All right at 1001 a.m.

we will officially call the community health committee meeting to order.

Please call the role.

Councilmember Castillo.

Councilmember Alderete Gavito.

Councilmember Mesa Gonzalez.

Councilmember White.

Chair Govan.

Here.

Chair, we have quorum.

Great.

Do you have any changes or adjustments to the minutes?

Great.

Can I motion to approve?

All those in favor of Ruby?

Aye.

Aye.

Any oppose?

Any extensions?

Beautiful.

We'll move into public comment.

We have one speaker signed up and a couple folks who uh sent some public input or public comments through SA Speak Up or Speak Up S.

Gosh.

Everyone on the committee got their written notes.

So we'll keep those into the record.

So thank you to Nadia, Emma, and Gracie for sending in your comments.

Our person here at the speak in person is Jamie Gonzalez from the Food Policy Council.

You have three minutes to speak.

I was about to say nobody provided a stool for me to stand on.

So good morning, everyone.

I think most of you know me here, but my name is Jamie Gonzalez.

But you know me as the Produce Lady of San Antonio, and I represent the Food Policy Council and River City Produce and Chicho Boys.

I came in this morning because I wanted to make a public comment about the conversations around the budget and the healthy neighborhoods program, amongst many of the other Metro Health programs and public health programs that are potentially being impacted by the uh the decreased budget next year.

I have had the privilege for spending of spending the last 10 years working with many of the community health workers in this community through the Food Policy Council through the variety of programs with Metro Health, especially the Healthy Neighborhoods program.

And while I know that the city is facing deep deficits over the next couple of years, I wanted to come and speak to some of the work and the behind the scenes work that the Healthy Neighborhoods team and our army of community health workers do in this community.

If it was not for healthy neighborhoods and the work of the many community health network workers that I've engaged with over the years, there's so many programs and initiatives that would have not moved as far along as they have.

These are people who are not just showing up for work with a city badge from nine to five going to meetings that they're paid to go to.

It's the evenings, the weekends, the nights, the time that these people spend of their own time volunteering in our community alongside the people that are embedded in the community.

When I think about dialing back the funding for these types of programs, this is the safety net that we have created in the city and and one where we're going to leave a very large gap as we lose this type of worker in our community and the impact of the healthy neighborhoods program.

This is not just community health workers door knocking and meeting with the community, but they are the most trusted people in these neighborhoods.

When there is a new initiative, when there is a project, when there is a program, when a city council member wants to have an event like a community platica, these are the people that are helping spread the word alongside of us.

These are also the departments that have uplifted private public partnerships in the community for many years, but impactfully for the better part of the last five years.

We would have not have started and grown the Healthy Corner Store program without the help of the community health workers and their participation with the food policy council.

And as that program phases out, the expansion of the Double Up Food Bucks program and just bringing that program to San Antonio happens in the heart of the Healthy Neighborhoods team.

This is where Via Coronado gets its legs.

This is also where community members, these are the first people that they go to when they're struggling.

We know that they go to city council, we know they go to your offices, but the people that they trust most, the people that they call, the people that are picking up their children and taking them to practices and making sure that they know about food distributions.

This is your healthy neighborhoods team.

This is that heart of the city.

I worry, and the Food policy council worries, that as this department is dialed back and the other departments in Metro Health.

How do we continue the bridge and fill the gap over the next few years that will occur in public health in this community?

And that is not just healthy neighborhoods.

That is in community nutrition, it is in chronic disease and prevention, it is also in your STI testing programs as well.

The vital resources that we have that the community doesn't often doesn't know enough about.

And I will say one more thing that's going to be a little more of an unpopular comment.

As we look to tighten the city's budget and to find money where money does not exist, I challenge you to look deeper within some of your other processes.

One of them is your RFP process, and I've spoken about that publicly many times in front of several of the city council members, the cost of that, the the gaps in the finance department, and the way that they're assigned to different departments and offices and the arbitrary way that they pay money, collect money, need a PO, don't need a PO, all of this because it is actually not synced up, because those processes are not consistent across departments.

That creates a huge gap.

It also creates money loss that could be used for public programming.

And the last one that I will mention is the marketing department of the City of San Antonio and Metro Health.

While I have enjoyed working with the marketing teams over the years, I will tell you that I have seen more performative work done from the marketing department of the City of San Antonio than anywhere else that I've ever worked or been a part of.

I love that we like our city.

I love that we want to promote it, but we don't want water bottles with city logos on them.

We don't need that.

We don't want the little gimmicky things.

We don't want the towels, we don't want the containers.

People need help.

People need food.

They need consistent access to quality affordable food and housing and health care.

I don't care how many billboards you put up, I don't care how many times you have Delomundo standing behind the camera, just so you all can have five people show up into a room that are often the relatives of the marketing department.

Those efforts are not reaching the community.

The people deeply embedded in the departments within Metro Health are the people that are connecting with the community.

Those are places to look for money.

Those are areas to tighten the budget.

Thank you.

And I do challenge you guys to maybe look at that just a little bit more.

I appreciate that time.

I appreciate your comments and I wanted to give you a little bit more time just because I know you do a lot of work in the community, so I appreciate it.

But thank you for their comments today.

Absolutely, thank you.

All right, we'll move into item number two Metro Health Maternal Health Programs.

We have a big stacked agenda today with Metro Health Programming, and so excited to jump right into it.

Go ahead.

Good morning.

My name is Marjorie White.

I serve as the Assistant Director for the Community Health and Safety Division within Metro Health.

Today's presentation will highlight our maternal health programs within this division, which consists of our women, infant and child program, also known as WIC, our San Antonio Lactation Support Center, as well as our Healthy Start program.

A common theme that you'll see throughout all of these programs is that we provide services throughout the full maternal health continuum from preconception to pregnancy to delivery to postpartum as well as interconception, which are all critical to a successful pregnancy.

The Women Infant and Child Program recently celebrated its 50 years of existence.

It was established in 1975 nationally and became to Metro Health in 1977.

This program is funded through our U.S.

Department of Agriculture.

Here in San Antonio, we have 10 Metro Health WIC clinics, which makes us the largest WIC provider in this community, as well as one of the largest in the state of Texas.

Our services include food benefits to bridge dietary gaps and improve access to healthy foods, nutrition education through 101 counseling and classes to help families make informed decisions and assist with dietary needs, especially with children with allergies, breastfeeding support, and providing referrals to health care providers as well as social services when there's a need within that household.

Our other services include providing WIC services at local hospitals, coordinating with the San Antonio Food Bank to provide summer feeding, as well as hosting dietetic interns throughout the year.

To qualify for the WIC program, a participant must be pregnant, postpartum up to six months after delivery, be breastfeeding at least a year after delivery, be either parents, stepparent, guardian, and some sort of a child under the age of five, they must meet the WIC income guidelines, which is based on the size of the household as well as the gross monthly income.

Please note that if a client is receiving Medicaid, SNAP, TANF, they do qualify for WIC, although those are not the only qualifiers for this program.

For our program, you must also live in Texas, and we also want to note that U.S.

citizenship is not a requirement for eligibility.

We want to ensure that we're reducing that barrier to care.

There are five goals and objectives for the WIC program.

One is to improve birth outcomes, definitely centered around infant mortality, low birth rates, as well as premature births.

When you look at our communities data, you'll find that we are we have a high infant mortality rate, a high low birth rate, and premature births were higher than the state of Texas as well as the national rates.

We also want to ensure healthy development by addressing nutritional and food insecurity needs, promote healthy behaviors, not just for now, but throughout the lifespan of that family, prevent nutritional deficiencies such as anemia.

On an annual basis, we do check for iron deficiency, and when we find that's happening, we do refer the individual and family to a healthcare provider.

We also support breastfeeding, which provides vital nutrients to a baby upon birth.

In fiscal year 2025, we decided to move our San Antonio Lactation Support Center underneath the umbrella of the WIG program for financial stability.

This program has international board certified lactation consultants who are there to provide one-on-one consultation to our families needing assistance with breastfeeding.

As you can see from the slide, we provide clinical assessment and management.

We do individualized care, not just for when they're with us, but also to sustain their plans and goals.

Maternal health screening, such as depression, we make sure we're connecting folks to services, care coordination and referrals, similar to what we do in our other programs when we find that a family has other social services needs, whether food insecurity, housing and insecurity, et cetera, as well as education and counseling.

By removing cost bearers and integrating clinical expertise with community-based consultation, this program serves as a critical bridge between healthcare systems and underserved families.

The impact of this program.7 million dollars of food benefits to our clients.

If you look at that table, you'll see it's definitely a jump from what we've been spending in the past years.

But due to increased cost in food as well as increased cost of food benefits, that's why the cost per client has increased to date.

As well as we're very pleased to see that there's also been an increase in breastfeeding initiation rates.

Before we transition to our next program, I definitely want to highlight a few things regarding WIC.

One, last year, our WIC program participated in an audit by the Texas WIC program, and there were no findings.

This is the first time ever for any WIC program of this size.

In addition, we continue to exceed our customer satisfaction scores, and next week, this team will also be recognized for the City Managers Excellence Award for their participation in the Feeding San Antonio Initiative.

Very proud of this team.

As we transition to our other wonderful team, our Healthy Start program, the mission of Healthy Start is thriving communities, strong families, and healthy babies.

This program is funded underneath the Health Resources and Services Administration, and it was originally funded in 2001, and it has served families in our community for over 25 years.

We are one of 115 Healthy Start sites across this country, and we're one of six to collaborate with the Texas Healthy Start Alliance here in the state of Texas.

Within this program, we also have a community action consortium, which is the Healthy Families Network, and within there is a subset of the African Americans Health Disparities Council, as well as the Los Senual STEM Mamas.

The Healthy START program provides both in-home and virtual case management services, screening assessments, as well as care coordination and referrals.

All of our staff are also trained to be dualists to help a mother pre-pregnancy, post pregnancy, as well as we provide lactation support, and we also do community health education classes for our clients as well as the community.

Other roles definitely include conducting the consortium as well as the work groups, in addition to participating in the infant death reviews through the child fatality review team to see what are some of the major causes of death for these children, as well as promoting evidence-based curriculum, whether trauma informed care classes as well as positive parenting.

To be eligible for this program, it's open to adults and teens who are preparing to have a child, expecting a baby, or parenting a child under 18 months old.

With this program, you must reside in one of the 11 zip codes.

These zip codes were identified because they were a higher infant mortality rate compared to the national rate.

And so, as you can see here, these are the 11 zip codes, and they touch about every council district in this community.

The data reflected here are healthy starts performance measures that specifically address leading causes of infant and maternal mortality and morbidity.

For example, individuals receiving first trimester prenatal care.

We all know the importance of that for early detection of any concerns, percentage of infants being breastfed, participants practicing safe infant sleep.

This has been identified as a top reason for many infants dying within their first year, as well as receiving proper reproductive life planning, as well as when there's needs such as mental health concerns, making sure that we're referring folks to the proper providers.

For both, I will note for Healthy Start, at the moment we've only received a partial installment, so this is not a true reflection of the full budget, but what we've received so far.

Opportunities and next steps.

Our goal is definitely to always increase participation for our programs.

The more folks that we can help, the better.

Implement eWIT Cards, which helps to make streamlining the distribution of our WIC benefits.

It makes it more sufficient and easier for our clients.

Increase visibility of the Healthy Start program.

It is a smaller program and it is focused on specific zip codes, however, ensuring that those who qualify are aware of this program.

Also continue to engage with a wide range of community partners.

What we're finding when we're meeting with our clients that although we're there for their maternal health needs, there's a plethora of other challenges that that family may be facing.

We want to ensure we're able to properly connect them.

Before I conclude, maternal health matters because it directly impacts the survival and well-being of a mother as well as their babies.

Especially given that approximately 80% of pregnancy deaths are preventable.

I would like to especially thank the leadership of our maternal health programs.

Some are present today, our maternal infant child, adolescent health, public health administrator, Miss Norma Sefuentes, our WIC leadership program manager, Ms.

Maria Sadana, who couldn't be here today, as well as Janet Burguette, our assistant social services manager, Miss Corey Everly, who's the program manager of Healthy Start, Suzanne Tejeda, program coordinator, as well as Zita Powell, who's our Healthy Families Network Consortium Coordinator, and all of our staff and partners who help to address maternal health issues in this community every day.

Thank you so much for your time.

Thank you so much, Marjorie, for the presentation, and thank you for all the uh mental health employees who make this these programs run.

Uh I try to be a little thematic today, looking at family planning and overall uh family health, and of course, starting off with maternal health is really crucial here.

So I appreciate going through both programs, Healthy Start and the WIC program, and like the Center, and how they all intertwine, of course.

Um, we like to start with any comments or questions.

Counselor de Gavito.

Thank you, Chair.

Thank you for this presentation.

It was really great.

Um, you know, uh these programs are extremely important.

So thank you so much for the um crucial work that y'all are doing for so many uh mothers and and their babies.

Um I definitely appreciate it.

On slide number three, I just have a few questions.

On slide number three, you mentioned the income guidelines.

What are they again?

The income guidelines for for them to get onto WIC.

So it's based off of the gross monthly income and the family household.

We can send you the table so that you can see what that we can provide that in a memo.

Okay, perfect.

Yeah, I'm curious about uh about that.

Also, two um what type of foods are available to WIC users?

Um eggs, uh example, eggs, peanut butter, um, milk, um, uh bread, healthy options for for the family, um, also um formula, that's a big thing.

Um, and fresh produce, vegetables and fruits and cereal.

Okay, thank you.

Thank you for that uh information.

Um, on slide number six, you know, we're seeing that the dollar amount is um for this year's above target.

Uh why is that or what are we doing about that?

Or is that by design?

It's okay.

Um, the WIC program did provide additional um food benefits for us to be able to serve this clientele.

So I believe across the country they're seeing an increase.

As we all know, the cost of living is going up across the board.

And this program, the way we get the revenue is based off of the number of clients that we do serve.

Okay, and so um we we do have sufficient funding to to provide this.

Okay, and the funding comes from this is um the US Department of Agriculture.

Okay, got it.

Thank you.

Um slide number 10.

The what is it, the um San Antonio Healthy Start, obviously is a great program surpassing nearly all of the targets.

So I can go to a slot.

Oh jeez.

So when we're looking at this, what what are some of the best practices that y'all have seen that have um like that um have attributed to this success?

I think it's the personalized touch that we do.

Um, we go to individuals' homes, so we we we try to alleviate that transportation barrier if we need to provide services virtually.

Also connecting folks to services.

I think when we are consistent with our efforts and our engagement with with our clients, and they're seeing the outcome.

Just last week, we had a mother, unfortunately, she's she's pregnant and on meth.

And um, it took a while for our staff to engage with that client, but once we built that rapport, we were also able to work with Center for Healthcare Services to get her connected and walking people through a system, especially if there's a need.

I think that helps us to build credibility with our staff.

Yeah, um, and as I said before, um, some of our staff are also dual-trained, so some are even in the delivery room, and so um I think building the trust and rapport with our clients makes this a success.

Okay, that's good to know.

Thank you on slide 11.

So both of these programs they're they're um they're fully funded by grants, right?

Correct.

And are we um have they been fairly secure?

Are we nervous about disturbances in funding?

Or what are our thoughts there?

Very good question.

So the WIC program is the most secure.

Um the Healthy Start program is one that um continues to face vulnerability um on a federal level.

Okay, and so even this past year we were unsure whether or not this program was going to continue.

Um, we did receive a notice of award in March, and we just received an additional one just um this week, and so um we're waiting to see whether or not the federal government will put it in the budget for the upcoming year.

And so the healthy start program is the one that's most vulnerable.

That's good to know.

Thank you.

Um yeah, and and you know, if there's ways that we can help uh spread the word about like the healthy start program um to our districts, please please uh let us know so that we we can be um uh partners in that.

But thank thank you again.

I mean, I think you know, uh we were texting.

I mean, even mothers who have all the resources in the world, this is still such a tough time.

Pregnancy after babies, I mean, is it a really tough time in people's lives?

So thank you for being there for so many in our community during that time.

Thank you.

Anybody else want to counter those?

Thank you.

Thank you for the presentation and uh for all the work that Metro Health is doing and um their employees and all the partners that they work with, uh, this is really boots on the ground, right?

Um, and so just a couple of questions on I think slide 10.

Um the goal is 700, I believe it was seven, yeah, 700.

Are we on target to meet that goal?

Um, yes, we are.

Yeah, we're continuing to increase our outreach efforts.

Um, but yes, and where um I think we talked about the federal dollars and making sure that those are intact, so um hopefully that's something we can uh get an update on from our IGR committee uh soon.

Um on the outreach too, or I don't know if this is and I appreciate you talking about the walking them through the system because I think that's what so much of this is, right?

Yeah, with a lot of the programs that we offer, whether it's ready to work or um our healthy start program, it's walking folks through a system that hasn't always met them where they need to be.

So um I I just appreciate the thoughtfulness in that.

Um my question is around um other services that we also share like that that we support.

So are we talking to these clients as well about ready to work or about pre-K for SA?

What does that look like?

So our programs do have a social services sheet of different resources, um, also the homeless division, making sure that we're connecting folks to the connections hotline, um ready to work, utility assistance.

So um we do work to ensure that our program staff are aware of these different resources to offer, and if they don't know, um we can help facilitate that on the ELT level as well as um their administrative level.

Then can you provide maybe in a report just kind of the breakdown of the the demographics of of folks coming through that I'm curious?

You want it for healthy start all of them?

Yeah, I'm just curious about like age range and number of children, all that.

Absolutely, thank you so much.

Those are all my questions.

Thanks again.

Thank you.

Anybody else can't work us too?

Thank you, Karen.

Thank you, Marjorie, for the presentation.

Um, in terms of the healthy uh neighborhoods program uh and the impact, and just looking at the overall presentations that we're gonna get today.

Right, right?

Key is access to quality foods.

Uh, and I think in terms of the funding that may be at risk, I think that's something that we should identify within our current budget to continue to support that programming because of the impact to our children.

Um I did have a question, right?

I'm thinking uh again, looking at all the presentations we're gonna receive today as a whole, uh, is a bit frustrating in terms of, you know, this is uh funding that we we have to fight to keep and/or identify.

Uh and I think in terms of like lobbying at the at the federal level and state level.

And I'm thinking about our trips to SA to DC.

Uh, is there uh, and I see on slide seven, there's um uh organizations that do some of that advocacy.

Um, but as Metro Health, when we go to SA to DC, uh, is there an agenda in which is is drafted and then we work with business partners to go and advocate for?

And can you walk me through a little bit about what that looks like?

I can speak a little bit regarding the Texas Healthy Start Alliance.

So, and our staff also attends the conference, the national conference in DC as well.

But there's a lot of talk of, you know, how do we sustain this?

Or who are the partners who can help support it?

So I think that there is lobbying happening at that level.

Um, in regards to other forums, um, I am not familiar, but I can you know speak to Claude.

Maybe when he goes to DC, maybe there's other opportunities.

Thank you, Councilwoman, for the question.

I would just say in general, we work very closely with key partners, depending on the initiative.

We are members of national organizations and local networks.

And so, again, we can talk more broadly in terms of other initiatives, but specifically to this, we do work with our partners on the ground and the clinical providers.

Yeah, because I'm thinking in terms right, uh, I always think in the framework of housing, and oftentimes folks assume that low-income housing will be under attack, and while like public housing is, um, we know many rural communities rely on affordable housing, uh, and many rural communities also rely on WIC in many of these programs.

So I think there's opportunity, whether it's with council meeting with uh our larger delegation to talk about the impact, not just uh for urban uh areas but rural communities as well, uh, to potentially uh help to to make the case on why we should continue to preserve this funding.

That's right.

Points well taken.

Again, we work with other parts of COSA and other community partners to at least make the case for supporting our programs.

All right, thank you.

Thank you, Dr.

Jacob.

Thank you, thank you.

Anybody else have any questions or comments on this program?

All right, well, thank you so much.

I have a couple quick things.

Um a lot of overlap with uh my colleagues, of course, very supportive of finding ways to maintain these programs in our budget and also continue to advocate for them during our regular uh legislative agendas and seeing what ways we can also align with any of the chambers, etc.

But the SADC work that we do there.

Um I mean, I think when we talk about any of these programs, and I know Council uh Messi Gonzalo is talking a little bit about them as it relate to workforce development, they relate to, of course, in my mind education as well, all aligned there.

Um, making sure that our kids are well fed, well taken care of that their parents too, right?

We often talk about in the Head Start world.

It's always looking at holistic care, right?

Because it's not enough to just say, okay, this kid's taken care of, it's also looking at their household as well.

You all get that.

Understanding how we can bridge that gap within um the economic development world, I think is really critical, particularly for our community, right?

It's not a it's one great thing to get someone a job.

Yes, uh, making sure that we have those access there, uh, but all other pathways there to the career, but also being able to actually get there is usually this, right?

Making sure that someone has child care, has the support they need, has the uh connection to navigate through those services uh that they may not be able to go through on their own is really critical, and so um very supportive of those comments made.

Um, appreciate the kind of clarifications on the funding uh for each of these programs.

Um things I wanted to ask was uh similar, I guess thinking about the educational aspect too, right?

Thinking about Head Start, thinking about um even the domestic violence programs, what other programs overlap here for these duplicated clients?

Um, duplication is the right thing to say there, but um see the level of investment we're giving to a lot of our residents here and seeing um just kind of what the next steps are for a lot of them.

I think we look at uh some of these programs, they're not uh in isolation.

They shouldn't be considered in isolation because I think it's very quickly for someone to fall off whatever kind of form it is of success without the support there.

So uh eager to see the memo uh that would be shared related to Council of Messian dollars' request, any other additional pieces there from the kind of big four uh human services programs and the whatever they may uh be, it would be really helpful there, okay.

Um, along with the NHSD um rate of work, etc.

Um, I think those are all my things as well.

So thank you all so much.

Thank you so much as well.

Have a great day.

Alright, moving to item number three, reproductive justice.

Um, and the programming there, Dr.

Wu.

Is this is this an agent button?

Yes, okay.

I found the button.

Um, so thank you.

This is us reporting back on the reproductive justice uh funding that was approved by council.

And that's that's what we're going to talk about.

So reproductive justice, you see the definition, one of the definitions up there, this was a movement and a framework created by black women in 1994.

Another way to describe it is it's the right to have children, the right to not have children, the right to nurture the children we have in a safe and healthy environment.

Council allocated 500,000 for this in September of 23.

We had the RFP go out in June of 24, and Metro Health created a framework, a preventive framework, right?

Because that's our public health framework.

So if, for instance, um it went upstream to downstream.

So if for instance your ultimate outcome is pregnancy that's downstream, then upstream of that would be a healthy healthy relationships, stable economic uh economics in the home, and um midstream might be something like training doulas.

So we had 10 responsive proposals, and uh four vendors selected that you can see there.

And I also want to thank our Sion Elmore and SJ Wagner from Metro Health who did a lot of this work.

Uh none of the selected vendors offered abortion related services.

Council approved the vendors in November of 24, and then the contracts ran from November of 24 through November of 25.

The evaluation panel ended up awarding just under 500,000, 499, 179.

So when we look at the work that was done upstream, we see evidence-based sex education in schools in um SAISD and North Side ISD for more than 5,000 youths, a number of community workshops that you can see here, uh, some of which, like the March of Dimes curriculum is actually still continuing now under a different funder, and um a lot of different topics and information on the Pregnant Workers' Fairness Act and Pump Act in multiple workshops.

And you can see a quote there from one of our participants, and that is a picture of a YWCA workshop, I believe.

In the midstream category, we had 30 doulas now added to our community, certified to serve as trusted providers in high need zip codes.

You can see a graduating class from Latch there on the right, and a quote.

189 people who got navigated to STI care and treatment, uh 25 people navigated to benefits, and 50 long-term reversible contraception uh devices, IUDs that were provided at no charge.

And then finally, downstream, we have 240 people receiving direct no cost maternity support, so doulas, therapy, acupuncture, direct assistance, all at no cost during pregnancy and postpartum, and 800 people receiving STI testing, resulting in 113 infections that were treated.

There's our summary.

So that's 12,509 people, and if you divide that into the 500,000, it's just under 40 dollars per person because public health is a good value, and that's what I got.

Thank you.

Thank you, Dr.

Wu.

I like that last comment.

Um like to start the conversation today.

Councilman White.

Councilman White.

Thank you, Chair.

Um, I'm having flashbacks to my first year on council.

This uh seemed to take up all the oxygen in those first uh those first few months.

Um obviously I had serious concerns about about this fund when it was uh when it was proposed due to potential legal exposure and all of that, but I'm glad ultimately the dollars um you know weren't weren't directed towards any um out of out of state uh abortion care, and then it was focused on on the issues that we see here in the slideshow.

Um I do want to ask this.

It looks like, and tell me if I'm reading this wrong, Dr.

Wu, but 12,500 people served, and we spent $500,000.

So my rough math is telling me that's somewhere around $40,000 a person.

Forty.

Huh?

Forty dollars.

40, 40 dollars, 40 dollars per per person is what we spent here.

Yes, sir.

And um, right, right.

Four forty forty dollars per per person, and it was on these the counseling, the the IUDs, and and some of this the stuff on the downstream was where most of the dollars were spent.

Were we always gonna focus most of the dollars on the downstream?

In my public health dream world, no.

Um what what we took is what the vendors proposed.

Like each of the vendors proposed a suite of services that they wanted to provide, and then through the procurement process, you know, you may remember we had to look at experience uh and um you know background, and then we also had to look at uh what their actual proposal was, and then procurement look at the cost, and then you know, when you put that all in the snow globe and shake it out, this is what we ended up with.

Right, and that was really my question because I thought when we originally proposed this that more of the money was going to be spent up top.

It's true.

We we go with the proposal, there that's part of the procurement process, yeah.

Okay, all right.

Um, so it was just sort of based on what was found to be needed.

Yes.

Yeah.

Um okay.

Um my second question is um, you know, before we spend if we're considering spending any future future general fund dollars here, um, can staff get us a list of um where some of these services that were provided by this fund are already provided in different programs through through Bear County and and other areas.

Other other um providers so right now I I mentioned that the um some of the classes were picked up by United Way SA, but the idea was that these are things that are not actually being done elsewhere.

We really looked hard for that.

Um, I would say the selection committee looked for that.

So even for instance, um, where'd it go?

The the sex education, you know, the San Antonio AIDS Foundation does do sex education in our schools, but um specifically this allowed them to bolster education um that was not being covered by other funding that they had, you know, that they would have had to pull back on it allowed them to maintain something.

So um, so WIC and Healthy Start and some of these other places don't don't provide some of these services.

So evidence-based sex education in schools I is not commonly provided, unfortunately, um by uh by nonprofits.

Um and then the workshops I we're not I we can look up, I know that these workshops were created under repro justice, so whether they are continuing now, that you know it could be that we laid the seeds and they're continuing under the organizations that the one of these four organizations.

Um and then I these others I am not aware the dual is you know, latched will continue to train doulas.

Um not under but you know, without the level of funding that we provided for some so some people could get trained at no cost, and then some of these downstream services, unless they get other funding, I do not see that continued.

Okay, so these are services that you don't believe are are provided elsewhere.

I don't believe that they're provided.

That was my question, is there I don't believe they're provided at no cost elsewhere.

Council member, we can do that analysis and see um where they are similar potentially, and other areas if they have continued these services, we can look at that and get and get back with you.

Got it, got it.

Yeah, that's just what what I want to check on.

Um other than that, I mean, those are really my questions on whether the you know the the $40 per per person we were helping you found to be in line, why most of the money was downstream, and then if there's any overlap with with other with other providers.

So I appreciate the the presentation.

And just really quickly uh share some similar uh thoughts there about just kind of like what's what's this work supplementing, right?

I think that's kind of the bigger point there, right?

How does this work scale up these programs?

At least that's my perspective of it.

I think that's what's clear with these programs that they were meant to add in that add into that work, not so they replace um added some extra support here and there, and so uh I would be interested in seeing, you know, um, and if it's just this, then that's great to know.

But if it's 800 people receive SAI testing from this fund who wouldn't have otherwise received it at all.

Right.

I think that's that's the key point there, right?

Yeah, that that one's a really good example.

So, for instance, that is for the San Antonio AIDS Foundation, and they get funding from different streams like all of us do, right?

So it the way funding is right now, it covers specific populations.

So they had a stream that was not covered, specifically heterosexual women, and needed testing for chlamydia and gonorrhea for heterosexual women that was not covered by any of their funding streams.

So that's uh the analogy I wasn't explaining well for all of these.

We were filling gaps, not adding to not duplicating.

Right.

I think that's the biggest thing, right?

When we look back and it's still, I think helpful to get those partner groups so we can understand where that full that full uh ecosystem is right in this world, um, whether it's an SDI testing or in general these other programs, and I know of course we have the main four who we uh help fund as well.

Um, but I think it's helpful for us to understand, okay, this is the work that they can do at this moment.

If they're also gonna see impacts of their funding, then where do we as a city step in?

I think it's kind of the conversation we've been having at budget and goal setting is kind of a little bit theoretical, maybe ideological about where does the government step in on some of these things, right?

And then for me, this is where we jump into say this can't be done otherwise.

Here's what we can support to address these public health concerns.

But anyway, I just wanted to kind of add to that conversation there.

Councilmember Aldertagovito.

Thank you.

Um, thank you for for this presentation, and also thank you for the work that you all have done for many as well.

Just you know, I had a quick question, um, or whoever um I remember there was two reproductive justice fund things.

One, I think, and sorry, correct me if I'm wrong.

I think what the first one was initiated by Councilwoman Castillo, and that was the use of CPS off system sales, right?

And then there was a second one with a hundred thousand dollars initiated by I think it was Councilwoman Haverta, correct me if I'm wrong, that ended up going nowhere, right?

Because there was a state law that went into effect that essentially we could not use that fund.

Yeah.

So everybody got hype, everybody got that, but that $100,000 did not help a single woman.

Correct.

We did not use that.

Okay, got it.

So they were talking about that first $500,000 from the off system sales, correct?

And we knew going into it that that was going to be just a one-time thing.

There was no talks of this being reoccurring in our general fund, right?

It was a one-time $500,000 because of that CPS.

Because we had that amendment, it was an amendment to the budget.

That's right.

Yes, yes, which by the way, I supported, you know.

Um, and I will also uh reiterate because I'm gonna reiterate all the time.

Um, I am pro-choice.

I have two daughters.

I do believe that this is essential for for women's health.

Um, but you know, I think we we do raise a strong concern when we talk about this money coming in from our our general fund, um, because then we're risking a lot of other funds not coming in, and then we how do we fund our nonprofits and how do we fund our streets and how do we fund all these other things that that the community needs?

So um I we all know.

I mean, I'm not being political here, but we all know that we are in a state that is um um not kind to women and not kind to to women's health.

Um, and we're we're gonna have to work around that, but I think if we're strategic about it, it is through funding nonprofits who can do the work without the risk.

Um, if we fund if we if this money comes in through the city, we risk getting penalized, and then we will be uh with less pots of money for other nonprofits who do so much great work.

So I I just want to make sure that we're all level set on that.

Um, and and I do just want to make sure that the nonprofits who were part of the upstream, midstream and and downstream, um, no doubt they do amazing work, but the expectations were set that this was going to be just a one-time fund.

And so I just want to make sure, and listen, you know, I was a nonprofit executive director, I know how hard it is, but if the expectations were set clearly, we just need to make sure that that um is processed, is you know, it and and also too that the community knows hey, they're no longer getting funds from the city, so how does the rest of the city come in and help support?

How do we as individual contributors go in and fund those nonprofits because that one of their funding sources is gone?

That's that's I think the larger conversation we need to have because um the city just obviously we're talking about our budget deficit, and we're talking about um how we have to tighten the belt.

Um, and then when we put the rest of our funds at risk, then then we're gonna be even in more dire conversation.

So, I I think the larger conversation, the larger point I want to make is we knew this funding was gonna end.

Uh the expectations were clear from the get-go, and so now I think as a community we need to say, as individual contributors, not in the city role.

How do we keep this these funds these nonprofits who are doing great work um alive, and how do we keep them um funded to to continue doing the great work that they need to do?

So those are all my comments.

Thank you.

Thank you.

Anyone else?

Uh Council Ruby Bascous.

Thank you.

Thank you for the presentation and all the work um that you're doing with your team, Dr.

Wu.

Just a couple of questions.

Uh, you know, I think obviously the partnering with these committed groups who are already doing the work is important um to deliver on our goal as a city uh to make sure that residents have access to care because those residents have access to care, and we'll continue hopefully to be productive members of our community.

That's what we all want at the end of the day.

Um, and whatever connections we can provide and uh support, I think is important.

Um, and so on the um the four selected vendors, are each of them providing upstream and downstream or specialties in that?

I mean it did it depends.

So some of them um I say some of them provided things in a couple of categories, some of them provided things in only one category.

For instance, Lapsjust trained doulas.

Um, but on the other hand, the YWCA did some presentations and workshops, and also um provided the the IUDs.

Um, so it it depends.

And is there a cross collaboration between the vendors?

Absolutely there was, yes.

Can you do you have an example of um the the classes?

I I mentioned that those workshops were new, and so the YWC and Empower YWCA and Empower House cre co-created those workshops rather than you know separately each creating them from scratch.

Okay, um I think you know, just because this funding is at risk, I think it's so important for us, and we're looking at collaboration and partnerships.

We're probably gonna hear us say that a million times in the next couple of months.

We've been saying that, but more so we're in it when we're in a deficit like this, and so uh, you know, medical centers and district eight, and so I'm always looking at Methodists and UT Health and UTSA as as possible partners.

Have you engaged with them at all or is there opportunity to so as part of the Center for Policy and Health Improvement?

Absolutely, they're part of the work.

Um, in I'm trying to think of whether they c they go across all of the categories of the community health improvement plan.

Definitely they're involved with food security, um, they are, and then housing stability is an offshoot of the food security group.

They are absolutely involved with behavioral health and mental well-being.

Um, and uh I know we've got university.

Oh, yeah, yeah, UTSA is also working with us with preenal care, so yes.

Wonderful.

Well, thank you again for all the work that you're doing and um to your team.

Thank you.

Thank you, Council Ruger Steel.

Um thank you, Chair.

And thank you, Dr.

Wu for the presentation.

Just wanted to emphasize um the great work of your team with the RFP process and working through and dispersing these funds to make sure that there's great impact.

Uh I'm looking at particularly the evidence-based sex education for over 5,000 youths, and just the overall impact that that has had in our community.

And as you highlighted in your comment, right?

This isn't something that we necessarily uh especially in the state of Texas receive public funds to help support, but we know the impact uh that this has in our communities.

Uh I I did have a question for our city attorney.

Uh, for example, with the midstream funding um that we see on slide six.

Um, if we were to reinstate this funding, would you see any legal risk with what's laid out on slide six?

So if funding were to be reinstated um through a budget amendment, right?

And then we work through where what the funding source is.

Um, would there be any legal risk associated with what we see on slide six?

Um to be honest, but I'd have to look at that a little bit more closely.

Um, just initial analysis.

I don't see a problem.

But this would have to run through the regular budget process as to whether it's acceptable or not.

No, thank you.

I appreciate that.

Um, because I just want to emphasize um everything that's gone out in terms of this RFP and has been dispersed.

Um I don't believe our city would uh put us at risk uh by dispersing these funds.

So I just wanted to uh clarify that there's nothing risky about um the nonprofits that we've served.

Uh and if we were to reinstate the funding, uh I I would assume with legal analysis that it also would not pose a risk.

Um but just wanted to emphasize uh again we know that um public health is public priority, it's not a nice to have, and we have a responsibility to ensure that our community members have access to sex education, health care, uh, so on and so forth, because that's how we have healthy communities.

If we want uh if we want a stronger economy, you have to have a healthy workforce.

Uh so I just want to highlight that intersection.

And of course, my message today, whether it's with the second item, the third or the fourth, is that we should be reinstating funding to support our community to have access to health care.

Uh and then, of course, if it is at risk, we should be working uh with our Bear County delegation to identify and lobby to go advocate for secured funding.

Um, but just wanted to thank the team for the work that they've done on this.

Thank you, Chair.

Thank you so much.

Any other comments or questions on this item?

Well, great.

Well, thank you, Dr.

Wu, for the presentation and for the entire team and of course all the partners who are doing this incredible work uh and the folks who advocated for this as well.

Um I don't think I have too many other questions uh on this.

Um I really appreciate from public comment earlier.

Was the kind of the conversation around uh the social safety net that we have here locally, right?

And a lot of this is exactly that when we talk about um economic times of economic uncertainty.

It's programs like these that keep people um alive, frankly.

Um, keep people safe, keep people healthy, keep people educated, keep people ready to stay in the workforce.

All the different things um come back to the kind of social safety net that we do our best to provide when especially in moments when uh other entities will not provide that, right?

And so I think this is something that's really helpful for a lot of our community members um in a variety of different ways.

It's not just the yes, the direct health support, but also the holistic care and the holistic uh support for their rest of their lives, right?

I think when we look at how we operate as city government, we gotta look at this from a larger scale and not just kind of a uh a one-off thing here and there that when we do these investments they go a lot longer than just the kind of this person got an STI test, great.

No, it's beyond to make sure that they're able to stay healthy their entire lives, have better relationships as well, and therefore also likely have better relations with their kids or they have kids later on or choose not to, whatever it may be, um with their family members, there's a lot of other extra uh external factors that will come into this, um, and ultimately support our entire public health and therefore our larger society.

So appreciate the work here, even if it seems small at one at one front, it's always part of the larger, bigger projects here to support all of our folks here.

Um so thank you again for that.

The only thing I had was if we could get um uh the zip codes of who was served through these.

Um I know there's you know some barriers here and there with the reporting, but if it could just be kind of a large scale, that'd be helpful or a high level, that'd be helpful to kind of see who was served throughout our city through this kind of funding.

Um yeah, I think that's it.

Thank you so much.

We'll have into item number four, no, five.

No, four.

Okay, sorry.

The Medicaid 1115 waiver update.

Glad to take us away.

All right.

Thank you.

Good morning, and thank you for the opportunity to provide this update regarding the Medicaid 1115 waiver reserves.

This presentation is part of a series of updates that we provided since last October.

Today's briefing is intended to share preliminary recommendations about our programs and solicit your input as we develop our FY27 budget packet.

So uh for uh reorienting to this process, just know that the Texas Medicaid 1115 waiver was originally established back in 2012 in order to help control costs and improve the state's health care infrastructure.

Local health departments, community health uh mental health agencies were engaged in this demonstration project.

The initial funding that we received and with council's approval back in FY13, it raised the department's annual operating 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 plan, and supported by our department's strategic plan.

Just know that although the funding helped to accelerate the department's population-based prevention efforts, the demonstration project itself ended in September of 2021.

So if you fast forward that over the years, the city has built uh reserves from incentive payments, which allowed the program to continue over the last few years, which include the peak years of the pandemic.

We've been concerned about the expiration of this fund initially projected to occur at the end of this fiscal year in September.

Over the past few months, our staff have been taking a deeper dive into the programs funded through this reserve fund.

As was mentioned during the FY26 mid-year forecast with the six plus six a few weeks ago, additional reserves have been identified to support the department's operational needs without moving to the general fund.

Currently, the amount is estimated at 20 million dollars due to accrued interests accrued since 2013, salary savings and outages, and reduced program expenses.

Keep in mind that there are several deliver variables throughout this planning process, including the right sizing of program accounts and expenses, which are ongoing.

Just know that the proposed FY27 departmental budget will present will be presented to full council later this summer.

This morning's discussion provides an opportunity to solicit your input as we develop our departmental budget.

So this snapshot, this slide provides a quick snapshot of our Medicaid 1115 waiver reserves and the allocations budgeted for this current fiscal year.

This amounts to $8 million, supporting eight different programs and a variety of cross-cutting teams and functions, and amounts to about 10% of our operating budget this year.

Since last fall, we highlighted the challenges experienced by some of our most impacted programs, which you've heard, and to include uh we did formal presentations on the healthy neighborhoods program, oral health, as well as our diabetes program.

In addition, this budget supports some innovative um programming tied to our communical disease division, the trauma-informed care trainings, our violence prevention programming, as well as critical operational support that include the requirements for maintaining national public health accreditation and augmenting our capabilities related to our capacity to analyze data and monitor disease patterns.

So over the next few slides, I'll highlight a few examples of the most impacted programs and share proposed funding framework based on the discussions that were held during last week's goal setting session and conversations since last fall.

So again, for your consideration based on the framework that was discussed during last uh Friday's goal setting session, we're looking at uh the constellation of mandated programs, priority programs, and programs previously funded by the general fund.

Additional factors for consideration would include program outcomes, having a multi-year strategy, looking at our collaborations on the ground with our community partners and city mandates as well as policy priorities.

For the rest of the presentation, I'm just gonna highlight what we have at least tied to programs specific to oral health, stand-up SA, uh HIV um prevention, as well as our diabetes prevention efforts.

It's important to uh underscore the need, though, as we see that there's a reference to our support functions.

What's less visible to the work of the department, even though it's not less valuable.

Just know that there are operational needs and supports and critical functions that uh under underscore our ongoing capacity to monitor diseases effectively.

It speaks to our ongoing investments in our trauma-informed care trainings, and it does speak to our investments and our continued compliance with requirements to maintain our designation as a nationally accredited health department.

Again, there are only eight other accredited local health departments here in Texas.

So with this, you may recall, again, just a few months ago, we provided a briefing about the oral health program back in February during National Children's Dental Health Month.

Just know that our department began these services many years ago, over 50 years ago.

And at that time, the line share of the support was anchored to the general fund.

Just know that the program's operating budget is $2.5 million and supports nearly 40 staff.

Again, a mix of temp staff and clinical staff and programmatic staff.

And just know that if you fast forward, our current support, the line share of the program is supported by the Medicaid 1115 waiver and external grants at about to about $2 million with nominal support from the general fund, about $400,000.

Today, the Oral Health Program's purpose is to improve overall health by providing or health services, increasing access to dental care for uninsured and underinsured families, and providing evidence-based oral health education.

We currently do this through a delivery of three initiatives that include Head Start and Early Head Start Oral Health Services, the Miles of Smiles program, and the Title V Dental Assistance Program.

Each year we serve over 17,000 children at no cost to families.

And just know that the complement in our mobile dental health clinics, the team provides oral health evaluations to children and administers fluoride varnish application and dental sealants when applicable to prevent cavities, again, at no cost to families.

And in addition to the clinical preventive services, we also provide robust case management services to participants in needs as well as referrals and assistance with coordinating dental care and oral health education.

Again, the impacts of a lapse of this funding would result basically in the elimination of this program and critical functions in doing this outreach service.

Therefore, we recommend continuing the funding from the Medicaid 1115 reserves to be allocated to support this program fully.

So the next example, again, this program, the Stand Up SA established back in 2015, is this is a violence prevention uh violence intervention and prevention program.

Again, it's using an asset-based uh model.

It speaks to the investments, like models like community health workers out in community.

And this is a dedicated to supporting individuals and families affected by gun violence.

This program has an operating budget of one and a half million dollars with half of that support coming from the general fund and supports about two dozen staff.

Program staff work in neighborhoods most impacted by violence to build trust, provide mentorship, and connect residents with critical resources and support services.

The team focuses on de-escalating conflicts and pervading violence before it occurs.

Stand-up SA also provides support to victims of shootings and stabbings through hospital visits, follow-up care, and community outreach, while encouraging positive life choices as alternatives to crime and retaliation.

By maintaining a strong presence in the community and building meaningful relationships, the program strives to create safer neighborhoods and long-term positive change.

Stand-up SA also operates through three distinct teams: the East Side team, the West Side Team, and the hospital initiative team.

This past year, the program expanded its efforts by engaging youth at the Crior Juvenile Detention Center through mentorship guidance and supported services aimed at fostering personal growth and reducing future involvement in violence.

The highlights include from this past fiscal year over 500 altercations interrupted, over a hundred hospital patients served, and nearly a hundred youth engaged at the juvenile detention center.

Again, a lapse in this funding was would result in the elimination of one of the outreach teams, the east site team supported by this program.

Therefore, we recommend continuing funding from the Medicaid 1115 waiver reserves be allocated to support the Stand Up SA program.

The next example, again, this is not the exhaustive list, but this was intended to share with you the most impacted program supported by the Medicaid 1115 waiver reserves.

The sexually transmitted infections or STI control and prevention program has an overall operating budget of nine and a half million dollars.

It includes a mix of the general fund grants and the Medicaid 1115 waiver funds and supports 58 staff in the program.

There are four components to this program that are funded with the Medicaid 1115 waivers funding specifically.

It's the SDI Clinic, it's the mobile Outreach team, it's the congenital syphilis team, and the Healthy Beats Program.

The mobile outreach team, which is another component, provides screening and treatment opportunities throughout the community at different events, targeted screenings of high risk populations or in response to investigation findings conducted by our disease intervention specialists.

The Healthy Beats component is uh one that provides case management on a voluntary basis to anyone who is pregnant and who has been uh diagnosed with syphilis or is at risk of being exposed to syphilis through their pregnancy.

And finally, the congenital syphilis team reviews and investigates all reports of babies born with a positive syphilis lab to determine if they're born with congenital syphilis.

Again, you see on the screen what we served again over the past fiscal year that over 15,000 individuals are served, and uh over 3,600 who have been treated for syphilis.

Um we conduct over 6,000 syphilis uh investigations, and we found that 161 conject congestional congenital syphilis investigations were conducted by our team.

For this, the recommendation is to support the mandated components of this program.

Again, if you look at our functions specific to the clinical services and our congenital syphilis investigations, therefore, we recommend continued funding from the Medicaid 1115 waivers reserves be allocated to support the clinical services and the congenital syphilis investigations.

And lastly, again, by way of uh this update, this program, the diabetes program, uh, was launched back in 2013.

It's anchored to our our diabetes, our chronic disease section at our department, and it's uh provides free diabetes prevention and self-management education workshops across the city.

The program itself is currently funded by a number of different streams that include the Medicaid 1115 waiver, the general fund, and the state grant.

There are about a dozen staff supported by uh this uh by these different funding streams.

Just know that uh most of the staff are supported by the Medicaid 1115 waiver.

The program offers no cost diabetes prevention and self-management education work cross workshops across the city.

Um, again, workshops are held at community centers, senior centers, places of worship, businesses, libraries, schools, and a whole host of community sites.

It's also important to acknowledge that this unit anchors the uh insulin insulin assistance program, which is uh supported by our general fund.

With this in mind, we recommend funding the Medicaid that the Medicaid 1115 waiver reserves uh support the educational and outreach component of this program.

This allows us to focus on our primary prevention efforts and our ongoing collaborations with our clinical and nonprofit partners like the YMCA, the SAVE Clinic, University Health, and Methodist Healthcare Ministries.

So for this morning, in closing, just know that our global recommendation is to establish a glide path that allows us to continue funding certain programs based on the framework that was discussed during last week's city council uh goal setting session.

Just know that the funding will allow us to continue selected programs and critical cross-cutting functions that include augmenting our data analytics, maintaining our designation as nationally accredited uh health department, and ensuring that we are in compliance with all the functions as required and mandated by law.

Our next steps would include incorporating today's feedback as we develop our budget for the next fiscal year to be presented to full council later this summer.

So your comments today allow us to factor in key considerations as we prioritize programs and functions at the department to mitigate uh burnout and to minimize the disruption of services.

So, for that, uh I want to thank you for at least allowing us to bring up the speed and uh we'll open it up for questions.

Thank you so much, Dr.

Jacob.

Really appreciate the presentation.

I know we had a little snapshot uh last Friday about this particular item.

Um, this is helpful to kind of get into more of the weeds of it.

Um, just a quick note for the committee.

Um, of course, we had diabetes program and oral health come to uh be presented here early this or late last year.

Uh stand-up SAI and the HIV syphilis prevention programs we'll be looking into the next couple months, just for more detail on those.

Um one quick thing I wanted to ask before I open it up was on the the deep dive portion.

Um I know we talked a little bit uh on Friday about what that kind of fully entails.

Could you talk a little bit more about I guess what the priority or how the these programs were selected?

Um was it based on funding?

Was it based on priority of the council or what was the the kind of background with that?

Sure, thank you.

What goes into a deep dive?

Sure.

Councilmember, thank you so much.

So just to recap, in the beginning, as we started this year, we anticipated that the funding would be would run out on September 30th.

So we started looking at what programs, you know, how how what programs are funded through the Medicaid waiver, and then as part of that, we went back and looked did a full reconciliation of the program.

And we're still finalizing that.

So I want to um be clear that we're the m numbers may change slightly.

Um but what we did is as part of that, we s based on what council discussed last week, in terms of what are mandated services, what are priority services, we looked at those functions or those programs being funded out of Medicaid waiver, and that's how we're coming up with these recommendations.

Uh we saw our HIV syphilis, a mandated program.

We want to fully we want to fund portions of that program, uh stand-up SA as well as the oral health program because based on our conversation with this committee last when we did the oral health, we understood that this was a priority as well.

Does that help answer your question?

I think it's a mixture too, right?

It's primarily prioritization, of course, what funding is available in this kind of bucket.

I know a lot of it was the reimbursement dollars that we typically not reimbursement dollars, but the money that we use to upfront the cost.

Yes.

Right.

So these this is a little bit differently because it's incentive payments that we received because when we received the money in 2013, it allowed us to at work as part of this program, we expanded programs or created new programs to address health needs in the community.

So we're really looking at what are those programs that we have that are mandated that are priority or that were funded through the general fund prior to 2013, which is the Oral Health Program.

Got it.

Okay, that's helpful.

Um I think that was just one of the biggest points here to want to make sure that you know how that process went through, uh and what the next steps are.

So glad to hear that we know there's still a little bit of flexibility, still options available throughout the summer, but of course those are all still gonna be worked on.

Um don't want to get ahead of ourselves, but sure.

And one thing that we also looked at is how can we continue these programs on a multi-year for as long as a glide path as we can.

So that's why we're recommending to sunset some of the programs, but that will allow us to fund some of these priority and mandated programs for a longer period of time.

Got it.

Without without the general fund supporting it.

Right.

Thank you, Justina.

Anyone want to start the council conversation?

Council White?

Yeah, thank you for the presentation.

Um the these programs, Stand Up SA, Children's Oral Health, you know, all of them do do great work and serve a lot of people in the community.

Um moving forward, I of course want to make sure we're we're uh being good stewards of taxpayer dollars.

Um same question I sort of asked a minute ago on on the on the reproductive justice stuff.

Are there any other organizations, Bear County, University Health, nonprofits, or other uh departments doing uh similar work that could potentially absorb these services?

We work, thank you for the question.

We do work with a number of community partners, and it depends on the program or initiative.

We have different collaborations on the ground.

So we I rattled off at least some of the nonprofits.

Um so we work with the Center for Health Empowerment in South Texas, we work with the SAFE clinic, we work with the school districts, we do work with uh community providers, the federally qualified health centers.

So depending on the disease pattern or the programming, we do have different partnerships on the ground, including the county.

Okay, and there's other grant opportunities and and models that we can look at as this phase is out.

True, and just know that over the last year and a half, the biggest concern has been about the instability of say federal grants to support these this work.

So this is specific to the Medicaid 1115 waiver reserves, which is unique in and of itself.

Yeah, so we're looking at impacts to our programs on the ground.

Okay.

Thanks, Claude.

Thanks, Chair.

Anyone else?

Have any thoughts or questions?

Counselor Mr.

Gonzalez?

Yeah, just quickly um thank you for uh the presentation and uh I agree all these programs are are so important for our community and um district eight is probably the most diverse district in this city.

Um, and so uh making sure, especially on the oral health side, uh making sure uh folks coming into our community who don't have as many preventative options um have them here.

Um, and so that we're uh supporting and um connecting them to uh those resources is important.

Um, I just had a question on the reserves because we've we've talked about the deep dive and it's come up a lot recently.

So we had reserves, and I don't want to re I don't want to read the slide directly, but the reserves um we were using those from 22 to 26, a set of reserves, right?

And then we've taken a deep dive into finding more reserve funding.

So where how are we where are we finding that exactly?

Okay, um, I'll take it up.

So so just know that there are uh we focus on program expenses year over year, which is what we present and gets adopted each year.

We do know that there's been an interest-bearing account that has been accruing interest over the course of the last uh 12 or 13 years.

Um besides salary savings, we were able to cobble this dollar amount, which is why it's an estimated uh um amount, the 20 million that was announced a few weeks ago.

So it's not in one fund, it's not in one cost center, it's an accumulation, and it's literally tied to these programs that were approved by the state when we participated in the demonstration program.

So because of the ins incentive payment structures, um there are nuances of the financing.

We don't have any other fund like this, but yes, we've been doing our due diligence and what we've done.

If only we did.

Sorry?

If only we did.

If only if only and just for more context, when we were in tw in 2013 when we did approve this, what was the the bigger goal?

Or I mean that's a hard question, but was there something happening at the state level or again?

Uh we were one of uh a number of partners, local health departments, mental health uh um providers that were invited to participate in the demonstration, which ended years ago.

So we've been managing these reserves, this one fund, and it's allowed us to not only expand but add the new programs like the expansion of stand-up SA or converting the support from the oral health program from the general fund to the waiver.

As part of the the program, they were really looking at innovative ways to provide health services.

So they looked at health providers in general and how we could expand services, make them better innovative ways.

So we were getting those payments as we look for ways we could better provide health services to the community.

Okay, great.

And one last question on standup SA.

I'm I'm interested in the hospital initiative team.

Can you share a little bit more about that?

Sure.

It's uh one of our the smallest team that we have.

It's a relatively new initiative.

We do work with the providers on the ground.

Um this was uh based on observations from our clinical providers that we need to have uh better nexus uh with patients who access the healthcare system.

Um so I would say that the more robust teams are the east and west side team, but the hospital team is a smaller unit, and it's uh just a couple years in the making, and it's tied to the hospital networks here in the city.

And is it is it putting ourselves in the hospital or is it so the mechanics of it having a dedicated staff person in the emergency department, but also working with the providers in terms of some of the clientele that come in that are um victims of uh whether it's a shooting or uh any other uh acute injury.

So it's something that we've uh identified as a resource as an opportunity and a gap, but again, it's the smallest of the three teams that we have.

Okay, well, and thank you so much.

I appreciate it.

Council Rika Steel.

Thank you, Chair and thank you, Dr.

Jacob, for the presentation.

Just also wanted to express my gratitude for um Jamie and the folks who gave public comment, uh written comment rather, Nadia, Emma, and Gracie, uh, in terms of the impacts of these programs.

And I appreciate uh you laying out how um these priorities were identified based off of past conversation, and I'm looking at the list and they're just uh very vital to our communities, particularly the inner west side, um, but just wanted uh to highlight and express my gratitude to Dr.

Julius with the diabetes prevention and control program, and seeing that there's been a 62% of participants who completed the program saw reduction of their risk of developing diabetes, which is very impactful.

Uh I'm hopeful with um some of the changes that we've seen uh in terms of what you can purchase with SNAP benefits, we'll also see better health health outcomes as well and the intersection with the dental care uh that we see with our youth.

Um so pleased to see that those are prioritized.

Um again, as Jamie articulated well in her public comment, just the overall impact uh to having access to healthy in our communities, and I know uh this is y'all's work, y'all's jam, so I'm teaching to the choir here, but just wanted to just re-emphasize the importance of that work.

Uh I was also interested uh with the stand-up SA program, uh, something that our team continues to advocate for.

Um, I was interested to see the work that you all do within the juvenile, and if there's opportunity, I would love to join your team and stand-up SA over uh at the Juve to see uh some of that relationship building and what that work looks like.

Um but just such impactful work, pleased to see that um funding has been identified to support the continuation of this work.

Um, but my only question is can you remind us how many employees uh are supported through this fund?

Stand up SA specifically?

Uh no, with uh everything supported through.

Yeah, so we had budgeted over 80 staff for the current fiscal year.

We currently have about 75, 76 staff.

Uh we have a few uh vacancies, but that's globally for supported by the Medicaid 1115 waiver.

Um again, it's embedded, integrated as part of our operating budget, but it's eight million dollars which budgeted it and over 80 staff for this current fiscal year.

Thank you for that clarification, right?

Because I think the 75 and the total of 80, these are positions that we can't afford to lose, right?

It's not about how can we afford to cover the cost, it's like we can't afford to lose these positions in our community.

Uh, but those are my comments.

Thank you, Dr.

Jacob.

Thank you, Chair.

Council Brial, did I think of you think?

Thank you, Chair.

Um, and thank you for the presentation.

So um, yes, I know that the oral health program, I think we've all mentioned, has a huge impact on the community.

Um these others, so but I do want us to be clear what so if we're gonna continue funding these programs, then what is what is not gonna get funded?

What programs are not gonna be funded?

Again, we're doing our analysis across a spectrum of these different programs, but we would end up forfeiting the um priority or non-mandated uh components, for example.

Um and our algorithm is looking at what we had historically invested in.

The oral health program is probably the cleanest to talk about.

The line share over 85% of that budget is anchored to the Medicaid 1115 waiver.

So if you imagine losing all that capacity, basically um undercuts that entire program.

Okay, so just to clarify a little bit.

So what we would be recommending is eliminating a pieces of the the mobile uh operations team for the SCI clinic, also healthy neighbors.

Uh so those are the two main programs and some of the support operations as well.

That makes sense, thank you.

And also, too, what is the plan for next year if and when the reserves run out?

So, right now, based on what we have estimated, we're looking at a multi-year again a glide pattern, which is why the reference to sunsetting components stretching the dollars as much as we can without adding more duress to staff, but also curtailing certain services.

Like we're talking about the SCI and a mobile outreach team.

So this is ongoing analysis, and uh that's what we would be presenting to full council this summer.

Our entire budget compliment.

Okay, thank you.

Thank you for that.

That helps.

Those are all my comments.

Thank you.

Anyone else have any questions or comments on this?

Great.

Um, well, thank you, Claude, for the presentation, and thank you for all the work on the back end to the to get us to this point.

I know these are really incredible programs that I know myself, very eager to see how we continue to maintain.

I know a lot of uh community members here too.

Are um I just had one last question really quickly uh on the mental health component on slide four.

Um, what what goes into that one?

Was that more internal for staff like within the like the kind of trauma-informed care or the different things?

Yeah, so we do have a dedicated staff or team helping to do the trainings for the level one trauma-informed care certification.

So that's what this funding supports.

We you probably are aware of the many grants that we provide through uh communities and schools, so that's not tied to this funding stream.

So this is specific to our capacity to conduct these trainings here within COSA.

Okay, so not essay core, not the educational.

Okay.

That is correct.

Okay.

We would look to move some of these trainings online.

Right.

So that would allow us to free up capacity in the in the Medicaid waiver.

Okay, got it.

And the team pregnancy one, uh, is it that's different from the Healthy Start Pro, right?

That is correct.

This was um again tied to our contracts with communities and schools, but also um tied to project worth.

So that is uh we've transitioned from that programming, so it is uh different allocation.

Do any of the funding or sorry, do any of the trying to think what the right word is, any of these programs that uh are potentially at risk, are they funded through a delegate agencies in some form or are they supplementary or what is the kind of is it similar to the reproductive fund conversation where it's more supplementary work or is it additional or duplicative?

Yeah, again, if you imagine the Braden funding here, this is a snapshot of the most impacted programs.

Um we can at least uh look at the crosswalk with what we have supported by delegate agencies.

Okay, I'd be interested in that that analysis or that evaluation, then a little bit of analysis of what's the best way to go as far as we can with it.

If it's more delicate agency funding towards a specific initiative that's tied to mental health or teen pregnancy, I'd be interested in seeing what that additional funding for that maybe agency would be and what that could look like in terms of the larger impact and scale of it, versus right, um potentially using that funding for supplementing these programs to stay maintained.

Um just interested in seeing the analysis of the scale that of impact we have on the community overall.

So I don't know if that could be that will already be done uh during the summer, but it would be interesting in seeing what that specific kind of uh comparison would look like.

Got it.

Well that's good to know.

And I think that's it.

All right, well, thank you all so much.

Um at 1124 a.m.

we'll officially adjourn the community health committee meeting.

Thank you so much.