Good afternoon and welcome to the Alameda County Board of Supervisors special meeting that is a joint meeting of the Social Service and Health Committee.

May I have roll call for January the 12th 2026?

Supervisor Fortunato Bass.

Present.

Supervisor Miley.

Present.

Supervisor Town.

Present.

We have a quorum.

Thank you.

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Thank you.

So we have three informational items.

This is a long-awaited joint meeting that will help us understand and prepare for the impacts of HR1 on the state and on the county.

So we'll start with the first informational item from Alameda County Health and Social Service.

Good afternoon, Supervisors.

Anika Chowder, Interim Director for Alameda County Health, and I'm joined by Director Ford from the Social Services Agency.

So we have three presentations for you today.

The first one is a backbone agencies update, followed by a budget update, and then a much uh lengthier one where SSA has done some deeper dives into some of the data and upcoming policy changes.

So to start with the backbone agencies, the context here, you know, as you just reiterated in your last meeting, is that HR1 is really pushing some very significant Medicaid policy changes that are phasing in over a number of years.

And there's a big impact on the Alameda County communities.

So there's narrowed, eliminated, narrowed or eliminated eligibility for many community members, and then of course uh increased and new requirements, such as the work required requirements for people who do remain eligible.

Um and that's uh there's also a lot of complex implementation challenges, so essentially uh, you know, any reduction in Medicaid eligibility or enrollment will result in revenue loss for our providers.

Um it also means increased administrative complexity, especially for the social services agency, uh, as they're doing eligibility and enrollment.

Um, there's a lot of policy and funding implications for the indigent care program, which is Health Pack, which is in our agency, and then of course, you know, one of the tricky things about doing this work is that there's so much that's dependent on state and federal guidance that hasn't yet come out.

Um, and so, and as you even heard with the budget, you know, we don't have all the information and and we're trying to plan ahead.

Um, so back in October, I believe it was the board designated um SSA and AC Health to help provide some backbone support to ensure coordination across our partners, and then report back regularly on Medi-Cal related efforts to this joint committee.

So on the right here is just a little bit of uh uh, there used to be a big Venn diagram of this uh previously, but essentially just to give you a sense of uh context for the backbone is social services, AC Health, and we're working closely with our board offices.

Um there's a core group of key health partners, uh, just because they're so large in the safety net space, which is Alameda Alliance for Health, Alameda Health System, and the Clinic Consortium, and then we've got a broader group of community providers to include the community provider advisory group, which is uh a meeting that uh was initially started by AC Health to join uh you know behavior health providers, homelessness providers, and public health providers in our system.

Um, and director Ford has uh been able to join those meetings as well because so much of the focus is uh now on HR1.

Um and uh we've got additional safety net partners, you know, in the social services space, and we're open to doing any ad hoc convenings as those happen.

Um, and then sort of at the broader county governance level is where uh this committee comes into play where we want to keep you apprised of the things that are happening.

So just recently, um, between SSA and AC Health, as you heard me list all the meetings.

We talk about a lot of meetings, and we meet to coordinate.

Um, we're also working on the implementation of some measure W funding that was allocated specifically for Medicaid outreach.

Um, and uh we're under we're developing a MOU between our two agencies, which will uh provide some enhanced um access to data for our health pack team because they have a team of people who help people enroll in different insurance options.

And so it would help that team to better refer people back to SSA.

And then as I mentioned earlier, working with our uh large healthcare safety net providers, and really the work there is to you know continue to do data analysis so that we're all working from the same numbers, and you know, working to develop different strategies for how we're going to implement things that are coming down the pike.

There's shared messaging work that I'll share a little bit about and um just coordinated medical outreach and engagement because that's probably the um biggest thing that I want to uh underscore is that uh the more we can prioritize medical outreach and engagement and enrollment retention, the better it will be for our system as a whole.

Um can we ask questions as we go along, or did you want questions at the end?

Um I think because this is going to be an extensive, let's ask them as we go along.

So feel free.

Okay, thank you.

So before you leave this slide, um, how often does this backbone body meet?

Um, so the uh SSA director and I have a regular meeting and regular check-ins, we see each other often.

The meetings with the key health partners, those are currently every couple of weeks.

Um, and I do want to thank the alliance for providing some additional um facilitation support for those.

Okay, and then the community health clinics, is that our federally qualified clinics, or does it also include our non-federally qualified clinics like Roots?

That one is specific to the FQHCs, the federally qualified, and then under community partners where you see the the CPAG roots is a part of that group.

And the CPAG meetings are currently quarterly.

Okay, so with the backbone, so all of this is backbone in terms of the two of you meeting, and then the CPEG and then key health partners and then others.

It's not like you're all meeting at once, it's a series of various meetings.

Now, are there other meetings in addition to those meetings?

Because I'm very sensitive to you just having so many meetings that you can't get the work done.

So can you speak to that?

Because I'm very, very sensitive to that.

Yeah, thank you for that, supervisor.

Those are the main ones that we're coordinating right now.

I don't know if director Ford might have some other social services specifically.

Yeah, I think as it relates to the backbone agencies and coordination, those are the only ones.

Well, there are all definitely other meetings that we have outside of the backbone discussion with in some cases some of the same partners.

Okay.

Well, I think we're gonna have to try to minimize um the number of meetings.

Let's just put it that way, so that you can really focus your time and attention.

Because I mean there's a lot of um stuff coming at us, and I think we can you can't do your best work.

I'm not just talking about the two of you, your your teams and everyone who's working with you, can't do your best work if there's all these um meetings going on.

Um it's sort of like I know for me, um, if I'm going to meetings, I can't do the work.

So if you're going to meetings, when do you get to do to do the hard work?

So I want to flag that and really track that.

And if it comes up again during this um the meeting today, I'll raise it again as well.

That's that's my only question at the moment.

Thank you.

Thank you.

Okay.

Um, so in the next few slides, I just want to spotlight uh some work that we've been doing.

Uh you know, the policy tracking and advocacy work, this thing that uh has been going on for well beyond uh before we formalized a backbone structure.

So uh really over the course of the last year in particular, uh we both of our agencies have regular meetings with our federal advocates as well as our state advocates to really discuss impacts and priorities.

Um we have been pretty good about submitting comment letters to federal agencies as different proposed rules come up.

Um, so uh for example, we uh opposed proposed changes to definition and expansion of public charge.

That was something SSA and Health worked on jointly.

We're also opposing rules from the Environmental Protection Agency that would roll back PFAS, those are the forever chemicals reporting.

And currently we're working together, we're working on a comments to oppose rules that would limit access to gender-affirming care.

And some of the mechanisms that are proposed for that would be to you know restrict Medicare and Medicaid funding for that and to change the definition of gender dysphoria as a disabling condition.

Budget tracking, so really, you know, closely watching things that are happening both at the state and federal level, and also trying to provide support for our staff wherever possible.

So we've been doing uh weekly federal policy updates, courtesy of our policy director at AC Health.

We also are, you know, monitoring relevant legal challenges and providing guidance to staff as appropriate.

So this includes things like, you know, a lot of the federal grants came down with language in there that you know you would be violating the grant terms if you were doing DEI type of programming or things like that.

And so we work closely with County Council to review grants before we're accepting them to make sure that we're not inadvertently going sideways with the grants, but then also, you know, staying true to Alameda County values and continuing to do the work that we think is necessary.

Um we've also developed some FAQs and job aids uh, you know, again, uh especially around data privacy, um and those have been helpful for our staff in-house.

Um another thing that uh we did uh this this spotlight is really to talk about some medical outreach and enrollment assistment assistance that was specific for the UIS population.

This UIS stands for unsatisfactory immigration status.

And so this was uh, you know, as a result of HR1 last year, the California budget included provision that people with UIS, if they were not already enrolled in Medi-Cal, they would no longer be eligible to enroll.

Um, and so there was a big push from Supervisor Fortunato Bash's office as well as our community partners, and we work together to really think about different ways that we could be getting some messaging out to help people enroll.

So the messaging I'll show you in the next slides, but on this one, uh, you know, our uh agency really put together some information sessions both with community partners that were really well attended as well as the health insurance technicians that are again with our health pack team to really provide like in-service for staff.

And our health equity and policy planning team at public health has also been holding office hours so that really again we're able to answer staff questions and when they're out there engaging with people in the community in their day-to-day work, they're able to better support outreach and enrollment for Medi-Cal.

We also leveraged an existing contract with Bay PLS, and this was to focus on Spanish speaking, mom speaking, and African immigrant communities.

Um, and this was a push that we did in the last latter part of the year to really get some promotorists and community outreach workers out across the county.

Um, and uh, you know, we supported more than 1,500 people, and uh it resulted in 418 referrals to enrollment assistance specialists, and those could be either on our health pack team in other community-based organizations or at the federally qualified health centers.

Um in terms of messaging and and medical outreach.

Uh, so again, this focuses a little bit on work that was specifically done around the UIS population focus in November and December.

Um there were a variety of texting campaigns, some supported by the county through El Timpano, uh, some supported uh by the FQHCs, like La Clinica did a big one, and I think other FQs also sent out texts to their uh providers to their clients, as did Alameda Health System.

And so I note all this to say that you know that backbone and some of those meetings that we were talking about, it was really critical that we were all able to meet together so that we weren't overwhelming people with information and that we were trying to roll out our cadence of information so that you know, oh, you received this thing from the Alliance, now you should call your primary medical care home, right?

Um, and so to be coordinated around that.

Um there was also some work that the public health staff supported with specifically the specifically with the My and Mom community, um, and this is uh because it's more of a spoken language, and so uh our staff presented in Spanish, it was translated into mom, and uh there's been uh really good viewing of both of those broadcasts, and again, this is about medical outreach and engagement and sort of the resources that are available to people.

This is a um just a screenshot of the postcards that the alliance sent out, um, again, with just information on what to do and where to contact, and you can see all the logos of the various CBOs that are also engaged there.

Uh, to go back to a little bit about just overall messaging and you know, not overwhelming folks, uh, one of the things that we've done is that as the pandemic emergency was ending, SSA had developed a website called healthyac.org.

Um so we've been leveraging that and uh as a place to drive people to for information on the county side, and then in terms of those key domains you see listed in the um in that table, these were all uh things messages that we landed on through uh provider convenings, so either things we heard at the community provider advisory group or a specific meeting that we convened, especially of healthcare providers.

Um, and we sort of landed on, you know, basic, easy to understand, be on the lookout for mail from Medi-Cal, keep your contact information updated, renew to stay covered, and then really uh, you know, on that trust and safety bullet, I just want to underscore there's uh there was pretty broad consensus across the group that you know we want to be a welcoming place for all, and at the same time that you want to say your information is private.

Um we did provide certain caveats and training to staff on how to talk about data that might already be shared at the federal level, right?

And so there's there's a lot of fear for people because that data is shared, but then at the end of the day, your health is important and it matters to you and your family and your community.

So kind of trying to nuance those and um, you know, some of these are things that can go out broadly.

Um, and then as we've talked as a group, it's it's also been really important to note that um at the end of the day, especially for people who are fearful, they're wanting to go in and talk to someone in person, like their trusted provider in their own language, you know, all of the things that we try to espouse in our safety net system as a whole.

So just in terms of next steps, uh we're gonna continue to do our work around messaging data analysis and implementation.

Um, there's, you know, one of the biggest things that's pending is that state guidance on work requirements.

I think we get a lot of questions about what are we doing to support people with that, how can the system be ready, and I think a lot's gonna depend on what kinds of solutions the state also puts into place because maybe there are some statewide uh things that we'll need to plug into.

Um the governor's budget, as you heard Amy mentioned at the last meeting, you know, does not fully account for HR1 impacts, uh especially in the health and social services space.

And so, you know, it it punted a little bit of the tough stuff to the May revise, and so we're really on the lookout for that.

Um there are a couple of uh specific projects that SSA and AC Health are coordinating around, and this is with implementing that $2.5 million that we received in Measure W funding for Medicaid outreach and enrollment.

So one is the Healthcare Access Outreach Project, which is we're in the process of finalizing a year-long uh sort of public information campaign, um, again, leveraging that site that I mentioned from social services earlier, and working with you know vendors that we already have so that we can get uh going faster.

Um the idea is that, you know, we did the push on the UIS population earlier, but this would be uh something that's longer and more sustained, and it can evolve as work requirements become clear, or we see that there's other um messaging that needs to go out.

And then on the um the second part of the measure W funds, we want to use it for enhanced outreach enrollment and retention through CBO partners.

Um so SSA has a list of providers they already contract with, and uh they've been looking at those to see where there's uh any need or room to add more.

Um, and then uh on the AC Health side, we're really looking to uh identify additional contracts that we could leverage for in-community support uh and for share for our priority populations that are listed here, and uh those are also populations that are shared with SSA.

So I don't know, Andrea, if you want to add anything before I close out.

No, thank you, Anika, for the very comprehensive presentation and information sharing.

Um, visor Miley.

Yes, thank you, Chair.

Um so under the the um unsatisfactory immigrant status enrollment prior to end of the year.

Um, how would you evaluate that?

I see the numbers, but the numbers still I mean I just see the numbers.

You know, tell me if what we did was no doing something is better than not doing anything.

Was it good, fair, poor, excellent, or what?

And in terms of you know, how many like what's the N that we're measuring that 48 out of?

That's a bit of a difficult question because that particular population was for people who could have been eligible for Medi-Cal but were not yet enrolled.

So they hadn't necessarily reached out to us already, they weren't people who had lost their coverage, so we don't have a good end for that.

Um, and so you know, if that was 418 new people that we were able to reach, we'd we think that's great.

Um but there's a as as you'll hear from Andrea, there's a lot of different cuts within the UIS population.

Okay, and that'll be the third presentation today.

Okay, so am I jumping ahead when I ask about with the enhanced Medi-Cal outreach enrollment or retention?

Do we have um any metrics associated with that?

Or is that coming up?

Uh that won't be in today's presentation, but we're actively working to so what we're wanting to do is to make sure that we're not um uh so if SSA is funding something already through their contracts, we want to figure out a way to be complementary to that in any new contracts.

Um so uh, but that we haven't gotten into the contracting process yet, so we don't have the metrics for you right away.

Okay, but you will.

Okay, absolutely.

Okay, thanks.

Questions?

Um, yes.

Well, first, thank you both, um, both directors and your staff for this work, it's so important.

And I also look forward to any additional information that we get in the future in terms of evaluation and metrics.

Um, maybe starting to look ahead.

Um, is there already some planning in terms of work requirements and how that will be impacting the clients that the county serves both for CalFresh as well as for Medi-Cal?

For Cal Fresh, the implementation month is sooner than Medi-Cal.

I'm as previously previously stated in other meetings, um, we'll get guidance from the federal government from Medi-Cal Medicaid work requirements in June or July of this year.

Um, but for for CalFresh, that would be ABOD, able-bodied working adults without dependents.

The implementation is June of this year, and we'll bring that presentation to this body next month.

And on the health side, one of the things that you know we're considering is again impacts on indigent care.

And so, but that's where we need additional clarity from the state because we don't know what happens if someone temporarily falls off and then goes back, like will there be a statewide solution for that, or is that going to be something that kind of falls on the counties?

Thank you.

Um I know uh in my um regular briefings with uh director Ford, she talks about the importance of trying to meet that December 31st deadline, and um that's been a high priority uh across the board because we need to get people enrolled because it's sort of you know, speak now or forever hold your peace type situation.

Well, when will we know how effective our outreach has been in terms of uh the enrollment that occurred by December 31st?

I'm not sure.

I'm just gonna ask Juan, will that come up in your presentation?

This happened to March.

Okay.

Um does that go through the state or do is it something we process through Cal SAUS?

It's something we process ourselves.

Okay.

So in terms of the outreach, uh was there a need to do any enhanced outreach with like the Asian community?

Because I know a lot of the uh Spanish speaking um uh pieces were pretty uh widespread, and like especially with the mom population that don't have a written language.

Was there a similar efforts uh with the API community?

Uh yes, I apologize for um I try to put examples of all the different languages that were done.

But so for example, the bus shelter ads, the radio ad, the uh and and the social media, we did them in multiple languages, including Asian languages, and then I know that um Asian Health Services, for example, has been a core partner with us in amplifying the work on this part.

Okay, um, we should probably just flag that so that uh Asian Health Services is um aware of that effort as well.

Do you know?

I I I know in in my conversations with Anika, you talked about um being more flexible and expansive with like health pack funding and I and then obviously, you know, we're looking at CalFresh in terms of HR1 impacts, we're looking at Medi-Cal, which is a big part of it with indigent care, you know.

Uh, we're also um cognizant of the fact that it affects Cal AIM, for example, um, which will apply to housing support.

Do we have a sense of how that might play out?

Uh that is the 10,000 question,000 question or $20 million question that we're we're working on.

So Dr.

Clan and we'll speak to it just a little bit at the end of the third presentation.

Um, but essentially, you know, Health PAC as our we're one of the few counties in the state that uh maintained an indigenous care program.

A lot of other counties have gotten rid of it.

Um, and so it's an opportunity for us to you know look at how we can align what's happening in health pack.

Like, for example, we're thinking about you know administrative changes that may need to happen so that it better aligns with the different uh administrative changes that'll need to happen for work requirements, for example.

We want to make it easier for eligibility workers to be able to go across the two programs.

But uh we'll do a deeper dive for you in either next month or the month after.

Um, but we are taking sort of a big picture approach to you know, look at health pack, look at Measure W, look at Prop One is another one.

Um, so within our agency, we've kind of been calling that like the 3D Tetris on the back end, where we're trying to minimize the harms that are happening from all of these different places.

Um, but we don't have really good numbers yet of you know how many people might fall into health pack, for example, again, because there's this flux at the state, um, and there's a big push to for the state to come up with some statewide solutions as well.

Okay, um I know uh we're all aware of what's been happening with the indigent care program, particularly with uh AHS and some of their projections in terms of their operating revenue shortfall and and what that has meant for staffing.

Are they um separate in this discussion or are they part of the ongoing efforts?

I know they're on the Alliance board, but is that how how's their conversation and their issues being a part of this effort?

Yeah, so um the uh HS CEO and I meet on a regular basis and we're uh in conversation a lot for health pack in particular.

Um AHS is the bulk of that program in terms of provider because they provide specialty care as well as primary care, and then the clinic consortium's FQHCs are the other component.

Um, so uh that's part of the reason we've been doing these backbone meetings and sort of making sure to talk with the healthcare safety net so that we're all aware of our um, you know, there's impacts from different sides, and it's helpful to understand uh what the pressures are for everyone so that we can think about ways that um we can try to solve for it together, uh knowing that you know we we're not gonna be able to fill the the whole if all of the HR1 things come to fruition as the government might have planned.

Yeah, I I appreciate we're not going to be able to fill those gaps completely, and and we're hoping that with this ongoing joint meeting and these briefings and updates that we can at least identify the phasing and the gaps and how we can bridge some of those funding needs, for example, that would occur uh within both our federally qualified health clinics and within AHS as well.

That's possible.

Yeah, our goal would be that you know whatever recommendations we bring to the board are informed by conversations and the needs that we're we're hearing from our partners, so that it's not a surprise to anybody.

Okay, thank you.

Uh, so are there any public comments or public input on the informational item on the safety net planning backbone?

Andy Martinez Patterson.

Is it on?

Oh, Andy Martinez-Patterson, CEO of Alameda Health Consortium and the Community Health Center Network.

We represent eight federally qualified health centers in Alameda and 180,000 patients who we care for.

I wanted to take this moment to thank you for your commitment to the safety net.

This meeting is one of the many um indications of how dedicated you are to the safety net that you made this meeting, social services and health, and indicative of the coordination that happens in Alameda.

I wanted to support the words of Director Chaudry, that we are one of the partners of the backbone and are so grateful for the coordination.

We've been planning for this since last year with the health plan, Alameda Alliance, with Alameda Health Systems and Public Hospital Systems, with social services, on how do we respond?

The FQHCs alone in this next year in the culmination to face 188 million dollars in cuts, the Alameda FQHs, including the community health center network as well.

But with coordination, and as we've all seen this in the safety net, as the resources shrink, the only way we are going to get through it is if the safety net acts as a unified system as opposed to independent departments.

And we are doing that together.

And little things.

When we would do the outreach, we just assumed that these were happening, but we weren't pairing them and meshing them.

We were not aligning the data when we collect data.

We weren't asking the county, how do you exactly define the data that you collect?

So we had different numbers.

These are the little things that are not sexy at all.

But if we can get through it and build this system, this safety net in Alameda will be stronger at the end of a shrinking, but hopefully more sophisticated and more impactful.

And just to name that we're leaning into that moment, is a terrifying moment, but this is what the safety net is for.

And I want to thank you for your commitment to this board meeting and that the health centers are going to be here through the whole thing.

Thank you.

No more speakers for item one.

Okay.

Um, we heard a little bit about the governor's budget, but we should probably hear more about what it means for our um health and social services programs and updates.

Thank you, Supervisor Tam.

I would like to call to the podium again, Andrea Ford, Agency Director for Social Services, Hannah Hamilton who will provide an update for social services, followed by Jessica Blake Moore, who's the interim policy director for Alameda County Health, and she will provide an update from that perspective and finally Amy Costa from the CEO of Full Moon Strategies will again provide more information about the governor's January's budget proposal from her perspective.

Hannah.

You only learned about this on Friday, didn't you?

Good afternoon, supervisors.

Actually, I believe Amy Costa is uh presenting first in the slide deck.

Let's see.

Yes.

Okay.

So I'm going to, so our agenda, um, Amy will be presenting the uh fiscal year 26-27 proposed budget overview.

Um, I will discuss the social services impacts, and then Jessica will uh go through our health and homelessness impacts.

So with that, I will hand it over to Amy Costa.

Great, thanks so much, Hannah Amy Costa, full moon strategies.

I proudly serve as Alameda County's legislative advocate in Sacramento.

I'm going to start with just some of what I consider the more structural elements of the governor's proposed budget, and some of the big top-line numbers, and then I'll defer to HANA and Jessica to talk about some of the programmatic impacts.

Um, as you all know, this kind of marks the beginning of budget season in Sacramento.

So a lot more will be uh revealed to us as we enter May Revise, um, when we have better numbers on revenues and when we may know more from the federal level, as both directors just noted.

Uh first slide, please.

So high level by the numbers, um, the governor has proposed a total budget of all funds of 348.9 billion dollars.

Of that 248.3 billion is general fund expenditures, and that's important because that's where most of our safety net programs live is on the general fund side of the state ledger.

Um, he's proposing uh 42.3 billion dollars uh, or pardon me, the the revenues are actually coming in at 42.3 billion dollars above what was projected upon enactment of this year's budget, 2526.

I would know administration officials had a lot of caution around those revenue numbers because much of the revenue is being generated by about three different technology firms, including Nvidia and Google, largely driven by AI, and so there's a real question mark and really some concern about how sustainable any of those revenues are.

Um, as you each know, um, we are disproportionately um reliant on personal income tax and capital gains, which is one of the more volatile revenue sources at the state.

Um, I think it's also important to know that we're actually the budget as proposed is balanced, but there is an operational deficit that our expenditures are outpacing kind of the revenues on the natural the state's project.

And we're able to bridge this through the current year and other carry-forward dollars.

But you know, we have an operating deficit of 20.9 billion dollars.

Given that uncertainty, the governor is proposing putting aside about 23 billion dollars in various reserve accounts at the state level.

Next slide, please.

As I said, the revenues are much better than projected.

And the administration or actually the governor noted in the state of state, the 42.3 billion dollars doesn't even take into account December revenues because of the timing of when the state puts together the budget.

So it could, and we likely will see in May that the revenues will actually be even a little bit higher with that extra month of receipts.

But as I said, it's really driven by AI stocks and personal income.

And so there's a lot of caution.

Some of us who have been around state budgeting for a while have seen this song before, where tech really kind of volleys the revenues up, but they're not sustainable.

And sometimes in the very next cycle, we're down on our revenues.

The other kind of structural element of the budget that I want to point out is one of the provisions of HR1 had to do with something that we call the managed care organization tax.

It generates significant revenue in California, anywhere between about $12 to $15 billion.

However, under the provisions of HR1, we're not compliant as a state with what the new law states on managed care organization tax.

States can apply for and be given an extension as we bring that revenue into compliance.

And so the administration has made what I consider a significant assumption in saying that this revenue source we will be able to hold on to throughout the calendar year versus just the fiscal year.

So that's an extra six months they think the state is going to generate this revenue.

Like so many things, it requires federal approval, the state hasn't heard back yet.

So should the feds deny us this extension, it will create another significant hole that state lawmakers will have to address in the budget year.

Next slide.

This is a bit of an eye chart, but I like to show it because I think it's kind of the most important document as you're thinking through county decisions and looking at the state's fiscal health.

As I noted at the bottom line, you can kind of see what the deficit numbers are that the state is projecting.

You can see in 26, 27, the 20.9 billion that I mentioned.

And you can see in 2728 that grows to 26, almost 27 billion dollars.

And I would note the last two years, as is often the case with projections, you know, they're not as reliable the further out we get, but nonetheless, the state faces some real structural issues.

The administration did say during the press conference, and they've done this for a couple of years, that they plan to present a balanced budget for two years.

And so ultimately in May revise, we will see how they bridge the gap to make sure that 2627 and 2728 are brought into balance.

In the past, what they've done is they've done this by scheduling reserve payments to help kind of offset the increased expenditures.

But again, more to come.

And I think, you know, oftentimes in the press conference, the administration was highlighting the volatility of the revenues and really wanting to make some of these bigger policy decisions in May revise when they have a better sense of where these revenues are going to land.

Next slide.

So this is one of the big numbers.

I think one of the directors said the 10,000, it's the 1.4 billion dollar question.

The state is basically noted that as has been noted by the directors, you know, many of the provisions of HR one happen over time.

But in budget year, the state projected and put in their documents an increased cost of the state of $1.4 billion dollars.

Much of this is really in both the Medi-Cal and the CalFresh programs, where some of the most significant policy changes have happened in HR1.

But I think it's important to see this because this is a significant number for the state.

And as we're trying to think through what the state may or may not do, how they may treat indigent care, it's important to note kind of the scale of what they face here.

And again, as I noted, this is absent the MCO tax.

So this number could get worse.

This is including the assumption that we can keep that current revenues for the first six months of 26.

And I think they went, you know, they kind of glossed over it, but I think it's really important to understand that they do not backfill really any of the CODs, nor do they offer any what I would consider administrative cost increases to counties who ultimately will be responsible for many of these increased costs, you know, in our offices through redetermination work requirements.

It clearly creates a bigger workload for counties, and it wasn't addressed in the governor's budget at all.

That's my last slide.

With that, I'm happy to answer any questions or turn it over to the department staff to take a click down into the more programmatic impacts and proposals that the governor released on Friday.

Any questions on the portion that Amy presented on the state budget?

Thank you, Amy.

I do have one question, and that we've talked about this because we get weekly updates at the PAL committee.

If expenditures at the state level are already outpacing revenues, and it's exacerbated by HR1 and the federal impact, has the, you know, we've talked about revenue measures that the state could propose, and there's been varying opinions about some of those measures.

Has the governor put forth any sort of um proposal to close the gap from a revenue standpoint?

No, he hasn't, supervisor.

And it was really noted during the presentation on Friday that you know he was not proposing new revenues.

I will say there's a very minor change in revenues that has to do with um third-party vendors, um, you know, people who deliver food, et cetera, and kind of a conformity measure.

It certainly wouldn't close this gap.

It's worth only around 20 million dollars.

Um, but I do think to your point, we're probably gonna hear um as the legislature begins debating the budget.

Um, both uh the assembly and the Senate have their overview hearings on the 20th and the 21st.

Um, I do believe some policymakers are going to bring up this particular issue.

Um, and as I've said before in PAL, um, you know, there's baseline funding also that will need to be re-ubbed at the state level.

Um, as you know, there is an incremental increase in high income earners that was passed by voters in Prop 30 and subsequently Prop 55, originally put forward by Governor Jerry Brown, those are set to expire.

And so, in addition to additional revenue needed to close this gap, there's a couple of revenue measures that are what we consider baseline that need to be extended as well.

Good point.

Thank you.

Uh Supervisor Miley, then surprise the project in the past.

Oh, yeah.

Amy mentioned uh Governor Brown, former Governor Brown.

So what I know he created a rainy day fund.

So, has that rainy day fund over time grown or diminished?

So that's a very interesting question, supervisor.

It has grown.

Uh and actually um in recent years, the legislature has put in more into the reserves than was required by the constitution, in part because of um some of the federal volatility candidly under both Trump administrations.

Um, and it's it's one of many different reserve funds that the state has.

Um, and so yes, over time they've increased it.

However, in the last two years, they've also utilized it.

Um, as I mentioned, the governor likely in May Revise will have a two-year strategy to bring both of those fiscal years into balance.

And in the past, they've used the reserve fund and scheduled out the payments across two years to help reach that balance.

What's what's the amount in the fund?

Do you know?

Give me one second.

Yes, I do.

For 2526 in what we call the budget stabilization account, the mandatory deposits were 9.5 billion.

They put in 11.3 billion.

In budget year, the mandatory deposits, again, driven by revenues, it is a formula that they utilize based on um PIT personal income tax is 12.5 billion, but the total deposits will be above that at 14.3 billion.

Okay, thanks.

Thank you for the uh report, Amy.

Obviously, it's uh it's relatively early in the budget cycle.

At least two of our state representatives, Assembly Member Ortega and Senate uh Senator Eric, made some public comments expressing their commitment to working families and to some extent uh health care and food assistance.

I'm curious if you're starting to hear any specific ideas about how some of our state lawmakers can help address these really dire impacts of HR1.

Well, one of the things that I think will be important, and I think the staff is going to present on this is you know, we've met with every member of our legislative delegation on this topic before the governor's budget was even proposed.

And I think we luckily enjoy um you know wide support from our delegation.

I think we will need to provide them um real estimates on what we think the administrative costs and the indigent care costs will be so that they fully can understand kind of that that delta.

Um, and you know, I look forward to working with your staff to provide them with those numbers.

Um I do think you know, one of the things it's a nerdy point, but it's an important point in the budget is you know that although they don't provide any funding for HR1, they do score the savings with people rolling off of these programs in caseload.

Um, and so you know, I I find it difficult to believe in the absence of as Supervisor Tam raised another revenue source that the state would be able to fully fund all of the different programs that are experiencing cuts under HR1, and you know, candidly with some of the state um budget proposals that were put forward last year.

Thank you.

Um Hannah, you want to continue?

Thank you.

Okay, well, picking up where Amy left off with this 1.4 billion.

I'll just break that out a little bit more.

Um so the state estimates that 1.1 of the 1.4 um cuts will or costs due to HR1 will come from Medi-Cal, primarily due to the six-month eligibility redeterminations, reduced federal match for emergency services, and reduce hospital uh quality assurance fee program.

Um they do note that Medi-Cal work requirements go into effect January 1st, 2027.

This, as we've uh stated, will um increase the administrative burden on our counties, and there is nothing in the budget uh to account for that just yet.

Um, and we are expected uh the the state notes that uh it is expected to see a reduce enrollment um in Medi-Cal due to those work requirements.

So for CalFresh, there's really two aspects of CalFresh costs that we're concerned with.

There's the administrative cost to run the programs as well as the benefit payments.

So for the administrative costs, the budget estimates a cost of 382 million.

Um, and um it is assuming um, so we I think we talked about this in another meeting, but um HR1 changed the ratio of administrative cost sharings from 50 50 federal, federal, and then the other 50% state and county to 2575.

Um, so uh the budget assumes due to this increase in uh burden on states and counties, uh, 382 million increase starting October 1st, 2026.

We still anticipate that the SSA share will be $8.8 million for a total of 24.9 million for Calfresh administration.

What the budget doesn't include is a line item for the benefits payments.

Historically, this has always been covered 100% by the federal government.

But what was introduced in HR1 was a cost sharing provision based on our payment, the state's payment error rate.

The budget does not acknowledge that cost at all and just says that the state is still assessing the fiscal impact of that cost sharing provision.

Estimates are with the state's current payment error rate above 10%, that those costs would be approximately $2 billion.

And we don't know if the state will pass those costs down to the counties or not.

And the state is also, or the budget also estimates a $66.2 million reduction due to HR1 immigrant eligibility restrictions that also begin October 1st, 2026.

So next is in-home supportive services.

So the budget accounts for natural growth in program costs and caseloads since the 2025 budget act, but as an exception to this is in IHSS, where 233.6 million is proposed as a cost shift to counties due to a typical growth beginning in the following fiscal year, fiscal year 27-28.

However, in fiscal year 26, Alameda County will receive an 8% increase for IHSS admin costs.

CIFCO stands for Community First Choice Option.

We are estimating a $5 million increase in net county costs here in Alameda County, and the county is fully responsible for that cost.

CalWorks, we're seeing so the single allocation refers to administrative funding for CalWorks as well as costs to fund our employment services, our welfare to work program.8 million in the current year and uh by uh 70.7 million in 2627 due to increased caseload growth for Alameda County.

This equates to 2.6 million in our allocation, and it should equal our increased labor costs for fiscal year 27.

And there is no maximum aid payment grant grant increase.

Wanted to just take a moment to discuss uh the realignment funds.

So there's for the 1991 realignment funds, we're seeing just a two percent increase up from the previous year, and for uh the 2011 realignment funds, we're also seeing about 1.98 increase from the previous year.

Uh this is important because realignment funds make up approximately a quarter, uh a quarter of our budgeted revenue and contribute largely to uh IHSS, uh adult protective services and children and family services.

So uh given that our COLA is uh around four point uh four four to five percent uh there's a concern that those revenues uh will not keep pace with those increase in costs.

Uh last I just wanted to touch base on the federal funding freeze.

Uh so uh this was uh uh last last week was a big issue on this on Tuesday, January 6th.

Uh ACF played placed temporary restriction on the drawdown of federal funds for these programs, and they were requesting uh the submission of requested data and wanted uh to hold on um uh uh allowing us to draw down those funds until we uh the state handed over the data um and until uh they completed the review and confirmed compliance with those programs on Friday, uh January 9th, California and other impacted states.

So this was I think just five Democratic states uh sued the Trump administration, and on the same day a federal judge temporarily blocked the action.

Um but I did just want to talk a little bit about what um what this would mean for uh for CalWorks, which that's what TANF is in uh California.

So uh the federal TANA funds make up 55% of our CalWorks program costs of 226.9 million or 124 million.

Uh we have approximately uh 23,300 individuals enrolled in CalWorks as of December 2025, and uh 5,600 were enrolled in welfare to work in the same month.

Um if you look at just the breakout of um what CalWorks funds from that federal share, uh the largest is uh 52 million in um uh single allocation.

So we had talked about that.

The admin costs um as well as the welfare to work costs, um, and then uh next is the direct payments to families.

So 30 million uh for that.

Uh and then there's a a child care uh component to that as well, and some other costs.

So we are very thankful that there is a hold on that freeze for now.

Um, and we will continue to monitor and provide updates accordingly.

That's all I have.

Thank you.

Are there any questions on this portion of um the state budget presentation on impacts to social service programs?

And I see supervisor Miley's light on.

Uh yes.

Thank you for the uh information.

Um this is uh informative.

Uh based on I know it's early at the moment, uh, we'll get the revise in May, but what's the overall um impact in Alameda County at this point in time in social services?

So I think you do have to look program by program.

Um, you know, certainly uh there's and there's those unknowns, right?

So we again going back to um to Medi-Cal, like we don't know um, or I'm sorry, with with Cal Fresh, we don't know about the cost sharing provision.

I think that that's really the biggest, the scariest thing.

We don't know if the state is gonna pass that on to the counties or how they're gonna grapple with that two billion dollars.

Uh if that comes to pass.

Um, you know, work requirements, there's there's a lot that's not here, I would say in the budget.

Um, how our agency is going to you know pay for those the increase um uh in cost to roll out those work requirements.

That's not in the budget as well.

So um I think there's a lot of unknowns, a lot of gaps, and we can just uh you know continue to to monitor you know program by program and try to fill in those gaps.

Yeah, I can I can appreciate what you're saying, but what I'm trying to get at is worst case scenario.

If the worst case scenario were to happen, I mean it's there arranged, like the worst case would be yada yada.

Um, the the you know, the the best case or the most likely case is this.

And if you haven't figured it out, that's fine.

But I'm trying to get a sense of what's the worst case scenario if you know that.

So, Supervisor Miley, um, we haven't figured it out.

So this just came down a pike on Friday.

We wanted to get this information to you all as quickly as possible.

Gotcha, gotcha, gotcha.

Okay.

All right.

And then um, I know your association, your state associations probably dialed into this.

What about CSAC?

What is CSAC doing around this?

We're looking at that now, so we always do a same-day preliminary uh summary, and then we'll we follow up with a three-day summary after we look at our associations and their comments.

Okay, great.

Thank you.

Thank you, HANA, and thank you to your whole team for this update.

Um in regards to the uh freeze on child care funding.

Um, I just wanted to point um the public's attention to first five alameda.

They've been working with your agency on monitoring things, and they actually have on their website some good information on what the impacts potentially could be if this um continues.

You know, 5,200 kids would potentially be impacted across the entire county.

So I look forward to that litigation proceeding after the 14 day stay.

Um I have one question, which is on page 12.

Um, it says here on the funding freeze, federal funding freeze uh slide that early indications are that Medicaid might be included.

Could you speak to that a bit more?

That is all I have on that piece, but this um uh yeah, that's um that is all I have.

We were just told from our uh association to look out for that.

We don't have any other information.

Um thank you.

Appreciate the presentation as well.

Um going forward and so subsequent joint briefings that we have with this committee.

Um I think Supervisor Miley's uh point about looking at the worst case if uh the funding gaps aren't filled, because I know there's a lot of uncertainty right now, and then obviously the best case, but this will help us understand better how to proportion the measured W essential services fund uh and allocate it to fill some of those gaps.

So understanding that by the time our you know, our budget process, which will be in around May, um would be very helpful.

I think we'll have more answers then.

Thank you.

Thank you.

So Medical and Healthcare access.

Okay, good afternoon.

Jessica Blakemore, interim policy director with Alameda County Health.

We'll share a bit about our initial assessment of impacts to our agency, particularly around health and behavioral health care access and homelessness in the proposed budget.

Uh so as has already been highlighted by both Amy and HANA, um, the budget does maintain Medi-Cal eligibility and coverage changes for the UIS population.

Um, another area of significant concern is the um safety net for the safety net system is the reduction in rates for UAS Medical patients at FQHCs.

It will take effect July 1st of this year and represents significant future loss of reimbursement for community clinics.

Um, as has also already been mentioned, just want to highlight again that no proposed additional resources to counties to ensure adequate funding for indigent programs to meet the needs of the newly uninsured were proposed in this budget.

Um Amy gave a really great um overview of the managed care organization or MCO tax um situation.

Um and just to highlight that long-term future MCO tax revenues will be limited because of the restrictions included in HR1, resulting in the loss of ongoing funding for Medi-Cal.

Um the state does plan to invest uh significant um funding over the next two years to support managed care payment increases, but it is unclear if those rates will be sustainable.

The budget does include 60 million one-time general fund um for um grants to reproductive health care providers to increase access.

In terms of behavioral health, the proposed budget reflects shifts driven by Prop One, the Behavioral Health Services Act.

Counties statewide are estimated to receive more than $4 billion for county behavioral health treatment and supportive services.

There was an additional 150 million placeholder for prevention programming with more details expected in the May revision.

On the Medical side, the budget allocates 65 million in this budget year and uh 95.5 million in 2627 MCO tax revenue for behavioral health priorities such as community-based mobile crisis services, transitional rent, and behavioral health rate increases.

There were significant changes to the Medical mobile crisis benefit identified in the budget.

Enhanced federal funding for this benefit expires at the end of 2026.

The current statewide mandatory mobile crisis benefit sunsets on March 31st, 2027, unless the state submits and receives approval for a state plan amendment.

The administration is proposing to transition the mandatory benefit to an optional benefit beginning April 1st, 2027.

Currently, the state covers the non-federal share of that mobile crisis cost, but under an optional benefit, counties would be responsible for that non-federal share.

On homelessness, the proposed budget continues to implement the centralized California Housing and Homelessness Agency.

The big homelessness budget item is $500 million in 26-27 for round seven of HAP.

That is contingent on new accountability and performance requirements.

If you recall, there was no HAP funding allocated in the current fiscal year.

Additionally, there will be 200 million available from NCO tax revenues to implement the transitional rent benefit in Medi-Cal.

And in the budget, the administration does acknowledge that recent federal actions have created significant volatility in the homelessness space, and that's the state will continue to explore ways to provide programmatic flexibility in response to the challenges, but it's not clear what that will look like yet.

And that's all I have.

Supervisor Miley?

Sure.

Thanks.

Thanks for the information.

I ask you the same question.

Do we have a cent of the worst case scenario?

I think we're also in the same space of not knowing exactly.

You know, there were not really many direct programmatic cuts to AC Health funding.

However, the bigger picture of what's happening within Medi-Cal and our safety net system as a whole, I think is really what we're looking at.

And I think we'll hear about some of those things in the next presentation.

And with the Prop one.

That's right.

For prevention.

Yeah, and so that's the funding that will be going both to the California Department of Public Health and the Department of Healthcare Access and Information for the Statewide Prevention Priorities.

Supervisor, I can add a little bit more context.

So just the prevention piece of that is uh really only about 50 million uh statewide.

And so the way that CDPH is uh proposing to roll it out is that they may um uh have some funding for uh county public health jurisdictions to do some convening processes.

They're also wanting to do some direct grants to CBOs, and um there may be another opportunity to partner with them.

But again, for context, you know, in our county um we had something close to 26 million dollars of prevention and early intervention programs under the behavioral health care.

Sorry, MHSA.

And the same question.

Um, your state association is dialed in, and you're working with CSAC as well.

Yeah, so CHIAC, that's the County Health Executives Association, the Behavioral health Directors, the CWDA, um, the county family Family, there's a few others in there, and Amy, I think, are all sort of working with CSEC to make sure that we're aligned with our advocacy around this.

Yeah.

Thank you, Chair Tam.

Um, I think I have two.

Well, thank you first for the information.

Appreciate the information, although a lot of it is not good news.

Regarding the MCO tax, could you say a little bit more about the requirements or restrictions and what some of the challenges we face are in terms of qualifying from the federal government?

Sure, I can say a little bit, but then I would invite Amy because I think she has a bit more knowledge about it.

But when HR1 was passed, a lot of the new requirements around the MCO tax, you know, included capping what the state is able to do for that, and our current structure does not comply with that requirement.

So as Amy stated, you know, the current tax as approved will expire.

And we'll have to apply again to have a compliant MCO tax.

So there is a assumption in the budget that we'll be able to have a transitional period, but as Amy stated, that's not necessarily known.

And then after that transitional period is over, you know, the compliant MCO tax, which will be generating less revenue over the long term, will would be in place.

Amy, do you have anything to add to that?

No, the only other complexity I would add is there was an initiative also that passed regarding the managed care organization tax that really more on the expenditure side kind of focused those revenue dollars on um on rates.

Um and so kind of just the outer limit of how much it's going to be able to raise um and in turn spend is much more limited than when it was originally passed.

And I think candidly folks are just worried about this assumption in the budget because so far the federal government hasn't been exactly friendly towards us, uh, and I think there's a lot of skepticism about whether or not they would allow us to extend it for the full calendar year.

Thank you.

And then um regarding the community-based mobile crisis services, um so this is an area that has been expanding in Alameda County.

Some of our cities on their own, and you know, our own CAT team for might be one example.

Could you talk a little bit more about what the potential impact will be for these services, both for the county and to the extent that you know for our cities?

Yeah, I think we're still assessing that.

Um there was, there is currently a mandatory uh benefit Medicail mobile crisis benefit.

So every um, you know, county behavioral health managed care plan needs to have this available.

Um so because it is mandatory, the state, and there is an enhanced um funding from the federal government that will end.

Um but because of the mandatory nature of the benefit, the state does cover the non-federal share.

Um, when that sunsets, the state is proposing to make it um not no longer mandatory.

So it will be optional.

Um, counties can opt in to provide that, but would um most likely be on the hook for the non-federal share of funding.

Um so it shifts that cost burden from from the state to counties.

Um, I you know, I think a lot of the city um programs are kind of external to that Medi-Cal benefit.

Um, but uh of course it's the whole the whole system.

So I think we'll still need to assess what that means.

Thank you.

Thank you.

Thank you very much.

Um I will move to public comment or public input on item number two, the governor's January budget.

Caller, you're on the line.

We're on item two.

Allison, you have two minutes.

Um hello, Alison Monroe here.

I just these are really enlightening presentations.

I hope they can be attached to the agenda and posted so that we can read them at leisure.

This is very important information.

Caller, you're on the line.

You have two minutes.

We're on item two.

Casey.

Good afternoon.

Uh I'm Casey.

I'm a um Alameda Health System employee.

And I was curious about um the impact of Prop 63 within the context of uh what has been presented today and just whether or not that's going to be changing at all.

Um also if it is uh like how it is used in regards to John George and what we're looking at moving forward.

Thank you.

Um I'm complete.

Tony Panetta.

Good afternoon.

I'm Tony Panetta.

I'm the chief impact officer with Alameda Health Consortium.

I want to thank our colleagues at Alameda County Health and the Alameda County Social Services for your comprehensive analysis of the state budget.

I did want to put a pin on a couple of things that were a surprise to the community clinics.

Um we were disappointed to see that the administration has decided to keep the cuts to the clinic's um enhanced payment rates when providing services to immigrants who remain in Medicail.

We are considering that to be a severe um risk to clinics overall sustainability, and we'll continue to work in partnership with our community to advocate to push up back on that.

We also were surprised to see that the state chose to treat asylumes, refugees, victims of human trafficking and violence as unsatisfactory immigrant status holders effective October 2026.

And the reason that this is a concern is because we had previously anticipated that when this change that is enacted at the federal level that affects federal payment for Medicaid eligibility would go into effect, we expected the state to treat those individuals as eligible for full medical benefits.

However, beginning in October, they would not be eligible for full Medi-Cal benefits, only restricted Medicail beginning in October.

So that's another example of a very specific nuance that I think we here in Alameda are sensitive to given the volume of asylum seekers and refugees in our community and those who have been given temporary protected status.

Thank you for taking concern and um paying attention to how we will be advocating in coalition going forward.

We have no additional speakers for item two.

Thank you.

Umika, could you uh address the comment about proposition 63?

Uh yeah.

So if they're referring to Prop 63 from the early 2000s, that was the MHSA, the Mental Health Services Act.

And so that is um transitioning over to the behavioral health services act under Prop 1 as of July 1.

Um, so our uh behavioral health department has been doing the work of one well, maybe I'll step back a little bit.

One of the things to know is that you know, in the budget, like when you see that four billion dollars in behavioral health services act funding going to counties, um, it doesn't really acknowledge that um it's there's not necessarily new money in that.

Um it's the same pot of money, but behavioral health departments are having to spend it differently.

Um so they've gone down from five mandatory categories to three mandatory categories.

Uh they have to spend a certain amount on uh housing and homelessness programs.

Um they can no longer fund things that are strictly prevention related.

Um, and so in trying to, and on top of that, there's uh reduced revenues that the counties are getting, and so against that backdrop, our behavioral health uh team has been um, you know, notifying providers and letting them know of uh shifts that are happening this coming year.

Um with specifically with regard to Alameda Health System.

I'm I'm not prepared to talk about specific providers here, but there are uh community-wide impacts.

Um happy to if if you want to to the caller, if you want to reach out to us, we can talk specifically about AHS.

Okay, thank you.

Uh let's move to the third item, which is the federal and state policy changes that will affect uh Medi-Cal for non-citizens.

Yes, I'll like to ask Juan Matania to come to the podium and after his presentation, Dr.

Kathleen Clanon will close it out.

But what I'll say is it seems like a really lengthy presentation, but a lot of it is graphs, so that we can get you all as many um data points as possible.

Good afternoon, supervisors.

So again, I'm here to talk about the federal and state policies that are going to impact our non-citizen uh community members.

Um so on this first slide, you'll see some of the major changes that are coming in the next couple of years.

And again, these are uh as a result of two uh events that occurred in 2025.

The first is in June of 2026 when the state budget for the current fiscal year was uh signed, and shortly after, in July of 2025, HR1 was passed into law.

Um so there are, as you can see, many, many changes that are happening through 2030, actually now is um the information that we've been given.

Um, however, the uh four that I wanted to cover today are the following.

So, first, um, which has already occurred uh in January uh 1st of 2026, the enrollment freeze for individuals with unsatisfactory immigration statuses, and this is for new enrollments into full scope coverage.

Um the second is uh this coming July 2026 is the reduction in dental benefits for again UIS individuals.

Um, as was mentioned earlier, um October 2026 is the redefinition of who is a qualified non-citizen, and then also in July of 2027 is the premiums for certain UIS individuals.

Um so diving first into the adult expansion um enrollment freeze, so effective January of 2026, um, all new enrollments into full scope Medi-Cal will be paused for individuals 19 or older who have UIS or who are unable to um establish that they have satisfactory immigration status or SIS.

Um previously, as you can see, we had four um expansions to Medi-Cal coverage specific to California.

Uh first is the children's expansion in 2016, uh followed a couple years later by the young adult expansion for 19 to 26 year olds in 2020, um, shortly after the older adult population, 50 and older in 2022, and the most recent one was the uh 26 to 49-year-old adult population in 2024.

So as of last year, uh effectively uh any um Alameda County resident or any California resident, if they met all the other eligibility requirements, they could have been uh potentially eligible for full scope Medi-Cal.

Um regardless of their immigration status.

However, with the passing of this um enrollment freeze for new um enrollments starting in January of this year, um only SB 75, which is the children's expansion to uh for individuals up to 19 year olds, up to 19 years old, um, is still in effect um currently.

Um so uh what that means is that um what what this freeze also does is that um current members who were enrolled prior to January 1st uh will continue to be eligible for full scope Medi-Cal.

So even if uh their eligibility uh their application wasn't approved in 2025, if they applied in 2025 and they ended up being approved, they would be able to um keep full scope Medi-Cal, um, unless they experience a loss of eligibility that exceeds uh three month um period following their discontinuance.

And the reason for the three-month uh period is because there is a grace period.

Um there is a three-month period in which the individuals uh can re-establish their eligibility to be able to re-enroll into full scope Medi-Cal if they um are otherwise eligible.

Um, so the most common reasons why there may be a loss of eligibility would be primarily first the um individuals not able to complete their annual renewal process, um, which is uh the most common uh reason why someone would fall off their full scope Medi-Cal.

Or there are also instances, a lot of instances where they become over the income limit for Medi-Cal.

So they would not be eligible for Magi Medical, and then they're also not eligible for Medi-Cal with a share of cost.

However, if within that three-month period after they discontinue their Medi-Cal, they're able to reestablish their eligibility, they will be able to get back onto full scope coverage.

The expansion freeze does not apply to only qualified immigrants or NQIs under the five-year bar.

Qualified non-citizens, which you know we'll cover that again in one of the later slides.

Individuals claiming to be permanent uh permanently residing in the United States under color of law or pro call, and then also pregnant individuals through their post-partum period, as well as individuals in the Medi-Cal Access Program, MCAP.

Now I believe, yeah, we're gonna be diving into some of the data now, and some of these data sets are a bit similar, but you'll notice a couple of differences, and this is primarily because the four changes that I'll be going over today impact slightly different populations.

And so that you may see some uh differences between the numbers as well as like um we'll be going over some countries of origin later, you'll be seeing some differences there as well.

Um, so for this first um change uh around the um expansion freeze, uh currently and uh currently um, and I'm saying currently as in as of the end of December, uh there's an estimated 51,200 individuals that are currently enrolled into full scope Medi-Cal as a result of the young adult, adult and older adult expansions.

Um, as you can see on your screen right now, this is the breakdown by supervisorial district.

Um I would just like to also point out that there is another category, and these are individuals who have out-of-county addresses.

So most of these individuals are in the process of being transferred out of the county, so they've moved um elsewhere, and they're in the process of that intercounty transfer.

Um we've broken down this same data um into the uh the adult and um the adult and young adult as well as the older adult um population, as and of course uh there's significantly more individuals in the 19 to 59-year-old age range.

Um we've also broken it down by uh the gender that they've uh identified in in our Cal SAW system.

Um, and as you'll see for districts one to four, there are slightly more uh females impacted by this change, um, although for district three you'll see it's a 50-50 split, but there is slightly there are slightly more females impacted in district um three.

Um the only difference is with district five where there's slightly more males impacted by this specific change.

Um, and then the last set of data that I'll be going over today for um this specific um uh change is the uh top five countries of origin per district.

For district one, the top five countries are Mexico, India, Colombia, China, and Guatemala.

Uh for district two, it's Mexico, Guatemala, El Salvador, India, and Colombia.

For district three, it's Mexico, Guatemala, El Salvador, Honduras, and China.

Uh for district four, it's Mexico, Guatemala, El Salvador, Honduras, and China.

And for district five, it's Mexico, Guatemala, China, El Salvador, and Eritrea.

Um, and so the next change I'll be going over is the one that's occurring in July of 2026, and that's the uh reduction in dental benefits for our UIS individuals.

So, again, effective in July of 2026, full scope dental benefits will no longer be available for individuals, only individuals 19 or older who have uh UIS, or if they're also unable to establish their satisfactory immigration status.

Uh while routine dental care will not be available, uh, they won't be covered for um for these individuals.

Uh, they will still have access to restricted scope emergency dental care um with their full scope medi-cal.

Um, pregnant individuals will also uh receive all necessary services through their pregnancy and the 12th uh and the 12 month post-partum period.

Um and uh what DHCS is calling this level of coverage is full scope medical with no dental, although again they do have access to restricted uh um emergency uh dental care um what i will actually add also um which is why you'll notice a bigger number on your screen right now is because in addition to the individuals impacted by the expansion freeze uh this uh uh this population also includes uh DACA individuals individuals who are paroled less than one year uh U visa applicants and then also the majority of the additions would be individuals who are um LPRs and battered non-citizens who are under the five year bar um so that's why there's a significant increase from the um first uh first um uh population um that I presented earlier so there are an estimated 74,000 individuals currently enrolled into full scope medical who will potentially have who will have their uh dental benefits reduced um as of July 1st of 2026 um again we did break it down by district um as you can see on the screen right now um we also broke this number down by the uh the different age groups you have your adult age group and then your older adult age group as well um and then um a little bit different from what we saw in the first set of data the uh reported uh gender in Cal SAUS um uh for the individuals impacted by these uh change uh by this change specifically um for all of the districts there are um uh more uh females currently enrolled into medical that are impacted versus males um uh who will again have their dental benefits reduced um again going over the uh the top five countries of origin for these uh for for this specific change um for district one uh the top five countries are Mexico India China Colombia and Afghanistan um the uh for district two it's Mexico Guatemala El Salvador India and Philippines uh for district three it's Mexico Guatemala China El Salvador and Honduras for uh for district four it's Mexico Guatemala China El Salvador and Honduras and for district five it's Mexico China Guatemala Eritrea and El Salvador um and then the third um change that I wanted to go over today is the reduction of qualified non-citizens um so the first two changes that I uh covered today those were as a result uh those were part of the state budget for the current fiscal year that was um signed in June last year uh the redefinition of qualified non-citizens this is uh as a result of the HR1 federal bill was passed in July so effective October 1st of 2026 the definition of qualified non-citizens or QNCs will be uh redefined to only include individuals who are um and apologies there um there's I'm gonna exclude some of the things that are mentioned here so the individuals that are included are lawful permanent residents Cuban or Haitian entrants as well as migrants legally residing in the United States and its territories under the compact of free association or COFA so that would be Micronesia Marshall Islands and Palau.

And so these individuals who are um still defined as QNCs uh they'll be continuing they'll continue to be eligible for full scope medical with um with dental coverage um if they meet all the other eligibility requirements um now the redefinition of Q and Cs uh now excludes conditional entrants before April 19th um before 1980 uh individuals paroled in the United States for one year or more uh battered non-citizens or parents or children of battered non-citizens uh refugees and asylum um and then um I know we've talked a lot about the um the governor's budget which uh which came out last week so for this next slide I did want to preface that um because of the in for the new information we learned um on that budget this next item that I'm gonna talk about is contingent on whether it does get um uh does end up being funded on the next fiscal year's budget.

Um if it does end up getting um funded in the next fiscal year year's budget, these individuals who um are no longer going to be qualified uh national uh non-citizens as a result of this change, they would potentially be eligible for full scope medical, um which would be funded by the state, but without dental coverage.

But again, this is contingent on whether it ends up on the um final budget that is passed um in June of this year.

Um, on the other hand, individuals who are not QNCs, but they were previously enrolled into Medi-Cal prior to October 1st, uh, they will continue to receive full scope Medi-Cal without dental coverage as long as they continue to be eligible for uh as long as they meet the other eligibility requirements, so they would effectively be grandfathered if they applied before October of 2026.

Uh so diving into the data, specifically the individuals that are impacted by the change, so individuals who will no longer be uh considered uh QNCs because of the redefinition of who is a QNC.

Uh we have about 10,600 individuals that are currently enrolled into Medi-Cal that are impacted by the redefinition of QNCs.

Um and this is again the breakdown by district.

Um we again broke it down this time.

We also added uh individuals who are zero to eighteen years old uh because specifically this change does impact um all ages.

Um I will point out, however, that these individuals, zero to eighteen, they would still be eligible for full scope because uh SB 75, the children's expansion is still in effect.

So essentially they wouldn't um uh new enrollments um past October, if they're zero to eighteen years old, they would still qualify for full scope Medi-Cal.

Um again, uh we broke it down um by the gender that they reported in our Cal SAW system, and um for all districts.

Again, there's um uh more females uh that are currently enrolled that will be impacted by this change versus males.

Um, and then district one, these are the top five countries of origin that will be impacted by this change.

Specifically uh for district one, again, it's Afghanistan, China, India, Ukraine, and Mexico.

Uh for district two, it's Afghanistan, El Salvador, Guatemala, Mexico, and Nicaragua.

For district three, it's Guatemala, El Salvador, Afghanistan, Mexico, and Eritrea.

For District 4, it's Guatemala, Afghanistan, El Salvador, Mexico, and Honduras.

And for District 5, it's Eritrea, Guatemala, Afghanistan, Ethiopia, and China.

And then the last thing I wanted to go over today is not happening until July of 2027, but it does also impact our uh non-citizen community.

So I wanted to go over the um uh premiums that will be uh imposed on uh certain UIS individuals starting again July of 2027.

Uh this is specific to adults 19 to 59 years of age who uh have UIS or who cannot establish their satisfactory immigration status.

Um they will be required to pay a monthly premium of $30 to keep their full scope coverage with no dental.

Um individuals who are unable to pay this monthly premium, they will be transitioned into restricted scope medical coverage.

Um individuals who are already on uh restricted scope coverage, they will not have to pay a premium.

So breaking down this data again, uh this is only for 19 uh to 59 year olds, and this is data for individuals who are currently enrolled in Medi-Cal.

Uh we have an estimated 57,600 individuals who are enrolled in full scope Medi-Cal currently who will potentially have to pay a premium effective July 1st of next year.

Um again, this is the breakdown by supervisorial district.

Um, and we broke this uh uh we we did not break this data down by age group because we only have one age group.

Um, but we did again break it down by gender, where uh again, for all five districts, um there are more females impacted versus males that are currently enrolled into Medicail.

Um the top five countries of origin for individuals impacted by this change for District One are Mexico, India, Colombia, China, and Afghanistan.

For district two, it's Mexico, Guatemala, El Salvador, India, and Colombia.

Uh for district three, it's Guatemala, Mexico, El Salvador, China, and Honduras.

For district four, it's Mexico, Guatemala, El Salvador, Honduras, and China.

And for District Five, it's Mexico, China, Guatemala, Eritrea, and El Salvador.

Now, the last thing I wanted to talk about today is of course, um, with all these changes, what are we currently doing to get that information out there?

And one of the major things that we're doing is um, I believe I've mentioned this a couple of times that I've been here in the past, is the Health Navigators Project.

We've had long-standing partnerships with several agencies, several community um based organizations throughout the county.

Currently, we're partnered with seven of them to conduct outreach activities, and really their primary um goal was to promote dual enrollment into Medi-Cal and CalFresh and to assist with applications and renewals.

But we've used our partnership with uh these uh community-based organizations to get the word out there about all the recent changes uh to both programs, um including the upcoming changes and the changes that just recently occurred.

So the seven agencies we're currently working with are Alameda Health Consortium, East Bay Agency for Children, uh Eden INR, who operates um Alameda County 211, uh Family Bridges, uh Maru, formerly known as uh Korean Community Center of the East Bay, and also their um uh that they also subcontract with Sari, the uh Center for Empowering uh refugees and immigrants.

Uh they all uh we're also partnering with La Familia and then lastly also Roots Community Health Center.

So uh ever since we found out the information last year, um we've been meeting uh monthly with uh uh you know, just as part of our partnership with them, we've been meeting with them monthly, and we've been discussing these changes and the outreach messaging to ensure that people um keep their benefits to sign up now.

Uh, you know, for example, to sign up in 2025 uh uh if they want to potentially be eligible for full scope Medi-Cal and the different ways that they can uh retain their full scope coverage into 2026.

Um the biggest of which is to, you know, complete their renewal paperwork to make sure that their um information with the county is up to date so that um uh the social services agency um sends their renewal paperwork to the correct place, um, and you know, just generally helping them fill out that paperwork and submit it.

Um also part of the Health Navigators Project was uh as um was mentioned earlier in uh the previous presentations, we have developed healthyac.org, which was developed as part of our multimedia outreach campaign.

Um this is a website where they can go to to learn more information about both programs.

Actually, Medical and CalFresh.

Um, they can also learn how to apply, uh they can learn about the uh application and renewal process as well as to uh uh how they can get help with um with submitting that application or renewal uh renewal paperwork.

Uh, what you can see on your screen right now is an interactive map that they can use.

It has all of our CBO partner locations, and um, you know, if they enter their zip code in there, they can see the uh locations that are closest to them.

Um also as part of our ongoing outreach efforts, any new materials that we develop to um uh to get the word out there about the upcoming changes to Medical and also CalFresh.

Um, they will be posted on this website for uh individuals to learn more about those changes.

Um, and with that, that concludes my presentation today.

Thank you all for your time.

Thank you for that presentation.

Um questions, comments?

Supervisor Miley.

Uh sure, thanks.

Yeah, very comprehensive.

Um, learn some stuff I didn't know before.

Um so the um, so prior to January, prior to January 1st, 2026.

Everybody was covered under Medi-Cal.

Eligibility as long as they meet all the other eligibility requirements.

So primarily in uh being within the income limit uh as well as um um having California residency, um, anyone regardless of their immigration status would have been potentially eligible for full scope coverage.

And was that number 51,000 or I'm sorry?

Was how what was that number?

51,000?

Um, so the 50 um the 51,200 number, those are the individuals that were specifically um in one of the um UIS categories.

Um they were specifically enrolled as a result of the young adult, adult and older adult expansions.

So what was the total?

Um 51,200 individuals?

But that's um that's since implementation.

That's not just in the last few months, that's um since each of those um those uh expansions took effect.

So for the lifetime of all those um expansions, those are the ones that are currently enrolled still.

Okay, so I just want to make sure I'm clear on this.

So the total universe, the folks who are enrolled in Medi-Cal prior to the end of the year was about 51,000.

Um who are still active at uh to as of December.

Okay.

Okay, all right.

And supervised, when you say enrolled in Medi-Cal, do you mean the larger Medical program or just these categories?

The larger medical programs.

So that's yeah, that's what I thought.

Yeah, okay.

So that's almost 400.

Over 400.

Over 400,000.

So with the the changes, uh we're anticipating that potentially in these different categories, 51,000 could be impacted.

Um, be impacted.

That's because um when the change took effect, they wouldn't be falling off.

It's more the new enrollments.

So unfortunately, we don't have the number of individuals who aren't signed up to Medi-Cal yet.

But it would be um the only way these individuals would be impacted by this change is if they fell off their coverage and had to reapply again and it's been over three months since they last had their full scope Medi-Cal.

The people that are really gonna be impacted by this are the people who haven't signed up for medical yet.

Okay, so if I could add one more piece of context to the thing to know about that universe of the 51,000, is that they are uh people covered under the state expansion.

So that's the state paying for them, and that's why the state did the enrollment freeze because the federal government will not pay for this group.

Um and so for purposes of as one's saying, if they fall off, um, then they may be people that are eligible for indigent care in the counties because they wouldn't be eligible for Medicaid the for the federal rules.

And as these different things roll out, uh we'll be getting kind of like the um impact of what's happening.

Primary ways that we can probably see the impact would be the be to see if there's a uh reduction in that 51,000 number um that don't re-enroll.

Um another way we can look at it is the past um the the last few months of um of 2025 to see how much more people or how many new enrollments we got um that were um part of these expansion groups.

Um I'm trying to think of other ways that we could track the data, but I'm not coming up with anything off the top of my head right now.

Um, but I think those are the primary ways that we can see, like again, how many uh more enrollments did we get kind of at the quote unquote last minute um and then um to see what that population looks like in a couple of months if that number grew or if it went down, because I'm trying to get a sense of the there'll be some people that'll be they'll be fine.

There'll be others that aren't gonna be fine, depending on what happens.

So I'm trying to get a sense of how will we monitor that so we know where we're gonna need to uh provide additional uh resources to help you know fill in the gap.

Well, so for this population, I think really what we'll need to monitor is um whether or not these individuals go forward, uh go forward with completing their um annual renewal process because that's really the main reason that they would fall off.

Um, so uh and and that is also one of like the major um the major focuses of our CBO partners.

Okay.

Hi, I just wanted to um help one a bit.

Um, I'm his manager, my name is Antoinette Barns.

So how we'll kind of monitor that is we're constantly pulling data, knowing that, knowing that um based on renewals or other eligibility requirements, individuals constantly fall off and on and off the rolls, but knowing the urgency of this, we'll constantly pull data.

So leading up to this, we're pulling data every month based on our enrollments.

So when Juan mentioned earlier, March will be able to give a better picture is because of what he's talking about, even with that three-month um time period that they have to um reestablish eligibility.

So anybody that applied in December, because of the timeline it takes to determine eligibility to get them on, then we'll have a better sense in March of what it looks like with people who may have re-enrolled in December, did their renewals, January.

You know, we're kind of looking at eligibility and then reassessing things.

People have time to provide verification, so March will be a better um time for us to really assess our activities from December to see what that'll look like.

So we'll be pulling data regularly.

Constantly.

Okay.

Yes.

And um and will that information be provided to this joint committee?

So it's my understanding we will be coming before you every month for the foreseeable future in the joint health care meeting.

So we'll be providing updates regularly.

Okay.

And then under the redefinition of qualified qualified non-citizens, I'm surprised that it included um refugees and those on asylum.

Um, any thoughts on that, why that was included?

Yeah, so so this is also a bit of a surprise on uh surprise for us.

Um this was um, and I can't really speak to why the decision was made, but this is uh I just again wanted to point out that this is on the federal level.

This this decision of um who would be excluded from the new definition of who is a qualified non-citizen.

Um, it was part of the HR1 bill on the federal level.

Okay.

I think that's all the questions I have for the moment.

Okay, thanks.

Thank you.

Um, this was a very comprehensive presentation.

So thank you so much uh for laying out all this information, the timelines, the changes, as well as the data, including by district.

Um I mean, my my main comment is that the work that um the departments, our community partners that all of us have been doing together in advance of the January 1st enrollment freeze for people with UIS, um, that will hopefully help really inform how we do the outreach leading up to these next three deadlines.

So really looking forward to everyone learning what we can from the prior work so that we can put it into action and make sure no one falls through the cracks.

Um, and certainly I know that my office wants to be as um collaborative as possible in doing any outreach that would be helpful.

Um, and then one question, you know, there's also going to be some work requirements for Calfresh.

I believe at a joint committee meeting some time ago there was some initial data that was presented about the numbers of people who would be impacted, and I believe that was also broke broken down by district.

Um, is that information also in the process of being developed?

We will bring an update to ABOD implementation next month to the joint um health social services committee meeting.

And it will include the last um bit of data up to what we've been doing since then.

Terrific, thank you.

Thank you.

Um I'm going to just use a point of privilege to ask um Matt Woodrough, who is the CEO of the Almeida Alliance for Health, to just kind of give us the bigger picture of number of people, the total number of people, not just non-citizens and UIS that are enrolled in Medical and the projected drop-offs that might occur because of variety of reasons, including HR one and how specifically that impacts the non-citizen and immigrant community as well.

Thank you, Supervisor Tam.

So to answer the question, I believe it reminds you that Miley that you were raising in Supervisor Tam, you just said, right now there's about 407,000 uh people on on Medi-Cal, and that's in total.

To answer your question, the federal government through HR1, and then also, as I've asked uh DHCS DHS, sorry, DHS, to um look at what is uh public benefit and who qualifies for public benefit.

So when Juan was talking about the qualified immigrants, all that's going through changes and still going through change, I believe it's in common periods, so there could be uh more groups that are added to that because they're looking at what is a who who qualifies and also what they consider to be a public benefit.

So that could all be changing in the next six months as we lead up to July, so definitely more to come on that.

So with the 407,000 total, um, we saw our largest decrease ever in the um unsatisfactory immigration status for January 1st.

Unfortunately, we lost almost 7,000 um unsatisfactory immigration uh with unsatisfied immigration status on in January.

Now that is preliminary because that's our initial file, and then we do get a file at the end of the month that is considered our final file.

So anybody that is going through the process that was laid out by SSA earlier, um, that they laid out the very nice process in regards to the pro how it goes through the 30 and 90 day process, we will hopefully get some of those members back, but currently right now it is 7,000.

So that was our one time largest drop ever.

So over the next with the changes that are going on in 26, 27, and then 28, the alliance has projected out that we will go from the 407,000 lives, we should drop down to about 240,000 lives, assuming that every state and federal change goes into place.

So that is a massive drop in the Medi-Cal enrollment.

Um that's based off the projections that the state gave us saying we assume that you should get you know 30% here, 20% there, and so that's where that 407 to 240,000 comes from by the end of 2028.

So that's a very daunting numbers, unfortunately, but that's currently where we sit, assuming that everything happens.

So uh the other thing that I wanted to add is that uh when we're going through the presentations earlier about the MCO tax.

So the MCO tax, uh, I just want to add this in real quick.

It's going to affect all the providers, but the cap is actually on what hospitals can get.

There's a there's a public hospital kind of tax-directed payment.

The cap is on that.

So I gave a presentation at the AHS board retreat in November showing that AHS is going to lose hundreds of millions of dollars starting this, sorry, 2027, I believe.

Um, and so that's where the cap is for the MCO tax.

The reason why that is a major change is because the Biden administration actually approved it, saying it's not a uniform tax, which is under the law.

And the Biden administration said, well, it's it doesn't match the law, but you can um well, approve it, just you know, know that you need to bring it in compliance with the law.

And so um California and many other states had not done that yet, and so what that means is that in order to have a uniform uh MCO tax, Medi-Cal providers right now are taxed a lot heavier than commercial uh providers, and so in order to have a uniform tax, you have to tax the commercial and the medical plans at the same rate, and so based off of that, but if we were to go to what the commercial plans are taxed versus the Medi-Cal plans, it's it goes from I'm gonna, if I remember correctly, I think it goes from 4 billion to about 700 million.

So you can see the the drop in the MCO tax overall.

And real quickly, what was the estimated number that it was the estimated number that it would drop by 2028?

Medi-cal.

You said it go from 400,000 to about to 240,000.

240,000, okay.

I know that's estimated, okay.

That's a 41% decline.

Yes, yep.

That's why we really want to keep everybody on Medi-Cal.

Yes.

And that's so also I want to say the partnership with SSA, um, and with um, I almost called you Hicks, sorry, Alameda County Health, it's hard to hard to write the habit.

Um, and then you've heard from the Alameda uh health Consortium that's here.

Um, you've heard from Andy, and then also with AHS.

So we did meet and we did go through and we did a lot of the same marketing.

Um you saw that it was up on the screen earlier.

So I can't tell you just some quick numbers in November, December, the alliance sent out 88,000 postcards, and we had about a five percent of reach back rate.

So in other words, about the 88,000, about 5% of the people that we reached out to saying, hey, you need to sign up or you need to take this action.

About five percent contacted us.

Now whether or not they were able to get on, or what happened after that, you know, there's a whole process that they have to go through, and some of them more than likely a large majority of them are still going through that process, because you do see that it does take about 30 to 60 days for everybody to complete a complete that process, but five percent is actually really good.

So any other questions, supervisor?

Um, thank you, that's very helpful.

Uh though the one question I had is uh the graphics that Juan showed um heavily impacts district three, but it also um points out that there's going to be a significant cut in um dental uh reimbursement.

And so I had a chance to visit all the federally qualified health clinics in my district, whether it's La Clinica, Native American Health, Asian Health, including uh Davis Street, and they all have dental clinics.

In fact, Asian Health just opened and constructed a new dental clinic.

So, what does that mean in terms of their ability to sustain those services if uh well dentals being cut for a certain population, and then we're seeing a huge decline potentially in um 2028 and the whole Medi-Cal enrollment population?

So I I think it it's actually not going to affect the alliance as much as it's going to affect uh as you heard from um Andy, the CEO of CHCN earlier, it's actually gonna affect them a lot more than it's gonna affect the alliance because the alliance doesn't do uh dental right now, it all goes through uh dental, but with um community health center network, what Andy was saying earlier is that they're not gonna be able to claim they're still gonna do the work, they're still gonna see those the those the people that they serve, but they're not gonna be able to claim for that extra money that they normally would have been able to claim for, and that's gonna be a massive, massive hit to community health center network and and all the clinics you just mentioned.

So it's not gonna affect the alliance that much, but it's definitely gonna affect the FQs a lot.

Okay, thank you.

Appreciate that.

Any other questions from Matt?

Thank you.

Okay, thank you.

Uh Dr.

Clannon, um, close out the presentation.

Just have a few slides, supervisors, um, that are really in the in the nature of setting the table for conversations that we'll have in the next couple of months.

So, given all of what you've heard today, what then happens?

If people are losing their Medi-Cal, what happens then, and what is our uh what is their recourse, what is our recourse in terms of how their um they receive care, how their care is paid for.

So, for um any uh public in the audience, um, and as a reminder for other people in the room, um, there is a California state law um referred to as Section 17000 that does obligate us as a county to provide um as it you see there in the text of the law as a county.

We're required to provide to relieve and support um individuals who are medically indigent is how this is usually described for anyone who's lawfully resident in our county.

So, what does that mean?

Um, there's you can see that it's quite vague.

The law was written in the 1930s and has not really been um updated significantly as to language, and as a result of that, there are uh there's a great deal of difference in how different California counties have interpreted it.

Um, the how do you define what on what constitutes being indigent?

And we do that by uh federal poverty limit, FPL percentages in terms of their income, that's quite different county by county.

Um the question of what services uh are we're required to provide, that's quite different county by county.

Um, and also whether or not to decide to provide services to people who are to go beyond those who are lawfully resident in the county.

So essentially whether or not to cover people who are undocumented as part of the program.

Those are all areas where counties have made different decisions.

Going on to the next slide.

Set to me.

Oh, thanks, in terms of how we have made those decisions for our indigenous care program, which as you know is called the health program of Alameda County or Health PAC for short.

You must be an Alameda County resident, that's what the law says.

Our program is you're eligible if you're 19 and over, and that's because children are covered differently.

Here we set the federal poverty limit at 200%, and you have to be not eligible for any other kind of insurance, in particular for Medi-Cal or Covered California.

Those are typically the other things people might be eligible for.

Before the ACA, before Obamacare came into effect in 2014, our program topped out at around 90,000 individuals who were covered, as of as a result of the state's expansion and of the ACA.

We've had over the years a great diminution in the number of people we were covering with the program down to, as you see there, 2600 most roughly most recently.

Those folks are people who are uh eligible for our program, because the Medi-Cal limit goes up to 138% of poverty, and ours goes to 200.

So essentially those 2600 folks are people whose income is between 138% and 200.

In terms of our network and services, we have contracted providers, Alameda Health System, and then the nine federally qualified health centers, including Davis Street.

The services, our services have mirrored very closely the Medi-Cal benefit, and just as a reminder, that includes office visits, so primary care and preventive care, it includes emergency and hospital care, it includes dental and it has and it includes prescriptions.

So that's what we are currently providing as of as of this moment in time.

In terms of looking into the next few months, as we are participating with you in the development of the budget for the coming years and looking beyond this coming budget year.

We don't have firm estimates yet for how many people are likely to lose their coverage.

I think Juan did a did a good job, as did Matt, of talking through a little bit why we don't have a hard number, the number of people who are who may come off.

The main reason for that is it's not a cliff, as in a whole group of people whose coverage will be removed, but rather it'll be an incremental loss because there will be additional barriers for applying, like eventually job requirements and needing to apply more frequently.

So those will be barriers to people getting staying on and getting on the program.

And then additionally, there will be uh people who will lose the program just because they they are concerned about about the potential impact to them legally going forward.

So those are all decisions that people will make or behavior that we'll have to see going forward, and we won't know.

There's not a cliff.

We need to actually look and see what happens to people.

What do people decide to do and how difficult is for them?

Is it for them to meet these criteria?

Um it uh I can tell you that we're highly concerned that it will not remain feasible to provide Medi-Cal level care if there is a substantial increase in the number of people who are eligible for health pack.

So the areas of uncertainty, there's as we, as I just mentioned, how many people will lose coverage?

How many people who lose their coverage will decide, will choose to enroll in health pack.

Um that's the concern sometimes you hear referred to as the chilling effect of the current climate, in which people decide it is uh better for them to forego any government insurance, including our any government coverage, including ours, or whether it's better for them to take the risk to go ahead.

Reenrollment rates similarly for people who remain eligible for Medi-Cal.

If they fall off Medi-Cal, then the Section 17,000 obligation could apply to them if they are not able to keep on the program regardless of the reason.

And then the state level responses.

We will also have better ideas about what sort of per individual, what the costs of their care is.

Thanks for this update.

So with the going from 90,000 down to 2600, were there savings or was that money reapplied in other ways?

It allowed for expansion of services so that, for instance, since the time that we were covering 90,000 people, we were able to greatly reduce the amount of time it takes for people to get into care, both primary care and also referrals to specialty care, is much much better than now than it was when we were at 90,000.

We also have greatly increased the amount of behavioral health that people get in our contracted clinics.

Before that, it was pretty sketchy whether people there just was not a lot of resources for people to get mental health care in particular and also care for substance use.

Now that those are greatly expanded in our clinics.

And we also asked the clinics, the clinics and AHS to use those dollars to uh do some improvements in, for instance, uh substance use screening and care, the um care for uh people who are um are homeless, uh can you know multiple different kinds of improvements things?

Colonel cancer screening, there have been many things over the years that we asked them to improve with those dollars.

So, since those doll dollars were used elsewhere, if we have to go back to uh increased enrollment in health pack, will there be an impact on how those dollars had been re-calibrated?

I mean, I'm trying to see if there's gonna be, I mean, another impact here because we're trying to help over here.

Yeah, um, I wish I had an answer to that question.

It's you know, it's the right, it's the right it's the right question to ask, and it's one that I think we're all gonna be facing, that um yeah, that's I don't have an answer to that.

At the moment, okay.

And then that was my concern, too.

You incentivizing, because we want people, if they can enroll in Medi-Cal, to enroll in Medi-Cal.

I mean, the work requirement, we might not like it.

Quite frankly, people should be encouraged to work.

So we don't want to disencourage them to not go with Medi-Cal because and go to Health Pack because they don't have a work requirement.

So we'll be monitoring that type of thing too.

Um I'm gonna say I don't want to go, I don't want to, so this is a county council matter.

Yeah, um, so in terms of eligibility, we're still sort of sorting some things out, but I think what I'll point out is that Medi-Cal, because it's insurance, it's a better product than what we can offer with, right?

So with HealthPack, um, we offer great services in HealthPack, but um it's limited to services within the county.

Um you can't take it, you know, if you're in Contra Costa County and you get hurt.

Like, even though Medi-Cal is county-based, um, it's it's a more comprehensive product.

Um, in terms of program costs, you know, over the last decade or so, uh, because we've maintained the health pack program.

What we've generally done with the provider network, it's it's maintained as the same provider network we've always had.

Um, but you know, they use it as infrastructure funding for the safety net essentially, right?

So there's that.

Um we did have uh the alliance give us sort of a back of the envelope estimate for um because theoretically, if you know that 80,000 people, 80 to 90,000 people moved into Medi-Cal.

Um, their estimate for one full year of all of the expansions, including care for one full year of all of the expansions for uh people who came over from ACA, people who came over from once the state started enrolling, right?

So full coverage, uh it was cl more than 300 million dollars, and our health pack program is about 70 a year, 70 million a year.

So it's just like the cost of care has increased drastically since we had a much more robust, you know, enrollment in health pack.

So Supervisor Miley, were you asking about jobs specifically about whether we could there could be a job requirement for health pack?

Did I understand that?

No, I wasn't asking that we impose a job requirement, but let's suppose I'm on Medi-Cal and I decide not to re-enroll because I don't like the job requirement, so I go to Health Pack.

Would how would we monitor that?

That's all I'm saying.

Because we would rather people be on Medi-Cal and be enrolled and fulfill the job requirement if they can, as opposed to, you know, just saying, okay, well, I won't, because it's easy for me to be in health pack.

Yeah, well, we'll be tracking what choices people are making about that as each of these, you know, these requirements come online at different points based on uh in the case of the job requirement, that's an HR one.

So that that, you know, that the timing of which what each of these things gets implemented, we'll be looking at what happens.

Do we see step offs like that?

But ultimately, we won't necessarily know why people choose or don't choose.

We may have a guess.

Okay, so we won't know.

I know Supervisor Jam will be chairing these joint meetings.

Uh, she set these joint meetings up, so uh I'll be waiting to see how all this, you know.

Guess we continue to monitor how this comes about.

Then we also don't want to incentivize people from other counties to come into Alameda County because we have health pack, let's say, and other counties don't.

We need to kind of be, you know, cognizant of that.

So that's another issue as well, I think.

So I just think this whole working with our regional partners or regional, other regional uh providers, counties, and then uh we don't want to disincentivize folks from going with Medical because they have an easier track with health pack because like you know like you said the cost of health pack and delivery of services has increased as well.

So I I seems like you're on it.

So just want to flag that.

Then the other thing is if we do health pack, now this might be once again a question for county council, will that affect any other um funding, um qualifications or uh disqualifications from the federal government?

So you know the Trump administration is saying other programs, funding programs might would be impacted if we do X, Y, and Z.

So if we do health back, will that affect other funding streams?

I'm I'm just asking the question.

And there, you know, there are there are comp very complex um interactions between local dollars and the way we can use local dollars spent to draw down federal dollars, and so the answer to that is yes, and that's about the best, that's about my level of expertise.

Yeah, I would say so.

Uh regardless of what's happening at the federal level, we would still have a state level mandate to provide indigent care.

Um, you know, there tends to be some sort of protection on your local general fund dollars, both from what the state can say about it and from what the federal government can say about it, but we haven't so far there hasn't been any indication that that's gonna be a reason to come down to people.

And I I suspect if that were to occur, we'd probably try to challenge it anyway.

But okay.

All right, I'm just flagging some stuff.

Okay, thanks.

Uh health pack is not a very big budget, right?

Relative.

It's about 70 million dollars a year right now.

Okay.

Um I think you know that almost two-thirds of our funding um for a lot of our public assistance programs come from the state, and so it's a little bit disconcerting when uh section 17,000 of the welfare and institutions code obligates the counties to put either provider of last resort without help from the state for all Californians.

So having said that, does that basically give us the county and the Alameda Health System discretion in what that level care would look like?

Because that's been the issue is some folks feel certain programs are more necessary, others feel like they're we've had to prioritize and triage.

There is so um the so the law, you know, the 1935 or 38 law is uh, you know, is kind of vague in terms of what it what it requires us to do.

So there is some discretion there, and it's the who's eligible in terms of income level, what constitutes being indigent in the language of the law.

So the FPL is up to us, doesn't really say what constitutes care.

So there's there is some discretion there, um, and then also the question of whether we extend the program to serve people who are um who are undocumented, essentially, which we have done.

This I mean, this board has supported for decades as fixed policy.

So those are places where there is um discretion that the law leaves us.

Uh the case law, um, and this is a place where you know we really need to um get advice from county council, which we've been in conversation with them about, um, you know, kind of suggests that we can't make huge shifts in what we decide to do without um, you know, if we've done something for a long time, we can't suddenly change to something very different without opening ourselves up to challenge from individual cases.

So, and that that you know, obviously there's a that that I'm all I'm also being vague because um there's some very careful dissection that we need to do there to understand this.

So there is some discretion, and um we will be bringing you know our best ideas about how to preserve, you know, preserve the health and well-being of people in the county, preserve the organizations that are so critical in you know in providing that care.

Um, you know, and uh trying not to break the bank.

Thank you.

Um, I think the questions that Supervisor Miley was asking about the choices and being the agency of last resort, um, there might be more incentives for people to move into a program that's very limited in the county because of what's happening with Medicail, and we don't necessarily have the ability to um provide that same level of care that Medical provides, right?

Okay, thank you.

Appreciate it.

Very grim news, very sobering, but we need to understand how to plan for it.

Um, do we have any public comments or are there any other comments before I open up for public comments from staff?

Tony Panetta.

Hi, Tony Panetta, chief impact officer from Alameda Health Consortium.

Again, thank you to our social services and AC health partners for laying this framework.

Um, I did want to provide a clarifying comment around the continuing work related to Medi-Cal renewal activities.

There had been some discussion about what are um some preliminary numbers looking like with Medi-Cal renewal efforts and Matt shared the very sobering analysis of 7,000 individuals falling off the rolls beginning in January, but we still are waiting for some time to follow through for two things.

One for our social services partners to be able to complete the process of renewal documents and verification documents, and the second part is that there is a 90-day grace period for individuals if they fail to renew by their retermination date, then they have 90 days to get back into Medi-Cal, and that's for the um individuals with that unsatisfactory immigration status classification.

So, as one of the partners that social services has contracted with through the Health Navigator Project, that's an example of how we want to very much be intentional of having kind of a chase effort to get those people re-enrolled within 90 days if they fail to renew by their renewal date.

And that's an example of what Andy had been talking about earlier of closer partnerships with data as well as partnering with clinics and with social services to leverage resources to do both renewals and reenrollments in 90 days.

So we are partnering with social services to pursue that request.

Thank you.

Kathy, you're on the line.

We're on item three.

You have two minutes.

I wanted to speak off-subject, so I could wait until that.

Okay.

Thank you.

We have no more speakers for item three.

Thank you.

Um we have any public comments on items not on today's agenda.

Kathy, we're on public comment.

You have two minutes.

Hi, I'm Kathy Rodriguez.

I am with the Llewellyn Explosion in Hayward, California.

Um, I wanted to find out when are we going to have a meeting for all the residents on the Welling Boulevard to address our safety concerns and what type of things that you guys have in place to ensure our safety, because that's been a big topic for the last year.

I've been advocating for the last year for this.

And now, as you all know, it's the big explosions been on the news.

And a lot of us are really concerned because number one, this is a commercial property on Llewellyn Boulevard, and it comes under different rules.

It comes under C1 commercial property, and your county employees have violated the Alameda County municipal ordinances.

When it comes to commercial property in that area, they're supposed to be 20 feet from the building to the sidewalk.

Now it's 15 feet in some areas it's even shorter.

And so, you know, one of my concerns is who holds them accountable for violating Alameda County ordinance.

Yet when we violate something, public work is quick to, you know, give us citations, but who's holding them accountable for violating Alameda County ordinance and putting homes and families in danger for not following policy procedures, county ordinances.

You know, they're like getting away with this stuff.

And you know, we want to have some kind of resolution, some kind of, you know, assurance that we're gonna be safe.

Recently, those houses have recently got robbed, and and that's been in the news as well.

And so we want to assure that our community is safe.

There are no more public comments.

Thank you.

Thank you, everyone, our staff and our partners for a very informative session.

This meeting is adjourned.