED AWAY FROM THIS INCLUDING
THE GOVERNOR. HE ALSO HAS TO
TURN AWAY FROM THIS
MISCONCEPTION. I'M CONCERNED
THAT THE BOND ISSUE WANT INCLUDE
MONEY. FOR THE 4700 SECURE BED
TO THE RAND CORPORATION FOUND
THAT WE NEED IN THIS STATE.
THESE 4700 BEDS ARE. SECURE
ACUTE AND SUB ACUTE BEDS. THE
BOND ISSUE I HEAR IS ONLY FOR
UNLOCKED FACILITIES. THAT'S THE
PROBLEM. UM. I'D ALSO LIKE TO
SUGGEST THAT THE BOND ISSUE
FOCUS AS TREAT THE COMSTOCK SAID
. GET ON LICENSED, PERMANENT
UNLOCKED RESIDENTS FOR THE S M I
BUT WE NEED THIS LOCKED UP. I
DON'T KNOW WHY THE BOND ISSUE
CAN'T BE USED FOR HOSPITALS.
PICTURES CAN BE CHIP IS ALMOST
OVER AND IT DID NOT SUCCEED IN
BUILDING AND SECURE BETS. THANK
YOU FOR LISTENING. I FEEL LIKE
WHERE I'M SEPARATE PLANETS
SOMETIMES THANK YOU SO MUCH,
THOUGH. THANK YOU. NEXT COMMENT,
PLEASE. THANK YOU. OUR NEXT
COMMENT IS FROM LINE. 47, PLEASE
GO AHEAD. YES. HI. I SHOULD
HAVE. REMEMBERS. MY NAME IS
TRINA. I'M A MOM OF A DAUGHTER
WITH MENTAL AND SPECIAL NEEDS.
MENTAL HEALTH AND SPECIAL NAMES.
I WOULD LIKE TO MAKE COMMENTS
TOWARDS ITEM 17 19. ADDRESS UM
UH, PRETEND GROUP WORK PROGRAM.
AND BARNETT. IN TODAY'S SESSION.
WORKING PROGRAM PEOPLE FOR
PEOPLE WITH SPECIAL NEEDS AND
MENTAL HEALTH INSURERS. NO IT
SEEMS TO BE THAT YOU JUST WANT
TO GIVE FREE SERVICES. INSTEAD
OF HAVING THEM CONTRIBUTE TO
SOCIETY. THEY ARE NOT BROKEN.
THEY ARE NOT. STUPID. THEY'RE
ALL. VERY UNIQUE. AND THEY
SHOULD GIVE BE GIVEN THE CHANCE.
PRODUCTIVE SOCIETY. AND I
BELIEVE THAT THERE NEEDS TO BE
MORE WORK PROGRAMS OUT THERE.
FOR THESE FOR THE HUMAN BEINGS.
IF WE GIVE OVER MANY WAYS MOVE
OVER TAXES. WILL BE NOTHING
THERE FOR ANYBODY ELSE. I THINK
WE NEED TO BE INVESTING IN MORE
WORK PROGRAMS. WE NEED TO GET
PEOPLE BACK TO WORK. AND I'M TO
ITEM 33. STOP WASTING OUR TAXES.
ON WIENER SPECIAL PROGRAMS.
OKAY? WE DON'T WANT THAT. WE
DON'T WANT THAT HERE IN
CALIFORNIA. AS A MOM. AS AN AS A
ADVOCATE. AS A AS A. MOM WITH
WITH A CHILD WITH SPECIAL NEEDS.
RIGHT? MY CHILD WAS ACTUALLY
HARMED BY THE STATE OF
CALIFORNIA. AND SHE HAS BEEN
FIGHTING. FIGHTING. POKER LIFE.
AND I'M I'M I'M REALLY ASHAMED
TO ACTUALLY. OF HOW THIS SYSTEM
HAS BEEN ABUSING OUR CHILDREN.
NO, WE DO NOT NEED POCKET.
ANYMORE. GOVERNMENT OFFICIALS.
HÌ TACTIC. WE NEED TO BE GIVING
THEM MONEY. TWO FAMILIES TO THE
CHILDREN TO THE PEOPLE. BUT
ACTUALLY DO NEED IT. TO HELP
THEM. TO HELP THEM BE MORE
PRODUCTIVE. FINALLY DEAL WITH
THAT. THANK YOU. THANK YOU NEXT
COMMENT, PLEASE. THANK YOU, MR
CHAIR AT THIS TIME. THERE ARE NO
OTHER COMMENTS. THANK YOU.
OPERATOR I WILL TAKE THAT AS THE
CONCLUSION OF PUBLIC COMMENT FOR
THE DAY. I WILL APPRECIATE ALL
OF OUR PANELISTS, THE
ADMINISTRATION DIRECTOR BOSS WHO
STAYED THE ENTIRE TIME HERE
TODAY, DEPARTMENT OF FINANCE L.
A OH! SERGEANTS ATTACK. MY STAFF
BUDGET STAFF MEMBERS WHO ASKED
IMPORTANT QUESTIONS, BUT MOST
IMPORTANTLY, THE PUBLIC WHO
MAKES OUR PROCESS BETTER AND
ALLOWS US TO BE THE PEOPLE'S
HOUSE WITH THAT WE ARE ADJOURNED
FOR THE NIGHT. HAVE A GOOD
NIGHT.