All right.

The uh I know, right?

The time is now 10.02 a.m.

on October 23rd, 2025, and we will call this community health meeting to order.

Uh, Madam Clerk, can you please call the role?

Councilmember Castillo.

Here.

Councilmember Alderete Gabito.

Councilmember White.

Chair Gabon.

Here.

Chair, we have quorum.

Thank you so much.

All right.

The first uh item we have on the agenda is the minutes, and so we'll go ahead and go over the approval of the minutes.

Any uh questions about the minutes from anyone on the committee?

Great.

Can I get a motion to approve the minutes?

Great.

Any seconds?

Great.

Uh all those in favor of approving the minutes.

Aye.

Aye.

Any opposed?

Abstentions.

Great.

Um next we'll go into public comment.

We have a few folks on for public comment for today's agenda.

Um we'll start off with Diana Lopez.

And you will have three minutes.

Uh last week we were in this room again talking about heat-related deaths, right?

And the importance to ensure that we're properly tracking and creating data that could potentially save lives.

I know right now it's getting cooler, so the urgency isn't as important, but we probably have about six months before we start reaching triple digits.

Last uh this year we started reaching triple digits in April.

Um the symptoms are just gonna get worse.

Um we why we're here is because it's up to this committee to try to to try to um figure out different different ways to be able to track those pieces.

Um by being able to have accurate data, um, it ensures that the proper resources, the proper funding, the proper solution is being brought to the neighborhood, and that might look differently based on certain neighborhoods.

I'm in district two.

Um we I'm very close to downtown.

Um, and part of um what we face is many people coming to our center seeking water, um, seeking shelter, uh people who are you know walking, people who are unhoused, people who um just need a break uh between where they're going and where they live.

Um, and that's a little bit about sort of why this important this topic is so important to us.

Um last week or the week before we had a person um who was having difficulty show up to our door um after about only it was it only took about 10-15 minutes of just sitting down, resting, having something to drink.

Um, and that that really helped the person, right?

This person was unhoused, we've seen him many times, and I think it's important to be able to think about um sort of what solutions could be had, um, not only for residents um who are who are afraid to turn on their ACs because of high bills, but also residents who have to walk, who take the bus, um, who work outside.

Um, all of these factors um play a larger role and with the worsening climate, right?

Um, we start seeing um the rise in deaths.

And if the data is not existing, if there aren't creative ways, if there isn't an interagency um collaboration that ensures that that this is tracked um all the way from down to uh from agencies down to community organizations down to people, then that data isn't gonna exist and we aren't gonna know the true um symptoms of what is happening.

And uh Houston actually just launched one that um alongside their um their their tracker forum um tracks uh different illnesses that are also exhaust exact exasperated by the heat.

And so thinking about it in different ways to access that data is extremely important.

Um so I just came here.

I know it's not on the item, but I just came here because it will be soon.

I want to make sure that um everybody knows that it's an urgent and important topic to keep on the agenda.

Thank you.

Thank you so much.

Uh our next speaker is Erica Alvarado.

And Erica, you have three minutes.

Hi, my name is Eric Alvarado.

I'm a resident of district two.

I also work in district two at Southwest Workers Union.

Um last week we saw the governments committee thankfully vote to continue the work on the CCR to track heat related deaths in San Antonio.

Now the CCR is at this committee, and I'm asking that this committee continue that urgency.

Although the temperatures are slowly coming down, they're not gone, and the heat will quickly be back again.

The need to have heat related debts tracked and transparently reported to the public is very important.

As um my boss, Diana mentioned, there's a lot of houses folks that come to our area.

We're right outside of downtown.

We see not only houseless neighbors but just people that live in the neighborhood.

It's very hot.

We live in urban heat islands.

We need this data tracked so that we can get the city to act on cooling centers and a lot of other important things.

So thank you for your time.

Thank you so much.

Next we have Molly.

Hi.

I wasn't sure how what to say this morning to the four of y'all.

Um, but it's just extremely important that y'all track heat-related deaths, but not only that, but also cold related deaths as well.

Because as we all remember, Patricia Lawrence climbed the City Tower building, didn't want to face another one, two, three months of freezing temperatures.

It is not freezing at 32 degrees.

It's freezing at 50 and 60 degrees when you're outside and you have nothing.

It's extremely cold at 50 and 60.

And that is why Patricia Lawrence walked up the City Tower building and fell to her death because she didn't want to go through another cold season.

But it's extremely important that we track heat-related deaths and also cold related deaths as well.

So thank you so much.

Appreciate it.

Thank you.

Are there any other speakers uh public comment?

All right.

We can move into item number two, the San Antonio Film update.

Uh Crystal Jones.

C is going for the presentation.

Thank you, Chair, and good morning committee.

Let me pull this up a little bit.

Um, I'm excited to talk to you today about the San Antonio Film Incentive program and a very worthy update to this program given what's happening in the state and in the uh climate with film in Texas.

So, first, if you weren't aware, the San Antonio Film Commission, which is managed by the Department of Arts and Culture, we work uh since 1985 to promote San Antonio to global film and media industries.

Um, and we do this in a number of ways with marketing, advertising.

Um, we also have our film commissioner behind us, uh, Christine Hill.

She will actually be in Austin today, joining a commission film commissions from around the state to talk about the importance of incentives and this important time in Texas for filming.

So we're on the on the road and then also um meeting people where they're at when it comes to film and media industries to let them know that San Antonio is open for filming.

We manage film permitting for 250 city-owned properties.

We have production directory and location directory, which helps uh productions find cast and crew to work on their projects as well as locations.

And then we also facilitate connections between our partners at our public works team when it comes to street closures that might be needed.

If you remember 1923 had a significant street closure on uh Broadway near the downtown area, so working with our public works team, our center city development offices, and other um entities that manage city-owned locations to make sure that filming can happen here easily.

We also support local filmmakers through our artist grants that we do, about $5,000 or sorry, $7,500 or $15,000 to artists, and we've had 22 local filmmakers receive those grants.

One of those is American Sons, which premiered at South by Southwest, and which will be having a screening on November 9th at the Carver.

So please look out for that information coming soon.

It's a fantastic film.

Uh, we also manage the film festival funding program where we provide nonprofit film festivals in San Antonio, up to 20% of their budget, um, and that that it has festivals including Cine Festival, the longest Latino-running uh film festival in the nation.

We also have uh San Antonio International Black Film Festival as a part of that program.

Again, bringing people to San Antonio to know that we have filming happening here.

And then, of course, what we're here to talk about today, one of our significant tools to bring filmmakers here is our film incentive program.

So the program is a rebate program, and right now it is a 7.5% rebate.

It works very much like the state's rebate program, and we're gonna talk a little bit about the state's program and our program because they work very well together, but they can be used independently.

So if you'll see the program timeline, this film incentive was passed in 2016 at the beginning of the fiscal year of 2017, and we started to implement the program in the spring of 2017.

We did have a pause because of the pandemic and the impact to the hotel occupancy tax.

So we brought the program back online in 2022.

But if you remember, there were significant film industry strikes in 2023 that really stopped production in its tracks.

Now that that time is over, and now we have the Senate Bill 2022, which is infusing 200, I'm sorry, 300 million each two-year cycle for the legislative session into our industry here in Texas.

You'll see that that's the time where we have new guidelines that we'd like to present to you today and then bring to council at a later date to talk about updating and preparing San Antonio for the big screen.

You'll see the Texas Moving Industry Incentive funding timeline where we were sitting at the 2022-2023 fiscal year at 45 million for that two-year period.

Now we're up to that 300 million for 2026 all the way to fiscal year 35, which is very important for productions because at the time when we only had a two-year program that wasn't a full 10-year commitment, productions would say, I got a TV series, and I don't want to be moving our teams every two years because Texas doesn't have a committed program.

This 10-year commitment is going to really put us in a position to keep productions here in the state, so they don't have to move in between a TV series season.

Now you might say, well, how does the state incentive impact filming here in San Antonio?

You can see between 2022 and 2023 and 24 and 25, that was when the incentive went from 45 million to 200 million.

We saw a significant increase in film incentives.

Not only is the incentive a financial tool for productions to come to a state and decide to come to a state or a city, but it is also a marketing tool.

It lets people know that hey, this is a film-friendly state, and if we have an incentive in the city, a film-friendly city.

So really the incentive gets a lot of conversations in the door.

And then if the incentive doesn't work out for whatever reason with the production, we've found that a lot of productions still decide to film here once they've come to see San Antonio.

We all live here, we know why we love it, and that's why productions love it as well.

It has locations that you can't find anywhere else.

So these are a few of the results of the incentive program.

I know I talked about the timeline, and there were some industry strikes, and the pandemic, of course, impacted the funding.

But this program is funded at 250,000 a year out of the hotel occupancy tax.

And we have had a total of eight projects that have come through this program for and just this year alone, this fiscal year, because of course the news at the state level is hitting all across the country and even worldwide about how Texas is open for business.

But this program again is a rebate program.

It's a rebate program on expenses that are spent in San Antonio.

So these are San Antonio wages, this is catering for casting crew locations.

So they only get the productions only get a rebate on what they've spent in San Antonio.

And it's making sure that our workforce are engaged in productions.

You've seen that there's 216 local hires estimated right now for this fiscal year for these four projects with a $600,000 local spend.

So again, it's big business for our local film cast and crew and also our locations.

Now, what does it look like a competitive set?

Of course, a lot of cities with the news of the Texas Film Incve have now started to look at film incentives on a city level.

So Austin just earlier this month increased their incentive to 2.5%.

Houston at the beginning of the month has a 10% rebate now.

We were at 7.5% the strongest film incentive in Texas and San Antonio.

And we knew that with the news of the Senate Bill 2022 and additional attention to Texas, it would be time to update this nearly decade-long program to make sure that we are competitive with other cities, like as you see Houston getting to that 10% rebate already.

We've got Pittsburgh, Texas at 10%, and Dallas and El Paso programs are being developed as we speak.

So now is the time to really get into that narrative that San Antonio is still a film-friendly city with a very strong film incentive.

We also have a view here of local production infrastructure.

That is one piece of the pie that we don't have here in San Antonio.

One thing that we've been looking at, the state of Texas has a media production development zone, and what that does is it designates a certain area for sales and use tax exemptions for new builds and renovations of studios.

And what that does is it designates a certain area for sales and use tax exemptions for new builds and renovations of studios.

It is led by studio facilities.

So this is something that we're looking into with a number of production companies who have been interested in this.

But you'll see that Austin, Dallas, and now Fort Worth have very large production facilities.

So that really just emphasizes the importance of having an incentive program because there are many pieces of a pie that come together to build a film, and the incentive program is one that has San Antonio has led with for this past decade, and that we want to continue to lead with.

Now the competitive set at large.

So the state of Texas's film incentive has 31% from the state of Texas.

That's a rebate you can get.

You have to be spending well into a three million dollar range in the state.

And so you can see that even at 31%, the state itself is still being beat out by places like New Mexico, Louisiana, Georgia, Mexico, Canada, the UK.

So if we have a local incentive here of 10% with some additional additional uplifts is what we would call them, but additional incentive markers, we would be competitive San Antonio would with on a state level as well as compared to our other states or cities in Texas.

So the proposed updates.

UTSA has a four-year program that was launched in 2022, and that enrollment has more than four times increased.

So we have about 300 students enrolled in that program this year.

And so you can see that there's a real drive to be in the film industry by our local casting crew.

We want to stay competitive with other cities.

And then of course, our our guidelines are a bit updated, even the name needs just change to be a little bit more friendly to the tongue as well.

So here's the recommended changes.

We want to just name it the San Antonio Film Incentive because it can be used independently, but it also can be used in conjunction with the state's incentive.

We would like to bring this up to a 10% base incentive.

Again, not increasing the pot of money in the bucket, just increasing access to that pot of money to 10%.

Then we have these uplifts, which I'll go into a little bit more detail in the next slides, but again, it's looking at local hires and hiring veterans.

And then also expanding our eligibility to include commercials.

Commercials are a very big market for San Antonio.

And so we want to make sure that instead of someone going to film them in Austin, Dallas, Houston, they're coming here in San Antonio, especially the the companies that are based here in San Antonio.

And then workforce development.

We want to add a workforce development component, which I'll again go into a little bit later here.

So this uplift, what I'm talking about, this 2% uplift, what you're seeing right now on the screen, this chart is what productions have to hire when they're hiring state of Texas casting crew.

So this is state parameters here for 35% for the next two years.

35% of your cast and crew need to be from Texas.

And then every two years that's going to increase.

Again, that thought of more productions will start to come here, casting crew will be trained, therefore, more casting crew will be available as the workforce grows.

So our San Antonio uplift that we want to look at is if projects exceed the minimum hire requirement for San Antonio residents, we would like to make them available to receive additional 2% rebate.

So what that means is the state requires you to hire 35% of your casting crew from Texas.

If 35% of your casting crew from San Antonio, you would get an additional 2% from the city for doing that.

Again, just really enforcing the matter that we need to hire local when we're doing these projects.

And so that would be the first uplift that we would like to consider for this program.

The second is that the state has an uplift incentive of 2.5% if your 5% of your casting crew are veterans.

We're military city USA.

We think that we should own this category.

So again, having an uplift of 2% available from the city of San Antonio.

If you hire, if you're 5% of your veteran hire that's required by the state, are San Antonio residents.

Again, making sure that our San Antonio veterans are front and center when it comes to making sure that we establish ourselves as a film city and military city USA.

And then I talked about the commercials expanded eligibility.

These are the eligible projects that you'll see on the left.

Ineligible project types are news or current events programming, talk shows, galas, infomercials.

These this program is really to look at film tourism, looking at feature films, commercials that establish San Antonio again as a film-friendly city, but also a place that people want to visit.

Where was my favorite movie?

I want to stand on the bridge where Jennifer Lopez stood in Selena.

We have those folks that are always seeking those opportunities.

So that's why we have a great partnership with Visit San Antonio to tell this film story as well.

And then finally the workforce development.

If a project is qualified for a film incentive, first they're qualified, then they have to complete their project and submit all of their expenses so that we can audit that and then they get their check after the project is done.

But they also would have to show proof that they worked with a higher education institution to have a workforce development component, whether it's a panel discussion or even better, if they have a chance for interns on set for students to learn on set.

This is something that the production needs to establish with one of our local higher ed institutions and have this workforce development component before they get a check from us.

So that is an additional thing that we feel is very important, especially with how many students we have going through these programs at Alamo Colleges and UTSA and UIW.

So with that, um we would like to for you all to consider this to go to the November 6th City Council A session.

And if approved, we would begin implementation and marketing immediately.

This will be very big news.

And it already established that San Antonio is a leader with the film incentive.

Of course, that was right, that was published right before the news of Houston doing that 10%.

So we want to continue our leadership in this in this state and in this industry, and uh we hope to do so with your support.

So with that, I'm happy to take any questions.

Thank you so much, Crystal.

And thank you to yourself and everybody on the team who's been working really hard on this.

Uh I really appreciate the pre-briefing we had, and you know how excited I am about this uh this potential uh update here.

Um the committee uh we'll be going around with two rounds uh with no time limits on the conversation, of course, be respectful and courteous to your colleagues uh for time, but otherwise I think we'll be good to pace ourselves.

So anyone want to talk first?

Marina?

Um Thank you, Chair, and thank you, Crystal, for all the work that you've been doing.

I mean, I remember when I was the founding executive director of Tech Block, and we were talking about about the this because we know that bringing films here to San Antonio is a huge economic generator for our city.

So thank you for your continuous work and and and getting it to this great point.

Um I had a quick question on referring to slide six.

What does our local production infrastructure look like?

Or is there things that we could do to be helping out with that?

Yeah, so we currently do not have a large studio facility.

Um we have more co-working spaces and a couple of um very small sound stages, if you will.

So if you've been to KLRN and those and those spaces, that's kind of the space that we're talking about.

Um so one thing that we can do is really look at that media production development zone.

That's something that we focused on for fiscal year 26.

Um, it does have to again be led by a production company, but we have a number of production companies that are meeting with us that have been interested in this program.

Um, and it's really kind of that uh conversation when it comes to studio facilities.

Like, do you build it and they come?

Do you build an incentive and they come?

It's always that um that that kind of ongoing conversation.

But I will say um connecting these production facilities, we've connected them to the Texas Film Commission.

They are the ones who manage the media production development zone.

I think that's really the next step in looking at where could the zone reside, who are the key partners to make it happen, and what kind of space are we looking at?

Um, so um that is the big the the big kind of um remaining factor in San Antonio is to have a large sounds sound stage.

Well, you could always come to the Deco district, District 7.

Dibs on that.

Anyways, um so with the increased funding, um, so this comes directly from the state.

There is city funding for this as well, and if so, what bucket?

Just so I can't.

Yes, so this is out of the hotel occupancy tax, and it's budgeted at 250,000, which is part of the city's budget.

So it's already approved as a part of the budget process, and we're not asking to increase that bucket of money, um, just increase the percentage that that folks could get.

And we we met with a number of production companies who have passed on the incentive, and they're just like a 7.5%, like a 10% would be a bit better.

Um, you know, I mean, I mean, it's I know it's more money for them, but it's also from a marketing perspective, 7.5.

How does that math work?

It's just like 10 across the board.

Yeah, that makes sense.

Um I was curious what colleges in San Antonio offer film studies.

So UTSA, um, Almo Colleges District does the associates degree, UIW, um, but UTSA does have um a very dedicated film studies four-year program that just launched in in 2022.

Um, and they've had significant success, and they're bringing in we partner with them uh a lot.

Um, they're the professor who launched the program was on our film committee, but um got very busy very fast.

So we we talked to them a lot, and they're very excited about this workforce development component because they have so many students coming through the program.

Got it.

I also wondered too, and I'm just kind of thinking out loud, because there is a great nonprofit in District 7, and they were seeing with so many film courses being cut from public schools, you know, he is helping students to learn um all the areas of of film and production.

Um, and you know, one of his ideas was you know, looking at maybe one of the um public schools as as uh housing, you know, as a place to do this.

So I can get you in contact with him because he's doing some great work.

Um yeah, but I mean this all looks great.

I'm supportive of of the recommended changes.

Thanks for your work on this, Crystal.

Thank you, Chair.

All right, thank you.

Council Ricastill.

Thank you, Chair, and thank you, Crystal, for the presentation.

In short, I'm supportive of SAS recommendation.

I'm pleased to see in terms of the uplifts continuing to prioritize local hire and veterans, uh, as you mentioned in your presentation as military city USA.

I think that's an expectation uh that San Antonio residents have, and then of course, folks visiting the city to participate, uh, whether it's through the film incentive program or whatever the case may be.

Uh, and as folks have already highlighted, I'm uh really excited to see the component for workforce development.

Uh, as you mentioned, UTSA San Antonio College in particular have really great programs, and I think this provides opportunity for students to get ex to gain experience uh as well as uh to network with folks that are doing the work.

So please to see what the recommendations are, and it makes me think of uh in D5 we have uh Urban 15, which has an international film festival, and it would be great.

And I know it's a big ask, but if there could be uh a request if they could participate in the festival or access to the San Antonio Public Library to receive a link of their film upon completion, I think would be um very valuable.

Um but other than that, just grateful for the work of uh you and your team.

Thank you, Crystal.

Thank you, Chair.

All right, thank you.

Thanks, Crystal.

Um thanks, Chair.

Um Crystal, thanks for the presentation.

I I think we have a giant opportunity um here in San Antonio uh to become uh at least the film capital of Texas.

Uh this is something that we we should really really lean into because I think the economic impact could be significant, not just revenue for our city, but in the jobs that we can create.

And I think uh the results you showed on on slide five um show that that this is something uh that we need to pay attention to and we need to make sure that we properly fund.

Um so a couple things.

Number one, the application process.

We sure we've got a user-friendly streamlined process in place.

Oh, yes.

Okay, yes, it's all right.

Um production say it's quite easy, it's just a two-page document.

How many people are you hiring?

How much you're gonna spend, where's your production, and who's your contacts?

Good.

Because let's let's not all too often I think I see I see good opportunities here, and we we we we get bogged down in a in a cumbersome process that that scares people away.

And and again, I think this is such a big opportunity.

We need to make sure this is easy as possible for folks uh again who can meet the qualifications to apply.

Uh, number two, the 250,000.

We where did that number come from?

Is using it as sort of a pilot or or yeah, it came from the 2017 film strategic plan.

Um, and so that that was the amount that we've been working with this whole time.

Um and uh quite frankly, I think um the 10% looking and seeing how this 10% works to spend this money because historically, with a lot of the challenges we've had, we have not spent the 250 fully um for the year.

So um, I think it would be uh responsible of us to look at a 10%, see if we can spend that 250 and then evaluate after that.

And when you say the challenges we've had, what are those?

Um the pandemic completely wiped out our funding um for about three years, and then this industry strikes really impacted filming.

So it hasn't been an apples to apples year at all in the past 10 years.

So I think that starting at the 250,000 dollars is a is a great start seeing where we go with this 10% um an up to 14% incentive program, and then if we start to really max out that 250, looking at next year's budget to to uh consider additional funding.

What kind of coordination with VSA and our our economic development department are we doing here to make sure that we we um really have marketed this across the country?

Yes.

So um right now we're entering a um really robust partnership with women in film in Texas, which is based here in San Antonio.

It's the newest chapter and the fastest growing chapter throughout the state.

And so Visit San Antonio, our department and women in film in Texas are gonna be holding a media summit here in January.

Um so that's one way that we're partnering with them on a on a big uh partnership and event uh way.

Um we partner with Visit San Antonio, we talk to them weekly about um production capability.

Um they send over leads to us whenever there's a film producer that contacts them, because quite often film commissions are housed within a tourism bureau, um, but it works really well to for it to be located in Department of Arts and Culture.

So they they send leads to us, um, and then we connect with them when it comes to hotel years.

So we have hoteliers that are very film friendly.

If they have a very big room block like 1923, we work with Visit San Antonio to block those rooms as well.

Now with economic development, they have been key partners and small business conversations.

We could not have done 1923 without the help of their small business support team.

They were out on the ground with us, letting small businesses who were impacted by construction at the time, know that this was a different kind of um opportunity and economic generator for them.

And we were with economic development every step in the way and communicating that message.

And all the businesses on that thoroughfare uh were very pleased with the business they they did during that week of filming.

And even some folks who were really concerned completely changed their narrative once they saw how much business they made that week.

So we we partner with them quite a bit.

Yeah.

Um so look, um, thank thank you for the for the work.

This is something that I think is is well, we know is sort of a new effort here in Texas.

And so we gotta get in on the ground floor and be the leading city when it comes to trying to uh uh attract these folks to come here.

And I think we have an opportunity to do so.

We're perfectly situated um geographically, and uh I think this is this is an area where where San Antonio can excel.

So um let's keep pushing.

Thanks.

Thank you.

Thank you so much.

Um just the last comment for myself.

One, I think all the comments my colleagues made are very helpful, and I support uh this update and this uh incentive recommendation changes.

Um I think to Councilmember White's point about uh the opportunity we have here, of course, Crystal shares with you.

Um, but I think about of course, if we're as the state moving towards the direction to try to encourage more film to come here, San Antonio in particular uh has a really unique role in terms of our uh our diversity here as well as our particular history, whether it's within political history or uh uh Chicano history or music history, there's a lot of if it's there, of course, as Hirse person, I always love historical things, but I think there's a lot of opportunities with that too, right?

Um and so I think that's something that we can definitely hone in on that other cities just simply do not have compared to our own.

Um of course, leveraging the nonprofits here at some of the local artists too, and ways that wherever we can, right?

Of course, the film productions have their own timelines, everything they can do.

Um, but if there's any ways that we can collaborate with even local artists to help with set designs or costumes or et cetera, or even to learn, right?

And those points about the workforce development, I think that'd be something that's some in really incredible uh outside of the kind of the filmmaking uh students, but even folks in our community who maybe aren't traditional students but are involved in these organizations or these art collectives, um preach of the choir already on that.

Yeah, uh if I may, because I did want to do one plug.

Um the say a little prayer movie that came out.

There were local artists that were featured um in that movie because they go through an art gallery, they they actually went through Center to Art This Gallery to film.

We also had a local musician do all of the soundtrack, like the the um opening song.

Um so uh we we are very much um hip to that point because we want our local artists and our city um portrayed very well on film and to let people know you don't have to find a composer anywhere else, you can find them right here in San Antonio.

So I'm with you on that.

Right.

Yeah.

Thank you so much.

Uh one of the last things I was gonna mention too.

Uh well, two quick things.

One on the local hire uh piece, I think it's of course incredible, and I think particularly the focus on the kind of build-up is something that I really enjoy just because it recognizes, right?

Just because it recognizes, right, that may not happen all at once, but we can actually build on it and make sure that more of the workforce is there as the production goes on or as the work goes on here.

Uh so I really enjoy that, and I would love to see that in other places as well if possible, um, within our state departments.

I think it'd be interesting to look at.

Um last point about education.

I know County Alder Govito mentioned some of this with the public school connection.

We have a lot of schools, of course, in district six, but across the city too, uh, that have our performing arts specific focuses, whether it's Taft High School with their Com Arts program or it's uh Edgewood and Stafford uh elementary and their performing arts programs.

And they're of course, again, same thing with the local arts right if there's a ways that we can incorporate that in.

I would love to see that uh all the way down through if possible.

Um but those are all my my point on that.

So thank you again for the cover presentation.

Um I wanted the chair to recognize in the committee.

Uh Crystal Jones recently got married.

Congratulations.

Thank you.

Congratulations.

Thank you.

Chair, um, my apologies.

I didn't realize that they needed an action on this item to move on to it.

Great.

Can I get a motion to approve the recommended changes?

All those in favor?

Aye.

Any opposed?

Abstentions?

Great.

Thank you for the wedding gift.

Thank you.

Thank you so much, Crystal.

Uh well, now with our next item, item number three, the Medicaid 1115 waiver program update uh with Metro Health.

All right.

Thank you.

Uh good morning, uh community health committee members.

My name is Dr.

Claude Jacob, and today we will be providing you an update on the Medicaid 1115 waiver, the charity care program, and an update on our Metro Health Moving Forward initiative.

This is going to be a two-part presentation, so I'll lay out the fringe of the puzzle, and then uh assistant director Marjorie White will talk about a specific example around our diabetes initiative.

So this is intended to pick up from where we left off back in the summer, and this will put into context the state of affairs at Metro Health.

So I'm gonna spend just uh a couple of slides to reorient you to where we were at the end of August.

Uh, this framework is a national framework from the public health accreditation board, and it defines a minimum package of public health capabilities and programs recommended for each and every jurisdiction.

So the Foundational Public Health Services, this uh framework outlines the unique responsibilities of governmental public health and can be used to explain the vital role of health departments in a thriving community.

Further, this framework positions the department to operate as an agency prepared to meet the challenges of the 21st century.

So there are two dimensions of this.

Just know that we'll be focusing in the second segment on the chronic disease portfolio.

So, really, uh, it's an opportunity to at least reorient you to our work on the ground, and this is applied to local, state, tribal, and territorial health departments across the United States.

This is uh just a quick reminder.

Uh, this is where we landed in terms of our FY26 operating budget.

So we're at uh just shy of 80 million dollars.

Uh, there are two dimensions to our portfolio it's the general fund and the support by our grants, and again, this segment is really looking at our challenges tied to our grant funding, and uh we'll put into context some of this work.

Just know that what you see here is uh staffing compliment of uh 593 uh authorized positions for this year.

Uh just know that in uh context of our work, uh about 40% of our budget is anchored to our community health and safety division, and you'll hear one example from uh Marjorie White.

And just know that that includes violence prevention, chronic disease, and maternal child health programming.

It's one of our largest uh the violence prevention section is one of our largest single sections at the department, reflective of the city's contributions uh that uh further upstream.

The complement to that is our ongoing work around communicable disease prevention and control, our support with environmental health, and our operational support anchored to the work of the department.

The next slide shows a composite of our grant portfolio and uh as a comparison to the support from the general fund.

So, again, there's a lot of chatter these days in terms of fiscal fragility and instability, and this is why this timing of this uh uh could not be better.

But just know that it this is an illustration of our plight on the ground through the lost years of the pandemic and the challenges we've had over the kind of last eight or nine months.

Uh, this is an opportunity to at least put into context where we are and what are some of the implications into the future.

So this slide uh shows an array of our grants and external funding secured by the department.

We've done very well over the years.

Uh and the Medicaid 1115 waiver is just one such example of of efforts that span over a decade.

Um, and this allows you to put into context the incredible investments in the work of our department.

Grants account for about half of our operating budget, uh, and this differs from the experience by uh other larger local health departments like Dallas, Austin, Chicago, which depend largely on external funding.

We have experienced an overall decrease in grant funding when compared to the last few years, and what we're seeing is a trend to return to funding to pre-pandemic levels.

Again, today the focus is on the scenario being further exacerbated by the Medicaid 1115 waiver reserves, which lapsed at the land at the end of this fiscal year, and the focus of today's presentation.

Just know that our that funding accounts for about a quarter of our grant funding this year, about $8 million.

In other words, our fiscal storm carries momentum well into FY27 and has implications for potential disruption of longstanding programs, initiatives, as well as maintaining the progress made during and since the acute stages of the pandemic.

This is just a reminder again, we just went through this FY26 budget planning process, and this is a quick snapshot of impacts as a result of our comprehensive budget review process that was conducted over the last few months.

The findings and recommendations were shared with you at the end of the summer during our budget work session.

And just to put this into perspective as I segue to the impacts of the waiver, uh just we experienced a four and a half million dollar reduction of our general fund for this three year and a reduction of nearly two dozen uh staff supported by the general fund.

This slide highlights units and the types of positions that have been impacted as we reallocated funding and staffing assignments to maintain critical functions at the department.

Again, our agility has remained our best asset on the ground.

We were able to keep the line share of the positions by tapping into existing vacancies.

And again, I'd really like to thank the city manager's office for helping to maintain this glide path, which allows staff to apply their skills to other areas, whether within the department or in other parts of COSA.

So with that, um, just wanted to tee it up and again I'll lay out the fringe of the puzzle and again and you'll get the context at least with one example specific to our chronic disease programming.

The Texas Medicaid 1115 waiver program was established back in 2011 in order to help control costs and improve the state's health care infrastructure, local health departments, and community mental health agencies were engaged in this demonstration project.

At that time, the initial funding raised our department's annual budget by more than 40% to support six new or expanded programs which were aligned with identified priorities established through community health assessment, community health improvement planning process, and supported by the department strategic plan.

This funding uh now accounts for about 10% of this year's operating budget and helped to accelerate the department's population-based efforts.

And these are just a few examples, and you'll hear more specifically about our diabetes prevention and management.

But just know that we've partnered with uh the YMCA in conducting uh over 60 uh prevention and self-management workshop series, and you'll hear more about that, especially as we focused on the areas of the city, specifically districts one through seven and those areas of need.

Our oral health program, which you'll hear about later in the winter.

Again, that program coordinates uh uh nearly 500 dental clinics and school-based settings, serving over 20,000 children who receive exams and treatments.

Uh, we have a robust uh infrastructure tied uh HIV and syphilis prevention.

We've served over 11,000 individuals at the STI clinic.

Our uh WIC program, again, which anchors our lactation center, has provided individualized lactation support to over 400 mothers and offered breastfeeding education and support to nearly 400 pregnant, breastfeeding or post-partum women.

Um, again, healthy neighborhoods stand up.

Again, these are examples that we'll be sharing throughout the course of the next couple presentations.

So, with that, uh the uh waiver reserve, as we call it, the 1115 waiver uh Medicaid 1115 waiver reserve sustained programs and operations, and this has allowed us to at least have some stability over the course of the last decade.

Since the end of this program, which again this expires at our current burn rate at the end of this fiscal year in September of 2026, while the official program ended a few years ago, we've been able to at least manage uh resources that we have and have maintained some stability to support key initiatives at the department.

This has allowed us to maintain our staffing capacity as we endured disruptions during the pandemic as well as current disruptions from federal funding cuts and other ongoing fiscal constraints.

Again, this is real, this is a reality on the ground.

And this snapshot really of these changes were provided during our budget work sessions.

There was a follow-up memo that we issued on September 5th to at least uh to council, um, which listed priority programs based on the impacts uh to the community of this specific funding stream.

Again, it amounts to eight million dollars and over 80 staff across eight distinct program areas and supported by a myriad of cross-country cross-cutting and operational units at the department.

So to drill down a little bit, uh just know that we identified, we've gone through some internal analyses, we've identified the main programs that we see impacted.

This is a quick snapshot.

I did want to note that the oral health program in particular, we know the line share of that program, one and a half million dollars, nearly 40 staff.

Uh, what we see here are a mix of uh authorized positions and temp positions.

So uh we sent a clarifying note late yesterday, just to let you know that we are while we have 13 authorized positions, we have a support of additional 20 temps, and that's where you get the 33 impacted staff, 33 out of 39, quite candidly, who are supported uh by this program.

And you see on the right side the description of the impacts around the uh impact to clinical oral services.

You'll hear more about our diabetes program, uh, the stand-up team.

This represents how half the staffing complement, healthy neighborhoods.

Again, we've uh benefited from anchoring that work to 15 neighborhoods across the city, and uh again, ongoing support for STI control and prevention efforts.

Uh the compliment to this again, operational uh supports.

Uh, while we've been able to at least anchor to eight distinct defined programs, we've also been able to leverage this and demonstrate the importance of supporting our foundational capabilities or our infrastructure of the department.

So, whether it's our admin support and operations, our ongoing clinic support operations, for example, uh having the staffing to for three accounting clerks, these clerks um support the immunizations clinic, the STI clinic and the lab, again, and and our ongoing investment in our violence prevention section, which is really the largest, one of the largest sections at the department.

As I've shared in previous presentations, we truly believe that it takes a village to raise a healthier community, and so just know that this is a short list of some of our key partners, uh, some of whom are here in the audience.

You will see that our external partners play a vital role in the success of our department's mission to promote and protect the health of our community.

Their expertise, resources, and deep connections to the populations we serve, help extend our reach and enhance the impact of our programs, whether through collaboration on public health initiatives, support in times of crisis, or long-term stand strategic partnerships, these organizations are essential in helping us to address complex health challenges, reduce disparities, and improve outcomes across the region.

We deeply deeply value their contributions and recognize that our collective efforts are made stronger together.

Just know that through the experience of the pandemic, one of our essential public health services defines that we are to strengthen and mobilize partnerships on the ground.

I would say that that is one of the key characteristics and claims to fame for what we've done here in across not only in San Antonio but across the Greater Bear County, and thanks to our partners and our staff for maintaining these linkages in area neighborhoods.

So different dimension of the support to the Medicaid 1115 waiver program.

Just know that the state also issued a few years ago a public health provider charity care program as a compliment.

This program is critical funding mechanism that allows eligible local providers to be reimbursed for delivering essential health care services, particularly when no other reimbursement source is available.

This includes behavioral health care, vaccine services, and preventative health services, all of which are vital to our community's overall uh well-being, but often going underfunded.

The program ensures that our local providers aren't forced to absorb these costs alone, helping to maintain access to care, especially for residents who are uninsured or underinsured.

And so this is authorized under the Texas Health and Safety Code, chapters 533, 534, and then you see the list of the different entities.

For Metro Health and our partners, this means a more sustainable way to deliver these services that prevent uh illness, reduce emergency care costs, and support mental health and physical health across the region.

In short, this is all about maximizing local capacity with the state support, helping to ensure that we can continue to deliver critical services even in a challenging budget environment.

There are about half a dozen cities that have that do participate in its charity care program, and just know we have been uniquely positioned to apply the talent of the department to make use of these resources.

So the compliment to this is that our department has been fortunate to participate in this program.

Uh for example, this past fiscal year, we secured cost reimbursements for staff supported by the waiver, the tune of one and a half million or 1.2 million dollars that anchors to the work of our STI program, oral health program, and diabetes prevention efforts.

Uh, while these uh this support provides some relief to those three programs in particular.

Again, the reason that we're sharing this with you today is uh in terms of the fragility, especially over the next 11 months as this uh raver reserve expires.

So just know that this is uh part and parcel to how the state has helped us to at least identify resources to offset some of the expenses uh expenditures on the ground.

So, in terms of uh Metro Health and moving forward, um, just know that we are a nationally accredited health department.

Uh we align a number of our initiatives to national frameworks.

Uh just know that we codified our departmental strategic plan, which we call MetroL 2.0, which is a requirement for national accreditation and reaccreditation.

Our department strategic plan operated operationalizes uh the critical and timely investments to support the our public health infrastructure and modernize our work.

Again, applying lessons learned from the pandemic.

What I did want to mention is that the national blueprint was released in December of 2021.

About a year later, uh the Centers for Disease Control and Prevention issued what's called the CDC's public health infrastructure grant.

And the intent was to at least uh dovetail the blueprint with funding, and so focusing on capacity, uh the capacity to recruit talent and maintain talent at the department.

We've mirrored our blueprint uh along with this national framework, and it's in these six focus areas around being a better partner and engaging uh community uh partners more intentionally, uh, making better decisions around data, um, revisiting financing models and algorithms, which is uh part and parcel of the this today's conversation, and then looking at the impacts of the pandemic and making sure that we invest in the talent at our department.

So just know that this is uh a national framework and we've used it for our Metro Health 2.0 departmental strategic plan.

So with that, the look closer to home.

This plan uh we received uh 25 million dollars over five years as a part of CDC infrastructure grant.

It allows us to be recognized and operate as a 21st century health department.

We're able to dovetail some of the support to accelerate the implementation of our SA forward plan.

And at the end of the day, it's really focused on people power and making sure that we mitigate burnout and uh maximize our impact in community by really focusing on these upstream and social determinants of health.

So, with that, we're what we've launched within the department.

Uh, we've been thinking about this for a long time, and yet here we are.

Um, the conversation as of late in terms of the impacts of general fund, that this is uh being catalyzed by this fragility and the challenges that we're seeing tied to this funding stream in particular.

So, as we tackle these mounting challenges at the department, we launched our Metro Health Moving Forward team.

The team has been in place since the spring and provide strategic guidance and support as we assess the impacts of the Medicaid 1115 waiver grant, which is coming to an end.

I do want to share with you a quick overview of the four phases of this initiative as we support the department's initi efforts uh applying change management principles, but just know that in terms of our season, we're now in phase two, um, and I wanted to at least highlight uh what we have as we're paying attention to the needs of staff and how we can be available to support the work of our community partners.

Um we are deeply committed to uh working not only uh with our staff but also with uh uh COSA's HR team to support staff through clear communication, professional development, and skill building opportunities.

It it really is telling in terms of the fatigue as we're still in recovery mode from the impacts of the pandemic, yet we're dealing with this instability.

Uh the impacted employees um uh receive updates and direct communication, and in addition, we are looking at an analysis of training and skills gap data that'll help identify individuals and organizational needs to guide and support our impacted staff.

We just went through a microcosm of this during the comprehensive budget review, and this allows us to at least look at other resources to make available as we do a better job, not only recruiting but also retaining staff to mitigate burnout and minimize the disruption of services to area residents.

So, again, I'll I'll end and then I'll transition to the next presentation.

As we do move forward, the next presentation will feature the diabetes program update led by assistant director Marjorie White, who oversees the community health and safety division.

This presentation will provide an overview of current initiatives, key outcomes, and opportunities for strengthening our impact and community.

Over the next few meetings, um, we will continue to showcase programs potentially impacted by funding changes in the coming year.

Uh, for example, in the next presentation, I would draw your attention to slides 12 to 14, which were an are an actual actual illustration of the fiscal impacts of the laps of the Medicaid 1115 waiver reserves.

These updates will highlight each team's vital work, accomplishments, and ongoing challenges as we advance the department's mission and public health priorities.

And what we've also cued up through the winter months are uh similar examples around our healthy neighborhoods program, the oral health program and stand-up team, only uh to make it clear in terms of the implications and some thoughts that you may have as ambassadors of our work.

So, with that, I'm gonna pause there.

Uh just know that today, while we are here with the community health committee, I'm looking to the chair.

Umorrow we have our virtual site visit for national public health reaccreditation.

So because of our agility on the ground, we're here today, and we'll we'll see uh we'll see you tomorrow to help us tell that story for that voluntary designation.

So thank you to the chair and councilwoman Castillo as well.

So, with that, I'm gonna invite that Marjorie White for the next part of the presentation, unless you want me to take questions now before we segue to the next presentation.

Yeah, thank you, Claude.

I was gonna ask my committee members do y'all want to ask questions now in this particular presentation, or we don't go to the back-to-back presentations.

Altogether bad.

All right, all right.

Thank you, Claude.

Roger, come on up.

Good morning.

As stated before, my name is Marjorie White.

I serve as the assistant director for the community health and safety division with Metro Health.

Today's presentation will provide an overview of the state of diabetes in this community, uh, talk about our Metro Health Diabetes Prevention and Control Program, our impact to the community, highlight some of our strategic partners, talk about fiscal challenges that we have moving forward and opportunities for innovation in the work that we do.

The state of diabetes.

Imagine waking up every day, having to check your blood sugar before breakfast, calculating what meals you're going to eat for the day, and constantly worrying about possible complications because of this disease.

Some of these complications include blindness, a stroke, heart disease, amputations to name a few.

Statistics show that one out of every six adults report being diagnosed with diabetes, and this statistics is expected to rise.

Diabetes rates in Bear County are higher towards the inner core of our community as well as the east-west-south corridors of this community.

And though prevalence rates are higher amongst women, we find that men have higher hospitalization rates as well as experience more severe complications.

When you compare our diabetes prevalence across many major cities within the state of Texas, you can see that we rank number two right behind Harris County, which is Houston, Texas.

If you look at the graph, you can see we're at 16.74, and Harris County is at 17.08.

And then we're slightly we're very high compared to Travis County, which is Austin, Dallas, and Tarrant County, which is the Dallas Fort Worth area.

But when you compare our prevalence rate to the whole state of Texas, you can see that we are definitely significantly higher.

In response to this growing concern, Metro Health in 2013 launched our diabetes prevention and control program.

Our program provides free diabetes prevention and self-management education workshops throughout this whole city.

We offer these um series at community centers, senior centers, businesses, places of worship, library schools, um, just to name a few.

This is a self-management program to help participants take control of their diabetes and risk the and reduce the risk of complications.

Our next series is the Diabetes Garage, which is a curriculum specifically for men.

We use automated maintenance comparison to improve men's interests in controlling their diabetes.

We also have the CDC's Prevent T2 Diabetes Prevention Workshop, which is a year-long curriculum designed for individuals seeking to prevent diabetes.

And then we have our newest initiative through the American Diabetes Association called Project Power, which is designed for youth to help address the increased hospitalizations of type 2 diabetes amongst pediatrics.

In fiscal year 25, our program conducted 65 workshop workshops, and out of them, 56 were conducted and targeted districts, districts one through seven.

As stated before, the higher prevalence of diabetes is within these areas.

562 community members actually enrolled into our programs, and 450, which is about 80% completed the workshops.

To help increase enrollment and spread the word about our program as well as diabetes, our team participated in 435 community engagement events, which included health fairs, they conducted diabetes presentations as well as local media.

Our program also achieved CDCU recognition, and of the completers of our prevention workshop, 62% reported a risk in their reduction rate.

Every year, our program highlights National Diabetes Awareness Month, which is in the month of November.

We host a youth art and poetry contest, and we have a health fair where we give out close to 250 to 300 Turkey voucher giveaways.

I'll give more information about this year's event towards the end of the presentation.

In fiscal year 24, City Council allocated funds for Metro Health to establish our diabetes insulin assistance program.

Through a competitive process, we partnered with HEB Pharmacy to have 19 HEB pharmacies around this city to participate in this program.

The blue dots on the on the map shows where those pharmacies are located.

With this program, we provide up to 100 per insulin prescription to pharmacy customers who cannot afford the copay or out of pocket costs to purchase their insulin.

As you can see, our this program served 1,445 individuals.

We covered 3,102 prescriptions, and on average, the amount of funding provided per prescription was $64.47.

We are currently working with HEB now to relaunch the program in fiscal year 25, 26, excuse me.

Some of our strategic partnerships.

Over the years, Metro Health has maintained strategic partnerships with several key organizations, most notably our partnership with YMCA of Greater San Antonio, which started in 2015.

Over the last 10 years, YMCA has helped us to extend our reach by offering diabetes prevention and self-management workshops to hundreds of individuals, and I want to thank them personally for being here with us but also partnering with us.

In terms of medical partnerships, we work with University Hospital who's helped us to establish a great referral process where we can receive referrals through their medical record system to enroll into our programs.

And although this is still in its early stages, just recently we've received 184 patient referrals.

Excuse me.

We are also very proud of our partnership with the Center for Refugee Services here in San Antonio.

We have provided several diabetes workshops to the Afghan community, as well as community first health plans, who's been another important partner for us.

They provide monthly diabetes garage workshops for their health plan members, and also an incredible referral resource for us.

We have over a hundred additional partners that make this work possible because we cannot do this by ourselves.

They provided sites for our workshops, helped to promote our program, provide referrals, and also expand our reach throughout this community.

As Claude mentioned before, many of our programs are facing fiscal challenges, inclusive of the diabetes program.

The diabetes program is funded by three funding sources Medicaid 1115 waiver, the Texas Department of State Health Services, and the City's general fund.

The total complement for this program is 12, as mentioned before, but this funding also takes care of all of the operational expenses, which includes program licenses, materials as well as incentives for our participants.

And right now, due to the end of waiver that anticipates to be ending in September of 2026, our program is now facing a 72% reduction in funding for fiscal year 27.

This slide gives a better picture of what this impact looks like.

So as you can see for fiscal year 26, our current funding on the left, our this budget is one point a little over 1.6 million dollars, but once waiver goes away, it leaves us with 465,038, which is a reduction of 72% as stated before.

In regards to staffing, this complement is the staffing of 12, but nine out of the 12 are funded by the waiver, leaving us with three health program specialists in 2027.

This also then impacts our capacity in regards to the number of workshops that we can conduct as well as community events that we can participate in.

And as you can see from this slide, it is an approximately 60% reduction in workshop capacity.

One of the benefits of this program is that it does generate some revenue for the city through the charity cares program.

As stated in the slide, um, this program received a little over 250,000 in re reimbursement, and this is due to the number of workshops that we've conducted as well as our successful participant outcomes.

But please note that this is based off of 12 staff members.

So once waiver goes away, this amount will be significantly lower.

Opportunities for innovation.

In fiscal year 27, we do anticipate to restructure and combine some of our programs within our chronic disease section.

One opportunity is to better um integrate our nutrition team into the diabetes programming.

They do conduct community platicas, um conversations and workshops about nutrition um in the community, as well as expand our project power youth curriculum.

This is new this year.

Um this year we're piloting it twice with community partners, and we will also like to maybe pilot it in school-based clinics that are managed by University Health, but we're also incorporating it into our mayor's fitness council student ambassador program.

We're also considering a new service delivery model that incorporates other programs and the positions across the section and division.

As Clause stated, this waiver is impacting so many of our programs that it does force us to reimagine what this work is going to look like.

We also will continue to increase wellness promotion efforts in collaboration with many of our community partners.

As mentioned before, November is National Diabetes Awareness Month, and we would like to invite all of you as well as your constituents to our fifth annual diabetes health fair, which is scheduled for Friday, November 14th from 4 to 6 at Monterey Park.

There are going to be many community partners there.

In addition, a free produce market.

Um we'll do turkey voucher giveaways, we'll have Zumba and line dancing and much more.

Um so please make sure, please um let your constituents know that this is a free event and open to the public.

I'm very excited to announce our winners for our second annual youth art and poetry contest, which encourages youth to express their voices and creativity regarding diabetes and wellness.

This year's youth poetry winner is Nina Rodriguez, who's Rodriguez, excuse me, who's an eighth grader from STEM Academy in Council District 1, and Anahi Jadamillo, a 12th grader from Roosevelt High School in Council District 2.

They competed with over 43 students who submitted entries for this contest.

Last Friday, we actually honored them at iHeart Radio, where they got a tour of that studio, as well as received um iPads, um tickets to entertainment events, um, as well as they were interviewed as you can see from the pictures above.

So we definitely thank them, their parents, as well as our wonderful team in iHeart who made this happen.

And you can see the poetry on the left by Nina, as well as the artwork.

At this time, I would like to thank our wonderful team who makes this work every day, as well as our many partners that are here and who are not here with us.

Um if it's okay, I would like to acknowledge Miss Kathy Shields, who's our public health administrator over our chronic disease section, Miss Denise Bueno Housney, who's the program manager for chronic disease, Dr.

Julius Hunter, who's our coordinator of our diabetes program, and the many staff that work underneath him, as well as our partners.

Thank you so much.

And I'll now yield to questions.

Thank you so much, Marjorie.

And thank you to both you and Claude for the presentation today.

I know it was a packed information.

Um but it's of course extremely relevant we talk about not only our landscape currently here with our public health issues that we have, uh, particularly of course within diabetes, but also of course with the fiscal environment that we're facing uh locally and federally.

Uh so thank you again for that uh those presentations.

Um I know we went through a whole bunch of pieces within the first one with Medicaid uh or the waiver um kind of a general landscape or general view of it all.

Yeah, just briefly a couple things.

So after the reserve fund expires, I guess.

Are we uh some programs are gonna are gonna sunset or are we gonna prioritize certain programs based on the outcomes and effectiveness we've we've seen?

So thank you for the question.

We're going through that process right now.

So what you saw was a snapshot of the most vulnerable based on the commitment, the contributions that we have for the waiver program.

So that's why we highlighted and featured the diabetes program.

Uh so we're looking at different options and working with staff.

Um, we do want to at least uh share with you the fragility of what we're seeing.

So, yes, looking at the burden of disease, you know about diabetes uh being the fifth leading cause of death in this county, uh, but we're also looking at other programs and initiatives and making sure that we have the capacity to still address the needs here in this local community.

Okay, and remind me again, I've asked you before how much funding does uh our health department get from the city annually.

Uh it's uh just uh a little over 46 million dollars tied to the general fund for this year for FY26.

Okay.

Um what about working with Bear County University Health and other hospital systems to look at you know shared service models and things.

Everything's on the table again as a dovetail to this conversation.

Uh believe it was a week ago, the city manager talked about the tabletop exercise and planning scenarios.

We are engaging our partners, our academic partners, and other community-based organizations to help us think through different options, different models.

Uh again, this is not a linear process only anchoring to our work.

It does impact other networks and other service lines across the city and to include the county.

Yeah.

You know, we we're we're uh money's tight all over the place.

And um, you know, I think I think there's a there's a healthy amount of the general fund, as you said, 46 million that we're that we're um investing here.

I I think what we're gonna need to do moving forward is try to coordinate, you know, with you know, uh for two years I we've been saying it, right?

More more coordination with the county um and and other related you know entities, I think is what we're gonna have to do to try to still provide some of these services, but at a but at a lower cost to uh to the city.

So uh that's really all I have.

Thanks, Chair.

Thinking, Councilman, other other things of Vita?

Thank you, sir.

Um thank you so much for for this presentation.

Uh you know, I I I was you know, Councilman White took a took uh chunk of my talking points is in that we you know I really want us to focus on partnering with the county and other strategic partners to see how we can still offer these services to the community.

Um but we're gonna need to do it more in a collaborative fashion.

Uh do we partner with the county when applying for grants?

Um I would say we confer.

Uh the county has a new public health division that's a couple years old.

Uh we've been applying lessons learned from the pandemic.

We realize that resources are finite.

Uh there are certain criteria and certain grants that we as a municipality are eligible for.

Um and so, yes, we're feasible.

We partner with the county and other uh other partners on the ground uh based on the criteria and the grant opportunity.

Yeah, and I think that pulling them in as a partner for our grant applications will make it stronger.

Um and and it's it's just an area I think that we could explore just because you know obviously funding's tight, so we're gonna need to be making be doing more grant applications, and I think pulling them in as a partner would be um uh wise of us.

You know, I'm definitely concerned about the reductions to oral health, diabetes prevention, and uh and control and the STI control and prevention programs.

Uh you know, we know that without access to these health care programs, uh our residents are gonna suffer.

And we also know that poor oral health increases risks for other diseases, diabetes included, and it's definitely you know extremely tight to obviously the socioeconomic status.

Um I I do appreciate on the Metro Health 2.0 plan how we're really gonna be how we really need to focus on the prevention side to reduce the need for some of these direct services that will be lost.

You know, I feel that the more upstream we can go, um, and and how y'all outlined how it's tied to the uh social determinants of health, I think it's smart, so that way we can just um prevent the need for us uh having to do all of these services because we we know it's just gonna get harder and harder.

I think it's smart so that way we can just um prevent the need for us having to do all of these services because we we know it's just gonna get harder and harder.

Um moving on to the diabetes uh side.

Thank you so much for for that presentation.

Uh we knew uh, you know, I know I already mentioned this.

This is this is huge for this will be detrimental to our community, and uh I know that diabetes is being the fifth leading cause of death in San Antonio compared to seventh in in the US.

We know that we need um these services, and um, but we also know it's so much tied to where you live, you know, and all all of those, all of those factors.

So um let me see.

I'm just checking if there was anything else.

You know, thank you for keeping us posted on it.

I yeah, money's tight.

I think we're just gonna have to be creative for on how we um find solutions and pull in other strategic partners, um, like Methodist Healthcare Ministries or whatever, uh, to see how we can partner with them to still be able to offer the services that our community requires.

Thank you.

Thank you.

Thank you, Council Delphic Steel.

Thank you, Chair.

Thank you, uh Dr.

Jacob and um uh Mrs.

White as well for the presentation, and I just want to commend your team, uh, particularly Dr.

Hunter, because I've known him as Julius, because prior to being elected, I'll go to the Wiha meetings where he would be presenting uh on just the great work that Metro Health was doing.

So uh just great to see you still doing the the really important work uh in for the city of San Antonio.

Um but as I mentioned over the last several fiscal years, when it comes to Metro Health, NHSD and these core services, I believe that council really needs to shift the paradigm of the ways in which we view these departments and the critical role that they play in the overall health and economy for the city of San Antonio.

And when I say that, I mean that we need to talk about how we fund Metro Health, right?

It's primary primarily reliant on federal grants, which we know often change depending on who's in office.

Um but these are core services.

If we have an unhealthy workforce, we're gonna have a problem.

So we need to make sure that we're meeting the needs of our community members by connecting them to services and also taking a step back on what we view as crisis, right?

I don't know the latest stats, but the last stats show that the city of San Antonio, Bear County is leading with STIs, right?

We know that we're leading in terms of having a population with diabetes, uh, so on and so forth.

And these are things that we have to tackle the way we tackle any other crisis, like for example, uh, whether it's a pandemic uh and or public safety, we need to move forward with initiative.

Uh and I know you all are doing the great work, but I I guess I'm speaking to my council colleagues in terms of how we need to redirect funds uh in terms of yes, we are facing um, you know, a a tight budget, but we can't leave families uh out without health care or resources and education uh in spite of these financial changes.

Uh now, with that being said, uh, this is something that I had requested from NHSD a while back, and you know, the answer I asked if we could look at, you know, the the change in terms, how much we've seen an impact of programming.

Um, like for example, there was a concern that we're gonna see drastic cuts to HUD, so on and so forth, and we did see some, right?

But I think just equipping council with information about what to expect, how to prepare, and how did we pivot during uh the last um term?

I'll leave it at that.

Um, but I understand there's going to be the tabletop exercise uh and what I shared during uh the B session is whether we're looking at the heat map that was presented today, we see where the high concentration of diabetes is, and it's the same map over and over again, no matter what uh systemic issue that we see in our communities, and we know who's going to be most impacted.

Um, I know you all coordinate with the county.

I think it's always important to continue to see um where there's opportunity to work collaboratively, um, but also how as it's a city, can we identify within the general fund to provide support to Metro Health?

Um, because I think again, emphasizing if we have an unhealthy workforce, that's not going to leave uh the city, that's not gonna help us meet our poverty uh goals or getting folks out of poverty rather.

Um, in terms of the pot I'm well, one I want to take a step back and express my gratitude in terms of using the vacant positions to ensure that there weren't any folks that had to be let go in terms of the reductions that were made.

So just grateful for your leadership and of course for our city manager on that issue as well.

Um, but how can we continue to again just hitting home the point of looking at the general fund uh to support Metro Health, and I know I'm being repetitive and redundant, but it just seems like um we have to be.

Um, but all that to say, just really grateful for the work that you all do.

Uh, and these are issues that we need to keep at the forefront because um it just impacts uh folks all throughout the city.

made so just grateful for your leadership and of course for our city manager on that issue as well um but how can we continue to again just hitting home the point of looking at the general fund uh to support metro health and I know I'm being repetitive and redundant but it just seems like um we have to be um but on that to say just really grateful for the work that you all do uh and these are issues that we need to keep at the forefront because um it just impacts uh folks all throughout the city um and I would like to talk about offline how we could potentially use D5 carry forward funds to help support the insulin cost share program uh to meet the needs of more families so just thank you all for the work that y'all do thank you thank you for that support and and recognizing that this these challenges are not unique to San Antonio or Metro Health uh just a week ago we had our annual meeting with the big cities health coalition so the 35 largest health departments as we compare notes looking at contingency planning looking at the impacts of these federal budget cuts and trying to maintain our capacity on the ground so recognize that we're trying we're tying that in we're keeping our ear to the ground and we are so appreciative of the substantial investments for Metro Health especially through the last years of the pandemic so where we are today we're sharing with you at least the challenges ahead we're still fatigued but we are responsive to the needs of the residents and we appreciate any uh ideas or suggestions or innovations as we've shared tied to the work of the diabetes program and the support of our partners.

So thank you for that support.

Thank you thank you Chair Thank you Councilmember uh Claude and team of course thank you again for presenting today uh I don't think I have anything too different from what most of my colleagues shared about ways that we can continue to leverage our partnerships and everything making sure that uh our funding is still going as far as it can right given the fiscal environment we're gonna face uh within our own general fund uh if I'm not mistaken I mean your your portion of uh the general fund is uh slivers in terms of everything else right when we look at percentages and so while I understand the the piece about the number that we have there of course we're looking at the number that we're gonna be losing as well from revenue that we have it's always just interesting that or it's always frustrating to me I guess that when we look at the smallest places first to to trim down versus anything else.

And to Council Burr Castillo's point, Council Maddo's point, the upstream pieces of this right that we're doing already um we know leading to better outcomes in terms of not only of course health but workforce needs uh economic conditions in our city and public safety needs too uh I'm very concerned of course and I think we all are on the kind of significant uh cuts that we're gonna see within particularly oral health right pretty pretty much elimination of it um stand up SA being cut uh in half other these groups or other these entities getting cut uh pretty significantly and ideally right we find ways to go about that um but I think it would be important for us to understand too right what are the direct effects of that um how many number of residents are currently served that won't be served anymore and you have some of that there so I appreciate that um but what are the other capacities for our partners too right is there enough funding within those groups those entities to do to bring in those residents within those same programs are there enough slots available in those in their programming without the funding from general from uh metro health um you know how much capacity does the county have to also do their own work um within this if they're not already doing it um even if they are right how many slots are there too I think that'll be helpful to paint this picture for us too and to determine what we're gonna do next um I think a lot about Santa Sue and of course we'll get to them later on uh within our committee but um the point about the the geography right it's a smaller program already and it's gonna it's been trying to expand further and further out into our city where we know we're seeing recurring issues of gun violence and crime uh and we know that the model uh is extremely successful right not only here but across the entire country where we see 68% plus reductions in gun violence uh never just a slim majority but a significant amount right reduced um and so understanding what the impact will be as soon as that cuts those funding cuts are made right that we're gonna see how much likely gun violence increase in these particular areas and then where these places will no longer have the support at all from this um this efforts or these efforts um again I know it's a bit bleak I guess but I guess um the data point will be helpful to understand um who our or who our partners are of course but how much capacity they really do have in this realm because I think it'll be it's sometimes easier for us and it's hopeful for us to think hopefully someone else can take this on but if there really isn't that then we leave our residents out to dry right um but I think those are all my comments um today thank you uh to my committee members for the good conversation here um excited to keep having these conversations go on thank y'all so much and that was the last item for oh sorry claude do you have any just uh underscore my thanks uh again um 30 years four states uh really appreciating the community here I can't say thanks enough to our fantastic team on the ground and the support of our partners while we have been paying more attention to the plight of public health tied to the pandemic just know that the challenges out there uh eclipse the experience we had during the last years of the pandemic so this is a great forum we will bring the topics um and for your consideration there's not an action to be taken this morning but this is intended to be a briefing and we'll bring as many examples and the support of our partners as we can muster over the course of the next year.

So thank you for your support to Metro Health and the team on the ground thank you so much Claude thank you everybody here today and Dave do you have any last comments?

All good thank you so much uh at this time 1127 a.m on October 23rd our meeting is a