Okay.

Okay, that goes.

All right.

Good afternoon.

And welcome to the Alameda County Board of Supervisors special joint meeting of the public purpose and health committee meeting for Monday, February the 9th, 2026.

We are formed to talk about HR one.

So may I have roll call, please?

Supervisor Miley.

Present.

Supervisor reports on the past.

Present.

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Thank you.

Today we are going to present on some of the updates related to the CalPresh program on HR one.

So to begin, we're going to talk about all of the provisions in HR one that pertain to Cal Fresh.

The first that we'll talk about is the limiting of the uh state utility allowance subsidies.

We also call that as SUAS.

This policy went into effect last year, October 31st, 2005.

What the SUAS is, it is a $20.10 cash benefit payment that's loaded onto a household's EBT cards, and it allows households to qualify for the largest utility allowance.

There are three of them.

There's the standard utility allowance, which is the highest, the limited utility allowance, which is the one below, and then lastly the telephone utility allowance.

What the standard utility allowance does is because it is the highest utility allowance, it will generally lead to a greater CalFresh benefit issuance for eligible households.

What HR1 has done now is added an additional requirement to qualify for SUAS.

So beginning October 31st of last year, only households that have a elderly, which is 60 or older, or a disabled member will now qualify for SUAS.

At each household's next recertification on or after October 31st, we will reevaluate to see if that household comprises an elderly or disabled individual.

And if it does not, that household will lose the standard utility allowance, the SUA, which is again the highest utility allowance, and they'll be bracketed down to either the limited utility allowance or the telephone utility allowance, or if they don't meet any of those utility allowances, they won't get a utility allowance at all.

What this does is the negative impact is that we will likely see the individuals that lose access to the SUS payment and to SUA, they will have a lower CalFresh benefit allotment.

And in some very rare cases, the household could also lose access to CalFresh entirely, can be no longer eligible.

The next uh impact is the reevaluation of the thrifty food plan.

This again is uh, oh sorry, uh what this does is it limits how frequently and how much the CalFresh benefit allowances the issuances can be.

Every year at the beginning of federal fiscal year, which is from October 1st through September 30th of the following year, uh USDA food and nutrition services, FNS, they calculate a cost of living adjustment.

And so the reevaluation of the Thrifty Food Plan uh has made it so that the cost of food increases over time or any changes to the dietary guidelines from the federal government will not be taken into consideration, and as a result, uh what we will likely see is the CalFresh benefit uh maximum benefit amounts will likely uh increase very low, very small each federal fiscal year or not at all.

Uh one other provision of this is that uh CalFresh benefits.

Currently there is no cap, but under HR1 household sizes of 18 or greater will be capped.

There'll be a maximum benefit that they can receive, even though they may be uh potentially entitled to more, they're just gonna be capped at 18.

In Alameda County, we do not have any households that are of this size, but there could be in the future.

Next is also an impact to our internet expenses.

Um, prior to HR1 in 2024, um, we USDA FNS did pass a provision that would allow the uh the expense of a basic internet service to be added on to the determination of the standard utility allowance, the SUA that I mentioned before.

This would likely have resulted in a higher SUA amount, which again, when we deduct against a household's income, would have resulted in greater CalFresh benefits.

HR1 has removed this.

So, beginning this current federal fiscal year, then again, October 1st of 2025.

We have removed the calculation of internet expenses.

Um the state's California Department of Social Services actually had not been able to implement these changes yet.

So there is no visible impact to the households, but it just in on policy-wise, it is a detriment to our CalFresh recipients.

And then lastly, on here, um another provision is the repealing of our SNAP education funding here in California that is referred to as the CalFresh Healthy Living Program.

Beginning this current federal fiscal year, again, October 1st of 2025, we are no longer able to use federal funding.

We did not receive new federal funding to continue the CalFresh Healthy Living Program.

And the feds did want us to return the money, but they did allow a provision that states can actually spend down what was remaining on your CalFresh Healthy Living budget.

And so what decided to do was to use that funding to actually preserve a lot of the research and the data that has been accumulated over the years, because HR1 did not eliminate SNAP ed entirely.

It just cut off the funding, so funding could be restored in the future years or under a new administration.

And so this will allow California to be ready to restart CalFresh Healthy Living quickly.

Next slide, please.

I think we've also discussed the first is our administrative cost sharing.

And so this is started slated to begin next federal fiscal year, which will begin October 1st of this year.

Currently, the How pressure administrative costs are split.

50% is covered by the federal government and 50% is covered by the state government or by C DSS.

What will happen under this implementation is that the state portion will now increase to 75%, and the federal portion will drop down to 25%.

Of the state portion that's that's being covered, so currently 50%, and then beginning October 1st of this year, that change will raise it up to 75%, but of the state costs, the state breaks that down a further 70% is covered by the state and 30% is covered by the counties.

From our finance department, as of last month of January 2026, initial estimates are that beginning October 1st, 2026, with this administrative cost sharing policy going into effect, we are estimating a 6.7 million dollar increase in county cost for this administrative funding.

The topic below that is the matching funds requirement.

This is slated to go into effect federal fiscal year 2028, which ends 1st of 2027.

So beginning in federal fiscal year 2028, states will be required to pay a portion or a percentage of the CalFresh benefit issuance, the total number of Calfresh benefits that we issue as a state, that is tied to our payment error rate, PER.

And so this slide actually, there's an error on it.

It should actually be if our payment error PER is equal to or more than 6%.

The amount that each state would pay is on a sliding scale between 5% all the way up to 15% if a state's PER is 10% or higher.

Currently, for federal fiscal year 2025, which ended September 30th, 2025, the latest data that we have from CDSS and from USDA FNS's QC department is that California's error rate is at 11.01%.

So we are over the 10% threshold, which slots us at the highest 15% matching funds proportional.

Currently, what that would look like if this was equivalent to effect this coming federal fiscal year, that would look like an additional 1.9 to 2.1 billion dollars that the state of California would have to come up with to cover the fine, if you will, for having a payment error rate above 10%.

I will note that California has not been under 10% since pre-pandemic, so since 2019.

Prior to that, we were we were a little bit lower under the 10%, but we were not below the 6% threshold.

I think you would have to go back to 2013.

I believe this is the last time we were under 6%.

Next slide, please.

And then these next two topics, these are what we will be focusing the rest of our presentation on.

My colleague Jaime here will be covering our non-citizen eligibility changes that are set to go into effect beginning April 1st of this year, 2026.

HR1 does drastically limit the number or the number of individuals of non-citizens that previously or currently are eligible to receive CalFresh because they have a an allowable non-citizen status, but beginning April 1st, that status will be different for some non-citizens.

Additionally, kind of as an added insults to the federal CalFresh access to state access to CalFresh, which we call the California Food Assistance Program or CFAP, because there were no changes to the definition of quality citizen.

Rather, what HR1 has done is just limited access to CalFresh.

Slides are ABOD changes that are set to take effect beginning January or June 1st, 2026.

Next slide, please.

And so what I want to do today first is just give a back please is to give a brief overview of the ABOD background for everyone.

Under HR1, the definition of ABOD has changed slightly.

An ABOD is now defined as an individual between the ages of 18 to 64.

They are able bodied.

We think they are maximally and physically, they do not have a dependent child under the age of 14.

ABODs that meet the individuals that meet the ABOD definition are subject to the work requirement, or they have to meet exemption.

Otherwise, they will be time limited to three months, three full months of Calfresh within a fixed 36-month time clock, after which they will be discontinued and they would have to meet the work requirements, meet an exemption or wait for the next 36 month clock to begin in order to regain CalFresh eligibility.

And the current 36 month clock began this year, January 1st, 2026.

It is set to expire December 31st, 2028, and then a new 36 month clock will begin January 1st, 2029, and October, December 31st, 2031.

Next slide, please.

So I mentioned earlier the ABOS, they have to meet work requirement or an exemption.

The first one we'll talk about is the work requirement.

So the current work requirement for ABODs is they must work an average of 20 hours per week or 80 hours per month.

The type of employment when we say work, this can be paid employment, traditional paid employment, self-employment, or it could be income in kind.

Alternatively, for our ABODs, if they don't, if they aren't able to meet the work requirement, they can also satisfy the work requirement through participation in a number of qualifying activities.

First is our CalFresh employment and training activities, which I'll go over in the next slide.

There's also workforce innovation and opportunity act or WIOLA programs.

These are helping individuals with cover letters with job search and job referrals.

There's also programs that are under section 236 of the trade act of 1974, and this refers to on the job training for individuals that lost their job or experienced a reduction in work hours due to increased imports.

And then lastly, they can also meet this through community service or volunteer work.

So as I mentioned earlier, discussion about our CalFresh and Employment Training Program.

This is a voluntary program that we offer all of our CalFresh recipients when they apply for CalFresh and at recertification.

Hours that are spent in qualifying Calfresh and Employment Training activities can be used to meet the ABOD work requirement.

And we do believe that once we enact ABOD beginning June 1st, we are going to be heavily promoting and encouraging individuals to participate in CalFresh Employment and Training as it will allow these individuals to continue receiving CalFresh without necessarily having to find a job that they may not be able to find as currently.

There aren't a sufficient number of jobs to meet the unemployment rate that we have.

Some of these qualifying CalFresh and Employment activities that are offered include workfare, work experience.

We also offer vocational training and self-employment training.

There's also educational activities that this includes GED prep classes.

And then we also have job retention services.

That image there is just a flyer that we have that's included in all of our package.

It's a dual-sided, so on the other side is more of a welcome to employment and training.

I know it's a little bit hard for you to see here, but that middle column that's actually listing all the CalFresh and Employment activities that are offered.

This is offered through the agency or do you have a CBO?

The CBO does so the agency run, we run this program, but we do also work with um with other external partners.

I believe our uh Gale Steel, I think it's the fourth floor, the third floor also has a business job center of America, I think is stationed there.

The third floor, Gale Steel, and overseen by workforce development board.

So it's the American Office Center.

And then this slide here, this is, as I mentioned before, as an ABOD, you would have to either meet the work requirements or meet an exemption.

So just a detail uh the list of current or of the exemptions as of uh June 1st, 2025.

So an individual that does not meet the work requirement, they can also be exempt from having to meet the other ABOD work requirements and still continue to receive CalFresh for more than three months if they meet one of these exemptions, and that would be if they are under the age of 18 or over the age of 64, if they're pregnant, if they're medically certified as physically or mentally unfit for work, if they are an Indian, urban Indian or Californian Indian as defined by the Indian Healthcare Improvement Act.

If they are a parent of or responsible for a dependent child under the age of 14, if they are exempt from CalFresh work registration requirements, except due to age, as CalFresh work registration is up through age 59, but the ABOD work rules are for individuals up through age 64.

I'll kind of cover that in a little bit in our one of our following slides.

I also do want to point out that exemption from CalFresh work registrations will likely be where a lot of our current ABODs will likely fall under because there is a long list of exemptions from CalFresh work registration.

But I do also want to call out that students would also fall under this category as students that are attending either higher education or vocational training, as long as they're participating in those programs at least half time, they will fall under this exemption.

And then lastly, for individuals that are also participating in our Office of Refugee Resettlement Programs at least halftime, it will also meet an exempt from the ABOD work requirement.

Next slide, please.

And so I just want to give you a brief on kind of what has changed.

What currently is the ABOD rules and then what is the new ABOD rules beginning June 1st under HR 1.

So what HR1 has done is increase the age require the age limit for ABODs.

It used to be 18 to 54, and now it is going to be 18 to 64 from June 1st.

What this also means is that there is now a subset of individuals, as I mentioned earlier, that are exempt from work registration.

They're over, they're over 59, but they're under 64 that are now going to be newly subject to the ABOD work requirements, which again means they must meet the work requirements or meet an exemption that I that we had listed earlier.

The age limit also for the dependents also decreased.

It used to be if you had a dependent, if you had a child or were um uh had exerted parental care control over uh a child under the age of 18, but now that is dropped down to under the age of 14.

Uh additionally, um it used to be that the individuals they're no longer exempt uh for uh for just having a child, like it didn't have to be a child that you are responsible for, it didn't have to be a child that was your own natural in the home.

Um but now under HR1, you do have to be either the parent of that child under 14 or you have to exert um parental care and control or be responsible for that child.

Next slide, please.

Additionally, HR1 eliminated three exemptions.

There was one exemption for the unhoused, there's one for veterans, and then there was another for uh former foster youth under the age of 24 who were in foster care on their 18th birthday.

And then, as I mentioned in the exemption slides, there was a new exemption for our Indian urban Indians and Californian Indians, and then lastly, our ability to request the state's ability to request waivers from the ABOD work department was reduced.

Now uh USDA FNS will only allow waivers if the unemployment rate in an area is above 10%.

Prior to this, we could also request a waiver when the number of jobs was insufficient to be that lost that ability.

That's why currently of the 58 counties, 55 will have to implement ABOD.

There are additional four more counties that the state is working to try to grant a waiver under this limited waiver requirement, but Alameda County is not one of those counties.

Next slide, please.

That's another question.

Of the folks who are receiving um CalFresh benefits.

Do we know how many were home or unhoused?

Yes, uh, I will get to that in a bit.

Yes.

Great question.

Thank you.

No problem.

Uh so yeah, just continuing, then we'll we'll move on to our implementation of ABOT.

So as I mentioned, for ABOT implementation, we are looking at June 1st, but it is going to be a little bit different depending on if you are newly applying for CalFresh or if you're already receiving CalFresh.

For individuals that are not receiving CalFresh and they apply for CalFresh on they are able to work and they don't have a dependent child under 14th, they would have to meet the work requirement or meet an exemption.

Otherwise, they will be time limited to three months.

For households that are currently receiving CalFresh, uh, we will begin their recertification is due, and due on or after June 1st of this year.

And for example, um, I have down there if a household recertification is due in May of this year.

Um, they will not be subject to the ABOD work rules, work requirements until their next recitation in May of 2027.

Next slide, please.

Then next, I just want to go over some of our preparation um activities and plans for ABOD, as this is going to be a large change.

Uh so currently we are doing uh training for all of our internal staff or our eligibility staff and supervisors as the ABOD rules have changed quite a bit.

We're also updating our internal staff policy and procedure handbooks.

That's those these are um handbooks that give our eligibility staff that make the determination guidance in terms of um what the new policy changes are, but also procedurally within the county what our business process will be.

We're also working on targeted quality assurance, our QA case reviews of ABOD screening.

We actually started this in October of 2025 in preparation for the resumption of ABOD.

These activities include random case review by our QA team to ensure that staff currently are screening for uh for ABOT exemptions and meeting the work requirement, and then also entering that information correctly into our L SOS system, as that will ensure that when we do begin implementation of ABOT, that the information in our system is accurate.

We're also working on public outreach as well as focusing on tying in the ABOT awareness to our May CalFresh Awareness Month, as May is just around the corner, and it will be a great time to not just expand CalFresh outreach across the county, but also to inform the individuals that are already receiving CalFresh what the impacts will be for ABOTs.

The CalSaw system, which is what we use to determine for updates in line with the state and federal regulations, is for May of this year as well.

We're also working with our CalFresh employment expansion efforts, and this includes expanding outreach with not just our partners, but also with the public about CalFresh and employment training opportunities, and also working with the Alameda County Community Food Bank to restart our workfare program with them.

And then lastly, we have promotion of our CalFresh, the CF377.11E, which is an ABOD exemption screening form.

This is a publicly available form on the CDSS website that we provided to our partners.

This form is essentially anyone can fill this form out and turn it in when they apply or for mid-feer reporting.

But this documents what exemptions and individual believes they may qualify for, or if they are meeting the board requirement.

This will help our staff also to key in on exemption screening for these individuals.

However, our staff are also, as I mentioned, undergoing training, and when we do have ABOD implementation, we will be doing a full review and full screening for all of our CalFresh recipient ABODs.

Next slide, please.

And so we're just gonna go ahead and get into some of our ABOD data for you.

This chart may be a little bit uh confusing.

And first of all, I'll try to explain it to you.

We're gonna be looking leftmost chart first.

This is kind of the chart I think we have seen a couple of times.

That first outer layer, that is our CalFresh recipients, that is everyone that is receiving Calfresh.

That's approximately 171,000 individuals as of January 2026.

The next layer is that lighter blue, which is our work registrants, and uh that is broken down in the middle chart of our work registrants on the left-hand side, the black side, 51.8% are our exempt work registrants because they are exempt, they are not going to be considered ABOD.

Whereas on the right hand side, that uh blue 48.2% is our non-exempt work registrants, and then from our non-exempt work registrants, this blue half, that is where we pull our ABODs from.

And then that is the uh is a donut chart on the far right, uh, of which there's approximately 40,000 ABODs that we have identified.

Uh, two and a half percent of these individuals from this donor chart, these are what we call our non-ABODs currently.

These are individuals that are receiving transitional CalFresh.

They may potentially become ABODs that are exempt or non-exempt depending on their status once they um once they transition out of the transitional CalFresh to either regular CalFresh benefits.

Uh the blue slice is 30.5%.

Um, so that is our exempt ABOTs.

These are individuals that meet an exemption.

They're not at risk of using CalFresh after three months.

And then that larger yellow slice or orange slice at 67%, these are our non-exempt ABOTs.

Next slide, please.

And so, as I mentioned before earlier, leftmost DOTA chart.

We those approximately 40,000 ABODs and 12, uh 12 and a half thousand are exempt, they're not at risk.

The 27,000, that was that orange slice, the 67%, these are our individuals that we will be focusing on our screening efforts at when their recertification comes due.

We will be screening to see if these individuals meet any of the exemptions and meet any of the work requirements, whether that is participation work activities or if they're working self-employment or income in kind.

And as I mentioned, if that individual does not meet an exemption or the work requirement, they will lose access to CalFresh after three full months, and their only way of regaining eligibility CalFresh is if they then meet the work requirement later on.

They meet an exemption or they wait until the next 36-month clock, which again will begin January 1st, 2029.

Next slide, please.

That middle column is the exempt ABOD.

So these are the individuals that are not at risk.

Those are the ones that are potentially at risk of losing access to Calfresh after three full months if they don't meet an exemption or work requirement.

We will be restreating each of these individuals at their next recertification.

And it's very likely that these individuals will meet some other exemption once we do the rescreening.

And then this is just a further breakdown of specifically exempt ABOTs, which is about 50.7% identify as male, 49.3 identify as female.

And then below here on the bottom, as supervisor Miley mentioned, we have our unhoused individuals.

This is the total population of unhoused individuals.

Approximately 76% of them are going to be exempt or will not be considered ABOTs, whereas a 24% of them will be.

Individuals that under HR1 potentially losing access to CalFresh.

As we see, there's approximately 64% or so of individuals that would need to meet the work requirement.

But as I mentioned earlier, a lot of these individuals likely will meet an exemption because a good amount of these individuals should be receiving some sort of disability-based benefit, like Social Security benefits, which will then make them an exempt individual, an exempt ABOD.

On the right hand side, that is our age range distribution.

We've broken that down by age in terms of decades.

So we have our teens, our 20s, 30s, 40s, 50s, and 60s.

I do just want to highlight from this, and I know it's a little bit hard to differentiate the two pinks, but the 60 to 64 range, that is our largest chunk, yet it is also the smallest in terms of the number of ages because all the other ages typically have from 50 to 59 or 30 to 39, whereas our 60s are only going from 60 to 64, because again, at 65, they're no longer considered an ABOD.

But this just highlights.

Next slide, please.

And then lastly, for our non-exempt ABOD data, we just have most common uh listed ethnicity.

Uh and so the best, but the most that we file currently is about 43% that identify as black or African American, followed by 20.4% that identify as white, 11.9 is other Hispanic, 10.9% of those Mexican, 9.5% Chinese, 4.2% Vietnamese.

And then spoken language, by and far English is the most common at 89%, followed by Spanish at 5%, Mandarin at 3.6%, Cantonese at 1.5%, Vietnamese at 0.5%, and Farsi at 0.5%.

And now I will pass it off to my colleague Jaime for the non-citizen updates.

Thank you.

Good afternoon.

My name is Jaimi Andamesco.

I am an associate program specialist at Alameda County Social Services for my friends.

Today I will be discussing about HR1 changes as it relates to non-citizing.

Next slide, please.

To give a brief background, federal non-citizen eligibility for CalFresh has been historically governed by the personal responsibility and work opportunity reconciliation act of 1990.

It's better known as the Aurora.

HR1 did not amend Aurora, nor does it change the definition of qualified immigrants, which are a list of immigrant groups that previously qualified for federal CalFresh.

HR1, however, specifically in the section of the Food and Nutrition Act of 2008, to narrow CalFresh eligibility to study individuals.

Next slide, please.

As a result, beginning April 1st under HR1, the following groups.

Those are US citizens, including individuals born in the United States, individuals born in US territories, such as Puerto Rico, Guam, or the Virgin Islands, naturalized citizens, non-citizen US nationals, including people born in American Samoa and Swains Island, permanent residents or LPRs, those are individuals with green cards, individuals with a compact of free association or COFA agreements, including lawfully present citizens of the Federal Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau, and Cuban and Haitian entrants, including individuals granted parole, not subject to final removal order, or have a pending asylum application.

Next slide, please.

Unfortunately, under HR1, there are a long list of immigration groups that would lose CalFresh benefits.

Those are, unless they later adjust to an LAST.

So when they receive their green card, they may regain eligibility of Cal Fresh.

Those groups are refugees, as silice, paroleese, with the exception of Cuban and Haitian entrants, individuals with deportation or removal with help, conditional entrance, victims of trafficking, battered non-citizens, certain Afghan nationals who were granted parole between July 31st, 2021, is the 30th, certain Ukrainian nationals granted parole between February 24th and September 30th, 2024.

Next slide, please.

Now that uh we have covered who will not who no longer be eligible for CalFresh.

Uh the next obvious question would be what if any other food assistance options do people have?

Uh, uh California food assistance program, which is um a state funding uh cow fresh benefit for certain legal non-citizens who do not qualify for federal cow fresh solely due to their immigration status.

Um however, CFAP California uh food assistance program is known as FEEP CPAP.

CFAP is governed by the personal responsibility work opportunity and reconciliation act of 1990 that I mentioned earlier.

HR1 does not change or restrict Aurora.

As a result, uh most non-citizens who are losing Alfresh eligibility uh because of HR1 will also not qualify for uh CFAP either, except uh battered non-citizens and parolees.

Uh right now we have about 572 uh parolees and about 312 battered non citizens who may later uh in the future qualify for CalFlesh.

But anyone who's not a battered non-citizen or a role does not have an alternative state funded food nutrition assistant program as of right now.

Next slide please I will now move on to uh discuss implementation timelines specifically when these changes will take effect for new CalFresh applications received before April 1st 2026 all applications will be processed under pre-HR1 non-citizen eligibility.

So anyone who has applied prior to April 1st will not be impactful on or after April 1st however HR1 non citizen eligibility criteria will apply.

And for ongoing cow fresh households individuals who currently receive cow fresh benefits their recertification due if they have a recertification due before April 1st 2026 it will be processed under HR1 pre HR1 excuse me a non-citizen rules and new HR1 eligibility criteria will apply at their next recertification or if their recertification is due on or after April 1st HR1 new HR1 non citizen eligibility on both of you and all of the certifications can you explain what that is when um so recertification is just the Cal Fresh terminology for renewal most households for Cal Fresh they have a 12 year I mean sorry 12 month certification so after the 12 months they have to recertify to continue receiving Cal Fresh for the next 12 months and to give a clear picture of what the scope of the impact will be we have just so we have a slight we have two pie charts um currently overall we have approximately 5,000 or from the non citizens individuals who are projected to use Cal Flash under HR1 of those the pie chart on the left hand side is an ethnicity based on their ethnic background 58% are Latino or Hispanic we have 17% identifying as other 11% Asian we have 8% unknown 4% white and 2% or less black or African American and for the gender breakdown we have 62% and 38% and to look at the impact geographically on the visor district breakdown and supervisor district one we have 622 and district two we have 962 and and district three we have 1,703 and district 4 we have 1,607 and in district 5 we have 352.

The vast majority appear to be in district two three four slides.

As I mentioned earlier the vast majority ethnicity are banned or Latino and their country of origin we have Guatemala we have about 1,323 individuals about 27% of the total next we have Mexico 1,021 at 21.4% we have Afghanistan with 1007 individuals or 21.44%.

We have unknown individuals uh 305.

That's about 7%.

And 252 individuals from the 5%.

And 117 individuals from Nicolagua, which is about 3%.

We have 94 people from Eritrea aid 85 people from China, 84 individuals from Ukraine, making up about 1%.

Next slide.

And when we look at the age distribution, the vast majority of people in the pie chart in orange.

At about 68% are ages 18 through 59.

And 24% in blue are ages 0 through 17 and through 17.

And at 8%, we have seniors, or you can next slide.

And lastly, we have for the beta district summary.

We have the language breakdown.

Since the vast majority of those will be affected by these changes are from Hispanic or Latin American countries, excuse me.

Yeah, Farsi at 319 individuals or 6%.

I'm sorry, 85 individuals at 1%.

Russian, 75 individuals also at 1%.

We have Mandarin, 51 individuals, Arabic, 44 individuals, Vietnamese, 16 individuals, and Cantonese.

Another 60.

Next slide, please.

Now that we have a clear view of the impact, with that context in mind, we can take a look at what the county or SSA schooling to prepare for these changes to prepare both our staff and our community.

We are working on automations for our CalSalt system, which wasn't mentioned earlier.

We are also updating policy and procedural handbook for our staff to make this transition as smooth as possible.

We are also working on community outreach effort and education effort.

We are partnering with uh community-based organizations that are working with uh immigrant communities.

We recently gave a briefing at the East Bay Refugee and Immigration Forum, which included about 30 coalition organizations that have immigration groups, and we anticipate higher demand for food legal service and other safety nets as well.

And in anticipation of these higher demands for assistance, we have identified a few resources for food assistance.

We have Alameda County Community Food Bank food hotline.

They provide free groceries, they have care mills, it is open for all residents irrespective of immigration status.

They have various uh pickup sites across Alameda County.

They also can deliver for those who are unable.

Uh people can find pantries uh and information at foodnow.net.

Uh, they can also be reached reached Monday through Friday from 9 a.m.

to 4 p.m.

They also provide uh language assistance would be a great help for this community.

Next slide, please.

Uh as I mentioned earlier, uh those who are going to lose calfresh eligibility as a result of HR1 can adjust their uh immigration status and can later uh qualify or be eligible again for HR.

Uh for that reason we have legal referrals uh available that they can reach out to.

We have Central Lego da La Raza, which provides immigration legal services.

Individuals can call their helpline uh to provide to gain support.

Their hotline is 510 241 4011.

They could also be uh more information.

Could also be found at ACILEP.org.

We have the Chinese uh Progressive Association, which provides uh legal support for individuals who may be facing immigration enforcement and removal.

Their information can be found at info at cij justice app dot org or through their website which is ci justice.org and we have finally california collaborative for immigrant justice and they also provide legal defense for those who are facing Google and uh Cynthia Muniz can be contacted as Cynthia CJJ C.

Um we also recognize that this is a community that is experiencing heightened anxiety and fear uh because of immigration enforcement as well as these policy changes in recognition of that we are working with immigration organizations that already have trust with these communities because they may be afraid to go to the food bank or seek other form of assistance and we want to meet them where they are be it at a church at a cultural gathering at a community community center or at a mosque so we're sensitive to that and working to ensure that they get the support that they need wherever they may be thank you question.

Thank you.

Very very thorough report and thank you for providing the added level of support on our safety net despite these cuts um supervisors I just wanted to uh correct some information then we can go to uh supervisor uh Miami and then to be corrected so the first bullet point central legal uh that is fine um the second bullet point um chinese progressive association this should be california collaborative for immigrant justice c ij they're associated with the Alameda County removal defense collaborative and the third bullet point um that could be Chinese progressive association they're the fiscal sponsor of tribajodores unidos workers united or two woo and um this contact is actually from quite a while back from the first Trump administration because that's one of my staff Cynthia so um for the record the email is to woo at two woo.org so t u w u at u w u dotorg and the phone numbers 415.

Okay then thank you for that you see some questions and they know their stuff too um there are some managing those contracts so I'm surprised that we don't learn that more presentation yes a couple of few questions refugees and folks who are do we know the numbers we're talking about how many specifically refugees or asylum we could give that precise number for you we have the general uh population parolees is that just refer to parolees or it's also folks with probation or it's just paroles do we know the number yes we have yeah it's not the parole in the criminal that's what I'm asking so it's not state parole immigration status that is granted to certain immigrant groups it is not uh criminal it's not related to I said criminal so it's pro so do we know that number we have 572.

Okay.

And then how long does it take somebody to get a law permanent resident status.

And they have to minimize.

Well, some people get immigration, the legal coming at residents when they arrive in the United States, depending on what type of status they arrived into.

So it depends on their status and their situation that they whether it's still asylum or um if they are a parolee, it depends on what type of uh status that they have when they come into the United States.

So what's kind of like the range?

Range time range.

It could be anywhere between a year, five years.

There are people I've known people who have waited 20 years.

I agree card.

So then with the uh ABOT, because I think with your presentation, you said there's a lot going on there, and I'm very impressed with the eligibility workers.

I don't know just trying to follow all this and who's going to be eligible and not eligible and this, that and the other.

It's a Herculean task.

So I take my hat out to the eligibility workers.

So I want to give them a big shout out and the training that's underway for them.

Yes.

Yes.

Yes, you guys are guys are awesome, and yeah.

So just want to mention that.

But you're saying some people might not be eligible under this, but then they might be eligible, or we might be able to get them in other pla other ways, and they might not have to wait till 2029.

When will we have a sense of the numbers we're talking about?

Will it be after June 2026 or will we know before June 2026?

Uh so right now we we do know is based on an estimate, as I mentioned, these are the highest estimates to get a more precise number.

We likely won't know until it actually occurs because we have to go in and screen each of those approximately 27,000 individuals to see if they do meet another exemption or not.

The way that the current system that we use to determine eligibility is it just shows you the first criteria that someone meets, and then um and then it just kind of moves on to the other points.

So we kind of had to um build out a uh spreadsheet of based off of if their exemption was because they were unhoused and we know the unhoused exemption is going away.

We have kind of put them all in that potentially they could lose benefits, but they may actually qualify for another exemption.

So um we won't know until it'll probably take uh at least a year because it's a sliding scale from when someone will actually undergo that rescreening, but everybody will be re-screened by May of 2027 because that's the last date that a continuing individual would have to um qualify for Calvary under the old um HR1 ABOD rules, but under the new ones they will start, you know, at latest um May of 2027.

Okay, will we be getting an uh an update?

Like a progress update before before next year, or will it or will it not happen until sometime next year?

Uh I'm certain we we will because uh we we meet with with you all quite frequently to give our our updates for the Calfresh program, and that is something that we will definitely include in those updates to you all.

Then let's suppose it's the worst case scenario.

Um what's our fallback in terms of folks qualifying for Cal Fresh?

If they if we can't get them anywhere, what what's the what are we gonna do?

Uh for now I think we'll just steer them to the food, right?

I want to do it's a work in progress.

But we're hoping that number is gonna be greatly minimized once we go through all the exemptions.

But at the moment we don't know what um the budgetary implications might be either.

The budgetary implications whether they don't qualify for CalFresh.

I suppose we turn them over the food bank, food bank might let's say they can't accommodate numbers.

Do they need more resources?

I don't have fundamental.

Okay, all right.

Okay, I think but once again, very impressive.

Very impressive, yeah.

You quizzed me on it, I probably see a lot.

Not B or an A, yeah.

Thank you.

Surprise, portion of asked questions.

Yes, thank you.

Um, very thorough presentation and great data analysis, so thank you.

Um regarding administrative cost sharing, uh, you mentioned that 6.7 million is the productive increase.

I know at PAL, we've been hearing from our state lobbyists, it doesn't sound like there's anything in the proposed governor's budget to help us with that.

Is that correct?

And do we know if CSAC or any of our associations are going to be lobbying for some assistance to the counties?

Uh I from the original bill that we that or the governor's bill that we had in the last one, I did not see that either, that there was additional funding.

Or at least advocacy for it because I do know that there are a lot of counties that won't have the budget for this.

We have our monthly meetings with C DSS.

And a lot of the counties are a lot smaller, but that increase uh shift of that of that cost is going to be a burden.

So I I would anticipate that there will be, but I don't have an exact answer for you.

Or uh CSAC just released questions last week that we can share with you all, which um is sort of with the whole county family.

So it's got the welfare directors association, the health directors, um, the public hospitals, um, as well as a few other of the CSAC subsidiaries, and essentially, or could lead to uh five to nine million dollars, nine billion dollars, excuse me, with a B in annual cost shifts to counties.

So it it's massive, and I think that the um they have estimates in there for uh statewide estimates related to uh what the administrative costs will be, what the cost for indigent care would be, um, and other broken down things like that.

But um, yeah, that's huge.

Um, in terms of the error rate, thank you for sharing that uh it's 11%, so that's on the higher end.

Um firstly, do we know what the state is doing with the error?

Lower and hopefully under 60 funds, and then secondly will the state pay the entirety of that fine or will they be passing off some of it to us?

Uh certainly.

So for that first part of your question, um, there is actually uh quite a lot of state activity that is going on to work on lowering um the payment error at the PER.

Um, we as a county, we're actually participating in the project, I think along with nine other counties to identify um commonalities, root causes of the errors, um, whether they are related to training or if it's any anything that can help assist, such as system updates in our Cal SAS.

Um, there has been a lot of advocacy and movement on that front, um, to in an attempt to lower our payment error rates.

Um, additionally, uh, we do have an ad uh an accuracy forum that the state is hosting in uh Santa Clara County, I believe is in April.

That we just got the invite um on Friday.

I think the invites went out.

Um so we will every county is going to be sending four representatives, so we will be sending as well, and that will be um to get information from the state on their current plans, anticipated plans, but also to network with other counties as other counties have lower error rates than some, and we can kind of work on best practices.

Um, and then to address your second half of your question, um, currently that administrative cost um uh penalty that 1.9 to approximately 2.1 billion dollars annually.

That is something that the state has said currently that they would be paying themselves because that has not been written into um state legislator to share amongst counties that because this was never expected that the state states would ever have to fund a portion of CalFresh or SNAP benefits, it's always been 100% federally funded.

And I was saying the operative workers currently, um, because it could be because it could change in um years, and what we've also heard is that the state could be creative and lower Calfresh administration allocation hours to pay it back.

So we we may not have to pay directly, but it could come from another source.

That's just the okay, thank you.

Um just a couple more questions in terms of the work requirements.

Can the California employment and training uh center have enough space for those um who need to satisfy the work requirements?

That satisfy that 20 hour per week requirement, and if we don't potentially have space to satisfy helping those people um who need to comply, how can we potentially get an early start on funding other opportunities?

So that was one question, but it's two entities um that can assist with them is the fresh and employment training employment staff who work within the workforce and benefits administration, and the center that Roland mentioned is the We OA Center.

So between the two, we could meet the need.

And I'll also just add to uh Brick Ford, um, another component is also through volunteer community service.

Um we anticipate that there's going to be a lot of individuals that will pursue that route as well.

So I think another part of our efforts is to work with our community partners um to kind of identify what activities would be and ways to report those hours um to the county so that we're ensuring that the individuals that are participating with them, they are getting that credit, the 20 hours per week, 80 hours per month, so we can continue these individuals uh on receiving health fresh.

And I'll just say workfare is not new.

Um it's been dormant for a long time, but when we did implement it some years ago, we worked with Goodwill, so they would um clients go there, and we also had some working in our offices, making application packets, just being as creative as we could, and then there was a a self-initiated work there component.

So with the clients and bottom fine are all.

Okay.

And can I just ask for clarification?

What is the in-kind work that was mentioned?

Yeah, so in-kind work is um it's not necessarily helping your your parents and then you get free rent or something like that.

It's actually um a type of employment where you're working for somebody, um, but instead of them paying you, they may give you free housing and meals instead.

And so you're getting that what they call as in-kind um payment.

So that also can be translated or used to be the work requirement.

Okay.

Um, and then I think this is my last question for um those who are impacted by the immigration rules of HR1.

Do we happen to know how many households that is?

We can give that information.

The exact amount of okay.

Yeah, we'll we'll we can definitely pull that for you.

Okay, thank you.

And then I noticed that um people from Guatemala are among the highest who were impacted.

Does that also include uh mom speakers?

Because I didn't see mom sort of pulled out as a language, but maybe that's for um language other than much where it was noted.

It was on the list, but it it wasn't a significant number, it's not as a significant, yes.

So it was less than one percent.

Yes.

Interesting.

Okay, thank you.

Thank you.

Um, you go last, everybody asked all your questions.

It's okay.

Just good.

Uh so I uh was trying to understand figure 15 uh because you know, hats off to the eligibility folks because super complex, and if you don't qualify for one, you qualify for others.

So I'm trying to understand the 27,000 uh non-exam ABOTs.

Is that as of January?

You estimate that's the amount of of um impacted individuals um that are not going to be exempted.

That that is the current estimate as of today that would lose the current exemption that they have in the system.

But as I mentioned earlier, the system just screens for the first exemption, so we there it's very likely that's an individual someone from that 27,000 population, they should meet another one, and as a key example, is um our elderly the age 60 to 64.

There was a large percentage of them that were currently in the system as determined to be um to be non-exempt ABOD, but it's very likely that a lot of those individuals are probably receiving social security benefits and receipt of social security benefits.

Typically is going to be associated with being physically in or mentally unable to work, and that will qualify for them for an exemption.

So it's very critical in what we're going to be teaching during our training to staff, and then when we have our guidances that come June 1st onward, we are going to be screening everyone for everything, regardless of what they say, what they filled out on the application or that C of 377.11E screening sheet.

Our staff are still going to be screening them for every exemption because we can't just rely on the application.

Some people they might put less on the application because they're not sure, and it's our job to kind of ask the questions to clarify the information as much as possible.

That's great.

Because like you had veterans, the foster children and the unhoused that are losing exactly their exemption, but they could potentially qualify with some other assistance programming.

And then those that are part of the CalFresh employment and training are used uh that qualify for that, but then they meet the ABOD rules.

Then we we can take that out of the uh total impacted correct, yes.

So likely the 27,000 SA is probably the high end.

We're gonna screen folks.

They're probably gonna meet ideally, I would say maybe a third to a half will meet an exemption, and then the ones that don't, those are the ones that we're gonna be promoting very heavily because uh employment the calfresh employment training is voluntary, we're gonna be very um kind of letting them know that this is uh an avenue and opportunity that they can participate in to continue receiving CalFresh, or there's others, but we will be promoting CalFresh employment and training heavily, is that's our own program internally here.

That's excellent.

Um, so just uh tagging off of what supervisor Miley was saying since I serve on the budget committee.

Um at some point, will we have an understanding?

Because, like you have there, the January 2026, the admin costs are effective uh October 1st.

So, at what point will we uh be able to understand like the budgetary impacts potentially on the department, uh whether or not we're gonna bring to this committee things that could potentially be funded with the measure W Essential Services Fund.

I think around May revise time, May rebonds.

Between May and end of June, we should have more information.

I just understand that advocacy efforts are happening now through the end.

So we'll know whether we're successful or not in May.

Okay, yeah.

Um we had uh our CWDA meeting.

Um some members of our CWDA Bay Area last Friday, and so CWDA is doing a lot of advocacy work around asking the state for extra general fund dollars.

So they're asking for extra money for eligibility workers and that sort of thing.

So those advocacy efforts will continue, and we'll we will be supporting um their work as well.

Okay, but based on what Anika was saying, CSAC is estimating a nine billion dollar impact on counties.

It's it's a conglomerate, yeah.

Um 9.1 billion.

Um that article came out last week as a Nika said, but that's minus the advocacy, the outcome of advocacy office.

That's worst case scenario.

Okay.

Thank you so much.

Appreciate it.

Are there any public comments on this informational item?

The comments.

Okay, let's go to the next informational item.

Thank you very much.

On the backbone agencies update, the ones who presenting.

Okay, there are mics up on the ceilings.

So last time we met in this room, we were phones with live recording.

According to Miley, he said that these mics pick up everything in the case.

You'll be fine.

Okay.

I'll just be.

Okay.

This is a lot of things.

Okay, supervisors.

So we have a um backbone agencies updates.

So the backbone agencies being social services and AC Health.

Next slide, please.

I will skip over this because we did uh some of uh well I won't skip over it.

So we'll talk a little bit about our recent backbone activities, talk about Medi-Cal outreach and enrollment, um, Medi-Cal work requirements update and data analysis and uh asset limits and data analysis that'll all be part of SSA's presentation and talk a little bit about what kinds of trends we're tracking.

Um and then the state last week or the week before uh released a plan recently about um how the state fans to implement HR1.

So just a high level overview of that.

Next slide, please.

Uh so Andrea and I both were recently at the Alameda Alliance for Health Retreat and Supervisor Town.

Um their board members, I was an invited guest, and so um it was really helpful to kind of be in that space to hear um breakout uh discussions on the importance of uh you know work that the plan is doing on member communications, um both in the intent of uh working with providers to make sure that they're helping to retain uh people as they fall off of Medi-Calm and coordinating with the county in terms of communications and uh you know thinking about um what kind of cadence they want to reach out to people as they start to lose uh lose coverage or just to remind them to get involved.

Um we also had our uh quarterly community provider advisory meeting chaired by Supervisor Miley uh last week and uh there we had a provider panel as well as a county uh team panel, and uh the focus there was really on the intersection of all of the big things that are happening more in the health space.

So there was uh discussion about the intersection of ROP one and what it means for providers in the county, as well as um, you know, when you layer on the anticipated reductions in medical enrollment and reduced Medi-Cal funding, um, and just sort of some of the pressures and um strategies that people are thinking through in terms of the next couple of weeks.

So we're also continuing to meet with our community partners, doing coordinated outreach planning.

Um, and then of course, as you just heard Director Ford mention, um, you know, doing policy and budget development and advocacy, both uh through the county as well as through our various uh state associations, um, and then continuing to refine our our data analysis, and so um before I turn it, oh I've got one more slide.

Um, on the data analysis piece, we've been uh core group again.

This is more on the health side.

Uh we've got SSA, AC Health, the Alliance, um really putting our heads together to think about what are the numbers that we need to be using so that we can share them with you all as well as in other advocacy spaces to see what the impact is on Alameda.

Um last time we were here, we heard uh we shared with you uh a little bit about the very um short-term outreach project that we did that had social uh media as well as bus ads.

Um, and I think Supervisor Tam had maybe asked who sees these things, and so we just have a little bit of data to share in terms of bus shelter ads.

We got about 2.8 million impressions.

Uh social media ads, we think we got more than 350,000 impressions.

Um, and uh through the El Timpano text messaging outreach, uh, we know that we reached at least 770 individuals.

Um so you know, our learnings from that was that out of home uh and transit ads do offer a good return on investment, so we'll want to continue to invest in those.

Um the social media work, especially when we're targeting it in specific areas, um, is helpful and we do see people clicking through to resources.

Um, and then uh we're really figuring out how to be uh better engaged in the texting space um to directly connect with um uh with residents.

And some of that's gonna be a little bit tricky because as you'll hear later, I think the state is also interested in investing in texting, SSA already does that, uh, the alliance does that, and so we also want to be mindful of not overwhelming people.

Um but we'll be working through that.

Um, and then I'll just note that tomorrow uh uh AC Health will be bringing a contract before your board uh to continue some of this campaign work um for the next two years, and that's uh funded through the Measure W allocation that the board approved previously through the Essential Services Fund.

And then for slides five through 18, Juan Bentonia Medical program specialists will provide enrollment data and analysis.

And Juan was um before your committee last month to discuss non-citizens.

Good afternoon supervisors.

Uh so first we'll take a look at um the total Medi-Cal caseload um in Alameda County for uh the last year.

Um we started off in January with about um 439,200 individuals uh enrolled into Medi-Cal, and you could see that number slowly decrease um to a low of 410,800 in um December.

Um I wanted to call out there was a significant dip between August and September, and um this is slightly speculation, but this would be around the time when people would hear a lot about the HR1 changes and the state budget changes.

Um, but we did see a slight increase to the case load number in October, um, which I'd like to think is partly due to outreach.

Um on the next slide, uh, you'll see a subset, um, and we'll we will explore a couple of subsets of this uh caseload information.

The first is the total new Medi-Cal enrollments per month.

Um, as you can see, the lowest month of new enrollments is in February with about 5,100, and the highest month is around August with uh around 7,700 new individuals enrolled into MediCal.

Um on the next slide, uh another subset again is specifically for the Magi population, which is um um individuals who um uh became eligible as a result of the Affordable Care Act.

Uh, we saw uh the lowest month of new enrollments is similarly to the first um uh to the to the second chart that we saw is the the lowest month of new enrollments is 3,300 in February, um, with the highest month of new enrollments being um in the latter part of the year with um August and October being around the 5,100 new individual mark.

Um and then um for the last uh for this set of data, the last chart that we'll look at is uh new adults, uh and this is a further subset of the um MAGI enrollments.

These are individuals 19 to 64 uh years old um who newly enrolled into Medical in 2025.

Um, well, actually I should say it's it's um there's an overlap with Magi, but because we included individuals in old um there um just um there is a slight um difference with these numbers.

So it is um still a subset though of our total uh new enrollments.

Um but for February we saw about 3,400 um enrollments, which is again our lowest uh month of new enrollments.

Um and then we saw again August and October uh share of uh the highest amount of new enrollment versus 5,300 new enrollments um in each month.

Um now before we dive into the next set of new advice, and then I wanted to circle back to this chart, which we've been showing in our past few um presentations around the uh state budget HR1 changes.

This is a timeline of uh you know the the biggest changes that are coming in the next few years.

Uh today I wanted to highlight first the um uh Medi-Cal work and community engagement requirements, which are um coming to Medi-Cal.

Uh it's new to Medi-Cal in January of 2027, and then also we'll briefly look at the um reinstatement of asset limits, which took effect uh last month in January 2026.

Um, so as a bit of background, um, first about the work and community engagement um requirements.

Uh on July 4th of last year, HR1 established Medical work and community engagement requirements uh for individuals between 19 and 64 years old who are part of the modified adjusted gross and uh income or magi uh new adult group uh of the Affordable Care Act, and this is going to uh take effect on January 1st of 2027.

Uh the way that this will be verified will be um at their next um uh renewal period.

Um, uh at that point they will be verified uh we will verify whether they are um meaning or exempt from one of the work requirements um uh through the ex parte process.

Um just a high level overview, I believe we'll explore uh the working community engagement uh requirements in a future meeting.

Um but uh the qualifying activities for an individual to meet the working community uh uh engagement requirements would be of course employment.

Um something specific to Medi-Cal, which I don't believe CalFresh has, is that you are able to meet the uh work requirements if you um make uh 80 times the uh uh federal minimum wage, which is seven dollars and twenty five cents, which uh times eighty out uh eight hours is about five hundred and eighty dollars a month.

Um you can also meet the requirements through community service.

Um if you're um uh if you're studying, if you're student half time or more, um, and also through participation in approved work programs.

What's community service?

Um, so I believe it is just volunteer work.

Oh, yeah.

Yes.

So um what we have first here is an overview of the individuals who are currently enrolled in Medi-Cal who may be subject to the work requirements.

So there is an estimated 151, 100 medical members currently active in Alameda County that uh maybe subject to the uh Medi-Cal work and community engagement requirements.

We broke them down um by age groups, as you can see, um, where um as pretty much expected, the uh highest um concentration of them would be within the ages of 26 to 49 at around 84,100 individual.

Um, and then we'll look into a couple of subsets of that group.

The first is um through the lens of uh individuals who are um who have unsatisfactory immigration status.

There's an estimated 39,700 individuals with unsatisfactory immigration status who are currently enrolled into full scope Medi-Cal who will be subject to work requirements um once those take effect in January, uh assuming they're able to keep their full scope um Medi-Cal through, of course, um uh submitting their um renewal uh paperwork.

Um and again, still um their the highest concentrations between the ages of 26 to 49 with 19,800 individuals.

Um on the flip side of that, um, we also got a rough number of the in uh the individuals with unsatisfactory immigration status who will not be subject to work requirements.

As you can see, um work requirements are only for individuals between ages 19 and 64.

So that there's a significantly high number of individuals between zero to 17, about 17,000 of them who are currently enrolled into full scope Medi-Cal um who will not be subject to work requirements.

And then uh wanted to call out also for ages 50 plus.

That includes individuals who were 65 or older who are currently enrolled into full scope Medi-Cal.

So this is our uh this is what the uh there are about 56,800 uh individuals who are UIS who are currently enrolled into Full Scope Medical.

Actually, sorry, they may or may not be enrolled into full scope Medical.

They may also be involved into restricted scope Medi-Cal.

Um and they will not be subject to work requirements because individuals who are not on full scope Medicail will not have to meet the Medi-Cal work requirements.

Um and then last for this set of data, um, these are the individuals with satisfactory immigration status who will be subject to work requirements.

We estimate about 1,021, uh 121,400 individuals uh with satisfactory immigration status.

We're currently all the Medi-Cal.

Uh and they will be subject to the Medi-Cal work and community engagement requirements.

Um, again, uh the largest concentrations with individuals between uh 26 to 49 years old at around 64,300 individuals.

Um then um I did mention again briefly briefly that we would take a look at the um figures for the non-Magi asset limit, which was reinstated in uh January of 2026, January 1st to be specific.

Um asset limits were reinstated for most of our non-Magi Medicail programs.

Some of the exclusions are individuals in the PICL program, disabled adult children, disabled adult widows and widowers, and minor consent, all those programs are exempt from the um asset limit reinstatement.

Um, and so an estimated 49,400 individuals um enrolled into non-Magi Medical between January 1 of 2024 to December 31 of 2025.

And this is the two-year period where there wasn't any um asset limit for the Medical program.

This was a time when uh DHCS eliminated the asset limit.

And so we'll look at the um enrollment numbers for those um past two years first with uh 2024.

Uh, these are the um approximate enrollment numbers um for each month in the year 2024, with um kind of, you know, a trend that we've been seeing with the past few um uh data sets is that the lowest month of new enrollments is February with about 1,400 individuals being newly enrolled into non-Magi Medi-Cal.

Um, and then you can see the highest numbers are at the um tail end of the year with about a couple of months there with about 2,000 new enrollments um in each of those months.

And then similarly in uh 2025, we saw um a little bit higher numbers in the next slide.

Thank you.

Um so we did see an increase, and again, um just wanted to point out again that we did have a lot of um outreach um working with our CBO partners to conduct outreach to let people know about the elimination of the asset limits over these uh two years.

Uh so we did see an overall increase in each of the months with the new enrollments in 2025, uh, with again our lowest month in February with uh about 1,600 new enrollments.

Um, and then the peak was again at the tail end of the year with November having the highest number with about 25 WP enrollments um for non-MAGI Medi-Cal.

Um, and so again, um we will be going over some um uh more detailed data about the um uh work and community uh engagement requirements in uh future meetings, uh including covering some of the um uh exemptions that uh to for the work requirements.

I also wanted to point out that where possible, I believe DHCS is trying to mirror some of the uh most of the exemptions uh that CalFresh has.

Um I will add first also um not to you know give too much for the next meeting, but um Medi-Cal will also have exemptions for foster care and former foster youth uh under 26 years old.

So that's staying for Medi-Cal.

Um and then uh also for incarcerated individuals.

Um, but again, we will be going over a lot more uh more of that information in depth in the future meeting.

Thank you.

Next slide, please.

So this slide, um, a little bit busy, are most of the footnotes, um, but one of the things that we've been working on as the backbone team is to think about how we can um sort of distill the potential impacts of both HR1 and state changes.

Um so you know, we've seen a lot of detail.

How can we also talk about them in higher level numbers?

And so I think Dr.

Clannen shared with you the last time she was here that we've got an engagement with Georgetown University's Better Government Lab.

Um who so we have a team of analysts who are assigned who've worked with SSA data and data from Alameda Alliance to pull together and then cross-referenced it to historical studies or experiences in other states.

For example, Arkansas and Georgia had used Medicaid waivers to do work requirements.

And so there's some history of how many people might lose their coverage when such policies are implemented.

So there they've been uh working with our local data and also applying, you know, list lessons and formulas from experiences in other parts of the county or other surveys that's available.

So based on that, um what we're anticipating is that because of the so in pink you see state changes and in blue is HR1 related.

Uh so the UIS enrollment freeze um could so this is people who are eligible but might be avoiding Medi-Cal due to immigration issues.

Um we could potentially see a 31% reduction in that population.

Um in the blue, you see work requirements.

Uh so this is a calendar year 2026 reduction, then in calendar year 20 uh 27, once the work requirements hit, uh we anticipate seeing a 21% um reduction in Medi-Cal enrollment.

Uh and this would be, you know, for people who are not exempt and uh not able to demonstrate that they're meeting the work requirements.

Um there's also a 20% reduction that we can anticipate in round six related to administrative barriers, and this would actually be 26 and 27.

Um, and so this is essentially people who um might be exempt from their uh work requirements, but um just for whatever reason are not able to get their paperwork in time or face other various barriers to actually be able to get things done.

The non-Magi uh that uh Juan just talked about, we're still working on that, um, and so this is a little bit of a work in progress, and we'll have more information for you.

But our next steps are to then kind of think through um who are the people in these categories.

Um, so maybe breakdowns by race ethnicity language, um, any other demographics that might help us kind of strategize where we need to target support.

Um so we uh hope to have those for you.

So next slide, please.

Um, so health pack, this is our intelligent care program in Alameda County, and um we've shared with you that prior to the Affordable Care Act, uh, it had more than 90,000 people enrolled in the program.

Um and here we're showing you data just from 2025.

Um so just you know, even over the last uh calendar year, we've seen enrollment decline from about 2900 to uh 2661.

Um, and we'll be continuing to see those trends because, in terms of, you know, again with that impact to counties, one of the biggest impacts that's gonna happen with people losing Medi-Cal is that there might be more people eligible for our index care program, right?

And so there's a lot of things that are happening at the state level to see, to see if there might be some statewide solutions because there's issues of churn and nuances like you might have um, for example, someone in the UIS category falls off, but they have three months to get back on.

And so during that three months, are they still eligible for Medi-Cal or are they now county industry and care, right?

And so those are things that we need more state guidance on.

Um, but there are going to be people who are just not eligible for either state or federal Medi-Cal who would potentially be in in health pack.

So we'll be keeping track of those data trends and you know, want to share those with you as we go.

These next few slides, I won't go into a lot of detail about them, but um because it's shared on January 29th.

Uh the Department of Healthcare Services uh released a report on the state's plan for mitigating impact on residents and minimizing coverage loss uh in terms of how they're implementing HR1.

Um so the plan, you know, at a high level, it's got uh it breaks down a lot of the federal requirements and what DHCS is planning to do in each of those buckets.

Um they also uh put an emphasis on stakeholder engagement and communication strategy and uh would talk a little bit about how they want to engage with with um members uh who are receiving different benefits under uh DHCS.

Um and it was assuring to see that there was uh sort of a consistent emphasis on wanting to support countries, you know, technical assistance or by figuring out ways to make the different processes easier.

Um, but I will note that it's still uh it's the framework of a plan.

Um there's not a lot of detail in there, but we think that you know the state is wanting to show that they know that the counties are waiting for a lot of information.

Yeah, it's a 38-page plan, and it's what Jael referred to during the PAL update.

Um, it's the state's implementation plan that does not include federal government um guidance yet.

Uh so just to go through a couple of things, um, you know, restricting federal funding for certain qualified non-citizens.

I think the theme that you'll just see in all of these is that you know they want to issue or they plan to issue guidance to county welfare directors.

Um in some cases it would be guidance for the managed care plans, um, and uh they want to update eligibility and determination systems uh to make it easier and uh a little bit more streamlined.

And more automation um to the process to sort of reduce the workload on staff is what they're is what the poll is.

Another thing I'll just draw your attention to is the timeline for engagement on all of these things is essentially you know, January 2026 through a good chunt of 2020.

Um so we don't have uh for some of the stuff we're gonna be waiting for.

Um, in terms of work reporting requirements, this is something we get asked about on the modified or community partners and when we will know things, but um it's some some of what DHCS shared is that you know they do plan to implement optional short-term hardship exemptions and automatically apply those to applicants where possible.

Uh again, they want to streamline processes and make it easier to report work ex uh activities or exemptions, um, and then throughout this October to next January process, uh, you know, they're planning to solicit input from community partners as well as um counties and others on um what works and and what the process design should be.

Uh there's an emphasis on ensuring that affected partners and uh benefit recipients um get communication in timely manner so that and it's easy to understand um and again updating systems and providing TAP.

Just a couple more.

They're a little bit redundant.

Um six month renewals.

Um this one I think is worth highlighting in terms of again wanting to streamline and reduce workload on counties.

Uh they're planning to apply the ex parte review of existing information on uh that DHCS has so that it makes it easier to get people re-enrolled.

Um, is something the state already does?

Is this a new yes?

You know, we're gonna be basically.

Okay.

Yeah, I don't think it's really critical to mention here, um, so we have the HCS's implementation plan, but it's critical that DHCS works closely with CDSS because there are work requirements across all programs.

Um you heard Roland mention earlier about Cal Fresh but there's also work requirements of Cal works that might also satisfy the work requirement in Medi-Cal.

So it's really for me to me it's critical for DHCS and CDSS to work very closely around examples.

I think that's part of the statewide advocacy.

So in terms of communications and outreach lots of policy guidance and implementation to come training and tools to come but uh it's reassuring to hear that you know there's a focus on being clear consistent and culturally responsive with messaging um because they recognize that it's a diverse community um rely on trusted messengers to share information including including coverage and back members.

So I think there's multiple programs like this that the state already funds and it's something that we'll want to track because occasionally like during COVID for example there were instances where the state was also just directly funding CBOs in counties but the counties didn't know and so it caused a little bit of confusion.

So we'll want to kind of track uh where those opportunities are so we can direct our partners to them.

And then a lot of social media mailed notices targeted texting and earned media so you know essentially TV commercials or or um newspaper articles and ads and we'll be on the lookout for some plain language materials and toolkits that you know again can be shared for the broader community so that we don't have to replicate all the information.

But I think it'll just be critical that timing will be really important because as you all have seen and experienced our people on the ground are already just clamoring for the information and the state is trying but as Andrea said they don't have the information from the federal government that they actually need to push it out.

So lastly this is again from the state's uh plan they recognize the increased administrative workload you know increased volumes of work um new verification and reporting workflows uh potentially increased foot and phone traffic at uh at like social services or self-sufficiency sites um and just an additional need to work with clients in a different way that um is a little bit more high touch than we might be currently um what I will say is that this doesn't show um you know kind of getting back to this uh the CSAC estimates of six to nine and a half billion dollars that would be shifted onto counties each year um a good chunk of that is for indigent care right so in terms of when people do lose their coverage they they get back onto the the county programs um it also doesn't account for um like all of the state stuff recently does not account for HR1 really even though this is about HR1 um that you know the public hospitals are taking a huge cut that that's included in the the CSAC estimates as well.

So cuts to public hospital systems indigent care and uh increased workload for counties are three of the biggest things in there.

And then the very last slide is just uh coverage loss and churn monitoring.

So this is a little bit about how DHCS plans to continue to see what's happening in the system especially with Medi-Cal.

And you know they want to provide feedback feedback loops with um the various stakeholders and in the landscape.

And on the churn I will notice like this was a word, at least in the health space, we used to hear a lot about it as the ACA was launched and it and it's fully back because we are going to have people fall off of Medi-Cal, get back on, fall off of Medi-Cal, get back on.

And it'll take just a little bit of time before we have data on that to be able to see, you know, what kind of pattern that is.

So we'll be carefully monitoring that least.

Andrea, if you have anything else you want to add.

Um no, um earlier I mentioned Summoner Bay Area directors um had a meeting last Friday.

Discussed some of the um harm mitigation efforts, and we were joined by Senator Becker, who's over this um human services committee at the state level.

So we did share a lot of these concerns with him and how he can help to advocate for counties to mitigate harm to the people that we and you committed to doing that.

In that meeting, he absolutely did.

Yeah.

I think he was really um he was really happy to hear a lot of the numerical impacts.

So we had Santa Cruz County, Santa Clara, San Mateo, Alameda, um, Sonoma, Napa, I think one other county.

And um just hearing what some counties are doing because of HR 1, they are anticipating some layoffs.

Um one county mentioned they had to they had a disaster preparedness fund that they well disaster preparedness they had to fund, which took money away from eligibility workers, so that might be um some layoffs there.

Um one county mentioned they had to go to air reserves uh to fund additional eligibility workers to take on the workload impact.

Um one county mentioned they're using measure a dollars to cover the cost of additional eligibility workers.

So it was pretty silvering.

I think he was happy to take in that information.

Okay, thank you.

Really helpful.

Um none of those other counties have measure W, right?

They have measure.

One of them has measure A.

Okay.

But some have but the but one mention a reserve fund, the county reserve fund.

We don't have it in the agents.

So all of them are anticipating an increase in eligibility workers, as we do too.

An increase in eligibility work for people and needing more workers.

Okay.

Supervisor what you know about us.

Questions, comments, still pondering.

Sorry to turn so much Michael.

I can share a couple questions.

Um first, I have to say, well, thank you for all of this information and data.

And your two agencies are doing a great job helping us prepare.

And I just have to say for the record, what terrible policies from the federal government.

I mean, this is just upending our safety nets.

And we're spending time trying to figure out how to maintain when things are getting stripped away and you won't even have the resources.

We need to figure out a backup plan.

So it's incredibly frustrating.

Nonetheless, you're both and your teams are doing um great work here.

Um, just a couple questions on slides five and six.

It's interesting.

Um, the total new Medi-Cal enrollments here were roughly the same month by month, but then the drop in terms of um active Medi-Cal went from 439,000 to 410,000.

And um we did hear that perhaps that was due to the news of the R1 being sign in July, but I'm just curious anecdotally, are we hearing from our staff or our partners what might be behind this?

Is it not wanting to share data because ICE might have access to it?

Are we hearing anything at all in terms of why such a steep department?

Oh so working with our CBO partners, I can say that that is a part of it.

There is a lot of uncertainty.

I think um in several meetings, we've um raised the the concern around the chilling effect, which uh also occurred back in, believe in 2021-2022 when we um uh had concerns about public charge, which I just wanted to point out.

I believe currently we are still following the 2022 final ruling about the Calvin Cal Fresh not being part of public charge.

Um also just I and I think this is even outside of the changes uh by HR one in the state budget.

Um there really is um uh there really has been a concern.

I I could say as far back as 2020 and probably even before that, um, just working with our CBO partners about a lot of people, not paying attention to the renewal needs, um, which is why I also just to kind of give you a little bit of a preview of some of the things we are working on in the future as far as our outreach, we are pivoting hard to um in um changing some of our enrollment outreach into renewal outreach, focusing heavily on reminding people about their renewal requirements, especially with six month renewals coming in the next year.

Um so that is also a big part of it that's you know that goes beyond even the uh HR one and state budget uh changes.

And I I would think some of the decline um has has to do with the unwinding period as well, because for was it four straight years we have to process renewals, and that's true, yeah.

So our um enrollment rate has been so high, as well.

Okay.

Um, and then for slides um 11 through 15 uh oh is this more easy to do to um address the work the new work requirements.

So I know you spoke to trying to see how we can um address both medical and fresh work requirements.

Can the Calfresh Employment and Training Center also potentially help people who have to fulfill work requirements to stay on Medi-Cal?

Yes.

Okay.

Um I think it's San Mateo County who's increasing their employment service the number of employment services workers to meet this to meet both needs.

Okay, and just given the sheer numbers, I mean up to what was it, 161,000 people who might need to comply with work requirements for medical, and we meet those needs.

If it's you know, so again, this is the first case scenario.

Um once we start applying exemptions and everything, they'll probably come down significantly.

Um but there's not a phrase on hiring eligibility I mean employment services workers.

We know we need to staff up, but typically um it's the eligibility workers who promote into the employment services field.

So it's a domino effect.

You lose one and you gain elsewhere.

Right.

Um, so just really trying to keep those two classifications down there.

And are those classes um close to fully staffed or do we need to sort of focus on staffing in those areas?

They're not fully staffed.

Okay, seems like we should make sure that they are to the extent possible.

I know we have a lot of openings, but we had a we are continuously recruiting for those classifications.

Okay.

I know that we had the um Department of Children and Families um announcements up on uh, you know, Instagram, for example.

So I put some of those in my newsletter.

I think I'm happy.

I'm sure my colleagues are happy to help promote those openings.

Yeah, the difference between what child welfare is doing and what we need for eligibility is um we don't have continuous hiring for the eligibility, I think.

Primarily because of training.

So there's a um, what is it, five to six months training, induction training for eligibility or and I think for um child welfare, it's a three week.

Yeah, six uh six weeks.

Yeah, about six weeks.

So do it so really just having our training and consulting team prepare to do those inductions after every cycle.

That's the difficulty.

And in addition, maintaining training, other likely fresher trainings and what have you.

So it's just a heavy lift all around, but we're still hiring on all the places.

Okay, and then I have to mention, you know, I have Cara here to my left.

Um so our um ESCs, which is um eligibility support clerks, which is Carol's classification, they promote into the Lomino effect.

We have to keep hiring to back fail.

IHRL's classifications.

Okay, I guess the bottom line is I know we we want to help for those positions.

And anyway that we can help.

And I will let you, and then my dear partner to my left, um healthcare, so yeah, we're just good.

Yes, workers can go.

Yeah, there we go.

That's right.

So you're making HS.

Yes.

Rog Peter people.

But um yeah, I was trying to like survivor to himself pondering all of this.

So with the eligibility work, is there any like formula formularic thing that can be done or anything that to um take ease the ability to to look at all the overlapping possibilities, you know, anything with AI or anything that would help the eligibility workers figure this stuff out.

So she's frowning up because she's thinking you're talking about having AI take jobs.

Trying to figure out plug it in here and it would figure out different things for the workers so they could just have an easier test.

Yeah, anything is possible, but you know, that's a formula no county as when they have a breakthrough.

Okay, but you know, because I was trying to understand the other work requirements, for instance, across the different programs.

And I know, you know, we talked to H and H last week about, you know, uh workforce development, and you know, just looking at all these different pieces.

Um just trying to have a person trying to sort through all of this manually is.

Yeah, I mean, you know, if it can be done, I I can think it through.

So give give me a bit.

Yeah, I'm just trying to throw it out to you because it's a lot of like some pressure Mass was saying it's just a lot.

It is a lot, and you know, there's that video on um AC Girl's website that talks about career ladders for um eligibility workers, and it they go up to social workers, so we lose them to so many classifications, and you don't want them to stay in that same classification if they can promote.

Yeah, right.

So I think uh and then uh Anika, you said nine billion is you did say nine billion, is that statewide?

That's statewide, right?

So we don't know, we don't know the estimate for Alamine County.

So we're we're working on those is trying to figure out what that impact is, um that I can share with you is that there are um there are um we're considered a public hospital county um in terms of how they think about indigent care.

And so the the CSAC report uh they did estimate they but for indigent care programs they did estimates at you know 33% of the people who fall off go into the county, 50% go to the county or 100% go to the county.

So that 9.5 billion is in the event of a hundred percent uh coming to the county.

Um when they did a look at the public hospital countries, there's only 12 of us.

Um that came out to 1.3 billion to 3.3 billion for the year, you know, just for those 12 counties.

Um those 12 counties combined.

Combined, yeah.

And so that includes LA, which is massive, uh, San Francisco, San Mateo, a lot of the Bay Area counties are from the hospital counties.

Um, and then you have you know some rural uh rural spaces, but we're working on getting those, we're working with the CAO's office also to make sure we get you those tests.

I just want to make sure.

So that figure is just based on HR one.

Yes, it does it also include when you said the public hospital county.

This is also include uh, the health systems figures, yeah.

So in this case, um what they looked at was uh HR one, you know, in addition to all of the medical uh enrollment changes and eligibility changes that we've shared with you about, um, there's very significant changes to hospital financing, um, and a couple of different like key funding streams that are going away.

And so those really hit next year.

So it's that too.

Yeah, so that includes federally qualified clinics includes.

Uh the FQHCs would those would not be picked up in this analysis, um, except to the extent that um, you know, for example, uh we meet uh for health pack, our network is the FQHCs, we provide the care, um, so that cost to the county for providing the introgenic care would potentially be a revenue stream to the FQHCs but um it they would still have additional losses um because of HR1 but that they're not captured in the C SE.

Okay.

Does the CSAC report capture prompt one?

It does not capture one this is just for HR1.

Okay.

And it does it doesn't capture any of the state's deficit.

Uh meaning that the state has billion dollar plus deficit.

No it it this is just saying that you know in the absence of um some sort of solution from the state level this is the amount of costs that would be passed on to the counties.

So if you kind of want it uh at the last work session where the CAO's office kind of shared that diagram with all the pressures coming together this would be one of those bigs of that.

Okay.

So refresh my memory is it in April or May that we're gonna have sets of basic May revise is when we'll know the state, prompt one, HR1, the impact on everything.

We're working won't know until the May revise.

Yeah no I think maybe I'll change the landscape a lot but we're continuing right that's when we'll know what the state will do.

Yeah but that's um but in terms of gathering what the impacts are in the absence of any state solutions we'd expect to have that sooner.

Because may revises like the first part of May.

May 15 yeah the government certainly supercenture maintenance of FR.

Yeah in April in April okay so we'll have kind of a clue in April then.

Right.

Just trying to sort all this out supervisor bass here to help us.

I just have two clarifying questions.

So at our last um joint session you talked about having the the data on the redetermination by next month is it?

Yes do we have a preview on that?

For the UI we're coming back with the UIS population actually um I did a little bit of math um because there is a little bit of overlap with the data that we have problems.

Um in the past so um the work requirements also include the individuals who will be impacted in in October the numbers that we gave the most would be would no longer be considered Q and C um this October because they are taking effect in January of next year.

And so the number that we had um for this month is around uh 79,500 UIS individuals and this is excluding children because children will still be on full scope medical um compared to last month um where if my math is correct we had about 81,600 individuals including the Q and the known the population that's no longer Q and C is about 10,000 uh individuals.

So we saw a decrease of about 2,000 in a month.

Yeah.

Uh I know uh the Alliance and and in this presentation we talked about like the expected worst case decline in medical uh recipient or clients uh has there been some projections on phasing it because I know you know going from 400,000 now to like 25000 the 31% I mean we we we obviously can't completely swallow all of that at once right I think what Matt present was over time.

It wasn't um yeah it was only like the 2028.

Yeah, and and in the absence of any mitigating efforts.

So if all of the things happen and people fall off and never get back on, that would be the total loss at that point.

But you know, as you'll see, like as Andrea was saying, once exemptions are built in, once we're able to see if we're able to actually retain people and put some effort into making sure that they're not completely falling off.

Um, the hope is not to get to that massive number.

Um, and then as we share the data with you, uh, you know, I think we want to get to a point where we're sharing some just sort of high-level things that you can see each month as trends go, um, and then deeper dives as as the teams go into specific topics, and I think we have to consider the human behavior too.

Um, a lot of times a person doesn't know they they lost medical until they need medical.

Um so if they show up at a hospital or clinic and they find out the medical is not active.

So it's you know, we work on access stabilization, but we have to also factor in human behavior.

Okay.

That's fair enough.

Do we have any public comments on this informational item?

There are no public comments.

Okay, do we have any public comments on items that are not in today's agenda?

No public comments on agenda, these items.

And this joint meeting is adjourned.

Thank you.