GOOD. THIS IS THE ASSEMBLY
BUDGET SUB-COMMITTEE NUMBER ONE
ON HEALTH. TODAY'S HEARING
COVERS THE PROPOSED BUDGET AND
KEY BUDGET PROPOSALS FOR THE
DEPARTMENT OF PUBLIC HEALTH. WE
HAVE SEVEN ISSUES ON THE AGENDA
EACH HOVERING UP TO A FEW
DIFFERENT PROPOSALS THAT ARE
RELATED TO EACH OTHER IN SOME
WAY OR ANOTHER. I'M GOING TO ASK
EACH PANELIST TO PRESENT ALL OF
THE PROPOSALS UNDER ISSUES
ALTOGETHER. AND THEN WE WILL ASK
QUESTIONS FOLLOWING ALL OF THE
PRESENTATIONS. I WOULD ALSO LIKE
TO REQUEST THAT THE PANELISTS
TRY TO BE BRIEF. SO THAT WE CAN
GET THROUGH THIS AGENDA AT A
REASONABLE TIME. FINALLY WE WILL
TAKE PUBLIC COMMENT. AFTER EACH
OF THE SEVEN ISSUES ON THE
AGENDA. OUR FIRST ISSUE WILL BE
THE PRESENTATION OF THE STATE OF
PUBLIC HEALTH REPORT BY THE
DIRECTOR OF THE DEPARTMENT OF
PUBLIC HEALTH, WHO IS ALSO
CALIFORNIA STATE PUBLIC HEALTH
OFFICER. DOCTOR, THOMAS ARAGON.
WELCOME. AND PLEASE BEGIN
WHENEVER YOU'RE READY.
MAYBE IT'S A HERE WE GO. GOOD
AFTERNOON. GOOD AFTERNOON CHAIR
MEMBERS. I AM DOCTOR. TOMAS
ARAGON, STATE PUBLIC HEALTH
OFFICER AND DIRECTOR OF THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH. IT'S AN HONOR TO BE HERE
TODAY TO PRESENT ON THE STATE OF
PUBLIC HEALTH IN CALIFORNIA. AT
èC Dð P HÌ. OUR MISSION IS TO
ADVANCE THE HEALTH AND WELL
BEING. OF CALIFORNIA'S DIVERSE
PEOPLE AND COMMUNITIES. WITH THE
VISION THAT ALL CALIFORNIANS
ENJOY HEALTHY COMMUNITIES WITH
THRIVING FAMILIES AND
INDIVIDUALS. PUBLIC HEALTH. IS
OUR COLLECTIVE EFFORT. TO
PROTECT, PROMOTE AND IMPROVE THE
HEALTH OF ALL COMMUNITIES IN
CALIFORNIA. THIS YEAR, èC Dð P
SUBMITTED THE INAUGURAL STATE OF
PUBLIC HEALTH REPORT
HIGHLIGHTING KEY PUBLIC HEALTH
INDICATORS. HEALTH DISPARITIES
AND LEADING CAUSES OF MORBIDITY
AND MORTALITY. THIS REPORT
SERVES AS A FOUNDATIONAL TOOL
FOR MONITORING POPULATION
HEALTH. INFORMING PUBLIC HEALTH
ACTION AND PROMOTING SHARED
ACCOUNTABILITY. OUR APPROACH TO
SAFEGUARDING AND ENHANCING
HEALTH IN CALIFORNIA, IS GUIDED
BY FOUR PRINCIPLES IN PUBLIC
HEALTH. FIRST ECOLOGICAL AND
SOCIAL ENVIRONMENTS. THIS PILLAR
CENTERS ON THE CONNECTIONS
BETWEEN INDIVIDUALS, THEIR
FAMILIES AND SOCIAL CIRCLES. AS
WELL AS THEIR INTERACTION WITH
THEIR NEIGHBORHOOD AND
ENVIRONMENT. SECOND THE LIFE
COURSE PERSPECTIVE. THIS PILLAR
ACKNOWLEDGES THAT HEALTH IS
INFLUENCED BY EXPERIENCES
THROUGHOUT ONE'S LIFE. AND THE
LIVES OF PAST GENERATIONS. THIRD
EQUITY AND HEALTH EQUITY. THIS
PILLAR FOCUSES ON CREATING FAIR
AND JUST CONDITIONS WHERE
EVERYONE HAS THE OPPORTUNITY TO
ACHIEVE OPTIMAL HEALTH. FREE
FROM DISCRIMINATION AND RACISM.
FOURTH PREVENTION FOCUSED. THIS
PILLAR PRIORITIZES PRIMARY
PREVENTION, PARTICULARLY
INTERVENING EARLY TO ADDRESS
POTENTIAL HEALTH PROBLEMS BEFORE
THEY ARISE. OVER THE PAST 20
YEARS. THE HEALTH AND WELL BEING
OF CALIFORNIANS HAS IMPROVED.
THESE ACHIEVEMENTS ARE DUE IN
PART TO OUR COLLECTIVE PUBLIC
HEALTH PREVENTION STRATEGIES AND
INVESTMENTS. LIFE EXPECTANCY
INCREASED OVER THIS PERIOD WITH
DECLINES IN ISCHEMIC HEART
DISEASE, STROKE, LUNG CANCER,
CHRONIC OBSTRUCTIVE PULMONARY
PULMONARY DISEASE, PROSTATE
CANCER AND BREAST CANCER. OUR
TOBACCO PREVENTION EFFORTS LED
TO A 59% REDUCTION IN LUNG
CANCER DEATH RATES, AND WE BOAST
THE SECOND LOWEST SMOKING RATES
IN THE NATION. SIMILARLY. PUBLIC
HEALTH AND MEDICINE CONTRIBUTED
TO A 60% DECLINE IN IN ISCHEMIC
HEART DISEASE DEATHS
INTERVENTIONS INCLUDED PROMOTING
HEALTHY EATING, AND, UH ACTIVE
LIVING AND INCREASING ACCESS TO
QUALITY HEALTH CARE.
CALIFORNIA'S INFANT MORTALITY
RATES RANK AMONG THE LOWEST IN
THE COUNTRY, DRIVEN BY MATERNAL
AND CHILD HEALTH PROGRAMS THAT
INCLUDE NUTRITIONAL SUPPORT,
GENETIC DISEASE SCREENING, HOME
VISITING AND THE WICK PROGRAMS.
DESPITE IMPORTANT HEALTH GAINS,
THERE ARE LONG TERM INCREASES IN
DEATHS DUE TO ALZHEIMER'S
DISEASE. HYPERTENSIVE HEART
DISEASE, DRUG OVERDOSES. AND.
RACIAL AND ETHNIC AND SOCIO
DEMOGRAPHIC DISPARITIES PERSIST
ACROSS THESE AND OTHER LEADING
CAUSES OF DEATH. THE COVID-19
PANDEMIC PRESENTED UNPRECEDENTED
CHALLENGES IMPACTING LIFE
EXPECTANCY FOR THE FIRST TIME IN
20 YEARS. THE PANDEMIC
UNDERSCORED AN AMPLIFIED
LONG-STANDING RACIAL, ETHNIC AND
SOCIO DEMOGRAPHIC HEALTH
INEQUITIES. OUR COVID-19
RESPONSE MITIGATED THE HEALTH,
SOCIAL AND ECONOMIC IMPACTS OF
THE PANDEMIC. AS A RESULT,
COVID'S IMPACT HAS SHIFTED. FROM
HIGH RATES OF HOSPITALIZATIONS
AND DEATHS TO A LESS SEVERE,
ENDEMIC TO THE LESS OF YOUR
ENDEMIC STATUS WE HAVE TODAY. AS
WE NAVIGATE THE POST PANDEMIC
RECOVERY, WE RE REMAIN FOCUSED
ON PROTECTING THE HIGHEST RISK
COMMUNITIES AND PATIENTS. THE
LIFE COURSE APPROACH. INFORMS
OUR PREVENTION STRATEGIES. I
WILL WALK YOU THROUGH SOME
SELECTED CHALLENGES, STARTING
WITH EARLY LIFE STAGES. A
HEALTHY START IN LIFE IS CRUCIAL
FOR LONG TERM WELL BEING.
FACTORS SUCH AS PRENATAL CARE.
ACCESS TO HEALTH CARE. ECONOMIC,
HOUSING AND FOOD SECURITY. AND
POSITIVE SOCIAL CONNECTIONS,
INFLUENCE HEALTH OUTCOMES.
ADVERSITY IN HEALTH DISPARITIES
EARLY IN LIFE DRIVE UNEQUAL
OUTCOMES. THROUGHOUT LIFE.
ALTHOUGH CALIFORNIA HAS SOME OF
THE LOWEST INFANT AND PREGNANCY
RELATED MORTALITY RATES IN THE
NATION. BLACK INFANTS AND FAMILY
FAMILIES EXPERIENCE SIGNIFICANT
DISPARITIES IN PERINATAL
OUTCOMES. IN 2022. THE MORTALITY
RATE WAS THREE TIMES HIGHER FOR
BLACK CHILDREN IN NEARLY TWO
TIMES HIGHER FOR LATINO CHILDREN
COMPARED TO WHITE CHILDREN.
INFANT MORTALITY RATES ARE ALSO
SIGNIFICANTLY HIGHER IN
NEIGHBORHOODS WITH HIGHER RATES
OF POVERTY. ALTHOUGH THE RATE IS
IMPROVING, BLACK WOMEN WERE
THREE TO SEVEN TIMES MORE LIKELY
TO DIE FROM PREGNANCY RELATED
CAUSES. STRUCTURAL AND
INTERPERSONAL RACISM IS A KEY
DRIVER OF THESE DISPARITIES
IMPACTING NEIGHBORHOOD
CONDITIONS. CHRONIC STRESS. AND
ACCESS TO RESPECTFUL CARE. TO
SUMMARIZE THIS EVIDENCE IN LATE
2023, èC Dð, P HÌ AND U èC S¼
F PUBLISHED A REPORT ENTITLED
CENTERING BLACK MOTHERS IN
CALIFORNIA INSIGHTS INTO RACISM,
HEALTH AND WELL BEING FOR BLACK
WOMEN AND INFANTS. RACIAL AND
ETHNIC DISPARITIES ARE ALSO
OBSERVED IN ADVERSE CHILDHOOD
EXPERIENCES, WHICH ARE LINKED TO
NEGATIVE HEALTH OUTCOMES
THROUGHOUT THE LIFE COURSE.
NATIVE AMERICAN PACIFIC ISLANDER
AND BLACK CALIFORNIANS
EXPERIENCE MORE ACES THAN OTHER
GROUPS. CONSISTENT WITH NATIONAL
TRENDS. IN GENERAL, SYPHILIS
CASES ARE INCREASING, BRINGING
THEIR HIGHEST LEVELS IN 30
YEARS. CASES WERE MORE COMMON
AMONG PARENTS WITH LIMITED
ACCESS TO PRENATAL CARE AND.
FACING SOCIAL CHALLENGES, SUCH
AS SUBSTANCE USE DISORDER.
NATIONAL DATA. CALIFORNIA YOUTH
EXPERIENCE AN INCREASE IN
DEPRESSION. OR ANXIETY. FROM 7%
TO ALMOST 12. AS WE MOVE ALONG
THE LIFE COURSE YOUNG ADULTS IN
CALIFORNIA ARE FACING A
SIGNIFICANT BURDEN OF INJURY
RELATED DEATHS. MENTAL HEALTH
STRUGGLES AND INTERPERSONAL
VIOLENCE. FOR YOUNG ADULTS AGED
15 TO 44. THAT SHOULD BE 24. THE
LEADING CAUSES OF DEATH IN 2022
WERE PRIMARILY INJURY RELATED,
INCLUDING DEATHS FROM TRAFFIC
INJURIES. DRUG OVERDOSE ALCOHOL
RELATED DEATHS, SUICIDE AND
HOMICIDE. YOUNG ADULTS HAD THE
HIGHEST RATES OF MENTAL HEALTH
RELATED EMERGENCY ROOM VISITS
AND HOSPITALIZATIONS WITH BLACK
YOUNG ADULTS EXPERIENCING
SIGNIFICANTLY HIGHER RATES.
AMONG ADULTS AGES. 18 TO 34
ADULTS. SORRY YOUNG ADULTS AGES
18 TO 34 EXPERIENCE THE HIGHEST
RATES HIGHEST PREVALENCE OF POOR
MENTAL HEALTH AND DEPRESSION.
YOUNG ADULTS ALSO EXPERIENCE THE
HIGHEST RATES OF HOMICIDE.
DEATH. BLACK MALES EXPERIENCE
HOMICIDE RATES EIGHT TIMES
GREATER THAN THE OVERALL
POPULATION, WITH HOMICIDE BEING
THEIR LEADING CAUSE OF DEATH.
FIREARMS ACCOUNTED FOR 72% OF
ALL HOMICIDE DEATHS. COMMUNITIES
WITH HIGH LEVELS OF HIGH LEVELS
OF VIOLENCE FACED SECONDARY
TRAUMA. FROM EXPOSURE TO
VIOLENCE, SUCH AS HEARING
GUNSHOTS AND WALKING TO WORK OR
SCHOOL NEAR SITES WHERE VIOLENCE
EVENTS HAVE OCCURRED. SUICIDE
AND SELF HARM ARE MAJOR
PREVENTABLE PUBLIC HEALTH
OUTCOMES THAT HAVE EMOTIONAL AND
COMMUNITY IMPACTS. WHILE THE
HIGHEST RATES OF SUICIDE WERE
NATIVE AMERICANS AND WHITE
YOUTH. THE LARGEST INCREASES IN
SUICIDE WERE AMONG BLACK YOUTH,
FOLLOWED BY LATINO YOUTH.
FIREARMS. ARE THE MOST COMMON
MEANS OF SUICIDE IN RURAL
COMMUNITIES IN THE NORTHERN
REGIONS EXPERIENCING HIGHER
MORTALITY RATES. AS WE MOVE
ALONG THE LIFE COURSE TO OLDER
ADULTS. CHRONIC DISEASES ARE THE
MAJOR HEALTH BURDEN.
CARDIOVASCULAR DISEASE,
INCLUDING STROKE IS A LEADING
CAUSE OF DEATH FOR CALIFORNIANS
AGED 45 AND OLDER. RISK FACTORS
ARE MORE COMMON IN LOW INCOME
COMMUNITIES AND COMMUNITIES OF
COLOR. THESE COMMUNITIES FACE
BARRIERS TO REGULAR PHYSICAL
ACTIVITY, HEALTHY FOOD ACCESS,
GAINFUL EMPLOYMENT AND QUALITY
EDUCATION. ALTHOUGH DEATH RATES
HAVE GENERALLY DECLINED, CANCER
REMAINS SIGNIFICANT CAUSE OF
DEATH, CLAIMING OVER 60,000
DEATHS IN CALIFORNIA IN 2022.
ALZHEIMER DISEASE WAS A LEADING
CAUSE OF DEATH FOR OLDER ADULTS.
EIGHT ADULTS OLDER THAN 85. AND
THE SECOND LEADING CAUSE OF
DEATH OVERALL IN 2022. SO WHAT
ARE WE DOING? AS CDPH. WE
PROMOTE. COMMUNITY-BASED
INTERVENTIONS AT THE EARLIEST
STAGES OF LIFE. AND PROMOTING
PREVENTION AND UPSTREAM
STRATEGIES TO IMPROVE SOCIAL
DRIVERS OF HEALTH AND EQUITY.
ADDRESSING GROWING BEHAVIORAL
HEALTH CHALLENGES IS A TOP
PRIORITY. OR INTEGRATING
BEHAVIORAL HEALTH INTO PUBLIC
HEALTH STRATEGIES, FOCUSING ON
PREVENTION, RESILIENCY AND
EQUITY. MORE THAN 50 DIFFERENT
PROGRAMS AT èC Dð P ARE WORKING
TO IMPROVE BEHAVIORAL HEALTH
OUTCOMES FOR ALL CALIFORNIANS.
UNDER CAL HÌ HÌ S¼. THE
CALIFORNIA CHILDREN AND YOUTH
BEHAVIORAL HEALTH INITIATIVE.
èC Dð P HÌ IS LEADING A
COMMUNITY BASED SUICIDE YOUTH
SUICIDE PREVENTION, MEDIA AND
OUTREACH CAMPAIGN FOR YOUTH AT
INCREASED RISK OF SUICIDE. A
PUBLIC HEALTH CAMPAIGN CO
DESIGNED WITH YOUTH. TO REDUCE
STIGMA AROUND BEHAVIORAL HEALTH
AND TO INCREASE HELP SEEKING
BEHAVIOR AND WELLNESS SUPPORT.
THE Y SUICIDE REPORTING AND
CRISIS RESPONSE PILOT PROGRAM IS
TESTING MODELS WHERE YOUTH
SUICIDE AND ATTEMPTED SUICIDE
EVENTS LEAD TO A RAPID AND
COMPREHENSIVE LOCAL COMMUNITY
RESPONSE. ADDITIONAL INITIATIVES
AND BEHAVIORAL HEALTH PREVENTION
INCLUDE GOVERNOR NEWSOM'S MASTER
PLAN FOR TACKLING THE FENTANYL
AND, UH, OPIOID CRISIS,
INCLUDING A ONE STOP RESOURCE
WEBSITE OPIOIDS DOT èC A.GOV.
FUNDING TO INCREASE. THE
SUBSTANCE AND ADDICTION
PREVENTION BRANCH OF CD P HÌ HAS
ENABLED US TO INCREASE OUTREACH
EDUCATION AND PROMOTE HARM
REDUCTION EFFORTS. THE
INNOVATIVE CALIFORNIA REDUCING
DISPARITIES PROJECT IS USING
COMMUNITY DEFINED EVIDENCE
PRACTICES TO PROMOTE AND IMPROVE
MENTAL HEALTH. AND THE CREATION
OF THE OFFICE OF SUICIDE
PREVENTION AND INCREASED EFFORTS
TO ADDRESS THE ROOT CAUSES OF
SUICIDE AND SELF HARM ARE AREAS
WHERE WE'RE MAKING PROGRESS. THE
LANDMARK. FUTURE OF PUBLIC
HEALTH INVESTMENT INITIATED BY
THE GOVERNOR AND THE LEGISLATURE
IN 2021 IS A PIVOTAL STEP IN
STRENGTHENING OUR PUBLIC HEALTH
INFRASTRUCTURE, DEVELOPING OUR
WORKFORCE, FOSTERING COMMUNITY
RESILIENCE AND PREPARING FOR
FUTURE EMERGENCIES AND THREATS.
èC Dð P WILL USE THIS REPORT TO
SEEK COLLABORATION OPPORTUNITIES
TO WORK TOWARDS EQUITABLE HEALTH
OUTCOMES, INCLUDING ADDRESSING
THE DRIVERS OF HEALTH PROBLEMS
AND HEALTH INEQUITIES.
STRENGTHENING PROTECTIVE FACTORS
SUCH AS NURTURING AND SAFE HOME
AND SCHOOL ENVIRONMENTS. ACCESS
TO PARKS AND GREEN SPACE,
INCLUDING ECONOMIC DEVELOPMENT
AND SUPPORTS QUALITY, HEALTH
CARE AND EDUCATION. CALIFORNIANS
ARE ENJOYING MAJOR IMPROVEMENTS
IN HEALTH AND WELL BEING OVER
THE PAST 20 YEARS. CALIFORNIA
CONTINUES TO BOLDLY ADDRESS
EMERGING PUBLIC HEALTH
CHALLENGES. WE ARE COMMITTED TO
REDUCING HEALTH INEQUITIES AND
ADDRESSING THE STRUCTURAL AND
SOCIAL DETERMINANTS OF HEALTH. I
LOOK FORWARD TO WORKING WITH
YOU. TO ACHIEVE OUR SHARED
VISION TO PROTECT AND IMPROVE
THE HEALTH AND WELL BEING OF
CALIFORNIA'S COMMUNITIES. THANK
YOU FOR YOUR LEADERSHIP. AND
PARTNERSHIP IN THESE EFFORTS.
THANK YOU, DOCTOR. UH ARAGON.
AND BEFORE, UM, I PROCEED WITH
MY QUESTIONS. I REALLY WANT TO,
UM, EXTEND, UH, OUR APPRECIATION
FROM THE LEGISLATURE TO BOTH YOU
AND YOUR DEPARTMENT FOR, UH, THE
REPORT THAT YOU HAVE, UH, THAT
YOU ALL HAVE CREATED AND FOR YOU
COMING TODAY TO PRESENT IT. I
KNOW THIS HAS BEEN, UM,
DISCUSSED FOR MANY, MANY YEARS
TO SEE IT. FINALLY DONE. UM IS
REALLY WHAT WE NEED TO KINDA
UNDERSTAND THE PUBLIC HEALTH OF
OUR STATE AND SEE HOW WE AS A
LEGISLATIVE BODY CAN DO BETTER
WORKING WITH YOU ALL. SO THANK
YOU SO MUCH FOR THAT. UM I DID
READ YOUR EXECUTIVE SUMMARY. IT
WAS, UM. NOT NECESSARILY
SURPRISING BECAUSE SOME OF THESE
THINGS WE'VE BEEN HEARING ABOUT
FOR YEARS. UM AS FAR AS YOU KNOW
WHO, UH, WHERE THE DISPARITY IS
IN TERMS OF CARE AND LIFE IN
EXPECTANCY AND OUTCOMES. UM I
DID HAVE A QUES. I HAVE ACTUALLY
, A LOT OF QUESTIONS FOR YOU.
AND SO SINCE I'M THE ONLY ONE I
GET A CHANCE TO ANSWER. ASK
THEM, UM YOU KNOW, ONE OF THE
THINGS THAT YOU TALKED ABOUT IS
THE FACT THAT, UM CALIFORNIA HAS
BEEN ABLE TO REDUCE THE ISCHEMIC
HEART DISEASE RATE BY 60% IS
THAT REGARDLESS OF RACE THAT
YOU'VE SEEN THAT DROP, OR IS
THAT JUST AN OVERALL FIGURE, SO
IN GENERAL, WE'VE SEEN
IMPROVEMENTS ACROSS ALL RACIAL
ETHNIC GROUPS. THE CHALLENGE
THAT IT CONTINUES TO EXIST IS A
PERSISTENT DISPARITIES BETWEEN
THE DIFFERENT GROUPS. AND THAT
YOU PRETTY MUCH SEE ACROSS ALL
IF YOU LOOK AT ALL LEADING
CAUSES YOU WILL YOU CONTINUE TO
SEE THAT DISPARITY AND IT'S A
IT'S ESPECIALLY PRONOUNCED AMONG
AFRICAN AMERICAN COMMUNITIES.
THANK YOU. AND WHEN I'M LOOKING
A Tð, UH, THE MULTIPLE LENSES
THE FIVE CONDITIONS BASED ON
MULTIPLE MEASURES LOOKING AT
DEATHS OF TOP FIVE DEATHS, UM
INCLUDE ISCHEMIC HEART DISEASE
AND HYPERTENSIVE HEART DISEASE.
UM DO WE NEED TO HAVE MORE
TARGETED PROGRAMS OR DO WE HAVE
TARGETED PROGRAMS? UM AND
INTERVENTIONS THAT REALLY FOCUS
ON HEART HEALTH? AN EARLY HEART
HEALTH. YEAH, SO UNDER THE WHOLE
AREA OF CHRONIC DISEASE, WE
APPROACH IT IN A VERY, VERY
HOLISTIC WAY. WE TRY TO
ENCOURAGE PEOPLE TO PHYSICAL
ACTIVITY, IMP IMPROVE, UM
IMPROVE NUTRITION DECREASE
STRESS. UM ALL THAT AND HAVING
GOOD ACCESS TO, UH, HEALTH CARE.
UM AND A LOT OF THIS SO èC Dð P
HÌ DOES HAVE SOME SELECT. WE DO
HAVE PROGRAMS IN THOSE AREA. WE
FUND LOCAL HEALTH DEPARTMENTS TO
DO MORE WORK IN THAT AREA, AND
THIS IS AN AREA WHERE THERE'S AN
IMPORTANT PARTNERSHIP WITH THE
HEALTH CARE SYSTEM BECAUSE THE
HEALTH CARE SYSTEM OBVIOUSLY HAS
THAT CONTACT WITH PATIENTS AS
THEY AS THEY DEVELOP ISSUES. SO
IT'S REALLY A COMBINATION OF ALL
ALL ALL OF THESE ALL OF THESE
COMING TOGETHER AND THE OTHER.
THE OTHER THING THAT'S HAD A BIG
IMPACT OVER THE OVER TIME IS
THAT HAS BEEN THE, UM WE'RE
REALLY WE'VE BEEN VERY
SUCCESSFUL AS AS A STATE TO
DECREASE THE PREVALENCE OF
SMOKING, AND THAT'S HAD A BIG
IMPACT NOT JUST ON LUNG CANCER,
BUT ALSO CARDIOVASCULAR DISEASE
OUTCOMES. AND WHEN YOU'RE
FUNDING OR YOU'RE WORKING WITH
DIFFERENT, UH LOCAL
ORGANIZATIONS OR COUNTIES, UM
WHAT KIND OF REPORTING
REQUIREMENTS DO YOU HAVE? AND IS
THERE A SPECIFIC BENCHMARK? MUST
THEY HAVE TO CONTINUE GETTING
FUNDS? YEAH. SO WE HAVE, UM AND
WE HAVE OVER 220 PROGRAMS. UM
AND SO IT DEPENDS. IT DEPENDS ON
THE PROGRAM. IT DEPENDS ON THE
DAY. UH GRANT REQUIREMENTS. SOME
OF THEM ARE FEDERAL FUNDS THAT
COME THROUGH US THAT HAVE
SPECIFIC REQUIREMENTS THAT WE
PASSED. AND THEN THERE ARE
THINGS THAT COME FROM THE STATE.
BUT YES, WE DO HAVE WE DO HAVE
RE REQUIREMENTS. UM AND I WOULD
SAY THAT'S ACTUALLY ONE OF THE
AREAS WHERE SINCE I BECAME
DIRECTOR IN, UM NOW I'M
BEGINNING. MY FOURTH YEAR IS
REALLY HAVING AN IN HAVING AN
INTENTION AND FOCUS ON ASKING
PEOPLE. WHAT ARE YOU TRYING TO
ACCOMPLISH? AND HOW DO WE KNOW
WE'RE MAKING PROGRESS, SO WE'RE
REALLY PROMOTING THE WHOLE
CONCEPT OF WHAT PEOPLE CALL
OBJECTIVES AND KEY RESULTS TO BE
VERY PUBLIC WITH? WHAT ARE WE
TRYING TO ACCOMPLISH? BECAUSE
THAT'S THE ONLY WAY THAT WE'RE
GONNA KNOW THAT WE CAN HOLD
OURSELVES AND OTHERS ACCOUNTABLE
TO THOSE GOALS. SO THAT'S THAT'S
THE APPROACH THAT WE'RE TAKING
BECAUSE IT THERE. WE ABSOLUTELY
NEED TO MAKE MORE PROGRESS. I
THINK SOMETIMES WE FORGET TO GO
BACK AND MAKE SURE THAT THE
THINGS THAT WE FUNDED ARE
ACTUALLY WORKING. UM AND IF WE
WANT TO NOT ONLY DECREASE THE
OVERALL UM AH, DISEASE
PREVALENCE OF CERTAINLY THINGS,
BUT ALSO DOES THE DISPARITY THEN
WE NEED TO MAKE SURE THAT WE'RE
KIND OF TACKLING. BOTH OF THEM
JUST WON'T MAKE ONE ADDITIONAL
COMMENTS. SOME OF THESE OUTCOMES
THEY HAVE COMPLEX. SOCIAL CAUSES
, SO THERE IS WHAT WE DO, AND
THEN THERE'S WHAT THE REST OF
CALIFORNIANS DO. SO REALLY, IT'S
A IT'S A TEAM CALIFORNIA EFFORTS
TO MAKE TO MAKE PROGRESS AND SO
SOME, EVEN EVEN IF WE DO OUR
BEST AND WE'RE IN, YOU KNOW
WE'RE DOING OUR BEST PERFORMANCE
SOMETIMES. THINGS CHANGE. UM
THAT ARE BEYOND OUR CONTROL.
THAT'S WHY IT'S IMPORTANT FOR US
TO REALLY TO ALL OF US WORK AS A
COMMUNITY ON THESE ISSUES,
RIGHT, AND I THINK THAT'S ONE OF
THE REASONS WHY THIS REPORT IS
SO GREAT SO BECAUSE WE ARE A
PART OF THAT TEAM TO, UM IMPROVE
THE HEALTH AND WELL BEING OF ALL
CALIFORNIA AND SO KIND OF ALONG
THAT LINE, UM DO YOU FEEL THAT
OUR LARGEST INVESTMENTS FROM A
LEGISLATIVE STANDPOINT AND
PUBLIC HEALTH ARE LINED WITH THE
LEADING CAUSES OF ORBIT. ITTY
AND MORTALITY THAT WE SEE IN OUR
STATE. I YES, I DO. AND I WOULD
SAY WHAT I'M REALLY PROUD OF THE
STATE IS THAT I FEEL THAT WE'RE
APPLYING THE LATEST SCIENCE AND
WHAT WE KNOW ABOUT CHRONIC
DISEASES. IN THE IN THE OLDER
DAYS, WE WOULD FOCUS ON CHRONIC
DISEASES BY JUST FOCUSING ON
ADULTS, SCREENING THEM GETTING
GETTING THEM INTO CARE. WE NOW
REALIZE THAT IT'S REALLY LIFE
COURSE AND ENERGETIC,
INTERGENERATIONAL PROCESSES.
CHRONIC TRAUMA, STRESS EARLY
LIFE ADVERSITY. PHYSICALLY
CHANGES YOUR BRAIN BODY AND
BEHAVIORS FOR YOUR WHOLE LIFE
COURSE. AND SO NOW WE'RE ABLE TO
CONNECT THE DOTS, AND THAT'S ONE
OF THE BIGGEST MESSAGES THAT
WE'RE TRYING TO GET OUT WITH.
THIS REPORT IS THAT A LOT OF THE
INDICATORS HAVE NOT CHANGED. BUT
WHAT HAS CHANGED IS OUR
UNDERSTANDING OF WHAT'S DRIVING
THESE OUTCOMES AND SO AN
EMPHASIS ON EARLY EARLIER LIFE
FOCUSING ON, UH, PREGNANT
PEOPLE. ALL OF THESE ARE WOULD
SAY OVER THE PAST SEVERAL YEARS
HAS BEEN A BIG FOCUS FROM THE
HHS ON DOWN, AND I THINK THAT
THAT'S AN IMPORTANT MESSAGE THAT
WE'RE TRYING TO GET OUT. UM, SO
ALONG THAT THAT ROUTE YOU
MENTIONED AND IT'S ALSO IN YOUR
REPORT ABOUT EARLY DEATH RATES
AND INFANT MORTALITY BEING
HIGHER IN AFRICAN AMERICANS AND
IN API COMMUNITY, UM, WHICH ALSO
CONTINUES THROUGHOUT THEIR LIFE,
LEADING TO, UNFORTUNATELY A
LOWER LIFE EXPECTANCY. DO YOU
HAVE ANY PROGRAMS OR WHAT ARE
YOU ALL SPECIFICALLY DOING? OR
RECOMMENDING TO SPECIFICALLY
FOCUS AND TARGET THESE
COMMUNITIES TO, UM TO HELP IN
THAT PARTICULAR AREA, SO WE'RE
PARTNERING WITH THE CALIFORNIA
SURGEON GENERAL IN THIS SPECIFIC
SPECIFIC AREAS, SO THERE IS A
COLLABORATIVE INVOLVING, UH,
THEIR OFFICE C D PH.
ACADEMICIANS AND COMMUNITY BASED
ORGANIZATIONS AROUND THE AREA OF
MATERNAL MATERNAL HEALTH AND
MORBIDITY AND MORTALITY. BUT
WITHIN CD PH. WE HAVE A LOT OF
PROGRAMS THAT TOUCHES THESE
LIVES. THE WIC PROGRAM HOME HOME
VISITING, UM AS WELL AS MANY,
MANY OTHERS, MATERNAL CHILD AND
ADOLESCENT HEALTH, WE HAVE OUR
BLOCK GRANT THAT GETS, UH, MONEY
OUT TO THE LOCALS IN THIS AREA.
UH AND SO I WOULD SAY, AND I WAS
ACTUALLY ACTUALLY, I HAD. I HAD
LUNCH TODAY WITH THE PERSON WHO
ACTUALLY LOOKS AT THE DATA IN
MATERNAL CHILD AND ADOLESCENT
HEALTH BETWEEN THE AGES OF ONE
IN 10, AND SO WE HAVE A LOT
GOING ON. BUT THERE'S AREAS THAT
WE CAN ABSOLUTELY MAKE MAKE MORE
PROGRESS. I THINK WE HAVE A LOT
OF A LOT OF WORK TO DO. ONE OF
THE CHALLENGES THAT WE HAVE IS
THAT WE HAVE DATA WHEN PEOPLE
ARE BORN, WE HAVE DATA WHEN THEY
START GOING TO SCHOOL. WE HAVE
THIS TIME PERIOD BETWEEN THERE.
WHERE THAT IT'S REALLY HARD TO
GET DATA, SO YOU HAVE TO
TRIANGULATE A LOT OF DIFFERENT
DATA SETS TO TRY TO FIGURE OUT
WHAT'S GOING ON BECAUSE THOSE
EARLY LIFE EVENTS ARE SOAKED ARE
SO CRITICAL TO THE TRAJECTORY OF
THOSE CHILDREN. SO WE ARE. WE'RE
WORKING IN THAT AREA. UM. BACK
TO YOUR FIGURE ON THE TOP FIVE
CONDITIONS WHEN YOU LOOK AT THE
NUMBER OF HOSPITALIZATIONS OF
THE TOP FIVE. YOU'VE GOT NUMBER
THREE FOR MOOD DISORDERS AND
NUMBER FIVE. LET'S GET SAFARINI
A BOTH OUR BEHAVIORAL HEALTH
ISSUES. UM, WHAT DO YOU THINK
THAT WE NEED TO DO BETTER AS A
STATE TO ASSIST IN THIS AREA.
YEAH AND I THINK YOU KNOW THIS
IS A CHALLENGE AT ALL. SO THE
BEHAVIORAL HEALTH CHALLENGES UM,
IS SOMETHING WE'RE SEEING REALLY
ACROSS THE UNITED STATES ACROSS
THE WORLD. AND. IN PUBLIC HEALTH
WE'VE BECOME. WE'VE COME TO
REALIZE PUBLIC HEALTH IN GENERAL
IN THE PAST WOULD FOCUS LESS ON
THE MENTAL HEALTH AND NOW WE'RE
RECOGNIZED THAT IT IS AMONG THE
MOST IMPORTANT AREAS TO US TO
FOCUS ON BECAUSE BOTH WHEN I SAY
BEHAVIOR HEALTH, I MEAN MENTAL
HEALTH AND ALSO SUBSTANCE USE
DISORDER. THESE ARE PRIMARILY
DETERMINED BY EARLY LIFE EVENTS,
SOCIAL CONDITIONS. YOU HAVE THE
ADVERSITY AND HOW IT IMPACTS
YOUR BRINGING AN EXECUTIVE
FUNCTION. IT IS. IT'S SO
CRITICAL SO FOR US TO SORT OF
CONNECT THE DOTS AND TO CONTINUE
TO FOCUS AND PRIORITIZE ON THE
YOUNGEST POPULATIONS. THE
YOUNGEST FAMILIES IS HOW WE'RE
GOING TO HAVE THE BIGGEST IMPACT
. ONE OF THE CHALLENGES YOU'RE
SEEING RIGHT NOW, FOR EXAMPLE,
IS JUST A DRUG DRUG OVERDOSE.
DRUG OVERDOSE DEATHS, THEY
CONTINUE TO GO UP. AND UP AND UP
. THE DRUGS ARE BECOMING MUCH
MORE DANGEROUS THINGS LIKE
FENTANYL AND OTHER SYNTHETIC
OPIOIDS THAT ARE GOING TO BECOME
AVAILABLE. IT'S REALLY HARD TO
TURN PEOPLE AROUND WHEN THE WHEN
THE DRUGS HAVE BECOME SO
POWERFUL AND SO DEADLY, WE HAVE
TO REACH PEOPLE EARLIER IN LIFE,
AND THAT'S AND THAT'S THE LENS
THAT WE'RE APPROACHING THIS AREA
OF BEHAVIORAL HEALTH. IS THE
FOCUS ON THAT LIFE COURSE. GOOD
THING I WANT TO MENTION IS THAT,
UM, WE KNOW THIS FOR PHYSICAL
HEALTH, PHYSICAL HEALTH, WE KNOW
THE CONCEPT OF PRIMARY
PREVENTION. IN MENTAL HEALTH.
THERE'S LIMITED DATA ON WHAT IS
WHAT CAN WE DO AROUND PRIMARY
PREVENTION OF MENTAL HEALTH? AND
SO THAT'S AN EMERGING AREA.
THERE'S THINGS COMING OUT ON
SOCIAL MEDIA. WE ALREADY KNOW,
FOR EXAMPLE, ADVERSITIES
IMPORTANT, BUT IT'S AN AREA THAT
WE AS A STATE HAVE MOVED IN THAT
DIRECTION OF REALLY BEGINNING TO
THINK ABOUT HOW DO WE USE
EMERGING EVIDENCE IN THESE
AREAS? SO I THINK THAT'S WHERE
WE'RE GOING TO HAVE THE BIGGEST.
WE'RE GONNA HAVE THE BIGGEST
IMPACT WE HAVE TO. WE HAVE TO GO
UPSTREAM WHO MAKE THAT
DIFFERENCE? YEAH UM, I LIKE THAT
FRAME THAT TERM UPSTREAM. I SAW
YOU GUYS USED IT QUITE A BIT IN
THE REPORT. UM I WANT TO ASK YOU
ABOUT SYPHILIS. UM, WE ARE
SEEING AN UPTICK. UM I HAD A
PATIENT REFERRED TO ME TWO WEEKS
AGO. TEENAGER WITH SURPLUS UM
WHY ARE WHY. DO YOU THINK WE ARE
SEEING SUCH AN UPTAKE IN OUR
SYPHILIS CASES? UM AND ALSO THAT
THEN TRANSLATES INTO NEONATAL SO
THAT THAT THAT'S A REALLY GOOD
QUESTION. AND, YOU KNOW, WITH
SYPHILIS HAS BEEN INCREASING
NOW. FROM MORE MORE THAN A
DECADE. WE'VE WE'VE SEEN THIS.
WE'VE SEEN THIS. IT'S BEEN
HAPPENING. IT'S BEEN HAPPENING
FOR A WHILE. AND IT HAS BEEN A
CHALLENGE. THE MORE MORE
RECENTLY IT HAS BEEN PRIMARILY
IMPACTED BY SOCIAL AND ECONOMIC
FACTORS. AND ALSO, FOR EXAMPLE,
UM HOUSING, DISABILITY,
HOMELESSNESS, DRUG USE. FOR
EXAMPLE, THAT WE'RE SEEING NOW
MORE CONGENITAL SYPHILIS CASES
AND WE'VE EVER WE'VE EVER SEEN.
UM AND SO THE STATE HAS
INITIATED A TASK FORCE TO WORK
ON THIS, AND WE'RE WORKING WITH
A NEW TASK FORCE AT THE NATIONAL
LEVEL THAT HAS ALSO BEEN
CONVENED TO FIGURE OUT HOW WE
CAN, HOW WE CAN GET AHEAD OF
THIS, AND THERE'S UM IT IS IT.
THIS IS A CORE CORE PUBLIC
HEALTH ISSUE. BECAUSE HE
REQUIRES THE MEDICAL SYSTEM
SCREENING DIAGNOSIS, GETTING
PEOPLE INTO CARE, GETTING THEM
THE MEDICATIONS. UM AND IT'S A
IT'S A CHALLENGE THAT WE'RE
WE'VE BEEN FACING, BUT WHERE
IT'S SOMETHING THAT THE 12
HOPEFULLY THE TASK FORCE WILL
COME UP WITH DIFFERENT WAYS OF
APPROACHING THIS, BUT THIS IS
IT'S A BIG CHALLENGE. WOULD IT
BE POSSIBLE OR EVEN USEFUL TO
CREATE KIND OF LIKE A CROSS WALK
BETWEEN STATE FUNDING AND SOME
OF THE LEADING CAUSES OF
MORBIDITY AND MORTALITY WITHIN
OUR STATE? YEAH WE THINK IT
WOULD BE FOR SELECTED INDICATORS
, UM AND THEN WE'D HAVE TO
RECOGNIZE THE LIMITATIONS. I'LL
GIVE YOU AN EXAMPLE. UM SO TAKE,
FOR EXAMPLE, DRUG OVERDOSES. UM,
THERE ARE CERTAIN THINGS THAT
WE'RE DOING AT THE STATE THAT
OBVIOUSLY OBVIOUSLY DIRECTLY
IMPACT DRUG OVERDOSES THAT IT'S
EASIER TO ENUMERATE THOSE. BUT
AS I MENTIONED SORT OF
PREVENTION ACTIVITIES, WHICH
MEANS HAVING A HEALTHY, SAFE
CHILDHOOD. THAT'S HARDER TO
MEASURE. HOW MUCH OF THAT WE
KNOW THAT THAT HAS A BIG IMPACT,
FOR EXAMPLE ON EVENTUAL DRUG
USE, AND THEN DRUG OVERDOSES.
HOW DO WE MEASURE THAT? IT'S
HARDER TO MEASURE AND THAT'S ONE
OF THE CHALLENGES THAT WE HAVE.
WE TEND TO FOCUS ON THE THINGS
THAT WE SEE A DIRECT CONNECTION.
IT'S CONNECTING THE DOTS AND
THESE INDIRECT CONNECTIONS THAT
REALLY MATTER, AND SO WE HAVE TO
RECOGNIZE WE CAN MEASURE PART OF
WHAT WE INVEST. BUT WE ALSO
INVEST IN THINGS THAT AREN'T WE
DON'T SEE THE DIRECT CONNECTION,
BUT WE KNOW THROUGH EVIDENCE.
MAKES A BIG DIFFERENCE, SO THAT
WOULD BE THE LIMITATION OF DOING
THAT. THAT KIND OF APPROACH.
HMM. UM MY FINAL QUESTION. UM
YOU MAY HAVE AN ANSWER FOR YOU
MAY NOT. IT MAY BE SOMETHING
THAT YOU THINK ABOUT, BUT ONE OF
THE THINGS THAT I WAS SURPRISED
THAT YOU TALKED A LOT ABOUT IN
THE REPORT AND YOU AND YOU
BROUGHT IT UP TODAY IN YOUR
PRESENTATION IS THE IMPACT OF
STRUCTURAL RACISM AND, UM THERE
WAS A PART OF THE CONCLUSION. IN
THE EXECUTIVE SUMMARY, UM STATED
THE EFFECTS OF STRUCTURAL RACISM
ARE EVIDENT ACROSS THE LIFE
STAGES. DISPARITIES IN HEALTH
CARE CONDITIONS AND LIFE
EXPECTANCY AS THEY CONTINUE TO
DRIVE UNEQUAL ACCESS TO THE
RESOURCES AND OPPORTUNITIES
NECESSARY FOR GOOD HEALTH AND
WELL BEING. AND THAT REALLY
STRUCK ME. HOW DO WE FIX THAT?
HERE IN THE GREAT STATE OF
CALIFORNIA? WHAT I WHAT? WHAT
I'VE LEARNED IN MY LIFE AND IN
MY CAREER FIXING ANYTHING STARTS
BY FIRST NAMING IT. IF YOU DON'T
NAME IT, YOU CAN'T FIX IT. AND I
TO ME. THAT'S THE FIRST STEP.
AND SO I AM. I'M PROUD OF THE
ADMINISTRATION HHS. OUR
DEPARTMENT IS THAT WE HAVE TO.
FIRST WE HAVE TO. FIRST WE HAVE
TO FIRST NAME IT. WE ALSO HAVE
TO RECOGNIZE OR THE THINGS THAT
ARE AGAINST SORT OF EASY, EASIER
TO MEASURE. UM THE THINGS THAT
ARE DIRECTLY IMPACT, AND THEN
THERE ARE THE THINGS THAT ARE
HARDER TO MEASURE THE INDIRECT
WAY INDIRECT WAYS THAT AFFECT
AFFECT RACE, SO WE HAVE TO KEEP
THIS IN A HOLISTIC WAY,
RECOGNIZED THE ROLE THAT RACISM
AND DISCRIMINATION TRAUMATIZES
PEOPLE ACROSS THE LIFE COURSE
RECOGNIZE IT THAT IT'S NOT JUST
RACES, ETHNICITY, IMMIGRATION,
SEXUAL ORIENTATION, GENDER
IDENTITY. IT'S OTHER OTHER AREAS
, AS WELL AS THEIR INTERSECTIONS
WHERE PEOPLE WHERE PEOPLE ARE
IMPACTED. THE OTHER THING I WANT
TO MENTION IS THAT ONE OF THE
THINGS THAT ARE WE KNOW THAT
THERE Dð LONGSTANDING POLICIES
POLICIES. HAVE A DIFFERENTIAL
IMPACT, AND THAT'S ONE WAY OF
THINKING ABOUT STRUCTURAL RACISM
WHEN COVID HAPPENED. AND THE
SCHOOLS CLOSE WHEN I WAS THE
LOCAL HEALTH OFFICER, WE
RECOGNIZE THAT WE KNOW WHAT
SCHOOLS ARE GOING TO OPEN UP
FIRST. WE KNOW THAT THE SCHOOLS
THAT ARE WELL RESOURCED HAVE THE
ABILITY TO GET OPEN. THEY'RE
GONNA THEY'RE GONNA THEY'RE AND
THEY'RE MORE LIKELY TO BE HIGHER
INCOME AREAS. THOSE SCHOOLS ARE
GOING TO OPEN UP FIRST, AND IT'S
THE OTHER SCHOOLS THAT GET LEFT
BEHIND. SO WHEN THAT HAPPENED,
WE CONSIDER THAT AS AN EXAMPLE
OF STRUCTURAL RACISM. IT'S NOT
INTENTIONAL. IT'S NOT OBVIOUS,
BUT WHEN SOMETHING LIKE THAT
HAPPENS, AND YOU'RE RESPONDING
TO IT, THAT DISPARITY IN THE
RECOVERY IS WHAT LEAVES A GROUP
OF PEOPLE BEHIND, AND THAT'S AN
EXAMPLE OF STRUCTURAL RACISM. WE
HAVE TO NAME IT AND THEN BE VERY
INTENTIONAL AND TRYING TO TRYING
TO IMPROVE IT. SO, UM SO THAT'S
WHERE THAT'S WHERE WE'RE AT. AND
THE LAST THING I WANNA MENTION
ABOUT JUST THIS TOPIC IS THAT AT
CPH. WE'RE ALSO FOCUSING ON THE
INTERNAL TRANSFORMATION. OUR
BELIEF IS THAT WE HAVE TO
RECRUIT MORE DIVERSE WORKFORCE.
WE HAVE TO WORK WITH OUR
WORKFORCE IN IN IN BEING ABLE TO
TRANSFORM OUR STAFF AND WORK
WITH THE COMMUNITIES IN THEIR
TRANSFORMATION. IT'S ALWAYS IT'S
ALWAYS AN INTERNAL AND AN
EXTERNAL BECAUSE THAT'S HOW THE
TRANSFORMATIONS ARE GOING TO BE
LONG LASTING INSTITUTIONS. IF WE
DON'T DO THAT, THEY'RE NOT GOING
TO LAST. YES THANK YOU SO VERY
MUCH FOR THAT ANSWER, AND FOR
THIS REPORT, AND FOR YOUR TIME,
UM SO SEEING THAT THERE IS NO
ONE ELSE ON THE DIETS TO ASK ANY
QUESTIONS. I'M GOING TO OPEN IT
UP TO ANY PUBLIC COMMENT FOR
MANY MEMBERS OF THE AUDIENCE.
YOU WILL HAVE ONE MINUTE. THANK
YOU, MADAM. CHAIR RAND MARTIN
HERE ON BEHALF OF THE AIDS
HEALTHCARE FOUNDATION. WANTED
TO, UM, ACKNOWLEDGE AND THANK
YOU FOR RAISING THE QUESTION
ABOUT SYPHILIS. HF NOT ONLY
BEING A LEADER ON HIV CARE AND
TREATMENT IS ALSO A LEADER ON
STD PREVENTION AND CONTROL,
PARTICULARLY CONCERNED ABOUT THE
RISE IN SYPHILIS RATES, IN FACT,
HAVE LEGISLATION THIS YEAR THAT
YOU'LL SEE LATER THAT TRIES TO
DEAL WITH IT. THE SOLUTION.
THERE ARE MANY SOLUTIONS THAT WE
NEED TO TRY. WE NEED MORE
FUNDING DEFINITELY INTO STD
PREVENTION AND CONTROL BECAUSE
IT'S NOT JUST SYPHILIS. IT'S
GOING UP. IT'S ALSO GONORRHEA
AND MEDIA AND BUT THE BUT THE
WORST OF IT ALL, IS THE
CONGENITAL SYPHILIS WHERE WE'VE
SEEN A RISE FROM 33 CASES IN
2012 TO 525 CASES IN 2021.
THAT'S AN OUTRAGEOUS RISE AND
REALLY HARMFUL BECAUSE SO MANY
OF THOSE LEAD TO, UM THE NEWBORN
DEATHS AND STILLBIRTHS AND
STILLBORN UM THE SOLUTION. ONE
OF THE SOLUTIONS THAT WE
ADVOCATE IS EDUCATION AND
GETTING TO PEOPLE WHO ARE AT
RISK OF BEING EXPOSED TO
SYPHILIS. WE DID THIS 10 YEARS
AGO WITH HIV, WHERE WE SPONSORED
LEGISLATION. THAT REQUIRES AN
OFFER OF AN HIV TEST EVERY TIME
SOMEBODY COMES INTO PUBLIC
HEALTH CLINIC, WE SAW A
REDUCTION FROM 2013 WHEN THAT
BILL WAS ENACTED TO TODAY IN HIV
EVERY SINGLE YEAR, SUBSEQUENT
NOT TAKING ALL THE CREDIT. THERE
ARE A LOT OF FACTORS IN PLAY BUT
EDUCATION AND GETTING TO PEOPLE
AND MAKING SURE THEY'RE AWARE IS
IMPORTANT. IT'S JUST AS
IMPORTANT FOR PEOPLE WHO ARE
EXPOSED OR POTENTIALLY EXPOSED
TO SYPHILIS. WE HOPE MORE OF
THAT WILL HAPPEN IS IN THE VERY
NEAR FUTURE. IF WE'RE GOING TO
TURN THIS AROUND, THANK YOU VERY
MUCH. THANK YOU. ALRIGHT SAYING
NO MORE PUBLIC COMMENT. I WANT
TO THANK YOU AGAIN DOCTOR
ERDOGAN AND THE DEPARTMENT FOR
THIS EXCELLENT REPORT. AND FOR
YOUR TIME. THANK YOU. OUR SECOND
ISSUE IS AN OVERVIEW OF THE
PROPOSED CD PH BUDGET. WE WILL
HAVE BRANDON NUNES. CHIEF DEPUTY
DIRECTOR OF OPERATIONS AND CDP,
CDP, PH AND JULIE. NAGATO.
NAGASE KOSTYA. KOSTYA SORRY, UM,
DEPUTY DIRECTOR OF THE OFFICE OF
POLICY AND PLANNING AT C D PH.
WE ALSO HAVE DEPARTMENT OF
FINANCE HERE AND L A. OH, I
BELIEVE. WHENEVER YOU'RE READY.
THANK YOU, MADAM CHAIR BRANDON
NUNES, UH, CHIEF DEPUTY DIRECTOR
FOR OPERATIONS AT THE
DEPARTMENT. THIS AGENDA ITEM HAS
ASKED ME TO DO AN OVERVIEW OF
OUR BUDGETS ALL PROVIDE A BRIEF
KIND OF OVERVIEW OF THAT AND
KIND OF GIVE YOU A FRAMING FOR A
LOT OF THE THINGS WILL ACTUALLY
BE DISCUSSING LATER ON TODAY'S
AGENDA. UM BUT AS IT RELATES TO
OUR DEPARTMENT'S GOVERNOR'S
BUDGET PROPOSAL, UM THE
DEPARTMENT PROPOSES A TOTAL
BUDGET OF 5,000,000,815 MILLION
OF THAT COMING FROM GENERAL FUND
2.2 BILLION FROM FEDERAL FUNDS
SOURCES AS WELL AS 2 BILLION
FROM ROUGHLY APPROXIMATELY 50
SPECIAL FUNDS THAT DEPARTMENT
AND MINISTERS UM SOME OF THE
THINGS THAT ARE HIGHLIGHTED IN
OUR BUDGET THIS YEAR,
PARTICULARLY ITEMS THAT ARE USED
TO KIND OF ADDRESS THE BUDGET
SHORTFALL THIS YEAR IS WE DO
HAVE SOME GENERAL FUND SAVINGS
AMOUNTS. UM A COUPLE OF THEM
THAT WILL BE TALKING ABOUT TODAY
ARE RELATED TO $900,000 GENERAL
FUND BEGINNING INCURRING YOUR AN
ONGOING FOR A SHIFT THAT WE'RE
GOING TO DO OF THE COVID 19
WEBSITE TO START HOSTING IT ON
THE CD PH PLATFORM. UM WE'RE
FLAGGING 1.7 MILLION IN GENERAL
FUND SAVINGS ON A ONE TIME
BASIS. THESE ARE ANTICIPATED
SAVINGS THAT WE HAVE IN OUR I T
AREA THAT ARE JUST GOING TO KIND
OF BE NATURAL SAVINGS FROM
SALARY SAVINGS AND THINGS LIKE
THAT. UM, AND THEN WE HAVE A
$3.1 MILLION GENERAL FUND. ONE
TIME. UM REDUCTION FOR 2324.
THIS IS FOR THE CLIMATE AND
HEALTH SURVEILLANCE PROGRAM. AND
THESE AGAIN ARE JUST ANTICIPATED
SAVINGS THAT WE HAVE WITHIN THE
PROGRAM. SO WE'RE SCORING THEM
HERE TOWARDS THE TO ADDRESS THE
GENERAL FUND SITUATION. WE DO
HAVE A COUPLE OF ITEMS THAT ARE
RELATED TO FUND SHIFTS. WE HAVE
A $4 MILLION PROPOSAL TO SHIFT
FUNDING THAT WAS ORIGINALLY
GOING TO BE FUNDED WITH GENERAL
FUND, UM TO THE SKILLED NURSING
FACILITIES SPECIAL FUND FOR
SKILLED NURSING FACILITY.
STAFFING AUDITS. UM, SO WE'LL
JUST HAVE A DIFFERENT FUND
SOURCE FOR THAT PARTICULAR ITEM
AS WELL AS IN BOTH CURRENT
YEAR'S BUDGET YEAR, THERE'S
GOING TO BE A $9.7 MILLION IS
PROPOSED TO SHIFT FROM THE
GENERAL FUND TO OUR PROP 56
TOBACCO. FUNDS TO SUPPORT
CLINICAL DENTAL ROTATION. SO
AGAIN, THE PROGRAM REMAINS
WHOLE, BUT JUST A FUNDING SHIFT
THERE. AND THEN FINALLY, WE HAVE
ONE ITEM THAT CONSTITUTES ALONE
TO THE GENERAL FUND. THERE'S UM
THE GOVERNOR'S BUDGET PROPOSES A
$500 MILLION LOAN FROM OUR EIGHT
APP REBATE FUND TO THE GENERAL
FUND. UM IT'S ANTICIPATED THAT
THIS WON'T HAVE PROGRAM. UM, ANY
PROGRAM SERVICES IMPACTS AS
THEY'RE STILL GOING TO BE A
SUFFICIENT FUND RESERVES TO
MAINTAIN SERVICES WITHIN THE
PROGRAM, SO JUST ALONE? THE
GENERAL PUBLIC. UM, AND THEN,
LIKE MOST YEARS, WE HAVE VARIOUS
ADJUSTMENTS IN THE BUDGET
RELATED TO OUR VARIOUS TOBACCO
TAX ITEMS IN PROP 56 AND PROP 19
1 99, RATHER ABOUT A $4.1
MILLION NET INCREASE ACROSS
THOSE ACCOUNTS, AND THEN YOU'LL
HEAR SOME DISCUSSION TODAY ABOUT
CHANGES FROM OUR AIDS DRUG
ASSISTANCE PROGRAM. OUR WEEK
PROGRAM AND RGDS P PROGRAM. AND
THEN FINALLY, IN THIS KIND OF
ONE OF THE OTHER THINGS THAT I
WAS GOING TO HIGHLIGHT IN THIS
KIND OF RELATES TO ONE OF YOUR
FIRST QUESTION IN THE AGENDA,
UM, THE GOVERNOR'S BUDGET,
YOU'LL SEE YOU YOU'LL DEFINITELY
SEE THAT IT REFLECTS A PROJECTED
, UM, ROUGHLY $700 MILLION
CHANGE FROM CURRENT YEAR TO
BUDGET YEAR. YOU MAY LOOK AT
THIS AND THINK THAT THAT'S A
LARGE REDUCTION, BUT IN FACT, IT
REALLY IS. UM NATURAL CARRYOVER
ITEMS, ONE TIME INVESTMENTS IN
THE DEPARTMENT THAT WERE
NATURALLY GOING TO COME OFF IN
THE 2425 FISCAL YEARS, SO
THEY'RE NOT ACTUALLY A
REDUCTION. IT'S ANTICIPATED IN
THE BUDGET PLAN THAT THESE WOULD
BE REDUCED AND ABOUT 500 MILLION
OF THAT IS RELATED TO THESE
CARRY OVERS THAT I MENTIONED, UM
ONE OF THE BIG AREAS FOR THIS
AND WE'LL BE TALKING ABOUT IT IN
A LITTLE BIT HERE IS RELATED TO
OUR FUTURE PUBLIC HEALTH. WE'RE
ON THE THIRD YEAR OF INVESTMENTS
OF 300 MILLION 200 MILLION TO
THE DEPARTMENT AND 200,000,002
LOCALS FOR FUTURE PUBLIC HEALTH
FUNDING. THE FIRST YEAR WE
RECEIVED THAT WE HAD TWO YEARS
TO SPEND THOSE DOLLARS AND SO A
BIG PORTION OF THIS CARRY OVER
ROUGHLY 240 MILLION OF THAT IS
THIS REDUCTION AMOUNT BECAUSE WE
WON'T BE SEEING THAT IN 2425.
AND THEN THERE WERE SOME ONE
TIME DOLLARS ABOUT 171 180
MILLION THAT WAS COMING OUT FOR
COVID DOLLARS THAT WE DON'T
NEED. UM, SO THAT KIND OF
EXPLAINS IN YOUR AGENDA DOES A
GREAT JOB ALSO KIND OF
HIGHLIGHTING WHAT THOSE CHANGES
WERE? SO THAT'S IN THERE AS
WELL? UM AND THEN, AS FAR AS
FUTURE PUBLIC HEALTH, THE $300
MILLION IS STILL IN THERE AGAIN
FOR 2425 FOR THIS I MENTIONED
FOR THE THIRD YEAR YOU DID HAVE
SOME QUESTIONS IN THE AGENDA. UM
I BROUGHT MY COLLEAGUE JULIAN
AKASAKA TO ADDRESS SOME OF
THOSE, IF NOW'S A GOOD TIME FOR
THAT WE CAN GET INTO IT OR OKAY.
OKAY. THANK YOU. THANK YOU.
CHAIR WEBER. MY NAME IS JULIA
NAGASAKI. WHO I'M, THE DEPUTY
DIRECTOR OF THE OFFICE OF POLICY
AND PLANNING. AND I'M HERE TO
PROVIDE A BRIEF UPDATE ABOUT THE
IMPACT OF THE FUTURE OF PUBLIC
HEALTH FUNDS WERE ALLOCATED TO
STATE AND LOCAL PUBLIC HEALTH
WORKFORCE AND PROGRAMS. WE'RE
CURRENTLY IN THE SECOND YEAR OF
FUNDING. UM AND SO THE PURPOSE
OF THE LANDMARK FUTURE PUBLIC
HEALTH INVESTMENT IS TO
STRENGTHEN AND TRANSFORM
CALIFORNIA'S PUBLIC HEALTH
SYSTEM. ADDRESSING CRITICAL GAPS
IN COURT INFRASTRUCTURE GROWING
A SKILLED REPRESENTATIVE AND
WELL SUPPORTED WORKFORCE,
INCREASING PREPAREDNESS AND
RESILIENCE BUILDING AND
IMPROVING SYSTEMS, CONTRIBUTING
TO EQUITY AND PROTECTING AND
IMPROVING THE HEALTH OF
COMMUNITIES THROUGHOUT THE
STATE. THESE OBJECTIVES ARE
ACHIEVED THROUGH INITIATIVES
ADDRESSING PRIORITIES.
ADDRESSING THE FOUNDATIONAL
PUBLIC HEALTH SERVICES THAT ARE
CRITICAL TO STRENGTHENING AND
SUSTAINING OUR STATE'S PUBLIC
HEALTH INFRASTRUCTURE. MOST
SIGNIFICANTLY IN THE FIRST TWO
YEARS. THESE RESOURCES HASN'T
HAVE ENABLED AN IMPORTANT
EXPANSION OF THE PUBLIC HEALTH
WORKFORCE. THE HEART OF OUR
PUBLIC HEALTH SYSTEM, CD PH AND
LOCAL HEALTH JURISDICTIONS HAVE
HIRED OVER 1200 NEW PUBLIC
HEALTH STAFF AT THE STATE AND
LOCAL LEVEL. THE STATE LEVEL
OVER 300 POSITIONS. 74% OF
PLANNED HIRES HAVE EXPANDED
PUBLIC HEALTH WORKFORCE CAPACITY
TO SUPPORT BOTH PROGRAM AND
OPERATIONAL ACTIVITIES. PROJECTS
HAVE ALSO FOCUSED ON WORKFORCE
DEVELOPMENT, INCREASING OUR HR
STAFFING, LAUNCHING A NEW HIRING
SYSTEM, EXPANDING MARKETING AND
PIPELINE EFFORTS TO PROMOTE
CAREERS IN PUBLIC HEALTH. CPH
HAS ALSO DEVELOPED A NEW PUBLIC
HEALTH CORE COMPETENCIES SYSTEM
WITH MODULAR PUBLIC HEALTH
TRAININGS AND A CAREER
MANAGEMENT PROGRAM TO HELP
SUPPORT DEVELOPMENT OF OUR
PROFESSIONAL PUBLIC HEALTH STATE
SERVICE. THE DEPARTMENT HAS ALSO
ESTABLISHED NEW STRUCTURES,
INCLUDING THE OFFICE OF POLICY
AND PLANNING, WHICH SUPPORTS
PRIORITY INITIATIVES ACROSS THE
DEPARTMENT, AS WELL AS OUR NEW
REGIONAL PUBLIC HEALTH OFFICE TO
SUPPORT LOCAL HEALTH
JURISDICTIONS WITH KEY PROJECTS
AND BIDIRECTIONAL COORDINATION.
CD PH IS LEVERAGING THE FUTURE
OF PUBLIC HEALTH RESOURCES TO
IMPROVE EMERGENCY PREPAREDNESS
AND RESPONSE CAPABILITIES.
EXAMPLES INCLUDE ESTABLISHING A
DEDICATED RECOVERY UNIT,
EXPANDING PLANNING, TRAINING,
EXERCISE AND EVALUATION
CAPABILITIES. DEVELOPING A 24 7
INTELLIGENCE HUB AND IMPROVING
STATE LABORATORY EMERGENCY
RESPONSE SUPPORT. OTHER KEY
IMPROVEMENT INITIATIVES ON CORE
PUBLIC HEALTH FUNCTIONS INCLUDE
IT AND DATA SCIENCE, SUCH AS
EXPANSION OF COVERAGE FOR THE
CALIFORNIA BIRTH DEFECTS
MONITORING PROGRAM.
COMMUNICATIONS INCLUDING A
COMMUNICATION STRATEGY, AS WELL
AS INCREASED DIGITAL,
LINGUISTICALLY AND CULTURALLY
RESPONSIVE COMMUNICATIONS AND A
COMMUNITY PARTNERSHIP AND
INCLUSION STRATEGY WITH
DEDICATED COMMUNITY ENGAGEMENT
PERSONNEL AND POPULATION FOCUSED
ADVISORY COMMITTEES. ALL OF
THESE WORKFORCE AND SYSTEMS
IMPROVEMENTS CONTRIBUTE TO THE
BROADER GOAL OF COMMUNITY HEALTH
IMPROVEMENT. ADDITIONAL
STRATEGIES FOCUSED ON ADVANCING
LIFE COURSE EQUITY AND
PREVENTION INCLUDE STRENGTHENING
OUR PARTNERSHIPS WITH HEALTH
SYSTEMS, HEALTH PLANS AND LOCAL
COMMUNITIES. DEVELOPING A
PLANNING GUIDE FOR STATE AND
LOCAL PUBLIC HEALTH TO INFORM
PUBLIC HEALTH FINANCING
STRATEGIES PROJECTS ADDRESSING
KEEP HEALTH IMPROVEMENT
PRIORITIES, SUCH AS BEHAVIORAL
HEALTH THROUGH A DEPARTMENT WIDE
EFFORT, INCREASED STAFFING AND
DEVELOPING A FRAMEWORK FOR
PREVENTION. AS WELL AS
ENHANCEMENTS TO THE STATE HEALTH
ASSESSMENT AND IMPROVEMENT
PLANNING FUNCTIONS, INCLUDING
THE INAUGURAL STATE OF PUBLIC
HEALTH REPORT RELEASED THIS
YEAR. AT THE LOCAL LEVEL
REQUIREMENTS INCLUDE THAT AT
LEAST 70% OF FUNDS BE DEDICATED
TO SUPPORT THE HIRING OF
PERMANENT STAFF. LH JS HAVE MADE
STRONG PROGRESS ON HIRING OVER
900 POSITIONS HAVE BEEN FILLED
IN JURISDICTIONS ACROSS THE
STATE, REFLECTING 74% OF PLANNED
HIRES. ULTIMATELY FUTURE PUBLIC
HEALTH WILL BE ADDING A TOTAL OF
1200 POSITIONS TO THE LOCAL
PUBLIC HEALTH SYSTEM. HIGHLIGHTS
SO FAR INCLUDE OVER 90
EPIDEMIOLOGISTS, 100, PUBLIC
HEALTH PHYSICIANS AND NURSES AND
100 AND 40 COMMUNITY HEALTH
WORKERS. ADDITIONALLY OVER 500
STAFF HAD BEEN HIRED IN ROLES
THAT INCLUDE A FOCUS ON
ADDRESSING HEALTH DISPARITIES
AND EQUITY. STAFF ARE FOCUSED IN
MANY PROGRAMS, AREAS, INCLUDING
CHRONIC DISEASE, INFECTIOUS
DISEASE ADMINISTRATION, PUBLIC
HEALTH LABORATORIES,
ENVIRONMENTAL AND FAMILY HEALTH
AND PREPAREDNESS. WITH STAFFING
PRIORITIES IDENTIFIED BASED ON
THE NEEDS OF EACH LOCAL HEALTH
JURISDICTION. ALL 61 LOCAL
HEALTH JURISDICTIONS HAVE NOW
SUBMITTED THREE YEAR WORK PLANS,
WHICH IDENTIFIES STRATEGIES AND
EVALUATION APPROACHES, AS WELL
AS KEY AREAS OF FOCUS INFORMED
BY PRIORITIES IN THEIR LOCAL
COMMUNITY, HEALTH IMPROVEMENT
AND STRATEGIC PLANS. A SUMMER OF
THESE WORK PLANS IS BEING
DEVELOPED AND WILL BE POSTED
PUBLICLY BY THE END OF MARCH.
THE FUTURE OF PUBLIC HEALTH
IMPLEMENTATION FRAMEWORK SUPPORT
SUPPORTS BOTH ALIGNMENT AND
FLEXIBILITY, THE AVAILABILITY OF
SUSTAINABLE NON CATEGORICAL
FUNDING AND PUBLIC HEALTH
INFRASTRUCTURE ENABLES LOCAL
HEALTH JURISDICTIONS TO ADDRESS
ISSUES THAT ARE RELEVANT AND
MEANINGFUL TO THEIR COMMUNITY
NEEDS, WHILE ALSO CONTRIBUTING
TO COLLECTIVE IMPACT AND
ADDRESSING KEY GAPS IN THE
GOVERNMENTAL PUBLIC HEALTH
SYSTEM. THE FIRST TWO YEARS OF
PUBLIC HEALTH ALLOCATION
INCLUDED CARRYOVER AUTHORITY TO
ALLOW FOR RAMP UP OF
INFRASTRUCTURE AND HIRING WHILE
BUILDING TOWARDS FULL
IMPLEMENTATION OVER THESE FIRST
TWO YEARS FOR STATE OPERATIONS,
CD PH HAS BEEN MONITORING
SPENDING AND ALLOCATING ANY
AVAILABLE UNSPENT CARRYOVER
FUNDS SUCH AS SALARY SAVINGS TO
ADDRESS PRIORITY ACTIVITIES IN
ALIGNMENT WITH THE IDENTIFIED
FOUNDATIONAL PUBLIC HEALTH
SERVICE AREAS. IN ORDER TO
EFFECTIVELY ABSORB THE FUNDS
WITH A MINIMUM OF FUNDING
UNSPENT. FOR LOCAL ASSISTANCE.
PROGRESS ON LOCAL HEALTH
JURISDICTION EXPENDITURES HAS
BEEN MONITORED THROUGH THEIR
SUBMISSION OF LOCAL EXPENDITURE
AND PROGRESS REPORTS AND LH JACE
HAD MADE SIGNIFICANT PROGRESS IN
SPENDING. PROJECTIONS OF LOCAL
EXPENDITURES SHOW THAT A LARGE
PERCENTAGE OF FUNDS WILL BE
EXPENDED, AND WE ESTIMATE THAT
THERE WILL BE A SMALL PERCENTAGE
OF FUNDS UNSPENT. THERE'S BEEN A
VERY HIGH LEVEL UPDATE ABOUT THE
ACCOMPLISHMENTS TODAY AND PLANS
GOING FORWARD. WE PLAN TO
CONTINUE TO KEEP THE LEGISLATURE
UPDATED ABOUT MILESTONES. WITH
THIS INVESTMENT. THIS INVESTMENT
WOULD NOT HAVE BEEN POSSIBLE
WITHOUT THE COLLABORATION AND
SUPPORT OF THE ASSEMBLY AND
SENATE BUDGET COMMITTEES AND
STAFF WERE TRULY GRATEFUL FOR
THE ONGOING PARTNERSHIP. BE
HAPPY TO ADDRESS ANY QUESTIONS
FROM THE COMMITTEE OR RECEIVE
ANY FOLLOW UP AFTER THE HEARING.
THANK YOU. THANK YOU. DEPARTMENT
OF FINANCE. AFTERNOON MADAM
CHAIR NICK MILLS DEPARTMENT OF
FINANCE NOTHING FURTHER TO ADD
ELIO. GOOD AFTERNOON, WILL OWENS
WITH THE LEGISLATIVE ANALYST'S
OFFICE? UM SOME OF OUR COMMENTS
ARE ON SPECIFIC PROPOSALS, SO
WE'LL BE READY TO ADDRESS THOSE
WHEN THEY COME UP. THANK YOU.
WELL THANK YOU BOTH FOR BEING
HERE. JUST A COUPLE OF
QUESTIONS. YOU SPOKE ABOUT THE
REQUIREMENT OF THE THREE YEAR
WORK PLAN FROM THE LOCAL
JURISDICTIONS. UM WHAT IS THE
REQUIREMENT AS FAR AS BUT THEN
THOSE THREE YEARS ANY FOLLOW UP
ANY SPECIFIC CHECK INS THAT THEY
WILL BE REPORTING TO YOU ALL.
YEAH, ABSOLUTELY. SO THERE'S A
QUARTERLY PROGRESS REPORTING
THAT THEY SHARE IN TERMS OF THE
PROGRESS OF BOTH THEIR
EXPENDITURES AND THEY'RE HIRING
AS WELL AS MEETING THE
OBJECTIVES IDENTIFIED, UM, IN
THEIR WORK PLANS ON THE SPECIFIC
METRICS FOR THE ISSUE AREAS THAT
THEY WILL BE WORKING ON. THANK
YOU AND WHEN DECIDING HOW TO
SPEND THE 100 MILLION DID YOU
CONSIDER CORE PROGRAMS THAT ARE
CURRENTLY UNDERFUNDED, SUCH AS R
CALIFORNIA CANCER REGISTRY. THE
SO THE FUTURE PUBLIC HEALTH
INVESTMENT AT THE STATE
OPERATION. SO THE 100 MILLION AT
THE STATE LEVEL ABSOLUTELY DOES
REINFORCE PROGRAMS ACROSS THE
DEPARTMENT. THERE'S A WHOLE
FOUNDATIONAL SERVICE AREA.
THAT'S SPECIFIC TO WORKFORCE
WHERE WE'RE ADDING ADDITIONAL
STAFFING. IN THE CURRENT YEAR.
WE HAVE USED SOME OF THE SALARY
SAVINGS TO PROVIDE AN
AUGMENTATION TO SUPPORT THE
CALIFORNIA CANCER REGISTRY
SHORTFALL. FOR THIS YEAR. SO I
GUESS MY QUESTION IS, IS THERE
A, UH METRIC A PRIORITY GIVEN TO
PROGRAMS THAT WE ALREADY HAVE. I
WAS JUST USING THAT AS AN
EXAMPLE. UM, THAT MAY BE
UNDERFUNDED. I THINK THAT IT'S A
COMBINATION OF TRYING TO AUGMENT
EXISTING PROGRAMS AS WELL AS TO
INVEST IN AREAS THAT WE'VE NEVER
HAD A FUNDING STREAM TO ADDRESS.
CORE PUBLIC HEALTH FUNCTIONS
WERE REALLY USING THAT
FOUNDATIONAL PUBLIC HEALTH
SERVICES MODEL TO LOOK AT WHAT
IS GOVERNMENTAL PUBLIC HEALTH
RESPONSIBILITY. AND THEN WHAT
ARE THE AREAS WE MIGHT NEED TO
SHORE UP? UM, IN ORDER TO BE
ABLE TO RESPOND TO THAT FULLY?
THANK YOU. I WILL NOW TURN TO
SEE IF THERE'S ANY, UH, PUBLIC
COMMENT. GOOD AFTERNOON,
MICHELLE GIBBONS WITH THE COUNTY
HEALTH EXECUTIVES ASSOCIATION IN
CALIFORNIA, JUST WANTED TO
REMARK AROUND THE FUTURE OF
PUBLIC HEALTH FUNDS. SINCE WE
REPRESENT THE LOCAL HEALTH
DEPARTMENTS, THOSE FUNDS HAVE
BEEN INSTRUMENTAL. I JUST CAN
ANECDOTALLY TELL YOU MANY
STORIES THAT WERE SUBMITTED TO
US AROUND REBUILDING OUR
LABORATORY CAPACITY BEING ABLE
TO ADDRESS CHRONIC DISEASE
PREVENTION WHERE BEFORE THERE
WAS LIMITED TERM FUNDING TO DO
THAT. ALSO ADDING TO, UH, OUR
INFECTIOUS DISEASE
INVESTIGATIONS AND THINGS LIKE
THAT, AND SO IT HAS BEEN
TREMENDOUSLY INSTRUMENTAL IN
REBUILDING. WHAT ARE OUR LOCAL
HEALTH DEPARTMENTS? I DO WANT TO
JUST MENTION THAT YOU KNOW, THIS
WAS NOT SHINY FUNDING TO DO
BRAND NEW, SHINY THINGS. IT WAS
BECAUSE OUR PUBLIC HEALTH
INFRASTRUCTURE HAD BEEN
DECIMATED AT SOME POINT, AND WE
JUST NEEDED THE FUNDS TO BE ABLE
TO REDO THAT. SO THE 1200
POSITIONS BEING ADDED INTO LOCAL
HEALTH DEPARTMENTS THAT WAS
STAFF THAT WAS MUCH NEEDED STAFF
THAT HAD WORKED READILY WAITING
FOR THEM TO BE ABLE TO ADDRESS A
LOT OF THE THINGS THAT WE SEE
ACROSS THE STATE. SO WE WANT TO
THANK THE LEGISLATURE FOR THAT,
AND WE HOPE THAT THOSE FUNDS
COULD BE PROTECTED AS WE GO
THROUGH THIS TOUGH BUDGET
CLIMATE. THANK YOU. THANK YOU.
ALRIGHT WELL, SEEING NO OTHER
COMMENTS, UM THANK YOU SO MUCH
FOR BEING HERE. WE WILL NOW MOVE
TO OUR THIRD PANEL AND OUR THIRD
ISSUE COVERS I T ISSUES,
INCLUDING FOUR PROPOSALS FROM
THE ADMINISTRATION, AS WELL AS
ONE OVERSIGHT ISSUE. WE WILL
BEGIN WITH ASSEMBLYMEMBER'S
DOCTOR. WOULD WHO IS HERE TO
TALK ABOUT CAL CONNECT WE WILL
THEN GO TO ADRIAN BARAZA,
ASSISTANT DEPUTY DIRECTOR FOR
CENTER FOR INFECTIOUS DISEASE,
CD PH. THEN WE WILL GO WITH JOHN
RUSSELL, CHIEF INFORMATION
OFFICER FOR INFORMATION
TECHNOLOGY SERVICES DIVISION.
AND FINALLY MICHELLE GIBBONS,
THE EXECUTIVE DIRECTOR, COUNTY
HEALTH EXECUTIVE ASSOCIATION OF
CALIFORNIA. DOCTOR WOULD. THANK
YOU, MADAM CHAIR. GOOD
AFTERNOON, MADAM CHAIR AND
MEMBERS. UM I'M HERE TO SPEAK IN
SUPPORT OF CONTINUING FUNDING
FOR THE CAL CONNECT SYSTEM. I'VE
HEARD FROM THE COUNTIES I
REPRESENT THAT HAVE YOU THAT
THEY HAVE USED THE CAL CONNECTS
SYSTEM AND FOUND IT TO IMPROVE
EFFICIENCY AND EFFECTIVENESS.
CURRENTLY YOU UTILIZE CAL
CONNECT FOR COVID PARKS. AVIAN
FLU AND EBOLA, MARBURG. AND LOOK
FORWARD TO USING IT FOR HIV
SYPHILIS, TUBERCULOSIS IN THE
NEAR FUTURE. ADDITION, IF OUR
LOCAL COMMUNITY HAS EVER HAD A
LARGE EXPOSURE TO A VACCINE
PREVENTABLE DISEASE, SUCH AS
MEASLES THEIR PUBLIC HEALTH
TEAMS WOULD USE CAL CONNECT FOR
TRACKING CONTACTS. IF USED. THIS
SYSTEM SENSES INCEPTION DURING
COVID 19. UM, TO NOT ONLY TRACK
COVID CASES BUT TO SUPPORT THEIR
NEED WITH DYNAMIC AND MODERN
CAPABILITIES TO IDENTIFY CASES
AND EXPOSED CONTACTS AND
MITIGATE THE SPREAD OF
INFECTIOUS DISEASE. THEY TOLD ME
THAT PRIOR TO THE CAL CONNECTS
SYSTEM. BEING ESTABLISHED. THEY
WERE USING MANUAL SPREADSHEETS,
EXCEL SPREADSHEETS TO GATHER
DATA. THEY OFTEN DO. IN MY
TESTIMONY. I POINT OUT THAT
RURAL COMMUNITIES ARE DIFFERENT.
THEY OFTEN HAVE LIMITED STAFF
AND THAT ANY SYSTEM, ALLOWING
THEM TO BE MORE EFFICIENT AND
MORE EFFECTIVE AND COLLECTING
DATA IS IMPORTANT AND WORTHY OF
FINANCIAL SUPPORT. I'M HERE TO
REQUEST THAT THE ASSEMBLY BUDGET
SUBCOMMITTEE ONE ON HEALTH AND
HUMAN SERVICES, RECOMMENDED THIS
PROGRAM, WHICH REQUIRES $33.5
MILLION TO CONTINUE ITS
IMPORTANT PUBLIC HEALTH WORK. BE
ALLOWED TO CONTINUE. I LOOK
FORWARD TO REVIEWING ANY AND ALL
POSSIBILITIES OF FUNDING OF THIS
IMPORTANT PROGRAM, INCLUDING THE
ALLOCATION OF EXISTING FUNDING
WITHIN THE CALIFORNIA DEPARTMENT
HEALTH A PUBLIC HEALTH. THE
COVID 19 PANDEMIC AS TRAGIC AS
IT HAS BEEN DID RESULT IN
INNOVATIONS IN MANY INDUSTRIES.
WE'VE SEEN THE BENEFITS OF THESE
IMPROVEMENTS AND ENHANCEMENTS
SUCH AS CAL CONNECT. THE STATE
SHOULD CONTINUE TO SUPPORT IT. I
FEAR WE GO BACKWARDS. OTHERWISE
UM AND I WOULD ASK, UM THIS TO
ME FEELS LIKE ONE OF THOSE
CLASSIC. ANY WISE AND
POTENTIALLY POUND FOOLISH CUTS.
SO I WOULD, UH I DON'T KNOW HOW
YOU MEASURE THE AMOUNT OF
DISEASE THAT HAPPENS THAT YOU IF
YOU CAN'T TRACK IT, HOW YOU
MANAGE THE PAIN AND SUFFERING
THAT GOES ALONG WITH THAT AND
MONETIZE THAT. SO UM, I'M
ANXIOUS TO HEAR HOW THE
DEPARTMENT OF FINANCE JUSTIFIES
CUTTING A DISEASE PREVENTION
SURVEILLANCE PROGRAM THAT MANY
COUNTIES, ESPECIALLY SMALL
COUNTIES, UM, HAVE COME TO RELY
ON IMPROVED DISEASES,
SURVEILLANCE AND PROTECT PEOPLE
FROM THOSE THOSE DISEASES. THANK
YOU. THANK YOU NEXT.
I'M SORRY. CAN YOU PUSH YOUR
CENTER FOR INFECTIOUS DISEASES?
THANK YOU FOR THAT. UM, SO THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH IS REQUESTING 26.9
MILLION IN GENERAL FUND. IN 2425
FOR MAINTENANCE AND OPERATIONS,
SUPPORT OF THE SURVEILLANCE AND
PUBLIC HEALTH INFORMATION
REPORTING AND EXCHANGE OR THE
SAPPHIRE SYSTEM. THE SAPPHIRE
SYSTEM IS A GATEWAY FOR
RECEIVING ELECTRONIC LAB DATA,
YOU KNOW, LIKE TRYING TO CASE
REPORTING FOR C D PH. THIS DATA
SYSTEM EVOLVED OUT OF THE
PREVIOUS STATEWIDE IT PLATFORM.
THE COVID CALIFORNIA COVID
REPORTING SYSTEM, WHICH WAS
DEVELOPED IN 2020 TO INCREASE
STATEWIDE CAPACITY TO MANAGE
EXTREMELY HIGH VOLUMES OF COVID
19 LABORATORY DATA. THE PANDEMIC
RESPONSE EFFORTS WHEN THE PRIOR
GATEWAY WAS NOT ABLE TO HANDLE
THE VOLUME. SAPPHIRE
FUNCTIONALITY ALLOWS FOR
RECEIVING PUBLIC HEALTH DATA FOR
ALL REPORTABLE CONDITIONS, NOT
JUST COVID 19, INCLUDING
INFECTIOUS DISEASES SUCH AS
TUBERCULOSIS, MEASLES, HIV,
SYPHILIS AND M POX. PREVIOUS
BUDGET. ALEX HAVE FUN TO THE
SAPPHIRE SYSTEM UP TO THE
CURRENT FISCAL YEAR. AN
ADDITIONAL EXPENDITURE AUTHORITY
IS NEEDED TO CONTINUE OPERATION
OF THE SAPPHIRE SYSTEM IN 2425.
CONTINUED MAINTENANCE AND
OPERATIONS. SUPPORT OF THE STAFF
FIRE SYSTEM IS NEEDED TO
MAINTAIN TIMELY AND ACCURATE
STATEWIDE HEALTH INFORMATION
EXCHANGE SYSTEM FOR EFFECTIVE
PUBLIC HEALTH SURVEILLANCE AND
DISEASE OUTBREAK RESPONSE. AS
WELL AS COMPLY WITH FEDERAL
HEALTH INFORMATION DATA
TECHNOLOGY REQUIREMENTS. THANK
YOU. THANK YOU. WE'LL MOVE ON TO
JOHN RUSSO. ALSO NUMBER THREE
COVID 19 WEBSITE. UM AFTER JUNE
2024 COVID 19 DOT CA.GOV RURAL
WILL BE REDIRECTED TO THE CD PH
HOSTESS SITE. COMMUNICATION HAS
BEEN PROVIDED TO THE GOVERNOR'S
OFFICE AND LOCAL HEALTH
JURISDICTIONS. THE MIGRATION OF
THE CD PH SITE. WE WORKED WITH
THE GOVERNOR'S OFFICE. WHO
PROVIDED US WITH THE APPROVAL
FOR THIS MOVE, WE EXPECT MINIMAL
TO KNOW USER CHANGES AS WE MOVE
FORWARD. THANK YOU, AND WE WILL
GO TO MICHELLE GIBBONS. THANK
YOU. GOOD AFTERNOON, THE COUNTY.
WE REPRESENT THE LOCAL HEALTH
DEPARTMENTS 55 OF THEM USE CAL
CONNECT, AND THEY'RE DEEPLY
CONCERNED ABOUT THE LACK OF
FUNDING BEING PROVIDED IN THE
BUDGET TO MAINTAIN THE SYSTEM. I
WON'T RESTATE EVERYTHING BUT AS
DOCTOR WOULD MENTION LOCAL
HEALTH DEPARTMENTS DID RELY ON
MANUAL PROCESSES. THEY WOULD
PICK UP THE PHONE. CALL SOMEBODY
AND SAY, HEY, WHO ARE YOUR CLOSE
CONTACTS THEY WOULD ASK FOR
THEIR PHONE NUMBERS. THEY WOULD
PUT THE PHONE NUMBERS IN THE
SPREADSHEET, AND THEN THEY WOULD
START THE CALLING ALL OVER
AGAIN. AND WHAT CAL CONNECTED IS
IT ALLOWED THIS TO BE AUTOMATED?
AND ALLOWED FOR US TO BROADLY
SHARE INFORMATION JUST ACROSS A
DISEASE PROGRAMS INTERNALLY AND
ALSO WITH OTHER LOCAL HEALTH
DEPARTMENTS AND CD PH. UM IN
TERMS OF CAL CONNECT, IT'S JUST
MORE STREAMLINED, EFFICIENT AND
COORDINATED. LOCAL HEALTH
DEPARTMENTS HAVE BEEN EXCITED
WITH CDP H S EFFORTS TO EXPAND
CAL CONNECT TO OTHER DISEASES,
AND WE HEARD ABOUT THE RISE AND
SYPHILIS THIS SUMMER. THE
EXPANSION IS SUPPOSED TO INCLUDE
STD'S AND HIV. SO IT WOULD BE A
TRAVESTY TO NOT ALLOW THE SYSTEM
TO CONTINUE MOVING FORWARD. UM
THIS IS WHY KAYAK AND THE HEALTH
OFFICERS ASSOCIATION OF
CALIFORNIA HO AC HAVE ALSO MADE
THIS ONE OF OUR PRIORITIES. WE
UNDERSTAND THAT THERE'S YOU
KNOW, TRYING BUDGET CLIMATE
AHEAD OF US. WE WERE JUST AS
DOCTOR WOULD MENTIONED. ASK FOR
US TO LOOK UNDER THE COUCH
CUSHIONS AS WE OFTEN DO WITHIN
PUBLIC HEALTH. A COLLEAGUE OF
MINE. LET ME KNOW ABOUT THE NEW
YORK TIMES ARTICLE THAT SAID THE
CYCLE OF FUNDING PUBLIC HEALTH
IS NEGLECT PANIC. REPEAT I WORRY
THAT WE'RE ENTERING INTO THAT
CYCLE AGAIN, AND WE'RE GOING TO
NEGLECT SYSTEMS THAT HAVE BEEN
TREMENDOUSLY HELPFUL FOR OUR
LOCAL HEALTH JURISDICTIONS. SO
WE JUST ASK THAT FUNDING BE
DEDICATED TO MAINTAIN THE SYSTEM
QUICKLY. I WILL JUST MENTION
THAT UNDER THE ADMINISTRATION
SYNDROME IQ SURVEILLANCE
PROPOSAL. I JUST WANT TO MENTION
THAT WHILE SHE ACT DOES NOT HAVE
CONCERNS WITH THE GOAL OR THE
INTENT LOCAL HEALTH DEPARTMENTS
ALSO HAVE SYNDROME IQ
SURVEILLANCE SYSTEMS AND WE WANT
TO ENSURE THAT WE ARE
COORDINATED AND WE ARE NOT
SUBBING ONE SYSTEM OUT FOR THE
OTHER AND ELIMINATING THE
ABILITY FOR LOCAL HEALTH
DEPARTMENTS TO GET THE REAL TIME
INFORMATION SO THAT WE CAN
RESPOND ON THE GROUNDS AS WELL.
WE'RE WORKING WITH THE
DEPARTMENT TO BETTER UNDERSTAND
HOW TO DO THAT. AND JUST WANTED
TO LET YOU KNOW ABOUT THAT AS
WELL. THANK YOU. THANK YOU.
ANYTHING FROM THE DEPARTMENT OF
FINANCE? UM, I WILL JUST NOTE
ABOUT CAL CONNECTING AND WE'VE
HAD SOME COMMENTS ABOUT CAL
CONNECT. UM THE DISCONTINUANCE
OF FUNDING FOR CAL CONNECT WAS
ONE OF THE TOUGH DECISIONS THAT
WE NEEDED TO MAKE IN THE
GOVERNOR'S BUDGET. DO THE DO THE
DO THE DEFICIT. AND I JUST
WANTED TO KNOW TO CONCERN ABOUT
THE PROPOSAL TO RESTORE GENERAL
FUND FUNDING FOR CAL CONNECT.
FINANCE IS CONCERNED ABOUT THE
AVAILABILITY OF RESOURCES TO
FUND THE OPERATION AND EXPANSION
OF CAL CONNECT TO ADDITIONAL
REPORTABLE CONDITIONS AND NOTES
THAT THE DEPARTMENT IS LOOKING
INTO EXISTING RESOURCES TO FUND
THE CORE OPERATIONS AND
MAINTENANCE OF THE SYSTEM. ANY
COMMENTS FROM L. A. WILL OWENS
WITH THE L A. YOU SO REGARDING
THE CAL CONNECT AND THE SAPPHIRE
FUNDING. OR, YOU KNOW, OUR
OFFICE HAS RECENTLY RELEASED A
REPORT THAT. SHOWED THAT THE
REVENUE OUTLOOK AND THE BUDGET
CONDITIONS EXPECTED TO BE WORSE
THAN WHAT IS CURRENTLY IN THE
GOVERNMENT'S BUDGET. SO THAT
BEING SAID ANY ADDITIONAL
GENERAL FUND SPENDING, PROPOSING
THE BUDGET OR TO BE ON TOP OF
THE BUDGET WOULDN'T NEED TO
RESULT IN SUBSEQUENT GENERAL
FUND SAVINGS ELSEWHERE. THAT
BEING SAID, AH, YOU KNOW, TO THE
EXTENT THAT THESE SYSTEMS ARE
PRIORITY FOR THE LEGISLATURE.
OUR OFFICE HAS WORKED TO
IDENTIFY RECENT ONE TIME AND
TEMPORARY SPENDING THAT COULD BE
. USED TO OFFSET THE FUNDING FOR
THESE PROGRAMS THAT ARE HIGHER
PRIORITY FOR THE LEGISLATURE AND
WE ARE AVAILABLE TO WORK WITH
THE COMMITTEE TO IDENTIFY THOSE
AND WORK ON THOSE. THANK YOU.
THANK YOU. AND IS THERE ANYONE
HERE FROM A CITY PH THAT COULD
ACTUALLY SPEAK TO CAL CONNECT. I
CAN SPEAK ON. I'M CAL CONNECTED.
THERE ARE QUESTIONS. THANK YOU.
ALL RIGHT. SO WE'LL START WITH
THAT ONE. CAN YOU PLEASE GIVE A
OKAY, I'LL GET TO BED. UM CAN
YOU PLEASE GIVE A BRIEF?
HISTORICAL PERSPECTIVE OF CAL
CONNECT WHAT WAS ITS PURPOSE?
WHAT DID WE FIND AS IT HELPED. I
THINK WE CAN SAY THAT IT'S
HELPED TREMENDOUSLY. CURRENT
UTILIZATION REMAINS VERY HIGH.
THERE ARE 55 LOCAL HEALTH CARE
DISTRICTS THAT CONTINUE TO USE
UM CAL, CONNECT. UM YOU KNOW, IT
REALLY DEVELOPED OUT OF A
NECESSITY DURING THE COVID 19
RESPONSE TO REALLY PROVIDE
ROBUST CONTACT, TRACING AND
DISEASES, INVESTIGATION TOOLS
AND AS ASSEMBLYMEMBER'S WOULD UM
, MENTIONED, UM YOU KNOW, IT'S
AH. A RESOURCE THAT'S PROVED
INVALUABLE AND HAS REALLY
ALLOWED US TO STEER AWAY FROM
REALLY ANTIQUATED DISEASE
INVESTIGATION TECHNIQUES,
RELYING ON PAPER CLIPBOARD PEN.
UM SO IT'S REALLY BEEN, UM,
VALUABLE INVESTMENT FOR THE
DEPARTMENT. UM AND ONE THAT
WE'RE CONTINUING TO INTERNALLY
LOOK FOR ADDITIONAL FUNDING TO
CONTINUE TO SUPPORT. WE'RE
LOOKING ACROSS VARIOUS FUNDING
STREAMS AND THE DEPARTMENT. UM.
WE DO ALL WE HAVE MAINTENANCE
AND OPERATION SUPPORT AS I
MENTIONED TO LAST FOR THE
CURRENT YEAR. WHAT THAT MEANS
FROM A CAPABILITY PERSPECTIVE IF
WE'RE NOT ABLE TO PROVIDE
ONGOING AND IT'S AN OPERATION
SUPPORT FOR THE CAL CONNECTS
SYSTEM. IS THAT THAT WILL MEAN
THAT THERE IS LESS ABILITY FOR
LOCAL HEALTH DRIFT DISTRICTS TO
INVESTIGATE AND RESPOND TO
REPORTED. INFECTIOUS DISEASE
OUTBREAKS. UM, THIS INCLUDES A
LOSS OF SYSTEM THAT PROVIDES
AUTOMATED SYMPTOM MONITORING FOR
PERSONS EXPOSED INFECTIOUS
DISEASES LIKE AVIAN FLU AND
EBOLA. LOSS OF TOOLS THAT
INCREASE LOCAL HEALTHCARE
DISTRICTS ABILITY TO TRACK AND
PRIORITIZE CONTACTS IN CASES FOR
INTERVENTION TO PREVENT DISEASE
AND STOP SPREAD. FOR EXAMPLE,
FOR SOME DISEASES LIKE MEASLES
AND HEPATITIS A AN ANTIBIOTIC OR
A VACCINE OR AN ANTIBODY CAN BE
GIVEN TO PREVENT INFECTION.
AFTER EXPOSURE. IF DONE WITHIN A
SPECIFIC TIMEFRAME. THE
TIMELINESS IS REALLY THE KEY TO
DISEASE INVESTIGATION, AND
THAT'S SOMETHING THAT CALDERON
EXT HELPS HELPS US ACHIEVE.
THANK YOU. WOULD YOU SAY THAT?
UM THE FORMATION IMPLEMENTATION
OF CAL CONNECT SAVE LIVES. I
THINK WE CAN LEAD TO THAT
CONCLUSION. DO YOU THINK THAT,
UH, THE ABILITY TO TRACE AND
CONTACT INDIVIDUALS THAT MAY
HAVE COME IN CONTACT WITH
SOMEONE WITH A COMMUNICABLE
DISEASE? DO YOU THINK THAT MAYBE
DECREASED HOSPITALIZATIONS?
ABSOLUTELY IT LEADS TO EARLIER
INTERVENTIONS. WITH THAT
DECREASE OVERALL COST TO OUR
HEALTH CARE SYSTEM. ONE CAN MAKE
THAT CONNECTION. SO IT MAY NOT
NECESSARILY BE VIEWED AS AN
EXPENSE BUT A COST SAVING
MEASURE, INCLUDING THE COST OF
SAVING LIVES. I DON'T THINK
WE'VE DONE ANY RESEARCH THAT, UH
, PROVE THAT, BUT I WOULDN'T.
UM, I DON'T THINK IT'S UH FAR
REACH TO SAY THAT THERE WAS A
DIRECT CONNECTION. SO, UM. I DO
HAVE A QUESTION FOR THE
DEPARTMENT OF FINANCE ON THIS
PARTICULAR ISSUE, UM,
UNDERSTANDING THAT WE ARE IN A
VERY INTERESTING PLACE WITH OUR
OVERALL BUDGET THIS YEAR. UM.
WAS THE THOUGHT THAT WE WOULD
NOT HAVE ANOTHER COVID LIKE
PANDEMIC IN THE FUTURE. UM, PART
OF PART OF THE RATIONALE IS JUST
THE ACKNOWLEDGEMENT THAT, UM,
THE. COVID PANDEMIC IS WINDING
DOWN AS OUR CONTACT TRACING
ACTIVITIES AND DUE TO MULTIPLE
COMPETING PRIORITIES. THIS WAS
ONE THAT UM, WAS IDENTIFIED TO
DISCONTINUE. UM WE ALSO
RECOGNIZE THAT THERE ARE OTHER,
UM, SYSTEMS SUCH AS SAPPHIRE,
WHICH CONTINUED TO BE AVAILABLE
TO COLLECT. UM LAB REPORTS AND
OTHER DATA THAT IS ALSO USEFUL
FOR CONTAINING INFECTIOUS
DISEASES. SO THE DEPARTMENT OF
THE THOUGHT PROCESS IS THAT UM
COVID IS THE ONLY TYPE OF. VIRUS
INFECTION OUT THERE THAT WE WILL
ENCOUNTER THAT COULD ESSENTIALLY
DECIMATE OUR COMMUNITIES LIKE
WE'VE HAD. NOT THAT THIS IS THE
FIRST OF MANY TO COME. UM, NO.
WE ACKNOWLEDGE THAT THERE ARE
OTHER REPORTABLE DISEASES THAT
THE SYSTEM WOULD, UM WOULD
ADDRESS AND. HOW EXPENSIVE WOULD
IT BE TO RESTART IT? IF WE SHUT
IT DOWN. I DEFER TO THE
APARTMENT. I DON'T HAVE
IMPLEMENTATION FIGURES IN FRONT
OF ME. ANY MONEY. WE'LL HAVE TO
LOOK INTO THAT AND GET BACK TO
YOU. MATT AGUILERA DEPARTMENT OF
FINANCE IS JUST TO ADD TO WHAT
MY COLLEAGUE SAID. YOU KNOW, THE
DEPARTMENT IS LOOKING, UH,
WITHIN THEIR BASED RESOURCES TO
SEE IF, UH WHAT THEY CAN DO IN
TERMS OF MAINTAINING THAT THIS
SYSTEM SO WE'RE STILL WORKING
THROUGH THAT ASPECT OF THIS
PROPOSAL. OKAY? ASSEMBLYMEMBER'S
DOCTOR WOULD. THANK YOU. DR
WEBBER. I JUST HAVE A QUESTION,
MAYBE FROM THE DEPARTMENT OF
PUBLIC HEALTH. THE STAND UP OF
CAL CONNECT DIDN'T HAPPEN
INSTANTLY. SO UM, IF THE FUNDING
FOR CAL CONNECT GOES AWAY UM AND
I DON'T KNOW HONESTLY, HOW LONG
IT TOOK TO STAND IT UP, BUT IT
WASN'T INSTANT AND IT WAS
EXPENSIVE. AND IT WAS IN THE
MIDDLE OF THE COVID PANDEMIC. I
REMEMBER BEING ON CALLS WITH, UM
DEPARTMENT OF PUBLIC HEALTH, THE
DEPARTMENT OF HEALTH CARE
SERVICES ASKING ABOUT DATA WHEN
CAL CONNECT WAS BEING DEVELOPED,
SO I WOULD BE NICE TO KNOW WHAT
IT COSTS TO STAND IT UP. HOW
LONG THAT TOOK AND YOU KNOW WHEN
YOU TALK ABOUT DISEASE AND THE
RAPID SPREAD THAT WE EXPERIENCE
WITH COVID WE DON'T KNOW WHAT
THE NEXT POTENTIAL PANDEMIC IS.
WE DON'T KNOW WHAT WE ALSO WE
HEARD EARLIER, DR ARAGON TALKING
ABOUT THE UPTICK IN SYPHILIS.
WE'RE SEEING THAT IN IN IN ALL
OVER THE PLACE IN THE STATE OF
VARIETY OF THINGS ONCE AGAIN,
HOW CONNECT CAN BE USED TO HELP
TRACE THOSE OUTBREAKS AND
HOPEFULLY MINIMIZE THEM THROUGH
EDUCATION, WHICH HEARD VERY
CLEARLY WAS ONE OF THE BEST WAYS
TO DO THAT. SO UM, SO I WOULD
LIKE TO KNOW HOW MUCH IT COSTS
TO STAND IT UP HOW LONG IT TOOK
BECAUSE IF WE HAVE, IF WE JUST
BAN THIS AND HAVE TO STAND IT UP
AGAIN, HOW MUCH DOES THAT COST
OUR HEALTH CARE SYSTEM, HOW MANY
LIVES WERE POTENTIALLY AFFECTED
OR LOST BECAUSE WE DECIDED TO GO
BACKWARDS. DECIDED TO GO
BACKWARDS. THANK YOU. AND WE'RE
MORE THAN HAPPY TO REPORT BACK
ON. YES IF BOTH THE DEPARTMENT
AND THE DEPARTMENT OF FINANCE
CAN CAN GIVE US THAT
INFORMATION, AND I COULD NOT
AGREE MORE WITH ASSEMBLYMEMBER'S
DOCTOR WOULD IT SEEMS LIKE THIS
PROPOSAL WOULD BE A HUGE STEP
BACKWARDS. UM. WE KNOW HOW
DEVASTATING AND EXPENSIVE UH
COVID WAS, UM AND CONTINUES TO
BE. IT'S NOT LIKE IT'S OVER.
IT'S NOT LIKE PEOPLE STILL
AREN'T GETTING NOTIFICATIONS
THAT THEY HAVE BEEN, UM AROUND
SOMEONE THAT RECENTLY TESTED
POSITIVE, BUT UM, YOU KNOW, AS
WAS STATED, WE'RE SEEING UPTICK
IN OTHER INFECTIONS, UM, THAT
COULD BE TREATED PREVENTATIVELY.
OR IF YOU GET IN CONTACT WITH
PEOPLE, LET THEM KNOW THAT THEY
MAY NOT EVEN GET IT AT ALL. SO
I'M I'M A LITTLE CONFUSED AS TO
THE RATIONALE TO NOT CONTINUE TO
FUND THIS PROGRAM. UM WE WILL
CONTINUE TO HAVE CONVERSATIONS
AROUND THIS, UM AND SEE WHERE WE
CAN POSSIBLY LAND. BUT I THINK
IT WOULD BE A HUGE MISTAKE. UH
FROM THE STATE. UM AND NOT
NECESSARILY LOOKING OUT FOR THE
OVERALL BEST INTEREST OF OUR
RESIDENTS TO DISMANTLE THIS
PROGRAM, WHICH REALLY IS LIFE
SAVING. AND AT THE END OF THE
DAY ALSO, UM COST SAVINGS TO OUR
OVERALL HEALTH CARE SYSTEM. SO,
UM. THANK YOU FOR THAT THE OTHER
THING ON THE AGENDA. I DID NOT
HEAR SOMEONE TALK ABOUT IS THE
FIFTH PROPOSAL. I'LL COVER THIS
IN GENOMICS SURVEILLANCE TRAILER
BELL LANGUAGE. UM CALIFORNIA
CURRENTLY DOES NOT HAVE A
COMPREHENSIVE STATEWIDE NEAR
REAL TIME CAPABILITY TO IDENTIFY
AND ANALYZE EMERGING PUBLIC
HEALTH THREATS. CALIFORNIA IS
CURRENTLY BEHIND OTHER STATES
AND ADOPTING SYNDROME IQ
SURVEILLANCE. 24% OF HOSPITALS
WITH EMERGENCY DEPARTMENTS IN
CALIFORNIA SUBMIT DATA TO
BIOSENSOR LOCAL ARRANGEMENTS
COMPARED TO 78% OF HOSPITALS
WITH EMERGENCY DEPARTMENTS
ACROSS THE COUNTRY. ARE PROPOSED
PLAN IS TO STAND UP A STATEWIDE
SYNDROME X SURVEILLANCE PROGRAM
IN CALIFORNIA ENHANCED REAL TIME
WIDESPREAD MONITORING OF PUBLIC
HEALTH. THIS TRANSLATES TO MORE
AND FORMED RAPID AND TARGETED
PUBLIC HEALTH. ACTION FOR
DISEASE CONTROL AND PREVENTION
AND HEIGHTENED SITUATIONAL
AWARENESS TO FACILITATE MORE
EFFECTIVE PREPARED AND
RESPONSIVE PUBLIC HEALTH
STRATEGIES AND POLICY
DEVELOPMENT. CP PH WILL STAND UP
A STATEWIDE SYNDROME X
SURVEILLANCE AND BECOME THE
CALIFORNIA STATEWIDE
ADMINISTRATOR FOR THE BIOSENSOR
PLATFORM. THE BIO SINCE PLATFORM
IS A FREE CLOUD BASED COMPUTING
ENVIRONMENT HOSTED BY CDCS
NATIONAL SYNDROME IQ
SURVEILLANCE PROGRAM. THE SYSTEM
COLLECTS, ANALYZES AND SHARES
ELECTRONIC PATIENT ENCOUNTER
DATA. RECEIVED FROM EMERGENCY
DEPARTMENTS WITHIN 24 HOURS OF A
PATIENT'S INITIAL ENCOUNTER. AT
THE TBL GIVE CD PHD EXPLICIT
AUTHORITY TO COLLECT SOME
GENOMIC SURVEILLANCE DATA. AND
TO REQUIRE HOSPITALS WITH
EMERGENCY DEPARTMENTS TO SUBMIT
DATA TIME. UM JUST FOR DRAMATIC
SURVEILLANCE SYSTEM. ANY
QUESTIONS THAT BE A DANCER?
THOSE. THANK YOU SO MUCH FOR
THAT PRESENTATION. NOW MY
UNDERSTANDING IS THAT THE
FUNDING FOR THIS IS ALREADY IN
PLACE. CORRECT IT WAS PART OF
THE FUTURES IN PUBLIC HEALTH
FUNDING. OKAY, SO MY QUESTION IS
WHY WOULD THIS GO IN THE BUDGET
AND NOT THROUGH POLICY
COMMITTEE? YEAH SO I THINK WE
WERE DRAWING BACK TO THE
CORRELATION ABOUT THE FUNDING
RECEIVED THROUGH FUTURES OF
PUBLIC HEALTH. UH UM, AND WANTED
IT TO FIGHT TO FOLLOW THE SAME
APPROVAL OF CHAIN AND PROVIDE
MATERIAL IMPLEMENTATION UPDATES
TO THOSE WHO WERE IN THE REVIEW
CHANNEL FOR THE FUTURES AND
PUBLIC HEALTH FUNDING. YEAH. SO
YOU KNOW THIS TO ME AS I WAS
LOOKING THROUGH IT. IT'S
DEFINITELY A NECESSARY THING
THAT WE SHOULD HAVE. UM, HOWEVER
, IT SEEMS LIKE IT'S SOMETHING
THAT SHOULD PROBABLY GO THROUGH
POLICY COMMITTEE ENSURE THAT
WE'RE NOT MISSING ANYTHING THAT
WE'RE NOT MAKING ANY MISHAPS AND
IT'S UM ROLL OUT AND
IMPLEMENTATION GOING THROUGH
PRIVACY COMMITTEE, MAKING SURE
THAT WE'RE NOT OVERSTEPPING OUR
BOUNDS. UM AND SO. WILL CONTINUE
TO HAVE CONVERSATIONS. BUT THAT
IS DEFINITELY SOMETHING THAT
JUMPED OUT TO ME SINCE THIS IS
AND ASKING FOR MONEY BECAUSE YOU
HAVE THE MONEY. IT'S JUST ABOUT
CREATING THIS PROGRAM, WHICH IS
MORE POLICY AND SHOULD MAYBE BE
A LEGISLATIVE BILL INSTEAD OF
GOING INTO THAT INTO THE BUDGET.
UM SO THANK YOU FOR PRESENTING
THAT. AT THIS POINT, I WILL OPEN
IT UP FOR PUBLIC COMMENT. EACH
INDIVIDUAL WILL HAVE ONE MINUTE.
THANK YOU. THANK YOU. KAT DE
BERG WITH THE HEALTH OFFICERS
ASSOCIATION OF CALIFORNIA IN
SUPPORT OF THE CAL CONNECT
PROGRAM, NOTHING TO ADD TO THE
EXCELLENT COMMENTS OF MY
COLLEAGUE, MISS GIVENS. YOU DR
WEBBER AND DOCTOR WOULD THANK
YOU SO MUCH. THANK YOU. DR
WEBBER. BRUCE PALMER WITH THE
CALIFORNIA ASSOCIATION OF PUBLIC
HEALTH LAB DIRECTORS IN LINE
WITH JACK, THE COUNTY HEALTH
EXECS AND HÌ ACT, THE HEALTH
OFFICERS ASSOCIATION AND STRONG
SUPPORT OF CAL CONNECT SPEED OF
RESPONSE IS EVERYTHING WITH THIS
AND CAL CONNECT. ALLOWS US TO
RESPOND QUICKLY. AND THAT MAKES
ALL THE DIFFERENCE IN TERMS OF
THE LEVEL OF MORBIDITY AND
MORTALITY. THANK YOU SO MUCH.
THANK YOU. GOOD AFTERNOON, DR
WEBBER. I JUST WANTED TO CONFIRM
OR WE DOING PUBLIC COMMENT ON
ONLY I T SYSTEMS WERE DOING
PUBLIC COMMENT ON ALL OF ISSUE
NUMBER THREE, OKAY. FOUR. SORRY.
FOUR. THREE. OKAY SO SEVEN IS
NOT YET ALWAYS THANK YOU. NOT
YET. OKAY SING NO FURTHER PUBLIC
COMMENTS. I WANT TO THANK
EVERYONE FOR YOUR PARTICIPATION.
AND WE WON'T MOVE TO OUR NEXT
PANEL, WHICH IS ISSUE NUMBER
FOUR. OUR FOURTH ISSUE COVERS
TWO PROPOSALS AND TO OVERSIGHT
ISSUES THAT FALL UNDER THE
CENTER FOR HEALTHY COMMUNITIES.
OUR FIRST SPEAKER IS MARIA OCHOA
, ASSISTANT DEPUTY DIRECTOR
CENTER FOR HEALTHY COMMUNITY.
AND AFTER MARIA WILL HAVE JOAN.
I'M GOING TO HAVE YOU PRONOUNCE
YOUR LAST NAME. I APOLOGIZE.
HE'S A PATIENT ADVOCATE. UM. BUT
WE WILL HAVE YOU BEGIN. THANK
YOU. JERRY. GOOD AFTERNOON,
MADAM CHAIR. MY NAME IS MARIA OH
CHILD, ONE OF THE ASSISTANT
DEPUTY DIRECTORS OVER OPERATIONS
IN THE CENTER FOR HEALTHY
COMMUNITIES. AND THE FIRST ITEM
THAT I WILL TALK ABOUT IS THE
CLINICAL DENTAL ROTATIONS, FUND
SHIFT AND TRAILER BILL. SO THE
BUDGET ACT OF 2022 APPROPRIATED
10 MILLION AND A ONE TIME
INVESTMENT FOR THE OFFICE OF
ORAL HEALTH. IN CONSULTATION
WITH THE CALIFORNIA DENTAL
ASSOCIATION, CALIFORNIA DENTAL
SCHOOLS AND OTHER STAKEHOLDERS
TO SUPPORT THE ESTABLISHMENT OF
A COMMUNITY BASED CLINICAL
EDUCATION ROTATION OR DENTAL
STUDENTS IN THEIR FINAL YEAR, OR
DENTAL RESIDENTS. 2024 25
GOVERNORS BUDGET PROPOSES TO
SHIFT 9.7 MILLION OF THIS
INVESTMENT FROM THE GENERAL FUND
TO THE PROPOSITION 56 STATE
DENTAL PROGRAM ACCOUNT TO
ADDRESS THE BUDGET SHORTFALL.
THE 2022 BUDGET ACT INCLUDED
PROGRAMMATIC AND PROVISIONAL
LANGUAGE THAT ONCE STATED THAT
FUNDS WERE AVAILABLE FOR
ENCUMBRANCE OR EXPENDITURE UNTIL
JUNE. 30TH 2027 PROVIDED A
PUBLIC CONTRACT CODE EXEMPTION
ESTABLISHED PROGRAM ELIGIBILITY
CRITERIA AND SPECIFIED REPORTING
REQUIREMENTS. BECAUSE PROP 56 IS
NOT SUBJECT TO AN APPROPRIATION
IN THE BUDGET ACT. STATUTORY
CHANGES TO THE HEALTH TENS TO
THE HEALTH AND SAFETY CODE ARE
ADDED TO MAINTAIN THE
PROGRAMMATIC REQUIREMENTS THAT
WERE ESTABLISHED IN THE
PROVISIONAL LANGUAGE AND THE
2022 BUDGET ACT. THE PROPOSED
CHANGES WILL ALLOW THE
DEPARTMENT TO CONTINUE PROGRAM
IMPLEMENTATION. CD PH WILL BE
REQUIRED TO PROVIDE A
LEGISLATIVE REPORT ON JULY 1
2027. AND SPECIFIED OUTCOMES,
INCLUDING THE NUMBER OF
UNDERSERVED CHILDREN AND ADULTS
SERVED BY STUDENTS AND
RESIDENTS. THE NUMBER OF
STUDENTS AND RESIDENT TRAINEES
AND THE PROPORTION OF
PARTICIPATING STUDENTS AND
RESIDENTS WHO EXPRESSED INTEREST
IN WORKING IN A DESIGNATED
DENTAL HEALTH PROFESSIONAL
SHORTAGE AREA. THANK YOU. AND
DID YOU HAVE ANY OTHER COMMENTS
ON ANY OF THE OTHER PROPOSALS?
UM I'M I'M PROVIDING ALL THE
UPDATES ON THE PROPOSALS, OKAY?
YOU CAN GO. OKAY. JUST GO AHEAD
AND GO THROUGH ALL THE PROPOSALS
BEFORE WE SWITCH OVER. ALRIGHT.
THE SECOND ITEM IS THE STATE
DENTAL PROGRAM PROPOSITION 56
FUNDING. SO THE GOVERNOR'S
BUDGET REFLECTS A DECREASE OF
7.554 MILLION IN STATE DENTAL
PROGRAM ACCOUNT, INCLUDING A
DECREASE OF 1.834. IN STATE
OPERATIONS AND A DECREASE OF
5.72 AND LOCAL ASSISTANCE AS A
RESULT OF THE UPDATED OPPOSITION
56 REVENUE PROJECTIONS. THE
FUNDS ARE USED FOR THE STATE
DENTAL PROGRAM FOR THE PURPOSE
AND GOAL OF EDUCATING ABOUT
PREVENTING AND TREATING DENTAL
DISEASE, INCLUDING DENTAL
DISEASES CAUSED BY THE USE OF
CIGARETTES AND OTHER TOBACCO
PRODUCTS. AND THEN THERE WAS A
QUESTION. DID YOU WANT ME TO
ADDRESS THE QUESTION NOW? SO
THERE WAS A QUESTION THAT THE
GOVERNOR'S BUDGET FAILS TO MEET
THE STATUTORY REQUIREMENT OF 30
MILLION AND FLAT FUNDING FOR THE
STATE DENTAL PROGRAM AND ASKED
THAT CD PH CONFIRM AND CLARIFY
THE BUDGET FOR THE DENTAL
PROGRAM. AND SO C D PH CAN
CONFIRM THAT THE STATE UM DENTAL
PROGRAM WILL HAVE 30 MILLION
AVAILABLE FOR FISCAL YEAR 2425.
SO WE WILL BE IN COMPLIANCE.
YES. THANK YOU. AND THEN THE
NEXT ITEM IS THE CALIFORNIA
CANCER REGISTRY OVERSIGHT
FUNDING. UPDATES. CD PH HAS
EXPERIENCED A DECLINE IN
CALIFORNIA CANCER REGISTRY
FUNDING OVER THE PAST DECADE AND
ORIGINALLY ANTICIPATED A DEFICIT
OF 1.9 MILLION IN FISCAL YEAR
2425. INCLUDING PROP 99
REDUCTION OF 239,000. CD PH WILL
BE SHIFTING $481,099. TO THE
CANCER REGISTRY THAT WAS
PREVIOUSLY PROVIDED TO OUR
ENVIRONMENTAL HEALTH
INVESTIGATORS INVESTIGATIONS
BRANCH AND USED TO FUND
APPROXIMATELY 1.5 FT. SO ARE
INVESTORS ARE. INVENT
ENVIRONMENTAL HEALTH
INVESTIGATIONS BRANCH HAS BEEN
PLANNING TO SHIFT THE FUNDING
FROM PROP 99 TO GENERAL FLYNN.
YOUR SOLUTIONS SUCH AS SALARY
SAVINGS, REDUCED TRAINING
SUPPLIES. SO THIS SHIFT WILL
BRING THE DEFICIT TO JUST OVER
1.4 MILLION. AS A RESULT OF
REDUCED FUNDING FROM PROP 99 AND
BREAST CANCER RESEARCH ACCOUNT.
THE CCR HAS USED SEVERAL SHORT
TERM SOLUTIONS TO MINIMIZE
FUNDING REDUCTIONS IN RECENT
YEARS, INCLUDING ONE TIME
INCREASES FROM STATE FUNDS. CDC
CARRY FORWARD AND FUTURE OF
HEALTH ONE TIME FUNDING CD PH
HAS NOT IDENTIFIED A SOURCE TO
OBSERVE TO ABSORB THE
ANTICIPATED ONE POINT 5,000,001
0.4 MILLION IN 2425. SO SHOULD
ADDITIONAL FUNDING NOT BE MADE
AVAILABLE. THE CCR WILL LOSE
APPROXIMATELY SIX CONTRACT STAFF
WITH ABOUT HALF OF THOSE AT THE
SENSE CENTRAL REGISTRY AND HALF
OF THE REGIONAL REGISTRIES.
LOSSES WILL RESULT IN REDUCED
DATA QUALITY. PARTICULARLY DATA
ON UNDERSERVED POPULATIONS AND
THOSE EXPERIENCING DISPARITIES
AND RESULT IN A FAILURE TO MEET
FEDERAL DATA QUALITY
REQUIREMENTS. IN ADDITION TO THE
RESEARCH FUNDING, NOTED ABOVE
THIS THREATENS UP TO
APPROXIMATELY 18.5 MILLION AND
FEDERAL COUNCIL CANCER FUNDING
AS PART OF AS PART OR ALL OF THE
FUNDS CAN BE WITHDRAWN, BASED ON
A COMBINATION OF A REGIONAL
INABILITY TO MEET FEDERAL
MATCHING REQUIREMENTS AND BE NOT
MEETING OUR FEDERAL GRANT
REQUIREMENTS. CD PH HAS
DEVELOPED A PROPOSAL TO SPLIT
THE DEFICIT SHOULD FUNDING NOT
SHOULD WE NOT FIND ADDITIONAL
RESOURCES. YES MAYBE MODIFIED
BASED ON AN ONGOING IMPACT
ASSESSMENT, THE STASIS THE STATE
IS PERFORMING TO ENSURE FUNDING
REDUCTIONS RESULT IN MINIMAL
FAILURE TO MEET FEDERAL
PERFORMANCE REQUIREMENTS. C D PH
. HAS BEEN PURSUING ADDITIONAL
EFFICIENCIES AND HAS ENGAGED
ARLENE TRANSFORMATION OFFICE AND
COLLABORATION LOOKING FOR
ADDITIONAL EFFICIENCIES. CD PH
IS COLLABORATING WITH
IMPLEMENTATION PARTNERS TO
IDENTIFY NON ESSENTIAL PROCESSES
AND COSTS. CD PH IS LOOKING TO
CONVERT TO A CONTRACT AGREEMENT
MECHANISM WITH PARTNERS WHEN THE
NEW CONTRACT CYCLE STARTS IN
FISCAL YEAR, 2526. AND THIS
COULD ALLOW CD PH TO, UM REQUIRE
DETAILED INFORMATION ON REGISTRY
PROCESSES TO IDENTIFY NON
ESSENTIAL PROCESSES. IN THE NEW
CONTRACT CYCLE. CD PH WILL ALSO
NEGOTIATE LOWER INDIRECT COST
AGREEMENTS WITH CONTRACTORS
RESULTING IN COST SAVINGS. AND
THEN THE LAST ITEM IS THE SICKLE
CELL. SO AS PROVIDED IN THE
BUDGET ACT OF 2019 CD PH,
RECEIVED A ONE TIME 15 MILLION
ALLOCATION TO ESTABLISH A
NETWORK OF SICKLE CELL DISEASE
CENTERS AND THE LOCAL HEALTH
JURISDICTIONS OF ALAMEDA, FRESNO
, CURRENT LOS ANGELES,
SACRAMENTO, SAN BERNARDINO AND
SAN DIEGO TO PROVIDE ACCESS TO
SPECIALTY CARE AND IMPROVE
QUALITY OF CARE FOR ADULTS WITH
SICKLE CELL DISEASE. SUPPORT
WORKFORCE EXPANSION FOR
COORDINATED HEALTH SERVICES
INDEX SURVEILLANCE TO MONITOR
DISEASE INCIDENTS PREVAIL INSIDE
AND OTHER METRICS, CREATE A
PUBLIC AWARENESS CAMPAIGN AND
PROVIDE FISCAL OVERSIGHT OF THE
RESOURCES. OF THESE FUNDS.
14,000,340. LOCAL ASSISTANCE WAS
PAID BY DIRECT ALLOCATION TO THE
CENTER FOR COMPREHENSIVE CARE
AND DIAGNOSIS OF INHERITED BLOOD
DISORDERS. 600,000 TO THE PUBLIC
HEALTH INSTITUTE AND CD PH
RECEIVED 60,000 FOR
ADMINISTRATIVE ACTIVITIES TO
ALLOCATE FUNDS TO THE PUBLIC
HEALTH INSTITUTE. IN SUPPORT OF
SICKLE CELL DISEASE SURVEILLANCE
AND MONITORING ACTIVITIES.
PUBLIC HEALTH INSTITUTES.
TRACKING CALIFORNIA TO
NETWORKING CALIFORNIA FOR SICKLE
CELL CARE BY SEPTEMBER 2020 TO
THE CENTER FOR INHERITED BLOOD
DISORDERS WAS REQUIRED TO SUBMIT
AN ANNUAL PROGRESS REPORT TWO CD
PH WITH THE FINAL SUMMARY REPORT
, WHICH WAS COMPLETED IN
OCTOBER, 2023. AFTER THREE YEARS
. THE IMPACT OF THE WORK TOTALED
12 CLINICS AND OVER 1000
PATIENTS AND RODENT,
COMPREHENSIVE TEAMS CENTERED
CLINICS. CURRENTLY NETWORKING
CALIFORNIA FOR SICKLE CELL CARE
IS TRYING TO FIND A SUSTAINABLE
MODEL NOW WITH THE HCS OR
POPULATION HEALTH IN ORDER TO
FIT IN WITH THE NEW CALEDONIAN
VISION SINCE FUNDING WILL BE
DEPLETED IN JUNE. THANK YOU.
THANK YOU. WE'RE READY WHEN YOU
ARE. UM HELLO. I'M JOAN VENTAS
INC WAY A PATIENT ADVOCATE AND
I'M HERE TO SPEAK IN SUPPORT OF
THE CALIFORNIA CANCER REGISTRY,
A VITAL RESOURCE FOR RESEARCH TO
TREAT CURE AND PREVENT CANCER.
THAT IS UNDER THREAT DUE TO
FUNDING CUTS. I WAS 40 WHEN I
WAS FIRST DIAGNOSED WITH BREAST
CANCER, IT WAS CUT VERY EARLY
AND EASILY TREATABLE. FIVE YEARS
LATER, I WAS DIAGNOSED WITH THE
SECOND PRIMARY KIDS BREAST
CANCER. THIS WAS MUCH MORE
SERIOUS AND AFTER SIX SURGERIES
IN THE YEAR OF ACTIVE TREATMENT
I HAD TO LIVE WITH THE KNOWLEDGE
THAT THIS CANCER COULD COME
BACK. I HAVE NO FAMILY HISTORY
OF CANCER, AND I KNOW GENE
MUTATIONS FOR CANCER RISK. YET
HERE I WAS, AND THIS IS A THIS
IS A POSITION SO MANY PEOPLE
FIND THEMSELVES IN. WHEN I ASKED
MY PHYSICIANS WHY I GOT CANCER.
THEIR ANSWER WAS, WE DON'T KNOW.
I'M SURE INDIVIDUALS IN THIS
ROOM EITHER WITH PERSONALLY OR
WITH THEIR FAMILY AND FRIENDS
HAVE ASKED THIS QUESTION THIS.
WHY QUESTION AND RECEIVE THAT
SAME ANSWER? WE DON'T KNOW.
WE'LL PROBABLY NEVER KNOW WHY I
GOT CANCER. WHAT I DO KNOW IS
THAT THE DATA FROM MY CANCER
DIAGNOSIS IN THE CALIFORNIA
CANCER REGISTRY CONTRIBUTES TO
THE RESEARCH THAT IS LOOKING FOR
THOSE ANSWERS AND HELPING TO
SAVE LIVES. THE CALIFORNIA
CANCER REGISTRY IS MANDATED BY
LAW TO TRACK EVERY CANCER THAT
OCCURS IN CALIFORNIA. THE CCR IS
EXCEPTIONAL IN THAT IT LEAVES NO
ONE OUT WHATEVER THEIR AGE RACE
AND IN THIS CITY, GENDER INCOME,
EDUCATION OR OTHER
CHARACTERISTICS, EVERY PATIENT
CANCERS JOURNEY IS RECORDED. SO
THE DATA IN THAT REGISTER
REGISTRY IS NOT MERELY NUMBERS,
BUT THE LIVED EXPERIENCE OF
MILLIONS OF CALIFORNIANS. THE
CCR SERVES IN ESSENTIAL HAS
SERVED AS AN ESSENTIAL BACKBONE
THAT ANCHORS OTHER DATA SOURCES
FOR CANCER RESEARCH, ALLOWING US
TO SEE THE SCOPE OF THE CANCER
BURDEN. WHO IS GETTING CANCER
AND WHO IS AT THE HIGHEST RISK.
AND THE DATA IS ALSO CRUCIAL AND
UNDERSTANDING WHY CANCER RATES
AND OUTCOMES DIFFER BY RACIAL,
ETHNIC AND POPULATION GROUPS AND
HOW WE CAN IMPROVE HEALTH
EQUITY. THE CCR IS FUNDED
THROUGH A BLEND OF STATE AND
FEDERAL RESOURCES, WITH MOST
FUNDING PROVIDED THROUGH THE
NATIONAL CANCER INSTITUTE SEAR
PROGRAM TWO OR THREE REGIONAL
CANCER REGISTRIES. THOSE FEDERAL
FUNDS REQUIRE 20% MATCH. FOR
DECADES, CALIFORNIA HAS RELIED
ON FUNDING FROM THE PROP 99,
CALIFORNIA TOBACCO TAX FOR THAT
STATE SHARE. UNFORTUNATELY
DECLINING TOBACCO TAX REVENUES
MEANS THAT CALIFORNIA WILL BE
UNABLE TO MAINTAIN ITS SHARE
COST OR COST SHARE. THE
DEPARTMENT OF PUBLIC HEALTH
ESTIMATES THAT THE PROGRAM WOULD
NEED AN ADDITIONAL 1.9 MILLION
JUST TO MAINTAIN FLAT FUNDING
FOR 2024 25. CALIFORNIA RISKS
LOSING $18.5 MILLION YEARLY FROM
IN FEDERAL FUNDS. THIS LAST
WOULD DEVASTATE THE CCR AND ITS
REGIONAL REGISTRIES. WITHOUT A
FUNDING SUPPORT FROM SEAR THE
CCR IN ITS CURRENT FORM WOULD
COME TO AN END. SO I URGED
ASSEMBLY BUDGET COMMITTEE TO
PROTECT THIS VITAL RESOURCE FOR
CALIFORNIA AND TAKE DECISIVE
ACTION. IN THIS YEAR'S STATE
BUDGET TO PROTECT PROTECT THE
CCR AND ITS REGIONAL REGISTRIES
WITH AN INVESTMENT OF $7 MILLION
. IT'S A IT'S A IT'S IMPORTANT
TO GIVE OUR STATE'S CLINICIANS
SCIENTISTS THE RESOURCES THEY
NEED TO ADVANCE CLINICAL,
EPIDEMIOLOGIC ALLOW AND HEALTH
SYSTEMS RESEARCH TO CONTINUE TO
SAVE LIVES. AND SO THAT SOMEDAY
NONE OF US HAS TO ASK THE
QUESTION OF WHY WE GOT CANCER.
THANK YOU FOR YOUR TIME AND
CONSIDERATION. THANK YOU. THANK
YOU SO MUCH FOR BEING HERE AND
SHARING YOUR STORY. ANYTHING
FROM THE DEPARTMENT OF FINANCE.
AFTERNOON MADAM CHAIR NICK MILLS
DEPARTMENT OF FINANCE ON ISSUE
TWO TO ECHO SOME OF THE DIRECTOR
OF TOES. COMMENTS ON THE
GOVERNOR'S BUDGET MAINTAINS $30
MILLION FOR THE OPPOSITE WORLD
HEALTH AND THIS FULFILLS THAT'S
TUTORIAL REQUIREMENTS. ON ISSUES
THREE. ADMINISTRATION WILL
CONTINUE TO EVALUATE ONGOING
COSTS OR STAY WITH THE CANCER
REGISTRY AND HOW TO BEST ADDRESS
FUTURE PROJECTED DECLINES AND
AVENUE. ELIO. THANK YOU, UM, SO
ON THE 1ST, 2ND AND 4TH
PROPOSALS ON THE DENTAL PROGRAMS
, AS WELL AS THE SICKLE CELL
CENTERS HAVE NOTHING FURTHER TO
ADD, BUT ARE AVAILABLE FOR
QUESTIONS REGARDING THE THIRD
PROPOSAL, TOUCHING ON THE
CALIFORNIA CANCER REGISTRY. JUST
LIKE TO ECHO OR EARLIER COMMENTS
ON THE GIVEN THE STATE'S BUDGET
CONDITION THAT ADDITIONAL
GENERAL FUND SAVINGS WILL BE
NEED WILL NEED TO BE FOUND IN
ORDER TO FIND MAYBE THIS AS
WELL. SOME OF THE OTHER
LEGISLATURES PRIORITIES THAT
BEING SAID, OR OFFICE HAS
IDENTIFIED ONE TIME IN TEMPORARY
SPENDING AS WELL AS ADDITIONAL
BUDGET SOLUTIONS AND ARE READY
TO WORK WITH THE COMMITTEE TO
FUND THE PRIORITIES THAT IT HAS.
THANK YOU. THANK YOU. UM, I HAVE
A COUPLE OF QUESTIONS ABOUT THE
CALIFORNIA CANCER REGISTRY. UM.
IN OUR REPORT. IT SAYS THAT THE
COLLECTION OF DATA IS BEHIND
ABOUT AN AVERAGE OF 1.5 TO 2
YEARS. WHY IS THIS THE CASE? I
HAVE CONFIRMED WITH PROGRAM, BUT
THIS IS A STANDARD PROCESS. UM
SO. EVEN IF WE WERE FULLY
STAFFED, AND THEY WE FOUND
ADDITIONAL RESOURCES TO KEEP THE
REGISTRY HOLD. THAT IS AN
ADDITIONAL TIME. I MEAN, THAT IS
THE APPROXIMATE TIME FRAME THAT
IT DOES TAKE FOR THEM TO PROCESS
THE DATA. WHY. UM. HAVE MARKET
JAMISON, HE'S CHIEF OVER THE
CANCER REGISTRY. HE CAN HELP
WITH THIS. THANK YOU. AND THANK
YOU. CHAIR WEBER. THE UM THE
REASON FOR THE DELAY IS A LONG
PROCESS THAT HAPPENS. THE
INITIAL REPORTS COME FROM
LABORATORIES AND OFFICES,
DOCTOR'S OFFICES. THERE IS A
LONG ADJUDICATION AND A VERY
STRICT PROCESS OF QUALITY
CONTROL, WHICH IS KURT, WHICH IS
DESIGNATED DICTATED BY THE
FEDERAL FEDS. THE FEDERAL
GOVERNMENT AND WE MUST MEET
THOSE QUALITY METRICS IN ORDER
FOR OUR DATA TO BE USED. THANK
YOU. AND IS IT TRUE THAT OUR
REGISTRY IS ONE OF THE LARGEST
IN THE NATION? THANK YOU. YES,
IT IS OF STATES THAT IS THE
LARGEST. IT IS THE LARGEST AND
SO IF WE DON'T FROM A STATE
CONTINUE TO FIND FUNDING, THEN
WE'LL LOSE THAT FEDERAL FUNDING
AS WELL. AS AS A MR CHUA SAID.
IT IS IT'S A IS AT RISK. THAT,
LIKE THE 18.5 MILLION IS AT RISK
IF WE ARE NOT ABLE TO MEET THOSE
TWO, BOTH MEET THE FEDERAL
MATCHING REQUIREMENTS AS WELL AS
CONTINUE TO HAVE THE QUALITY OF
THE REGISTRY TO MEET THE QUALITY
STANDARDS. AND WHAT IS THE
OUTCOME OF HAVING A QUALITY
REGISTRY? LIKE WHAT DOES THAT DO
TO THE EVERYDAY CALIFORNIANS
LIFE? I THINK I WANT TO POINT TO
HEALTH EQUITY. BECAUSE THE MORE
DIFFICULT CASES TO GET AND THE
MORE DIFFICULT QUALITY TO MEET
AS IT ALLOWS US TO THEN IS
HAPPENING IN THOSE HARDER TO
REACH POPULATIONS, WHICH TEND TO
BE THE POPULATIONS WHO ALSO HAVE
A DISPARITY HAPPENING. AND SO
THAT IS WHERE THAT'S THE OUTCOME
IS WHERE LESS ABLE TO PROMOTE
HEALTH EQUITY AND MEET THE NEEDS
OF EVERY CALIFORNIAN. SO AND IN
GENERAL TERMS. IF WE NO LONGER
HAD THIS REGISTRY, WHAT WOULD BE
THE IMPACT? UM ON THESE
COMMUNITIES AND OUR RESIDENTS.
THE IMPACT WILL WOULD BE
ESSENTIALLY A NOT KNOWING WHAT
WHAT? WHERE THE PROBLEMS ARE,
ETCETERA, YOU KNOW, UM REALLY?
DID YOU WANT TO COME INTO THAT?
YOU'RE FINE. MARCO AHEAD. THANK
YOU. UM WE WOULD. THERE'S
ACTUALLY MANY LAYERS OF IMPACT
BECAUSE OF THE WAYS THAT THE
CANCER REGISTRY DATA IS USED.
BUT AT ITS MOST SIMPLE WE IT'S
LIKE OPERATING BLIND ON A VERY,
VERY IMPORTANT KILLER IN THIS IN
THIS STATE, AND ONE THAT ONE
THAT IMPACTS MANY, MANY LIVES,
EVEN FOR THOSE WHO WHO ARE
LIVING WITH THE CONDITION.
THERE'S MANY PROGRAMS THAT ARE
WORKING IN ALL AREAS OF WHAT WE
CALL THE CANCER CONTROL
CONTINUUM FROM PREVENTION TO
DIAGNOSIS, OF COURSE, WHEN IT IS
EARLY AS POSSIBLE TO GETTING
INTO TREATMENT GET AND THEN WHAT
WE CALL SURVIVORSHIP. MM. MANY
MANY AREAS WHERE WHERE
INTERVENTION IS HAPPENING
WITHOUT THE CANCER REGISTRIES,
VALUABLE DATA AND HIGHEST
QUALITY OF DATA. THE THOSE
EFFORTS ARE OPERATING WITHOUT
THE INFORMATION THEY NEED. THANK
YOU. THANK YOU FOR STANDING UP.
UM I ALSO WANTED TO ASK ABOUT
YOUR SICKLE CELL. CENTERS OF
EXCELLENCE. UM I UNDERSTAND THAT
YOU HAD TWO REPORTS IN SEPTEMBER
OF 2022 AND OCTOBER 2023. CAN
YOU KIND OF GIVE US A LITTLE BIT
MORE INFORMATION ON WHAT HAVE
BEEN THE OUTCOMES OF FUNDING
THESE SICKLE CELL CENTERS OF
EXCELLENCE. SO C C D PH DOES NOT
HAVE THE PROGRAM, SO WE WERE
WORKING WITH THE CENTER. UM AND
FROM WHAT I UNDERSTAND IN THE
FINAL REPORT THEY WERE ABLE TO
HELP OVER 1000 PATIENTS. THEY
HAD 12 DIFFERENT CLINICS
ENROLLED. UM. AND THEY REALLY
LIKE WITH THE SURVEILLANCE AND
DATA THAT THEY PROVIDED THEY
WERE PUBLIC HEALTH INSTITUTE.
THEY WERE ABLE TO LOOK AT THE
AVAILABILITY AND ACCURACY OF THE
DATA THAT WAS AVAILABLE FOR SICK
OR SO DISEASE. UM. WE JUST HAD
IMPROVED VISIBILITY AND UTILITY
OF DATA THAT WAS PROVIDED. AND A
LOT OF DATA SHARING ACROSS THE
INDUSTRIES TO SUPPORT THE
DECISIONS THAT WERE MADE, UM OR
IN THE REPORT, BUT I WOULD HAVE
TO GET MORE DETAILED INFORMATION
BACK FOR YOU. YES IF YOU COULD.
PLEASE DO THAT, BECAUSE FROM MY
UNDERSTANDING, WAS SPEAKING WITH
SOME OF THE, UM ADVOCATES FOR
THIS, THAT THEY WERE ACTUALLY
THE CENTERS AND THEIR
RELATIONSHIPS WITH COMMUNITIES
AND THEIR ABILITY TO GO OUT AND
EDUCATE, ACTUALLY, UM, DECREASE
THE NUMBER OF HOSPITALIZATIONS
DECREASED THE NUMBER OF SICKLE
CELL CRISIS. DECREASE THE NUMBER
OF PATIENTS NEEDED TO BE
INEXPENSIVE MEDICATIONS. AND SO
IF WE NO LONGER FUNDED THIS, IT
WOULD NOT ONLY BE VERY
DEVASTATING AND EXPENSIVE TO THE
COMMUNITY, BUT IT WOULD ALSO
IMPACT WITH COMMUNITY TRUST. SO
IF YOU COULD GET THAT
INFORMATION THAT WOULD BE VERY
BENEFICIAL FOR OUR COMMUNITY FOR
OUR COMMITTEE. UM SO. JUST
LOOKING AT PROPOSALS THREE AND
FOUR. FROM MY UNDERSTANDING, AND
I'M LOOKING FORWARD TO THE
FURTHER INFORMATION THAT I
RECEIVED THAT THESE ARE PROGRAMS
THAT, UM, THAT WORK, UH, THAT
SIGNIFICANTLY IMPROVE THE LIVES
OF OUR RESIDENTS. THEY DECREASE
MORBIDITY AND MORTALITY OVERALL
DECREASE THE COST OF HEALTHCARE.
UM YET AS A STATE WE ARE EITHER
UNDERFUNDING THEM OR THERE IS NO
PROPOSAL TO CONTINUE FUNDING SO
I AM A LITTLE CONCERNED ABOUT UM
THE INABILITY FOR US TO LOOK AT
PROGRAMS THAT EVIDENCE SHOWS IS
WORKING EVIDENCE SHOWS IS SAVING
LIVES AND IMPROVING QUALITY OF
LIFE. UM AND SO YOU KNOW, WE
WILL CONTINUE IN OUR
CONVERSATIONS, BUT I AM VERY
CONCERNED ABOUT THE PROPOSALS
FROM NUMBER THREE AND FOUR ON
THE AGENDA. WITH THAT WE WILL
TURN IT OVER TO PUBLIC COMMENT.
IF ANYONE WOULD LIKE TO SPEAK,
PLEASE COME AND USE THE
MICROPHONE. OR YOU WILL HAVE ONE
MINUTE. THANK YOU. MADAM CHAIR
REMEMBERS AUTUMN OGDEN SMITH
WITH THE AMERICAN CANCER SOCIETY
CANCER ACTION NETWORK. UM I
WANTED TO THANK THE DEPARTMENT
AND JOAN FOR THEIR AMAZING
PRESENTATIONS TODAY. UM AND I
CONCUR WITH EVERYTHING THAT WAS
SAID. I JUST WANTED TO ADD TWO
THINGS. THE FIRST IS TO YOUR
QUESTION ABOUT THE DELAY THE TWO
YEAR DELAY. UM WE CURRENTLY HAVE
AN UNFUNDED MANDATE. THAT'S THE
ELECTRONIC PATHOLOGY AND IF WE
CAN KEEP THE CCR FUNDED THAN IT
IS SOMETHING THAT COULD HELP
EXPEDITE THE OR SHORTEN THE
DELAY. AND THAT BRINGS ME TO MY
SECOND POINT, WHICH IS I
REALIZED THAT WE HAVE A BIG
DEFICIT THIS YEAR, BUT THIS IS A
CRITICAL PROGRAM AND IT NEEDS TO
MAINTAIN ITS FUNDING. SO THANK
YOU SO MUCH. THANK YOU. MADAM
CHAIR MEMBERS MATTHEW MARCIN
WITH PUBLIC HEALTH INSTITUTE. I
ALSO WANT TO ADD MY STRONG
SUPPORT FOR THE CALIFORNIA
CANCER REGISTRY AND URGED THAT
THE LEGISLATURE SECURED THE
FUNDING NECESSARY TO PROTECT THE
PROGRAM. WE'RE GRATEFUL FOR THE
QUESTIONS RAISED TODAY AND
DEEPLY APPRECIATIVE OF JONES
TESTIMONY AS WELL AS THE
DEPARTMENT'S COMMENTS AROUND THE
IMPACT OF THE PROGRAM ALSO WANT
TO ADDRESS THE QUESTION THAT WAS
RAISED AROUND WHAT IS THE IMPACT
OF THIS AND WE KNOW FROM
SPEAKING TO RESEARCHERS WHO USE
THE DATA. BUT THE CANCER
REGISTRY DATA IS AN INVALUABLE
RESOURCE FOR RESEARCHERS NOT
JUST HERE IN CALIFORNIA, BUT
ACROSS THE GLOBE TO INFORM THE
WAY IN WHICH TREATMENTS ARE
WORKING, AND IT HAS BEEN USED TO
ALSO DIRECTLY INFORM, UM,
SCREENINGS FOR BREAST CANCER,
FOR EXAMPLE, AND WE KNOW THAT
WITHOUT THE REGISTRY DATA, THOSE
EFFORTS WOULD BE HAMPERED AND WE
WOULD SEE A FURTHER IMPACT UPON
NEW TREATMENTS THAT WE HOPE ONE
DAY WILL MEAN. THE CANCER WILL
BE ACTUALLY BE ELIMINATED. SO
THANK YOU SO MUCH. THANK YOU
MAKE A COMMENT ABOUT THE SICKLE
CELL PROGRAM, AS WAS MENTIONED.
PUBLIC HEALTH INSTITUTE HAS THE
PRIVILEGE OF ADMINISTERING THE
PROGRAM AND WE HAVE AN OFFER
HERE IF WE CAN BE A RESOURCE TO
BRING THE PROGRAM TO MEET WITH
STAFF AND MEMBERS TO ANSWER
QUESTIONS YOU MAY HAVE ABOUT
SICKLE CELL PROGRAMS THAT OFFER
THANK YOU. MADAM CHAIR,
REMEMBERS NEW ORLEANS WITH
CHILDREN NOW WE WANT TO
ACKNOWLEDGE THE DEPARTMENT OF
PUBLIC HEALTH AND FINANCE,
SAYING THAT $30 MILLION WILL BE
IN THE STATE DENTAL PROGRAM
ACCOUNT. AND WE WOULD LIKE TO
POINT OUT THAT, ACCORDING TO THE
FUND CONDITION STATEMENTS, IT
LOOKED LIKE THE PROPOSED
ADJUSTED BEGINNING. BALANCE OF
18.95 MILLION FOR 2425. APPEARS
TO APPLY RESERVES GAINED FROM
PREVIOUS FISCAL YEARS AS IF THEY
WERE REVENUE. UM WHICH IS
INCONSISTENT WITH THE CONTINUOUS
APPROPRIATION OF $30 MILLION
MANDATED BY A B 133. THE FUN
CONDITION. STATEMENTS LIST 21.62
MILLION FOR FISCAL YEAR 2324 AND
19.88 MILLION PROPOSED FOR 2425.
IN TOTAL. THIS IS A LITTLE MORE
THAN 18.49 MILLION SHORT OF THE
$30 MILLION CONTINUOUS
APPROPRIATION TO THE STATE
DENTAL PROGRAM ACCOUNT. WE
ENCOURAGE THE COMMITTEE TO
ENSURE THIS FUNDING. THANK YOU.
THANK YOU. GOOD AFTERNOON, MADAM
TERROR. JESSICA RAN WITH THE
CALIFORNIA DENTAL ASSOCIATION
HERE TO GIVE COMMENT ON ITEMS
NUMBER SO SUPER NUMBER ONE AND
NUMBER TWO, STARTING WITH NUMBER
ONE, AND WE SUPPORT THE
DEPARTMENT'S TRAILER BILL
LANGUAGE TO ENSURE THE FUNDING
FOR THE CB, CLINICAL BASED
COMMUNITY EDUCATION, WROTE
ROTATIONS FOR DYLAN STUDENTS. WE
REALLY BELIEVE IN THIS PROGRAM.
WE HAVE THREE START THREE
SCHOOLS THAT ARE CONTRACTED WITH
10 SITES THAT ARE STARTING UP
THIS SUMMER. I REALLY BELIEVE
THIS IS A GREAT WAY TO EXPOSE
DENTAL STUDENTS TO UNDERSERVED
AREAS. F Q S REALLY GET THEM IN
THE PRACTICE EXPERIENCE THAT
THEY NEED AND THEN THEY CAN ALSO
RETURN TO THIS PRACTICE AREAS
AFTER GRADUATION, UM, ON ISSUE
NUMBER TWO WONDER ECHO THE
COMMENTS THAT NORA FROM
CHILDREN, AMI AND ALSO JUST SAY
THAT WE SUPPORT THE CONTINUOUS
SPENDING OF THE OFFICE, ORAL
HEALTH AND REALLY BELIEVE IN THE
INITIATIVES OF THE OFFICER OR
HEALTH PUTS OUT AND, UM THE
CONTINUED 20 WILL ALLOW THEM TO
CONTINUE TO, UM, IMPLEMENT THEIR
, UM, THEIR STATE ORAL HEALTH
PLAN. SO UM, LOOKING FORWARD TO
WORKING LEGISLATURA ABOUT THESE
ISSUES. THANK YOU SO MUCH. THANK
YOU. GOOD AFTERNOON, MADAM CHAIR
TYLER AGUIAR ON BEHALF OF THE
UNIVERSITY OF SOUTHERN
CALIFORNIA, HOME OF ONE OF THE
THREE REGIONAL CANCER REGISTRIES
, AND WE'RE JUST REQUESTING YOUR
FULL SUPPORT AND FUNDING TO
MAINTAIN THE REGISTRIES. THANK
YOU. THANK YOU. MICHELLE GIBBONS
OF JACK JUST WANTED TO SHARE A
LITTLE BIT MORE ON THE LOCAL
ORAL HEALTH PROGRAM. WANT TO
ALIGN MY COMMENTS WITH THOSE
THAT CAME BEFORE ME? I THINK THE
CHALLENGE IS IT'S A LITTLE HARD
TO TRACK. WE SEE THAT THERE'S
ABOUT 19.8 MILLION IN THE FUND
FROM PROP 56. WHAT WE CAN'T
UNDERSTAND IS HOW MUCH OF THE
GENERAL FUND IS ACTUALLY GOING
BACK TO BACKFILL TO GET TO THE
30. I HAVE SEEN ONE ESTIMATE OF
ONLY 4 MILLION GOING IN. BUT
OBVIOUSLY TO GET TO 30 MILLION
WOULD NEED TO BE A LOT HIGHER.
SO WE HOPE THAT WE COULD WORK
WITH YOUR COMMITTEE AND THEN
ALSO WITH THE DEPARTMENT OF
FINANCE AND OTHERS WITHIN THE
ADMINISTRATION TO UNDERSTAND THE
EXACT AMOUNT OF GENERAL FUND
DOLLARS THAT'S BEING ADDED TO
GET TO THE 30 MILLION. THANK
YOU. THANK YOU. AND SINCE WE
HAVE THE DEPARTMENT OF FINANCE
HERE, WOULD YOU LIKE TO ADDRESS
THAT? NICK MILLS DEPARTMENT OF
FINANCE THE 4.6 MILLION GENERAL
FUNDERS IN C, D. P. H S, UM
GENERAL FAN STATE OPERATIONS
ITEM. I BELIEVE IT'S PROVISION
13. IT SPECIFIES THAT THERE'S
$4.6 MILLION FOR THE OPPOSITE
ORAL HEALTH, SO THAT'S WHERE
THAT FIGURE IS REFLECTED IN THE
BUDGET. I GUESS THE QUESTION IS
EXACTLY HOW MUCH FROM THE
GENERAL FUND HAS BEEN USED TO
ENSURE THAT YOU GET TO THAT
REQUIRED. 30 MILLION. SO FOR
2425. THERE IS 25.4 MILLION
PROPOSITION 56 STATE DENTAL
PROGRAM ACCOUNT TO SUPPORT
OFFICE OF ORAL HEALTH
ACTIVITIES. AND THEN WHEN YOU
ADD $4.6 MILLION TO THAT THAT IS
A TOTAL OF 30 MILLION IN
FUNDING. SO YOU'RE SAYING THAT
THERE'S 25.4 FROM PROP 56?
THAT'S CORRECT. THAT IS, UM THE
PROPOSITION 56. ALLOCATION FOR
FISCAL YEAR. 2425 IF YOU LOOK AT
THE FUN CONDITIONS STATEMENT,
THE TOTAL AMOUNT OF 35.1 SO THE
REMAINDER OF THAT IS FOR THE
CLINICAL DENTAL ROTATIONS FUND
SHIFT OF 9.7 MILLION OKAY? THANK
YOU, MADAM CHAIR. I THINK THAT'S
WHERE THE CONFUSION COMES FROM
ANY OF US, UH, THAT THAT AMOUNT
THAT WE'RE REFERENCING AROUND
THE 25 MILLION. WE SEE THAT FOR
FISCAL YEAR 2223. BUT IN FISCAL
YEAR 2425 THE AMOUNT IS MUCH
SMALLER COMING IN FROM FROM PROP
56. IT'S 19.8. AND THAT'S
ACTUALLY WHAT I HAVE IN MY
INFORMATION AS WELL. 19.8
MILLION FOR 2425. SO WHERE IS SO
HOW MUCH OF THE GENERAL FUND
WILL THEN COME IN TO HELP US?
GET TO THAT 30 MILLION UM IT
WILL BE, UM 4.6 MILLION BECAUSE
IN ADDITION TO THE REVENUE
COMING IN, AND 2425, WE ARE
USING UNSPENT FUNDS FROM PAST
YEARS TO GET TO THE 30 MILLION.
AND MADAM CHAIR. THAT WOULD BE
THE RESERVE AMOUNT. BUT OUR
UNDERSTANDING OF HOW THAT READS
IS THAT IT'S SUPPOSED TO BE WHAT
PROP 56 ALLOCATES AND THEN THE
GENERAL FUND BACKFIELDS TO GET
TO THE 30 MILLION IRRESPECTIVE
OF WHAT THE FUND BALANCES.
RIGHT, BECAUSE I THINK THAT'S
SUPPOSED TO BE 30 MILLION EVERY
YEAR, RIGHT? SO UM, IF YOU HAVE,
YOU KNOW, 19, WE'LL JUST BUMP IT
UP TO 20. THEN YOU'VE GOT 4.6.
THEY'RE STILL THAT GAP THAT'S
THERE. AH UM, THAT COULDN'T BE
FILLED BY THE RESERVES BECAUSE
IT WAS THIS ISN'T THIS WOULD BE
A NEW YEAR. SO. WELL, YOU CAN
GET BACK TO US ON THAT BECAUSE I
THINK READING, EVEN FOR MYSELF
READING THROUGH. THIS WAS VERY
CONFUSING AS TO HOW WE'RE
GETTING 30 MILLION NEW DOLLARS
EVERY YEAR REGARDLESS OF HOW
MUCH IS LEFT OVER FROM BEFORE.
UM. OKAY SO SEEING THAT THERE
ARE NO MORE PUBLIC COMMENTS. I
WANT TO THANK EVERYONE ON THE
PANEL, ESPECIALLY THANK YOU FOR
COMING TO GIVE YOUR STORY AND WE
ARE NOW GOING TO MOVE TO ISSUE
NUMBER FIVE AND PANEL NUMBER
FIVE. THIS COVERS THE AH AID APP
OR A D ÁP ESTIMATE AND PROPOSED
ADAPT REBATE FUND LOAN UNDER THE
CENTER FOR INFECTIOUS DISEASES.
FIRST WE HAVE ADRIAN BARRAZA,
ASSISTANT DEPUTY DIRECTOR CENTER
FOR INFECTIOUS DISEASE FROM CD
PH. THEN WE HAVE CHRIS. STONES
ETTA ETTA. SECTION CHIEF
ELIGIBILITY OPERATION SECTION
FOR INFECTIOUS DISEASE FROM CD
PH. AND WE ALSO WILL HAVE LARA
THOMAS, SENIOR DIRECTOR OF HIV
AND HARM REDUCTION POLICY FROM
SAN FRANCISCO AIDS FOUNDATION.
AND OUR REPRESENTATIVE FOR THE
END OF EPIDEMICS COALITION AND
WE WILL START WITH ADRIAN. THANK
YOU. I'M ACTUALLY WHAT'S THAT?
I'M A CON. YOUR YOUR MIKE ISN'T
ON. SO WHAT WE JUST HEARD FROM
ADRIAN IS THAT HE'S GONNA LET
CHRIS START ONCE MIKE IS WORKING
. AND THEN WE'LL GO BACK TO
ADRIAN. ALRIGHT. WE'RE GOOD NOW.
ALL RIGHT. GOOD AFTERNOON. MY
NAME IS KRISTEN'S WEATHER, AND
I'LL BE PROVIDING YOU A BRIEF
OVERVIEW, THE EIGHT APP
ESTIMATE. FOR CURRENT YEAR THE
2324 BUDGET ACT INCLUDED EIGHT
APP LOCAL ASSISTANCE FUNDING OF
398 MILLION THE REVISED CURRENT
YEAR. 2324 BUDGET IS 3353.9.
MILLION, WHICH IS A DECREASE OF
44.1 MILLION WHEN COMPARED TO
THE 2324 BUDGET ACT. INCREASES
DRIVEN PRIMARILY BY LOWER
MEDICATION, EXPENDITURES AND
MEDICAL OUT OF POCKET
EXPENDITURES THAN PREVIOUSLY
ESTIMATED. OR BUDGET HERE. THE
PROPOSED AID APPLICABLE
ASSISTANCE FUNDING. UM IS 366
MILLION, WITH NO STATE GENERAL
FUND APPROPRIATION, WHICH THE
DECREASE OF 32.1 COMPARED TO THE
2324 BUDGET ACT. THAT INCREASES
ALSO DRIVEN BY PRIMARILY THE
SAME FACTORS, LOWER MEDICATION
EXPENDITURES AND MEDICAL MEDICAL
OUT OF POCKET EXPENDITURES THAN
PREVIOUSLY ESTIMATED. THANK YOU.
SO FOR THE NEXT ITEM REGARDING
THE EIGHT APP ALONE, THE
GOVERNOR'S BUDGET 2425 BUDGET
INCLUDED A PROPOSED $500 MILLION
LOAN FROM THE AIDS DRUG
ASSISTANCE PROGRAM REBATE FUND.
THE DEPARTMENT'S PRIORITIES
ENSURING CONTINUITY OF CRITICAL
AID FOR AIDS DRUG ASSISTANCE
PROGRAM. UM AND PRE EXPOSURE
PERIPHERAL ACCESS ASSISTANCE
PROGRAM SERVICES. CDVA PH DOES
NOT ANTICIPATE THESE LOANS,
DISRUPTING SERVICE, SO THAT'S TO
EIGHT APP OR PREP APP CLIENTS.
AS THE BUDGET PROPOSES USING
FINANCE FROM AVAILABLE FUND
RESERVES AND DOES NOT GET ANY
AUTHORIZED EXPENDITURES.
ADDITIONALLY THE AIDS DRUG
ASSISTANCE PROGRAM REBATE FUND
IS PROJECTED TO HAVE A REMAINING
RESERVE AND ALONE MONIES MAY BE
RETURNED TO THE PROGRAM IF
NEEDED. AND I SEE THAT THERE ARE
ALSO SOME QUESTIONS. AND IF YOU
WANT US TO GO INTO THOSE NOW
WE'RE MORE THAN HAPPY TO. YEAH,
THAT WOULD BE GREAT. THANK YOU.
PERFECT. SO YOUR FIRST QUESTION
UM, ASKED TO PLEASE EXPLAIN THE
VOLATILITY AND THE TOP REBATE
FUN AND THE VARIABILITY IN
REVENUE COMING INTO THE FUN. SO
THE EIGHT UP REBATE FUND
BALANCES HIGHLY EVOLVED VOLATILE
. IT HELPS PHARMACY BENEFITS
MANAGER MAGELLAN RX MANAGEMENT
PRODUCES QUARTERLY REBATE
INVOICES, REFLECTING THE REBATE
DUE TO ADAPT. AND THE TIMING OF
PAYMENTS BY DRUG MANUFACTURERS
ARE VARIABLE. MEANWHILE
EXPENDITURES IN ANY GIVEN MONTH
MAY INCLUDE MULTIPLE MILLION
DOLLAR MEDICATION AND VOICES.
HEY, MR HUNDREDS OF ENROLLMENT
SITES FOR ENROLLMENT SERVICES.
THOUSANDS MORE AND INVOICES TO
COVER INSURANCE PREMIUMS AND
MEDICAL OUT OF POCKET COST AND
OTHER ANCILLARY SERVICES. WERE
THERE ANY OTHER QUESTIONS ON
THAT FIRST ITEM? UM LATER THERE
WILL BE YEAH, PERFECT. MOVING ON
TO QUESTION NUMBER TWO A D
BELIEVE THAT LARGE TOP REBATE
FUND LOANS TO THE GENERAL FIND
POTENTIALLY CREATE SOME RISK TO
THE STATE OF LOSING SOME EITHER
REBATE OR FEDERAL FUNDING. IN
SHORT, YES, FEDERAL LAW REQUIRES
THAT ANY REBATES RECEIVED ON
DRUGS PURCHASES WITH FEDERAL
RYAN WHITE FUNDS ARE APPLIED
TOWARDS STATUTORILY PERMITTED
PURPOSES UNDER THE RYAN WHITE
PART B PROGRAM WITH THE PRIORITY
THAT REBATE BE PLACED BACK IN A
TOP USE OF THESE REBATES FOR
OTHER PURPOSES COULD JEOPARDIZE
ADAPTS FUTURE FEDERAL RYAN WHITE
GRAND AMOUNTS. IN ADDITION, THE
AIDS CRISIS TASK FORCE IS
HISTORICALLY NEGOTIATED ON
BEHALF OF ALL US STATE AND
TERRITORIAL AID APPS. AGREEMENTS
WITH VARIOUS DRUG MANUFACTURERS
FOR REDUCED DRUG PRICING. THESE
AGREEMENTS DETERMINED THE
MANDATORY 340 B AND SUPPLEMENTAL
REBATE AMOUNTS. IN ADDITION, THE
MANUFACTURER PROVIDES VOLUNTARY
SUPPLEMENTAL REBATES. ONE OF THE
LARGEST HIV DRUG MANUFACTURERS
HAS ALSO ALREADY CONTACTED THE
DEPARTMENT, UM AND HIS VOICE
CONCERNED REGARDING THE PROPOSED
REBATE LOAN. LOANS AGAINST A DAB
REBATE FUND MAY UNDERMINE THE
EFFORTS TO NEGOTIATE REBATES
THAT EIGHT APPS THROUGHOUT THE
UNITED STATES DEPEND ON TO
SERVE. TREAT AND CARE FOR PEOPLE
LIVING WITH HIV AND AIDS. THANK
YOU. WE WILL MOVE ON TO LARA
THOMAS. YES I'M LAURA THOMAS.
I'M THE SENIOR DIRECTOR OF HIV
AND HARM REDUCTION POLICY AT THE
SAN FRANCISCO ITS FOUNDATION AND
WE ARE A FOUNDING MEMBER OF THE
ENDING THE EPIDEMICS COALITION
THAT WORKS TO ADDRESS THE
INTERSECTING EPIDEMICS OF HIV
VIRAL, HEPATITIS, SEXUALLY
TRANSMITTED INFECTIONS AND
OVERDOSE HERE IN CALIFORNIA AND
THANK YOU FOR UM, ALLOWING ME TO
SPEAK HERE. UM I WANT TO ECHO
SOME OF THE COMMENTS THAT YOU
JUST HEARD AND ADD SOME
BACKGROUND ON THE DRUG
ASSISTANCE PROGRAM AND RAISE
SOME CONCERNS ABOUT POTENTIAL
UNINTENDED IMPACTS OF TAKING
DOLLARS OUT OF THE REBATE FUND.
THE REBATE FUND EXISTS PRIMARILY
BECAUSE OF LEADERSHIP FROM
CALIFORNIA. AND HAS SERVED AS A
MODEL THAT HAS INCREASED ACCESS
TO LIFE SAVING HIV MEDICATIONS
ACROSS THE COUNTRY. THIS IS ONE
OF THE MANY AREAS WHERE
CALIFORNIA HAS BEEN A LEADER IN
IMPROVING HEALTH ACCESS, AND I
HOPE THAT WE ARE NOT A LEADER IN
UNDERMINING HEALTH ACCESS FOR
PEOPLE WITH HIV BECAUSE OF THIS,
UM BACK IN 2002 AS YOU HEARD,
CALIFORNIA, ALONG WITH NEW YORK
AND A FEW OTHER STATES CREATED
THE CRISIS TASK FORCE. AND USED
OUR POSITION AS A SIGNIFICANT
PURCHASER OF HIV MEDICATIONS TO
NEGOTIATE VOLUNTARY REBATES WITH
PHARMACEUTICAL COMPANIES. UM AND
THIS HAS EFFECTIVELY ADDRESSED
THE CRISIS AND ELIMINATED WAIT
LISTS AND OTHER RESTRICTIONS ON
HIV MEDICATION HERE AS WELL AS
ELSEWHERE. UM ONE OF THE RESULTS
IS THAT SINCE 2008 WE HAVE NOT
HAD TO SPEND ANY STATE GENERAL
FUND DOLLARS ON OUR AIDS DRUG
ASSISTANCE PROGRAM HERE IN
CALIFORNIA. UH EVEN THOUGH
CALIFORNIA HAS ONE OUT OF 68 UP
CLIENTS NATIONWIDE, WE'VE BEEN
ABLE TO ENSURE APPROPRIATE CARE
FOR ALL PEOPLE LIVING WITH HIV
HERE IN CALIFORNIA. UM AND JUST
TO READ SOME OF THE CONCERNS
ABOUT THE UNINTENDED
CONSEQUENCES, THE NATIONAL
ASSOCIATION OF STATE AND
TERRITORIAL AIDS DIRECTORS HAS
BEEN RAISING THESE CONCERNS AND
SENT A LETTER TO GOVERNOR NEWSOM
THAT HAS BEEN SHARED WITH
COMMITTEE STAFF. ONE OF THE
CONCERNS IS THAT TAKING FUNDS
OUT OF THIS REBATE FUND WILL
LEAVE THE STATE UNABLE TO MEET
OBLIGATIONS BECAUSE OF THE
VOLATILITY IN THE FUND. AS YOU
JUST HEARD, REBATES ARE OFTEN
DELAYED BY 6 TO 12 MONTHS, AND
THERE ARE OFTEN SIGNIFICANTLY
LARGE PURCHASES OF MEDICATIONS.
UM, IT IS, IT IS OUR CONCERN
THAT IT IS TOO IMPORTANT TO RUN
THE RISK OF REDUCING WHAT IS A
WORKING BALANCE OF THIS FUND. IT
IS NOT A RESERVE THAT IS SET
ASIDE. IT IS A WORKING BALANCE.
SECONDLY WE ARE CONCERNED ABOUT
A CHILLING IMPACT OF THIS. UH UM
ON THE REBATE PROGRAM ACROSS THE
STATE AND CONCERNED THAT THIS
WILL POTENTIALLY JEOPARDIZE THIS
EXTREMELY EFFECTIVE NEGOTIATIONS
OF VOLUNTARY REBATES WITH
PHARMACEUTICAL COMPANIES. UM
BECAUSE WE HAVE BEEN ABLE TO USE
OUR PURCHASING POWER TO
NEGOTIATE THESE THEY REBATES
THEY'VE BEEN ABLE TO BENEFIT ALL
56 FEDERAL JURISDICTIONS,
INCLUDING TERRITORIES, THE
DISTRICT OF COLUMBIA, AND THIS
COULD RESULT IN PEOPLE LIVING
WITH HIV ACROSS THE COUNTRY
LOSING ACCESS TO THEIR
MEDICATIONS. AND THEN THE THIRD
CONCERN IS THAT THE FEDERAL
REQUIREMENTS, UM THAT WE WILL
RUN AFOUL OF THE FEDERAL
REQUIREMENTS OF THAT THESE
DOLLARS BE SPENT ON THE PROGRAM.
UM, WE KNOW THAT THE AH UM. THAT
HERSELF TO AS PART OF, UM THE
FEDERAL GOVERNMENT HAS BEEN VERY
TAKING AN INTEREST IN WHAT
HAPPENS WITH THIS. THEIR THEIR
REQUIREMENT IS THAT ANY REBATE
ON A FEDERAL DOLLAR IS USED TO
EXPAND THAT PROGRAM. UM AND WE
ARE CONCERNED THAT WE MAY BE
AGAIN IN JEOPARDY OF LOSING.
THIS IF WE LOSE EITHER THE
FEDERAL DOLLARS OR THE REBATES
THAT WILL CREATE ENORMOUS BUDGET
REQUIREMENTS. THAT GENERAL FUND
WOULD THEN BE ASKED TO PICK UP.
UM CALIFORNIA TRADITIONALLY, YOU
KNOW, OUR LEADERSHIP ON HIV, AS
WELL AS OTHER HEALTH ACCESS HAS
BEEN SUBSTANTIAL. IT HAS BEEN
HISTORIC. UM, WE ARE VERY
CONCERNED NOW IS NOT THE TIME TO
RISK THIS PROGRAM AT ME FEEL
LIKE A RELATIVELY SMALL ISSUE IN
THE CONTEXT OF OUR MUCH LARGER
STATE BUDGET. UM BUT MEDICATIONS
FOR PEOPLE LIVING WITH HIV
ACROSS THE COUNTRY ARE AT STAKE
HERE AND WE WOULD ASK THE
COMMITTEE TO PLEASE TAKE THIS
POTENTIAL IMPACT INTO ACCOUNT.
THANK YOU. THANK YOU. DEPARTMENT
OF FINANCE. UM YES. CHRISTINE
SCHURMAN WILLING DEPARTMENT OF
FINANCE. UM I'D LIKE TO, UH, GO
BACK TO ADD COMMENTS FOR
QUESTIONS, NUMBER ONE AND TWO.
JUST ADD A COUPLE LAYERS OF
CONTEXT. UM AND THEN WE CAN
ANSWER QUESTIONS THREE AND FOUR
AS WELL. UM SO REGARDING NUMBER
ONE VOLATILITY IN THE BACK 88
APT READING REBATE FUND. UM SO
FINANCE WOULD LIKE TO NOTE THAT
THE DEPTH FUND HAS CONSISTENTLY
BROUGHT IN ABOUT $325 MILLION IN
REVENUES ANNUALLY, WHILE THE
FUND AVERAGES ANNUAL
EXPENDITURES OF ABOUT 259
MILLION ANNUALLY, JUST LOOKING
AT THE THESE LAST THREE YEARS,
UM SO FROM THE PERSPECTIVE OF
FINANCE, UM THERE THERE IS NOT
VOLATILE IAN IN THE REBATE FUND
AND ITS REVENUES. UM NOT
WITHSTANDING COMMENTS FROM THE
DEPARTMENT. WE ALSO RECOGNIZE
THAT THERE IS A LARGE RESERVE TO
ABSORB THE IMPACT OF ANY FUND
VOLATILITY. UM AND WE DO
RECOGNIZE THE SIX PLUS MONTH
DELAY IN THE RECEIPT OF REBATE
REVENUES AND ARE WORKING CLOSELY
WITH THE DEPARTMENT TO ENSURE
THAT THE TIMING OF LOAN FUND
DISBURSEMENT AND REPAYMENT DOES
NOT JUST DROPPED PROGRAM CASH
FLOW NEEDS. UM, REGARDING NUMBER
TWO. UM SO. A DEPTH REBATE FUND
LOANS AND RISK TO THE STATE. UM
SO. FINANCE WOULD LIKE TO NOTE
THAT THE LOAN FUND IS COMING OUT
OF A RESERVE AND IS NOT CUTTING
ANY FUNDS ALLOCATED TOWARDS ANY
A DEPTH FUNDED PROGRAMS. THE
STATUS SUCCESSFULLY REPAID ITS
FIRST AID UP LOAN IN FISCAL YEAR
2122 AND CONTINUES TO RECEIVE
FEDERAL FUNDING AND A REBATE
RATE OF 114% OVER LAST SIX
YEARS. UM OR NUMBER THREE.
REGARDING WHEN THE LOAN WILL BE
REPAID, SO THE STATE IS
OBLIGATED TO REPAY ALL OF THESE
LOANS AND THE REPAYMENT DATES
FOR ALL OF THE LOANS WILL BE
ASSESSED, BASED ON PROGRAM NEEDS
, AVAILABILITY OF FUNDS AND
COMPETING PRIORITIES THROUGH THE
ANNUAL BUDGET PROCESS,
AUTHORIZED SPENDING REVENUES AND
RESERVES WILL BE TAKEN INTO
CONSIDERATION AND WITH NUMBER
FOUR UM. REGARDING THE SPECIFIC
CONTROL SECTION LANGUAGE. THE
LOANS WILL BE REPAID IN A FUTURE
YEAR WHEN THE FUND OR ACCOUNT
FROM WHICH THE LOAN WAS MADE,
HAS A NEED FOR THE MONIES. UM SO
THE LOAN FUNDS WILL BE REPAID IF
THE DEPARTMENT HAS A NEED TO
FUND CRITICAL PROGRAM OR IF AND
WHEN. THE WELL WHEN THE
DEPARTMENT HAS A NEED TO FUND
CRITICAL PROGRAM ACTIVITIES
UNDER THEIR, UM, APPROVED
EXPENDITURE AUTHORITY IN THE
ADEPT FUN, SO IT'S THE SAME
RESPONSES AS PREVIOUSLY THE
REPAYMENT DATES. ARE BASED ON
THIS ASSESSMENT OF PROGRAM NEEDS
AND AVAILABILITY OF FUNDS AND
COMPETING PRIORITIES. THANK YOU.
L A OH! YES WE HAVE NOTHING
FURTHER TO ADD ON THESE ITEMS.
HOWEVER, WE ARE AVAILABLE FOR
QUESTIONS. THANK YOU. THANK YOU.
SO I HAVE A QUESTION FOR
FINANCE. UM. EVEN THOUGH IN THE
PAST THERE, UH REVENUE HAS
SUPPOSEDLY OUTWEIGH THEIR
EXPENSES. WHEN YOU'RE LOOKING AT
THEIR CURRENT REVENUE, IT IS
GOING DOWN. SO HOW DO YOU KNOW
THAT? YOU WOULD, UM, THAT YOU
CAN GUARANTEE THE ABILITY FOR
THEM TO BE ABLE TO MAINTAIN
THEIR PROGRAM IF YOU TAKE THIS
$50 MILLION LOAN. UM SO AS
MENTIONED PREVIOUSLY WE ARE
CONFIDENT IN THIS FUND RESERVE.
MADIGAN LARA FINANCE. YEAH SO
WE'LL CONTINUE TO MONITOR ALL
THESE LOANS THROUGH OUR ANNUAL
PROCESS, AND WE'RE TAKING INTO
CONSIDERATION. YOU KNOW PROGRAM
NEEDS AVAILABILITY OF RESOURCES.
YOU ARE ANNUAL PROCESS. IN THIS
CASE, WE HAVE A SUBSTANTIAL
RESERVE THAT I THINK IS ADEQUATE
TO MEET ANY PROGRAM NEEDS AND
I'M SORRY. WHAT EXACTLY IS THAT
RESERVE NUMBER AGAIN? THERE'S
STILL 177 MILLION IN THE FUND AS
OF THE END OF THE BUDGET YEAR.
I'M SORRY I MISSPOKE. I SAID 50,
I MEANT 500 MILLION. SO UM,
RIGHT, AND IS IT THE STANCE OF
THE DEPARTMENT OF FINANCE THAT
SINCE YOU'VE TAKEN THIS LOAN
BEFORE, AND IT HAS NOT IMPACTED
THE ABILITY TO GET FEDERAL
FUNDING OR NEGOTIATING POWER, UM
THAT YOU ARE PRETTY MUCH SURE
THAT IT'S NOT GOING TO IMPACT
FEDERAL FUNDING AND THE
NEGOTIATION POWER THAT WE'VE
HEARD FROM A COUPLE OF SPEAKERS
ALREADY TODAY. YEAH, I THINK,
UH, I THINK THAT ANY RISK IN
THOSE AREAS WOULD BE FAIRLY LOW
IN THE FIGHT FINANCES VIEW. AND
IN THE EVENT THAT WE DID HAVE
FUTURE PROGRAM NEEDS. YOU KNOW
IF ANY OF THAT VOLATILITY
VOLATILITY ACTUALLY
MATERIALIZED. THE LOAN AUTHORITY
IN THIS CASE ALLOWS US TO PUT
DOLLARS BACK WHERE NEEDED, SO WE
HAVE THAT FLEXIBILITY. OKAY, SO
WHAT YOU'RE STATING IS THAT IF
WE GOT WORD FROM THE FEDERAL
GOVERNMENT THAT SINCE WE'RE NOT
ACTUALLY USING SOME OF THESE
FUNDS DIRECTLY TO THE PATIENTS
THAT IT'S WAS FUNDED FOR, UM,
THAT WE WOULD BE ABLE TO GIVE
THEM BACK ALONE IMMEDIATELY.
YEAH, WE HAVE THAT ABILITY TO.
CONSIDER THOSE TYPES OF
SITUATIONS. YEAH, THE LANGUAGE.
NOW. THE FIRST LOAN WAS TAKEN
OUT WHEN. HMM SO THE FIRST LOAN
OF 100 MILLION WAS AUTHORIZED BY
THE 2020 BUDGET ACTORS AND HAS
BEEN FULLY REPAID IN FISCAL YEAR
2122 RIGHT, AND THAT'S WHEN WE
HAD AN EXCESS. SO SEEING THAT WE
ARE IN A DIFFERENT SITUATION NOW
AND UNFORTUNATELY, IT'S
PROJECTED THAT WE WILL BE IN A
DEFICIT FOR THE NEXT 23. HOWEVER
MANY YEARS DO WE HAVE ANY KIND
OF, UM, REQUIREMENT TO PAY THIS
BACK BY A CERTAIN PERIOD OF
TIME? YEAH, THERE IS NO. THERE
IS NO SPECIFIC REQUIREMENT IN
THE LAW JUST THAT WE ASSESS THE
STATE'S FISCAL CONDITION
ANNUALLY THROUGH OUR OUR BUDGET
PROCESS. SO WE HAVE THAT WE
WOULD HAVE THIS ON THE BOOKS AS
AN OBLIGATION. AND THE LOANS
WOULD BE REPAID. BUT WE WORKED
THROUGH THE PRIORITIES FROM THE
YOU KNOW THE WHOLE LIST OF
VARIOUS LOANS. YOU KNOW, JUST TO
PROVIDE THAT WHICH IS NEEDED AT
THAT GIVEN TIME. OKAY THANK YOU.
AT THIS POINT, WE WILL GO TO
PUBLIC COMMENT. THING THAT THERE
IS NO ONE WHO WANTS TO GIVE
PUBLIC COMMENT. I WANT TO THANK
EVERYONE FROM PANEL NUMBER FIVE.
AND WE WILL NOW MOVE TO ISSUE
NUMBER SIX PANEL NUMBER SIX THIS
COVERS FOR PROPOSALS THAT FALL
UNDER THE CENTER FOR FAMILY
HEALTH. FIRST WE WILL HEAR FROM
CHRISTINE SULLIVAN WICK DIVISION
CHIEF CENTER FOR FAMILY HEALTH
CD PH. NEXT WE WILL HEAR FROM
LESLIE GAFFNEY, ACTING DEPUTY
DIRECTOR FOR THE CENTER OF
FAMILY HEALTH, FROM C D PH. YOU
MAY BEGIN WHENEVER YOU'RE READY.
GOOD AFTERNOON, CHRISTINE
SULLIVAN FROM THE WICK DIVISION.
AND I'VE BEEN ASKED TO PROVIDE
AN OVERVIEW OF WICK
MODERNIZATION AND PARTICIPATION.
I'LL START WITH PARTICIPATION
SINCE THAT'S THE SHORTER UPDATE.
A WEAK PARTICIPATION IN
CALIFORNIA AND NATIONALLY HAS
BEEN INCREASING SLIGHTLY. FOR
CONTEXT IN JANUARY OF 2020,
CALIFORNIA WICK SERVED 833,000
INDIVIDUALS TWO YEARS LATER IN
JANUARY OF 20. 2022 WE SERVED
920,000 INDIVIDUALS. AND THIS
YEAR IN JANUARY OF 24, WE SERVED
991,000 INDIVIDUALS. AND USDA S
LATEST REPORT REPORT ON WIC
PROGRAM REACH CALIFORNIA SERVED
67% OF ELIGIBLE INDIVIDUALS IN
2021, WHILE THE NATIONAL AVERAGE
WAS 51. WE WERE THE SECOND
HIGHEST STATE, AND WE TEND TO BE
THE HIGHEST STATE ABOUT EVERY
OTHER YEAR. WE FLIP FLOP WITH
VERMONT QUITE REGULARLY. UM, THE
INDIVIDUALS THAT WE ARE NOT
SERVING TEND TO BE TODDLERS AND
CHILDREN, MANY OF WHICH WERE IN
THE WIC PROGRAM. WHEN THEY WERE
INFANTS. WE HAVE A VERY HIGH
COVERAGE RIGHT FOR PREGNANT AND
POSTPARTUM WOMEN AND INFANTS. UM
AND THEN CHILDREN TEND TO DROP
OFF AS THEY GET OLDER, AND THAT
IS A NATIONAL TREND AS WELL. IN
OUR LATEST BUDGET ESTIMATE. UM,
THE CURRENT YEAR WE REVISED
ESTIMATE IS 993,000 INDIVIDUALS.
UM A 0.1% INCREASE OVER THE
PREVIOUS ESTIMATE, AND THIS
ESTIMATE IS RIGHT IN LINE WITH
THE ACTUAL NUMBER. WE SERVED IN
JANUARY OF 2020 FOR THE BUDGET
YEAR ESTIMATE IS JUST OVER 1
MILLION PARTICIPANTS A MONTH. A
3.8 INCREASE OVER THE PREVIOUS
ESTIMATE. REGARDING WICK
MODERNIZATION. IT'S A FEDERAL
INITIATIVE BY THE U. S.
DEPARTMENT OF AGRICULTURE TO
REACH AND RETAIN MORE FAMILIES
ADVANCE EQUITY IN THE WIC
PROGRAM AND IMPROVED PROGRAM
SERVICES. OR FAMILIES SO THAT
THEY CAN RECEIVE BETTER SERVICES
MORE SERVICES AND REDEEM MORE OF
THEIR FOOD BENEFITS. WE DIVIDE
DIVIDE THAT, UM WICK
MODERNIZATION INITIATIVE INTO
TWO BUCKETS. THE FIRST IS
COMMUNICATION WITH FAMILIES IN
ROMAN IT LOCAL AGENCIES, THE
NUTRITION AND BREASTFEEDING
SUPPORT THAT'S PROVIDED BY LOCAL
AGENCIES AND STATE SUPPORT TO
THOSE LOCAL AGENCIES. AND THEN
THE SECOND COMPONENT HAS TO DO
WITH WIC FOOD BENEFITS. AND THE
MAJOR COMPONENT OF THAT IS
ONLINE SHOPPING. SO ADDRESSING
THE FIRST COMPONENT THOSE LOCAL
SERVICES AND FAMILY SUPPORT. WE
ARE REQUESTING 14 POSITIONS IN
THE BUDGET YEAR AND OF COURSE
FOR WEEK. WE'RE TOTALLY
FEDERALLY FUNDED. SO THERE'S NOT
A REQUEST FOR ANY GENERAL FUND
JUST FOR POSITION AUTHORITY. FOR
COMMUNICATION WORK THAT OUR OUR
NEW POSITION WOULD DO. WE ARE
DEVELOPING AN ONLINE APPLICATION
AND NEED TO CONTINUOUSLY IMPROVE
THAT THE ONLINE APPLICATION
WOULD STREAMLINE ENROLLMENT INTO
THE PROGRAM. UM AND SAVES
CONSIDERABLE TIME AT THE LOCAL
AGENCY STAFF AS WELL. WE NEED TO
CONTINUOUSLY UPDATE THE PHONE
APP THAT WICK FAMILIES USED TO
CHECK AND SEE WHAT THEIR FOOD
BALANCES SCAN ITEMS AT THE
GROCERY SORT OF SEE WHAT'S
ALLOWABLE CHECK THEIR
APPOINTMENTS. UH DO SOME
NUTRITION, ONLINE EDUCATION,
THAT SORT OF THING, AND WE HAVE
A ARM WHAT WE CALL OUR MY FAMILY
WEBSITE, WHICH IS GEARED TOWARDS
WICK FAMILIES, OF COURSE, AND WE
NEED TO CONTINUOUSLY IMPROVE
THAT. AS WELL. FOR ENROLLMENT
IMPROVEMENTS. WE HAVE OUR CASE
MANAGEMENT SYSTEM THAT NEEDS TO
BE, UM, CONTINUOUSLY IMPROVED
THE TO MAKE IT AN EASIER PROCESS
FOR ENROLLMENT AND SUPPORT LOCAL
AGENCIES FOR THAT. WE ALSO NEED
TO MODERNIZE FAMILY EDUCATION
AND TRAINING OF LOCAL AGENCY
STAFF. WITH THINGS LIKE E
LEARNING, DESIGNING MORE
EVIDENCE BASED EDUCATION. AND
THIS WORK FOR THIS FAMILY
SUPPORT LOCAL AGENCIES SUPPORT
WHERE THE REASON WE'RE ASKING
FOR THE POSITIONS AT THE STATE
LEVEL IS SO THAT WE CAN ENSURE
THAT THERE IS GOOD STANDARD
IZATION GOOD THAT THAT THE WORK
IS MEETING APPROPRIATE STANDARDS
, AND IN FACT, LOCAL AGENCIES
HAVE ASKED US TO DO A LOT OF
THIS WORK AT THE STATE LEVEL
BECAUSE IT EASES THE BURDEN ON
THEM. THE SECOND COMPONENT OF
WICK MODERNIZATION IS ONLINE
SHOPPING, AND WE HAVE REQUESTED
THREE POSITIONS IN THE BUDGET
YEAR AND AN ADDITIONAL EIGHT
POSITIONS AND THE FOLLOWING
STATE FISCAL YEAR. ONLINE
SHOPPING FOR WIC WILL IMPROVE
ACCESS AND CONVENIENCE OF THE
PROGRAM, REDUCE THE STIGMA AND
PROMOTE EQUITY. UM FAMILIES WILL
STILL HAVE ACCESS TO BRICK AND
MORTAR STORES. ONLINE SHOPPING
DOES NOT NECESSARILY INCLUDE
DELIVERY. IT COULD INCLUDE
DELIVERY. UM BUT THAT WILL MOST
LIKELY BE AN OUT OF POCKET
EXPENSE FOR FAMILIES. WE ARE
AWAITING THE FEDERAL REGULATIONS
COMING OUT, HOPEFULLY, THE
BEGINNING OF NEXT CALENDAR YEAR
FOR ONLINE SHOPPING. AND THEN WE
WOULD MOVE FORWARD ON OUR STATE
PROCESS, AND THERE IS A NEED TO
ADJUST SOME STATE REGULATIONS,
WHICH IS LEADING TO THE REQUEST
FOR THE TRAILER BILL LANGUAGE
FOR AN EXPEDITED PROCESS THERE.
THANK YOU. AND TURNING TO THE
GENETIC PRETTY SCREENING
PROGRAMS ESTIMATE THIS YEAR. GSP
UM, IS ADJUSTING THE 2324 BUDGET
DOWNWARD BY JUST UNDER $20
MILLION TO 167.8 MILLION. UM,
AND THEIR REVENUES FOR THE
CURRENT YEAR BEING ADJUSTED DOWN
, UH, $24 MILLION DECREASED TO
$152.2 MILLION. BOTH OF THOSE
REDUCTIONS ARE ATTRIBUTED TO THE
CONTINUED DECLINE IN THE BIRTH
RATE, AS WELL AS THE PRENATAL
SCREENING PROGRAMS. LOSS OF
EXCLUSIVITY FOLLOWING A LAWSUIT
WHEN THEY. TRANSITION FROM
BIOCHEMICAL SCREENING TO C F D N
A. AND SO, UM PRIOR TO THE LOSS
OF EXCLUSIVITY ABOUT 72% OF ALL
BIRTHS WERE SCREENED BY THE
PROGRAM, AND THAT'S NOW DOWN AT
52. FOR THE BUDGET YEAR. UM WE
ARE EXPECTING A DECREASE OF $6.1
MILLION COMPARED TO U 23 BUDGET
YEAR. UM. AND THAT IS ATTRIBUTED
TO THE ONGOING BIRTH RATE DROP
AS WELL AS THE LOSS 
EXCLUSIVELY IN ADDITION TO THE
REDUCTION OF THAT ONE TIME
FUNDING THAT WAS GRANTED LAST
YEAR $7.4 MILLION FOR A DATA
MIGRATION TO CLOUD PLATFORM AND
THOSE REDUCTIONS ARE OFFSET BY
$1.2 MILLION INCREASE FOR
CONTRACTING INCREASES, AS WELL
AS A $4.4 MILLION INCREASE FOR
THE, UH, PRENATAL TESTING THAT
PRENATAL NEWBORN SCREENING
TESTING THAT WILL BE ADDED THIS
SUMMER. REVENUE PROJECTIONS FOR
BUDGET YEAR ARE $182.4 MILLION.
THAT'S AN INCREASE OF 6.2
MILLION COMPARED TO 2023 BUDGET
ACT. UM WE WILL BE ADDING
SCREENING FOR SEX CHROMOSOME AND
EMPLOYEES TO THE PRENATAL
SCREENING PROGRAM NEXT MONTH.
AND IN ON JULY 1ST. WE WILL BE
RAISING THE FEE OF $112 SO THAT
WILL RAISE THE FEE FOR PRENATAL
SCREENING TO $344. IN ADDITION
THIS SUMMER WILL BE ADDING TO
THE NEWBORN SCREENING PANEL
SCREENING FOR POLICY. RIDEAU,
SIS, TYPE TWO, AND GUANA DINO
ACETATE METHYL TRANSFER IS
DEFICIENCY. UM THOSE WILL HAVE
THOSE ADDITIONS WILL HAPPEN IN
JULY AND JULY 1ST. WE WILL
REWRITE RAISING THE FEE FROM 211
2 TO 26. THAT'S A $15 INCREASE.
UM THE FUND BALANCES ABOUT 10%
THIS YEAR, AND IN THE BUDGET
YEAR WE PROJECTED TO BE 9. THANK
YOU. DEPARTMENT OF FINANCE. NICK
MILLS DEPARTMENT OF FINANCE WERE
IN SUPPORT OF THE STAFF'S
RECOMMENDATION ON THIS ISSUE.
THANK YOU. HELLO. YES SO WE'LL
OWNS A LEO. WE HAVE RAISED NO
CONCERNS WITH THE WICK
MODERNIZATION BI CPM. NOTHING TO
FURTHER ADD, UM, ON THE OTHER
ITEMS. THANK YOU. I JUST WANNA
POINT OF CLARIFICATION, SO THE
DECREASE AND THE PNS OR THE
PRENATAL SCREENING CASELOAD.
IT'S NOT A DECREASE IN THE
NUMBER OF WOMEN. I'M GETTING IT.
IT'S JUST THAT THEY ARE NOW
USING THEIR OPTIONS AND THAT
ACTUALLY ENTERING THE PROGRAM.
THAT IS WHAT WE WOULD ASSUME.
BUT WE DON'T HAVE ACCESS TO THE
TESTING NUMBERS FOR THOSE
PARTICIPATING OUTSIDE OF OUR
PROBE. THANK YOU. SO AT THIS
POINT, UM. I AM GOING TO OPEN IT
UP TO ANYONE FROM THE PUBLIC WHO
MAY HAVE COMMENTS. YOU WILL HAVE
ONE MINUTE EACH. THANK YOU. GOOD
AFTERNOON, MADAM CHAIR, MISSY
JOHNSON HERE ON BEHALF OF MYRIAD
GENETICS, A COMPANY THAT
DEVELOPS AND COMMERCIALIZES
GENETIC TESTS THAT DETERMINE THE
RISK OF DEVELOPING DISEASE,
ASSESSED THE RISK OF DISEASE
PROGRESSION AND HELPED TO GUIDE
TREATMENT DECISIONS ACROSS METAL
MEDICAL SPECIALTIES, MARRIED HIS
LONG SUPPORTED THE DEPARTMENT'S,
UH, IMPLEMENTATION OF C C F. D.
N A COVERAGE AND APPLAUDS THEIR,
UM, PROPOSAL FOR ADDING S CH THE
PROGRAM AND AT THE APPROPRIATE
TIME WE HAD ASKED THAT THE
BUDGET COMMITTEE SUPPORT THAT.
THANK YOU. THANK YOU. GOOD
AFTERNOON, LINDA WAY WITH
WESTERN CENTER ON LAW AND
POVERTY REGARDING THE WEEK
ONLINE ORDERING TRAILER BILL WE
SUPPORT INCREASING ACCESS AS
LONG AS IT DOESN'T CONTRIBUTE TO
FOOD DESERT, RECOGNIZING THAT
THE DEPARTMENT IS STILL AWAITING
FEDERAL GUIDANCE, WE REQUEST
THAT PROTECTIONS BE IN PLACE FOR
WIC RECIPIENT TO OUR LOW INCOME
THAT THEY NOT BE CHARGED ANY
FEES, DELIVERY OR OTHERWISE, AS
THIS EATS INTO THEIR, UH FOOD
AND NUTRITION BENEFITS. THANK
YOU. THANK YOU. FARLEY WITH THE
CALIFORNIA WICK ASSOCIATION. UM
I JUST WANNA SUPPORT EVERYTHING
THAT CHRIS IS OUTLINED HERE AND
JUST CALL TO YOUR ATTENTION THE
OUTSTANDING PERFORMANCE OF THE
LOCAL AGENCIES 84 AGENCIES
ACROSS THE STATE AND THE STATE
STAFF. IT WEATHERED NOT ONLY THE
COVID CRISIS, BUT THE INFANT
FORMULA CRISIS WHICH FOR THEM
WAS EVEN MORE DIFFICULT FROM THE
FOR THE GENERAL THEM FOR THE
GENERAL PUBLIC. AND ALSO ROLLING
OUT ROLLED OUT MANY, MANY
MODERNIZATIONS. AND REALLY,
REALLY REORIENTING. THE WHOLE
PROGRAM IS TO A NEW NORMAL WITH
LOTS OF STAFF TRAINING AND AN
OPPORTUNITIES FOR THE FAMILIES
TO BETTER COMMUNICATE. AS CHRIS
SAID THE ONLINE APPLICATION WILL
HELP STREAMLINE REFERRALS FOR
PROVIDERS AND FAMILIES AND
REALLY TRYING TO SIMPLIFY AND
IMPROVE ACCESS FOR THE FAMILY.
SO WE'RE JUST REALLY PROUD TO
SUPPORT THEM AND REALLY LIKE TO
CALL IT CALL THEM OUT BECAUSE
THEY'RE VERY HUMBLE WORKFORCE.
THANK YOU. THANK YOU. SO MUCH
FOR YOUR COMMENTS. UM. YOU KNOW,
ONE OF THE. PEOPLE WHO SPOKE
FROM THE WESTERN LAW. POVERTY
TALKED ABOUT SOME SUGGESTIONS AS
FAR AS THE ONLINE ORDERING
TRAILER BILL. I YOU KNOW, THIS
IS ONE OF THE REASONS WHY WE'RE
NOT NECESSARILY APPROPRIATING
SOMETHING IN THE BUDGET.
UNDERSTANDING THIS IS FEDERAL
FUNDING, AND WE'VE GOT TO PROVE
IT. BUT THIS IS ONE OF THE
REASONS WHY I LIKE THINGS GOING
THROUGH POLICY COMMITTEE BECAUSE
WE'RE ABLE TO HAVE THE INPUT
FROM ALL STAKEHOLDERS. UM AND
YOU JUST HAVE MORE EYES ON
SOMETHING SO THAT LIKE I SAID
EARLIER. WE'RE NOT MISSING
SOMETHING. WE'RE NOT
INADVERTENTLY, UM, LEAVING A
GROUP OUT OR HAVING OR CAUSING
UNINTENDED HARM. UM AND SO YOU
KNOW IF THIS CONTINUES IN A
TRAILER BULL, AND WE'LL SEE WHAT
HAPPENS, I DO STRONGLY RECOMMEND
THAT YOU WORK WITH IT. THE
STAKEHOLDERS TO MAKE SURE THAT
WE GET THIS RIGHT AND IT'S NOT
SOMETHING THAT WE END UP HAVING
TO GO BACK AND FIX LATER ON. SO
WITH THAT I WANT TO THANK THIS
PANEL AND WE ARE GOING TO MOVE
TO OUR FINAL PANEL PANEL NUMBER
SEVEN. OUR FINAL ISSUE COVERS
FOR PROPOSALS UNDER THE CENTER
FOR HEALTH CARE QUALITY. WE WILL
HAVE A MONICA NELSON, ACTING
CHIEF OFFICE OF INTERNAL
OPERATIONS CENTER FOR HEALTH
CARE QUALITY CD PH TWO. COME AND
SPEAK. AND YOU MAY BEGIN
WHENEVER YOU'RE READY.
GOOD AFTERNOON. GOOD AFTERNOON,
MADAM SHARE. THANK YOU. I'M
MONICA NELSON. AND I'LL GO AHEAD
AND JUST GET STARTED ON THE
PROPOSAL NUMBER ONE WITH A
BUDGET HIGHLIGHTS. FOR CURRENT
YEAR 2023 2023 BUDGET ACT
APPROPRIATED 462,000,002 CHC
QUÊ. SECURE PROJECTS, CORINTHIA
EXPENDITURES TO TOTAL 481.8
MILLION AN INCREASE OF 4.3%
COMPARED TO THE 2023 BUDGET ACT.
IT'S INCREASES THE TO THE
BASELINE ADJUSTMENTS, ANOTHER
PROJECTED INCREASED EXPENDITURES
ATTRIBUTED TO TITLE 18 G. FOR
BUDGET YEAR 2024 25 CHC QUÊ
ESTIMATES EXPENDITURES WILL
TOTAL 473.7 MILLION, WHICH IS AN
INCREASE OF 11 POINT 7,000,002
0.5% COMPARED TO THE 2023 BUDGET
ACT. IT'S INCREASED INCLUDES A
REQUEST OF 1.1 MILLION FOR THE
APPLICATION AND PROCESSING
EXPANSION, AS WELL AS A 2.4
MILLION DECREASE IN FEDERAL
TRUST FUND EXPENDITURE AUTHORITY
AS WELL AS VARIOUS BASELINE
ADJUSTMENT. ALL THE CHC QUÊ WILL
NOT BE REQUESTING POSITIONS
THROUGH THESE ESTIMATES. 2425.
WE DO WANT TO POINT OUT SOME
PROGRAMMATIC ACHIEVEMENTS
REGARDING COMPLAINTS, TIMELINESS
AND COMPLETION. AS A QUARTER ONE
OF 2023 24 CH. SECURE COMPLETED
93% OF LONG TERM LONG TERM
HEALTH CARE FACILITY COMPLAINTS
WITHIN 60 DAYS OF RECEIPT. THIS
REPRESENTS A 30% IMPROVEMENT IN
THE TIMELINESS OF LONG TERM CARE
COMPLAINTS SINCE QUARTER FOUR OF
2021 22. CHC QUÊ. HAS COMPLETED
97.6% OF BACKLOG LONG TERM CARE
COMPLAINTS THAT EXISTED AS OF
APRIL 1ST 2021. AND CHC QUÊ HAS
REDIRECTED RESOURCES TO ADDRESS
THIS OPEN COMPLAINTS WITH THE
GOAL OF ELIMINATING THE BACKLOG
BY THE END OF FISCAL YEAR, 2023.
AS OF QUARTER ONE OF 2023 24.
THERE ARE ONLY APPROXIMATELY 645
OPEN LONG TERM CARE COMPLAINTS
REMAINING. REGARDING THE BACON
FOR THE NEXT STILL IN THE SAME
TOPIC REGARDING THE VACANCY AND
RECRUITMENT INFORMATION. AS OF
JANUARY, 2020 FOR THE CENTERS.
OVERALL VACANCY RATE IS 13% AND
20.9% OF HEALTH FACILITY
EVALUATOR NURSES. WHICH IS AN
INCREASE OF 9.2% SINCE THE
BEGINNING OF THE COVID 19
PANDEMIC IN FEBRUARY, 2020 LOS
ANGELES COUNTY SURVEYOR VACANCY
RATE. IT'S 17% AN INCREASE OF 9%
SINCE FISCAL YEAR 1920. THIS
COMBINED INCREASES DUE TO IMPART
THE TO THE NEWLY AUTHORIZED
POSITIONS, BUT ALSO BECAUSE OF
INCREASED RETIREMENTS AND
SEPARATIONS. IT'S ALSO IMPORTANT
TO NOTE THAT THE SURVEYOR
SHORTAGE IS NOT LIMITED TO
CALIFORNIA, BUT IT'S ALSO
AFFECTING OTHER STATES ACROSS
THE NATION. AND IT HAS BECOME
INCREASINGLY CHALLENGING TO
COMPETE FOR REGISTERED NURSES,
GIVEN THE EXPONENTIAL,
INCREASING DEMAND AND SALARIES
IN DIRECT HEALTHCARE SETTINGS.
HOWEVER OR CENTURIES, EXPLORING
OPPORTUNITIES TO DIVERSIFY THE
CLASSIFICATION MAKEUP OF OUR
FIELD OPERATIONS SURVEYORS TO
INCLUDE PROFESSIONALS WHO ARE
NOT REGISTERED NURSES BUT CAN
COMPLEMENT NURSE SKILL SETS AND
ALLOW OUR NURSE SURVEYORS TO
FOCUS ON ELEMENTS OF THE JOB
THAT REQUIRE THEIR CLINICAL
EXPERTISE. FINALIZE THE CENTER
HAS MADE SIGNIFICANT PROGRESS
TOWARDS RESTORING NORMAL
OPERATIONS AS THE STATE
CONTINUES TO RECOVER FROM THE
PUBLIC HEALTH EMERGENCY. WELL,
STAFFING CHALLENGES ARE LIKELY
TO REMAIN GIVEN THE NATIONWIDE
NURSING SECURITY. THE CENTER IS
DEVELOPING AND IMPLEMENTING
STRATEGIES TO ADAPT AND CONTINUE
DELIVERING CRITICAL LICENSING
AND CERTIFICATION SERVICES.
THANK YOU. THANK YOU. YOU LIKE
ME TO GO INTO PROPOSAL TO, OF
COURSE. YEAH. PROPOSAL TO THE
SIEGE, SECURE APPLICATION
PROCESSING EXPANSION BUDGET
CHANGE PROPOSAL. CHC QUÊ IS
REQUESTING 11.5 POSITIONS AND
1.1 MILLION IN 2425 AND 1.6
MILLION IN 2025 26. AND I'M
GOING FROM FROM 3098 TO SUPPORT
APPLICATION AND PROCESSING
EXPANSION. THE PROPOSAL INCLUDES
ADDING POSITIONS INTO BRANCHES
AT CHC QUÊ. THIS IS MAINLY
ADDRESSING INCREASED WORKLOAD IN
THEIR RESPECTIVE AREAS SUCH AS
APPLICATION PROCESSING AND
PAYMENT PROCESSING. FOR EXAMPLE,
UM, OR NUMBER OF HEALTHCARE
FACILITIES AND HEALTHCARE
AGENCIES THAT ARE CENTRAL
LICENSES AND CERTIFIED HAS
INCREASED FROM 11,000 TO 14,000
IN THE PAST FEW YEARS. ONE OF
THE BRANCHES AT EACH SECURE IS A
CENTRALIZED APPLICATIONS BRANCH
THEY PROCESS ALL APPLICATIONS
SUBMITTED BY HEALTH FACILITIES
FOR VARIOUS LICENSURE CHANGES,
INCLUDING CHANGE OF OWNERSHIP
LOCATION. NAME. NUMBER OF BEDS
AND VARIOUS KEY PERSONNEL SUCH
AS ADMINISTRATOR AND MEDICAL
DIRECTOR. THE SAME BRANCH HAS
EXPERIENCED A STEADILY
INCREASING WORKLOAD TO AN
OVERALL INCREASE IN THE NUMBER
OF FACILITIES FOR WHICH CHC QUÊ
HAS OVERSIGHT. ADDITIONALLY
RECENT LEGISLATION HAS MADE
RELATIONSHIP REQUIREMENTS MORE
STRINGENT AND CERTAIN FACILITY
TYPES. PARTICULARLY HOSPICES AND
NURSING HOMES. FURTHERMORE AN
AREA OF THE THC QUÊ FISCAL
SERVICES BRANCH IS RESPONSIBLE
FOR PROCESSING ALL LICENSING
PAYMENTS, WHICH ARE SUB
SUBMITTED VIA PAPER CHECK,
INCLUDING ALL PAYMENTS RECEIVED
FOR REPORTED CHANGES. OTHER
RESPONSIBILITIES FOR THIS BRANCH
INCLUDE PROCESSING THE POSITS
ANNUAL FEE NOTICES, RENEWAL
APPLICATIONS PAYMENT
NOTIFICATIONS, RECONCILIATIONS
OF THE POSITS AND FEED.
REVOCATIONS AND CUSTOMER SERVICE
TO THE ENTITIES. I'LL STOP NOW.
THANK YOU. NUMBER THREE. HEALTH
CARE FACILITY APPLICATION FARE
REVISIONS TRAILER BILL. SEE THE
PH. IS PROPOSING A STATUTORY
CHANGES TO SET AND ADJUST FEES
FOR APPLICATIONS AND WRITTEN
NOTIFICATIONS FOR LICENSURE
CHANGES SUBMITTED BY HEALTHCARE
FACILITIES AS WELL AS TO ASSESS
PENALTIES FOR UNTIMELY PAYMENT
AND TO HARMONIZE CERTIFICATION
REQUIREMENTS. ALL LICENSES. FOR
CONTEXT EACH YEAR. SWITCH SECURE
PROCESSES OVER 10 THOUSANDS OF
MEDALS FROM HEALTH FACILITIES
FOR VARIOUS LICENSURE CHANGES.
AND ALL THE PROCESSING THESE
CHANGES GENERATE SIGNIFICANT
WORKLOAD. CURRENT LAW LIMITS THE
TYPES OF LICENSURE CHANGES FOR
WHICH CITY PH MAY CHARGE A FEE.
ADDITIONALLY SOME EXISTING FEES
SUCH AS CHANGE OF OWNERSHIP
MAKES IT WORKLOAD COSTS. CD PH,
RECENTLY PARTNERED WITH THE
DEPARTMENT OF FINANCE RESEARCH
AND ANALYSIS UNIT TO REVIEW THIS
WORKLOAD. AND HAS DEVELOPED AN
UPDATED FEE SCHEDULE. THE BETTER
ALLIANCE FEE REVENUE WITH
WORKLOAD COST. THIS WILL ALLOW
THE DEPARTMENT TO IMPLEMENT THIS
UPDATED FEES SCHEDULE AND THE
PROPOSED AMENDMENTS WILL
AUTHORIZE CD PH TO CHARGE A FEE
FOR ALL TYPES OF LICENSURE
CHANGES AND ADJUST THEM
THROUGHOUT THE FEE REPORT
PROCESS THAT IS USED TO UPDATE
ANNUAL HEALTH FACILITY LICENSING
FEES. THE PROPOSAL ALSO
AUTHORIZES THE DEPARTMENT TO
ASSESS PENALTIES FOR THE LATE
PAYMENT OF FEES RELATING TO
CHANGES AND PROPOSES LANGUAGE TO
STANDARDIZE CERTIFICATION AND
FACE SUBMISSION. REQUIREMENTS
FOR LICENSURE CHANGES ACROSS ALL
FACILITY TÌM. ADOPTING THESE
AMENDMENTS WILL ALLOW CITY PH TO
IMPLEMENT OFFICE SCHEDULE FOR
LICENSURE CHANGES THAT ALIGNS
FOR REVENUE WITH WORKLOAD COSTS.
ADDITIONALLY IT PROVIDES SOME
MORE EQUITABLE DISTRIBUTION OF
COSTS AMONG FACILITIES. IT. IT
ADDRESSES STAKEHOLDER CONCERNS
WITH THE CHANGE OF OWNERSHIP FEE
AND REDUCES COST PRESSURES TO
ANNUALIZED FEES. ONE THING
THAT'S IMPORTANT TO NOTE IS
THEIR ANNUAL FAIR REPORT IS IN
THE FINAL APPROVAL STAGES, AND
WE'RE ESTIMATING TO POST A NET
EARLIER THIS WEEK. MOVING ON TO
PROPOSAL NUMBER FOUR. SKILLED
NURSING FACILITIES, STAFFING
AUDITS FUND SHIFT. THE
GOVERNOR'S BUDGET REFLECTS A ONE
TIME SHIFT OF 4 MILLION IN 2024
25 FROM THE STATE GENERAL FUND,
001 TO FUND 3098 TO ALLEVIATE
THE PRESSURE ON FRANCE 001 SUCH
FUNDS WILL SUPPORT THE MANDATED
ACTIVITIES RELATED TO THE
MONITORING AND ENFORCEMENT,
SKILLED NURSING FACILITIES, MANY
OF MONTHS STAFFING REQUIREMENTS.
THESE ACTIVITIES WILL BE
CONSISTENT WITH THE ALLOWABLE
USES OF THE LICENSING AND
CERTIFICATION FUND, AND THIS
FUND WILL SUPPORT THIS
ACTIVITIES FOR AT LEAST ONE YEAR
WITHOUT INCREASING HEALTH
FACILITIES. LICENSE FEES. FOR
ADDITIONAL CONTEXT. CHC QUÊ HAS
AN INTERAGENCY AGREEMENT WITH
THE DEPARTMENT OF HEALTH CARE
SERVICES TO PERFORM THIS WORK.
THE CONTRACT USED TO PROVIDE 50%
OF THE FUNDING FOR THE STUFF IN
AUDITS PROGRAM FROM THE DHC S
STATE GENERAL FUND,
APPROPRIATION AND 50% FROM A
FEDERAL MATCH. HOWEVER ON
DECEMBER 31ST 2022, THE DHC IS
FUN. SOME SAID IT AND THE STATE
APPROPRIATION IS NOT WITH CITY
PH. THANK YOU VERY MUCH FOR ANY
QUESTIONS. THANK YOU. DEPARTMENT
OF FINANCE. DEPARTMENT OF
FINANCE NOTHING FURTHER TO ADD
AT THIS TIME. THANK YOU, LEO.
YES REGARDING THE BUDGET CHANGE
PROPOSAL THE TRAILER BILL. WE
HAVE NOT RAISED CONCERNS WITH
THESE. UM AND REGARDING THE FUND
SHIFT. WE FIND THAT PROPOSAL TO
BE REASONABLE TO ADDRESS THE
BUDGET SITUATION. THANK YOU. AND
I WANNA JUST THANK YOU ALL FOR
ALL OF THE WORK THAT YOU'VE DONE
TO IMPROVE THE TIME THAT
COMPLAINTS WITHIN THE NURSING
FACILITIES ARE A VALUE WEIGHTED
THAT IT'S EXTREMELY IMPORTANT
AND ONLY FOR THE RESIDENTS BUT
ALSO FOR THEIR FAMILIES. UM I
WILL NOW TURN IT OVER AND SEE IF
WE HAVE ANY PUBLIC COMMENT FOR
THIS PANEL. YOU WILL HAVE ONE
MINUTE EACH.
GOOD AFTERNOON, DR WEBBER. MADAM
CHAIR. UM SO I HAVE PRINTED
COMMENTS THAT ARE BEING
SUBMITTED RIGHT NOW. JUST
BECAUSE THEY'RE THEY GO INTO
GREAT DETAIL, SO I'M HERE.
CHRISTINA BOSS HAMBLETON.
REPRESENTING THE CALIFORNIA
ASSOCIATION FOR ADULT SERVICES,
UM, IN RESPECTFUL OPPOSITION TO
THE PROPOSAL FROM CD PH AROUND
LICENSING FEE INCREASES
SPECIFICALLY AS THEY APPLY TO
SEA BASS, WHICH ARE COMMUNITY
BASED ADULT SERVICES, ALL
OTHERWISE KNOWN AS ADULT DAY
HEALTH CARE. UM THE UNIQUE
NATURE OF THE SEA BASS INDUSTRY.
IT'S VERY DIFFERENT FROM OTHER
MEDICAL PROVIDERS IN THAT SEA
BASS FACILITIES PREDOMINANTLY
SERVE ONLY MEDICAL RECIPIENTS.
99% OF THOSE CENTERS ARE ONLY
MEDICAL, WHICH MEANS THE
PROVIDER THE REIMBURSEMENT RATES
THAT THEY GET FROM THEIR MANAGED
CARE PLANS DO NOT INCREASE WHEN
LICENSING FEES AND OTHER COSTS
OF GOING BUSINESS GO UP, AND IN
FACT THE INDUSTRY AND SO A LOT
OF THIS IS IN THE LETTER AND
WE'LL WE WILL SUBMIT MORE
INFORMATION TO YOU AS WELL. THE
INDUSTRY IS ON THE VERGE OF
COLLAPSE AS IT IS DUE TO THE
UNSUSTAINABILITY OF
REIMBURSEMENT RATES THAT HAVE AN
INCREASED IN OVER 15 YEARS. THE
COST OF DOING BUSINESS BEING SO
VERY HIGH, AND ALL OF THESE
COSTS ARE MANDATED THROUGH STATE
REGULATION AND MEDICAL MANAGED
CARE REGULATION. THE
REIMBURSEMENT RATES ARE SET. YOU
KNOW, THE STATE SETS THE FEW FOR
SERVICE RATE THE PLANS, YOU
KNOW. THEY SAY THEY NEGOTIATED
RATE, BUT THEY DON'T REALLY
BECAUSE THEY HAVE ALL THE POWER.
BUT THE POINT IS, THESE CENTERS
ARE STRUGGLING TO STAY AFLOAT.
IN FACT, WE HAVE BEEN PROPOSING
A MORATORIUM ON LICENSING FEES.
THEY'RE $10,800 A YEAR. FOR A
SMALL MOM AND POP. COMMUNITY
BASED ADULT SERVICES PROGRAM.
MANY ARE IN ETHNIC COMMUNITIES
THAT SERVE UH, YOU KNOW, VERY
PARTICULARLY CULTURALLY
RESPONSIVE SERVICES. THESE
CENTERS ARE BARELY STAYING
AFLOAT AND FEES OF 10,800. YOU
KNOW IF WE CAN JUST DO A
MORATORIUM, TAKE GET, YOU KNOW,
SAVE EVEN THAT LITTLE AMOUNT OF
MONEY. WE'RE TRYING TO KEEP THE
INDUSTRY ALIVE, NOT ADD MORE
FEES. AND SO THERE'S A LOT OF,
YOU KNOW, DETAIL IN THE LETTER.
YOU KNOW, THERE'S A LOT OF
HISTORY OF JUST PROBLEM WITH THE
LICENSING IN GENERAL, AND I
WON'T GET INTO THAT NOW, BUT WE
DO WANT TO RESPECTFULLY OPPOSE
THAT PROPOSAL AS IT RELATES TO
SEA BASS. THANK YOU. THANK YOU
AND THANK YOU FOR COMING IN
PROVIDING THIS HANDOUT WILL
FOLLOW UP. THANK YOU. GOOD
AFTERNOON RICHARDSON DAVIS WITH
THE CALIFORNIA COUNCIL OF
COMMUNITY, BEHAVIORAL HEALTH
AGENCIES. UM JUST WANTED TO
ACKNOWLEDGE THE, UM SORRY.
REPRESENTING MENTAL HEALTH AND
SUBSTANCE USE CLINICS JUST
WANTED TO ACKNOWLEDGE THE NEXUS
BETWEEN ALL OF THE HEALTH THINGS
THAT WE TALKED ABOUT TODAY IN
THE LINK TO BEHAVIORAL HEALTH.
JUST HOW IT RELATES TO, YOU
KNOW, PREMATURE DEATH AND
HOSPITALIZATION IN THE REPORT
EARLIER AND ALSO C C C. H. Q. C
S AND ALSO JUST WANT TO THINK
THE DEPARTMENT FOR THEIR EARLIER
REPORT. AND THEN ALL THE GOOD
WORK THAT WAS DISCUSSING TODAY'S
COMMITTEE. THANK YOU. THANK YOU.
SAYING NO MORE PUBLIC COMMENT. I
WOULD LIKE TO THANK THE
ADMINISTRATION, LAO ALL OF OUR
PANELISTS, STAKEHOLDERS AND
PUBLIC AND EVERYONE WHO
PARTICIPATED IN THIS HEARING. UM
WE WILL DEFINITELY CONTINUE WITH
THESE CONVERSATIONS AND YOU
REACHING OUT TO SOME OF YOU FOR
FURTHER INFORMATION AND
DISCUSSION. BUT AT THIS POINT,
THIS HEARING IS ADJOURNED. THANK
YOU.