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.

We expect those last two to have probably the biggest impact of any of these.

Cumulatively, you've you you've heard from the alliance and from our colleagues at social services and uh other places that we could be looking at very large numbers, tens of thousands of people who will lose coverage in the county.

The state changes have uh have been accumulating, the impact of those has been accumulating since January with the enrollment freeze for people who are in the uh in the immigrant population that's designated by the Fed the Feds as unsatisfactory.

Um and then we will see uh beginning next year, the middle of next year, the implementation of monthly premiums.

We don't know exactly what impact that will have.

There's still negotiation about how it will be implemented, but that's another thing that we expect to have significant impact on who's enrolled.

There are additional changes that impact not whether or not you can enroll or successful enrolling, but more what your experience of being in the program is.

So that's co-payments for the adults.

That's a federal change that will take place not until October of 28, after that year's elections.

Um then uh state changes that will uh are uh closer.

There were formulary changes, uh so what medications you could fill beginning in January of this year, primarily affecting the uh GLP one injectable weight loss medications and a few others.

Um, and then uh in July of this year we'll see a change that um that routine dental care will not be covered by the state for people who are not covered by uh federal Medi-Cal.

The the uh those same these same um uh tent poll changes are listed for you here uh in a in a way that you can sort of see the way that they play out over time.

So, in terms of our recommendations for next year, what we used as guiding principles for the development of this, we've been looking at surrounding counties, we've been uh connecting with our colleagues in Sacramento and elsewhere, and also consulting with experts in health care uh nationally.

We know that our guiding principles are that we need to meet the legal requirements.

We have to take care of the people that we have to take care of.

We also are hoping to preserve access to care for all Alameda County residents, whether or not they fit under the Section 17,000 obligation.

Uh we it's very important to support the uh stability and resilience of our safety net providers to keep the doors of those organizations open.

Uh the um we need those organizations in order to be able to care for the people who live here, regardless of what's happening in Washington.

Um it's very important also, as you all know and have been investing in, that we maximize Medicaid enrollment.

There's a direct relationship between losing Medi-Cal and needing health pack, and to the extent that we keep people on Medi-Cal, we will be able to continue to afford to offer the health pack benefit to the most people who need it.

That's a very important principle.

We also would like to minimize the administrative burden for these organizations in order to really optimize the ability of those dollars to go towards care rather than reporting, for instance, or and other kinds of services.

So our recommendations for this year, we are happy to say that we believe that we can maintain the current eligibility and scope of services.

Uh we are uh hope we we believe it's important to do that, first of all, uh, most obviously, so that people can continue to get their comprehensive coverage.

Uh if we were to make changes in health pack that have not been made for state, the state Medi-Cal, we would end up with two standards of care.

People who have their health pack would not receive the same care as people on Medi-Cal, and it has been an important principle that for many years that we have a single standard of care in our in our organizations that we support.

It also allows us time to see what is the actual impact of these changes on human beings.

We know what the so we have some sense of what the impact on our uh organizations will be, uh, and you've heard them, you've heard from them about that in terms of the dollars.

There are things that we don't know yet about how individual people will make these terrible, awful choices are being presented with between risks to their residency here and the obtaining care that's essential.

So we need time to see how people make those decisions and how successful we are in supporting their continuing to stay on Medi-Cal.

We are hoping to augment uh the funding in this year and next year in order to mitigate what we will be uh difficult to sustain uh challenges, financial challenges for the organizations we contract with, and we also would like to expand the provider network to include two additional safety net clinics.

We anticipate there will be some increased demand and uh also the um we want the the reason that we did not include them before the prospective payment, the PPS funding is uh less of an issue now because of state changes, still still real but less of an issue.

Um but we will uh need to lean into trusted relationships that people have in order to get people into the doors uh to be able to get care they need.

So here's what we're looking at.

The 70.5 is what we uh have what our budget was in the last year.

We see spending uh half of that amount on the uh going to AHS for hospital ED and specialty, the other half going to primary care, including the two new clinics, and then we are uh planning to present to you information about in the future about uh additional dollars that could be um uh could be directed as we see what actually happens to the Medi-Cal enrollment.

Uh we are looking at that.

Um, our colleagues at social services and others were looking at that and following it very closely month by month.

Uh there's still a lot we don't know about what's going to happen to the actual numbers.

So here so just in summary, uh the rationale for this.

We are recommending that we not make changes in either the eligibility or what we cover in the health pack program for now.

Uh during that this time uh in this coming year, we hope to really focus the the this the fact that we're continuing to support our organizations.

We're asking them to really focus on maximum maximizing the medical enrollment.

We are we want to continue to support access for health pack enrollees.

We don't want to reduce the roles of that program uh if people have no opportun no other opportunities, nor can we under Section 17,000.

We want to support the organizations with stability so they know what they're going to be getting in terms of dollars from us, and then that gives us time to adjust allocations for the future based on what actually happens to the health back enrollment as people make these changes.

Um there are a few items that we're waiting for that we don't have, we don't know yet what how they're going to play out.

So the actual numbers of people losing coverage may be different from the forecasts.

Some of the changes, in particular, the work requirements and co-pays are still in development at the federal level or a state level.

We don't know the details of those yet, and that will have an impact on what happens.

And the state is still exploring coverage options for people in the UIS groups.

Uh the uh programs, there were there was no description of any programs in their January budget, but we know that agencies are continuing to talk about uh a program, and uh we're waiting to see what happens in the May revise in terms of whether there's um the ability for them to assign any dollars there.

So that's the end of my uh presentation, and I'm happy to take any questions.

Thank you for that presentation and also for the rationale and the recommendations.

Um, thank you so much, Dr.

Klan and to you and your team for this presentation.

Um it's very thoughtful, and I definitely hear the feedback and input from a number of stakeholders.

I think I just have two questions.

The first one is in terms of state advocacy.

I know there's a number of things that the department, the agency has brought to PAL.

Um, but it is are there a particular set of things you think we should focus on in terms of state advocacy.

Um there are two things my uh uh director Chowdry may have others to add, but there are two things that that uh from my kind of medical point of view are important.

One is if they're thinking about having a program to support, continue to support undocumented people, and that's who we hear that that that is that will make such an enormous difference for us.

They have they have supported that group, they just brought in some the uh young adult group just brought them in to their state funded Medi-Cal in 23, 24.

Um, it will cause a lot of disruption if they don't continue to support that group.

And we understand that that uh they don't have to do that, uh, but so the advocacy is important.

The other one is um a little more ac uh maybe um not obvious, but it's for their support in uh data sharing uh allowing uh data sharing, and in particular, uh data sharing between the social services department and our medical folks that allows people as much as possible when people are coming in, for instance, uh to help them stay on Medi-Cal, we'll need to know the the more of our assistors know uh what people's um work requirements are, whether they could be exempted, et cetera, the more information that a lot of there's a lot of um places where it crosses over whether what information that is needed to make a decision about whether this person is eligible or not is in the medical system and in the social services systems.

And right now the law prevents those things, state and state custom prevents those things from overlapping.

So more permission for us to be able to share those data securely.

And we understand that that people are nervous about that.

But the more people we can administratively say based on information we have, we know you are exempt from a work requirement.

Then and they don't have to collect information from their doctor and other places, their job.

The more people we can do that for, the more people will stay on Medi-Cal.

So those two things.

Thank you.

That's helpful.

I actually do have a few more questions sure.

In terms of maximizing enrollment, I know you're working with the FQs.

Is there anything that the community providers need in order to do that work of maximizing enrollment?

So they need education, and that needs to be done repeatedly because this is complicated.

It's very complicated.

So they need the information updated repeatedly to be able to give clear information to the people they're working with.

And they need you know support for and time for people to be able to actually do the work of connect of outreach and connection.

And of course, you as you know that you have been supporting that working.

Yes, very important.

Um I think you alluded to the PPS.

How are those payments for medical patients specifically for UIS patients being impacted by the state budget?

The state is no longer gonna be applying the PPS rate, the the additional, there's additional uh dollars that come for for uh visit.

They're no longer gonna be applying that to all the people who are in their program, whereas they have been.

And I I know that there are colleagues here in the audience who could who could say more about that in detail.

Great, thank you.

Um, and final question.

Um, in terms of augmenting funding going forward, do you have a sense of what amount is needed to bridge these impacts from HR1 and Prof1?

No, we're working on that.

We're working on that.

Okay, thank you.

Thank you.

Um I appreciate the clarification on the um the history and how we got here.

But when we look at uh the December 2025 reliance on health pack, you said there's 2,456, and we have 70.5 million dollars.

Uh it just seems to me that when we were at the peak of 90,000 people, we had pretty much the same amount.

So I'm glad you asked that question because I whenever I show those slides.

I know that it's gonna bring up those questions.

So um the 90,000, the at the peak at 90,000, we had uh a great deal more federal funding.

There was additional federal match that came in in order to support the development of systems to make it possible for people to um move into ACA for the the organizations and the individuals.

So there was a speed uh spike.

But the amount we were putting in was has been fairly stable actually over time and came down to to that you know baseline amount.

What we found over time, and the reason why, you know, essentially why those dollars didn't decrease as the enrollees decreased is that we we um what we were asking the clinics to do uh has gotten progressively more difficult.

And there's not really a line for that on that on that graph.

But um, for instance, we have asked them to connect with each other more.

We've asked them to connect with our with our systems more just for some homely examples.

They have they now are able to uh follow people in the hospital.

You know when their people are in the hospital and they're able to make sure that they have appointments as they come out and they have specific amounts of time before an appointment happens.

There were ways that the health pack dollars alone and the Medi-Cal dollars they were getting before ACA supported the basics of health care but not the um not adding in the mental health, the substance use, the other parts of health that we know are so critical.

So we have with those dollars have supported a whole person care approach, the expansion of behavioral health and some interclinic intersystem improvements in cancer screening in hepatitis C and HIV treatment.

So those system wide things that go beyond you know the the actual just you see a patient in the exam room you take care of them.

That's helpful to understand that they're doing more go ahead.

Sorry if I could just add one other thing is that um over time the cost of health care has also just continued to increase beyond COLAS beyond what we're we're providing and so um in general even with Medi Cal rates um you know I regardless of how large our indigenous care program is we're never actually going to be able to meet the cost of providing the actual care.

So as Dr.

Clannon said this funding has been really used by the um health pack providers to really support the full infrastructure of ensuring that our safety net is robust kind of across the board I I appreciate that clarification.

I mean as you said health pack is not insurance it's basically the last resort if you are not covered by Medi Cal, private insurance, Medicare this this is it.

So um as we move forward with HR one I I guess the biggest question is the UIS population that were on Medi Cal but will no longer be on Medi Cal will be relying on these health pack funds but we don't know what that would look like at least this coming year.

We don't know how many people will find themselves in that situation.

And there's still some big moving pieces that haven't landed.

Okay.

Will over the summer not before then um so I I understand uh and um Director Ford was actually complimented at the Alameda Alliance um because of the work that her office has done in trying to make sure people got re enrolled uh with the redetermination and we had a higher amount than we than even the executive director had expected because we have programs that go deeply into working with trusted messengers so we're we're going to continue moving forward on that front but as you said there's some elements where there might be some intersections between for example the job requirements on MediCal and Calfresh that would need to be better mesh.

So um do you expect um the sustainability of the funding what I'm hearing is you ended up having to provide more care that you than you normally would under Health PAC for the 2,456 enrollees but then if you have more people enrolled in health pack certain levels of care may end up not being um available for everyone yeah um so the more care um that we're supporting with those health pack dollars actually was for everybody being seen in those organizations so in fact the majority of people the organizations were able to do these things for their Medi Cal population.

So it's really the entire system that benefited from those dollars in addition to the health the people who were on health pack for their care.

For the most many of the people we're talking about they won't there will be some people who have been covered and seen in the community who will need us and will come into our contracted network.

But for the most part what will happen is we'll see the same people who have been on MediCal will no longer be on Medi Cal but we'll keep seeing them in the same place.

But what will happen is the funding that was associated with them will suddenly be reduced.

Okay.

You know, the the it that in the future will need to be very what we'll be watching this, but I'm afraid that we'll see increasingly that it takes too long for people to get the care that they need.

And that's how primarily how we'll see uh the stress that the system is under.

Okay.

Thank you very much.

Appreciate it.

Um there any other comments from staff?

If not, I will open it up for public comment.

Um just a couple of other things, supervisors.

So back to what uh Supervisor Fortunato Bass had asked about state advocacy.

I believe that um we've either already brought it through PAL or will be bringing a joint request with social services to join the urban counties ask related to HR1, which is nested within the CSAC Ask.

Um, and so we're really following budget developments with the May Revise very closely, and that'll sort of be a big next marker for understanding what the state is going to do because as Dr.

Clanan mentioned, they are looking at um uh you know, thinking about whether there's some solutions that they can put forward, but it's a balance of making sure that you know they can provide a robust benefit and not create multiple levels of care for people or disparate levels of care.

Um, and then also it just health care is expensive.

So we'll we'll keep an eye on that.

Um and then in terms of uh the providers and sort of some of the other hits that they're taking.

Uh part of what we're doing in our back end analysis is looking at um some of the FQs, for example, are also going to be losing Prop One funding again in that integrated behavior health space, right?

So for some providers, there's a double hit.

Um, and for others, um, like AHS, which is our only specialty and emergency room provider in the mix uh for the network.

Um, you know, we can see an anticipated increase in ED costs and um because at least before the ACA, people definitely um delayed getting their primary care and and used relied the ED, relied on the ED some more.

Um so just kind of trying to put all of those things together to think about how we can continue to support the health pack network, make sure that um too much stuff doesn't break in the next couple of years while the state figures out what it wants to do.

Um, and you know, uh also just keeping in mind that the health pack funding that Dr.

Kalanen talked about, that is all county general fund um and has been for a very long time.

And so this is a we're one of the few counties that makes such a significant investment.

Um, and we are really reliant on the Health Pack Network to help us meet our um indigent care mandate.

So just to put those out for consideration.

Thank you.

Are there any other comments?

Hearing none, um, let's open it up for public hearing or excuse me, public comment.

All righty.

Let's see Lily Kelly, Lucy Hernandez, and Yuhua Guan.

All right.

Uh hello.

Uh, thank you for holding this meeting.

Uh my name is Lily Kelly.

I represent La Clinica de la Rasa, where I've worked in grants management for about 10 years.

We strongly support the CAO and Alameda County Health recommendation to allocate 34 million in Measure W funds to increase funding for Health Pack.

This is especially urgent given that La Clinica and other FQHCs are already facing serious losses due to medical freezes for immigrant patients and upcoming Medicaid work requirements.

These are explicitly designed to disenroll currently eligible enrollees.

The savings claimed at the state and federal level are going to come directly at the expense of our patients.

Pay about $30 to $60 per visit, but each visit costs us at least $200 or thereabouts.

Currently, 11% of our patients are uninsured, a number that's expected to rise starting in July and increase further when Medicaid work requirements take effect.

While we're committed to helping patients retain coverage, the state has worsened the situation by cutting FQHC reimbursement rates beginning in July of 2026 when we serve Medi-Cal patients with unsatisfactory immigration status.

Importantly, FQs are the only Medi-Cal providers receiving this rate cut for caring for immigrant patients.

We're already seeing the consequences of lack of health coverage.

For example, a young patient with spina bifida has had repeated emergency room visits simply because she can't access essential medical supplies.

Another patient has a family history of brain tumors, but is unable to get the specialized diagnostic care needed to rule out a brain tumor as a cause of several months of ringing in her ears, decreased hearing, and frequent episodes of vertigo.

These are not hypothetical harms, these are harms that are happening now.

We urge the board to allocate Measure W funds to increase health pack funding for two years to prevent these avoidable suffering for Alameda County residents.

Thank you for your time.

Good morning.

My name is Lucy Hernandez.

I'm with Bay Area Community Health, and I want to share with you a patient story.

We recently saw a hardworking mother who came to us who came to us after losing her coverage.

She delayed her care for months, not because of cost, but because of fear of her immigration concerns.

She finally came after her condition worsened after a visit to the emergency room.

This was something that could have been prevented with earlier access to care.

Health PAC made it possible to continue her care with us.

We support the recommendation to increase funding from Measure W.

We urge you to increase funding for Health PAC.

We re we already see patients impact from Medicaid and enrollment freeze.

The anticipated federal work requirements, and for our patient, this means more fear, more delay, and more preventable emergencies.

Health PAC is essential for protecting access to care.

And thank you for behalf of our patients we serve.

Two Quak Julia Lyon and Andy Martinez Patterson.

Good morning, supervisors.

My name is Two Quarch, and I'm the president of Asian Health Services.

We agree with the prior recommendation in March to allocate $34 million in Measure W Essential Health Services Fund each of the next two years to stabilize the safety net providers.

We strongly encourage increased funding for the Health PAC program.

As a federally qualified health center serving 50,000 residents in Alameda County, we're extremely concerned about how the federal and state policies will cause millions of Californians to lose Medicail coverage.

We know from experience that when patients lose coverage, they will continue to seek care at community health centers like ours, but as uninsured patients.

Health centers will continue to provide care, but without reimbursement.

This will effectively shift the cost of providing care onto safety net providers.

Under HR1 and the state budget policies, 6,000 of our patients at Asian Health Services may lose coverage, resulting in approximately $6 million each year, which will force us to cut services and even resort to layoffs of our hard working staff.

A vast majority of our patients who are on Medi-Cal are limited English proficient and struggle with both health problems and face barriers to finding work.

As one of our young patients shares, without Medi-Cal, I don't know how my mother would be able to receive medication that lets her go to sleep at night from the pain she endures or how she can continue to see her neurosurgeon.

She lives with severe chronic pain and could not easily get a job due to language barriers and her pain.

With or without Medi-Cal coverage, we're committed to continuing to care for our patients like that mother.

This is the right thing to do.

Yet the right thing should not mean putting the lives of our patients and the livelihood of our 600 dedicated staff at risk.

Help us help our patients by providing an increase to the total health pack budget.

Thank you.

Each of the next two years to stabilize the safety net and encourage increased funding for health pack.

The request to increase funding for the health pack program is critical to ensuring that our current safety net is kept stable in light of the millions of revenue losses due to state and federal cuts.

As a health care provider, we are already seeing significant impacts already.

Since January, we have seen our alliance membership, especially Medicail expansion go down by 20%, and our membership for families and children decrease by 13%.

We are also gravely concerned about the upcoming federal work requirements given recent analysis have consistently identified adult patients age 50 to 64 as being most at risk of losing coverage due to work requirements.

At Asian Health Services, our adult population makes up 45% of our patient population.

It is not uncommon for our adult populations to be living with multiple chronic diseases as they have aged.

Hypertension, diabetes, and other chronic decision conditions, we see quite a bit, and they can be managed in a clinic setting at a much lower cost than if patients forego care due to cost barriers and end up in the ER.

Our older adult patients with chronic disease, if they're not addressed through routine in clinic or telehealth services, they can result in hospitalizations that will cost much more to treat at places such as Alameda Health Systems.

Given the tremendous impacts on our patients, we urge the board to increase the total health back budget for each of the two years to reduce destabilization at Asian Health Services, our fellow clinic partners, and overall clinic safety net.

Thank you.

Good morning, supervisors.

My name is Andy Martinez Patterson.

I'm the CEO of the Community Health Center Network, 8FQA2s in Alameda.

I wanted to address two items that came up today.

Um there was mention of what is the state doing.

Um I sit on this uh California Primary Care Association board and have been working on what we refer to as the alternative coverage program really hard to find a mechanism to provide care for UIS as well as those individuals who are going to be falling off MediCal due to work requirements.

Um we've been working really hard at it.

It's going to be more than a couple billion dollars, and with the state's projected deficit, it's not an assured bet that it will happen.

Um so as of late, as of last week, Department of Health Care Services started to talk with us about how we have to implement what we refer to as the PPS penalty.

That's where the FQHCs lose the wraparound payment, which is the bolus of the resources they get for Medi-Cal.

In counties that pay capitation, which Alameda is one, FQHCs will continue to receive capitation.

That is maybe one tenth, one maybe one fifth of what they would be receiving in counties that they could that are fee for service, where you can bill itemized amounts per what happens in a visit.

Those FQHCs might possibly come much closer to what they can receive in PPS, but in Alameda, that is not as our that's not our system.

At present, we have 40,000 UIS just within our eight FQHCs.

Um, Alameda Alliance for Health has 80,000, and they have reported receiving 600 million dollars for that population.

That is just too much to withstand, and the FQHs that we have in Alameda are going to be penalized because we are capitated and because we see so many of the UIS who we will continue to see regardless.

And for those reasons, we support the proposal that takes us putting forward.

Thank you.

You go see Hong Young the Hope and Nan.

So go to Hong Kong bin.

I have been a patient at Asian Health Services for over 20 years.

AHS is the only health center that can provide the culturally linguistic services I need.

AHS is incredibly important to me, my family, and the broader Asian immigrant community.

It is an indispensable and vital part of my healthy lifestyle.

As someone who had immigrated to a new country, the language barrier was a significant obstacle in my daily life.

If I had to visit a larger hospital for every minor ailment facing communication difficulties and the inconvenience of long distance travel, it would be truly arduous.

Asian Health Services has been a lifeline for me, offering services in multiple languages in my own community.

I'm able to communicate in my native language, making it convenient and reassuring to see a doctor pick up prescriptions and undergo various medical tests.

They've also assisted me in securing the appropriate health insurance coverage.

For these reasons, I support the health pack increases for AHS and other FQHCs.

Thank you, everyone.

Hello, I'm Tony Panetta, Chief Impact Officer for Alameda Health Consortium.

Hello, supervisors.

Thank you for your time today.

Thank you to Alameda County Health and to Dr.

Clannen for your presentation today.

I'm here to testify in support of the recommendation to augment the current health pack budget, the countywide budget to offset the effects of HR1, Prop 1, and the state instability related to Medi-Cal coverage for patients who are considered to have unsatisfactory immigration status.

We know that you have heard in March during the Measure W update about recommendation to allocate some Measure W funds from the Essential Community Service Fund to stabilize the safety net.

You're certainly hearing about that today.

You've also heard from Dr.

Clanon and from Director Chowdhury and from Andy.

Every day we're getting more information about what the state can or cannot do with backfill.

The bottom line is that we expect and our clinics currently already are experiencing significant fiscal destabilization because of the combination of those policies.

And for our clinics to continue to be able to provide access to mitigate the projected increases in wait times and to reduce the risk of decoupling integrated whole person care that we have done so well.

We are requesting an increase beyond the maintenance of effort budget to the health pack contracts across the board that have been recommended by AC Health.

Thank you.

Happy to answer any questions you might have.

We'll ask our questions later.

Okay.

Thank you again always for listening to us and having this.

My name is Robert Phillips.

I'm the CEO of Baywell Health.

And so I'm here to associate myself with the support for the proposal that's being made by AC Health and the CAL's office.

I just wanted to add two things in support of that.

One thing is to remember the clinics that you see today aren't the clinics that you saw last year.

And I'll just give you an example of ourselves.

Within the last year, we've absorbed a practice of an independent physician practice that closed.

So we've had to adjust to both the acuity of that patient population, but also the provider needs of that patient population.

And that's just true for us.

And all of our colleagues go through the same thing.

And the second thing I would ask is you know, protecting the budget is protecting access.

For the 30 years I've been working on healthcare in this county, access is a hard fought when for this county.

So this is just maintaining that.

And you've heard Dr.

Clan and articulate really well what it means to protect kind of the investment.

The budget means that we don't experience the things that happen when you lose revenue.

When you lose revenue, um there are longer wait times when they're longer wait times.

We send folks to the ER, when we send folks to the ER, we put more pressure on the system.

So thank you all for considering this on the eve of the budget.

Um, and just wanted to make sure that we held those two things in balance too.

Iris Martinez and Ella Schwartz.

Good morning.

My name is Cyrus Martinez, and I am the director of Access Community Health operations at Access Community Health.

I've been with Axis for 22 years.

I started as a medical assistant, uh, working directly with patients, and I have seen firsthand what it means to our community when people have a place to turn for care.

I'm here today to urge the increase of the funding for the health pack program for each of the next two fiscal years and to support the CAO and the AC Health recommendations to allocate additional funds in Measure W Essential Health Services Fund to stabilize our safety net.

I want to be specific about why this moment is so important.

Beginning in July 2026, the state will cut reimbursement rates for FQHCs and only FQHCs when we care for the patients classified as having unsatisfactory immigration status.

No other medical provider faces this penalty.

And starting October, lawfully present immigrants, asylumes, refugees, survivors of domestic violence will lose their Medical eligibility because of HR1.

Having been on the front line of care, I've sat with patients like this for over two decades, and I have seen what it looks like when our immigrant community delays care and when they end up in the emergency room at a far greater cost to everyone.

Healthback is a bridge that keeps those patients connected to care.

We're asking today to police increase a health pack budget.

The safety net depends on it, and so do people we serve.

Thank you.

Good morning.

I'm Ella Schwartz.

I'm the Chief Impact and Partnerships Officer at Tiburcio Vasquez Health Center.

I'm speaking today to express my appreciation to each of you for your continued support of Health PAC, including this increased or supplemental funding through Measure W.

The funding allows us to provide health care services to those that need it most in the unincorporated areas of Ashland and Castro Valley, as well as Hayward and Union City, where Tabersio has primary care clinics and is one of the only safety net providers in these geographies.

As Dr.

Clanon noted, the fiscal this fiscal year, we will experience the greatest cuts to health insurance coverage due to the state reductions of Medicaid for adults without satisfactory immigration status and increased federal requirements for Medicaid enrollment and the work requirements.

Clinics across the state are facing the greatest time of uncertainty in Medical's history.

Your continued support of the of our clinics through Health PAC and Measure W funds provides the funding and infrastructure that we can rely on during these most critical and destabilized times.

In advance of this testimony, I outreached to providers and staff at Tibersio to let them know that I'd be speaking here today and asked if they had any short stories that they would like to share that demonstrate the value of Health PAC.

My inbox was flooded with messages.

Our providers and staff took the time to let me know just how important this program is for them, their patients, and our communities.

I'd like to highlight just one story for you today.

In December, St.

Rose Hospital outreached to us as they prepared to discharge a 19-year-old patient who is admitted for vomiting nausea and shortness of breath.

We connected this patient to primary care in our Castor Valley Clinic, and our eligibility enrollment team worked with them to inform the patient about how to get enrolled in Health PAC and help them complete the application.

Our primary care team diagnosed the patient for type with type 1 diabetes for the first time in this patient's life.

And our clinical pharmacy team is working with the patient to manage medications and stabilize their treatment to prevent future hospitalizations.

Thanks to Health Pack Funding, the teams at Tiburcio and St.

Rose hospital provided life-saving treatment.

Thank you.

I see no other comments, Chair.

Thank you very much.

Appreciate everyone's comments.

Sorry.

I'm sorry, but one person online.

Harsha Ram Chandani.

Hi, good morning, Board of Supervisor.

I hope you all can hear me well.

My name is Dr.

Harsha Ramchandani.

I'm chief medical officer at a federally qualified health center called Bay Area Community Health.

And I'm also public health commissioner in the Alameda County representing District One.

And I'm here today in strong support of the Alameda County Health Recommendation to allocate $34 million in Measure W Essential Funds to stabilize the Health Pack program.

I also specifically urge the funding for the Edge PAC program for two years.

And as you know, federally qualified health centers are backbone off of our safety net.

We care for everyone, regardless of their ability to pay with dignity and respect.

And I know Board of Supervisors, you've heard a lot of numbers about the cuts that's going to happen in the next couple years for the safety net clinics.

So I want to uh actually share what it looks like in the real life.

And being a medical provider and working with the other providers in the clinic, I want to share this two stories.

So recently we treated a gardener who came in with a deep infected wound on his hand.

He had tried to manage it at home because he was afraid of the cost of care.

By the time he reached us, the wound was serious.

We were able to treat him immediately in the clinic, clean the infection, provide antibiotics, and follow up very closely.

Within a week, he healed.

Without access to timely care, this could have led to severe infection, hospitalization, or even amputation.

There's another patient of 50-year-old women who had just arrived from another country, came to us after running out of her diabetes medications.

She had delayed care out of fear of cost.

When she finally came in, we were able to assess her, restart all our medications, including insulin, and provide education on managing her condition.

That intervention likely prevented a life-threatening infection and hospitalizations.

And these are not isolated stories.

This is what we do every day, and it only works because programs like HPAC exist.

This funding is essential for us to sustain operations, prevent avoidable emergencies, and keep people healthy in our communities.

I really urge you to support this allocation.

Thank you for your time and consideration.

Thank you for your comments.

Seeing no hands, I'll pass it back to Chair Tam.

Thank you.

Once again, thank you all for your comments.

And I know you know the board um supports all of your work because you are at the heart of the front line when it comes to making sure that we have a system that offers a safety net when it comes to health care.

Um I just need some clarification from staff.

In terms of what um is recommended to us.

Tomorrow we're going to start our early budget discussions with the maintenance of effort.

And last month we talked about uh prospective allocations of um the funds when it comes to measure W.

Can you refresh my memory in terms of what we had anticipated with both Health Pack and Prop One, and then how we're also uh reflecting that in tomorrow's maintenance of effort.

Uh thank you for that question, Supervisor.

So uh for tomorrow's maintenance of effort, because that is our uh current maintenance of effort, we don't uh anticipate having information specifically around Prop One or the Measure W Essential Services.

We're continuing to work with County Administrator's Office.

Um, and that's kind of the hesitancy that I have with sharing explicit numbers because we're um figuring out where uh we have one-time sources available that we can plug in from our own agency, um, and then you know, before making an ask to the board.

Um so that that's the note there.

But this is uh, of course, uh, as you know, there were 53 million dollars one cuts that were issued for the whole system.

Um, and we haven't quite landed on what kind of a uh bridge we might want to recommend for uh health pack.

But in the March 10th uh work session, we had put in a 20 million placeholder for the essential services ask.

But if you'll recall, um, you know, central services is 34 million dollars per year for that bucket, um, and all of the asks that we collected from across the county agencies were close to 200 million.

Um, so there's just a lot of back-end uh sorting out to do.

Um thank you for that refresher.

Um I mean, the highest priority for us obviously is uh making sure there's a health fee and health pack um support and also try to look at ways in which we look at Prop 1.

But what I recall from the March meeting is that the people that were asking, some of it was overlapping with each other, and then we're gonna have to sort through uh what that means so that there's some uh discreetness in terms of uh making sure we adequately fund each of those programs because uh I know that there's a number of um providers that had gotten onto the call and had different expectations or understanding of what was available.

Um could you uh let me know?

Uh you said that um we're also looking at increasing the number of clinics that will be getting some allocations.

Could you uh let me know you said that we're also looking at increasing the number of clinics that will be getting some allocations and are are these two additional federally qualified health clinics are coming online?

Um yeah, so they are organizations that have long done similar work to to help back, but not necessarily in an FQ model.

Um one of them is becoming an FQ lookalike, and the other is one that has perhaps a uh much smaller um uninsured population or undocumented population, but certainly a much larger Medi-Cal population.

And so, in one of those spaces where you know, as you saw in the coverage changes that happened for a long time, uh Health Pack was covering people who weren't eligible for Medi-Cal.

And now, as work requirements come on, we're gonna see some disparate impacts on other clinics that are Medi-Cal serving.

Um, so we would uh and and we've been asked by the board over the past several years to see uh if there's an opportunity to add into that network.

So we'd like to you know figure out how we can provide some seed funding or you know, bring them into the health pack program and sort of adjust uh the the different allocations without causing pain.

Do you need to be an FQ to receive HPAC dollars?

Historically, that's been our policy, um, and that was partially because as Dr.

Clannon was mentioning, um, you know, the PPS rate is a bundled higher rate.

So the idea is that you know, every general fund dollar we're putting in, the FQs are able to leverage a lot more to bring it to the system.

Um, and it's just that with the Medicaid work requirements, we're kind of in a different spot, um, and we're gonna need more capacity because it's potentially thousands of people returning to Health Pack.

Okay, thank you very much.

Um Supervisor Martin Abbas, any other questions or uh yes, a comment and uh and a question.

I mean, firstly, thanks for this presentation and all of the ongoing work, and I think um, you know, it's very evident that our community clinics together with Alameda Health System uh really provide a robust ecosystem to provide health care to our community, and so I am very supportive of the guiding principles and especially ensuring access to our community members.

I mean, over the past uh few years, as we saw through the presentation, we've been able to make sure that less and less people are uninsured, and not only that, we've really been able to boost preventative care and whole person care, and it would be devastating to go backwards.

So we have a hard job in front of us as we make these budget decisions, but I think these principles are a great framework for us to uh be making our decisions as a board.

Um I had one brief question.

Um I wanted to ask if our staff knows when the next time the measure W Essential Services Fund will be presented at a work session.

I heard it was April 28th, and just wanted to confirm whether that is in fact the date we'll be looking at.

Um Andrea Ford Agency Director for Social Services, that's also the date that um I have on my calendar for the next one.

Okay, great.

Thank you.

Thank you very much.

Umika?

I apologize.

I don't want to end on a sour note of any kind, but I think just as we're thinking about um, you know, upcoming meetings and and proposals, I I just want to be really clear that in all of the the bridge requests or you know, uh trying to lessen the pain of what's gonna come.

Um, what we have available to us are short-term limited time resources.

Um, so one of the other things that we're thinking through is how do we avoid being in the same place the next year or the following year?

And so I think that's where we'll need um partnership from our our networks and and community-based organizations to see where things can be done differently and to you know uh think about sustainability rather than uh one-for-one backfills.

Um thank you for that reminder.

Um that's a reality we're all facing, but we are very fortunate in Alameda County to be able to rely on Measure W, even though it is a short term and has an expiration date.

Um it's just making sure that we um judiciously use that funding and also um as supervisor Miley would often say not get penalized by the state of California for having planned well and having uh that sort of uh backup funding for our community.

So thank you very much.

We will now at this time go to our next item, which is the site opportunity guide and site assessment tool for homeless use.

Good morning, supervisors.

Jennifer Pierce, Deputy Housing Director.

I'll do a brief introduction and then introduce Selima Jones.

We are very excited to present to you our site opportunity guide and tool for homeless housing.

This was developed in collaboration with cities across Alameda County in an effort to help them identify sites within their jurisdiction that are publicly and privately owned for homeless housing.

So here to do a more detailed presentation is Selima Jones, our housing finance manager.

Good morning, supervisors.

My name is Selima Jones, and I'm here on behalf of the Housing Community Development Agency.

And here to discuss the site opportunity guide and the site assessment tool and its impact on site selection for homeless uses.

On September 19, 2023, the Alameda County Board of Supervisors declared a state of emergency for homelessness, recognizing the rapid escalation of the crisis over the past decade.

This declaration provides the county with additional tools to accelerate and expand its response with a critical shortage of affordable housing for extremely low and acutely low-income individuals and families.

Expanding physical spaces where the unhoused can be safe offers a practical and immediate solution.

These types of spaces serve as a bridge between living on the streets and securing stable permanent housing, providing temporary supportive residential options for individuals experiencing homelessness.

And that takes us right into our site selection for homeless uses.

Today we'll go ahead and discuss our agenda as well as next slide.

As well as the purpose, our key concerns and evaluating site opportunities and a short walk through the site opportunity guide and the site assessment tool.

Now, what is the need to evaluate these sites?

As stated earlier, the Board of Supervisors declared a state of emergency on homelessness and having called for that for evaluating available real properties for rapid homeless serving uses.

Statewide homeless housing assistance and prevention grant requires counties and local governments to maintain lists of surplus properties and have a site selection framework for homeless uses.

Local jurisdictions, including cities, school districts, and park districts often need technical assistance to evaluate sites for homeless use.

The site opportunity guide and site assessment tool can get this started.

Now, what can the site assessment tool and the guidebook do?

It can help familiarize non-housing staff with possible rapidly deployable homeless serving uses, arm staff with the right questions to ask when approached by property owners, assist HCD in providing technical assistance to city staff, and provide the basis for a feasibility analysis.

Length of availability determines possible uses.

We can have a long-term use, which is the purchase of a site or government ownership, allowing longer-term investments in the property, or we can have a short-term use, which is what be a lease or site that has a future use and the planning process, but that also dictates a smaller investment.

Now, what do we need to know about the site before we can get started?

We have the legal status, the physical attributes, as well as how soon can work start.

With the legal status, we go to we go into who owns the land, are the any liens and encumbrances on the land, and what kind of transaction and how long for physical attributes, where is the land located?

Has the land been improved upon?

Has it been paved?

Are there structures or utilities?

And then how soon can we start the work?

Are there any tenants on the property?

Will we have to relocate them?

Are there any types of environmental issues?

As well as what would have to be brought onto the site to make it livable, power, water, bathrooms, and other utilities.

This leads us into our possible homeless serving uses.

And we'll start with our short-term uses, safe parking.

Safe parking programs for the homeless provide designated parking lots where individuals leaving in their vehicles can safely park overnight and access support services.

This, excuse me, these programs aim to offer a more stable and secure alternative to sleeping and unauthorized locations, while also connecting participants with resources to help them transition into permanent housing.

Community cabins.

These are often called tiny homes, but they are not permanent uses on a site.

They are similarly situated where they are small standalone structures, but without individual climate control, water, cooking facilities, or utilities.

That moves us into more of our mid to long-term uses, such as a navigation center.

A navigation center from the homeless is a type of interim shelter that offers a low barrier, high service environment to help individuals experiencing homelessness transition into permanent housing.

Now, unlike traditional shelters, navigation centers have fewer restrictions, allowing individuals to bring partners, pets, and possessions, and they are designed to have a much higher level of intensive services that were traditionally not provided by emergency shelters.

Motel conversions.

Acquisition of conversion of hotel properties into housing involves repurposing hotels or motels into permanent or temporary housing for individuals experiencing homelessness.

Now, this strategy is often used as a quicker and potentially more cost effective alternative to building a new housing development.

One housing unit turn into shared housing.

Shared housing programs for homeless individuals involve multiple people living together and one housing unit, sharing costs and responsibilities.

These programs can either be short-term, like rapid rehousing or long-term serving as permanent supportive housing.

They utilize the existing housing stock either by purchasing or leasing the real estate.

They often require a high degree of supportive services to allow people to live together, such as case management, employment assistance, and conflict mediation.

Moving into our more long-term uses, tiny home villages.

Tiny homes for the homeless are small individual dwelling units, typically under 250 square feet that can be permanent, excuse me, that can be on permanent foundations.

They are used as either an interim housing solution for people experiencing homelessness or housing.

These units do come with kitchens and bathrooms, generally include infrastructure calls such as water, sewer, and electrical.

Commercial spaces that can be converted to housing uses.

Use as either an interim housing solution for people experiencing homelessness or permanent supportive housing.

Converting underutilized commercial spaces can be a quick solution.

However, infrastructure like kitchen and baths required for permanent housing is more costly than building congregate shelters with shared facilities.

Now, this brings us to a short walkthrough of our site opportunity guide and the site assessment tool.

Now, the guide offers a structured step-by-step method to evaluate whether a parcel or building is suitable for housing sites.

Now the guide itself gives more detailed detailed information about the site selections.

The guide also provides instructions on the site tool and instructions on each tab.

Here you can see getting to know the site tool.

Again, it offers step-by-step instructions on how to actually use the site tool, and each tab the site tool covers.

Getting into the site tool is an it is an Excel spreadsheet with various tabs to assist users to better understand to a better understanding of the site's suitable uses.

Now we'll take a short walk through the types, excuse me, through the site tool itself.

We'll start with the universal site criteria page, which is critical information that is gathered about the site regardless if the site is vacant or not.

It is standard information needed for the property.

Just some of the questions that may be asked is the property contact information.

Who can we contact as far as the property is concerned?

Who owns the site, as well as what is the proposed project of the site.

One tab on the site assessment tool is vacant land.

We need to know how will utilities be brought to the site.

Excuse me.

How will utilities be brought to the site?

Is there a space for construction vehicles?

Finding out if there's any easements and where are they?

How will the site be secured?

As well as if there are any covenants or deed restrictions on the site.

These are just a few of the tabs within the site assessment tool and a few of the questions that can greatly impact the site selection for homeless uses.

Any questions?

Sorry.

Thank you for that presentation.

I I do have a few questions, but let me start with Supervisor Fortunatabas.

Thank you so much for this information.

I think this site assessment tool is going to be extremely valuable.

I do have a few questions.

Well, one thing we have already done was share this tool with the cities within the jurisdictions.

We've shared the site assessment guide as well as the co excuse me, as well as the tool, and then had feedback sections with them as well.

Getting more of an understanding and making it more collaborative to determine is this the best way to use the guide?

Is this the best way to use a tool, getting their feedback and implementing that within the guide as well as the tool?

And then continuing to have those sessions with them as well.

That's terrific.

And does the list of surplus property already exist, or is that something that the department is pulling together?

That is something the department is pulling together.

So in doing so, we are reaching out to this different CETAS as well, getting their um surplus land information, and something that we are continuing to do.

Is there a date by which that lists would be available?

I do not have that, but that's something that I can definitely look into.

Okay.

I mean, especially as Measure W funds and new RFPs are being rolled out, that seems like it would be very valuable to have that list together with this uh site assessment tool.

Um I when I was on the Oakland City Council, I did uh stand up in interim tiny home community, and one of the things that was uh very evident to me as I was talking with people who were unhoused and who were refusing services is that amenities like having storage space or the ability to have your pet there was really valuable.

Um the uh the sample chart was a little bit hard to see, but are there also more um more fields for the interim sites in particular about those type of amenities so and the possibility for those amenities because I think that does make a difference in terms of um more and more people being willing to take those services?

Yeah, um to be honest with you, I'm not sure if that if it has that type of information due to the fact that it just really all depends on that particular location, but that's something that if it's not in there, we can add will possessions, pets, partners, and things like that be able to come on those tiny home sites.

Right, and obviously it may depend on the service provider.

Um, but even assessing whether there's potentially space at the community that my office put together, we used um an old container for storage space, for example.

We used a converted AC transit bus for showers, so even kind of knowing more about the specs might be helpful in determining whether or not some of those amenities could be placed.

And that's why some of those questions on there, even if it doesn't have the information as far as bring a possession or pets to the actual site, getting the information about the space is very valuable to determine if something like a storage space or an area for pets um can be used at that particular site location.

Thank you.

And last question.

So obviously with Measure W, there'll be a number of RFPs over the course of this year for uh funding that could potentially help support these type of interventions and programs.

Um I am curious about, I know we've got some RFPs that will support um interim shelter and our bed night rates.

Are there any planned funds that would support capital or construction that are in the pipeline?

Ask the last question one more time.

I just want to make sure I'm hearing you correctly.

Sure, and this might be a question for Director Chowdry.

Um, in terms of the measure W RFPs that we're anticipating, are there any additional RFPs that would be available to support the capital or construction costs of interim shelter?

So we just actually closed an RFP for construction costs, probably like about a month or so ago.

Um so we just had that one and we had 11 projects that were awarded funding for that for any more in the future after that, I'm not sure of.

Okay.

Yeah, uh, I can add to that supervisor.

So I believe that in that initial allocation that we set aside for capital projects there is a the potential for some additional in in the future as well as in the interim services interim shelter services.

I I don't there is a um the one that we've been calling like the rehab and acquisition portion so that would allow for um purchase or lease or you know uh redoing the the properties so short answer is yes uh long answer is I can get you a more clear um follow up by email thank you thank you thank you for those questions um just to follow up so when um the city of Oakland and Almia County uh jointly participate in securing hap funding um we we've been doing that for for a while now it's not just recent right and and so I thought part of the requirement for the HAP grant is that we maintain a a surplus properties list yes it does say that we do need to maintain a um surplus properties list which is something again that we are working on um to get and acquire so we don't have one now uh not that I'm aware of but I can double check on that yeah I think it's important if if we're trying to be compliant with the grant because we we're trying to make the case that it's important um that we look at these opportunities particularly in given some of the um policy changes that might be forthcoming in the city of Oakland when it comes to uh providing some sort of temporary or permittive supportive housing as they address some of the encampments that are um are going to be benefiting from some of the HAP funding again we definitely have reached out to the cities as far as their surplus lands as well but has that list been formalized I'm not sure of but that is something I can check into.

And and this also includes the schools right because I know some school sites were also interested because the enrollment has shrunk and there's schools that are going to be vacant and available and the the one question I had on this front is when it comes to um like for example uh hotel vouchers those are administered mainly by the cities does the funding cover it depends on the funding that's available to so some cities will cover it on their own or maybe they're using HAP funding or they're using uh other funds it just sort of depends on what each jurisdiction has available to it.

Okay so um in order to have the vouchers you have to have a shelter to use the vouchers and so are there um like in the surplus property list or in some sort of list are there ways in which we could use some of the underutilized hotels at least temporarily so I think that could be something that's a part of the interim use RFP that comes down the pike and it would really be up to you know what the cities can cite and uh what the neighborhood will support and so um but even in the interim use RFP that we did previously that wasn't allowed an allowed use.

Okay.

And on just on this request property survisor uh I do know that on the county side the general services agency does have a list that they've uh helped prepare for us um and so HCD and H and H I know it's in the pipeline to get that full mega list together.

Okay that's helpful to know um do you would you like to basically describe the conversation we had with Senator Grayson on Friday and what his offer was uh sure um so Supervisor Tam and I uh had a meeting with Senator Grayson uh who uh whose district uh state Senator Grayson who's a part of whose district covers our county and um he was he offered his support in helping us think through how to partner with Caltrans for example um as well as um areas where there are um overlaps between state and county property um and sort of to talk a little bit about you know many of the things that you shared in your presentation um to think through if there's interim uses that are available that we could couple with um wraparound services and so um in and uh potentially request some pilot funding from the state but we'd have to see what that looks like um thank you uh the reason I I asked that is because I I noticed that under the description on like short term and midterm uses the wraparound

Um, and sort of to talk a little bit about you know many of the things that you shared in your presentation to think through if there's interim uses that are available that we could couple with wraparound services and so um in and uh potentially request some pilot funding from the state, but we'd have to see what that looks like.

Um thank you.

Uh the reason I I asked that is because I I noticed that under the description on like short-term and midterm uses, the wrap around or the navigation services are not often in the um the shorter term.

They're usually in the midterm or longer term type facilities.

And Senator Grayson talked about a a site in Foster City where they were able to secure state funding, and there's like a combination of county funds and I guess city funds in which they looked at um I I think as Supervisor Fortunato Bass talked about uh making use of some of the the container homes and then also providing those wraparound services because that's critical for longer term um transitions for people that are um often in the encampments that are under the state properties like state freeways.

Um but if we can find a potential site, I think the senator was very enthusiastic about helping to secure um some piloting funding as well.

And I presume this is not HAP funding.

Yeah, I think it would be outside of HAP funding for maybe uh Alameda County specific um project, and I just want to underscore what you just shared about um the level of services and the types of services that people need in those interim spaces so that um they're uh you know uh receiving all of the the the services that they need and being set up to be successful in permanent housing later um because as we've kind of seen, you know, regionally there's been um a push to just really build more shelter recently without necessarily uh coupling it with PSH on the other end, and so we're really committed to making sure that we have that, you know, we have exits for people because otherwise um shelter stays are really long and then people are just not able to move out.

So so we really need um multiple types of resources and uh interim housing types so that um people are set up for success in the long run.

Thank you.

Those are the all the questions I have.

Do we have any public comments on this item?

I see no hands, Chair Tam.

Thank you very much.

Uh there are any public comments on items that are not on today's agenda.

There are no hands up for public comment on non-agendized items either.

Thank you.

Hearing no, then this meeting's adjourned.