Good afternoon and welcome to the Alameda County Board of Supervisors Special Meeting of the Joint Social Service and Health Committee meeting for Monday, March the 9th, 2026.

May I have roll call, please?

Supervisor Fortunato Bass.

Supervisor Miley.

Supervisor Tim.

Present.

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Let's start with the first informational item, which is the state budget and HR1 impacts on the Cal.

Good afternoon, Supervisor Tam, Fortunately Bass and Miley.

I would like to invite Juan Ventania, Emilia Sanders, and Tammy Lou to the podium, and they will provide an update on non-citizen eligibility for Medi-Cal in some other state budget and house of representatives' impacts on Medi-Cal regarding non-citizens.

Supervisor Tam, Supervisor Fortinato Bass, Supervisor Miley.

So today again, we're here to talk about some but uh state budget and HR1 updates.

Um most of them are updates from the uh presentations that we did in January and February.

Um specifically, uh we wanted to go over on the side.

So this is the again uh timeline, the broad overview of the um key changes to Medi-Cal that will be occurring between 2025 and 2029 specifically.

Um on the next slide, please.

We will be going over updates to the January meeting, uh, the joint January meeting where we went over some uh numbers for the changes impacting our non-citizen community members.

And then I'll also hand it off to my colleagues, Amelia Sanders and Tammy Lu today to go over some Medi-Cal work and community engagement um policy updates as well as some preliminary data analysis.

Um, but first I'll go ahead and give my updates on the state and federal medical policy changes that impact our non-citizens.

Um, specifically, we'll be going over updates for the uh um enrollment freeze for individuals with unsatisfactory immigration status or UIS that took place in January.

Uh, we'll also be going over the upcoming reduction to dental benefits for UIS individuals uh this July, as well as the redefinition of qualified non-citizens this coming October 2026.

Um first, though, we'll be going over the adult expansion enrollment freeze.

Again, this was effective on January 1st of 2026.

The uh a freeze was placed on individuals 19 and older uh who are newly applying for Medi-Cal on or after uh January 1st of 2026 if they have unsatisfactory immigration status or if they're unable to provide proof of satisfactory immigration status.

Um defreeze does not uh apply to newly qualified immigrants or NQIs under the five-year bar.

It also doesn't apply to qualified non-citizens.

Uh, it also does not apply to individuals who are permanently residing in the United States under color of law or pro call, as well as pregnant individuals through their post-partum period and pregnant individuals who are in the medical access program or MCAP.

So looking at the numbers, um, as of the uh data that was pulled in late February, uh, an estimated 49,910 individuals are currently enrolled into full scope Medical as a result of the young adult, adult and older adult expansions.

So this is a decrease of about 1,290 individuals from the 51,200 individuals that we reported in January, which is December, uh late December data.

So what you can see on the screens right now is across the different districts.

There was a reduction in the number of individuals in each district.

I did want to call out, however, the other um uh portion of the graph, which is again our individuals who have addresses outside of Alameda County.

There was a slight increase.

Um, and so these are individuals who were in the process of being transferred to another county within California.

Um some key things that I wanted to highlight.

Actually, could we go back to the graph, please?

Um, some key things that I wanted to highlight with the um the reduction.

So there was a reduction of about 1,290 individuals based on a sample size of individuals who were discontinued or who lost their Medi-Cal between the December data and the February data.

The largest reason that we saw for the decrease would be individuals who did not complete their um uh Medi-Cal renewal.

Uh, that was about 70% of the individuals that we sampled.

Other reasons would include failed magi.

So those would be things like being over the income limit or no longer having California residency, among other things, it could also involve individuals who voluntary uh voluntarily requested to um end their Medi-Cal.

Um there were also a handful of intercounty transfers that were completed.

So those would be um uh considered as closed cases for our county, as well as a handful of individuals who are now deceased.

Um, so what we are doing because of the large number of individuals um that uh lost their medical because of not completing their renewal, is we're looking at um potential targeted outreach for these individuals, possibly uh a robocall or a text message for the individuals who did not complete their renewals to let them know that they still have an opportunity um for them to get back onto full scope Medi-Cal if they complete their renewal within three months of when they um lost their Medi-Cal because of the three-month grace period that is available for the enrollment freeze population.

Um now going to the next uh item, which is through the reduction of dental benefits for uh UIS individuals.

Um, so again, as a quick recap, this is going to take place effective July 1st of 2026, um, where full scope dental benefits will no longer be available to individuals 19 or older who have uh unsatisfactory immigration status or are unable to establish satisfactory immigration status.

And while routine dental care will no longer be available for this population, they will still have access to emergency dental coverage through Medi-Cal.

Um, similar to the previous uh change to the enrollment freeze, um pregnant individuals um will not be impacted by the dental freeze during their uh pregnancy period and during the 12 month postpartum period.

Um and DHCS or the Department of Healthcare Services will call this benefit level full scope Medi-Cal with no dental.

Uh looking at the data for this um population, it tells a similar story to the previous data that we saw because there is uh an overlap.

The uh enrollment freeze individuals are also um part of this population who will be impacted by the reduction in dental benefits.

Um, as of the again that data that we pulled in late February, an estimated 71,790 individuals are currently enrolled into full scope medical who will potentially be impacted by the reduction in dental benefits this July.

Uh, this is a decrease of about 2,210 individuals from the 74,000 that we reported um in the January meeting, which is again December data.

Um, and uh as you can see um between all the districts, it tells a pretty much similar story where there was almost or uh there was a reduction in almost all the districts except for district five, which is real still approximately the same number of individuals.

Um again, just to call out similar to the uh previous set of data, the largest number of in uh of the of individuals discontinued were uh due to them not completing the annual renewal, so they would be also included in any potential additional outreach that we do.

And then the last set of data that we wanted to look at for today is around the redefinition of qualified non-citizens.

Um next slide, please.

Um, which again takes place in October 2026, where the uh definition of qualified non-citizens will be redefined to only include lawful permanent residents, Cuban or Haitian entrance, and migrants legal leaders in the United States and its territories under the compact of free association or COFA.

So those would be um the Republic of Marshall Islands, Federal States of Micronisia, and the Republic of Palau.

Individuals who are in these Q and C categories will continue to be eligible for full scope Medi-Cal with dental coverage if they meet all the other eligibility requirements for Medi-Cal.

Uh now, on the other hand, on the next slide, the new definition of QNC would exclude individuals who were conditional entrants before April 1980, individuals paroled into the United States for one year or more, battered non-citizens, as well as uh their parents or children, and then also refugees and asylums would no longer be uh considered as qualified non-citizens for you know Medi-Cal purposes.

So individuals with statuses that were removed from this new federal definition of Q and C would only be eligible for restricted scope Medi-Calm effective October 1st if state funding is not allocated to provide full scope Medi-Cal without dental for these individuals on the this coming year's uh state budget.

I did want to point out though that there may be a possibility that these individuals see their full scope coverage continue past October, uh, depending on uh whether Cal SAWs does or does not need additional time to program the changes into the system.

So it um according to our partner our the people we coordinate with at DHCS, there is a possibility that Cal SAWs may need additional time to program the changes in order to grant uh restricted scope benefits to these individuals when the policy takes effect in October.

So we'll keep track of that to see if uh they do get uh an extension on their full scope at least temporarily because of the programming change that needs to happen.

Um so looking at this last set of uh data for the uh changes um to our non-citizen uh community members, an estimated 8,960 individuals will potentially no longer be considered QNCs because of the redefinition of who is a QNC.

So this is a decrease of about 1,640 individuals from the 10,600 that we reported again on uh in our January meeting.

Um, and similarly, um, we can see a decrease in the number of individuals in each of the districts, and again, the biggest uh cause is for uh not submitting the uh annual redetermination.

Um shifting a little bit, I wanted to go over our health navigators project.

So again, we've been partnering with our CBO partners to assist with um outreach for both Medi-Cal and CalFresh, promoting uh dual enrollment in Medi-Cal and CalFresh.

Um, and they also assist our community members, especially the most vulnerable community members with um application and renewals so that they can submit the application or renewal to us at SSA.

Um, I wanted to highlight the um key outcomes that um or basically the key outcomes from the past six months, specifically on this slide, you can see the new enrollments.

Um there were a total of 1,453 new enrollments on 1,149 cases or households in the past six months uh or in the in the last six months of 2025.

And then on the next slide, um we can see the number of Medi-Cal renewals.

So the uh the CBO partners assisted uh community members with uh 2,957 uh so 2,957 individuals on 1,275 cases with their Medi-Cal renewals.

Um one of the things that I wanted to highlight with these two uh um numbers is this is the overall enrollments and renewals that they've assisted with.

So this includes both non-citizens and citizens.

Um, however, what I also wanted to point out is we've been working with our CBO partners to um conduct outreach on the um on the upcoming changes to both programs to both Medical and Calfresh, um, almost as soon as we heard about the changes in back in 2025, back in like uh June and July of 2025 when we got the updates on the signing of the state budget as well as the HR one um bill.

So we've been working with them, um obviously focusing on the soon the changes that are soonest to happen, so that we're not overloading uh community members with changes for the next four or five years.

Um and then uh what I wanted to highlight now, I I'm not gonna go, I'm not gonna tell the full story, but we wanted to highlight some success stories, um, two success stories from our um from our partnerships with our CBOs about how they assist community members.

And I wanted to highlight two specifically that have to do with our non-citizen population.

Uh, the first story that you can see on your screen right now pretty much highlights a situation that we've seen um in one form or another over the past few years with working with our CBO partners, where um a family newly enters into the country.

Um, often they're fleeing a dangerous situation in the country that they're coming from in their home country.

And you know, obviously being new to the country, they're dealing with 20 plus different things, trying to navigate through everything when everything is pretty much new to them.

And um Medi-Cal is one of those more difficult, you know, navigating through the uh healthcare system is really uh confusing, especially for someone who you know is newly uh arrived into the country.

And so one of the key things that our CBO partners are able to do is assist these community members with navigating through the healthcare system with applying for Medi-Cal with using their benefits.

So that's one less thing they have to worry about.

And many of our CBO partners also offer other immigration-related services to help them with some of the other things that they have to deal with being new to the country.

Uh, the next story that I wanted to highlight is also something that has to do with our um non-citizen community members, but it's not unique to just them.

Um, I wanted to highlight how uh in this story I wanted to highlight how Medi-Cal policy is always changing, as we can see with these meetings a couple of years ago, we were dealing with the expansions to Medi-Cal, but now we're dealing with a couple of reductions to eligibility to Medi-Cal.

And for someone who's trying just to survive day-to-day, um, keeping up with all these policy changes can be a lot, and it's hard to keep up with those policy changes.

So one of the things that our CBO partners are able to do and have been doing is to provide um uh uh information to community members about the newest changes to Medi-Cal and CalVish and assisting them with the application and renewal process as well as with navigating their benefits so that they're able to get the care they need.

So just wanted to highlight some of the key things that our CBO partners have been doing for community members.

Um for the non-citizen section, the last thing uh I wanted to go over today is uh regarding an update to the uh CMS data sharing um that we heard about uh late or close to mid-last year.

Um so just as a recap for everybody in July of 2025, DHCS was able to confirm with um the Center for Medicaid and um Medicare and Medicaid Services uh that there was an agreement to share data with the Department of Homeland Security for the purposes of immigration enforcement.

And in August of 2025, there was a multi-lawsuit um uh multi-state lawsuit and uh a temporary injunction to stop the data sharing.

Um, and so in January of 2026, uh DHCS updated their statement from uh uh the from 2025, um, which is titled News Release 25-20 statement from the Department of Healthcare Services on the Federal Use of Medi-Cal data and member privacy.

Um, it was updated to state uh the following.

It updated uh the guidance stating that uh as of December 29 of 2025, a federal court ruled that the uh Center for Medicaid and uh Med Medicare and Medicaid Services or CMS may be able to share limited information with um immigration customs enforcement or ICE, um, but only for individuals who are not lawfully residing in the United States.

So to give some background, DHCS or the state is already sharing um certain information with uh uh as required by federal law, um, and they submit a monthly report to CMS, which includes basic demographic and eligibility details such as name, address, date of birth, social security number, Medicaid ID, and immigration status.

However, what I wanted to point out with the immigration status is that these aren't the individual immigration statuses that we're familiar with, such as legal permanent resident or undocumented, these are broader categories uh as far as the third-party research done by the Kaiser Family Foundation was able to determine because they also have access to the files being submitted by DHCS.

Um to give you an example, one of the categories is um under immigration status would be eligible only for payment of emergency Medicaid services.

So that could include both uh lawfully present and not lawfully present individuals.

And so basically what that it tells us is that if the data of the individuals who are lawful uh who are not lawfully residing cannot be separated out from the individuals who are lawfully residing, um it cannot be shared um for the purposes of immigration enforcement based on the uh ruling by the judge.

So if it includes data of lawful and permanent residents, US citizens or sensitive health records, it cannot be shared uh to ICE for the purpose of immigration enforcement.

Um my understanding is this is still an ongoing lawsuit, so we will continue to keep track of updates from DHCS as they make up available.

And so with that, that concludes the updates for our UIS uh or rather our non-citizen um community members for today.

Um, I'll go ahead and pass it off to my colleague Emilia Sanders to provide some policy updates for the Medi-Cal work and community engagement requirements.

Thank you.

Good afternoon, supervisors.

I am Emilia Sanders, and I will be reviewing our uh the preliminary uh policy for Medical work and engagement requirements.

Go ahead, next slide.

On July 4th, 2025, HR1 was signed into law and establish the Medicaid or Medi-Cal in California work and community engagement requirements for certain individuals enrolled through the Affordable Care Act or ACA adult expansion called the modified adjusted gross income or magi new adult group.

The Magi New Adult Group consists of individuals aged 19 to 64 with incomes over 109%.

These individuals requirements go into effect in January 1st, 2027.

Also, I wanted to note that this policy at this time is preliminary guidance and it is subject to changes based on developing federal policy guidance and state legislative changes.

So the first slide we have here is included excluded populations.

The following individuals are excluded from having to participate in the Medi-Cal work and community engagement requirements.

They consist of folks in our non-Magi group, which includes our aged and disabled population, along with those in long-term care facilities.

The mandatory children's group, which has children newborn to age 18 years old, those in the pregnancy group, and any individuals eligible for restricted scope Medical or Emergency pregnancy services.

This includes our UIS population.

Next slide.

So this means that Alameda County residents will not meet this requirement, this exemption, but can be in any of the other following.

If they're receiving Medicare parts A or B, American Indians or Alaska Natives, parents or caretakers of a child under the age of 13, if they are pregnant or in their 12-month postpartum period after the pregnancy, and it does not matter how the pregnancy ended.

They still entitled to the 12 months after.

Short-term medical hardship, which includes individuals receiving inpatient hospital care, nursing facility services in an intermediate care facility for individuals with intellectual disabilities, inpatient psychiatric hospital services or services of similar acuity, including outpatient care relating to other services as specified.

Also, individuals or their dependents who must travel outside of their community for an extended period of time for to receive their medical care as it is not available in their home residence.

And then lastly, federally declared disaster or emergency area.

And individuals can satisfy the requirement through one of the following having gross income equal or greater to $580 a month.

And this amount is figured by multiplying 80 hours to the federal minute minimum wage of $7.25.

Income is also not limited to earned.

It can be unemployment benefits, state disability or retirement, to name a few.

An additional guidance will be provided by the state on the job training and community service.

And also if an individual is attending school full or part-time, or 80 hours of any of the combined participation, whether they're working, school, community service, as long as there's 80 hours total of any of the mix of them, they will satisfy the requirement.

Next slide.

So the process at application is that we will be looking at the 30 days prior to their application, whether they are meeting the requirements.

If they are not, we issue a notice of noncompliance and they're then given 30 days to provide the compliance to us.

And at that time, we will then go ahead if they meet all other eligibility, we will approve them under this requirement.

And then at their six month renewal, individuals must meet the requirement in any one of the six months prior.

And it does not have to be consecutive if it's more than one month.

And if again, if they're not meeting it within those previous six months, again, we give them 30 days to comply.

Thank you.

Good afternoon, supervisors.

My name is Tammy Lu, and I will be going over some of our preliminary data regarding Medi-Cal work and community engagement requirements.

Before I dive into the summary, I just wanted to note that these numbers are based on what's currently in our case records, and that there is currently no functionality in Cal SAWs to track Medi-Cal exemptions or qualifying activities for meeting work requirements.

These numbers may also change based on future guidance that we receive from the federal government and the state.

And once additional programming is done in Cal SAS to track these exemptions and qualifying activities.

And then by full implementation in 2030, DHCS is projecting a 12.24% overall reduction in the statewide Medi-Cal caseload.

And full implementation means that by the time the changes take effect for all individuals in the Magi New Adult Group, this is due to the work requirements and the six month renewals being a phased implementation approach.

And applying this percentage to our current caseload in Alameda County, that's about 50,300 individuals.

So diving further into the numbers, the 158,900 residents affected by the work and community engagement requirements is a decrease of 2100 individuals from the 161,000 individuals from early February.

Similar to the data that Juan presented, according to a sample size of these individuals, most of these individuals, the decrease in the individuals is due to a failure to complete their renewal.

And these numbers are likely to fluctuate, and we will be monitoring them leading up to implementation.

So looking at the individuals subject to work requirements by age group, the majority of those affected are in the 26 to 49 age group.

But I did want to know that there is a significant number in the 50 to 64 age group.

And then looking at the gender breakdown across all districts, there are more males than females subject to work requirements.

And then taking a look at the country of origin for individuals who are subject to work requirements.

But individuals from Mexico, China, Guatemala, and Vietnam make up the next largest groups.

And then taking a look at the breakdown by language, it follows the country of origin pretty closely.

With English being the majority, and then Spanish, Cantonese, Vietnamese, and Mandarin making up the next largest groups.

Now taking a look at the individuals who may meet an exemption based off of our preliminary estimates and current case records, there are a current total of 15,100 individuals with district three having the highest at 3,800 individuals.

And these individuals may also meet more than one exemption.

And then looking at the age groups for individuals who may be exempt, again, the age group 26 to 49 has the highest number of individuals, followed by 50 to 64, and then 19 to 25.

And then gender, looking at gender distribution, there are more females than males who are exempt whom who may be exempt from work requirements across all of the districts.

And then we wanted to highlight just our largest exemption group, which is caring for a child under 14 years old.

This represents about 9,500 individuals, with district three again having the highest number of individuals at 2400,000 people or 2400 people.

And then we grouped all of the other exemption groups due to the smaller numbers.

So there are about 6200 individuals who meet all the other exemption groups.

And just to reiterate the groups that Amelia mentioned, these are individuals who may be pregnant in their 12-month post-partum period.

They are in jail or recently released in the past 90 days, former foster youth under the age of 26, individuals who are entitled to or receiving Medicare Parts A or B, American Indians and Alaskan natives, individuals in a drug and alcohol treatment program, people caring for a disabled individual, disabled veterans, individuals meeting TANF or CalWorks work requirements, meeting CalFresh work requirements, and individuals who are medically frail.

And then shifting our focus to the individuals who do not meet an exemption but may meet work requirements.

This is about 55,900 individuals.

Some of these individuals may meet this work requirement in multiple ways.

For example, if someone's working 80 hours or more per month, they are more than likely earning $580 or more per month.

And again, as Amelia stated, we are waiting additional guidance on what constitutes a work program and what constitutes an acceptable form of community service.

And looking at the age breakdown, similar to the previous age breakdowns, the 26 to 49 age group has the highest number of individuals followed by 50 to 64 and then 19 to 25.

And then looking at the gender breakdown, all districts aside from district five have a higher number of females who may meet work requirements than males.

And then we are going to look at some of the qualifying activities that meet work requirements.

So the first is the individuals who are employed 80 hours or more per month.

This comprises about 7,000 individuals with district three having again the highest at 1800 individuals.

And then the qualifying activity of $580 or more per month.

This is about 47,900 individuals.

And I did want to reiterate that this can be any income.

It doesn't have to be employment or self-employment income.

It can be social security income, disability unemployment, dividends, things like that.

And then the last qualifying activity we're going to look at is individuals who are attending school part-time or more.

And this comprises of about 10,900 individuals, with this time district two having the highest number of individuals at 2400.

And this is again 87,900 individuals with district three having the highest at 21,900.

Looking at the age breakdown, similar story as the other data points.

The individuals in the 26 to 49 age group have the largest number of individuals who do not meet an exemption or a work requirement, followed by individuals in the 50 to 64 age group, and then the 19 to 25 age group.

For the gender breakdown, there are across all of the districts more males than females who currently do not meet an exemption or have a qualifying activity that meets the work and community engagement requirements.

And then next, I wanted to touch upon some potential future enhancements to the uh work requirements data and identifying individuals who may need an exemption or a qualifying activity.

Um at the state level, they are creating an exemption and work reporting form.

Um they are planning to use this uh form or insert as part of the application process to assist individuals with reporting their exemptions or any of the activities that they are currently doing that might meet work requirements.

Um they are also looking at a host of data sources to automatically identify exemptions and verify work requirements.

Some of them they currently have access to and have programmed into the system.

Um, some they have access to, but they haven't programmed yet, and then some that they're still exploring to see if it's feasible to incorporate that data into the system.

And then lastly, um with the additional guidance that the federal government is still yet to provide, um, that could also um help or change the way they develop the categories and data sources that they're looking at.

Um I also wanted to go over some of the data sources that they um are looking at.

So currently the data sources that they have and are already programmed are from the uh Cal Here's or Covered California Business Rules Engine, which include EDD and IRS data.

Um they are currently utilizing Equifax work number information and their the income data from the various programs that we administer uh are also programmed in there, um, which include CalFresh CalWorks and General Assistance.

Uh data sources that they currently have but aren't programmed are veteran service history and eligibility information, uh the short Doyle Medical System, which is psychiatric inpatient hospital services data, and then the CalSaw's um CalWorks and CalFresh Work Requirements data.

And then uh for potential data sources that they're looking at, some of them are pretty interesting.

Um, so they're looking to incorporate some gig economy data uh via TRUVE.

Um they're looking to incorporate some of their claims and encounters data.

Um so this includes individuals who are on home and community-based services waiver programs, um, enhanced managed care, uh, enhanced care management and community supports.

Uh, they are also looking, they're they're working with their internal clinicians to identify um international classification of diseases or ICD 10 codes and current procedural terminology CPT codes uh to be able to map it to different uh medically frail categories.

And they are also looking at managed care plan care management systems.

Um for the qualifying activity of going to school part-time or more, uh, they are looking to incorporate uh data from the California Student Aid Commission or CSAC, uh data from the UCs and the CSUs and the Department of Education.

And then lastly, for the uh work program qualifying activity, they are looking at uh incorporating data from the Department of Rehabilitation.

And then uh moving on to what we're doing on the county level.

Oh, sorry, let me go back.

Yeah.

Uh what we're doing on the county level.

Uh, we are working with CALSOS to optimize our um data queries in order to um pull the information um in uh faster and more accurate manner, and we are looking at additional data points to um refine our data and to more accurately identify individuals who are exempt from or meet work requirements.

And then shifting our uh focus to outreach uh on the state level, um they are carrying out their outreach activities into two phases.

The first is the awareness phase from February to July of 2026.

And this is to just send out mass information to individuals who may be affected to let them know that what changes are coming up and what they can do.

And then the second phase from October 2026 to July of 2027.

This is to support affected individuals in responding to these new requirements.

Some uh community commute communication channels that they're looking at are direct mailers, um, updating their websites and social media, um, building out tool kits for the community to be able to spread the message, which includes flyers, FAQs, and messaging guides.

And then they are also looking to partner with managed care plans and community health care workers uh to do more outreach.

Um they did start uh their text messaging campaign earlier last month in February of 2026.

Um they started sending out uh text messages for those who have January and February 2027 renewals.

Um so the text messages, they are going to have information about the work requirements and also to the six month renewals.

Um they the messages will follow the the the different the different phases.

So the first phase is that awareness text message, and then um the second text message is the preparation text message, and that's going to be sent out six months uh before their next scheduled renewal.

So for January 2027, um the state is estimating about 222,000 members statewide will get that text message, and that's about 6500 in Alameda County for the February 2027 rules.

Uh, the state is estimating about 204,000 members statewide who will be sent that text message, and that's about 6300 in Alameda County.

And they are still currently trying to finish out the translations for the other languages for the text.

So once that's finished, um, it'll be sent to the individual in their preferred uh language.

And then they are also leveraging their coverage ambassador program, which was started during the COVID-19 pandemic.

Um, they are using these individuals who could be from community-based organizations and advocates to distribute resources and messages at the local level to help individuals um find better understand and keep their health coverage.

And on the screen, there is the website to the DHCS coverage ambassadors and the email if there are any questions.

And then lastly, um at the county level, um, there are going to be automation and enhancements to our eligibility determination systems, um, Calsaws and Calheres or Covered California, and there are there's going to be changes to the consumer-facing um portals too in Covered California and Benefits Cal.

And these are expected to be implemented by January 1st, 2027.

Uh, we are also convening a work group to develop a plan for um staffing, training, outreach, and engagement with our community to keep these um beneficiaries or members informed and covered.

And um our current local outreach efforts um include the health navigators project, which Juan has mentioned um previously, and the CBOs that are under the Health Navigators Project, they are already aware of the changes coming in January 2027, and they are preparing to um do outreach activities for the multimedia marketing campaign, which is also a part of the Health Navigators project.

Um we are working on additional materials um such as transit shelters, bus interior cards, um hand sanitizer store displays, and a variety of radio, TV, and online uh targeted outreach efforts to be able to spread the word.

And uh that concludes our presentation.

Thank you for having us this afternoon.

Are there any questions?

Thank you very much for that very data presentation.

Um let me turn to my colleagues first uh to see if they have any questions.

Supervisor Fortunata Bass.

Thank you so much to all of you for the update uh in terms of uh information on the policy changes, the data, the impacts in our district, and the plan.

Let me see here.

Um just one clarifying question.

So um on page 23.

In terms of the qual uh what qualifies is it is it possible to qualify um and meet an exemption if you earn five hundred eighty dollars per month or more and work less than 80 hours of employment.

Yes.

Okay, so it's one or the other.

It's not that both of them need to be.

Okay.

Thank you.

And um, I wanted to also mention I really appreciate you sharing the success stories.

It's really great to hear the more qualitative information about the work that the um health advocates and other staff do in addition to all of the data.

So thank you for sharing that.

Um and I think my main comment is knowing that there's almost 88,000 people who have um no case record of potentially meeting an exemption.

The work of the work group is really critical.

And so I wanted to just underscore that, you know, this needs to be all hands on deck.

So please keep the board informed.

And if there is anything that is needed, whether it's resources, people, the board should be aware of that.

Um, it would just be pretty devastating to let that num let that many um people go without coverage.

So um is there yet a plan for how the board will be informed of that work group and the various plans?

It would be by way of updates on to this committee.

Um, we've made that agreement as your board um and as the agency that will bring up updates regarding HR1 to this joint committee.

So we'll be pretty current and constant with that information.

Thank you.

Supervisor Miley.

Oh, yes, thanks.

Thanks for all the information.

Um with folks enrolling into full scope Medical.

Um, based on the timeline.

I think it was mentioned that they maybe still have another couple of months or to enroll.

But after that, it it's it's it's done.

Yes.

So um for individuals that are currently or were enrolled into full scope medical prior to January 1st of this year, uh, they have a three-month grace period to um get back onto full scope medical for any reason.

So if it's a renewal, um, or if they lost uh so if it's a renewal, they can submit their renewal and get back onto full scope medical, or if it's for another reason, they can reapply and still get back onto full scope medical if it's within that three-month grace period.

Um after that, uh they would only be able to get a restricted scope medical if they reapplied after the three-month period.

So what if you don't get a DNA of those categories and you become eligible later on?

Is there any can you enroll later you know at some point some other point in the future?

Um no, so it um because uh there for individuals that are in the statuses that are impacted by the freeze.

Um if it's past the uh three months uh and they try to reapply even if they meet all the same eligibility requirements, they would only get restricted because they're in one of those categories that are impacted by the freeze.

Okay.

Um then the only other question I had at the moment was the 87 almost 88,000 individuals who are currently um meeting the requirements, right?

uh there for individuals that are in the statuses that are impacted by the freeze um if it's past the uh three months uh and they try to reapply even if they meet all the same eligibility requirements they would only get restricted because they're in one of those categories that are impacted by the freeze okay um and then the only other question I had at the moment was the 87 almost 88,000 individuals going currently um meeting the requirements right the work requirements or exemption is that yes though there's about uh 8800 individuals who aren't meeting are we looking to see how we can set up something to help them either meet the work requirements or meet the um community service I mean the yeah the community service engagement I know we're still waiting for you know more the uh definitive information on that but can we set up something to help them?

Yeah so the state is looking into potential uh Medi-Cal only programs to um have people meet the work requirements uh they are seeking federal approval to include employment supports as a county opt-in medical covered benefit so the state is looking into it um and we have also looked into it too um to see if there's any um anything we can do to help these individuals yeah because maybe I'm off here off track here but what I was thinking is if through social services we were able to offer you know these are places you can go to get you know to meet the work requirement or these are options this menu of options you can you can pursue to meet the community engagement requirements in that way you know we are we're helping them because I would think unless I'm missing it and maybe I might be because everybody doesn't think like I do I would think people would want to be motivated to either meet the work requirement or or meet the community service engagement requirement so they could stay on Medi Cal I would think I would yeah I would think so too yeah so um I think we do have to wait for additional information because we are um they are looking for um additional programs and awaiting that federal approval yeah because you know just thinking out of the box and I'm just thinking out of the box I don't even know if this would fly and if it will meet the requirements for community services but there's a lot of litter and the legal dumping out there that you know somebody were coming to social services and say I can't meet the requirement you could say hey we got a program here where you can volunteer go and pick up some trash and legal dumping and forever how long they've got to do that to meet this requirement because it's it's every six months and it's and if I re recall it's one month within that six months that they've got a show right yes.

Okay well yeah I mean if you can think of some stuff yeah I mean maybe you don't want to work but we you know we've got some community engagement you could get involved in to help help help help yourself and help the community at the same time so just kind of thinking out of the box yeah okay I'm done thank you um this uh presentation is helpful because it provides us a very methodical way of thinking through the phasing of HR1's impact on Medi-Cal and the recipients because you know when we first heard about it it's everything all at once everywhere happening at the same time we we were just kind of in this panic mode but um just I know the eligibility criteria is complicated so I just had two questions about that related to your case study so in terms of the redefinition of qualified non-citizens um so the first case this uh the person was a refugee and they were able to get um help through medical and that's because of the exemption is that correct for um refugees as under the redefinition of qualified non-citizen um so historically they were considered just qualified non-citizens and even with the um um past expansions all the way up to 2025 pretty much anybody as long as they establish that they're within the income limits and they um um meet so they meet all the eligibility requirements they're a California resident they could have qualified for full scope medical so with the change in the definition of qualified non-citizens effective October um they may be switched over to uh restricted scope medical uh if uh there is no funding in the state budget for this coming fiscal year to um fund full scope without dental coverage for them um and again um they still might see their um full scope last a little bit longer than October depending on how long it takes the Calsaw system to um add the updates into the system to change their coverage to restricted scope how long does that coverage last uh in terms of their status as long as they're a refugee uh yes so yeah so if they uh change to another uh so so they you know being a refugee they still have legal status as far as immigration status if they shifted to a different um immigration status that would

Um and again, um they still might see their um full scope last a little bit longer than October, depending on how long it takes the Cal SOW system to um add the updates into the system to change their coverage to restricted scope.

How long does that coverage last uh in terms of their status as long as they're a refugee?

Uh yes.

So yeah, so if they uh change to another uh so they you know, being a refugee, they still have legal status as far as immigration status.

If they shifted to a different um immigration status that would uh consider them as a qualified non-citizen, then they could switch on to full scope medical.

Okay.

And then in the second case, um the gentleman is an undocumented senior, but was able to get through to Bercio Vasquez uh enrollment in Medical.

Which category would they fall under, even though they're a qualified non-citizen?

So they're um they're in the enrollment freeze category as far as my understanding goes.

Um so currently they are still on full scope Medical because they enrolled prior to uh January 2026.

As far as um October, I'm actually not clear.

I'm actually going to see if either of my colleagues um are more clear on that.

It would appear that they would still continue to be eligible for full scope after October 1st of this year.

Okay.

Are they answering?

Yes, they would still be able to be covered under Medicaid.

Okay.

Um so the the last question I had, oops, sorry, has more to do with um sort of this the sum of the parts adding to the whole.

I know uh the directors and I serve on the Alameda Alliance for Health, and we we have this broad projection of covering now 400,000 people, potentially going down to 250,000 in Alameda County, and then we're looking at uh 88,000 or 87,000 uh 900 people potentially that could lose coverage because of the work requirements.

How is this uh on track in terms of the overall estimate that we have with the alliance of people potentially losing Medi-Cal coverage?

Um, I don't have a response to that right now, Supervisor Tam Andrea Ford, agency director, but I think uh Tammy spoke a little bit to the phases that we might lose 30 percent um it was 3.55 percent the first year and then 12.24 percent uh for full implementation.

And what's that slide number, Tammy I could add something, supervisors?

Uh any kachaver interpartive for Alameda County Health.

Um if you're asking about sort of the broader projections that we had shared with you all uh last month, um, those have been done with SSA numbers, alliance numbers, as well as state projections and um kind of experience from other states that had done work requirements before.

And so as there's more detailed information available from SSA, that team that's kind of doing those overall projections can can update it.

But I would say that because SSA has the most robust data here, um, it's it's the most complete set.

Um generally it's on par with it, you know, these numbers are consistent with what we've shared with you before.

It's just in a little bit more detail than what we shared.

Okay, uh I mean, maybe I'm looking at this differently despite the fact that my district is with the most impacted district three.

But when you look at the numbers, uh maybe it's because it's being phased.

It it doesn't seem as bad as I had thought it would be.

Yeah, I think what Matt presented was worst case scenario.

Okay.

And um, what this team presented here today is that the numbers are always changing based on what the HCS um is automating or you know, looking for rule change to the federal government.

So the number that Matt shared is not absolute.

Um, but it's forever changing based on circumstances of the state and federal levels.

Okay.

I mean uh any number is bad, but you know, 12 and a half percent is not as bad as 30 percent, but it's a phasing approach.

I appreciate that.

So uh thank you for that clarification because that's really helpful to know.

Um I don't have any further questions.

Are there any public comments on our first item?

I have no speakers on item one.

Uh Supervisor Marley has another question.

Yeah, just um the eligibility workers for this.

How many do you have?

And what's their case load?

Um, caseload, I'll start with that question first, is probably 2,000 higher per worker.

Per worker.

And then we have um about 140 vacant full-time equivalent positions, um, probably about three to four hundred field.

And that field could be a combination of those who are um at work or who might be on some long-term medical leave.

Okay.

Yes.

You mentioned that the state's looking at what constitutes um work or community service.

Do you have a sense of when that guidance will be available?

Um, so the federal government is supposed to provide guidance by the end of June 2026.

Um, so probably a month after that would be about the time.

Any further questions?

Um so I appreciate the updates, and we will look forward to uh further updates as we get more information about the eligibility and the requirements.

And you know, I I like the fact that you have a working group that is going to make sure to keep Alameda County Medical beneficiaries informed and covered as many as we can.

Thank you.

We support you completely.

Okay, at this time, uh, let's go to the second informational item, which is the Alameda County Council for Age Friendly Communities, our 2025 update for the year.

Thank you.

Well, um, Faith Battles, assistant agency director for donating services, and can be enter the podium.

We'll sit this is our annual update.

It's typically done at the Social Services Committee, but at the request of Supervisor Miley, we're giving the update at the Joint Health and Social Services Committee.

Thank you, Supervisor Miley.

Good morning, everyone, or good afternoon.

I'm Faith Battles.

I'm the assistant agency director for the Department of Adult and Age Services under Director Ford to direction for the Social Services Agency.

The age-friendly council happens to be within my department, and I'm here with Kimmy Watkins Tart, the director for Alameda County Public Health.

They are our partner in this work.

I'm happy to present to you, Vice President Tam, Supervisor Fortinano Boss, and Supervisor Miley the update for the council for the year.

So just to ground us a little bit, I wanted to make sure that everybody understands that the age-friendly council is a coordinating body that's responsible for finding out what the gaps are in systems in this county that serve older adults, raising awareness for those older adults, and advocating for them throughout the county.

We are in partnership with the cities and the county departments here in Alameda County and various community-based organizations.

So if we can go to slide one.

Those standing committees are facilitated and led by members of our leadership executive committee, which I want to acknowledge today.

Wendy Peterson with the Senior Services Coalition.

Benjamin Chen with the Public Health Department, Andrea Dodge with the Public Health Department, Julene Shrick with Alameda County Behavioral Health, and Caitlin Chan with legal assistance for seniors, and Amred Paul Gill, who happens to work with adult and aging services.

The council aligns most of its work, all of it with the Master Plan on Aging, your Board of Supervisors Vision 10X Goals and Vision 2036, that 2024 to 2028 Countywide Area Plan and the World Health Organization, American Association of Retired Persons Age-friendly Domains, which you see on the slide.

Housing, outdoor spaces, and buildings, respect and social inclusion, communication and information, transportation, social participation, civic participation and employment, and community health services.

Next slide, please.

In terms of housing, the data that we have available to us at the time of this presentation includes the following.

In fiscal year 23-24, over 8,000 older adults were served through the homeless management information system.

Of those 1,200 about older adults, they obtained housing and over 3,500 exited the system with received services during their enrollment.

We do want to note that of those 1,200 new entries into the homeless system, there were older adults that were 50 plus.

1,200 were older adults that were 50 plus.

Over 4,000 of the individuals served were black or African American, and that represents a pretty stark racial disparity that underscores why the equity lens is really important in this work compared to the size of the population in the county.

That's an overrepresentation.

22% of older adults returned to homelessness within two years of receiving those services.

That's seven percentage points higher than the countywide average.

That gap lets us know that more targeted sustained support is needed and a gap that the council has identified as something we are committed to resolve.

I do want to call your attention to the Home Safe program as noted in the slide.

HomeSafe is an effort by the state to assure older adults that are eligible for APS receive support to remain housed if they are insecurely housed or if they are unhoused to find them housing if possible.

With the senior services coalition's leadership, the agency rallied behind and we were successful in getting legislation secured to renew home safe for fiscal year 27-28.

And since that launch, over $8 million has been dispersed and nearly 500 clients enrolled in Alameda County.

The allocation for Alameda County for fiscal year 25-26 is $2.75 million.

We share that money in between our case management contracts and tangible services for older adults that are insecurely housed or unhoused.

HomeSafe connects those APS involved clients or APS eligible clients with tangible services or support for their housing needs.

I'll give a quick example.

We do a good number of cleanouts we contract for older adults to have their homes cleaned out when they are in pretty bad condition and the older adults' housing is at risk.

We actually funded a clean out for an individual in the county whose home was red tagged, and that amount was about 22,000.

Without that assistance, they would not have been able to remain in their home.

We also will provide payment for utility bills if that is helpful to keep them home, to make repairs to their home.

We paid for somebody's water heater recently and to redo their bathroom, which was really unsafe for them.

So there's lots of different ways we can use home safe funding to keep our older adults at home.

We know they do better when they stay at home.

And we also make sure they're connected to longer-term services to assure that they have case management services that will stop them from finding themselves in that position again in the future.

Also, I want to add UCSF Vinioff Homelessness and Housing Initiative study on Home Safe.

It just came out and is very positive.

It says that flexible funding is a good thing for resolving homeless or insecurely housed individual issues.

It found that 93% of the people that were housed when they came into HomeSafe remained housed at the exit from HomeSafe, and that 58% of the unhoused at entry were housed at exit.

Alameda County, when compared to LA County, we've served probably twice as many home safe clients as LA County has, and that could be for a number of reasons, but I like to think it's because we're really making a big effort to make sure we get most of that money out to our seniors to keep them housed.

I'm very proud of our APS staff for that work.

Another example is 64-year-old individual with a cognitive impairment was at risk for eviction, and we connected with them through Home Safe with rental assistance.

We supported them with getting connected to IHSS for their caregiver support and Meals on Wheels, very important partner with our triple A to stabilize her housing and ensure her ongoing safety.

A few more things that we managed to do on the council in 2025 related to this particular AARP domain is we developed and submitted to your board for your consideration, measure W recommendations to apply an aging lens to housing policy.

We share that with your board staff and the housing and homelessness department.

We also strengthened our structural partnership with the housing and homelessness department.

That department has a representative now on our council and meets with us every month.

And we're improving our coordination around CalAIM community supports and housing systems.

Next slide, please.

For this domain regarding health and community supports, a few things the council was able to do with the Healthy Brain Initiative.

That was about a $700,000 grant from July 1st of 2023 through July 30th of 2025.

The intention of the Healthy Brain Initiative is to build more coordinated system of care for people at risk or living with Alzheimer's disease or related dementia.

During that grant period, we had HBI contractors and the public health department internal partner care partners.

They conducted over 110 training and listening sessions throughout the county.

Nearly 1,700 care providers participated, including 550 family caregivers and 300 first responders.

The behavioral health department completed a train the trainer series, which makes sure that older adult providers in the give the have the independent capacity continue to provide those trainings going forward, which is a lasting infrastructure investment.

In terms of food security, we partnered and watched closely what was happening with our triple A contracts.

We have over 623,000 meals that were delivered in fiscal year 24-25.

Those were delivered to the homes of over 3,600 older adults.

Nearly 200,000 congregate meals provided to over 2700 older adults at senior dining sites.

They provided direct legal services to over 3100 older adults in housing, elder abuse consumer law and public benefits.

The health insurance counseling and advocacy program, also known as HICAP, provided one-on-one health care counseling to over 2200 Medicare beneficiaries, resolving coverage issues and assisting them with cost-saving programs.

We also advocated for Medi-Cal reimbursement rates to be increased for adult day services and additional funding for the California Alzheimer's disease centers.

We partnered with Sutter Health to showcase age-friendly health systems, best practices and explore broader adoption across Alameda County in the various health systems.

That's a joint initiative across the SSA, AC Health, Sheriff's Office, Cities and CBOs to make sure we're advocating for emergency preparedness for older adults and people that live with disabilities.

And lastly, we hosted community health presentations from the public health department on the community health needs assessment and from the CDA housing on point in time count data, making sure that the council's work remains evidence-based and reflects current community needs.

Good afternoon.

Good afternoon.

Good afternoon.

Next slide.

So digital inclusion is still a priority for the council and a big part of communication and information.

The council applied for, we as a collaborative applied for two grants.

Unfortunately, they were not able to be funded, but the first was $4 million grant to the National Telecommunications and Information Administration or NTIA Digital Equity Grant and a 1.2 million dollar state digital equity plan grant.

Unfortunately, both of those programs were terminated due to the fund due to the federal funding shifts, and so we were not able to receive those dollars.

But despite these setbacks, the council remains a regional leader in digital inclusion.

We are supporting Oakland Undivides, Undivided's transition into the East Bay Broadband Consortium.

This consortium and this fund and this opportunity will allow the consortium to be able to collaborate better across all of our counties, Alameda and other neighboring counties.

This consortium account, this the funding if uh received is through the CPUC.

We also hosted a stakeholder convening around the California Advanced Services Fund, a public housing account.

This connects internet service providers, housing developers, uh, and includes a CPUC representative on deploying high-speed broadband services to publicly supported housing.

This fund is administered by the California PUC.

We also conducted with Alabama connected with Alameda County ITD to explore their device refurbishing and redistribution program in order to see if we could get computer equipment refurbished computer equipment provided to senior centers and libraries throughout our county.

We published an older adult data resource directory, which is on the age-friendly website, and it organizes resources by the age-friendly domains.

It's a practical tool for advocates and planners and older adults.

Um, in order to keep digital inclusion front and center and a priority for older adults and our legislative priorities for the county, sharing updated information and priorities with the CBO partners as well as our agency policy offices.

Turn it back over to my colleague for slide six.

Thank you.

With this age-friendly domain, civic participation and economic security, want to highlight a few things.

The legislation and advocacy committee conducted detailed reviews of state budget proposals and took positions on key bills affecting older adults in 2025.

Some of those bills included AB 561, which was about elder abuse legal protections.

It made sure that older adults had easier access to protective orders, clear instructions, and seniors can attend those hearings remotely.

Another bill was AB 1069, emergency shelter access for older adults.

That requires triple A and independent living centers and ADRC agreements to support older adults in disasters.

The triple A and the ADR can work inside shelters in the event of a disaster.

Another bill is Senate Bill 470, the Open Meeting Act.

This was a big bill.

Our older adults were very interested in, which extended remote meeting attendance by phone and video through 2030.

That's really important because our older adults can always make it to actual sites and they can continue to participate under that bill.

Then lastly, AB960, patients with dementia allowed support persons.

Very simple.

Bedside visitors are allowed outside of visiting hours for patients with dementia, and the hospitals have no edit legal risks if there is nothing amiss with the individual visiting.

All four of those bills passed.

So for the legislative legislative and advocacy work, it's a really good opportunity for council members to see how bills become law, to see what the advocacy needs to be for bills to become law, and to make sure their voices are heard.

We finalized issue briefs on Alzheimer's disease and related dementias in older adult employment.

Those will be published on our age-friendly website as resources for policymakers and advocates.

We also identified a really critical gap.

The eviction data gap does not show age reported at the time of eviction.

And we think that's important information to have as we advocate for improved collection of data that impacts older adults.

We also launched a submission campaign for client stories on our age-friendly website.

That's really important.

What we've learned in advocacy for legislation is it's enough to have letters of support, but we need to have real life stories for how these bills and lack of bills are impacting older adults.

So we're excited about that.

In terms of transportation, we participated in the Alameda County Transportation Commission listening session.

We wanted to make sure that older adults' needs were reflected in the plans for the region for the transportation and paratransit needs assessment.

We also attended an AC transit community event meeting where members voiced concerns about proposed negotiations to paratransit services.

We made sure that they heard us say that we don't want to see any reductions in paratransit or other services due to those negotiations.

And the elective board members heard our concerns and ultimately preserved all of those services for the year.

And the final slide, Kimmy.

Nearly 3850,000 Alameda County residents are already 60 and older.

And by 2040, we believe that that number is projected to reach 600,000 residents, and now it's a 70 to 80% growth rate, well above the statewide average.

Half of all single older adults in the county report not being able to afford basic living costs, and more than 69,000 residents age 65 and older are projected to be living with Alzheimer's and related dementias by 2060.

2,406 older adults were served, have been served through behavioral health services in FY2223.

And that number is expected to grow significantly in the coming years.

We know that behavioral health services and access to those services are critical to our older adult population and behavioral health will be one of the central focuses of the council this year, given the Behavioral Health Services Act changes and reductions in funding.

No single department, as you've already heard a lot about, can really address the certain the needs of older adults alone.

And so the existence of the council becomes critical in helping to have those conversations and convene uh county departments as well as community-based providers so that we can all work together to advance uh solutions and to shine a light on gaps that remain.

The age-friendly council is actively strengthening all these relationships to promote a unified system level approach to age-related issues.

As Alameda County continues to age, and we've talked about this over the past years, the council remains committed to promoting dignity, equity, and opportunity for all older adults.

And we of course appreciate your board's ongoing support and partnership, and we look forward to strengthening collective efforts in 2026.

Thank you.

Thank you.

Ready for questions?

Thank you for that presentation.

Uh I'm going to turn it over to my colleagues, but I do have one off the bat.

Um, we use all of the board received uh a letter from the senior services coalition.

And I noticed that in your first slide you said you have 20 different community-based organizations that help provide the services throughout the county.

Can you help clarify what they meant when they said that there was an effort to try to consolidate it to have just one contracted agency?

Thank you for your question.

I'll defer to Director Ford for that answer.

Um, I think there was probably some confusion and uh scope of work.

Um RFP, there was one section of that particular scope of work that indicated they would be selecting one provider, and later um it indicated multiple providers.

So the one provider who said they could cover the entire county is one who was awarded the contract.

The other bid or the other BS that came in were pretty much all over the place.

Okay.

I think there might be some public comments to get some clarification on this as well.

So it was a matter of not understanding what the services are for that one area.

Yeah, so again, there was one section of the scope of work that indicated one provider would be selected to provide all services.

And then later in the document, um there was a section that said multiple.

Um the final selection ended with one.

We'll see if they could serve the entire county.

Okay.

Thank you.

Okay, thanks.

Okay.

Thanks for the report.

Um initially, before I get into the report, let me just uh uh let me think here.

Um fake battles.

Apologize to Faith for being so rough on our last year.

I'll try to be a little gentler to this year, but I can't, you know, we'll see.

Um let's see.

What concerns me about this report is it it's good for what you present, but it's hard for me to kind of get a real good sense of how the county is advancing as an age-friendly county.

Um we've got housing.

If I'm not correct, tell me, are the eight sections of age friendly the ones that were outlined in this initial slide?

Yes.

Okay.

And we started age friendly in 2017.

Yes.

Okay.

So it's just difficult for me to see, other than anecdotally.

Um if we are just kind of maintaining status quo, or if we're um regressing, or if we're progressing uh on all on all fronts.

And maybe if we had a dashboard that might help with some um baseline.

This is where we started in 2017 in these various areas.

This is our dashboard.

This is where we are presently.

Uh and maybe in certain areas we didn't advance, or we're just kind of treading water because of you know, HR one or Pro One or this, that or the other.

Um, because that's I think what's causing me some difficulty because I think what you present is fine, but I just don't I just have a sense that it's not giving me what I need.

Um, as the um this the old guy on the board of supervisors, and the guy who kind of champions older adults.

Um I do think it's good that this has been institutionalized in the county.

So, you know, I'm I'm here at least till 2028, so you're gonna have to put up with me at least till 2028, maybe longer, who knows.

But um we want to make sure that we don't backslide, and if we do, we can kind of get a sense of why we're backsliding in certain areas.

So that's the first thing, just the way this report is laid out and trying to have more of a dashboard that represents from whence we've started to where we are presently in these various areas.

Then as we go through the report, I was curious, because kind of mentioned partnering with H and H, but um, do we partner, for instance, with um Spectrum?

Because you know, we had to give Spectrum money for LIHEAP.

Um, do we partner with uh the food bank and all those organizations we had to give money to for food?

I you know, was there any partnering there?

Or do you know?

Yes, all of those entities were at one point or the other participating on the council, whether or not their participation is sustained over time, that's to be determined in terms of outside of the council.

Remember, the council doesn't deliver the service.

We bring the people together to talk about the need outside of that.

We do partner with them within our agencies, like triple A, for example, is very familiar with Spectrum and the food bank.

So we do have partnerships with them there, and we also use the council as an opportunity for them to come and talk about their services so that the individual entities on the council can actually refer their clients to those services.

You want to add anything, Kimmy?

The only thing that I would add is that we are continuing to work to um encourage all of us to bring updates and bring information to the council and in front of the council because but that does require consistent participation from all of us across all of the different uh domain areas, and I think that we are making progress in that regard in terms of the more consistent participation of all the entities, especially those that carry very lead roles in these areas that are reflected in the domains, but we'll continue to you know press our partners and press ourselves to make sure that everyone stays uh engaged and leaned in.

And I think the dashboard is not a bad idea.

Do we need to um is there a limitation on the number of folks that can be on the council?

Technically, there's no limit to the number, but we want people on the council that will actually consistently participate on the council and not pop in and pop out.

It's a fairly large body of individuals now.

If they're committed to bringing their membership to the council and participating on the committees, that's even better.

Okay.

Because it just seems to me that over the last year, there have been some very like the food programs, has been some very and all of it isn't seniors, obviously.

Um I heap it's in all seniors either, but a lot of it is.

It just seems to me when we get these prominent priorities, and I don't see any mention of it really in the age-friendly report.

It just to me it's a disconnect.

Uh and we're not delivering the service, but it seems like the age friendly council would be saying, oh my goodness, this has got to be a priority.

So we need to um highlight that, resonate that, uh, lift that up as um uh something that we need to uh have everybody kind of looking at.

I don't I don't know, but that's that's just something I'm throwing out here because it just that I'm I'm just looking at this in that context.

And then with the um the broadband, we're hoping to get some money from the California uh public utilities commission.

So I think our staff are also on the line.

Um, Ben Chen, who is really helping to lead that work with the subcommittee, but I believe that those dollars and that resource is available already.

Oh, good um, and so it's not it's the different than the two grants that we applied for and did not receive.

Okay.

And then I know because I'm all over the place with this.

Uh Faith, you mentioned that uh age-friendly um is in alignment with the master plan on aging.

That's the state's master plan.

Yes, that's the state's master plan.

Is there anything from the state's master plan that um is providing us with any further uplifting of our ability to provide um age-friendly Alameda County, making our county more age-friendly or helping us to you know achieve that's what that status, that goal?

Yes.

Well, the master plan on aging highlights the areas that the state wants counties to focus on, and counties can pull down different parts of that where they want to focus.

So instead of us focusing on the entire master plan on aging is huge, you wouldn't be able to.

We pull out various pieces that would work for our workforce now and what your board's priorities are.

So, yes, we take a lot of guidance from the count from the master plan.

In the master plan's not providing any funding, right?

It's just this it's yeah, it's a big 10x vision, yeah.

But no funding.

No funding.

Is anything in the master plan?

Are they mandating anything from the master plan?

Are there any mandates?

Or is it just a plan?

No, it's just a plan, no mandates.

Yes.

Yeah, I mean, that's unfortunate.

Not that the mandate part.

I don't, if we're gonna have mandates, we need to have money with mandates.

But what's unfortunate is it's a plan with no funding.

I mean, thank you very much.

But okay, how's that helping us with the plan?

Exactly.

I mean, I guess it's a step in the right direction, but I would also like to once again um see if the age-friendly council would do advocacy around trying to get the state to provide you know funding for certain areas that we consider priorities.

I mean, we decide what the priority is, and we say to the state, let's try to get some funding in these areas that fit within your category is under the master plan on aging.

Supervisor Molly, to your point, the senior services coalition was significant in leading the charge for the county to get behind the ask for home safe funding to be continued because it was scheduled to be sunset, and they did a fantastic job and were able to serve more seniors with actual money to keep them in their homes.

Okay, okay.

Um let me see here.

And then with H with the homeless, because I know we've got the stuff around the evictions and stuff, but a lot of our seniors, a lot of the aging population are homeless.

Does the does the master plan excuse me, does the age friendly council do they decide on maybe what some of the priorities might be?

You want to add Kim?

Yeah.

So um the H does participate uh on the council and has communicated and been in conversation with the council around the home together plan, around the updates of the plan and that sort of thing.

And so I do believe that the council members have given feedback and will continue to give input into centering older adults and really lifting up the particular needs of adults.

What I will also say is that uh the particular needs of adult of older adults is also currently reflected in some of the data that H currently does have.

We do see disproportionate impact on older adults in terms of the numbers of people who are homeless in our county.

We also see, which is good news, that the number of people who are getting into permanent housing are also heavily weighted in the older adult uh arena.

Um and uh H will continue um to focus, you know, it's its attention on those most vulnerable in our county, which do happen to also be older adults who have more complicated medical conditions, complicated behavioral health conditions that really put them at very high risk.

Uh HH is also looking at the increase in number of older adults who are experiencing homelessness for the first time after age of 50.

Um, I don't have any data in front of me that points to the root cause of that, but it is something that we are interested in learning more about to see if we could get in front of that.

But being able to provide more resources around prevention and preventing home uh older adults from becoming homeless in the first place is key.

So these things are already happening, and H is an active participant.

Okay, because I just want to make sure, and if it requires the board to the board of supervisors to what's the word I'm looking for, to I don't say I don't want to use the word enable, but to reaffirm the fact that we want Alameda County to be an age-friendly county, and we want the age-friendly council to help with frost departmental as well as cross-sector, as you pointed out, collaboration and involvement.

Um, you know, uh I'm prepared to suggest that to the board because um I just don't want to have because I think a quarter of the aging pop, a quarter of the county's population is aging.

Um, so it's about 25% if the county's population is about 1.6 million and about 400,000 are older adults, and that's um that's 60 plus, yeah.

So I I just don't I just I feel the age-friendly council just needs to know that they've got the backing of the board of supervisors to really encourage all county departments and agencies that have a role to help promote and ensure that Alameda County, I mean, I want Alameda County to be at the forefront, the cutting edge to be that that is that North Star that all other counties aspire to be.

Um and then I was glad you mentioned behavioral health because I was wondering about that.

But that was in the last slide and it really just talked about the number of folks that were served through behavioral health.

Is there any more that you could say about behavioral health and their involvement?

They are an active member of the council and have actually been an active member of the council pretty much from the beginning.

And so behavioral health will continue to be a focus of the council um over time and with the older adult population increasing behavioral health is expecting that their participation their system will also increase and so we're all looking at that as we look at the demographic shifts when I say we all of the county departments we have to look at those things and have to really make sure that we're able to adapt the services to meet the needs of the changing demographics.

Okay.

And then my last question I think this is it and I'm appreciated Supervisor Tim letting me um ask a few questions on this matter because it's a particular interest to me since I've been working with older adults for the last since 1986.

So I haven't been an older adult since 1986 but I've been working with them since 1986.

Did the age-friendly council put any um I don't I don't know if it would be request but did the council seek or desire any measure W monies for for aging any of these categories?

We the council didn't ask for the funding for itself but it did give recommendations to your board about how to leverage some measure W funds to make sure older adults were included in all the plans were being that were being discussed for the use of the measure W fund.

Do you know how much we of Measure W is associated with aging adults or the age friendly no I don't have an exact number for that we don't even have a percentage huh okay you don't want to guess on that I can discover that Kimmy would you know I was going to say supervisor we can um so in the Essential Services fund component there were some older adults investments that were made and then as you heard both of the directors say the um uh with regard to the home together plan um you know that plan is going to be formalized refreshed this year and there were very explicit recommendations that came from that so it's something we could uh back into um but yeah yeah well just keep in mind you know older adults they do vote and measure W was uh initiative that required voter approval and it's not like we're trying to carve out you know funding for each segment of our population but older adults I mean if they don't see their needs being met they might not want to support this in the future just saying I hope I wasn't too hard on the two of you because you know I love my public health director and my adult aiding director so thank you so very much but take some of this under advisement.

Okay.

Thank you you're welcome.

Anika I I thought uh when we last had the work session on measure W we had earmarks on funding for senior meals um that was part of the SNAP program restrictions.

That's true.

I think it was a little over two million that we allocated.

Okay.

Thank you.

Supervisor fortune Automas thank you so much for the presentation um I actually found it to be very informative uh and very positive I definitely like how you sort of pulled out very specific ways that we are serving uh the older adult population through housing as well as health care um how that we're how we're collecting data I don't necessarily think I have any questions following Supervisor Miley um just a couple quick questions one is I didn't see the um age friendly website on this uh presentation so if I missed it uh maybe I missed it but um it's a great website so uh maybe making sure you promote it as a resource thank you and um I will look on the website for the older adult directory um really interested in seeing that and I guess one one um one observation is that with the older adult population growing six uh 70 to 80 percent it seems like there's also a trend that people are living longer and so with people living to 70, 80 I mean I've got um my husband's parents are in their 90s um you know what's the trend in terms of longevity and how is that potentially going to impact the need for services do we know that yet well I can add some anecdotal information based on the work that happens in the Department of Adult and aging services.

And so with people living to 70, 80, I mean, I got um my husband's parents are in their 90s.

Um, you know, what's the trend in terms of longevity and how is that potentially going to impact the need for services?

Do we know that yet?

Well, I can add some anecdotal information based on the work that happens in the Department of Adult and Aging Services.

The majority of the clients we serve in IHSS and home supportive service or APS, they're like 70 to 90.

So people are living longer, but they're not living longer healthy, and they're not living longer fully resourced.

And even individuals that are fully resourced, it is very expensive to age in this country.

Different things that you get as you're a younger person, whether it's for your vision, you know, I I have I should be wearing bifocals, but I just can't do it.

So I have two pairs of glasses, but as you get older, that is not as protected.

Things with your feet are not as covered for your medical, things with your ears are not as covered with your medical, those and your teeth can be very, very expensive.

So the trends that we're seeing consistently are older adults are isolated, they are outliving their family members, and there's nobody around to help care for them.

They are um not resourced, very isolated in terms of um internet.

That conversation we were having about making sure older adults are not left behind with connectivity is important because everything has kind of moved online, and certainly with their physical well-being.

So those are the trends that we're seeing.

You're living longer, but you're not living healthy much longer, and you're under-resourced.

And even if you are greatly resourced, it is still very expensive to age in this country.

I would just add uh to what uh my colleague is saying that in terms of the health part of this, that as we see in many of our presentations, the disproportionate impact of poor health status on several populations.

Well, that carries out as we age.

And so what we see is that life expectancy in our county is not necessarily equal, and that we don't all we can't all be guaranteed a long, healthy life.

And so the public health department is definitely looking at what kinds of things we can be doing to really um support people earlier on, so that a, we live longer, but also that our health status, our health supports us in the years that we are here, because uh the leading a shorter, sicker lives is kind of what we see right now, and our systems are not currently really equipped to handle uh a very large older adult, older and sick population with very few family resources and support.

Really helpful to hear.

It seems like the council could pay special attention to longevity and what's needed as um people live into their 80s, 90s, and uh, like you said, doctor also looking at um the social determinants of health and the racial disparities as well.

Thank you.

Thank you for those questions.

Um I really appreciate the presentation as well.

The part that I want to especially call out is the advocacy that the count did with paratransit.

Um, I thank you.

My mom thanks you.

So that was very important.

Thank you.

That's nice.

Uh the the question I had pertained to what you're seeing in terms of the the needs of the aging population or are because we all want to age, but the issue is around um uh the affordability that you talked about, because um if 50% of the people can't afford basics going forward that are among the 380,000 seniors, does that mean about 50% of them also rely on Medical in addition to Medicare?

More than likely, yes.

And in terms of the affordability, when I talked about that UCSF Bini Off study, one of the key findings out of that was home safe could be even more impactful if it wasn't so expensive to live here.

If it wasn't so expensive to build housing and to locate housing for seniors.

When we deal with seniors in adult protection services or even IHSS, a lot of their income is going towards rent, way more than 30%.

So they actually need subsidized housing, which we can't offer them.

We can't offer them money every month to make sure that they'll never get behind in their rent because so much of their money is going towards their rent that they don't have enough money for their food.

They don't have enough money for transportation to get to their doctor's appointments.

And it just is kind of like a snowball.

So yes.

Okay.

Um because like when you look at um medic, which doesn't really cover like like uh in-home service or long-term care.

And then when you look at Medica, uh there are certain even restrictions with that, but all the things that you talked about, like you know, hearing aids, uh, vision care, dental care, podiatry, that's not covered.

And so how much how's that offset in terms of like the counseling that we do uh for some of the health care needs for our seniors?

That's an interesting question.

I think legal assistance for seniors, they do help with high cap with the health insurance counseling program, they help them to understand that without if they're not full scope medical, that still is a challenge.

The IHS consumer is a full scope medical, they have to be so under the poverty line that they benefit from that.

But anybody that's even it's almost like you're not poor enough.

If you make a little bit more than the poorest person, you don't qualify for those services, and you can run through your family's assets trying to get the support that older adults need 24-7 in a lot of instances.

So I I don't have a quick answer for that, Supervisor Tim.

I wish I did about how to patch in additional supports for those unintended needs, uh, just making sure that they get connected to resources.

There are some community-based organizations that will help with those kind of things, but it's not a long-term plan for someone that has a persistent issue with their foot as an example.

What we're seeing in terms of our uh what we're seeing in terms of what our staff are also reporting when they're working with older adults, is that while there may be programs available to assist with those things that my colleague talked about, like the um oral health, the dentures and keeping those maintained, making sure the hearing aids, all those things, it's not sufficient for all the adults that actually need them.

And so when you don't have those things in place and you don't have family members that can just pay for that for you, then we have older adults who their health becomes even more compromised because they can't really engage with their providers, they can't engage with their community when they become more hearing impaired, their health is compromised if they don't have functional dentures to be able to eat healthy food um for a long long periods of time.

And so having funding, having resources to really cover those individuals who have no other source to get those supports covered is really critical.

And I don't have the data in front of me, but I think it's obtainable in terms of that the number of older adults who kind of fall in that hole, who are not on Medicaid, are not, but they don't have a lot of money.

Those are probably the also the same adults who may technically own their home but can't afford to maintain the home.

And that's the home that falls into disrepair and that kind of thing.

And so um there's a lot of work for us to do.

There are a lot of encouraging things that are happening, a lot of bright spots, and we have a lot more to do as a county to protect our seniors.

Okay, thank you so much for your presentations and the responses.

Um let me uh call the public speakers now on this item.

Um, can I just give an update about the measure W investments?

So it was two million um for nutrition and then 1.7 million for food recovery, and that'll come to your board on March 24th for approval.

The two million was for the senior meals, right?

Yes.

And 1.7 for food recovery.

1.7 million.

The 1.7 was that the one to Mercy Brown bag?

Yes.

And the the two million is coming to our board.

That's already that's been approved by your board already.

The two million was approved maybe a couple of months ago.

Um who was the award again?

It was multiple um providers.

Okay.

And that's measure W.

Yes.

And what was the how much did we allocate out of Measure W for this last year?

It would be 347 million total.

No, not just for um for food, but overall.

Wasn't it set?

Was it 20 million?

25 million.

Okay.

I'm just looking at the percentage.

Yeah, that went to senior services of the 25 million that came out of Measure W.

So once again, I would just if if you need the board to uh reaffirm the importance of age friendly, the need for collaboration across uh sector um involvement, um the importance of this and even looking at um ensure that there's resources out of measure w for older adults.

Um don't hesitate.

Yeah, because once again a closed mouth don't get fed.

Yeah.

Thank you very much.

Um public comments.

Wendy Peterson.

Oh, yeah, go ahead.

Um I'm Wendy Peterson.

I want to say it's been an absolute honor to serve on the age friendly council with colleagues who are dedicated to working across sectors to improve outcomes and um identify and address gaps and advocate for older adults.

From the start, the council has understood the that centering equity is essential in supporting the health and well-being of older adults in this really diverse county of ours.

And this is why I'm imposing today on this meeting on behalf of the senior services coalition to uh raise the alarm about the notice of intent to award the triple A's information and assistance contract to a single provider.

This is an unprecedented departure from the contracting process that has supported a network of locally based providers that supplement the AAA's 800 number with people and presence in communities across the county.

I hope you've had a chance to read the letter I sent yesterday.

It describes our deep concern about this decision to maximize efficiency in the contracting office.

If it if this fundamental change in priority stands, and if it is driving decision making in six RFPs that have yet to be released, it will immediately reconfigure the service landscape.

This will be catastrophic.

Especially catastrophic for those providers that are deeply embedded in local communities and do not have countywide reach.

Um is on us, and their presence is needed more than ever.

I'll be really brief.

Anna and Baptist.

Good afternoon, Board of Supervisors.

My name is Anna Baptist with the City of Oakland.

And I'm here to speak on this item about the single source um contracting for the information and assistance.

The city of Oakland as well as the other providers that are present here, and me some of them are not here today, have provided information and assistance for decades.

The city of Oakland, what notwithstanding had been providing information and assistance for over 20 years.

So this news on single sourcing information and assistance to serve the entire county is really not a um uh it's it's it's a way to um make something centralized and and create efficiency, but it's not going to primarily because a lot of our CBOs in the cities know their communities better, and it's not gonna cost uh create the efficiency necessary.

I also want to respond directly to the inadequacy of transparency in the in the RFP process.

The statement that there was a information that it will be source sourced.

Um that's actually not what's in the RFP.

In fact, I pulled out the RFP and reread it, and there's nothing there that says specifically and unequivocally that it's gonna be sole source on page 1713 of this RFP, it says in order to provide services across the full geographic spectrum of the county, multiple awards within a service category may be awarded.

And this came up during the um bidder's conference, and it was asked specifically of staff whether or not it will be multiple service providers and I quote, we do not have a set number of organizations.

Will we be funding?

They may be multiple awards depending on the RFP submission.

So from tech but the technical standpoint, this RFP was not adequate.

Thank you.

Thank you.

Umly.

Um is this coming from the social services agency?

Can you explain uh what's going on?

It is coming from the social services agency.

Um, and not one time did I say the RFP indicated it would be sole sourced.

I said um in one section of the RFP, it's that we will award to a provider, not sole source or provider.

In another section, it said maybe awarded to multiple providers, which is that's public comment or just read.

Um I'm sorry, what was your question, Supervisor Miley?

So what's the intent?

Is he intent to if we're not talking sole sources intent to do one triple A food provider countywide?

I can't say that was the intent, but it just wasn't clear in the RFP.

Um it was the RFP was written in a way that it was hard to score because it it did not limit it to certain areas throughout the county.

So oftentimes an RFP might say region one, region two, it didn't identify areas within the RFP itself, and the bidder who scored the highest um was selected because they said they could serve the entire county, every region.

It's um will this be coming to the Social Services Committee before it gets to the full board?

No, when it comes to the full board, it'll come with a recommendation.

Okay, because I can't believe there'll be one provider that can serve the entire county.

I mean, I've obviously I don't know what you folks know because you've done the the RFP and you've done the scoring, you've done this and the other, but I can't just sitting here hearing this and knowing what I know, not just because I work with a lot of these folks, but having known stuff over the years, I can't see one provider providing services to the full county.

So I'm gonna be very interested in seeing what that is when you're prepared to uh provide that information uh to the board.

Because you know, we might we might quite quite honestly reject it.

Um I'm just trying to get some better understanding of this situation because uh the when you explained it to me at the beginning, you were saying that this is like one area we were not um intending to do a sole source with one provider, uh, but we were uh looking at multiple uh services.

So when you um talk about this one provider, what ex what service is this provider supposed to?

I don't know if I'm at liberty to go into details about the RFP itself before it becomes public.

Um County Council.

Okay, if if it's not public, we don't need to talk about it at the moment, but uh we'll um we'll we'll track it more closely.

Supervisor Miley.

So when do you anticipate this coming to the board?

I don't have a date.

This just started um percolating last week, so a board date has not been assigned.

Oh, yeah, because typically, you know, we don't get the information until after they have finished their processing, but clearly now that I'm alerted to this, we're gonna be on, we're gonna be on it.

um county council okay if if if it's not public we don't need to talk about it at the moment but uh we'll um we'll we'll track it more closely supervisor miley when do you anticipate this coming to the board i don't have a date this just started um percolating last week so a board date has not been assigned oh yeah because typically you know we don't get the information until after they have finished their processing but clearly now that I'm alerted to this we're gonna be on we're gonna be on it yeah for rest assured because I'm gonna have questions about this okay uh it's understandable that we hadn't seen it since it's not ready yet thank you um any other questions or follow-up if not um are there any public comments on items that are not on today's agenda I have no speakers for public comment thank you this meeting is adjourned