Recording in progress.

Good morning and welcome to the Alameda County Board of Supervisors Special Meeting of the Joint Social Service and Health Committee meeting for Monday, April the 13th, 2026.

May have roll call, please.

Supervisor Portonado Bass present.

Supervisor Miley, excused, Supervisor Town.

Present.

We have a quorum.

Thank you very much.

We have two informational items.

This committee joint committee was formed to assess the impacts of HR1 in terms of our planning at the county.

So we'll start with the HR1 implementation and health pack recommendations.

Good morning, Dr.

Connen.

Good morning, supervisors.

Good morning, supervisors.

I'm Dr.

Kathleen Klan and I'm the medical director of Alameda County Health, and I'll be talking about recommendations for Alameda County Care Program Health PAC.

First, we will go through a little bit of history of the Health PAC.

We can go ahead to the next one.

A little bit of history of the Health PAC program, just uh especially for the public, but also as a reminder, um, go through the federal and state policy changes that are most relevant to uh budgeting and program recommendations for health pack, and then get into our actual recommendations for the upcoming year.

So, first, in terms of the background and history.

So, a little bit about the basics of what the Health PAC program is again as a review and for the public.

Um, so Health PAC is a low cost to the participants health access program for low-income adults uh with a who meet the federal poverty limit below 200% who are residents of Alameda County.

And uh an important eligibility factor is that they are not eligible for other kinds of insurance, whether public or private.

Uh, primarily because it only covers you for care within the contracted network.

So if you are elsewhere, if you're in San Francisco for work and you are in an accident, that care would not be covered.

So it is not portable because it's not insurance, and that definitely uh can be a problem for people.

The contracted network, uh, we're lucky enough to have a very able and extensive contracted network.

All of the federally qualified health centers in the county are part of that network, including Alameda Health System.

The system does uh specialty hospital emergency care as well as primary care and all the other federally qualified health centers do primary care.

It's important to remember that as part of their foundational uh funding and uh as in the nature of being a federally qualified health centers.

They also are required by their federal funding to have a fight, a sliding scale fee uh ability to serve low-income people, whether they're enrolled in insurance or health pack or not.

Next one.

In terms of the history of health pack, we have this program uh in part because of the section 17,000, part of the welfare and institution code in California.

Um, different states have different arrangements for how care of people who are not able to afford care is covered, but this is ours in the state of California.

Um into the late 70s, uh, the county met its obligation for this section 17,000 coverage of people who cannot afford care through uh contractual relationships with community clinics.

Um that people may remember that was called CMSP, standing for the County of Municipal Services Program, I think.

What was CMSP?

Um then uh in the run up to uh the Affordable Care Act, um, we were able to uh utilize federal funding that specifically supported uh formalizing uh what had been CMSP into a program that we then at that time named Health PAC was funded.

Uh some of that work of uh of organization was funded by the Bridge to Reform uh waiver that you can see described there.

Uh we were very successful as a result of leveraging that funding and had a great large number of people who had been in the indigent care program were able to get onto Medi-Cal through ACA.

Post-ACA, we included only the federally qualified health centers in the provider network primarily because they were able to leverage the PPS or prospective payment system to pull down additional federal and state funds.

So since 2014, since the ACA, only federally qualified health centers have been part of the network, including of course the hospital system.

Next one, in terms of enrollment, we peaked at 90,000 just before the implementation of ACA, then saw that large drop as many people transitioned.

And then the history of the program since then, beginning in especially in 2022, the state began to expand the criteria for enrollment in their state-funded program for people who were otherwise unable to participate in ACA.

So if you look at what that looked like graphically over the years, the next one.

So just a few milestones that so there was the peak and fall around the ACA.

The funding fell to the baseline of around 54 million.

Annual COLAS since then have brought us up to about 70.5 million, which is was in last year's budget.

Next one.

So what's coming then in terms of these changes?

Again, there will be things that you've seen before in these presentations, but as a reminder for the public.

Next one.

So the primary big changes are the federal changes in particular are expected to reduce the overall number of people who are able to enroll in Medi-Cal and ads make some maze, a maze, a difficult to navigate maze in front of the people who are still eligible.

So the HR1 changes, primary ones that will be have an impact on people's Medi-Cal eligibility.

We have already seen the re-implementation of the asset test.

So if you have things that you own even if you have no income, the asset test, asset test says you have to spend down assets that you have before you'll be eligible.

We will see in October of this year a revised definition of who among documented legal immigrants are eligible for these programs.

That's the change that in the definition of a qualified non-citizen.

And then beginning next year for all participants, whether or not you're an immigrant, the six-month redeterminations, so needing to reapply every six months instead of once a year, and then work requirements.