Good afternoon, everyone.

I'd like to call to order the special meeting of Tuesday, no, Tuesday, June 23rd, 130.

This is a special meeting of the Board of Supervisors for Alameda County.

I'd like to ask the clerk to call roll and establish our quorum.

Supervisor Marquez, excuse Supervisor Cow.

Present.

Supervisor Bartonana Bass.

President Hobart.

Present.

We have a quorum.

Thank you very much.

I appreciate those uh members of the public participating in our meeting in person and online.

If you're here to comment on any items before us today, either closed session or open session, we ask that you would fill out a speaker slip and to participate online.

We have some special instructions which the clerk will now provide.

Detailed instructions are provided in the teleconferencing guidelines.

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When called, you will have two minutes to speak.

Please limit your remarks to the time allocated.

Public comment will generally alternate between in-person online speakers as determined by the president of the board and subject to overall time limits.

In the event that technical difficulties disrupt the Zoom webinar, the meeting may be recessed and reconvened via Microsoft Teams.

Detailed instructions are provided in the teleconferencing guidelines.

Thank you.

Thank you.

I note that we have Supervisor Tam participating remotely under the Just Cause provisions of State Senate Bill 2449.

Supervisor Tim, would you care to make your uh required declaration?

Thank you, President Halbert.

I am participating remotely under government code section 549538.3 parentheses and parentheses under the just cost provision because of medical recovery.

There are no adults 18 or over present in the room.

Thank you, and we wish you a full and speedy recovery.

I note that we also are joined by Supervisor Marquez.

So we have a full uh 100% participation today.

Our next item is to provide public comment on closed session items.

There is a list of specific items under closed session.

We will take public comment only on those items at this point.

There will be public, well, actually, we don't have public comment on open session items.

That's right.

So if anybody would like to make a comment on closed session items, now would be the time to do that.

Do we have any speakers on closed session items in the room first and online after that?

First speaker is Kathy Reeves.

Welcome and just let us know which item you're speaking on.

The first, right?

Thank you.

Good afternoon.

My name is Kathy Reeves.

I have been a legal secretary in the public defender's office for 26 years, and I'm a shop steward with SCIU 210 to 1.

I spoke to this board earlier regarding how the more than 4,000 plus employees of Alameda County who are members of SCIU 1021 are being treated.

I reminded this board and the county administrator that we are the wheels that make this county run.

I said we are being treated like indentured servants, scraping by from paycheck to paycheck.

And the fact that many employees travel for up to two hours just to come to work every day because they cannot afford to live in Alameda County.

Those in leadership are well compensated, while we, the frontline workers who keep this county functioning, are given crumbs.

You want us to pay for our benefits, but you don't want to give us enough money to pay for housing, food, and gas, which are the basic basic necessities of life.

Previously, I said we deserve respect and fair wages.

Now I'm saying we demand respect and fair wages.

Stop treating us as though we should simply be grateful.

We are the backbone.

Without us, this county would shut down.

I said that we are getting tired.

Now I'm saying to you, we are past tired.

We are done with being treated like peons.

We work hard every day.

We are not afraid.

You are about to meet in closed session with the labor negotiators.

I hope that you carefully considered the points that I have made today.

Thank you.

Thank you.

Next up is Jean Moses.

Jean, please unmute.

Jean.

Hello.

Okay.

Go ahead.

Yes.

Can you hear me?

Yes.

Is this the correct time to make a comment on the budget?

Thank you.

I wanted to say, first of all, Jean.

This is only for closed session items.

Got it.

Thank you.

Sorry to uh interrupt.

There are no more speakers.

Thank you very much.

Um just another reminder to the public.

We uh meeting tonight today does not include public comment on the budget.

We have closed public comment, which was uh concluded after two days of um meetings uh last Thursday and yesterday.

Um, and so there's no more time for public comment on the budget.

I did welcome and I do welcome SCIU's comments on our labor negotiations.

So thank you for sticking to that as agendized.

And so we are finished with closed session on public comment on closed session items, and we are now going to recess into closed session.

We will return when we're done with our discussions in closed session with it that we are now in recess.

Good afternoon.

It's 3:35.

I'm re asking that we readjourn to open session.

Will the clerk please call the roll to establish our quorum?

Supervisor Marquez.

President.

Supervisor Town.

Present.

Supervisor Miley.

Supervisor Park and Alabama.

President Albert.

Present.

We have a quorum.

Thank you very much.

I'll ask our county council as we are reconvening from closed session.

Is there any reportable action from closed session?

Thank you, President Habert.

Uh, your board took no reportable actions in closed session today.

Thank you.

I note that we have Supervisor Tam also uh joining us remotely under uh just cause provisions.

So we are in full attendance.

The next item before us is listed as item number one on today's agenda fiscal year 2026-2027 recommended proposed budget deliberations.

This is a meeting continued from yesterday, June 22nd.

I'll ask our county uh administrator.

The floor is now yours.

Thank you, President Halbert.

Uh, members of the board, we're before you today uh for your board's deliberations on the fiscal year 2026 27 proposed budget that was submitted to your board on May 28th.

We just distributed a letter that I will read into the record with two attachments as well.

We will have a brief presentation to provide some additional information to frame your discussions today.

Today you will deliberate on the fiscal year 26-27 proposed budget, which was presented to your board on May 28th and has been available to your board and the public since that time for viewing.

Your board held public hearings on June 22nd, and following extensive public comment, close both the hearing and public comment period on next year's budget.

The budget before you provides a balanced $6.7 billion spending plan across all funds, supporting county programs and services throughout the county, and a workforce of more than 10,400 employees.

The budget closes a 185 million dollar funding gap while maintaining critical investments in county priorities without major funding reductions or layoffs.

The recommended general fund budget totals 4.3 billion and includes over 1.2 billion of investments for services delivered through community-based providers.

Prior to the close of budget hearings yesterday, your board received a letter from my office recommending final budget adjustments for inclusion in the final budget.

These adjustments reflect board approved actions and technical corrections and do not increase county costs.

In addition, prior to the close of hearings yesterday, a letter was submitted by Supervisors Fortnotto Bass and Miley for discussion.

In summary, to approve a one-time allocation of up to 19.3 million for the Alameda Health System to help mitigate the proposed reductions in force, conduct a performance audit of AHS, extend the PHP IOP program through October 31 of 2026.

Direct staff to convene a planning group for the PHP IOP program.

That you extend the board's AHS ad hoc committee and also direct the county administrator in collaboration with the auditor controller and AC Health Director to identify one-time funding options.

Today your board will deliberate on the proposed budget as well as the final budget adjustments and the letter submitted by Supervisors Miley and Fortinato Bass.

Following your discussions and deliberations today, we will provide direction to the county administrator to prepare a final budget that will incorporate your direction as well as the final adjustments and bring that back to your board for formal adoption this Thursday at a special meeting that will convene at 4 p.m.

So what you have before you is a copy of a letter summarizing my comments as well as another copy of the final budget adjustment letter and the copy that of a copy of the letter that was submitted by the supervisors related to the Alameda Health System.

We'd like to start today by providing you with yet some additional background information, a couple of updates related to the final budget adjustments to help both inform and frame your discussions and deliberations today.

So with that, we're going to start with just another brief overview.

And again, today we're at almost the final phase of your budget with deliberations and direction to the county administrator and final adoption on Thursday.

We want to just call attention again to the pressure environment that your board is operating under with stakeholder pressures, fiscal pressures, policy pressures, as well as external stakeholder input and your board initiatives.

Again, emphasizing that these are interrelated, definitely not in independent, and our competing priorities for the same resources, staff capacity, and leadership attention.

The goal is to balance our immediate operational demands with long-term strategic goals, and our challenge is to remain fiscally responsible, policy compliant, responsive to stakeholders and aligned with your board's priorities while continuing to deliver high quality services to our residents throughout the county with that we're going to just quickly provide an overview of the budget that's under your consideration and provide some additional context related to Measure W as well as Alameda Health System.

The fiscal year 2627 proposed budget totals approximately 6.7 billion across all funds the general fund budgets totals approximately 4.3 billion and the proposed budget includes over 10,400 full time equivalent positions representing a reduction of approximately 45 full time equivalent positions compared to the prior year.

The proposed budget includes approximately 1.25 billion in contracts with 271 community based organizations.

These partnerships support healthcare behavioral health housing social services public safety programs and other community here we see the uh the uh budget of CBO contracts over time and you can see that uh the proportion of the value of health program contracts administered by CPOs compared to the other program areas just to recap some of the Measure W information this is your board's policy approved policies that govern how Measure W revenues are managed and allocated um as we went over yesterday and this represents the home together fund budget um in AC Health and here we have the total HH budget that includes um the home together investments and as uh as noted here this also includes that 5.5 million dollars in new Prop one back bill which is included in the final adjustments the um FY 2627 essential county services fund um budget allocates 58.7 million dollars total including the 20 million dollars in estimated excess measure w sales tax receipts which are currently unallocated and those are represented in both the total and the basic needs category as a reminder your board heard testimony at your April 28th work session from a variety of community providers and it is captured here in the request that came from the senior services coalition as well as the other community groups that came to speak before the board those requests total 19 million dollars and represent a continuation of programs that were funded in the 2526 Measure W Essential County Services Fund budget.

In follow up to your questions yesterday about the contracts specifically in social services this represents um those specific contracts um the first one is a um $2.2 million dollars in social services and uh for the information we got from social services, those contracts are expiring at the end of this month, and a new RP is in process with the start date of July 1st.

30 out of the 77 contracts are being extended with a temporary six month extension.

That second line is a new ASC.

So it doesn't support existing and existing allocation in the 2526 budget.

The third, the 1.7 million dollars supports those 14 contracts, and they will also have a temporary six-month extension through the end of the year.

And then the emergency prepared meals program, that contract expires on at the end of June 2027.

And you can see the expiration dates of those additional contracts there, which is not June 30 of 2026.

And the Social Services Director is here if you have additional questions.

This next slide represents the county's investment in Alameda Health System.

As you can see, the top part of the table is are the contracts that we have with the hospital system, totaling 170.35 million dollars.

The bottom portion is our financial agreements with the hospital.

We return $7 million to them annually, which was initially part of a capital designation that came to the county to help with the acute tower replacement debt service, but we now provide it back to them to support the electronic health record project.

We pay approximately 50 million dollars annually on our debt service for the Highland Acute Tower Replacement Project.

And the hospital system has a net negative balance limit of 100 million dollars at June 30 of the fiscal year, but uh within the year they have the ability to borrow up to 200 million dollars.

Um the agreement is that they bring it down to the 100 million dollars by June 30 of the at the end of the fiscal year.

So in total, we have uh investments of 327.35 million dollars with the Alameda Health System.

And just to note, those are direct investments through the county.

And in addition, as you know, AHS receives directly 75% of the measure receives.

Probably close to $150 million annually.

And to review at the end of our hearing yesterday, um county administrator Miranishi will will review the letter that was submitted.

So attached in your packet is the letter that you received yesterday from Supervisors Miley and Fortinato Bass.

And we wanted just to highlight and summarize um the recommendations and the um content of that letter, but essentially it was a request that your board consider investing up to an additional 19.3 one-time funding for Alameda Health System to eliminate the remaining 92 proposed layoffs that they have as part of their budget balancing plan, and that you direct the county administrator to work with the auditor and AC Health Director to identify one-time funding options for the upcoming year.

There was also a provision that AHS conduct an independent performance audit with an outside firm, that there be an extension of the partial hospitalization intensive outpatient behavioral health program through October 31 of 2026, that uh AHS operations be stabilized and strengthened by convening a planning group to evaluate the long-term feasibility of the PHP IOP services, and that the board oversight be continued through continuation of the AHS ad hoc committee that has been convened by supervisors Miley and Fortinato Bass.

And that finally, if the PHP IOP program is determined not to be feasible, that there be insured continuity of patient care and support of the staff who would be impacted by layoffs without the county's intervention.

So those are the items that are before your board for discussion and deliberation today.

As noted, your official public hearing is closed.

Today is an opportunity for your board to discuss and deliberate amongst yourselves and to request additional information or questions from staff.

And as you know, most of the department heads are present or available to respond to questions as is the AHS CEO in the audience today.

Thank you.

Let's bring it back for deliberations.

Who would care to start?

Supervisor Miley.

Sure, thank you.

Uh President Halbert.

Yeah, thanks a lot.

And um, as it's uh to be said, appreciate the county administrator, her team, and the county uh agency and department heads for all the work on the on the budget.

Um, you know, I've had the benefit of sitting through 26 of these uh budgets since I've been a county supervisor.

Um, and we continue to do justice, I think, and provide the necessary safety net services to the county uh population that is so deserving, as well as to support our our work, our workforce, frontline workers and others, and uh to rely on our community-based organizations to help us provide the services we need to provide to the um to the client population.

The um initially uh before I talk about AHS, I I just want to be reassured that the funding for the triple A contracts, uh that funding is if the uh HC director, so services director could approach the mic.

Um I know I can see you out of my peripheral vision.

Um the um those contracts, triple A contracts are being extended by six months, and then the additional funding for the balance of the fiscal year is committed and will be available.

Can you put us slide back up again, Annie?

Um while Amy brings a slide up, Andrea Ford Agency Director for Social Services.

So yes, um, this slide explains the funding that will be available.

Um, in addition, I have a few updates about the pending RFPs.

Um, the senior injury prevention and health promotion, um, anticipated award date will be July 10th, 2026.

Um, Cal Fresh outreach anticipated award date will be July 14th of this year.

Telephone reassure and visiting July 14th is the anticipated award date, supportive services, adult day care case management.

They receive a six-month extension, legal services, elder abuse prevention transportation, anticipated award date August 7th of 2026, senior center activities, August 7th is the anticipated award date, nutrition services, six-month extension, July 1st, 2026 is the anticipated award date.

Family caregiver support program, six-month extension, June 26th is the anticipated award date of the RFP.

And so far, um, three RFPs have been awarded.

I miss the ombudsman, information and assistance awarded contract on July 14th.

I mean, it'll be on your board's agenda on July 14th, then a health and Medicare advocacy and information awarded and contracted.

Okay, well, hopefully that gives those CBOs the assurance that they can move ahead with their staffing, with their obligations, recognizing that not only are their contracts being extended, but there'll be funds available for them to compete for through the balance of the fiscal year.

That's yes.

Okay.

Because I do think it's it's refreshing when the board is um so attuned to the needs of older adults.

I really like that.

And I can just sit back and relax because a lot of the the advocacy was already done and is being handled.

So I think you understand how we feel about those contracts.

Yeah and as the agency director over golden aging services I feel the same way.

Good excellent excellent and I know my colleagues will probably ask a little bit more about the food recovery and American services and that sort of thing.

I'll leave that up to them now and then I know this isn't is on you but I know with the uh bridge funding for bring the other agency director up you can sit down now thank you Andrea yes.

So the bridge because we haven't talked about this because it's baked and we're good to go the bridge funding for the CBOs who are relying on funding for preventive mental health that is solid and moving forward.

Yes supervisor your board approved on June 2nd 37 million dollars in bridge funding um and that covers a wide variety of uh prevention programs that um including well I won't talk about the UELP because that went as a part of the uh BHSA plan but that covers uh the vast majority of the cuts that we were anticipating and the other um entities that were concerned about their contracts um that they're not being cut right the UELP providers uh so we've talked about them a couple of times those are the cohort of providers that opted into early intervention which uh their funding is not cut for this year uh ACBH will uh hold them harmless for uh as they transition to um early intervention which will actually set them up for billing in the future which we think is a more sustainable path right and and we're doing this because we as you said we feel it's a more sustainable path we've got to comply with uh Prop One and we're just and we want to do the best we can to continue to support those CBOs both their staffing and their ability to deliver services but they've got to transition to um billable and and we're going to provide them with the technical assistance.

And behavioral health has uh set up a technical assistance team specifically to support uh with that transition um and then separately as I shared yesterday our public health department will also be convening um some uh groups specific to prevention so that we can think about how to leverage any state resources that might be available okay thank you we can have a seat so now for the the the big kahuna that's in the room like you know James Jackson I don't mean health systems and my good friend Jeanette Dong who used to work for the county and I've known Jeanette since her time is working at the city of Oakland Mary Harris and I've got her smiling over there.

So I just want to point out that we appreciate the work of Valamita Health Systems um both your executive team your staff and the work of um the bargaining units uh at uh age and I appreciate the work that uh supervisor uh Fortunato Boss uh is um collaborated with me on the ad hoc committee and also you know her chief of staff uh Dave Brown and Aaron Armstrong my deputy staff to help us with all of this.

It's been a herculean uh task, but um we're we're here.

And we do value the need of AHS to be um fiscally sound and to be able to deliver the services it delivers and to ensure um that you the frontline workers are secure in their in their jobs.

And I think that's one reason why Supervisor Bass and I are coming forward with this request to the board for this 19.3 million dollars.

Because you know we're all in this together and we didn't produce this the situation that caused the fact that HS has these challenges.

Some of it is in external to our control with HR1 for instance.

But because we're all in this together the county HS, which is theoretically it's independent but it's an extension of the county, particularly since we have the 17,000 obligation to provide safety net services around health care here in the county.

And so we need to look at that very uh carefully and ensure that that's happening.

So and we want to make sure that there I think we all value labor peace.

We all value that in Alameda County you know we've we've often said Alameda County is a labor county.

You know we hold ourselves to that um standard and that it and that value so in order to ensure your ability to to balance your budget to ensure labor peace to ensure um support for our frontline workers and to ensure the continuity of services I think Supervisor Bass and I have worked hard with you labor uh our staff the county administrator as well as um the agency director uh and in some cases even the county auditor um although she likes to stay in the background but she's there uh to try to come up with a package that is really sound and it's also understanding if the board comes forward with this 19.3 million dollars that will um forestall any reduction in force for these 92 workers for an entire year it will also provide a built the ability to transition uh the IOP it will also allow us to continue our work as the ad hoc to look at not just the present situation but we you know we need to look be looking two and three years down the road for the next uh couple of fiscal years uh trying to adjust this and we do recognize that this isn't just AHS we need to look at this in the context of I mean the health systems our federally qualified clinics our CBOs that deliver health services of the alliance um and then labor we need to all be looking at this comprehensively in terms in terms of of the safety net services for health health uh services here in the county so the ad hoc we we're taking on that um that burden that responsibility that heavy lift um because um supervisor bass um is up for the challenge and I'm up to uh uh collaborate with her around that challenge um so with all that being said that's and again I'm framing this that's why uh we really feel the board needs to come up with this 19.3 um I think it's also and we're not telling the county administrator where to get the funding from we're just saying we want the funding to be provided to HS the 19.3 million and then AHS will deal with um balancing your budget um around the additional resources that you need and then it's also understanding HS has passed their budget but they will be coming back uh to their board of trustees in September to once again review and um uh their budget and determine if there's any adjustments that need to be made and then we'll be looking at that again at our health committee supervisor TAM and I in September as well so we've got both the ad hoc committee working on this and we got the health committee uh monitoring it and tracking this as well.

So that provides some of the framework for this around AHS.

So I'm hoping that uh the board uh supports this, and then AHS has done some efficiency uh reviews, and since we started down this road, has come up with about 30 million dollars in efficiencies to address uh some of its deficit.

But I think it will continue to work on efficiencies, but that's another reason why we're um putting in our proposal the idea of having a performance audit and efficiency review of HS to see if there's any further efficiencies that can be ascertained, but even more importantly, to try to build confidence and support among HS management and its bargaining units, uh its frontline workers that efficiencies are being looked at and being looked at from an objective perspective and from a perspective of which all can uh hopefully have some assurance that the information provided is accurate information.

Uh, and so that's another reason why we're proposing other performance audit and the efficiency study.

So, and the final thing I would say about AHS, AHS has stepped up.

Um, I know being on the board and then with Supervisor Marquez joining us on the board, you know, there's there was a strong push to stabilize St.

Rose.

I know since I've been here, uh Supervisor Steele carried that burden for many years, and then supervisor uh Valley, and then um Supervisor Marquez finally was able to get it into a position within the county family through HS and AHS stepped up in you're doing that.

So you've been a very good partner.

So I think it's incumbent upon the county to do what we can to be a partner and supportive of AHS uh in this time of challenge.

So that's some of my framework at the moment.

I don't know if um uh the if James Saxon wants to say anything at the moment, or if you want to wait until Supervisor Bass has a chance to weigh in on this.

But with that, I would recommend that we all maybe have a couple of comments and then uh because we all have comments.

All right, uh yes, Mr.

President, if that's okay.

Mr.

President, I always elders and I always respect my president, Supervisor Fortinata Bass.

Thank you, President Halbert.

Um, I wanted to touch on a few topics, but I'll start with Alameda Health System and our board letters since um Supervisor Miley kicked that off.

Um, I will just add that providing health care, especially to those who are uninsured who are um not able to um have the benefit of private insurance.

Um, you know, that's really one of our most important tasks as a safety net system, and so really investing in our public hospital system as well as the broader health ecosystem is really important, and HR1 is causing seismic shifts, which we are just starting to see.

I think that uh this board letter and hopefully the board's approval will allow us to really set the stage for better preparing ourselves for what's to come and for having a much more uh collaborative process than we've been able to have, given how some of these impacts have been felt and how things rolled out.

So I concur with my colleague that this is really about um shoring up our safety net, looking to the future and making sure that moving forward, all of us as stakeholders, the county, AHS, our labor partners, that we can all work together uh transparently and collaboratively to solve these problems together, and they will likely be even harder than they have been over these past few months in order to address how things are changing.

Um, secondly, I wanted to just highlight a few things in the board letter.

Uh, we have not yet had a formal report back to the board on what this ad hoc has done over the course of four meetings, and so I'll try to do this quickly since it's already in writing.

Um, in November, uh the board of trustees at Alameda Health System approved a reduction of force of 372 employees, and then our board, as required by law, conducted our B.

Lenson hearing that was in February, and we also had another uh meeting that uh concluded that process in March.

And so with our board direction during that here, those hearings, we were able to move forward with a number of things, including the creation of the ad hoc committee as well as some additional county investments.

One of them our county administrator touched upon, which is our net negative balance or a line of credit.

So increasing that limit, as well as allowing for a higher intra-year maximum and allowing a foregoing of the five million in annual debt payments.

So again, that credit line increased by 100 million.

In addition to that, we also reduce the AHS behavioral health funding withhold from 20% to 10%, which provided approximately $8 million in additional cash flow.

Now at the ad hoc meeting, there were a lot, there was a lot of discussion about additional revenue generating strategies.

I won't go into everything that we discussed, but there were a number of items that were brought forward by labor, which we had discussed in terms of additional services that could be provided with new revenue, also coming along with that.

The CAF lab in particular is one where there is additional room for demand.

We brought in the Alameda Alliance, and they were able to increase the reimbursement rates by an additional 1% in July of this year and 1% in January of next year, which is resulting in an estimated $3.2 million in revenue.

So all of that has been factoring into this process.

We've looked at billing optimization and revenue cycle improvements.

That work is still ongoing.

There have been a number of meetings as well as a task force that AHS has convened.

There have also been performance improvement initiatives.

And these initiatives have been able to generate about, well, almost 30 million dollars to help close the deficit that AHS has.

We talked about cost savings strategies, including lease consolidation.

So AHS will be exploring ways to reduce future leases.

Some of them don't expire until next year, as well as exploring ways that they could house more of their operations on county properties.

And then we also looked at the executive bonus policy and AHS confirmed that there were no bonuses paid this current fiscal year and there will be no bonuses paid next fiscal year.

We also talked about increasing transparency around that policy, which they are considering considering.

So where we are today is that, as you heard from the introduction of the letter, there are currently 92 remaining reductions in force.

That's FTEs, which our board action could address.

So that's the information we have.

We discuss extending the IOP PHP program for four months.

As I said yesterday, there's a group that has already met once and that will meet my office and my staff in particular, are certainly available and willing to support Alameda Health in whatever it needs to move that process forward.

So I believe that's a summary of most of the items.

And I do want to clarify that because somebody asked, in terms of the funds that need to be identified for the up to 19.3 million, we do not anticipate that any measure W funds would be utilized.

I want to make that clear.

I certainly don't support that.

I want us to be able to look at other funds because we have had many, many conversations about how to add that.

So in summary, we have done a lot of work.

It's been a very rigorous process, and I think that this board letter really sets us up for more collaboration and more board engagement engagement of all the partners in the future so that we can really weather this unprecedented storm that our health system is going through um President Halbert I have at least one question on the measure W slides I have other comments but I can hold them until everyone has a chance to speak.

Supervisor Marquez oh can I actually can I just ask the measure W question so um thank you to the county administrator in terms of clarifying the Measure W Essential County Services Fund and that estimated overage of 20 million being included in the budget that is in front of us for adoption in regards to the slide with the 19 million allocation thank you for sharing that um we had talked on April 28th at our work session and then again on May 19th at our work session and the total I have on those slides is 19.5 million so it looks like there is a triple A Senior Community Services employment program allocation of 5000 that is not included that is not a contract our social services agency has so that um that would be a new service um andrea has more information about maybe where that came from our understanding is that's a a city of oakland program not a county program.

Okay.

Good afternoon again Andrea Ford agency director is an employment program that used to be run out of the triple A and it was taken over by California Department of Aging.

So we no longer run that employment program in social services and I don't think we should be funding the city of Oakland to run their program.

Thanks for that clarity.

Is that conclude your comments for now Supervisor Marquez uh thank you President Howard again thank you to everyone who's worked uh tirelessly this entire year on this budget it's been an innovative process and a lot has occurred so um proud of the good work um and more obviously for us to still um attend to but just want to highlight a couple things that I want to make sure I flag um we talked yesterday about uh the idea of updating our master fee schedule uh before the end of the year want to thank supervisor Fortano Bass for also flagging the assessment of pills application and reevaluating that I believe uh supervisor Miley brought up the environmental fees for environmental health services and um so definitely want to see us work on that um in this upcoming year and then we also talked about our operational reserves being at five percent so I'd like to also respectfully have a plan come back to us to get that up to the 16% level at least a plan to get as close as we can um it's really important that we have um that level of resiliency and sustainability we don't know what's gonna happen in the general election in November so just kind of have to brace ourselves for that impact so it's really important that we get ahead of these issues as much as we can.

With respect to the uh senior coalition and their advocacy thank you Wendy Peterson for being here thank you to staff for clarifying where we're at with the contracts the timeline the extension the uh 20 million dollars being captured in the budget for the excess funds for measure W.

So I'm I'm satisfied with that.

I do, however, want to flag um we know that seniors are the fastest growing population in our county.

And um, to Supervisor Miley's point, it is really difficult to see every year.

I feel like that coalition is constantly advocating for um really a nominal amount of money in comparison to our total budget.

So I would like us to look at what are we going to do to deepen and provide more meaningful investment to our seniors and aging population.

So something that we need to look closely at in the upcoming year.

Um, also just want to put on everyone's radar next Tuesday, June 30th.

We're going to receive a presentation and an update from our reparations commission.

And so just want to put that on everyone's radar to be mindful of that meaningful work.

I know that it's captured under our um board priorities, but we um excited and honored that our county is taking this seriously, despite what's happening in the federal level, and obviously we aren't taking action on that today, but just want to make sure that that stays top of mind for all of us, and we will hear from the commissioners that have dedicated hours and hours of time doing that work with the listening sessions in the community.

Just want to thank everybody for their engagement on that, and um, also proud of the work that this entire body has done with respect to the Russell City redress fund.

Um, so wanted to flag that with respect to, and then the lastly, before I get into the board letter brought forward by my colleagues, um, also really pleased to hear the advancement for the work for the office of immigrant refugee affairs.

We've got the 3.3 million contract extension captured here.

As I mentioned yesterday, we'll be receiving an update on the current contracts at our act committee on July 16th, and then a full presentation so the entire board can learn the work of the implementation study done by our consultants and supported philanthropy.

That will take place on July 28th.

So, also exciting that that work is advancing.

Um, with respect to the board letter, the 19.3 million, um, it says up to.

So, what are going to be like the checks and balance?

If we could just kind of have a sense of how much we're actually going to have to draw down, um, I'm really uh pleased to see the performance evaluation and efficiency savings.

I think that's going to be critical as we see with the budget projections in the upcoming years.

We're projecting a deficit for the next five years.

So we are going to continue to have some hard conversations, and I do think it's important that we discuss and look at every role entity in this discussion.

Like, what are we all doing to help resolve this?

Because it's it's going to take all of us.

And um, I am struggling with the fact that I want to provide these services to the patients to the community, but the asks keep on coming, the hits keep on coming.

I'm even saying I'm bringing up initiatives that we don't even know exactly what the funding is.

So this is just going to be a really difficult year for us.

So we are going to have to show some restraint.

I know that's hard to say and hard to do, um, but I think it's something we have to start preparing for.

Uh, so just want us to be mindful of that, and then with respect to wanted clarification on the ask for the um intensive outpatient services in the board letter, it's for four months, but I know many of the people that were calling and advocating were requesting for a six months.

So I don't know if we have clarity around that.

So that is a question I have.

I'm gonna answer that.

I think between Supervisor Bass and I we can answer the question.

First of all, the 19.3 million, we're not designating that so much go to these different things, but we do know 92 people need to retain their jobs.

That's gonna be about 17 to 18 million right there for the entire year.

And so that would leave a balance of about 2.3 million dollars that would have to be spread out to deal with the IOP and the performance.

But let me pass a baton to Supervisor Bass.

That is exactly right.

Um, in terms of, yeah, that's exactly right in terms of the um up to amount for 19.3.

In terms of the PHP IOP program, you know, I have um met with a number of those workers.

Um we have heard a lot of them speak at our meetings as well.

Um it is a very important.

Uh both myself and Supervisor Miley um separately have also had conversations with our professional staff, our behavioral health uh team as well as our um our um AC Health Director.

And um, you know, to be honest, it was a bit of a compromise in terms of um what we think we can do and how long it would take to do a feasibility study to look very closely at uh what the options are for continuity for financial viability, etc.

We have been getting a lot of um information around revenue generation in particular.

That's one of the items we want to dig deeper into.

So um I personally was hoping we could keep it going longer, but we have ended up having to compromise um among the various parties, okay.

And certainly I will say um my staff is very, very eager and ready, willing, and able to support with that feasibility study and to work with the various stakeholders because we want we we care very deeply about that program too.

Okay, thank you for that work.

Um, with respect to extending the ad hoc, do we know for how long?

I think we're gonna probably need to extend the ad hoc for at least the next two fiscal years, I think 27, 28, 28, 29.

And yeah, and I think by November 2028, we'll know if there's a new administration, and with the ad hoc, potentially would be able to conclude uh June 30th of 2029.

Okay, yeah.

So I'm thinking at least the next two fiscal years.

Okay.

And then do we have a list?

Not today, but can we be provided a list of the 92 positions that will remain intact?

Do we have that?

Welcome.

Thank you very much.

Good afternoon, Supervisors James Jackson, CEO of the Media Health System.

We can provide that list.

I do not know that we have provided this specific list thus far, but that's certainly something that we can provide.

Let me just say, too.

Um, Supervisor Bass, or um, Mr.

Jackson can chime in.

The 92 covers all of the uh bargaining units, and then there's an additional 28 that are in the IOP that are being covered as well with the extension over the next four, you know, four months could be a little bit longer.

It just depends.

Yeah.

So that's 123 people, yeah, or 120 people.

That um provides clarity.

Um, and again, uh, I do agree, you know, we want to maintain the entire healthcare ecosystem.

We've fought really hard.

Um, no more questions for you.

Thank you, Mr.

Jackson.

Um, and do appreciate Alameda Health System's support and the affiliation with St.

Rose Hospital.

So I think these conversations are timely and it just shows you how quickly the landscape changes, you know, within the last year.

So this is a moving target.

So I do appreciate everyone's involvement.

Um, but I do think, you know, we're gonna have to continue to have hard conversations, and at some point, we're gonna have to like dig deeper and explore other options, uh, because I'm just I'm fearful of uh setting the precedent that we're always going to be the answer because I we don't know what's coming, right?

So I just I just want to caution us with that.

That's all.

Thank you.

Finish.

Yep.

Supervisor Tam, join us, thank you, President Albert.

Um, yes, I have served on the um finance and budget committee with you for the last year, the social service, and also the health committee.

Um, so there's uh some issues that I have a deeper dive and understanding of what that was presented uh based on yesterday's public comment.

But first off, I want to appreciate um the sacrifices and the hard work that went into closing this 91.4 million budget deficit that would have been more than twice that amount had we not done some prudent planning, or the board prior boards have done some prudent planning uh combination with one-time funding and the elimination of 45 positions, which I know comes mostly almost half of it comes from the Alameda County Health Department.

So this budget provides bridge funding from the Alameda County Health to the community-based organizations that will transition from prevention to early intervention, backfilling funding that would not qualify under proposition one, and we've incorporated most of the 23 recommendations from the care first jails last initiative into the three-year behavioral health plan that was reported and presented at the health committee and the home together plan with housing for justice-involved individuals.

We talked about a staffing study at Santa Rita jail and also added the standalone 36 million dollar in the forensic plan that was presented in the public safety budget.

And this budget also protects our safety net services from HR1 with Measure W.

And I would support a greater connection and collaboration and nexus between the work that we're doing uh with the immigrant community under Measure W with some of our UELP providers in the long term.

And I think we protected the most vulnerable populations by funding the rest of its centers for the unhoused by providing compassionate care for those that have terminal illnesses or chronic conditions.

We also invested in the African American Wellness Hub to the tune of almost 30 million dollars to address health disparities.

With this board letter that's being presented with Supervisor Miley and Supervisor Fortunatabas, and I really appreciate their work in convening the meetings and trying to get at uh solutions that we can see today.

Um but essentially we're being asked to shift a quarter of AHS's deficit to the county, uh, asking us to close instead of a 91.4 million dollar budget deficit to add 19.3 million dollars or 110 million dollars at the county level.

And so I just have some questions about uh that effort because you know I agree with everyone, uh health care for all is a priority for the county, it is core to our uh mission and our reason for being, but we need to understand how we can sustain this.

And so I'd like to understand um maybe like three or four questions that I have about the board letter.

Um, it was noted that we raised the NNB by 100 million dollars, so now AHS has access to 200 million dollars, and how much do they intend to use uh in this coming year to address some of their budget uh shortfalls?

And then we also heard from the May revise that the um state senate and state assembly will be delaying the program cuts to Medical to July 1st of 2027.

Um, and hopefully soften the impacts of HR1 to AHS.

And more importantly, I'd like to understand the potential sources of funding for the 19.3 that we're asking both the Alameda County Health Director and the auditor controller to identify funding options to provide that one time supplemental allocation because after yesterday's presentation by the auditor on the CAFR, we don't seem to have the two months of operating cost in reserves while we're also facing rising costs of risk and in insurance, and we have some exorbital settlements that we are having to pay out right now, and I want to also understand like the uh configuration of the ad hoc committee when we formed it after the Bullenston hearing, it was uh primarily with Supervisor Fortunato Bass and Miley, because well um they don't serve in committees together.

There wasn't going to be a Brown Act issue.

But going forward, if this is a standing ad hoc committee, uh is it going to follow the Brown Act with the noticing?

Is it going to be open to the public?

And will they offer uh opportunities for the public to comment as well?

So those are my questions on the board letter.

There was a couple of questions in a row there, why don't we unpack those?

Do you want to ask the specific ones one by one of AHS?

Dr.

Jackson, or do you want to separate questions for him separate from staff?

You asked a few different questions in there.

Right.

So the first one was um we had just raised the NNB uh back in March to by a hundred million dollars.

How much of that do you intend to use?

Let's take the questions for Dr.

Jackson now, and um, then let him sit back down, and you can ask uh questions of staff after after that if there are any.

So NNBs.

Certainly, and umbert, thank you for the deference, but I I am not a physician.

I my father was, but I am not a physician.

But I I appreciate the second time I've done that, isn't it?

It's okay.

Yeah, that's right.

I don't mind.

I don't mind, but I just want to be clear.

Very good.

Um, so to your question, Supervisor uh Tam.

Our intent is to not use any of the NNB to close our budget gap because we have operational costs, which our projections show over the next couple of years, we will reach and exceed without significant changes to our cost structure, the the ceiling that the new debt limit imposes.

And so we don't think it's fiscally prudent to close a budget gap with more debt, but our projections show that we're going to use the entirety of the additional space that was granted by virtue of the work of the uh county administrator in the course of the expenses that we believe were going to accrue over the next couple of years.

So, what happens to the uh 92 positions that we're saving now for one year going forward, and how is the NNB going to be used operationally to fund those positions?

Because I want to understand if it's a sustainable model that we're working with.

Sure.

So the positions um you've heard this before, I know, but 75% of our expenses are in labor.

So the vast preponderance of what we spend goes right in the payroll, and so we believe that to change our cost structure in a significant way, we've got to have less FTEs.

And the other piece of that is that you know, people drive AHS.

By no means are we suggesting we don't need people, but our volumes are only now approaching where they were pre-COVID.

So our staffing has continued to accelerate the numbers, but our volumes haven't, and we're only now back to the levels.

And so I want to assure the supervisors as there is a need for more staff and the volumes warrant that we're prepared to have more staff.

What we have seen is that our staffing has grown without a commensurate requirement because of the volumes that we're seeing.

And so I never want to suggest that we don't need people, people need jobs, and we need individuals to do this work, which it has to be done in a way that aligns, and that's what we're doing.

So to your question, we do believe that we can take this time that presuming the supervisors endorse the recommendation of the chairs of the ad hoc and use attrition, voluntary separation programs, such as the early retirement and the voluntary SEP um separation to let people choose to leave the organization as opposed to having to do a reduction in force, which is what we have been contemplating for the past six plus months.

And so we still intend to change our cost structure, but we intend to do it in with the runway that this would provide to do it in a way that is frankly less onerous on the individuals involved.

Yeah, and if I could just wait and um uh Mr.

Jackson is correct because our understanding, Supervisor Bass and I our understanding is you know, labor's position is this will allow for some conciliatory time so that potentially it can be um a systematic approach to maybe negotiations at the bargaining table so that uh we can achieve um a balanced budget in the future, but at this point, without this money, uh labor is not prepared to move forward with any you know uh consideration, any conciliatory uh steps uh and we can get into more detail around that, but that's the bottom line.

And so uh our feeling is we'd rather provide that runway, we'd rather keep labor peace, we'd rather keep people employed, providing services, and give the time for all sides to come together and negotiate something that um is um agreeable to you know to to all of us.

I appreciate that clarification.

Um so will the effect of the May revise in terms of the delay in the program cuts to Medical and the impacts on HR one will that also help lengthen your runway and help you evaluate, or is it because it didn't sound like uh the RIFs needed to be implemented at this moment, right?

You were looking at uh starting potentially the next fiscal year, but this will buy you an additional year with the 19.3, but will the um the slowdown in the HR1 impacts uh provide more um I guess runway time for you.

So um I I guess I would ask for more clarification about the slowdown in HR1 because we haven't seen a change in HR1 implementation.

And so these reductions in force were originally planned to take place on March 9th of this year.

Uh the supervisors in their wisdom asked that we delay that for the ad hoc process to take place and and we did, and so they were projected to take place at the beginning of the new fiscal year, which was going to be July 6th.

And so, and in full transparency, that's still kind of tracking because we believe that the supervisors will um take the action that has been contemplated, but we have to plan for the worst and hope for the best.

And so, assuming that the supervisors do endorse the plan that was put forward, then the rifts will not happen.

But we have maintained the cadence because if that were not to happen, we have to begin changing our cost structure.

What this action that you are considering does is it does bias the time that Supervisor Miley alluded to for us to allow for natural attrition and other methods of changing our cost structure.

Okay, thank you.

Certainly.

So the other two questions I had were for staff, um, is just to get a better understanding of what um what options we have with the 19.3, given that we uh we had a pretty extensive uh presentation on our CAFRE and the restrictions on our reserves and um the fact that we we don't even have the recommended two months of operating reserves and the fact that we're dealing with exorbital settlements.

Uh supervisor Tam, you're you're correct, and we uh also just closed a significant uh funding gap.

So um I think we will need some time to consider options.

Um we'll be looking at one-time funding, um, the NNB is in the line of credit that your board is extended, is certainly something that we would also be looking at and consistent with our policies.

We'll also be looking at the most restrictive funds.

Part of this is gonna rely on our year end and the extent to which there might be some unanticipated funds.

But again, as you know, the county has many needs, as do um county departments who have also uh requested supplemental funding.

So it will be a challenge, but we're committed to working together and come back with options for your board to consider.

Thank you.

And um to Supervisor Miley, did you intend at Supervisor Fortunata Bass that the ad hoc committee becomes like an AC for all committee with the board that's brown acted, noticed and open to the public?

We might have to go down that road eventually, but at the moment we're not intending uh it to be brown acted just yet, because uh supervisor bass and I need to um agree on the stakeholders who need to participate.

We need to get a sense of the scope uh as well as um the facilitation and things of that nature.

So ultimately we might come back to the board requesting that it become a standing committee, but at the moment we're just looking for the board to authorize the ad hoc to continue so that we can do the work necessary around um heavy lift, not just that what we're doing immediately, but over the next two to three uh fiscal years and not just with AHS, because I know you know this, uh the whole health system is in crisis because of HR one.

So we want to pull all of the stakeholders together to see how we can uh better uh address that whole ecosystem uh going forward.

So we possibly will be coming back to ask it to be a standing committee.

And then the other thing uh around the funding, Supervisor TAM, keep keep in mind that if the board doesn't provide the funding, and there's uncertainty and there's um uh uncertainty around delivery of services as well as uncertainty around job continuity.

Uh that you know that could bite us in the butt and provide even more challenges for us, um, of which we're trying to avoid.

I appreciate that.

Uh it's just I'm trying to uh reconcile the fact that we have the standing committees.

You and I serve on the health committee.

We we get briefings, uh extensive briefings, including a recommendations and adoption of the three-year mental health care services act funding.

We get updates from AHS on the budget, and so um uh obviously for me and and the reason I'm on the health care committee, it's a priority.

Uh our our whole health care ecosystem is a priority.

I have four, excuse me, three out of the four county hospitals in my district, and four out of the eight federally qualified health clinics are also in my district.

And as you saw earlier, we are supporting the health care ecosystem with what 327.35 million dollars from the county to the AHS, and then we have 74 million dollars in health pack funding for the FQs, which provide um the indigent care for those that are uninsured, whether they have no Medi-Cal, they have no private insurance, they have no Medicare, they don't have anything.

So I I'm just trying to understand our workload and and how uh we're making sure that the information is presented.

Oh, yes.

The um it it's my intent, and I think I've kind of talked it over with Supervisor Bass that whatever comes out of the this ad hoc, we will be bringing to the you know the health committee ultimately, but the ad hoc by being an ad hoc gives us more flexibility at the moment.

Um, and definitely we don't want to create any more uh forums and any more committees.

Uh, because even at one point in my conversations with um the health director, agency director, you know, we thought about my staff using the community advisory um uh group, uh community provider advisory group uh for this, but um thinking it through, we just think the ad hoc would probably be a better forum for this, and if we have that level of flexibility and it's not subject to the Brown Act initially, it just kind of gives us that that luxury to uh create the meetings, the agendas and things of that nature, and then like I said, ultimately anything we come up with that is related to the um health safety net will be coming to the health committee, and then depending on what uh what is advanced uh will ultimately be ultimately come to the full board.

Okay, thank you for the responses.

I see we have our county council possibly wanting to weigh in on this, Scott.

Okay, so I just wanted to point out that the uh an ad hoc committee is limited in time and limited in uh purpose, and the ad hoc committees you've been talking about extending uh in this week.

Uh both look like if they're not really limited in time or in subject, and that makes them look a lot more like a standing committee, which was subject to the Brown Act, and uh has to be public just like your other standing committees.

So um, in the early stages when you're trying to sort of work things out, I think you can continue to be an ad hoc committee, but if you're talking about three or four years, that's gonna be a standing committee, it's gonna have to be public.

What's that?

You let us know, county council when we need to become a standing committee.

I'll be on it.

Because I think we've got a isn't the finance committee ad hoc, the um we we have a couple of ad hoc committees, but I understand where we'll transition when you tell us we need to transition.

Because I always listen to the president of the board and county council.

I don't know.

I'm hearing that it's not uh standing, it's not a it's not ad hoc, it doesn't meet the definition of ad hoc today, other than it's preliminary.

When when it was formed, it it did.

If you're talking about it continuing it to 2029 on whatever subjects that looks a lot like a standing committee, so um perhaps as long as we don't take action to define it as that long, then it isn't that long.

Would that be okay?

But uh I hear your point that what we are going to be discussing the topics, um so yeah, you'll continue to keep us apprised.

Yes, we don't have to decide this today.

No, President Halbert, perhaps we could return to the board with an update before the end of the year so that we can evaluate the status of it.

I think that's fine.

Supervisor Tam pointed out that the health committee also does this.

Why don't we just have a committee of three and make that be uh the board, a quorum?

Fine, I get that, but anyway, the point the point is pick one or the other, but if we're going to do both for a while, that's fine.

But I hear her um comments and points that there's a lot of overlap.

Uh but uh uh let's just continue to hear a report by the end of the year.

Is that what the suggestion was, Supervisor?

That's my suggestion.

I mean, I do think things are pretty sensitive at this moment, and assuming the board uh does have a majority to pass this, we will need to sort of monitor things, you know.

There's the October 31st deadline for the feasibility study of the IOP.

Uh we do want to get the um performance audit going.

There are some things that I think we want to currently track, so coming back by the end of the year, I think would be a good touch point.

Yeah.

Uh just as a go ahead.

Just as a reminder, uh, we do have a committee of three to deal with HR1.

It's the joint social service and health committee, which um includes Supervisor Fortunata Bass, Supervisor Miley and myself.

It's not really done.

It can be done.

You're right.

We don't have to solve it today.

But your point is very well taken.

I have one more response.

Supervisor Tim, were there other um questions or comments?

And Supervisor Fortunately Bass would like to weigh in on comments already made.

Um yes, um, I thought it might be helpful uh to hear a perspective from labor since the ad hoc on AHS involved the county, AHS and Labor.

Um it might be helpful to hear their perspective very briefly.

And we do have Maria Betancourt, who's the president of SEIU 10 to 1 on Zoom.

If we're able to um if she raises her hand and we can unmute her, I think she could provide a perspective so the board has a more well-rounded um more well rounded information, Maria Bencourt to raise her hand and then promote her to a speaker.

Maria, you can unmute.

Hi, thank you, um, supervisors.

My name is Maria Betcourt.

I'm a specialist clerk at John George and a proud SCIU member, also the chapter president for SEIU.

And I'm here to request that you support the work of the ad hoc committee led by the supervisors, um, Bass and Miley to reduce impacts of the cuts and layoffs at AHS.

After months of meeting and deliberations, we asked that you support the request to provide funds to reduce the number of impacted members and workers and to the services.

Um, while HR1 will continue to have negative impacts on our social safety net, we call on the leadership of the county to help support much-needed health care services for Alameda County residents.

We call on the state also to ensure that we have local resources to help keep our local public hospitals open and available to everybody.

Only through our partnership at the local, state and federal level can we turn the tide on these attacks on our safety net.

We ask that you help us keep as many healthcare workers' services open and valuable people employed while we fight the cruelty of the HR1 cuts.

Um I don't know if any of the supervisors have any questions for me.

I am on the ad hoc committee.

I'm I'm part of it.

Um, you know, with Peter and other folks from labor.

So if you have any questions, I mean I can answer whatever you guys ask.

Supervisor Tam, do you have any questions of uh yeah, in your opinion, how has the ad hoc committee been working in terms of trying to get a meeting of the minds on some of the operational efficiencies and things like collection?

Um I think at first the first few meetings, um, if I'm gonna be really honest about how I felt about it, felt like they weren't going anywhere in the beginning, not until I think we were able to to show some inefficiencies, and it seemed like people were more willing to listen.

So I think at this point it has become helpful.

Yes, the first two I didn't feel like went too well, but I do feel like having the ad hoc committee is gonna help us long term, and you're optimistic.

Go ahead.

You're optimistic that uh you can find or the ad hoc committee collectively can find um uh the savings that would offset the deficits that are anticipated.

I mean, that's the hope.

I think what what's really good about the ad hoc is that the transparency that it brings having supervisors, HS leadership, and labor present.

Would you have a problem if it was a brown Act of committee?

Um I mean, I don't know what what well that that means increasing the transparency.

That means it gets noticed.

It I guess get um there's opportunities of participation both virtually and in person.

I mean, I I don't think I would have an objection to that.

Okay.

Thank you.

Of course.

I no, I don't have any further questions on the board letter.

Okay.

Well, um, so I have questions.

Uh well, I have a few comments to make, and then I have some questions of the about the board letter as well.

So, um, first of all, I don't know, we have 15 or 20 professionals over here working around the clock.

We started in December.

We had ongoing meetings periodically in the months of February and March.

This month alone, we've had numerous meetings, countless hours.

I don't know how many trees we used a lot.

There's a lot of work that goes into this budget.

There's a lot of work that goes into this budget preparation and analysis every single year, binders, binders, binders, a lot of work that goes into this.

In addition, this year we had a lot more megabytes and bits of information downloaded to our website.

So a lot of people able to see without having to print everything out.

Uh that's because uh our staff worked really hard.

So thank you for doing that.

I am also continually impressed that we have different ways of looking at the information.

Um, in fact, today some things just sort of popped, and I don't know if I missed them before, but they popped.

Could we put up the slide four from the presentation?

And here we show 2025-26, 6.14 billion dollars spent.

Our proposed budget, six point seven billion dollars.

Taxpayers of Alameda County funds, federal government funds, state funds.

We know how vulnerable we are to the federal cuts, but yet a 569, 570 million dollar increase, nine point three percent.

I still can't get us to put the percent change, but I have a calculator nine point three percent change in spending this year.

Yes, we have pressures from HR one cuts, but we're spending 9.3% more, five hundred and seventy million dollars more.

And how are we able to do that?

The generosity, I'm assuming this measure w is in these numbers, the generosity of our community that allows us to do this so that we can adequately fund the safety net services that we are mandated to provide, so that we can fund the unfunded mandates that are placed upon us.

This includes discretionary funding, so we're able to fund the discretionary projects that we choose to fund, even though some people feel we shouldn't be able to do that.

I would say nobody knows our community better than us, and we know those groups that deserve discretionary funds, and we work hard to make that happen, but it becomes comes from the generosity of our community.

That said, I also like to turn to slide six, two more slides, and this is also very illuminating.

These are just the CBO contracts, and we see health care services.

I mean, back, I know COVID was 2021, 21, 22, 22, 23, but look at it from 500 million in 2223 to 900 million, almost double in CBO contracts in healthcare services, the others somewhat flat, but um we've seen an explosion there, it's not without the generosity of our community that we are able to provide that.

But indeed, we have disastrous cuts from HR 1.

Some would call them almost emergency levels.

It's good that we have Measure W, but if we're not continually prudent with the dollars that we have, and if we're not continually questioning the dollars that we have to spend, we may not get the next measure W.

And I'm concerned about that, and so I'm thankful that Supervisor Miley and Fort Senato Bass did this board letter, which not only preserves jobs, important jobs, jobs by people that came and spoke to us about their jobs and what they do at the Baylinson hearing that have come continually to our committees, called us, called the on us individual offices, had Zoom meetings.

I see some members in the audience today that have been on Zoom with me, fighting for their jobs, important to do, and bringing the board letter that provides temporary relief to maintain those jobs, but it's going to be imperative, and even though we have measure W, we should be acting as if it's an emergency that we find efficiencies across our system.

Now, questions I have for our, was it the president of the SEIU?

The lady, and Dr.

Mr.

Jackson.

And the crossover between behavioral health.

So I'm just going to come out and say it.

I absolutely support finding efficiencies at AHS.

I've talked with Mr.

Jackson.

He's already found 28, 30 million dollars.

Can we find more?

He has a great um go get them attitude.

Yes, we should be always looking for more.

If another company is willing to help us do that, then why shouldn't we look at it, especially if the county's going to pay for it?

Um, that's great.

And it's the right thing to do optically that we are going to be looking at under every rock.

If we're not in the situation that we're in today financially with cuts, what message does that send?

They've already done a lot, we're going to continue to do more.

But I just have to understand and believe that we're not going to scratch the surface of the cuts that we could find, not cuts the efficiencies we could find if we consider PHP IOP and behavioral health and synergies with our own county behavioral health.

When I heard at the um the Allenson meetings, workers at AHS describing what they do and its social work functions that they provide, and God bless them for doing that, because we have people in a very vulnerable situation at the hospital, and they're there for medical attention, but they're getting great connections to services.

That's social service work being done in our hospitals.

The crossover, the interconnectedness, the linkage between our hospital system, our health team, and our social services team.

It's inextricably linked, and I don't know that we're going to be successful.

I hope we are, but I think we would be more successful if we viewed this board letter through the lens of a more holistic approach.

That does not mean necessarily taking every county agency and department through an efficiency review, although I think that's needed.

I'll separate the two.

That's one thing I was pleasantly surprised to learn we already do a lot of that by ourselves.

I did not know that our county administrator is going to be providing us information that outlines some of that, but I still believe that we should be looking at across the board efficiencies, but at least as it relates to this board letter, which is before us, I don't see how we should reasonably limit a study of efficiencies to just AHS without exploring the linkages to public health and social services.

So that would be a question for Mr.

Jackson and a question for the member of the ad hoc committee, the president of SEIU.

What will be what would be the benefits or not, the disadvantages or advantages, the pros and cons.

Should we or shouldn't we be pushing for an efficiency review including the linkage with the departments that I mentioned?

Please, your position.

As it pertains to behavioral health, I I welcome that opportunity.

I will never disparage the work that they do.

Their work is extraordinarily valuable.

And you've never heard me say anything differently, and you won't, because I I understand the value of that program.

I've had family members who have benefited from that program.

So that's a personal note, but I just want to share that professionally, personally, I see the value.

I am also the steward of scarce resources, and I can't, in good conscience, indefinitely endorse a program that we cannot see a way to at least have it at a break-even proposition.

It's something that we were able to carry in the past, but I cannot, as the CEO of the organization, endorse carrying that kind of a negative margin on an indefinite basis.

And so the supervisors who are chairing the ad hoc and their wisdom have given us this additional time to look at other options, how we might be able to working in concert with Alameda Health and Behavioral Health specifically, either reimagine the program or create a handoff to other resources in the community.

And that's we we can do both things, and that's exactly what I believe will happen over the next four months.

So optimistically, we'd come up with a way to keep this work going in some constitution.

If we can't, we have sufficient time to try to find safe and appropriate placements for the patients who currently receive services from that program.

Supervisor, I I hope I've answered your question.

If we go to look for efficiencies, should we be looking for them across the agencies that provide these services, including AHS and public health and social services, or what good will it do if we're not looking at the different pieces of the puzzle?

I appreciate the question, Supervisor.

I'm just reticent to weigh in on areas that are outside of my scope of responsibility.

And so as it pertains to AHS, 100%.

But I I am reluctant to make that sort of a judgment on other agencies that I think you're referring to.

Okay.

What about um Melissa?

Maria logo.

Oh, okay.

All right.

No, no, I'm still on.

Oh.

Yeah, I'm just Maria.

We're talking about doing an efficiency study.

Have you been able to follow the dialogue so far?

Yes, I was listening.

I think the efficiency study on AHS is something that yes, SCIU, we we also requested it.

I think it makes perfect sense.

And I don't disagree with you that it would also make sense to look at the social services in the county.

But I also don't represent those members.

I represent the SEIU members out of Alameda Health System.

But I don't disagree that it sounds like it makes sense.

Alright, very good.

Um indeed uh we are very compartmentalized.

Uh I I see.

Well, I see the broader view of efficiencies and um uh thank you, Maria, for that efficiencies, money to be saved, no better time to start than sooner than later.

A question though, I have about the board letter, remind me again what is the stipulated time frame for procuring.

And as I understand, this would be an AHS procured uh service that we will then pay for, and it has to be mutually agreeable between our board and their management.

Is that right?

So the board letter uh will allocate up to 19.3 million dollars because that's what we understand will cover um saving those ninety-two uh positions that are now um slated as a reduction in force, uh doing a allowing time four months time for a feasibility study of the PHP IOP program and allowing AHS to procure this performance audit.

Uh they need to procure that audit separately.

I don't know if they want to answer directly the time it will take to procure the audit as well as to complete the audit.

I had heard an estimate of nine months total, but it might be better for them to speak for themselves.

Yes, the procurement process and timing and then how long it takes to do.

So we are, after we spoke last week, we have activated our procurement team to really um start putting the pieces in place to allow this to happen, presuming that again the board letter is approved by the supervisors and the funding is made available.

So I I think we can expedite that process.

Um in terms of how long the evaluation will take, I believe that the assessment period that's been identified is six months.

So presuming that we can expedite consummating an agreement, which should take anywhere from I would think, you know, at the outside three months, and I'm hoping much sooner than that, and then the evaluation to follow at six months.

So we're probably talking maximum nine months, um, ideally faster than that.

What would that procurement process have to look like in your world?

I am, you know, supervisor.

I don't want to say things that I can't, you know, deliver on.

Um our procurement team as of the end of last week, when you and I spoke, they've begun doing the work, and so they're looking at it right now exactly what it will take.

As soon as I have clarity on that, I'm more than happy to come back, whether it's via email or in person and explain how that process is going to work, but I just I don't want to say things here that I can't deliver.

So we time wise, so you're thinking not three months and then six months to do, so nine months.

And then this doesn't have a budget amount in here.

And so the question I have for the team that wrote the board letter, unless I'm missing it, is this meant to be something that they procure and we pay for?

We are um proposing to allocate up to 19.3 million, which would be used for those three um bullet points.

Oh, eliminating the reductions in force, procuring the performance audit, and also extending the PHP IOP program for for farmers.

Got it.

So that's 19.3 million for all of those three.

Right.

Inclusive of okay.

I didn't realize that.

Well, all right, that's that you have a bucket of money and you have to do those three things with it.

Okay.

Then um, I would suggest that we do get a report back to us at the major milestones.

I would say that procurement would be one of them.

When you get it done, let us know.

Let all of us know whether it's a letter or a report to our board would be helpful.

And then with regard to the uh outcomes at the nine-month mark, whenever they're done, that you would report back what the results were.

Um so that's fine.

I would still prefer that we allow this study to somehow include a linkage to, I mean, I think it'll be a shame if we do a study like this and we don't allow AHS to explore or the group that they contract with to explore synergies and efficiencies with their team and our teams that again are working s on the same thing in different places, and maybe that's why we have I don't know 271 nonprofit organizations across our county.

We have to be efficient.

I don't think we're gonna get there until we do it across the entire organization, but that's another story.

So um I've said my piece.

I don't know what the the passion or the uh room for compromise is, but that's what I would like to see have happen, Supervisor Marquez.

I see you itching at the microphone.

Yeah, I gotta leave in like 10 minutes.

So um thank you for everyone's work on this, and I hear you in terms of efficiencies, and I agree with you, but I strongly feel that is a separate conversation.

If we combine it to the task at hand, it's only going to further delay what we're trying to accomplish here.

So I hear you loud and clear.

I would prefer that we discuss a work session when we come back from a recess.

I'm not adding anything else before August for it, and we're adding on.

Um it's something that we take up, but but but I mean it like seriously.

If we add it to this, there's no way we're gonna get an RFP done in three months.

Um and then study six months, it's just that's a good point.

I do have a question about that.

We've talked about HR1 cuts as the extent existential emergency of our day.

Emergencies allow for should allow for speed of movement.

If we can't do something as if our hair is on fire, Supervisor Miley, if we can't do something that expeditiously, then either it's not that big of a deal, which I believe it is, or we don't have the will to move quickly.

My opinion, but I I'm the only one that feels that way, or at least I may be the only one that feels that way.

And so if we take it to a work study session, then so be it.

Supervisor Miley, I see recognize you.

Oh yes, I just would like to say I agree with uh Supervisor Marquez.

And you know, the ad hoc committee, we were focused on AHS, and that's why we suggested the um efficiency study, the performance audit directed at AHS, so that would help us with that particular piece, but um clearly uh I support what Supervisor Marquez was saying, and I support your concern about us looking at efficiencies uh throughout the entire county.

And you know, I've suggested on many occasions that certain county departments uh be um, you know, we have performance audits for certain county departments um on a regular ongoing basis.

We queue we cue them up.

Um, and I just don't think we need to kind of mix the two at the moment, but I do think it's important that we maybe identify what county agencies or departments we want to have a performance and um lower efficiency study undertaken and then um pursue uh that uh post-haste, but I just don't think it should be part of today's discussion.

And unfortunately, we do have a lot of um a lot of priorities and demands, and it's it's challenging to prioritize what is a priority because when we try to prioritize what's a priority, a lot of things become a priority.

Um look at that, and we don't even have the um sheriff oversight or office of inspector general up there.

I know some of you think that's important.

I don't necessarily think it's as important presently, but I mean there are many priorities, you know.

So I would say we should take it up, but I would try to keep it separate from what Supervisor Bass and I are requesting today.

Supervisor Bass and then Tam, thoughts.

Um, I don't think I need to necessarily add to this.

I think a performance audit is important for our county as well.

Um but like Supervisor Miley said, we really focused in on our ad hoc uh mission.

Um I did want to speak to a couple other things that I haven't yet shared.

Um, one is you know, just a big appreciation to everyone who's participated in our budget process because we have learned um a lot from the community, and we have been doing, you know, ongoing work to make sure that the needs in our communities are addressed, and I think hopefully people see that through the measure W allocations.

There's great um investments in food and seniors in our immigrant and refugee community.

Um so I wanted to make sure I acknowledge that.

Um I spoke yesterday about some of the work that we heard about from the Prevention Matters Coalition, the Care First Jails Coalition, the Care Collaborative, and really appreciate all of that work.

Um, in regards to deliberating on the board letter that we will get on our budget on Thursday, I wanted to share a couple things that I would like to see in the final budget letter.

Um, one is the children's services budget that was actually mentioned in uh prior letters.

I would like that to also be mentioned again in the letter that we end up approving, and specifically what we heard the other day in terms of that children's services budget coming back to the board so we can really see what we're investing in terms of children and give the public an opportunity to participate.

And then secondly, um I really appreciate our county administrator uh sharing with us that she and her team are going to be doing work on updating our master fee schedule.

You know, we have to look for any source of revenue, whether it's here at the county or at the state level, um, and again, would really appreciate if the um letter that comes to us on Thursday includes a reference to that master fee schedule as well as the prioritization of the assessment appeal fee.

And I heard Supervisor Miley mentioned the environmental health inspection fee.

Is that correct?

Um and then lastly, um, well, maybe not lastly, I understand that there are some uh answers in response to the board's questions.

I don't think we've received those yet.

So at the appropriate time, we'd like to get those.

And then finally, I really want to appreciate our staff for continuing to improve our budget process.

You know, we have our proposed budget that was two weeks earlier, which really gave me and hopefully others time to digest it.

We have our budget books, the online budget.

Um, there's even great information from each of our department heads about um metrics and alignment and goals with uh our um EV 2036.

So it's really great work and a mountain of work and wanted to appreciate that.

And I just had two suggestions for continuing to improve our budget process.

One is that if the budget book is able to be a searchable PDF documents.

I know some of us looking at this might find that to be a useful tool.

So, you know, you can answer that question online or you know, email me to let me know if that's at all feasible for next time.

And then I I think we mentioned this quite a bit, but to the extent that we can get um presentations and slides in advance, it really helps us digest.

I mean, I found yesterday getting the slide the day of and trying to respond and react and ask questions.

It was a lot to take in, even though it's a lot of it is already in the budget that was proposed.

So I just want to really encourage us to continue to try to you know push for getting those documents in advance and also posted online for the public.

Thank you.

Thank you, Supervisor Tem.

Any other comments?

Supervisor Tam still with us.

No, I don't have any further comments uh other than echoing the appreciation that's already been said.

Um I did have a chance to go through the budget book um pretty extensively online, and I I don't know, I was able to search at least for the the CBOs that um were funded by the various departments.

I I guess there's a different feature that Supervisor Fortunatabas may be talking about.

Um so I I appreciate all that hard work, and I do support um the board letter that's before us uh for funding for AHS, but I also want to point out that it's gonna come potentially at the expense of our ability to do other things like you know, perhaps bankroll a real estate transaction.

Um, but if I had to choose, I would choose the fund supporting AHS and patient care any day.

Very good.

Do we need um a motion or we actually want to recess again until Thursday?

Well, I would like a sense motion to give um the county administrator direction, and let me just um repeat what I heard from the board and what we would bring back to your board as part of the final um budget.

So the direction that I would be seeking from your board is that we incorporate in the final budget the proposed budget presented by the county administrator's office on May 28th, that we incorporate the final adjustments that have no net cost increase that were presented as the part of the letter yesterday and attached again to your memorandum today.

That we also include the letter from Supervisors Miley and Fortunato Bass regarding AHS with the following amendments or clarifications um item A with regard to approving the allocation to mitigate reductions in force as well as support a performance audit and extension of the PHP IOP program.

There was a comment about having regular updates and reports back, particularly with regard to the performance audit uh procurement and performance.

Um also on item C with regard to extending your ad hoc committee's work.

We won't put a date on there that was discussed, but there was a request that there be a report back by the end of the year or a commitment to do that regarding the status of the ad hoc committee extension and continuation beyond the end of this year.

And then you have items D and E as they stand uh in the letter.

Um, and then we will also address in the board letters some of the policy statements that your board made today um with regard to reserve levels, senior services, efficiencies, and we do already plan to include some information and departments have been submitting data to us on that, as well as uh reference to the children's budget, which we've also referenced in the memo that we just handed out to you, as well as the master fee schedule.

So we'll we'll reflect those as policy statements in the final budget letter that we bring back to you on Thursday.

And and then with respect to the master fee schedule prioritizing the assessment application, environmental health permits, and you've already addressed the reserve for the operating budget.

If you need a motion, I can move that.

Second, okay, it's been moved and second.

Supervisor Tam makes the motion incorporating our administrators' comments.

Supervisor Miley seconds the motion.

He would like to have discussion.

Well, I just want to i neglected to thank the um county administrator or staff for their work in the unincorporated area because i are painfully aware of the advocacy that's taken place in the unincorporated area around budget justice uh budget transparency etc i think this budget um uh shows a lot of improvement so thank you supervisor marquez can we also just make sure that the director position for the office of immigrant refugee affairs is also captured i know specifically we called out the contracts but want to make sure we can reference that as well thank you is there anything more to add to the budget we're good okay oh just one question um thank you for uh the memo answering the questions regarding the budget i had emailed over will this also be posted online with the other budget documents yes it yes it will thank you a motion's been made by supervisor tam seconded by supervisor miley roll call vote please supervisor marquez aye supervisor tam aye supervisor miley supervisor for dinosaur aye president hubbard i vote yes motion passed now technically we are recessing or correct okay we're gonna recess our meeting today we will take up final deliberation final budget adoption no more deliberations no more adoptions do we have public comment on thursday okay yeah public comment has been closed for the budget deliberations have been closed we're going to read into the record what the final budget adoption is and we're gonna take a vote on it correct and that's scheduled for this Thursday at 4 p.m this Thursday at 4 p.m which we will have a closed session before preceding so plan accordingly everyone see you at four o'clock we're in recess thank you