ALL RIGHT. GOOD AFTERNOON,
EVERYONE. WE WILL NOW CALL
SUBCOMMITTEE ONE ON HEALTH TO
ORDER. WE WILL START BY CALLING
ROLE DOCTOR WEBER HERE. MISS
MONTOYA HERE. MR. PATTERSON.
OKAY. TODAY WE WILL BE
ADDRESSING A VARIETY OF
DIFFERENT ISSUES WITHIN THE
HEALTH BUDGET. AND WE WILL START
WITH THE DISCUSSION ON THE
CALIFORNIA HEALTH BENEFIT
EXCHANGE. TODAY ON THE PANEL, WE
WILL HAVE KATIE RAVEL FROM
COVERED CALIFORNIA. JOSEPH
DONALDSON FROM THE DEPARTMENT OF
FINANCE, ALBERT PANETTA FROM THE
DEPARTMENT OF FINANCE, AND RYAN
MILLER FROM THE LEGISLATIVE
ANALYST'S OFFICE. YOU MAY BEGIN.
GOOD AFTERNOON, DOCTOR WEBER AND
ASSEMBLY MEMBER BONTA. I'M KATIE
RAVEL. I'M THE DIRECTOR OF
POLICY ELIGIBILITY AND RESEARCH
AT COVERED CALIFORNIA. I'M HAPPY
TO BE WITH YOU THIS AFTERNOON,
AND I'M READY TO PROVIDE A BRIEF
OVERVIEW OF COVERED CALIFORNIA
AND OUR AFFORDABILITY PROGRAMS,
AND THEN ANSWER ANY QUESTIONS
YOU HAVE. THE AFFORDABLE CARE
ACT, WHICH WAS PASSED IN 2010,
DRAMATICALLY CHANGED THE
INDIVIDUAL HEALTH INSURANCE
MARKET. A KEY COMPONENT OF THE
AFFORDABLE CARE ACT WAS THE
CREATION OF HEALTH BENEFIT
EXCHANGES THAT OFFER
COMPREHENSIVE HEALTH PLANS WITH
INCOME BASED FINANCIAL HELP TO
LOWER PREMIUMS AND OUT OF POCKET
COSTS FOR INDIVIDUALS WHO DON'T
HAVE COVERAGE THROUGH THEIR
EMPLOYER, MEDICAID OR MEDICARE.
AND COVERED CALIFORNIA AS OUR
STATE'S HEALTH BENEFIT EXCHANGE.
OUR MISSION IS TO INCREASE THE
NUMBER OF INSURED CALIFORNIANS,
IMPROVE HEALTH CARE QUALITY,
LOWER COSTS, AND REDUCE
DISPARITIES THROUGH OUR
INNOVATIVE, COMPETITIVE
MARKETPLACE THAT EMPOWERS
CONSUMERS TO CHOOSE THE HEALTH
PLAN AND PROVIDERS THAT GIVE
THEM THE BEST VALUE. COVERED
CALIFORNIA CONTRACTS WITH 12
HEALTH INSURANCE COMPANIES
THROUGHOUT THE STATE. OUR
MEMBERS CHOOSE FROM SEVERAL
COVERAGE OPTIONS THAT VARY IN
THE AMOUNT OF MONTHLY PREMIUM
AND THE COST SHARING THAT THEY
PAY. OVER THE LAST FIVE YEARS,
CALIFORNIA AND FEDERAL ACTION
HAS BUILT ON THE FOUNDATION OF
THE AFFORDABLE CARE ACT TO
PROVIDE MORE SUPPORT FOR OUR
ENROLLEES TO AFFORD THEIR
COVERAGE. FEDERAL ACTION
INCLUDES ENHANCED PREMIUM
SUBSIDIES, WHICH WERE AUTHORIZED
BY THE AMERICAN RESCUE PLAN AND
EXTENDED THROUGH 2025 BY THE
INFLATION REDUCTION ACT OF 2022.
CALIFORNIA HAS TAKEN SEVERAL KEY
ACTIONS ON AFFORDABILITY. IN
2020, WE IMPLEMENTED A NATION
LEADING PREMIUM SUBSIDY PROGRAM
THROUGH WHICH MIDDLE INCOME
CALIFORNIANS WERE ABLE TO ACCESS
PREMIUM ASSISTANCE FOR THE FIRST
TIME AND JUST LAST YEAR, WE
IMPLEMENTED SUBSIDIES TO REDUCE
OUT OF POCKET COSTS, AND WE
IMPLEMENTED THE HEALTH CARE FOR
STRIKING WORKERS PROGRAM. IN
PARTICULAR, THE BUDGET ACT OF
2023 AUTHORIZED COVERED
CALIFORNIA TO SPEND 82.5 MILLION
TO LOWER OUT OF POCKET COSTS FOR
COVERED CALIFORNIA ENROLLEES. WE
CALL THIS THE CALIFORNIA COST
SHARING REDUCTION PROGRAM FOR
BENEFIT YEAR 2025, WE USE THE
FUNDING TO ELIMINATE DEDUCTIBLES
AND LOWER COSTS FOR KEY SERVICES
LIKE PRIMARY CARE, OUTPATIENT
MENTAL HEALTH, AND PRESCRIPTION
DRUGS FOR OUR LOWEST INCOME
ENROLLEES. WITH THE
IMPLEMENTATION OF THIS PROGRAM
COVERED CALIFORNIA WAS ABLE TO
OFFER THE HIGHEST LEVEL OF
AFFORDABILITY OF FINANCIAL
ASSISTANCE IN OUR HISTORY.
CURRENTLY, MORE THAN 700,000
ENROLLEES ARE RECEIVING THESE
NEW PLANS WITH LOWER OUT OF
POCKET COSTS AND NO DEDUCTIBLES.
THE RECORD AFFORDABILITY THIS
YEAR PUSHED OUR SIGNUPS TO AN
ALL TIME HIGH. AS OF JANUARY
31ST, THE END OF OUR OPEN
ENROLLMENT PERIOD, OVER 1.78
MILLION CALIFORNIANS HAD
SELECTED A COVERED CALIFORNIA
HEALTH PLAN FOR 2024. NEW
SIGNUPS INCREASED ABOUT 16% OVER
2023, EXCEEDING 300,000 NEW
ENROLLEES. THE HIGHEST LEVEL FOR
US SINCE 2020. BEFORE I STOP FOR
QUESTIONS, I'M PLEASED TO SAY
THAT WE'RE NOW WORKING ON THE
DESIGN OF THE 2025 COST SHARING
PROGRAM, THE GOVERNOR'S FISCAL
YEAR 2425 BUDGET INCLUDES AN
APPROPRIATION OF 165 MILLION FOR
THE PROGRAM, WITH THIS HIGHER
FUNDING LEVEL, THE 2025 PROGRAM
WILL CONTINUE TO SUPPORT THOSE
WHO ARE ELIGIBLE FOR THE PROGRAM
TODAY AND SIGNIFICANTLY EXPAND
ELIGIBILITY ABOVE OUR CURRENT
INCOME CAP AT 250% OF THE
FEDERAL POVERTY LEVEL. WE'RE
DOING OUR FINAL WORK NOW ON
MODELING, AND WE'LL HAVE A
DESIGN FOR OUR COVERED
CALIFORNIA BOARD TO ADOPT LATER
THIS SPRING. WITH THAT, I'M
HAPPY TO STOP AND TAKE ANY
QUESTIONS YOU HAVE ABOUT OUR
PROGRAM. THANK YOU ALL FOR C.F.
ASSEMBLYMEMBERS HAS ANY
QUESTIONS? THANK YOU. I DID HAVE
SOME QUESTIONS ABOUT THE,
RESERVATION OF THE $2 MILLION,
$2 MILLION FOR THE STRIKE FUND.
ESSENTIALLY, I KNOW THAT THERE
WAS A LEGISLATIVE PROPOSAL TO
INCREASE THAT FUND FROM 2
MILLION TO 20 MILLION, AND
WANTED TO JUST UNDERSTAND THE
IMPLICATION OF THAT WITHIN THIS,
WITHIN THE CONTEXT. SO JUST
SPECIFICALLY, CAN YOU PROVIDE AN
UPDATE ON THE STRIKE FUND THAT
WAS FUNDED LAST YEAR? I CAN I'LL
PROVIDE AN OPERATIONAL UPDATE,
AND THEN MAYBE DEPARTMENT OF
FINANCE WOULD LIKE TO ADD, WE,
HAD FUNDING FOR THE FIRST TIME
IN JULY OF 2023, AND THE PROGRAM
ACTUALLY STARTED IN JULY OF
2023. THERE WAS A SMALL TEAMSTER
STRIKE. SO THOSE WERE OUR FIRST
ENROLLEES UNDER THE PROGRAM, AND
WE PROVIDED BETWEEN JULY AND
DECEMBER, WE PROVIDED ABOUT 75,
CALIFORNIANS COVERAGE THROUGH
THE PROGRAM. THEY WERE EACH
ENROLLED FOR ABOUT TWO MONTHS,
AND OUR EXPENDITURES WERE A
LITTLE UNDER $40,000 FOR THE
PROGRAM. AND THAT SOUNDS LOW,
BUT THAT THE PROGRAM IS ON TOP
OF FEDERAL SUBSIDIES, WHICH WILL
OFTEN PAY MANY OF, MUCH OF THE
PREMIUM COSTS FOR THOSE MEMBERS.
SO THEN THE STATE SUBSIDY SITS
ON TOP OF THAT. SO IF THERE WAS
AN KIND OF A CONSIDERABLE STRIKE
LAST YEAR. SO FOR INSTANCE, THE
TEAMSTERS, IF THEY OR LAST YEAR
IN THAT STRIKE, IF THEY DO, YOU
HAVE AN ESTIMATE OF HOW MUCH IT
WOULD HAVE COST IF THE STRIKE
HAD GONE ON BEYOND ONE MONTH,
GIVEN THE SIZE OF THE STRIKING
WORKFORCE. YEAH. THE UPS STRIKE
WOULD HAVE BEEN SIGNIFICANT. I
DON'T HAVE OFF OF THE TOP OF MY
HEAD WHAT OUR MODELING WAS. IF
THAT'S IF THAT STRIKE HAD
RESULTED IN WORKERS LOSING THEIR
HEALTH COVERAGE AND THEN RELATED
TO THAT, THE HEALTH CARE
AFFORDABILITY RESERVE FUND CAN
PROVIDE AN ESTIMATE OF HOW MUCH
IS IN THAT FUND CURRENTLY IN THE
RESERVE THERE'S $124 MILLION.
SORRY ALBERT. THAT DEPARTMENT OF
FINANCE. AND HOW IS THAT FUND
FUNDED CURRENTLY? SO IT'S FUNDED
THROUGH THE INDIVIDUAL, STATE
MANDATE OR THE ISRP, WHICH IS, A
PENALTY THAT INDIVIDUALS THAT
HAVE ELECTED NOT TO HAVE HEALTH
CARE PAY. AND WHAT PROGRAMS ARE
PAID FOR FROM THIS FUND? THE
COST SHARING PROGRAM IS BEING
PAID FROM THAT FUND, AS WELL AS
THE HEALTH CARE FOR STRIKING
WORKERS PROGRAM. OKAY. WHAT
WOULD HAPPEN IN THE EVENT THAT
WE EXPENDED THE $2 MILLION IN AN
ADDITIONAL STRIKE? IF WE
EXPANDED THE PROGRAM COVERED,
CALIFORNIA WOULD HAVE TO STOP
PROVIDING THOSE SUBSIDIES. ANY
ENROLLEE WHO WAS ELIGIBLE TO
ENROLL IN COVERED CALIFORNIA,
GENERALLY HAVING LOST THEIR
EMPLOYER COVERAGE, COULD STILL
RECEIVE FEDERAL PREMIUM
SUBSIDIES AND COST SHARING THAT
THEY WERE ELIGIBLE FOR BASED ON
THEIR INCOME. BUT WE WOULDN'T BE
ABLE TO PROVIDE THAT ADDITIONAL
STATE PREMIUM SUBSIDY. THANK YOU
. JUST A FEW MORE QUESTIONS. SO
THERE IS A POTENTIAL THAT THE
FEDERAL PREMIUM TAX CREDIT WILL
EXPIRE IN 2025, HOW HOW ARE YOU
ENVISIONING THAT TO POSSIBLY
IMPACT YOUR CASELOAD? WE THINK
THE, THE IMPACTS WOULD BE QUITE
SIGNIFICANT. WE THOUGHT IT COULD
HAVE BEEN IN THE NEIGHBORHOOD OF
OVER 150,000 ENROLLEES WHEN WE
FACED THIS BEFORE. IN 2022,
WE'LL BE DOING UPDATED MODELING
AND PROBABLY LATER IN THE FALL.
ONCE WE KNOW OUR 2025 RATES AND
WE'LL BE ABLE TO UPDATE THOSE
NUMBERS, OUR CASELOAD HAS GROWN
SIGNIFICANT SINCE THEN, SO WE
WILL HAVE UPDATED NUMBERS
AVAILABLE. WE'LL BE ABLE TO
PROVIDE TECHNICAL ASSISTANCE ON
THE TOTAL SIZE OF THE ENHANCED
FEDERAL SUBSIDIES, AND THEN ANY
ENROLLMENT IMPACTS. OKAY AND
HAVE YOU NOTICED THAT WITH OUR
MEDI-CAL REDETERMINATION
DEADLINE, HAS THAT IMPACTED YOUR
PROCESS ANY WAY? WE WERE FAIRLY
WELL PREPARED FOR THAT. WE WERE
QUITE FORTUNATE IN CALIFORNIA TO
BE ABLE TO IMPLEMENT SENATOR
HURTADO'S SB 260 FROM 2019. THAT
BILL GIVES US THE ABILITY TO
AUTOMATICALLY SELECT A PLAN FOR
PEOPLE WHO LOSE MEDI-CAL. WE
IMPLEMENTED THAT WITH THE START
OF THE REDETERMINATIONS IN MAY,
AND WE'VE SEEN GOOD EARLY
SUCCESS. EVERY MONTH. THOUSANDS
OF PEOPLE TRANSITIONED TO OUR
COVERAGE FROM MEDI-CAL UNDER THE
PROGRAM. OUR OPERATIONS HAVE
BEEN STABLE. BOTH OUR WEBSITE
AND OUR CALL CENTER AND
CONSUMERS HAVE REPORTED
GENERALLY A POSITIVE EXPERIENCE,
FEELING LIKE THE TRANSITION HAS
BEEN SMOOTH. SO WE'VE BEEN VERY
PLEASED SO FAR. AND THAT'S A
PROGRAM THAT WILL GO ON, BEYOND
THE UNWIND PERIOD. AND IT WILL
BE THE NORM FOR US TRANSITIONING
INDIVIDUALS FROM MEDI-CAL. OKAY
WELL, THANK YOU VERY MUCH. IF
THERE'S NOTHING ELSE, WE WILL
MOVE TO OUR SECOND PANEL, WHICH.
THIS. AND WE WILL TAKE ALL
PUBLIC COMMENTS AT THE END. THIS
WILL, REVIEW OUR DEPARTMENT OF
HEALTH CARE ACCESS AND
INFORMATION.
SO, MADAM CHAIR, ASSEMBLY
MEMBER, MY NAME IS SCOTT
CHRISTMAN. I'M THE CHIEF DEPUTY
DIRECTOR FOR THE DEPARTMENT OF
HEALTH CARE ACCESS AND
INFORMATION, OR CHI, I'LL
PROVIDE AN OVERVIEW OF THE
DEPARTMENT'S PROGRAMS AND BUDGET
. AND A BRIEF UPDATE ON THE
HEALTH CARE PAYMENTS, DATA
PROGRAM, I'M JOINED BY TWO
DEPUTY DIRECTORS TO PRESENT
UPDATES AS WELL ON THE OFFICE OF
HEALTH CARE AFFORDABILITY K¾T
THE CALOREX INITIATIVES, AS WELL
AS AN UPDATE ON THE HEALTH
WORKFORCE DEVELOPMENT PROGRAMS,
AS INDICATED IN THE AGENDA FOR
THE DEPARTMENT OF HEALTH CARE
ACCESS AND INFORMATION WAS
RECAST FROM THE OFFICE OF
STATEWIDE HEALTH PLANNING AND
DEVELOPMENT, OR OSHPD, IN 2021,
IN RECOGNITION OF OUR EXPANDING
PROGRAM PORTFOLIO, OUR MISSION
IS TO EXPAND ACCESS TO QUALITY,
AFFORDABLE HEALTH CARE FOR ALL
CALIFORNIANS THROUGH RESILIENT
HEALTH FACILITIES, ACTIONABLE
INFORMATION, AND THE HEALTH
WORKFORCE EACH COMMUNITY NEEDS.
THE DEPARTMENT INCLUDES FIVE
PROGRAM AREAS THAT I'LL TOUCH ON
FACILITIES, FINANCING, WORKFORCE
DATA, AND AFFORDABILITY. SO
FIRST, HCCI SERVES AS THE
BUILDING DEPARTMENT IN
CALIFORNIA FOR HOSPITALS AND
SKILLED NURSING FACILITIES,
MONITORING THE CONSTRUCTION,
RENOVATION, SEISMIC SAFETY OF
THESE FACILITIES. OUR PRIMARY
GOAL IS TO PROMOTE PATIENT
SAFETY BY ENSURING THAT EACH
FACILITY REMAINS FUNCTIONAL IN
THE EVENT OF A NATURAL DISASTER,
INCLUDING MAJOR EARTHQUAKES. IN
TERMS OF FINANCING, HCCI
ADMINISTERS THE CAL MORTGAGE
LOAN INSURANCE PROGRAM, OFFERING
LOAN INSURANCE TO NONPROFIT AND
PUBLIC HEALTH FACILITIES FOR THE
DEVELOPMENT AND EXPANSION OF
HEALTH CARE SERVICES THROUGHOUT
CALIFORNIA. WE ALSO IMPLEMENTED
THE DISTRESSED HOSPITAL LOAN
PROGRAM LAST YEAR, WHICH WAS
DISCUSSED ACTUALLY IN PREVIOUS
OVERSIGHT HEARING THIS THIS
CYCLE, WE ALSO ADMINISTER THE
NEW SMALL AND RURAL HOSPITAL
RELIEF PROGRAM, WHICH PROVIDES
GRANTS TO SMALL RURAL AND
CRITICAL ACCESS HOSPITALS FOR
SEISMIC SAFETY COMPLIANCE
PROJECTS, IN TERMS OF WORKFORCE,
ALL HCCI MANAGES A VERY BROAD
EXPANDING PORTFOLIO OF HEALTH
WORKFORCE DEVELOPMENT PROGRAMS
WITH THE GOALS OF BUILDING A
WORKFORCE THAT ONE REFLECTS
CALIFORNIA'S RACIAL AND
LINGUISTIC DIVERSITY, TWO SERVES
MEDICALLY UNDERSERVED AREAS AND
THREE SERVES MEDI-CAL MEMBERS
ACROSS CALIFORNIA. THESE
PROGRAMS SPECIFICALLY SUPPORT
DELIVERING PRIMARY CARE,
BEHAVIORAL HEALTH, AND ORAL
HEALTH. AND THROUGH THESE
PROGRAMS, WE APPLY A RANGE OF
STRATEGIES THAT INCLUDE DIRECT
GRANT FUNDING TO MEDICAL
SCHOOLS, NURSING PROGRAMS, AND
OTHER HEALTH CARE TRAINING
INSTITUTIONS. SCHOLARSHIPS AND
LOAN REPAYMENTS TO STUDENTS AND
HEALTH PROFESSIONALS WHO AGREE
TO PROVIDE PATIENT CARE IN
MEDICALLY UNDERSERVED AREAS, AND
PIPELINE PROGRAMS THAT INTRODUCE
HEALTH PROFESSIONS TO YOUTH FROM
UNDERREPRESENTED COMMUNITIES.
HØI ALSO FUNDS SEVERAL IMPORTANT
PROGRAMS SUPPORTING HEALTH CARE
PROVIDERS THAT ENSURE
CALIFORNIANS HAVE ACCESS TO
REPRODUCTIVE HEALTH, INCLUDING
ABORTION SERVICES, OUR FIFTH AND
LATEST PROGRAM AREA FOCUSES
SQUARELY ON HEALTH CARE
AFFORDABILITY, INCLUDING THREE
PARTS THE OFFICE OF HEALTH CARE
AFFORDABILITY AND CAL PHARMACY
PROGRAMS, WHICH YOU'LL HEAR MORE
ABOUT, AND THE HOSPITAL FAIR
BILLING PROGRAM. SO VISHAL
PAGANI WILL PRESENT UPDATES ON
OHCA AND CALOREX IN THE NEXT
AGENDA ITEM. BUT I'LL JUST ADD
THAT THIS YEAR, NEW TO HCCI, WE
TOOK OVER ENFORCEMENT OF THE
HOSPITAL FAIR BILLING ACT, WHICH
IMPOSES RULES ON HOSPITAL
BILLING PRACTICES FOR UNINSURED
AND UNDERINSURED PATIENTS. SO WE
NOW ACCEPT COMPLAINTS DIRECTLY
FROM CONSUMERS ABOUT HOSPITAL
BILLS AND REVIEW THOSE TO
DETERMINE IF A HOSPITAL FOLLOWED
THEIR OWN DISCOUNT AND CHARITY
CARE POLICIES. WE ALSO CHECK TO
CONFIRM THOSE POLICIES, COMPLY
WITH LEGAL REQUIREMENTS, AND
THAT HOSPITALS ARE CONFORMING TO
THOSE REQUIREMENTS, IN TERMS OF
BUDGET AT HCCI, OUR CURRENT YEAR
BUDGET IS $1.2 BILLION AND OUR
PROPOSED BUDGET FOR 2425 IS 525
THREE 523 MILLION. EXCUSE ME,
MANY OF THESE FUNDS INCLUDE
MULTIYEAR AUTHORITY SUCH THAT WE
CONTINUE TO SPEND DOWN SOME
PRIOR YEAR FUNDING, THE PROPOSED
BUDGET REFLECTS A REDUCTION OF
$716 MILLION COMPARED TO THE
CURRENT YEAR BUDGET OF 1.2
BILLION, BUT THE CURRENT YEAR
BUDGET INCLUDES CARRYOVER FROM
FISCAL YEAR 2223 OF
APPROXIMATELY $823 MILLION, 753
MILLION OF THAT IS GENERAL FUND.
SO, IF WE REFER TO THE ORIGINAL
CURRENT YEAR BUDGET OF 667
MILLION, THE ACTUAL DIFFERENCE
YEAR OVER, IS 143 MILLION,
MOSTLY DUE TO DELAYS IN HEALTH
WORKFORCE FUNDING FROM THE LAST
CYCLE. HIS PROPOSED BUDGET ALSO
REFLECTS DELAYS IN HEALTH
WORKFORCE MANAGEMENT PROGRAMS.
PROGRAM FUNDING OF $770 MILLION
FOR NURSING, $70.1 MILLION FOR
SOCIAL WORK, AND 189.4 MILLION
IN VARIOUS BEHAVIORAL HEALTH
PROGRAMS. FUNDING FROM THE 2324
BUDGET, FOR A TOTAL OF 329.5
MILLION, AND PROPOSED DELAYS,
WHICH LIBBY ABBOTT WILL COVER IN
MORE DETAIL IN HER PRESENTATION.
BUT WE ARE REQUESTING POSITION
AUTHORITY ONLY, NOT FUNDING FOR
19 POSITIONS IN THE PROPOSED
BUDGET, WHICH WOULD BRING THE
DEPARTMENT TO 748 AUTHORIZED
POSITIONS IN THE BUDGET YEAR.
I'D BE GLAD TO ANSWER ANY
QUESTIONS OR MOVE TO THE UPDATE
ON THE HEALTH PAYMENTS DATA
PROGRAM. YOU CAN MOVE TO THE
UPDATE. THANK YOU, THANK YOU.
OKAY, THE HEALTH CARE PAYMENTS
DATABASE, OR HPPD, IS
CALIFORNIA'S ALL PAYER CLAIMS
DATABASE. THE INFORMATION FROM
THE HPPD IS INTENDED TO SUPPORT
GREATER HEALTH CARE COST
TRANSPARENCY AND USED TO INFORM
POLICY DECISIONS REGARDING THE
PROVISION OF QUALITY HEALTH CARE
AND TO REDUCE HEALTH CARE COSTS
AND DISPARITIES. DISPARITIES
BROADLY MORE SPECIFICALLY, THE
HPPD IS A LARGE RESEARCH
DATABASE MADE UP OF HEALTH CARE
ADMINISTRATIVE DATA, PRIMARILY
OF HEALTH CARE CLAIMS AND
ENCOUNTER DATA, INCLUDING THE
CLAIMS THAT PROVIDERS SUBMIT TO
HEALTH PLANS FOR PAYMENT AND THE
ENCOUNTERS FOR SERVICES PROVIDED
UNDER A MANAGED CARE
ARRANGEMENT, WHICH INCLUDE
HEALTH PLANS, INSURERS, PUBLIC
SELF-INSURED ORGANIZATIONS,
MEDI-CAL AND MEDICARE. THE
DATABASE INCLUDES PATIENT
CHARACTERISTICS, PROCEDURES AND
SERVICES, INFORMATION PROVIDER
INFORMATION, COST INFORMATION
AND MORE. THESE DATA CAN BE USED
TO UNDERSTAND TRENDS AND
VARIATIONS IN HEALTH CARE COSTS,
UTILIZATION, QUALITY, AND
EQUITY. IMPLEMENTATION OF THE
DATABASE WAS AUTHORIZED BY THE
BUDGET ADOPTED IN 2020. IT
INCLUDED A ONE TIME, $60 MILLION
GENERAL FUND APPROPRIATION
AUTHORIZED THROUGH FISCAL YEAR
2425, COMING UP, I'M PLEASED TO
REPORT THE DATABASE WAS
SUCCESSFULLY IMPLEMENTED COMING
ONLINE LAST YEAR, JULY 23RD, AS
SPECIFIED IN THE STATUTE. HØI
HAS SINCE RELEASED TWO PUBLIC
ANALYTIC REPORTS AND THE DATA
SETS ASSOCIATED WITH THAT, AND
IS DESIGNING POLICIES AND
PROCEDURES NOW FOR CONTROLLED
ACCESS TO NONPUBLIC DATA BY
REQUEST FROM THE RESEARCH
COMMUNITY, BEGINNING LATER THIS
YEAR. IN MARCH OF THIS YEAR, HCI
SUBMITTED A REPORT TO THE
LEGISLATURE THAT DETAILS THE
STATUS OF THE DATABASE CURRENTLY
AND SPECIFICALLY EVALUATING THE
DATA QUALITY AND COMPLETENESS.
THE REPORT CONCLUDES THAT THE
HPD DATA IS COMPARABLE TO OTHER
CLAIMS DATABASES IN OTHER
STATES, AND SUITABLE TO SUPPORT
A NUMBER OF USE CASES FOR
RESEARCH AND ANALYSIS.
ADDITIONALLY HPD INFORMATION IS
USED TO SUPPORT THE OFFICE OF
HEALTH CARE AFFORDABILITY, WHICH
YOU'LL HEARD MORE ABOUT
NECESSARY FOR OHCA TO FULFILL.
FULLY ASSESS TOTAL HEALTH CARE
EXPENDITURES. IDENTIFY COST
DRIVERS, AND TO PERFORM TARGETED
ANALYZES BY POPULATION,
GEOGRAPHY, AND HEALTH CARE
SECTOR, A QUESTION IN THE AGENDA
WAS, HAS THE HEALTH CARE
PAYMENTS DATA PROGRAM DATA SET
BEEN USED TO ANALYZE HEALTH CARE
COSTS? YES. THE HPD PROVIDES A
CRITICAL OPPORTUNITY ANALYZE
HEALTH CARE COSTS IN THE STATE,
OUR HPD STAKEHOLDER ADVISORY
COMMITTEE HAS PRIORITIZED TWO
AREAS IN PARTICULAR FOR PUBLIC
REPORTING ON HEALTH CARE COSTS.
THIS INCLUDES PRESCRIPTION DRUGS
AND HOSPITAL COSTS. SO HCI IS
NOW IN THE PROCESS OF DEVELOPING
THE FIRST PRESCRIPTION DRUG COST
REPORT, WHICH SHOULD BE RELEASED
SOON, AND HAS SET HOSPITAL COSTS
AS A PRIORITY FOR FUTURE PUBLIC
REPORTING. ADDITIONALLY, OHCA
HAS BEGUN TO ASSESS HPD DATA
THAT CAN SUPPORT THEIR
AFFORDABILITY AND SPENDING
GROWTH ANALYSIS FUNCTIONS, FOR
EXAMPLE, ATTRIBUTING CLAIMS AND
SPENDING TO HOSPITALS AND USING
CLAIMS DATA TO UNDERSTAND HEALTH
CARE UTILIZATION BY REGION IN
CALIFORNIA. TO SUPPORT OCHA'S
EQUITY WORK. ADDITIONALLY, THE
CALOREX PROGRAM IS ALSO
EVALUATING HPD DATA TO
UNDERSTAND PRESCRIPTION DRUG
DISTRIBUTION PATTERNS THAT CAN
HELP THE PROGRAM MAXIMIZE COST
SAVINGS FOR CONSUMERS. SO WITH
THAT, I'D BE HAPPY TO ANSWER ANY
QUESTIONS ON THE OVERVIEW, OR
MOVE US TO THE NEXT ITEM ON THE
AGENDA, WHICH BE, UPDATES ON THE
OFFICE OF HEALTH CARE
AFFORDABILITY AND THE CALOREX
INITIATIVES. LET'S GO AHEAD AND
DO THAT. VERY GOOD. I'M GOING TO
TURN IT OVER TO VISHAL BACANI,
OUR DEPUTY DIRECTOR. THANKS.
GOOD AFTERNOON. MEMBERS OF THE
COMMITTEE, I'M VISHAL PAGANI,
DEPUTY DIRECTOR FOR THE OFFICE
OF HEALTH CARE AFFORDABILITY AT
HCCI. I'LL FIRST PROVIDE AN
UPDATE ON THE PROGRESS OF
IMPLEMENTING THE OFFICE OF
HEALTH CARE AFFORDABILITY, OR
OHCA. OKO WAS ESTABLISHED IN THE
20 2223 BUDGET TO ADDRESS THE
CRUSHING COSTS CONSUMERS FACE IN
PAYING FOR HEALTH CARE PREMIUMS
AND SERVICES. WE KNOW THAT MORE
THAN HALF OF CALIFORNIA'S
CALIFORNIA CONSUMERS GO WITHOUT
HEALTH CARE SERVICES DUE TO COST
AND FACE WORSE HEALTH CONDITIONS
AS A RESULT, AND THOSE IMPACTS
ARE WORSE FOR BLACK, LATINA AND
LOW INCOME CALIFORNIANS. IN
RESPONSE TO GOVERNOR AND
LEGISLATURE PARTNERED TO CREATE
OKA. OKA HAS THREE MAIN EFFORTS.
FIRST IS SLOWING HEALTH CARE
SPENDING GROWTH. THE SECOND IS
TO PROMOTE HIGH VALUE SYSTEM
PERFORMANCE, AND THE THIRD IS
ASSESSING MARKET CONSOLIDATION.
WE HAVE HAD OUR FIRST FULL YEAR
OF ENGAGEMENT WITH HEALTH CARE
STAKEHOLDERS, SIBLING STATE
DEPARTMENTS AND THE PUBLIC AND
I'M PLEASED TO GIVE AN UPDATE ON
OUR PROGRESS. THE HEALTH CARE
AFFORDABILITY BOARD WAS
APPOINTED AND BEGAN MEETING IN
MARCH. LAST MARCH. OUR BOARD
MEETS MONTHLY WITH THEIR LAST
MEETING, OCCURRING A FEW WEEKS
AGO, AND WE HAVE VERY ROBUST
STAKEHOLDER ENGAGEMENT ON
ESTABLISHING A SPENDING TARGET.
OKA AND THE HEALTH CARE
AFFORDABILITY ARE WORKING
TOWARDS THE JUNE 1ST STATUTORY
REQUIREMENT TO SET A STATEWIDE
SPENDING TARGET THAT ESTABLISHES
AN ACCEPTABLE ANNUAL RATE OF
GROWTH FOR PER CAPITA HEALTH
CARE SPENDING. IN JANUARY, OKA
RECOMMENDED TO THE BOARD A 3%
STATEWIDE SPENDING TARGET FOR
CALENDAR YEAR 2025 THROUGH 2029,
THIS, RECOMMEND ACTION WAS BASED
ON THE 20 YEAR AVERAGE ANNUAL
CHANGE IN MEDIAN HOUSEHOLD
INCOME OVER THE 20 YEAR PERIOD
FROM 2002 TO 2022. THERE ARE
SEVERAL REASONS FOR TYING THE
TARGET TO HISTORICAL MEDIAN
HOUSEHOLD INCOME GROWTH. FIRST,
BASING THE TARGET BASING THE
TARGET ON THIS MEASURE ADHERES
TO THE STATUTE'S REQUIREMENT TO
PROMOTE THE GOAL OF IMPROVED
CONSUMER AFFORDABILITY. THIS IS
ALSO IN ALIGNMENT WITH THE
BOARD'S PREFERENCE FOR USING A
CONSUMER CENTRIC ECONOMIC
INDICATOR, MOST IMPORTANTLY,
TYING TO A HISTORICAL MEDIAN
HOUSEHOLD INCOME GROWTH SIGNALS
THAT HEALTH CARE SPENDING SHOULD
NOT GROW FASTER THAN THE INCOME
OF CALIFORNIA'S FAMILIES. THIS
RECOMMENDATION PLACES CALIFORNIA
ON THE PATH OF A MORE
SUSTAINABLE, AFFORDABLE, AND
EQUITABLE HEALTH CARE SYSTEM,
SLOWING THE TRAJECTORY OF HEALTH
CARE SPENDING GROWTH AND
IMPROVING AFFORDABILITY FOR
CALIFORNIANS. I'LL NOW MOVE ON
TO PROVIDING AN UPDATE ON OUR
TOTAL HEALTH CARE SPENDING DATA
COLLECTION EFFORTS, OKA HAS
FINALIZED EMERGENCY REGULATIONS
ESTABLISHING REQUIREMENTS FOR
PAYERS TO SUBMIT DATA ON TOTAL
HEALTH CARE EXPENDITURES BY
SEPTEMBER 1ST OF 2024, AND
ANNUALLY THEREAFTER. THESE
REGULATIONS FACILITATE THE DATA
COLLECTION NECESSARY TO MEASURE
TOTAL HEALTH CARE EXPENDITURES.
OKA WILL PUBLISH A BASELINE
HEALTH CARE SPENDING REPORT IN
2025, BASED ON THE ENABLING
STATUTE, SPENDING IN CALENDAR
YEAR 2026 WILL BE SUBJECT TO
PROGRESSIVE ENFORCEMENT, WHICH
INCLUDES ENGAGING IN TECHNICAL
ASSISTANCE WITH ENTITIES THAT
EXCEEDED THE TARGET, COMPELLING
PUBLIC TESTIMONY AT A PUBLIC
MEETING OF THE BOARD IN
IMPLEMENTING PERFORMANCE
IMPROVEMENT PLANS. AND AS A LAST
RESORT, ASSESSED FINANCIAL
PENALTIES, MOVING ON TO HEALTH
SYSTEM PERFORMANCE ACTIVITIES TO
ENSURE A BALANCED APPROACH TO
SLOW SPENDS, TO SLOWING SPENDING
GROWTH, OKA IS PROMOTING HIGH
VALUE SYSTEM PERFORMANCE THROUGH
CREATING ALTERNATIVE PAYMENT
MODEL STANDARDS OR ADOPTING
ALTERNATIVE PAYMENT ADOPTION
GOALS OR VALUE BASED PAYMENT
ADOPTION GOALS, AND SETTING A
PRIMARY CARE INVESTMENT
BENCHMARK INFORMED BY A MULTI
STAKEHOLDER INVESTMENT IN
PAYMENT WORK GROUP. OKA IS ALSO
LAYING THE GROUNDWORK TO FULFILL
ITS REQUIREMENTS TO ADVANCE
WORKFORCE STABILITY, TO ADOPT A
BENCHMARK FOR SPENDING ON
BEHAVIORAL HEALTH, AND TO ALSO
MEASURE A SET OF EQUITY AND
QUALITY METRICS, ALONGSIDE
SPENDING PERFORMANCE AND GOING
TO THE THIRD PRONG OF OKA'S
EFFORTS. MARKET CONSOLIDATION,
BECAUSE HEALTH CARE
CONSOLIDATION IS A MAJOR
CONTRIBUTOR CONTRIBUTOR TO
HEALTH CARE COSTS, THE THIRD
AREA, OKA HAS AUTHORITY OVER IS
HEALTH CARE MARKET OVERSIGHT IN
THIS AREA. OKA HAS ISSUED
REGULATIONS IMPLEMENTING ITS
COST AND MARKET IMPACT REVIEW
PROGRAM AND DEVELOPED A WEB
PORTAL FOR HEALTH CARE ENTITIES
TO SUBMIT NOTICES OF PROPOSED
MERGERS AND ACQUISITIONS. AS OF
JANUARY 1ST, 2024, HEALTH CARE
ENTITIES ARE REQUIRED TO PROVIDE
OKA WITH 90 DAYS NOTICE OF
COVERED TRANSACTIONS SUCH AS
MERGERS, ACQUISITIONS, AND
CORPORATE AFFILIATIONS THAT ARE
EXPECTED TO CLOSE ON OR AFTER
APRIL 1ST, 2024. THROUGH ITS
REVIEW OF TRANSACTIONS, OHKAWA
WILL MONITOR THE IMPACT OF
MARKET CONSOLIDATION AND WILL
EVALUATE AND REVIEW PROSPECTIVE
TRANSACTIONS THAT COULD AFFECT
AFFORDABILITY, ACCESS, EQUITY
AND CARE IN CALIFORNIA'S HEALTH
CARE MARKET AND PUBLICLY REPORT
ON THESE TRANSACTIONS. OKA'S
REVIEW WILL FILL A GAP IN THE
OVERSIGHT OF TRANSACTIONS, THAT
ARE CURRENTLY NOT REVIEWED BY
OTHER REGULATORS, SUCH AS THE
ATTORNEY GENERAL OR OTHER STATE
AGENCIES, I'LL NOW PROVIDE AN
UPDATE ON, ON, THE CALOREX
PROGRAM, I'D FIRST NOTE THAT THE
AGENDA INCLUDES OUR TECHNICAL
ADJUSTMENT BCP, WHICH WOULD
PROVIDE POSITION AUTHORITY,
USING EXISTING BUDGET RESOURCES,
I'LL NOW PROVIDE UPDATES ON
IMPLEMENT THE CALOREX BIOSIMILAR
INSULIN INITIATIVE AND THE CAL
RX NALOXONE ACCESS INITIATIVE,
FIRST BIOSIMILAR INSULIN. AS
MANY OF YOU ARE AWARE, IN
FEBRUARY 2023, HCCI INITIATED A
CONTRACT WITH CIVICA RX, A
NONPROFIT DRUG COMPANY FOR THE
DEVELOPMENT OF BIOSIMILAR
INSULINS FOR THE THREE MOST
POPULAR FORMS ASPART LISPRO AND
GLARGINE CIVICA. IS ADVANCING ON
ITS DEVELOPMENT EFFORTS AND
MAINTAINS CLOSE COMMUNICATIONS
WITH THE FDA. THEY DO NOT AT
THIS TIME HAVE A SPECIFIC TIME
FRAME FOR APPROVAL, IN HIS ROLE
AS A CIVICA FOUNDATION BOARD
MEMBER, HEALTH AND HUMAN
SERVICES SECRETARY, DOCTOR MARK
GALLI WILL CONTINUE TO WORK WITH
AND HELP DRIVE OUR CIVICA
PARTNERS TO MAKE INSULIN
AVAILABLE AS SOON AS POSSIBLE.
CIVICA IS MAKING ENHANCEMENTS TO
ITS PETERSBURG, VIRGINIA TEAM,
TO HELP FURTHER THESE EFFORTS
FOR DRUG DEVELOPMENT, REGARDING
THE GOVERNOR'S BUDGET DEFERRAL
OF THE 50 MILLION FOR THE
MANUFACTURING FACILITY, WE NOTE
THAT THIS THIS COMPONENT OF THE
INITIATIVE ENTAILS COMPLEX
PLANNING WITH ACTIVE
COLLABORATION AMONG HCCI CIVICA
AND THE GOVERNOR'S OFFICE OF
BUSINESS AND ECONOMIC
DEVELOPMENT. IT IS ANTICIPATED
TO EXTEND BEYOND THE CURRENT
FISCAL YEAR DUE TO ITS
MULTIFACETED NATURE THAT
INCLUDES SITE SELECTION,
ASSESSING WATER AND ENERGY
NEEDS, AND ENSURING ACCESS TO
SKILLED LABOR. THIS PROJECT WILL
BE NECESSARY WHEN CIVICA NEEDS
TO EXPAND BEYOND ITS INITIAL
OVERSEAS SUPPLIER FOR ACTIVE
DRUG SUBSTANCE, AT WHICH TIME
THE CALIFORNIA BASED
MANUFACTURING FACILITY WOULD BE
THE DOMESTIC SOURCE FOR ACTIVE
DRUG SUBSTANCE, EFFORTS TOWARDS,
GETTING THE PRODUCT, IN MARKET
OR COMMERCIALIZED THÀNH IS ALSO
IN PROGRESS, WITH CIVICA
FOCUSING ON DISCUSSIONS WITH
HEALTH PLANS AND PBM OR PHARMACY
BENEFIT MANAGER ENTITIES, TO
ACHIEVE PREFERRED FORMULARY
STATUS FOR THE CALOREX BRANDED
INSULIN PRODUCTS ONCE THEY'RE
APPROVED BY THE FDA. I'LL NOW
COVER THE CALOREX NALOXONE
ACCESS INITIATIVE REGARDING OUR
WORK TO BRING A LOW COST,
OVER-THE-COUNTER VERSION OF
NALOXONE, WE HAVE BEEN HAVING
POSITIVE, ONGOING DISCUSSIONS
WITH MULTIPLE VENDORS. WE ARE
CONFIDENT WE WILL. WE WILL BE
ABLE TO PROCURE AN
OVER-THE-COUNTER, VERSION OF
NALOXONE AT A SIGNIFICANTLY
REDUCED PRICE THAN THE CURRENT
PUBLIC INTEREST PRICE, THAT THAT
IS AVAILABLE TO THE DEPARTMENT
OF HEALTH CARE SERVICES AND
NALOXONE DISTRIBUTION PROGRAM.
OUR GOAL IS TO HAVE A
PARTNERSHIP AND AGREEMENT IN
PLACE BY SUMMER AND CALOREX
BRANDED, NALOXONE PRODUCTS
AVAILABLE FOR PURCHASE BY THE
END OF THE CURRENT YEAR, THAT
COVERS MY OVERVIEW. I'M HAPPY TO
TAKE ANY QUESTIONS OR MOVE ON TO
THE NEXT ITEM. QUESTIONS WANTED
TO FOCUS SOME, QUERIES AROUND
THE WORKFORCE INITIATIVES. I
THINK ONE OF THE THINGS THAT WAS
MOST STRIKING TO ME WAS THAT WE
JUST DECIDED TO MOVE FORWARD AS
A STATE WITH PROP ONE,
EVERYWHERE YOU LOOK, THERE IS A
NEED FOR BEHAVIORAL HEALTH
WORKERS. WE'VE HAD SEVERAL
HEARINGS IN TERMS OF THE NEED TO
DIVERSIFY OUR HEALTH CARE
WORKFORCE. AND, WANTED TO, JUST
HIGHLIGHT THE FACT THAT THERE
HAVE BEEN SIGNIFICANT DEFERRALS,
IN SPENDING AROUND HEALTH CARE,
WORKFORCE TRAINING AND PIPELINE
DEVELOPMENT IN THE GOVERNOR'S
PROPOSAL. AND IN YOUR BCC PIECE.
SO IF YOU COULD JUST KIND OF
STEP BACK INTO THAT SPACE AND
GIVE US A, A SENSE OF WHAT HAS
BEEN HAPPENING IN TERMS OF THE,
THE, THE OVERALL WORKFORCE
INITIATIVES, JUST AN UPDATE ON
THE STATUS OF THOSE AND, AND
THEN MORE SPECIFICALLY, WHAT
WOULD A DELAY IN THE WORKFORCE
FUNDING THAT HAS BEEN
ARTICULATED, Dð. TO IMPACT
WORKFORCE TRAINING? YEAH.
ASSEMBLY MEMBER, THE NEXT
SPEAKER, LIBBY WOULD BE HAPPY TO
ANSWER THOSE QUESTIONS. OKAY.
YEAH, ABSOLUTELY. AND. OKAY.
GREAT. CAN YOU HEAR ME, THERE
ARE A NUMBER OF QUESTIONS IN THE
AGENDA THAT I CAN TALK THROUGH.
MAYBE I'LL START WITH JUST THE
FIRST ONE TO GIVE YOU AN UPDATE
ON SOME OF OUR MAJOR
INITIATIVES. SO LIBBY ABBOTT,
DEPUTY DIRECTOR FOR THE OFFICE
OF HEALTH WORKFORCE DEVELOPMENT.
I'LL START THERE AND THEN FEEL
FREE TO JUMP IN, WE HAVE QUITE A
FEW QUESTIONS TO GET THROUGH.
HCCI CURRENTLY IMPLEMENTS A
TOTAL OF 56 PROGRAMS SPANNING
PRIMARY CARE, BEHAVIORAL HEALTH,
AND ORAL HEALTH. IN RECENT
YEARS, WE HAVE TAKEN ON THE
WORKFORCE COMPONENTS OF SEVERAL
MAJOR INITIATIVES. SO IN THE
INTEREST OF TIME, I WON'T WALK
YOU THROUGH OUR 56 PROGRAMS, BUT
I'LL FOCUS ON TWO OF THOSE MAJOR
INITIATIVES IN 2021 THE CHILDREN
AND YOUTH BEHAVIORAL HEALTH
INITIATIVE, CYBER WAS LAUNCHED
AS PART OF THE MASTER PLAN FOR
KIDS MENTAL HEALTH, A HISTORIC
INVESTMENT BY THE STATE OF
CALIFORNIA THAT TAKES A WHOLE
CHILD APPROACH TO ADDRESS THE
FACTORS THAT CONTRIBUTE TO THE
MENTAL HEALTH AND WELL-BEING OF
OUR CHILDREN AND YOUTH. FROM
THIS PACKAGE, HCCI RECEIVED JUST
OVER $338 MILLION IN LOCAL
ASSISTANCE TO STAND UP A NEW
TYPE OF PROVIDER, CERTIFIED
WELLNESS COACHES, WHO WILL BE A
CULTURALLY DIVERSE AND
REPRESENTATIVE WORKFORCE THAT
WILL SUPPORT CHILDREN'S SOCIAL
AND EMOTIONAL DEVELOPMENT AND
PROVIDE APPROPRIATE REFERRAL
SERVICES IN SETTINGS THAT REACH
ALL CHILDREN, INCLUDING
PRIMARILY SCHOOLS AND COMMUNITY
BASED ORGANIZATIONS. OVER THE
LAST TWO YEARS, HCCI HAS WORKED
HARD TO PUT IN THE LEGWORK TO
RESEARCH, DESIGN, AND ROLL OUT
THIS NEW PROVIDER TYPE. IN
FEBRUARY, WE LAUNCHED THE
CERTIFICATION PLATFORM AND I'M
VERY PLEASED TO BE ABLE TO SHARE
THAT. AS OF THIS MORNING, WE
HAVE CALIFORNIA'S FIRST 48
CERTIFIED WELLNESS COACHES WITH
OVER 1000 ADDITIONAL
CERTIFICATION ACCOUNTS CREATED
AND AN ONGOING ACTIVE MARKETING
CAMPAIGN TO RECRUIT ADDITIONAL
CANDIDATES FOR CERTIFICATION. WE
WILL SOON BE ANNOUNCING $120
MILLION IN AWARDS AS PART OF OUR
EMPLOYER SUPPORT GRANT WORK
STREAM, WHICH GIVES COUNTY
OFFICES OF EDUCATION, LOCAL
EDUCATION AGENCIES AND COMMUNITY
BASED ORGANIZATIONS THE
OPPORTUNITY TO HIRE THEIR FIRST
WELLNESS COACHES. WHILE THE
SUSTAINABLE FINANCING SOLUTION
IN THE FORM OF THE MEDI-CAL
BENEFIT IS EXPECTED TO COME
ONLINE IN 2025. SO THAT'S SORT
OF A BRIDGING GRANT TO GENERATE
DEMAND AND GET FOLKS ONLINE.
THIS MONTH. WE WILL ALSO LAUNCH
OUR FIRST SCHOLARSHIP CYCLE FOR
STUDENTS INTERESTED IN BECOMING
WELLNESS COACHES. THE SECOND
INITIATIVE, I'LL PROVIDE A BRIEF
UPDATE ON IS THE REPRODUCTIVE
HEALTH INITIATIVE IN 2022, HCCI
WAS AUTHORIZED TO IMPLEMENT
$113.3 MILLION OF AVAILABLE
FUNDS TO EXPAND ACCESS TO
REPRODUCTIVE CARE AND ABORTION
SERVICES. IN OUR FIRST TWO
YEARS, WE'VE ADMINISTERED 44
MILLION, OR 39% OF THOSE FUNDS
TO EXPAND THE WORKFORCE NEEDED
TO PROVIDE REPRODUCTIVE HEALTH
AND ABORTION SERVICES, SECURE
PHYSICAL INFRASTRUCTURE, AND
PROVIDE FINANCIAL SUPPORT BOTH
TO FACILITIES THAT ARE PROVIDING
CARE TO LOW INCOME PATIENTS AND
TO INDIVIDUALS WHO HAVE TRAVELED
TO AND WITHIN CALIFORNIA TO
RECEIVE CRITICAL REPRODUCTIVE
HEALTH CARE. SOME OF OUR
SPECIFIC RESULTS THUS FAR
INCLUDE THAT WE HAVE PROVIDED
FINANCIAL SUPPORT TO 1074
INDIVIDUALS SEEKING ABORTIONS.
WE HAVE AWARDED $8 MILLION TO 21
FACILITIES AND PROVIDERS TO
SECURE PHYSICAL AND DIGITAL
INFRASTRUCTURE, FOR WE HAVE
PROVIDED UNCOMPENSATED ABORTION
CARE SERVICES IN MORE THAN 40 OF
CALIFORNIA'S 58 COUNTIES, AND WE
HAVE AWARDED $3.9 MILLION IN
SCHOLARSHIPS AND LOAN REPAYMENT
TO 186 HEALTH WORKERS WHO HAVE
COMMITTED TO PROVIDING
REPRODUCTIVE CARE. AND WE WILL
BE AWARDING AN ADDITIONAL 2.4
MILLION TO 75 ADDITIONAL
AWARDEES. HCCI IS ALSO USING THE
REPRODUCTIVE HEALTH INITIATIVE
FUNDING TO SUPPORT THE
UNIVERSITY OF CALIFORNIA, SAN
FRANCISCO TO STAND UP THE
REPRODUCTIVE HEALTH WARMLINE, A
CONFIDENTIAL NON-EMERGENCY CALL
CENTER THAT FOCUSES ON PROVIDING
REAL TIME CLINICAL CASE
REPRODUCTIVE HEALTH AND ABORTION
EDUCATION AND SUPPORT TO
CLINICIANS IN PRIMARY CARE
SETTINGS BOTH WITHIN AND OUTSIDE
OF CALIFORNIA. TO SUPPORT THE
IMPLEMENTATION OF THESE CRITICAL
INITIATIVES AND OUR MANY OTHER
HEALTH WORKFORCE DEVELOPMENT
PROGRAMS, HCCI HAS SUBMITTED A
BUDGET CHANGE PROPOSAL,
ALIGNMENT OF HEALTH WORKFORCE
DEVELOPMENT PROGRAMS AND
STAFFING RESOURCES. THIS BCP
REQUEST POSITION AUTHORITY FOR
16 POSITIONS FOR THE OFFICE OF
HEALTH WORKFORCE DEVELOPMENT FOR
FISCAL YEAR 2425 AND ONGOING TO
IMPLEMENT MULTIPLE NEW AND
EXPANDING HEALTH WORKFORCE
DEVELOPMENT PROGRAMS AND
INITIATIVES, AND WOULD BE
SUPPORTED BY PREVIOUSLY
AUTHORIZED EXPENDITURE
AUTHORITY. THERE IS NO
ADDITIONAL FISCAL FOR THESE
POSITIONS. THE BCP IS A TRUE UP
FOR WORKLOAD, AND WE ARE USING
THIS TO REPLACE CONTRACT AND
BLANKET STAFF AND TRANSITION
THEM TO PERMANENT STATE STAFF IN
ORDER TO CATCH UP WITH AND
SUSTAIN WORKLOAD ASSOCIATED WITH
A SIGNIFICANT INCREASE IN
FUNDING THAT WE'VE SEEN OVER THE
LAST SEVERAL YEARS. I'M HAPPY TO
PAUSE THERE. I KNOW THERE WERE
SEVERAL OTHER QUESTIONS IN THE
AGENDA THAT I CAN ADDRESS
HELPFUL. HAVE A SPECIFIC
QUESTION AROUND THE IMPACT OF
THE PROPOSED WORKFORCE
INITIATIVES ON THE CHW PER
CERTIFICATION PROGRAM. SO THOSE
FUNDS ARE NOT IMPACTED BY OUR
DEFERRALS. WE MAINTAIN I BELIEVE
IT'S 188 MILLION FOR THE COMING
BUDGET YEAR. WE ARE GOING
THROUGH AN EXTENSIVE, AS YOU
HEARD, AT OUR OUR LAST HEARING
ON THIS, AN EXTENSIVE
CONSULTATION PROCESS TO MAKE
SURE WE USE THOSE FUNDS WISELY
AND IN THE MOST IMPACTFUL WAY.
AND WE EXPECT THAT WE WILL HAVE
A CLEAR SENSE OF HOW BEST TO
ALLOCATE THOSE FUNDS AND HOW
BEST TO SUPPORT STATE WIDE
PROFESSIONAL DEVELOPMENT AND THE
OPTION OF A CERTIFICATE IN THE
COMING MONTHS.
SINCE WE'RE ON THE, SUBJECT OF
PROGRAMS, I HAD A CONVERSATION
ABOUT THIS. I BELIEVE IN THE
LAST BUDGET HEARING, AND I
DIDN'T REALLY GET A CLEAR
ANSWER. SO YOU ALL WERE
ALLOCATED MONEY FOR A
PSYCHIATRIC LOAN REPAYMENT
PROGRAM, WHICH YOU CHOSE NOT TO
IMPLEMENT. WHY WHY DO YOU WANT
TO TAKE THIS? OPPORTUNITY. THE
DEPARTMENT OF FINANCE. SO I
WOULD NOTE THAT THIS IS A NEW
PROGRAM THAT'S A WORK IN
PROGRESS ADMINISTERED BY HCCI ON
THE BEHALF OF THE DEPARTMENT OF
STATE HOSPITALS. AND ALTHOUGH A
SUBSTANTIAL AMOUNT OF WORK HAD
BEEN DONE BY HCCI TO
OPERATIONALIZE THIS NEW PROGRAM,
SUCH AS DEVELOP THE APPLICATION
PROCESS, DEVELOP ELIGIBILITY
CRITERIA, AWARDS AND REPORTING
CRITERIA, THE PROGRAM FUNDING
HAD NOT GONE OUT YET, AND THE
ADMINISTRATION IDENTIFIED THIS
AS A PROPOSED SOLUTION TO THE
BUDGET PROBLEM. IN ORDER TO
MINIMIZE THE IMPACT TO CORE
PROGRAMS. SO UNFORTUNATELY, THAT
WAS THE SAME ANSWER WE GOT IN
THIS IN THE LAST SESSION. AND SO
I WAS HOPING THAT, YOU KNOW,
WITH HCCI HERE, WHO WAS PLACED
IN CHARGE OF OVERSEEING THE
PROGRAM, THAT I WOULD GET A
DIFFERENT ANSWER OR I WOULD SAY
A MORE THOROUGH, IN-DEPTH ANSWER
AS TO WHY THIS MONEY WAS
ALLOCATED IN 2022, SAYING THAT
WE HAVE ISSUES WITH, BEHAVIORAL
HEALTH WITH UP AND DOWN OUR
STATE, WE ALL ACKNOWLEDGE THE
LACK OF PROVIDERS, AND THIS WAS
GIVEN TO YOU AS ANOTHER TOOL IN
YOUR TOOL BELT TO GET MORE
PSYCHIATRISTS INTO OUR STATE
HOSPITALS TO REALLY CARE FOR
SOME OF OUR MOST SEVERE,
PATIENTS THAT HAVE BEHAVIORAL
HEALTH NEEDS AND IT WAS NOT
IMPLEMENTED. AND NOT ONLY WAS IT
NOT IMPLEMENTED, BUT NOW YOU'RE
SAYING, YOU KNOW, TAKE THE MONEY
BACK. BUT I GUESS I WON'T BE
GETTING AN ANSWER AS TO WHY THAT
WASN'T COMPLETELY IMPLEMENTED. I
WILL GO ON TO THE OFFICE OF
HEALTH CARE AFFORDABILITY. VERY
EXCITED TO HEAR ABOUT ALL OF THE
THINGS THAT YOU ALL ARE
TACKLING. VERY MUCH. LOOKING
FORWARD TO SEEING HOW EVERYTHING
PLAYS OUT. WAS VERY, IMPRESSED
TO HEAR LOOKING AT DIFFERENT
PAYMENT MODELS SUCH AS THE VALUE
BASED PAYMENT. I THINK A LOT OF
PEOPLE HAVE KIND OF TALKED ABOUT
WE NEED TO KIND OF SWITCH OVER
TO HOW WE ARE PAYING OR
REIMBURSING PROVIDERS, ONE OF
THE THINGS THAT I, I HAVE HEARD
AS A CONCERN IS THIS 3%
STATEWIDE SPENDING TARGET AND I
WAS WONDERING IF YOU ALL HAD
TAKEN INTO ACCOUNT THAT, CERTAIN
ISSUES SUCH AS INFLATION, SUCH
AS INCREASE IN PAYMENT FOR
WORKFORCE, AND THOSE OTHER
ITEMS, LEGISLATURE, NEW LAWS
THAT COME DOWN THAT WILL COST,
HEALTH PLANS MORE MONEY. DID YOU
ALL TAKE THAT INTO CONSIDERATION
WHEN YOU CAME UP WITH THAT 3, IS
A 3% SEPARATE. AND SO AS PLANS
ARE EXPLAINING WHY THEY MAY BE
OVER 3, THOSE THINGS ARE KIND OF
PULLED OUT. CAN YOU EXPLAIN THAT
TO ME? YES. ASSEMBLY MEMBER
WEBER, SO THE PROCESS WE TOOK
WAS, BASED ON THE STATUTE
REQUIRING US TO REVIEW, ECONOMIC
AND POPULATION BASED INDICATORS,
THE BOARD EARLY ON SIGNALED THAT
THEY WANTED US TO FOCUS ON
CONSUMER CENTRIC MEASURES SUCH
AND SUCH AS MEDIAN HOUSEHOLD
INCOME. SO THE 3% RECOMMENDATION
IS BASED ON THAT, HAVING SAID
THAT, WE HAVE, DISCUSSED, HOW IS
GOING TO PROGRESS OR HOW OHCA IS
GOING TO ASSESS PERFORMANCE ONCE
THE DATA COMES IN AND WE ASSESS
HOW HEALTH CARE ENTITIES DO
AGAINST THE TARGET. SO, THERE'S
SEVERAL, FACTORS THAT HAVE BEEN
IDENTIFIED BY, BY STAKEHOLDERS,
SUCH AS, THE ROLE OF TECHNOLOGY,
INVESTMENTS FOR, FOR TECHNOLOGY,
HIGH COST SPECIALTY DRUGS. AND
IT'S DIFFICULT FOR OHCA TO,
ADJUST FOR THOSE FACTORS ON THE
FRONT END BECAUSE THEY DON'T
IMPACT EVERYONE EQUALLY OR IN
THE SAME WAY. SO WHAT WE HAVE
SAID IS THAT ON THE BACK END,
WHAT WE'RE CALLING ASSESSING
PERFORMANCE, WE WOULD TAKE INTO
ACCOUNT ADDITIONAL INFORMATION
FROM THE HEALTH CARE ENTITY,
FOR, FOR REASONS, A REASONABLE
EXPLANATIONS FOR WHY THEY MAY
HAVE EXCEEDED THE TARGET AND WE
WOULD HAVE A CONVERSATION WITH
THEM ABOUT THAT. THANK YOU. DID
YOU JUST HAVE A BROADER
QUESTION, PERHAPS IN SOMETHING
THAT WE COULD PROBABLY SAY OF
MANY DIFFERENT DEPARTMENTS AND
INITIATIVES, WHEN THERE IS A
JUST ON THE LEVEL OF KIND OF
OFFERING TRANSPARENCY AND
ACCOUNTABILITY, SO WHEN THERE IS
A LEGISLATIVE INITIATIVE LIKE
THE PSYCHIATRIC LOAN REPAYMENT
PROGRAM, FOR INSTANCE, WHERE,
IT'S BEEN INDICATED AS A
PRIORITY OF THE LEGISLATURE AND
THERE HAVE BEEN YEARS OF KIND OF
ESTABLISHING THE PROGRAM, AND
THEN ULTIMATELY IT DOESN'T GET
ESTABLISHED. AND THEN WE CUT THE
FUNDING. WHAT IS THE ALIGNMENT
BETWEEN THE KIND OF AGENCIES
LEVEL OF ACCOUNTABILITY FOR
IMPLEMENTATION OF LEGISLATIVE
PRIORITIES AND THE PROCESS THAT
WE'RE GOING THROUGH NOW? I WOULD
HATE FOR US TO BE IN A SITUATION
WHERE, WE JUST KIND OF DELAY AND
DELAY AND DELAY IMPLEMENTATION
AND ULTIMATELY END UP NOT MOVING
FORWARD WITH WHAT WE SAID THAT
WE WERE GOING TO DO, AFTER 120
LEGISLATORS VOTED ON SOMETHING,
THE GOVERNOR CHAPTERED IT, AND
IT ENDS UP BEING SOMETHING THAT
WE ALL BELIEVE IS GOING TO
HAPPEN FOR OUR CONSTITUENTS. AND
NOW WE'RE FACED WITH MAKING
SERIOUS BUDGET CUTS. I THINK
THAT THESE DECISIONS REFLECT THE
DIFFICULTY IN DEVELOPING A
BALANCED BUDGET AND BALANCING
LEGISLATIVE AS WELL AS
ADMINISTRATIVE PRIORITIES.
DOESN'T REALLY ANSWER MY
QUESTION. I'M ESSENTIALLY GOING
AT GETTING AT THE FACT THAT
WE'RE GOING TO BE HAVING A LOT
OF THESE CONVERSATIONS, AND I
WOULD HATE FOR AROUND CUTS, AND
I WOULD HATE FOR THE STRATEGY TO
BE THAT WE DELAY IMPLEMENTATION
ON PROGRAMS THAT WE'VE
IDENTIFIED THAT WE NEED, AND
THEN JUST ULTIMATELY END UP
CUTTING THEM BECAUSE THEY
HAVEN'T BEEN IMPLEMENTED FULLY.
SO HOW CAN WE FROM AN
ACCOUNTABILITY STANDPOINT AND
IMPLEMENTATION STANDPOINT,
ENSURE THAT WE'RE ACTUALLY
MOVING FORWARD WITH THE PROGRAM
THAT WE FIGHT SO HARD TO GET
FUNDED? THAT'S STILL A QUESTION.
HOPING FOR A DIFFERENT ANSWER
THAT MIGHT BE MORE SPECIFIC TO
THE QUESTION THAT WAS ASKED. HI,
JASON CONSTANDUROS, LEGISLATIVE
ANALYST OFFICE, YOU KNOW, FIRST
I WANT TO NOTE THAT, YOU KNOW,
THERE ARE A LOT OF INITIATIVES
THAT ARE BEING PROPOSED FOR
DELAY OR REDUCTIONS. IT LOOKS
LIKE YOU'VE FOUND THE PAGE, BUT
JUST SO YOU'RE TRACKING ON PAGE
EIGHT, THERE IS A TABLE THAT
SUMMARIZES ALL OF THE PROPOSED
REDUCTIONS AND DELAYS IN THE
GOVERNOR'S BUDGET. THERE WERE
ADDITIONAL DELAYS THAT WERE
ENACTED LAST YEAR. THAT TABLE
ONLY SHOWS WHAT'S WHAT'S BEING
PROPOSED THIS YEAR. AND YOU
KNOW, I DEFER TO THE
ADMINISTRATION TO EXPLAIN WHAT'S
GOING ON WITH THAT, PARTICULAR
LOAN REPAYMENT PROGRAM. YOU'LL
SEE THAT THERE ACTUALLY WERE TWO
LOAN REPAYMENT PROGRAMS, ONE FOR
COUNTIES AND ONE FOR STATE
HOSPITALS. THE ADMINISTRATION'S
PROPOSING TO DELAY, FUNDING FOR
THE COUNTIES, BUT REDUCE OR
ELIMINATE FUNDING FOR THE STATE
HOSPITALS. SO THERE'S A THERE'S
A DIFFERENCE IN TREATMENT THERE.
AND JUST WANTED TO MAKE SURE
THAT WAS, THAT WAS CLEAR. BUT
BUT GENERALLY, YOU KNOW, A, YOU
KNOW, A KEY ISSUE FOR THE
LEGISLATURE THIS YEAR IS THE
STATE'S CONSTRAINED BUDGET, AND
THIS DOES, I THINK, PLAY A KEY
CONSIDERATION THIS YEAR, THE
GOVERNOR'S BUDGET AND OUR OFFICE
AS WELL ANTICIPATE, YOU KNOW,
PROJECT THERE TO BE DEFICITS IN
THE OUT YEARS. ABOUT $30 BILLION
WAS SORT OF THE LAST ESTIMATE.
THOSE WILL GET UPDATED IN A
REVISION. WHEN THERE'S A
PROPOSED DELAY THE ASSUMPTION IS
THAT AND AT LEAST IMPLICITLY IS
THAT FUNDING WILL RESUME IN,
2526. BUT AGAIN, IF THERE ARE
DEFICITS IN THAT YEAR, THAT
MIGHT BE HARD TO DO. SO THIS IS
A KEY, SORT OF ISSUE FOR THE
LEGISLATURE TO GRAPPLE WITH,
TYPICALLY, YOU KNOW, FOCUSING
ON, YOU KNOW, HAVING A MULTIYEAR
THAT DOESN'T HAVE DEFICITS AND
ENSURES THAT THERE'S CAPACITY
CAN BE CAN BE ONE TOOL TO HELP
ENSURE THAT THE THAT THE
INTENDED INITIATIVES ARE, ARE,
YOU KNOW, BEING IMPLEMENTED AND
AS SORT OF THEY ARE INTENDED,
BUT IT IS A Kò IT IS A KEY ISSUE
FOR THE LEGISLATURE THIS YEAR IN
TERMS OF ITS BUDGET, CAPACITY
AND YOU KNOW, WHAT, WHAT
PRIORITIES IT CAN FUND THIS
YEAR, GIVEN GIVEN ITS SORT OF
BUDGET CONSTRAINTS. I THINK MY
QUESTION IS MORE AROUND JUST
GENERAL OVERSIGHTS OR WHAT WE
CAN ACTUALLY DO TO SUPPORT,
OVERSIGHT IN PERHAPS A MORE,
PROACTIVE WAY THAT ENSURES THAT
WE ARE MOVING FORWARD, WITH THE
VARIOUS MILESTONES THAT ARE
REQUIRED TO SET UP A PROGRAM AND
ESTABLISH THE PROGRAM, ENSURE
THAT, THE FUNDING THAT WE,
APPROPRIATE IT IN PRIOR BUDGET
YEARS ACTUALLY GETS ALLOCATED
AND THAT THE THAT THE
INITIATIVES GET SET UP BECAUSE
THEN WE'RE FACED WITH ON PAPER
SEEMING TO MAKE A VERY
REASONABLE CUT OF A CRITICAL
PROGRAM AROUND ELIMINATING
PSYCHIATRIC LOAN REPAYMENT
PROGRAM OR CUTTING WHAT IS IT,
200 AND WHAT'S THE NUMBER HERE?
$115 MILLION FROM COMMUNITY
HEALTH WORKERS. AND THE FUNDING
RELATED TO THAT. IT JUST ON AND
ON WHERE THE THINGS THAT ARE
LEFT ON THE TABLE TO CUT ARE
ESSENTIALLY THINGS THAT WERE
JUST NOT IMPLEMENTED WHERE WE
WEREN'T ABLE TO BE ABLE TO MOVE
FORWARD WITH SPENDING, SPENDING
THE MONEY, THAT WE COMMITTED TO
SPEND. AND WHAT I'M ASKING FROM
YOU ALL, WHAT CAN WE DO AS A
LEGISLATURE TO PERHAPS PROVIDE
GREATER OVERSIGHT, IN THESE
HEARINGS, WHICH IS WHAT WE'RE
HERE FOR, TO ENSURE THAT WHEN WE
SET UP LEGISLATION OR MOVE
FORWARD WITH INITIATIVES, THOSE
PROGRAMS ACTUALLY GET
IMPLEMENTED. MATT AGUILAR,
DEPARTMENT OF FINANCE, SO I
APPRECIATE THE QUESTION. AND,
YEAH, I CAN ASSURE YOU THAT
THERE IS NO INTENTIONAL DELAY.
YOU KNOW, ON THE PART OF THE
ADMINISTRATION IN TERMS OF
ROLLING THESE PROGRAMS OUT, THE
WORKFORCE PACKAGE, YOU KNOW, IN
TOTAL WAS A HUGE PACKAGE. AND
THOSE FUNDS WERE APPROPRIATED
FUNDS OVER A MULTI YEAR PERIOD.
SO THOSE DOLLARS, AS THOSE
DOLLARS ARE MOVING THROUGH OVER
THE VARIOUS MULTI YEAR
ALLOCATION, YOU KNOW, THERE WAS
A TREMENDOUS AMOUNT OF WORK THAT
WENT INTO GETTING THOSE
PROGRAMS, FUNDED AND YOU KNOW,
THIS HAPPENS TO BE ONE THAT THE
MONEY, YOU KNOW, THE, THE EFFORT
WAS NOT COMPLETED AND THE MONEY
HAD NOT GONE OUT THE DOOR, WE
ALSO WERE IN SUPPORT OF THE
PROGRAM, IT JUST HAPPENED TO BE
THAT YOU KNOW, WE WERE WHEN ONE
OF THE THINGS THAT WE WERE
LOOKING AT WHEN WE WERE TRYING
TO FIGURE OUT HOW WE'RE GOING TO
SOLVE THE BUDGET PROBLEM, WAS TO
LOOK AT, YOU KNOW, THINGS THAT
WERE IN FLIGHT. BUT THE MONEY
HAD NOT YET GONE OUT. AND THIS
ITEM JUST FELL IN THAT POT OF
FUNDING. SO I GUESS, WHAT
ASSEMBLY MEMBER BONTA IS
ALLUDING TO? I AM ALLUDING TO.
AND YOU KNOW, IF YOU ARE A PART
OF ANY OTHER HEARINGS, I GUESS
THERE HAS JUST BEEN AN
EXPECTATION THAT WHEN WE, YOU
KNOW, PASS A BILL OR WE PASS A
BUDGET AND WE, STAY THAT THIS IS
A PRIORITY, WE WANT THIS DONE,
THAT IT WILL ACTUALLY GET DONE,
AND IF IT'S NOT, AND WE ASK WHY,
THERE IS A REASON WHY. AND
THAT'S WHY I'VE BEEN ASKING WHY
WAS THIS NOT IMPLEMENTED, WAS IT
A, A PROBLEM WITH NOT HAVING
ENOUGH PEOPLE TO DO IT? WAS IT,
SOMETHING MORE LOGICAL?
LOGISTICAL? I DON'T KNOW, BUT
I'M NOT GETTING THOSE ANSWERS,
IT'S JUST THAT IT IT WASN'T
DONE. AND NOW WE ARE IN A
DIFFERENT KIND OF BUDGET
OUTLOOK. AND SO WE NEED TO LOOK
AND SEE WHERE WE CAN KIND OF CUT
SOME THINGS OR TRIM SOME THINGS
THAT WOULD CAUSE THE LEAST
AMOUNT OF HARM. AND SINCE THIS
WAS NEVER IMPLEMENTED, THEN IT'S
KIND OF AN EASY FIRST STEP. BUT
YOU KNOW, WHEN WE TALK ABOUT
OVERSIGHT OR BEING ABLE TO WORK
TOGETHER TO HAVE SOME KIND OF
COMMUNICATION TO SAY, HEY, YOU
GUYS PASSED THIS A YEAR AGO, TWO
YEARS AGO, THREE YEARS AGO, THIS
IS A LEGISLATIVE PRIORITY. WE
HAVEN'T BEEN ABLE TO DO THIS
BECAUSE X, Y, AND Z, AND WE'RE
LOOKING AT THIS PROGRAM NOW
BECAUSE OF WHERE WE ARE IN THE
BUDGET. BUT IF WE WERE IN A
DIFFERENT PLACE, WE PROBABLY
WOULD HAVE NEVER KNOWN THAT THIS
STILL HAS NOT BEEN IMPLEMENTED.
AND THAT IS A PROBLEM FOR US.
YOU WANTED TO SAY SOMETHING?
YEAH. IF I MAY, I JUST WANT TO
ADD, AGAIN, LIBYA, THE OFFICE OF
HEALTH WORKFORCE DEVELOPMENT AT
HCCI, I SHOULD SAY I'M NEW IN
THIS ROLE, SO I'VE BEEN HERE SIX
MONTHS, AND SO I JUST WANT TO
OFFER WHAT I'VE OBSERVED, WHICH
IS BUILDING ON WHAT YOU JUST
DESCRIBED. WHILE WE WERE WORKING
ON THE PROGRAM. WE MAY NOT HAVE
GOTTEN TO EXECUTION, AND THAT'S
BECAUSE OUR WORKLOAD AND OUR
BUDGET TEN XT OVER A PERIOD OF A
FEW YEARS AND OUR STAFFING TO
XT. SO THIS IS NOT TO MAKE
EXCUSES, BUT YOU DID SORT OF
SUGGEST, IS THIS BECAUSE WE
DIDN'T HAVE ENOUGH PEOPLE? WE'RE
STILL CATCHING UP ON THAT
WORKLOAD. SO I DESCRIBED SOME OF
THE WORK WE DID, FOR EXAMPLE
WITH SAIBAI, WHICH IS A
SIGNIFICANT AMOUNT OF WORK.
WE'RE CREATING AN ENTIRELY NEW
PROFESSION IN THE STATE, AND
THAT REQUIRED AN IMMENSE AMOUNT
OF RESEARCH AND A LOT OF STAFF
EFFORT WENT TO THAT SAME THING
FOR THE REPRODUCTIVE HEALTH
INITIATIVE. SOME OF THAT WORK IS
ACTUALLY NOT WORKFORCE WORK, SO
IT TAKES A LOT OF ENERGY FOR US
TO FIGURE OUT HOW TO DESIGN AND
ROLL THAT OUT. AND WE KNOW THAT
THAT'S ALSO A LEGISLATIVE
PRIORITY. SO I JUST WANT TO
OFFER THAT I, ON BEHALF OF MY
TEAM, BECAUSE I'D BE REMISS IF I
DIDN'T. I THINK THEY'RE DOING
THE BEST THAT THEY CAN, BUT WE
HAD A SIGNIFICANT INCREASE IN,
IN RESOURCES AND PROGRAMS, AND
WE ARE DOING OUR BEST TO KEEP
UP. SO ARE YOU STATING THAT YOU
ALL PRIORITIZE THE THINGS AND
BASED ON YOUR WORKFORCE YOU
DIDN'T GET TO IT? IS THAT
ESSENTIALLY WHAT YOU'RE SAYING?
WE HAD WE WERE JUGGLING A NUMBER
OF PRIORITIES. AND SO THE DESIGN
OF THIS PROGRAM WAS IN THE
WORKS. WE JUST HADN'T GOTTEN TO
EXECUTION YET. I JUST HAVE A AND
AGAIN, JUST A BROADER
CONVERSATION TO BE HAD. AND WE
COULD PROBABLY BE HAVING THIS
CONVERSATION WITH ANY DEPARTMENT
SITTING HERE. SO SORRY THAT IT'S
KIND OF COMING FORWARD WHEN WE,
MOVE FORWARD WITH LEGISLATION
AND WE GO THROUGH AN
APPROPRIATIONS PROCESS, IT GETS
TAGGED WITH A PARTICULAR, FISCAL
AMOUNT ASSOCIATED WITH THAT
INITIATIVE, MY UNDERSTANDING IS
THAT THE REQUISITE STAFF
REQUIRED TO BE ABLE TO MOVE
FORWARD WITH THAT INITIATIVE IS
ESSENTIALLY FOR ACCOUNTED FOR IN
THE IN THE FISCAL TAG, WHICH IS
WHY FISCAL JUMPS SIGNIFICANTLY
ON PROJECTS. MY ASSUMPTION IS
THAT MEANS THAT THERE IS OUR
ADDITIONAL BODIES AND STAFF THAT
ARE HIRED OR REALLOCATED TO BE
ABLE TO MOVE FORWARD WITH A
PIECE OF LEGISLATION OR AN
INITIATIVE. SO I'M HAVING A HARD
TIME KIND OF JIBING THE
STATEMENT THAT YOU JUST MADE,
WHICH ESSENTIALLY SAID THE
PRIORITIES THAT WE WERE,
REQUIRED TO MOVE FORWARD WITH
WENT UP TEN X, BUT THE STAFFING
DID NOT GO TO X BECAUSE MY
UNDERSTANDING IS UP COMMENSURATE
, BECAUSE MY UNDERSTANDING IS
THAT WE ACTUALLY ARE PAYING FOR
NHÀ AND ALLOCATING FUNDS WHEN
THEY'RE PASSED THROUGH
LEGISLATION TO BE ABLE TO DO
THAT. SO I'M CONFUSED. YEAH. AND
I MIGHT OFFER TO FINANCE. YEAH.
I WOULD JUST SAY I THINK WITH
LEGISLATION IT IS SOMEWHAT OF A
MIXED BAG. BUT YOU'RE CORRECT
THAT, YOU KNOW, OFTENTIMES THERE
IS A STATE ADMINISTRATION PIECE
THAT GOES ALONG WITH WHATEVER
THE POLICY IS THAT'S BEING
CONSIDERED THROUGH LEGISLATION.
THÀNH OKAY. SO WE'LL SETTLE ON
THE MIXED BAG AND MAYBE WE'LL
TAKE IT UP WITH OUR BUDGET
SUBSET AS A BROADER
CONVERSATION. THANK YOU. JUST TO
SIT ON THAT POINT, IN TERMS OF,
YOU KNOW, WHAT TOOLS, OVERSIGHT
TOOLS ARE AVAILABLE TO THE
LEGISLATURE, OF COURSE, YOU
KNOW, HEARINGS ARE A KEY
OVERSIGHT TOOL. THERE ARE OTHER
OVERSIGHT TOOLS. FOR EXAMPLE,
SOMETIMES THE LEGISLATURE ADOPTS
REPORTING LANGUAGE THAT, YOU
KNOW, HELPS FACILITATE OVERSIGHT
BECAUSE IT, YOU KNOW, IT
REQUIRES THE ADMINISTRATION TO,
YOU KNOW, FORMALLY REPORT ON
MEASURES THAT THE LEGISLATURE
DEVELOPS. THERE ARE OTHER
OVERSIGHT TOOLS, TOO. SO THERE
ARE THERE ARE VARIOUS OVERSIGHT
TOOLS AVAILABLE TO THE
LEGISLATURE AS IT AS IT SORT OF
WEIGHS HOW TO HOW TO BEST
OVERSEE. THERE ARE A LOT OF
INITIATIVES HERE. SO THAT THAT,
YOU KNOW, THERE'S A LOT OF, YOU
KNOW, OPTIONS HERE FOR THE
LEGISLATURE TO CONSIDER. THANK
YOU. JUST ONE MORE QUESTION. SO
THERE ARE PROPOSED DELAYS AND
HEALTH CARE WORKFORCE, HOW DO
YOU THINK THAT THESE DELAYS ARE
GOING TO IMPACT WORKER TRAINING?
SO THERE ARE THREE MAJOR BUCKETS
OF DELAYS $70 MILLION, FOR THE
NURSING INITIATIVE, 70.1 FOR
SOCIAL WORK INITIATIVE, AND
189.4 MILLION FROM THE MENTAL
HEALTH SERVICES FUND. WE HAVE
ESTIMATED WHAT WE THINK THE HOW
WE WOULD HAVE USED THOSE FUNDS
AND THE IMPACTS THEY WOULD HAVE
HAD. SO FOR THE NURSING
INITIATIVE, WE ARE IN THE
PROCESS OF PROGRAMING OUR
EXISTING 70 MILLION AND SO
APPLIED THE ESTIMATES OF THAT
PROGRAMING TO THE 70 MILLION WE
WOULD HAVE GOTTEN NEXT YEAR. AND
WE THINK WE WOULD HAVE REACHED
ABOUT 3570 NURSES THROUGH
SCHOLARSHIPS, EDUCATION,
CAPACITY EXPANSION AND
INTERVENTIONS DESIGNED TO
ADDRESS BURNOUT AND CLINICAL
TRAINING. SO DEFERRING THAT
MONEY A YEAR WILL DEFER THE
IMPACTS OF THOSE PROGRAMS A
YEAR, SO THE FOR THE SOCIAL WORK
INITIATIVE, THE $70.1 MILLION,
THOSE FUNDS WERE PRIMARILY GOING
TO AUGMENT EXISTING PROGRAMS AND
ENHANCE UPCOMING FUNDING CYCLES
FOR THE FOLLOWING PROGRAMS
SOCIAL WORK, EDUCATION AND
CAPACITY EXPANSION. SCHOLARSHIPS
FOR UNDERGRADUATE STUDENTS
PURSUING SOCIAL WORK FUNDING TO
SUPPORT MASTERS OF SOCIAL WORK
STUDENTS THAT ARE COMPLETING
THEIR PRE AND POST DEGREE
CLINICAL HOURS. FUNDING TO
ENHANCE THE CAPACITY OF CLINICS,
FACILITIES AND OTHER SERVICE
SETTINGS TO SUPERVISE SOCIAL
WORK STUDENTS. WITH THAT
FUNDING, WE WILL NOT BE ABLE TO
IMPLEMENT OR EXPAND SOME OF
THOSE CYCLES, AND WE ESTIMATE
THAT WE WOULD HAVE REACHED 1634
SOCIAL WORK STUDENTS THROUGH
THOSE SCHOLARSHIPS, FELLOWSHIPS,
SUPERVISION AND CAPACITY
EXPANSION. AND THEN FINALLY,
WITH THE DELAY IN MENTAL HEALTH
SERVICES FUND, THAT WILL SOME OF
THAT WILL IMPACT OUR SOCIAL WORK
INITIATIVE. WE WERE GOING TO
ALLOCATE 51.9 MILLION TOWARDS
THE SOCIAL WORK INITIATIVE, WE
WERE ALSO GOING TO STAND UP NEW
PROGRAMS WHICH HAVE NOT YET
LAUNCHED. AND SO WE DON'T HAVE
ESTIMATES FOR NUMBER OF
APPLICANTS OR AWARDEES. THOSE
WOULD HAVE BEEN THE ADDICTION
PSYCHIATRY AND ADDICTION
MEDICINE FELLOWSHIPS, UNIVERSITY
COLLEGE GRANTS TO BEHAVIORAL
HEALTH PROFESSIONALS, EXPANSION
OF MASTERS OF SOCIAL WORK SLOTS
AT PUBLIC UNIVERSITIES, AND
WHILE WE DON'T HAVE PRECISE
NUMBERS, AGAIN, WE APPLIED
ESTIMATES. WE THINK WE WOULD
HAVE REACHED 2238 INDIVIDUALS
THROUGH THOSE PROGRAMS. SO ALL
OF THOSE IMPACTS ARE DELAYED A
YEAR WITH A DEFERRAL OF THE
FUNDS BY A YEAR. WOW. THOSE ARE
SOME SIGNIFICANT NUMBERS. THANK
YOU SO MUCH. SO QUESTION, YOU
KNOW, THIS BUDGET DEFICIT THAT
WE'RE IN IS NOT WE'RE NOT
PROJECTING IT TO BE FOR THIS
YEAR ALONE. SO HOW DO WE KNOW
THAT WE SAYING THAT THIS IS
GOING TO BE DELAYED FOR ONE
YEAR? HOW DO WE KNOW IT'S NOT
GOING TO END UP BEING A DELAY
FOR 2 OR 3. AND SO THESE NUMBERS
THAT WE'RE HEARING ABOUT WILL
THEN BE TWO, THREE TIMES, FOLD
IN TERMS OF THE IMPACT ON OUR
WORKFORCE WITHIN OUR HEALTH CARE
. I THINK, MATT AGUILAR FOR
FINANCE, WE, YOU KNOW, WE
TYPICALLY, ARE WORKING ON OUR
BUDGETS IN CALIFORNIA. ONE YEAR
AT A TIME. IT'S TRUE THAT WE DO
HAVE DATA TO KIND OF TRACK THE
LONG TERME VIEW, WHICH, IS BEING
CONSIDERED, BUT WE ARE BACK
EVERY YEAR REVISITING YOU KNOW,
OUR COMPETING PRIORITIES. OUR
AVAILABILITY OF RESOURCES AND
OTHER, OTHER MEANS JUST THROUGH
OUR PROCESS. ALL RIGHT. WELL,
WITH THAT, I WANT TO THANK THIS
PANEL, AND WE WILL NOW MOVE TO
OUR THIRD PANEL, WHICH WILL
FOCUS ON EMERGENCY MEDICAL
SERVICES AUTHORITY. I WILL BRING
ASK TO COME UP ELIZABETH BASNET,
CRAIG JOHNSON, CHRISTINE NOT
GOING TO BUTCHER YOUR LAST NAME
NINA HONG AND WILL OWENS. OKAY.
AND YOU ALL MAY BEGIN WHENEVER
YOU'RE READY.
ALL RIGHT. WELL, GOOD AFTERNOON,
DOCTOR WEBER AND SENATOR BONTA
AND MEMBERS OF THE COMMITTEE. MY
NAME IS CRAIG JOHNSON, AND I'M
THE CHIEF OVER THE
ADMINISTRATION AND HUMAN
RESOURCES DIVISION FOR THE EMS
AUTHORITY, CALIFORNIA EMERGENCY
MEDICAL SERVICES AUTHORITY. AND
WITH ME IS ELIZABETH ELIZABETH
BASNET. SHE'S THE DIRECTOR. SO
TODAY I WOULD LIKE TO PROVIDE
YOU WITH A BRIEF OVERVIEW OF OUR
DEPARTMENT. I'LL GIVE YOU A
BRIEF OVERVIEW OF OUR BUDGET AND
ALSO PROVIDE A BRIEF OVERVIEW OF
OUR THREE PROPOSALS. SO EMS WAS
FORMALLY ESTABLISHED BY THE
EMERGENCY MEDICAL SERVICES
SYSTEM, PRE-HOSPITAL EMERGENCY
CARE PERSONNEL ACT, SB 125, IN
1980, AS THE STATE LEAD AGENCY
AND CENTRALIZED RESOURCE TO
OVERSEE EMERGENCY AND DISASTER
MEDICAL SERVICES IN CALIFORNIA,
CALIFORNIA, CALIFORNIA'S
EMERGENCY MEDICAL SYSTEM IN
CALIFORNIA WAS CREATED IN 1981
BY THE HEALTH AND SAFETY CODE
DIVISION 2.5, WITH THE INTENT OF
CREATING A STATEWIDE SYSTEM WITH
EMS RESPONSIBLE FOR THE
COORDINATION AND INTEGRATION OF
ALL STATE ACTIVITIES CONCERNING
EMERGENCY MEDICAL SERVICES. TO
ENSURE THE PROVISION OF
EFFECTIVE AND EFFICIENT
EMERGENCY MEDICAL CARE. IMSA IS
CHARGED WITH PROVIDING
LEADERSHIP IN THE INNOVATION AND
ADMINISTRATION OF THE EMERGENCY
MEDICAL SERVICES SYSTEM
THROUGHOUT THE STATE, WHICH
INCLUDES SETTING STANDARDS FOR
THE TRAINING AND SCOPE OF
PRACTICE FOR VARIOUS LEVELS OF
EMS PERSONNEL. EMS IS ALSO
RESPONSIBLE FOR PROMOTING
DISASTER MEDICAL PREPAREDNESS
THROUGHOUT THE STATE AND, WHEN
REQUIRED, COORDINATING AND
SUPPORTING THE STATE OF
CALIFORNIA'S MEDICAL RESPONSE TO
MAJOR DISASTERS. EMSA WORKS
CLOSELY WITH MANY LOCAL, STATE,
AND FEDERAL AGENCIES PROVIDING
PRIVATE ENTERPRISES AND THOSE IN
DISASTER MEDICAL SERVICES ROLES
TO PROMOTE QUALITY EMS SERVICES
STATEWIDE, THE EMS AUTHORITY'S
PROGRAM FUNCTIONS ARE ORGANIZED
INTO THREE DIVISIONS EMS
PERSONNEL STANDARDS DIVISION,
EMS SYSTEMS PLANNING AND
DEVELOPMENT DIVISIONS, AND
DISASTER MEDICAL SERVICES
DIVISION. FOR THAT, I'LL MOVE TO
THE BUDGET OVERVIEW. IF THERE
ARE NO NO QUESTIONS. THE
GOVERNOR'S BUDGET FOR FISCAL
YEAR 2425 INCLUDES EXPENDITURE
AUTHORITY FOR 57.6 MILLION AND
109 PERMANENT POSITIONS. OF THIS
AMOUNT, 33.8 MILLION, OR 59% IS
DELEGATED FOR STATE OPERATIONS
AND 23.7 MILLION, OR 41% IS
DELEGATED TO LOCAL ASSISTANCE.
THIS IS A REDUCTION OF
APPROXIMATELY 22.2 MILLION OVER
LAST YEAR'S BUDGET, WHICH IS
MAINLY DUE TO A GENERAL FUND
REDUCTION OF 19.4 MILLION FOR
THE CALIFORNIA EMERGENCY MEDICAL
SERVICES DATA RESOURCE SYSTEM,
KNOWN AS CEDARS, AND THE
ELECTRONIC PHYSICIAN ORDERS FOR
LIFE SUSTAINING TREATMENT, ALSO
KNOWN AS IPOST FUNDING. THE LOSS
OF TEN LIMITED TIME GENERAL FUND
POSITIONS AND VARIOUS OTHER
APPROPRIATION ADJUSTMENTS, AND
THE DEPARTMENT HAS THREE BUDGET
PROPOSALS CONTAINED IN THE
GOVERNOR'S BUDGET, CURRENTLY
UNDER CONSIDERATION BY THE
LEGISLATURE, WHICH I CAN GO
THROUGH NOW IF YOU LIKE.
PROPOSAL NUMBER ONE CALIFORNIA
EMERGENCY MEDICAL SERVICES
INFORMATION SYSTEM, ALSO KNOWN
AS CMS MAINTENANCE AND
OPERATIONS EMS, IS REQUESTING
4.2 MILLION GENERAL FUND AND 24,
25 AND 4.4 MILLION GENERAL FUND
AND 2526. THE REQUESTED
RESOURCES WILL PROVIDE FOR THE
CONTINUED MAINTENANCE AND
OPERATIONS OF THE CALIFORNIA
EMERGENCY MEDICAL SERVICES
INFORMATION SYSTEM. ADDITIONAL
RESOURCES WILL CONTINUE TO ALLOW
NSA TO MONITOR AND IMPROVE
CALIFORNIA, CALIFORNIA'S
EMERGENCY MEDICAL SERVICES
SYSTEM TO MEET THE PATIENT AND
CLINICAL CARE NEEDS OF ITS 39
MILLION RESIDENTS AND 268
MILLION VISITORS PER YEAR, CMS
IS A SECURE, CENTRALIZED DATA
SYSTEM FOR COLLECTING DATA ABOUT
INDIVIDUAL EMERGENCY MEDICAL
SERVICES REQUESTS. PATIENTS
TREATED AT HOSPITALS AND EMS
PROVIDER ORGANIZATION CMS USES
THE UNIVERSAL STANDARD FOR
COLLECTING PATIENT CARE
INFORMATION FROM AN EMERGENCY
911 CALL FOR ASSISTANCE, CALL
THE NATIONAL EMERGENCY MEDICAL
SERVICES INFORMATION SYSTEMS AND
IMSIS CMS. DATA RELATED TO EMS
IN CALIFORNIA IS CURRENTLY
CAPTURED, LOCATED BY EMS
PROVIDER AGENCIES, TRAUMA
CENTERS, STROKE CENTERS, STEMI
CENTERS, AND EMS FOR CHILDREN
CENTERS AS REQUIRED BY TITLE 22
OF CALIFORNIA CODE OF
REGULATIONS, CMS PROVIDES THE
ONLY STATEWIDE MEANS OF
MONITORING THE OVERALL HEALTH OF
EMS SYSTEMS AND THE CARE THAT
EMS AGENCIES PROVIDE TO
CALIFORNIA RESIDENTS AND
VISITORS, AND IDENTIFYING
STRAINS AND THREATS TO THE EMS
SYSTEMS FROM LOCAL AND STATEWIDE
EVENTS. THROUGHOUT THE COVID 19
PANDEMIC, CMS HAS PROVEN AN
ESSENTIAL SOURCE OF CRITICAL
INFORMATION FOR EVALUATING
PATIENT CARE. AND THEN IF THERE
ARE NO QUESTIONS, I'LL GO TO
PROPOSAL NUMBER TWO. CONTINUE
ATION OF RESOURCES FOR
MAINTAINING STORAGE OF EMERGENCY
MEDICAL RESPONSE EQUIPMENT AND
SUPPLIES AND WAS A REQUEST
GENERAL FUND OF 3,000,024 20 53.
1,000,025 26 AND 3.2 MILLION AND
2627. THE REQUESTED RESOURCES
WILL BE USED FOR THE CONTINUED
STORAGE AND SECURITY OF
EMERGENCY MEDICAL RESOURCES,
EQUIPMENT AND SUPPLIES DURING
THE COVID 19 PANDEMIC. EMS, A
SINGLE WAREHOUSE WHICH CONTAINED
25,000FT² OF STORAGE, WAS
INSUFFICIENT TO HOUSE THE NEEDED
EQUIPMENT AND SUPPLIES TO
SUPPORT THE DEPARTMENT'S COVID
19 RESPONSE EFFORTS, AS WELL AS
ANY OTHER FUTURE RESPONSES TO
MEET THE IMMEDIATE NEED FOR
SPACE AND EMS. AT LEAST THREE
ADDITIONAL WAREHOUSES TO SUPPORT
EMERGENCY OPERATIONS, INCLUDING
THE IN-PROCESSING AND STORAGE OF
NEARLY 16,000 VENTILATORS AND
OTHER RELATED PATIENT INTERFACE
DEVICES AND MEDICAL SUPPLIES TO
SCALE BACK WAREHOUSE STORAGE
CAPACITY AND PROPORTION TO
DECLINING EMERGENCY MEDICAL
RESPONSE NEEDS. AFTER THE
INITIAL COVID 19 PANDEMIC SURGE,
THE THREE ADDITIONAL WAREHOUSES
WERE THEN CONSOLIDATED IN 2122
INTO A ONE SINGLE WAREHOUSE WITH
255,000FT², WHICH INCLUDES
13,000FT² OF OFFICE SPACE. EMS
DOES REQUIRE APPROXIMATELY
255,000FT² OF WAREHOUSE SPACE,
AS WELL AS SECURITY SERVICES AND
JANITORIAL SERVICE TO ADDRESS
CURRENT WAREHOUSE, OPERATIONAL
NEEDS AND TO ADEQUATELY STORE
AND MANAGE EXISTING INVENTORIES
OF MEDICAL EQUIPMENT, SUPPLIES,
AND OTHER EMERGENCY RESPONSE
ASSETS. AND THAT'S IT FOR THE
SECOND PROPOSAL. THE THIRD. SO
THE THIRD PROPOSAL WAS
MAINTENANCE AND REPAIR OF
CRITICAL BIOMEDICAL EQUIPMENT.
IMSA IS REQUESTING 2 MILLION
GENERAL FUND AND 2425 AND
ONGOING TO MAINTAIN CRITICAL
BIOMEDICAL EQUIPMENT AND MEDICAL
SUPPLIES ACQUIRED DURING THE
COVID 19 PANDEMIC AND PROVIDE
LIFE SAVING RESUSCITATIVE AND
MEDICAL SURGE SERVICES TO
RELIEVE SUFFERING FOR DISASTER
VICTIMS DURING PANDEMICS OR
OTHER CATASTROPHIC EMERGENCIES.
THE 20 2122 BUDGET ACT INCLUDED
2 MILLION GENERAL FUND TO
MAINTAIN APPROXIMATELY 83,600
PIECES OF EQUIPMENT, FUNDING FOR
THE MAINTENANCE CONTRACT EXPIRES
AT THE END OF 2324. THESE FUNDS
ARE USED TO CONTRACT WITH THE
BIOMEDICAL EQUIPMENT MAINTENANCE
COMPANY VIA THE DEPARTMENT OF
GENERAL SERVICES, EQUIPMENT
MAINTENANCE AND MANAGEMENT
INSURANCE PROGRAM. THE COVID 19
PANDEMIC IMSA HAS APPROXIMATELY
3000 PIECES OF BIOMEDICAL
EQUIPMENT DEPLOYED WELL DURING
THE PANDEMIC. WE HAD
APPROXIMATELY 3000 PIECES OF
EQUIPMENT DEPLOYED THROUGHOUT
THE STATE AND COUNTRY. THE
REQUEST OUTLINED IN THIS
PROPOSAL WILL KEEP THE SAID
EQUIPMENT READY TO DEPLOY FOR
FUTURE LARGE INCIDENTS,
DISASTERS OR PANDEMICS. THANK
YOU. QUESTIONS? THANK YOU SO
MUCH FOR THAT PRESENTATION.
SEEING THAT YOUR EMT WORKFORCE
WAS HIT REALLY HARD DURING THE
PANDEMIC, AND I'M NOT SURE HOW
WELL YOU'VE BEEN ABLE TO
RECOVER, CAN YOU KIND OF GIVE US
THE CURRENT STATUS OF YOUR, EMT
WORKFORCE? AND ARE THERE ANY
INITIATIVES IN THIS SPECIFIC
AREA? AND IF NOT, WHY? YEAH.
THANK YOU SO MUCH, DOCTOR
ROBERT, FOR THE QUESTION AND FOR
BEING HERE TODAY. SO I THINK
WITH OUR EMT WORKFORCE, I DO
THINK THE AGENDA DID A GREAT JOB
OF OUTLINING IS EVEN THOUGH
WE'VE SEEN A 6% INCREASE IN THE
PARAMEDIC WORKFORCE IN TERMS OF
NUMBER OF LICENSURE, AND WE ALSO
SAW IN THE LAST FIVE YEAR ABOUT
A 2.2% INCREASE IN THE EMT
WORKFORCE. WE ARE STRUGGLING TO
FIND THE DATA OF EXACTLY HOW
MANY OF THOSE ARE PRACTICING IN
EMS. AND SO WE'RE, YOU KNOW,
LOOKING TO MODERNIZE OUR CENTRAL
REGISTRY AND DO THINGS THAT
HELPS US CAPTURE THAT DATA. BUT
I THINK WHAT I CAN SPEAK TO
ANECDOTALLY AND MEETING WITH OUR
PARTNERS STATEWIDE AND PROVIDING
PROVIDERS STATEWIDE IS THAT I
THINK WITH THE CHANGES THAT
WE'RE SEEING IN OUR SOCIETY
AROUND THE BEHAVIORAL HEALTH
CONTINUUM AND HOW EMS IS
EVOLVING, ALMOST INTO THE
PREVENTATIVE HEALTH SPACE,
RIGHT? WHEN WE SEE, PUBLIC
HEALTH BACKUP INTO THE EMS
SYSTEM OR HEALTH CARE BACKUP
INTO THE EMS SYSTEM BECAUSE
THOSE SYSTEMS ARE OVERWHELMED,
AND THEN PEOPLE CALL 911, I
THINK IT BECOMES YOU SEE THIS
HIGHER LEVEL OF BURNOUT BECAUSE
FOLKS ARE RESPONDING TO THE SAME
FREQUENT UTILIZER THAT MAY BE
UNHOUSED OVER AND OVER. RIGHT?
AND WE HAVE ALL THESE WONDERFUL
INITIATIVES THAT WE'RE LOOKING
TO IMPLEMENT STATEWIDE AS A PART
OF A HEALTHY CALIFORNIA FOR ALL.
BUT I THINK THAT GENERAL FEELING
OF GIVING FOLKS THE TOOLS THAT
THEY REALLY NEED TO BE
SUCCESSFUL, I THINK WOULD HELP
SIGNIFICANTLY WITH THAT BURNOUT
THAT WE'RE SEEING ACROSS THE
WORKFORCE. AND AGAIN, IT IS
ANECDOTALLY, WE'RE TRYING TO
MODERNIZE TO SEE IF WE CAN GET
MORE OF THAT DATA IN A
QUANTIFIABLE WAY. BUT THAT'S
REALLY WHAT WE'RE HEARING ACROSS
OUR CONVERSATIONS IN TERMS OF
WORKFORCE INITIATIVES, WE IMSA,
DO NOT HAVE ONE, BUT I WOULD BE
REMISS NOT TO MENTION THAT, HCI
WITH LDA, IN THE 2324 BUDGET
ALLOCATION FOR THE WORKFORCE FOR
A HEALTHY CALIFORNIA, THERE IS A
LINE ITEM INITIATIVE IN THEIR
EMS CORE, AND THAT IS LOOKING TO
INCREASE THE GEOGRAPHIC, RACIAL,
AND ETHNIC ETHNIC DIVERSITY
WITHIN THE EMS WORKFORCE. AS
WELL AS PARTNER WITH COMMUNITIES
TO PROVIDE PATHWAYS FOR EMT
CERTIFICATION IN ADDRESSING
BARRIERS TO EMPLOYMENT THROUGH
TRAINING, STIPENDS AND SUPPORT
SERVICES, AND I DO THINK THEY'RE
READY TO LAUNCH 11 NEW TRAINING
PROGRAMS IN 2025. THE LAST TIME
WE MET. SO, I KNOW THAT THERE'S
A GOOD PARTNERSHIP THERE. OKAY.
THANK YOU. AND DO YOU HAVE AN
ESTIMATE ON THE TIME FRAME WHEN
YOU WILL HAVE BETTER DATA TO
TRULY DETERMINE, LIKE WHO'S
ACTUALLY WORKING AS AN EMT
VERSUS WHO JUST HAS A LICENSE
AND IS WORKING, YOU KNOW, IN A
DIFFERENT FIELD. YEAH. SO THE
CALIFORNIA DEPARTMENT OF
TECHNOLOGY, WE GO THROUGH THE
PROJECT APPROVAL LIFE CYCLE, AND
WE'RE IN STAGE TWO NOW. IT'S A
FOUR STEP PROCESS TO MODERNIZE
OUR IT SYSTEM. NORMALLY THE FULL
LENGTH OF THAT PROCESS IS 3 TO 4
YEARS. WE'RE ABOUT TWO YEARS IN.
SO HOPEFULLY WITHIN 24 MONTHS WE
WOULD HAVE THAT DATA MAYBE LESS.
ALL RIGHT. WELL THANK YOU VERY
MUCH FOR THE PRESENTATION AND
YOUR TIME. WE WILL NOW MOVE ON
TO THE LAST DEPARTMENT ON OUR
AGENDA TODAY. THIS IS THE
DEPARTMENT OF MANAGED HEALTH
CARE. IF WE CAN HAVE, MARY, WE
WANT TO BE DAN SELF, ALBERT
PANETTA AGAIN. JOSEPH DONALDSON
AGAIN AND JASON KANSTEINER. AND
YOU MAY BEGIN WHEN YOU'RE READY.
THANK YOU. GOOD AFTERNOON. MY
NAME IS MARY WATANABE. I'M THE
DIRECTOR OF THE DEPARTMENT OF
MANAGED HEALTH CARE, OR DMHC.
WITH ME, I HAVE DAN SOUTHARD,
OUR CHIEF DEPUTY DIRECTOR, THE
DEPARTMENT'S MISSION IS TO
PROTECT CONSUMERS HEALTH CARE
RIGHTS AND ENSURE A STABLE
HEALTH CARE DELIVERY SYSTEM. WE
LICENSE AND REGULATE 143 PLANS
THAT PROVIDE HEALTH COVERAGE TO
30 MILLION CALIFORNIANS. THAT'S
ABOUT 96% OF COMMERCIAL AND
GOVERNMENT STATE REGULATED LIVES
IN THE STATE. OUR 2425 BUDGET IS
163 MILLION AND 724 AUTHORIZED
POSITIONS. THE DEPARTMENT IS
SPECIALLY FUNDED BY ASSESSMENTS
ON THE HEALTH PLANS AND RECEIVES
NO GENERAL FUND MONEY, WE ALSO
DON'T HAVE ANY BUDGET CHANGE
PROPOSALS CURRENTLY. THAT'S A
QUICK OVERVIEW OF OUR BUDGET.
I'D BE HAPPY TO GO INTO KIND OF
AN OVERVIEW OF OUR DIFFERENT
PROGRAM AREAS, OR WE CAN GO TO
THE QUESTIONS THAT WERE IN THE
AGENDA. I'LL DEFER TO YOU ON
WHERE YOU WANT TO GO NEXT. YOU
CAN IF YOU'RE READY TO ANSWER
THE QUESTIONS AND THE AGENDA,
THAT WOULD BE GREAT. SO I THINK
YOUR FIRST QUESTION HERE WAS,
WHAT ARE SOME OF THE MAJOR
TRENDS YOU'RE SEEING WITH HEALTH
CARE PLANS? AND MAYBE I'LL START
WITH WHAT KEEPS ME UP AT NIGHT,
I THINK SIMILAR TO WHAT YOU
HEARD FROM H. CHI AND THE OFFICE
OF HEALTH CARE AFFORDABILITY,
JUST THE COST OF HEALTH CARE, WE
DO RATE REVIEW, FOR THE
INDIVIDUAL SMALL AND LARGE GROUP
MARKET EVERY YEAR, WE TYPICALLY
HAVE BEEN SEEING KIND OF STEADY
SINGLE DIGIT INCREASES OVER THE
LAST FEW YEARS. AND FOR 2024,
WHICH I THINK MANY OF US
EXPERIENCED IN OUR OWN HEALTH
CARE, WE SAW PREMIUMS THAT WERE
DOUBLE DIGITS, THE AVERAGE COST
OF HEALTH CARE FOR OUR
COMMERCIAL MARKET IS AROUND $600
PER MONTH AND A MONTHLY PREMIUM,
SO THAT'S A SIGNIFICANT AMOUNT
OF MONEY. WE'RE SEEING, FAMILIES
SPEND ON THEIR HEALTH CARE AT A
TIME WHEN WE'RE ALSO SEEING THE
COPAYMENTS, COINSURANCE AND
DEDUCTIBLES GOING UP. SO I THINK
THAT IS SOMETHING THAT IS
CERTAINLY TOP OF MIND FOR ME.
AND ONE OF THE BIG TRENDS WE
SAW, PARTICULARLY GOING INTO
2024, AND I WOULD BE REMISS IF I
DIDN'T MENTION THE OTHER ONE,
WHICH IS JUST BEHAVIORAL HEALTH,
WE'RE SEEING OBVIOUSLY INCREASED
DEMAND FOR BEHAVIORAL HEALTH
SERVICES. REYES, AND SO THAT'S
WILL CONTINUE TO BE A TOP
PRIORITY FOR ME AT THE
DEPARTMENT, SO I WOULD SAY IN
TERMS OF HEALTH CARE TRENDS,
THOSE ARE PROBABLY THE BIG
BUCKETS, THE SECOND QUESTION,
MAYBE I'LL LET DAN, ONCE YOU
TAKE THAT ONE, YOUR SECOND
QUESTION IS WHAT LED TO THE RISE
IN COMPLAINTS IN 2022? AND DO WE
SEE THAT CONTINUING INTO 2023
AND THE RISE IN COMPLAINTS
BETWEEN 2021 AND 22 WERE MAINLY
RELATED TO TWO DIFFERENT
COMPLAINT TYPES BENEFIT COVERAGE
DISPUTES, WHICH CAN MEAN ANYONE
IS REQUESTING INFORMATION OR
SERVICE THAT THAT ISN'T
CURRENTLY COVERED UNDER THE PLAN
. THEY WANT TO SEE AN
OUT-OF-NETWORK PROVIDER. A DME
IS ANOTHER LARGE BUCKET OF NOT
COVERED BENEFITS. SO THAT WAS
ONE AREA WHERE WE SAW AN
INCREASE. THE OTHER WAS ACCESS
TO CARE. AND ACCESS TO CARE
COULD BE AS IT SIMPLY STATES, I
CAN'T GET IN TO SEE AN
APPOINTMENT WITH ANY TYPE OF
PHYSICIAN OR THERE MAY BE A
DELAY IN THE HEALTH PLAN
AUTHORIZING CARE. SO THOSE ARE
THE MAIN CATEGORIES THAT FALL
INTO THE ACCESS OF CARE ACCESS
TO CARE. WE DO SEE THAT
CONTINUING IN 2023 AND BEYOND.
AS MARY JUST NOTED, THE
INCREASED DEMAND FOR BEHAVIORAL
SERVICES. WE TALKED ABOUT THIS
IN THIS HEARING. THE SHORTAGE OF
PROVIDERS IN THE STATE HAS LED
TO CONTINUED ACCESS CONCERNS. SO
THOSE ARE THE TWO MAIN BUCKETS
THAT WE'RE SEEING IN. WE
CONTINUE TO SEE THOSE IN THE
CURRENT YEAR. BEFORE YOU GO TO
THE NEXT QUESTION, JUST TO
PIGGYBACK, WHEN NOW WHEN YOU SAY
ACCESS TO CARE, IS THERE, WHEN
YOU REALLY HONE IN ON THOSE
COMPLAINTS AND THE NUMBERS, ARE
THEY SPECIFICALLY REFERRING TO
PRIMARY CARE PROVIDERS,
SPECIALISTS, SPECIALTY SERVICES,
OR IS IT JUST IN GENERAL? IT'S
ACROSS THE BOARD. IT ALL
DEPENDS. IT'S SPECIFIC TYPE FOR
THAT CONSUMER. BUT I WOULD SAY
THE LARGEST BUCKET IS GETTING IN
TO SEE A BEHAVIORAL PROVIDER AT
THIS TIME. AND DURING 2022, WE
HAD AN ANOMALY TOO, BECAUSE
KAISER HAD A STRIKE FROM ONE OF
THEIR UNIONS THAT IMPACTED
BEHAVIORAL SERVICES. AND SO WE
SAW AN INCREASE IN ACCESS TO
CARE TO BEHAVIORAL SERVICES AT
THAT TIME TO DO YOU AND WHEN YOU
LOOK AT YOUR NUMBERS AND YOUR
DATA, DO YOU SEE TRENDS AS FAR
AS CERTAIN REGIONS HAVING MORE
COMPLAINTS? DO YOU SEE IT MORE
IN RURAL AREAS, INNER CITIES, OR
IS IT JUST ACROSS THE STATE? WE
ARE NOW BUILDING OUT A VERY
SUBSTANTIAL DATA ANALYTICS UNIT.
I CAN'T ANSWER THAT QUESTION
TODAY, BUT I THINK IN THE NEAR
FUTURE WE WILL BE ABLE TO ANSWER
THAT QUESTION. OKAY. QUESTION
THREE. THIS IS THE BIG ONE HERE,
SO WE'VE HAD SIGNIFICANT GROWTH
OVER THE PAST TWO FISCAL YEARS,
HOW HAS THE DMHC UTILIZED THESE
RESOURCES TO IMPROVE CUSTOMER
SERVICE FOR CALIFORNIANS? SO
MAYBE I'LL HIGHLIGHT A COUPLE OF
REALLY RECENT LEGISLATION THAT'S
BEEN SIGNED, OBVIOUSLY THERE'S
BEEN A LOT OF FOCUS ON HEALTH
CARE THE LAST FEW YEARS THAT
HAVE REALLY CONTRIBUTED TO OUR
GROWTH, THE FIRST AND PROBABLY
MOST SIGNIFICANT CHANGE RELATED
TO BEHAVIORAL HEALTH WAS THE
PASSAGE OF SB 855, WHICH REALLY
OVERHAULED OUR MENTAL HEALTH
PARITY LAW IN CALIFORNIA,
BEGINNING JANUARY FIRST OF 2021,
ALL FULL SERVICE HEALTH PLANS
AND ALL MARKETS WERE REQUIRED TO
COVER ALL MEDICALLY NECESSARY
SERVICES TO TREAT ALL BEHAVIORAL
HEALTH CONDITIONS RECOGNIZED BY
THE MOST RECENT DIAGNOSTIC AND
STATISTICAL MANUAL OF MENTAL
HEALTH DISORDERS, OR DSM. IT
ALSO REQUIRED, I THINK, MORE
IMPORTANTLY, FOR HEALTH PLANS TO
ARRANGE FOR OUT OF NETWORK CARE
WHEN APPROPRIATE IN NETWORK
OPTIONS ARE NOT AVAILABLE WITHIN
TIME, AND GEOGRAPHIC ACCESS
STANDARDS, AND THAT'S AT NO MORE
THAN THE IN-NETWORK COST SHARING
FOR CONSUMERS, THIS WAS REALLY
INTENDED TO MAKE SURE THAT
ENROLLEES WERE NOT GIVEN JUST A
LIST OF PROVIDERS AND ON THEIR
OWN TO ARRANGE FOR THEIR OWN
CARE. SO THAT WAS A VERY
SIGNIFICANT EXPANSION THAT LED
TO SOME GROWTH FOR THE
DEPARTMENT, THE OTHER ONE WAS SB
221, WHICH WAS IN FISCAL YEAR
2022, 23, WHICH APPLIED A TEN
DAY FOLLOW UP APPOINTMENT FOR
NON-PHYSICIAN MENTAL HEALTH CARE
PROVIDERS, SO THAT WAS ANOTHER
ONE THAT LED TO GROWTH FOR THE
DEPARTMENT. THE OTHER ONE WAS
BEHAVIORAL HEALTH
INVESTIGATIONS. SO WE RECEIVED
FUNDING IN 2021 TO CONDUCT,
BEHAVIORAL HEALTH INVESTIGATIONS
OF ALL OF OUR FULL SERVICE
HEALTH PLANS. WE'RE DOING ABOUT
FIVE A YEAR TO REALLY UNDERSTAND
THE CONSUMER'S EXPERIENCE
NAVIGATING THE BEHAVIORAL HEALTH
SYSTEM, WE HAVE VERY STRONG
CONSUMER PROTECTIONS HERE IN
CALIFORNIA, BUT WE UNDERSTAND
THERE'S A LOT OF BARRIERS STILL
IN ACCESSING BEHAVIORAL HEALTH.
SO WE REALLY WANTED TO
UNDERSTAND WHAT THOSE BARRIERS
ARE. AND WE'RE FINDING
DEFICIENCIES IN VIOLATIONS OF
THE LAW BUT ALSO BARRIERS, WE
ALSO HAVE OUR HEALTH EQUITY AND
QUALITY INITIATIVE, THIS WAS IN
FISCAL YEAR 2122. WE CONVENED A
COMMITTEE TO MAKE
RECOMMENDATIONS ON QUALITY
MEASURES THAT WE COULD COLLECT,
REALLY WITH THE GOAL OF
ADDRESSING LONG STANDING HEALTH
DISPARITIES. THE COMMITTEE
RECOMMENDED 13 MEASURES, WHICH
WE HAVE ADOPTED, AND WE HAVE
ALSO APPLIED A STANDARD OF THE
NATIONAL MEDICAID 50TH
PERCENTILE, WHICH WE WILL BE
ENFORCING ONCE WE HAVE
REGULATIONS IN 2027. SO WE HAD A
NUMBER OF POSITIONS RELATED TO
THAT, PROBABLY THE BIGGEST ONE
WAS SB 858, WHICH WAS IN FISCAL
YEAR 2324, THIS INCREASED OUR
PENALTY AMOUNTS THAT WE CAN
ASSESS WHEN WE TAKE ENFORCEMENT
ACTION AGAINST THE HEALTH PLANS.
IT ALSO GAVE US SPECIFIC
AUTHORITY TO REQUIRE CORRECTIVE
ACTION PLANS. AND SO I THINK WE
ADDED ABOUT 40 POSITIONS TO OUR
OFFICE OF ENFORCEMENT WITH THAT.
AND THEN DAN CAN TALK ABOUT SOME
OF OUR WORKLOAD POSITIONS. SO
MARY WENT THROUGH OUR RECENT
LEGISLATIVE REQUEST FOR
RESOURCES. I WANT TO TALK ABOUT
SOME OF OUR WORKLOAD, REQUESTS
OVER THE PAST COUPLE OF YEARS.
THE FIRST IS THAT OUR HEALTH
CENTER BETWEEN 2014 AND 2020, WE
SAW AN INCREASE ACROSS THE
DIFFERENT PROGRAM AREAS IN OUR
HEALTH CENTER OF 16 TO 46. AND
SO THAT RECENT BCP REQUESTED 21
POSITIONS TO HELP US MAINTAIN
THAT WORKLOAD AND ADDRESS
COMPLAINTS IN THE MANDATED TIME
FRAMES THAT WE HAVE. ONE OTHER
WORKLOAD, BCP WAS FROM OUR
OFFICE OF PLAN MONITORING AND
WITHIN THAT OFFICE PLAN
MONITORING. OUR DIVISION OF PLAN
SURVEYS EXPERIENCED AN INCREASE
IN WORKLOAD RELATED TO AN
INCREASE IN NUMBER OF LICENSED
HEALTH PLANS. I BELIEVE IN 2015,
WE HAD 121 LICENSED HEALTH
PLANS. AS MARY INDICATED EARLIER
, WE ARE NOW UP TO 143 LICENSED
HEALTH PLANS. SO TO ADDRESS
THAT, THROUGH OUR MEDICAL SURVEY
ACTIVITY, WE'VE INCREASED THE
AREAS WE'RE LOOKING AT IN THE
HEALTH PLANS RELATED TO THEIR
COMPLIANCE WITH THE LAW. AND SO
THAT WORKLOAD BCP IS GIVING US
THE NECESSARY RESOURCES TO DO
THAT WORK. AND THEN OUR FINAL
WORKLOAD, BCP, I WANT TO TALK
THROUGH IS OUR OFFICE OF
FINANCIAL REVIEW. AND AGAIN,
BECAUSE OF THE INCREASED NUMBER
OF LICENSED PLANS THAT INCREASES
THE WORKLOAD THERE TO CONDUCT
FINANCIAL EXAMS, NOT ONLY OF THE
HEALTH PLANS, BUT OF RISK
BEARING OR MEDICAL GROUPS AND
BASED ON FINDINGS WE HAD HAD
OVER THE PAST COUPLE OF YEARS,
WE THOUGHT IT WAS MORE PRUDENT
TO DO MORE FREQUENT
EXAMINATIONS. SO AT THE BEFORE
THAT BCP WENT THROUGH, WE ARE
CONDUCTING HEALTH PLAN FINANCIAL
EXAMS ONCE EVERY FIVE YEARS.
WE'RE NOW MOVING THAT TO ONCE
EVERY THREE YEARS AND ONCE EVERY
EIGHT YEARS FOR THE MEDICAL
GROUP, AND WE'RE MOVING THAT TO
ONCE EVERY FIVE YEARS. SO THAT
BCP WAS TO ADDRESS THAT
WORKLOAD. WELL, THANK YOU VERY
MUCH TO OUR FINAL PANEL. WE WILL
NOW MOVE TO PUBLIC COMMENT. EACH
INDIVIDUAL HAVE ONE MINUTE.
SI. BUENOS TARDES. MY NAME IS
ISMAEL RAMIREZ. VENIMOS DEL
VALLE DE COACHELLA DEL SUR DE
CALIFORNIA, YO SOY UNA FAMILIA
DE SIETE DE ME MIEMBRO DE SU
FAMILIA. AND ME FAMILIA. TODOS
EXPERIMENTAL FUE EL COVID.
GRACIAS A DIOS NO TUVIMOS C¯ A
UN HOSPITAL I ME SECUELAS TENGO
VALORES DE ESPALDA. VALORES DE
CABEZA IN IN OCASIONES ME SIENTO
MAL PARA IR A TRABAJAR. PERO
TENIENDO CINCO HIJOS DE FAMILIA.
NO PUEDO HACER EL TRABAJO CUANDO
SENTIMOS MAL LO UNICO QUÊ
TOMAMOS SON ANALGÉSICOS PORQUE
NO CALIFICADOS PARA TENER UN
MEDICAL. HEMOS APLICADO IN
VARIOUS OCCASIONS IN LA
APLICACION, PORQUE TRABAJAMOS
LOS DOS ME ESPOSA YO Y EL
INGRESO PARA PARA CALIFICAR. POR
ESO ME PETICIONES C¯ VALLAPUDUA
UN MEDICAL PARA TODOS LOS
TRABAJADORES AGRICOLAS DEL CAMPO
SIN IMPORTAR EL INGRESO NI
ESTATUS MIGRATORIO POR EL COSTO
DE LA VIDA C¯. AHORA ES MUY
ALTO, ES DEMASIADO ALTO. ESTE ES
NUESTRA POSICION TESTIMONIO
MUCHISIMAS. GRACIAS. GRACIAS
CADA PERSONA SOLO TIENE UN
MEMENTO OKAY. GRACIAS SI. BUENAS
TARDES. BUENAS TARDES. ME NOMBRE
ES ARACELI RAMIREZ. VENGO DE
TODEC DEL VALLE DE COACHELLA Y
LES PIDO. POR FAVOR. UNA
PETISYON PARA PARA SALUD. SI
GRACIAS. GRACIAS NOMBRE ES MARIA
. VENGO. THE RIVERSIDE DEL
CONDADO DE RIVERSIDE. ME
PETICIONES C¯ APOYAN LA SALUD
PARA TODOS. GRACIAS, GRACIAS.
CHRISTINE SMITH WITH HEALTH
ACCESS. CALIFORNIA ONE OF THE
CO-CHAIRS OF THE HEALTH FOR ALL
COALITION SINCE 2016, CALIFORNIA
HAS MADE SIGNIFICANT PROGRESS IN
REMOVING IMMIGRATION STATUS AS A
BARRIER TO OUR MEDI-CAL
ENROLLMENT. HUNDREDS OF
THOUSANDS MORE CALIFORNIANS ARE
NO LONGER UNINSURED. HOWEVER,
DUE TO FEDERAL RESTRICTIONS,
UNDOCUMENTED CALIFORNIANS ARE
STILL UNJUSTLY EXCLUDED FROM
PURCHASING COVERAGE IN COVERED
CALIFORNIA. OUR STATE'S
MARKETPLACE, EVEN USING THEIR
OWN MONEY RIGHT NOW, OVER HALF A
MILLION UNDOCUMENTED
CALIFORNIANS ARE UNINSURED
BECAUSE THEY EARN TOO MUCH FOR
MEDI-CAL AND OTHER THAN
IMMIGRATION STATUS, THEY WOULD
QUALIFY FOR COVERED CALIFORNIA
PLANS. IN ADDITION TO
SAFEGUARDING THE PROGRESS THAT
WE HAVE MADE IN MEDI-CAL
EXPANSION THIS YEAR, WE URGE THE
LEGISLATURE TO PRIORITIZE AN
INVESTMENT FOR THE CREATION OF A
COVERED CALIFORNIA MIRRORED
MARKETPLACE THAT WOULD ALLOW ALL
CALIFORNIANS TO ENROLL. ALSO ON
ITEM TWO, HEALTH ACCESS SUPPORTS
THE WORK OF THE OFFICE OF HEALTH
CARE AFFORDABILITY TO REDUCE
OVERALL COSTS, AND WE SUPPORT
THE PROPOSED 3% TARGET TO
ACCOMPLISH THIS GOAL. THANK YOU.
THANK YOU, THANK YOU. VANESSA
KAHENA WITH CP PUBLIC AFFAIRS ON
BEHALF OF THE CALIFORNIA PAN
ETHNIC HEALTH NETWORK HERE IN
SUPPORT OF EXPANSION OF COVERED
CALIFORNIA TO ALL CALIFORNIANS,
REGARDLESS OF IMMIGRATION
STATUS, WHOSE INCOME IS TOO HIGH
FOR MEDI-CAL. THANK YOU. THANK
YOU. HELLO, WHITNEY FRANCIS WITH
THE WESTERN CENTER ON LAW AND
POVERTY AND HEALTH FOR ALL
COALITION STEERING MEMBER. IN
ADDITION TO MAINTAINING OUR
STATE'S MEDI-CAL EXPANSION, WE
REQUEST THE LEGISLATURE MAKE
INVESTMENTS TO ENSURE ALL
CALIFORNIANS, REGARDLESS OF
IMMIGRATION STATUS, CAN PURCHASE
HEALTH CARE COVERAGE THROUGH
COVERED CALIFORNIA. OVER HALF A
MILLION CALIFORNIANS EARN TOO
MUCH TO QUALIFY FOR MEDI-CAL AND
ARE EXCLUDED FROM COVERED
CALIFORNIA SOLELY DUE TO THEIR
IMMIGRATION STATUS. THANK YOU,
GOOD AFTERNOON. ON BEHALF OF
SEIU CALIFORNIA, IN SUPPORT OF
HEALTH FOR ALL AND ECHO THOSE
COMMENTS ALREADY MADE, ALSO JUST
WANTED TO SUPPORT THE, SUPPORT
FOR THE STRIKING WORKER PROGRAM
WITHIN COVERED CALIFORNIA. IT'S
AN INCREDIBLY SUCCESSFUL PROGRAM
AND WOULD LIKE TO CONTINUE TO
SEE THAT MOVING FORWARD. ALSO
SUPPORT THE OFFICE OF HEALTH
CARE AFFORDABILITY, THE 3%
TARGETS AND THE STRONG FOCUS ON
WORKFORCE CGRTS, AND THEN WITH
REGARD TO WORKFORCE, INCREDIBLE
SUPPORT FOR THE MEDI-CAL
WORKFORCE POOL INVESTMENT FROM
THE MCO TAX WITHIN HCCI. I THINK
THAT'S A REALLY IMPORTANT
PROGRAM, PARTICULARLY GIVEN SOME
OF THE DELAYS AND CUTS ON THE
WORKFORCE SIDE. THANK YOU VERY
MUCH. THANK YOU. GOOD AFTERNOON.
MY COMMENTS ARE IN RELATION TO
ITEM NUMBER THREE, MY NAME IS
JOHN POLAND. I'M REPRESENTING
THE EMERGENCY MEDICAL SERVICES
ADMINISTRATORS ASSOCIATION OF
CALIFORNIA. SO WE REPRESENT ALL
34 LOCAL EMS AGENCIES IN ALL 58
COUNTIES IN CALIFORNIA. I'M ALSO
THE REGIONAL EXECUTIVE DIRECTOR
OF THE SIERRA SACRAMENTO VALLEY
EMS AGENCY, WHICH REPRESENTS TEN
COUNTIES IN NORTHERN CALIFORNIA
AND WE'RE JUST HERE IN SUPPORT
OF THE EMS AUTHORITY. THEIR
BUDGET PRIORITIES AND THE WORK
THAT THEY DO AS A PARTNER FOR
OUR ORGANIZATIONS. THANK YOU.
THANK YOU. GOOD AFTERNOON. I'M
ALSO HERE TO TALK ABOUT ITEM
NUMBER THREE. MY NAME IS DAVE
MIGNANO, AND I'M A, EMS
ADMINISTRATOR FOR SACRAMENTO
COUNTY EMS AGENCY AND HAVE BEEN
FOR OVER TEN YEARS. I'M ALSO A
LICENSED PARAMEDIC AND FORMER
CHP OFFICER THAT I FIRST STARTED
WORKING WITH THE STATE EMS
AUTHORITY IN 1983, WHEN I FIRST
BECAME AN EMT, AND SINCE THEN
I'VE HAD AN INTIMATE
RELATIONSHIP, WORKING
RELATIONSHIP WITH ALL STAFF
MEMBERS AT MSA, AND THEY DO A
GREAT JOB. AND SO I'M TOTALLY IN
SUPPORT, AND SACRAMENTO COUNTY
IS IN SUPPORT OF THEIR BUDGET
PROPOSALS AND REQUESTS THAT YOU
CONSIDER THAT. THANK YOU. THANK
YOU. HELLO CHAIR. JANICE
O'MALLEY WITH ACME, CALIFORNIA.
I JUST WANTED TO ECHO OUR
SUPPORTS FOR OUR HEALTH FOR ALL.
ALSO WANTED TO EXPRESS OUR
SUPPORT FOR $20 MILLION FROM THE
HEALTH CARE AFFORDABLE K¾T
RESERVE FUND FOR AB 2530 HEALTH
CARE FOR STRIKING WORKERS, AS
WELL AS CLARIFYING THAT FUNDS
MAY BE CONTINUOUSLY APPROPRIATED
FROM THAT SAME SOURCE, AND ALSO
WANTED TO AGAIN EXPRESS OUR
SUPPORT FOR THE OFFICE OF HEALTH
CARE AFFORDABILITY AT THE 3%
COST TARGET. THANK YOU. THANK
YOU, MADAM CHAIR. MEMBERS SARA
FLOCKS, CALIFORNIA LABOR
FEDERATION WE ARE HERE MAINLY ON
HEALTH CARE FOR STRIKING
WORKERS, AND WANTED TO EXPLAIN A
LITTLE BIT ABOUT THE ASK THAT WE
HAVE, AS YOU CAN SEE FROM THE
ANSWERS FROM COVERED CALIFORNIA
AIR STRIKES ARE VERY HARD TO
PREDICT. WE NARROWLY AVOIDED A
TEAMSTERS STRIKE, WHICH WOULD
HAVE BEEN 40,000 WORKERS WHO ARE
AT RISK OF LOSING THEIR HEALTH
COVERAGE. WE AVOIDED THAT, SO
RIGHT NOW, THE $2 MILLION THAT
WAS ALLOCATED IS SUFFICIENT TO
COVER WHAT COULD BE A LARGE
NUMBER OF WORKERS WHO WOULD BE
LEFT WITHOUT COVERAGE, AND SO
WHAT IS REALLY MOST IMPORTANT IN
OUR ASK, AND THE REASON WE DID
20 MILLION WAS TO SHOW THAT
THAT'S WHAT COULD BE THE COST OF
STRIKES. HOPEFULLY NOT, WHAT IS
MOST IMPORTANT IS A CONTINUOUS
APPROPRIATION FROM THE HEALTH
CARE AFFORDABILITY RESERVE FUND,
SO THAT THAT MONEY, WE KNOW WILL
BE ABLE TO BE THERE IF THERE ARE
STRIKES AND WORKERS NEED THE
FUNDING, BUT IF IT'S NOT NEEDED,
IT STAYS IN THE FUND. AND
HOPEFULLY WITH AB 2530 WE
ACTUALLY WILL AVOID STRIKES.
THAT IS OUR GOAL. WE DON'T WANT
TO USE THIS MONEY. WE WANT TO
AVOID STRIKES, AND WE THINK BY
TAKING THIS WEAPON AWAY FROM
EMPLOYERS, THAT COULD BE
POSSIBLE. SO WE WOULD URGE THE
CONTINUOUS APPROPRIATION, AND WE
ALSO SUPPORT THE OFFICE OF
HEALTH CARE AFFORDABILITY AND
THE 3. THANK YOU SO MUCH. THANK
YOU. HELLO. LUIS GALLEGOS WITH
THE INLAND EMPIRE AND COACHELLA
VALLEY HERE SUPPORTING ITEM ONE
HEALTH FOR ALL EXPANSION,
ESPECIALLY FOR UNDOCUMENTED
IMMIGRANTS THAT WE THROUGH OUR
GRASSROOT WORK, WE CONTINUE TO
SEE OUR OUR STATE'S MOST
VULNERABLE WORKFORCE, FARM
WORKERS THAT ARE NOT QUALIFIED,
THAT EXPOSE THEIR LIFE TO FEED
US ALL THROUGH PANDEMICS,
EXPOSURE, CLIMATE CHANGE AND
MORE. AND MORE, WE ARE SEEING
THAT MANY OF OUR MEMBERS,
ESPECIALLY HERE, THE ONES THAT
ARE HERE REPRESENTING THOUSANDS
OF STATE OF OUR STATE'S FARM
WORKERS THAT ARE NOT QUALIFYING
FOR MEDI-CAL, BECAUSE OF THE WAY
THE, THE, THEIR HOUSEHOLD INCOME
IS CONSIDERED. PLEASE SUPPORT
THIS. THANK YOU SO MUCH. THANK
YOU. HI, MADAM CHAIR, MY NAME IS
CHLOE STACK. I'M HERE ON BEHALF
OF THE CALIFORNIA IMMIGRANT
POLICY CENTER, WE'RE PROUD TO
HAVE WORKED ON THE HEALTH FOR
ALL CAMPAIGN FOR THE LAST
DECADE, AND WE WANT TO THANK THE
LEGISLATURE FOR THEIR LEADERSHIP
AND SUCCESSFULLY ACHIEVING
MEDI-CAL FOR ALL. I JUST WANT TO
UPLIFT ALL THE COMMENTS OF OUR
PARTNERS AND COALITION MEMBERS
HERE, WHEN EVERYONE IS ABLE TO
ACCESS THE CARE THEY NEED, WE
MOVE CLOSER TO OUR VISION OF AN
EFFECTIVE AND EQUITABLE HEALTH
CARE SYSTEM BY COVERING AS MANY
LIVES AS POSSIBLE AND PROMOTING
THE WELL-BEING OF ALL
CALIFORNIANS. THANK YOU. THANK
YOU. GOOD AFTERNOON. JOHAN
CARDENAS WITH THE CALIFORNIA
ETHNIC HEALTH NETWORK AND HAVING
OUR STATE COALITION, ALSO A
PROUD MEMBER OF THE HEALTH FOR
ALL COALITION, WE RESPECTFULLY
REQUEST THE LEGISLATURE TO
PRIORITIZE AND INCLUDE
INVESTMENTS IN THE 2024, 2025
STATE BUDGET THAT WILL ENSURE
ALL CALIFORNIANS, REGARDLESS OF
IMMIGRATION STATUS, CAN PURCHASE
HEALTH CARE COVERAGE THROUGH THE
COVERED CALIFORNIA MARKETPLACE,
WE ALSO BELIEVE THAT BY
CREATING, A MIRRORED MARKETPLACE
THAT'S AFFORDABLE AND ACCESSIBLE
FOR UNDOCUMENTED CALIFORNIANS,
COULD ALSO BE A STEP Ã KEY STEP
IN ADVANCING, CALIFORNIA'S
PROGRESS IN MOVING TOWARDS A
UNIVERSAL COVERAGE AND ALSO
IMPROVING EQUITY IN ACCESS TO
HEALTH COVERAGE FOR ALL, BY
ENSURING THAT EVERYONE IS ABLE
TO ACCESS THE CARE THEY NEED, WE
BUILD A STRONGER AND MORE
HEALTHIER CALIFORNIA. THANK YOU.
THANK YOU. AND SEEING NO MORE
PUBLIC COMMENT, I WANT TO THANK
ALL OF THE DEPARTMENTS WHO CAME
OUT AND EVERYONE WHO
PARTICIPATED IN THIS HEARING.
THIS HEARING IS ADJOURNED
.
AND NOT FORGET IT. SEE YOU BACK