Good afternoon.

The meeting will come to order.

Welcome to the April 8, 2026 meeting of the budget and appropriation committee.

I'm Supervisor Connie Chan, Chair of the Committee.

I am joined by Vice Chair, Supervisor Matt Dorsey and members, Supervisors Danny Sauter, Shimon Walton, and Cheyenne Chen.

Our clerk, it's Brent Halipa.

I would like to thank uh Colina Mendoza from SFGov TV for broadcasting this meeting.

Mr.

Clark, do you have any announcement?

Thank you, Madam Chair.

Just for friendly reminder to those in attendance to please make sure to silence all cell phones and electronic devices to prevent interruptions to our proceedings.

Should you have any documents to be included as part of the file, it should be submitted to myself, the clerk.

Public comment will be taken on the item on this agenda.

When public comment is called, please let me speak on the west side of the chamber to your right, my left along those curtains.

And while not required to provide public comment, we do invite you to fill out a comment card and leave them on the tray by the television to your left by the doors.

If you wish for your name to be accurately recorded for the minutes.

Alternatively, you may submit public comment in writing in either of the following ways.

He mail them to myself, the budget and appropriations committee clerk at B R E N T dot J A L I P A Hat S F G O V dot O R G.

If you submit public comment via email, it will be forwarded to the supervisors and also included as part of the official file.

You may also send your written comments via U.S.

Postal Service to our office in City Hall at one.

Dr.

Carlton, be good to place room 244, San Francisco, California.

94102.

And Madam Chair, that concludes my announcements.

Thank you, Mr.

Clark.

And before we call our agenda item, we will need to excuse President Rafael Mendelman.

I'd like to make the motion to excuse uh President.

Second by Vice Chair Dorsey and a roll call, please.

And on that motion by Chair Chan, seconded by Vice Chair Dorsey.

Do we excuse Supervisor Mandleman from attending today's meeting?

Vice Chair Dorsey.

I Dorsey.

Aye.

Member Sauter.

Sauter.

Aye.

Member Walton.

Walton.

Aye.

Member Chen?

Chen.

Aye.

Chair Chan.

Aye.

Chan I.

We have five eyes.

The motion passes.

And with that, Mr.

Clark, please call item number one.

Yes, item number one.

Is our hearing on the March update of the city and county's five-year financial plan, the threat of federal and state funding cuts and their impact on city programs and services and planned approach to mitigate these cuts.

Madam Chair.

Thank you, Mr.

Clark.

And today we have Sophia Kittler, Mayor's budget director, as well as our controller's office here to make this presentation.

Good morning, members of the committee.

Thank you.

I am attempting to get the slide version rather than the TDF version up.

So apologies.

Bear with me.

All right.

Thank you, Chair Chan.

Thank you, members of the committee.

My name is Sophia Kittler, Mayor's Budget Director.

I am joined by Michelle Lersma and Devon McCauly from the budget analysis division of the controller's office.

And we are updating on the March 2026 updates to the five-year financial plan and joint report.

So released on March 31st, we had a um a much improved and still not very good deficit report.

You can see across the top here, kind of like the four-year projection on which of what our annual shortfall is in each year.

Year one is 168.5 million, growing to just over a billion dollars by year four.

Um that gives us a two-year deficit of 240 or 642.8 million dollars.

That is a nearly 300 million dollar um improvement over this uh the December joint report.

Um we continue to assume 306-ish million dollars um of HR1 revenue loss, and that is about 48 percent of the deficit at this point.

Um a couple things to flag here on these numbers.

168 is below any of our baseline triggers, so we will expect to pay out all of our baselines this year.

But we still, and but despite all of this good news, we still have a very significant growing deficit as our costs continue to rise over the next four years.

And we will talk about the shape of this deficit over the next coming slides.

The good news.

There is good news, and I put it all on the same slide.

In year one, and these are all with the exception of fund balance, year one numbers, we saw an increase in the first year of the budget on business tax.

Prop M timing kind of shifted when we are receiving a bunch of money, and so we are seeing a big spike in business tax in year one.

Hotel and sales tax, after having been downward revised for the last several joint reports, is finally starting to show some signs of life, which is great news for our city and kind of come a comeback downtown.

Transfer tax is continuing to climb up.

As you know, that is an inconsistent tax.

Um, but we do see some good news in year one.

Um in fund balance, uh, this is a current year fund balance number that we then spread over three years.

And I think we talked about that last time.

Uh we have 150 million dollars of additional fund balance reported in this update, and that reflects really two things.

Um I guess it's not additional, 149 versus December.

Um that was around 90 million dollars from the six month report, which is unspent savings from department costs, salary and benefits, things like that.

And then we had um uh a bunch of tax revenue in the current year in particular.

And Michelle's coming to save me for myself, I think.

Um the uh the Airbnb settlements, notably is a part of that, um, particularly the general fund portion.

And again, what we do with fund balance is we tend to spread it over three years rather than have it as a big lump in the first year.

Um and then finally, we are seeing increased patient census at um SF General and Laguna Honda and expanded billable encounters.

This has been a big initiative of the Department of Public Health, making sure that all of the things that we could bed bill Medical for that we had not been doing, um, we are starting to see some of that revenue where we are eligible.

And so that shows um an additional 30 million dollars of um revenue in year one.

Um we do have some cost increases and downward revenue pressures as well in across the two-year deficit and across the um the forecast in general.

Um we continue to have rising labor costs.

Uh we did have some mix some good news at retirements.

Um, they had an actuarial change that has um kind of smoothed how we think about um Michelle, you might have to explain this better than I, but smooths how we think about um uh the cost of living adjustments at the retirement board, and that has saved us uh around $30 million in general fund and $60 million all funds over the two years of the deficit.

Um health insurance rates are continuing to rise.

Um we had previously forecast them at 9% a year, we are now forecasting them at 9.5% increases annually.

Um citywide operating costs continue to drive up.

Um our property tax appeals refunds um are also climbing, and so that added about a $56 million hit to our property tax.

Um we had a correction in how we thought about the property tax, and I'm gonna get this, I'm gonna say it wrong, and I apologize, but um SB 593, which gives the um OCII the authority to sell debt for affordable housing.

Um effectively like comes in at the top of the funnel of our property taxes and kind of reduces our property tax revenue.

Um we had previously had a different thought about how that hit the general fund.

Um this March update corrects that, and that adds kind of a 40, it is 86% general fund property tax funded.

Um there is ERAF risk.

There are two things in here, and Michelle will correct my numbers on them.

Um AB 2526 would divert additional excess ERAF money to special education, um, which would reduce the city's share, and then simultaneously there is a push by a number of superintendents to shift kind of the accounting at the state level from uh enrollment based or from attendance base to enrollment based, and that would also have a significant impact on our XSERAF.

Um I have heard a few estimates there from anywhere from 15 to 90 million dollars.

Um and then finally, Prop M filing timing.

Um, we had a number of businesses uh uh shift their filing from the March deadline, kind of file the extension for November, so we have a little bit more uncertainty, and that shifts those receipts from the current year to next year.

Um Michelle, any time you want to tap in on these, you let me know.

So here's our business tax revenue projections.

And I I think I want to really call your attention to a couple things.

First, the gold line is where we had previously forecast in the December update.

So the blue line is what the March update is assuming.

You will see that in year one, we have a huge spike, and then it comes back down.

And that is largely driven by the timing of those Prop M business tax payments.

So where we had assumed some next year, a bunch of them are pushing forward.

We are still, because we've had fewer filings, and this is the first Prop M filing, we're still the team is doing excellent job, but we're still kind of figuring out like what the effect of Prop M is.

Against the deficit, there is $90.7 million in upside, but as you can see, that is a kind of entirely in year one.

Um and then we have a little bit of downside in year two.

Um and then in general, the underlying driver of all of our business tax receipts is continues to be, and again, we had talked about this last time.

The city's collected share of global business activity.

It is not necessarily driven by like local businesses.

Um then we continue to have uncertainty with Prop M because of that filing deadline.

Anything you would like to add, Michelle.

All right.

I've kind of like taking all of their talking points, unfortunately.

Um hotel tax.

Uh, as I mentioned, this is a bright spot for us.

Um the the controller's office has um revised upwards their hotel and sales tax projections starting in current year, and the growth continues to be modest, but it is um around 36 uh 37 million dollars of good news in the in the deficit.

Um Super Bowl 60 was a great revenue breaker for us, and we hope that that kind of we continue to ride that good news vibe shift, whatever we are calling it.

Um but the gains do slow, right?

I think we there's like a big push from Super Bowl, but we do not necessarily expect that that rate of growth continues.

Um and then sales tax, there is some upside, but it is um limited.

It's about 11 million dollars over the two years.

But we are very excited about this.

This is historically we have been revising these down.

This time the controller's office has revised them up.

Property tax revenue projections.

Um over the two years, we are seeing a decrease in traditional property taxes with an increase, a small increase in XS ERAF.

Um in total, this kind of affects our two-year deficit by around 46 million dollars.

Um we continue to see additional appeals against property taxes, and so we continue to withhold me working through those as we have discussed.

That requires a certain amount of staffing across a number of departments to make sure that we are not that we are at least keeping up with those appeals so that they are not automatically decided against us.

Um then, but we do kind of see once they go through that process, it is resetting property taxes at a lower rate.

That is both true of the appeals and just generally kind of like the movement in the commercial market on buildings that have been kind of like sold at a discount to their previous rates.

Um again, the OCII bond correction is reflected here, where um that that is a higher portion of our traditional property taxes than we had previously thought.

Um and as I mentioned, XSERAF is volatile and uh subject to a number of state bills and initiatives.

Um and then lastly, I wanted to um call attention to our projected baselines.

Um we are expecting to pay 1.5 billion dollars in baselines in the first year of the budget growing to 1.65 in year 2030.

Um, and that is 142 million dollars additional in the first year of the budget growing to 231 by the end of the four-year forecast above what we had previously projected, or what we are currently spending, rather.

Um I will not walk through the baselines unless you would like me to.

Um so talking about federal and state funding changes and threats.

So last time I was here, we talked a lot about HR one and how we assumed HR one in the budget.

As a reminder, there are kind of three things that are driving our HR one revenue revenue forecast decrease.

I don't know how to say that more eloquently.

Um was the number of uh unsatisfactory immigration status, as they call it in HR one.

Um, and the number of people that we currently have billing against Medi-Cal that lose their their Medi-Cal eligibility.

Um that was around 7500 people, 75 to 10,000 people.

Um there is an increased work requirement and some changes on how people get an automatic waiver from the work requirement.

For example, um you used to be able to get a waiver automatically if you had been experiencing homelessness or were living in permanent supportive housing, that is no longer true.

Um so we see kind of like a number of people that we think will probably not stay on Medical eligibility because of that work requirement.

And then the third was the friction of the six month re-enrollment.

Um right now, people have to kind of re-up their eligibility once a year.

That is shifting to every six months, and we will start to see like that we had kind of forecast that that would overall have between a 200 and 400 million dollar hit on revenue of people that we currently serve and give care to um and then bill Medical for.

Um and instead, we will see like we will not be getting that revenue anymore.

We do plan to continue providing care.

Um so as I said, we that that we kind of got a range from DPH and HSA of what we think that will look like.

It could be up to 400 million dollars of annual lost revenue based on last year's HR one.

Um and we assumed um 86 million dollars in year one, growing to around 220 in year two for that 300 million number that I'd given you earlier, um, and then stabilizing in the out years closer to 200, 210 million dollars.

Um the president's reconciliation bill, which is in its early stages, um compounds all of this.

A few things that have come out of that are first um there is zero funding assumed for the continuum of care.

Um we get in any given year between 55 and 70 million dollars for the continuum of care.

Um so that would be a huge hit to our supportive housing and shelter system.

Um they are assuming uh or they have floated, and this is again very early stages, um, elimination of any non-citizen on MediCal.

Um we have not gotten anywhere near a costing for that yet, um, but it is a huge risk and something that would kind of again take the bottom out of our medical revenues.

Um we talked about the two changes at state funding for ERAF.

Um again, one the increased funding for special education, and second, the change in enrollment or from enrollment to attendance, both excellent things for our school systems, um, but both mean reduced revenues for our general fund.

Um then as a reminder, we had set aside approximately 400 million dollars in last year's budget as a one time for um kind of like sudden shocks to these things so that we can give ourselves time to figure out how to rebalance as these kind of impacts hit outside of the budget cycle.

Um so that does continue to remain there.

We have spent three and a half million dollars out of that reserve this year for the immigration legal supplemental.

Uh and then finally a few key risks to the forecast.

Um we do not assume a recession scenario.

Um that would be very bad.

Um a couple things we would watch there is the effect of oil impri uh oil prices, interest rates, kind of like the ongoing job cuts um across the city and particularly in the tech sector.

Um HR1 implementation uncertainty, as we said, we assumed kind of a middle of the road revenue loss, and that could be much higher.

We will start to have um better information on what that looks like starting around December.

Um federal policy volatility again between oil prices, tariffs, um, changes to HR1, changes to H1B limits.

There is a lot kind of going on at the federal level that affects our economy significantly.

Um our pension return rate is doing pretty well.

We assume a 7.2% return at last check, it was year to date around 8.45, but again, the markets um have been volatile, and so where that closes the year would affect um what we contribute to the pension system.

Um police and fire labor negotiations are not finalized yet.

Um, so they are not reflected.

The the tentative agreements are not reflected in this report.

Um, and then there are a few ballot measures on the June ballots that would either reduce revenue or significantly increase revenue, and we will not be contemplating the effects of either of those in our budget because it all happens after we introduce.

And that is all.

I am available for questions, and I will absolutely defer to Michelle Lertima, who is much better at the revenue issues than I thank you.

Thank you.

Um Supervisor Walton.

Thank you, Chair Chair.

Thank you, Director Kidler.

So in your opinion, do we have are we in a better situation in better shape than we were at this time last year?

No.

I don't believe so.

I don't think we're in a significantly worse shape, but we we had we had hoped to be in a much better shape given um a lot of really tough decisions that were made in the budget last year, as as I've think I've said before.

Like the mayor is very focused on thoughtfully, not all at the same time, reducing the structural deficit and thinking about the long-term fiscal health of the city.

We made a lot of really tough decisions in last year's budget, and then HR1 just kind of bottomed those all out and reversed all of that progress.

I think we are very fortunate to be able to, with the shape of this deficit and with kind of the the spike in revenues in year one, that will allow us to smooth the impacts of these continued tough choices, and and I think that that is a it is helpful to have that breathing room, and I think that is really a good sign for us.

Um but the out years are not improving, and and we need to figure out how to reduce our spending growth.

So I know we're being cautious, and I am now very confused.

Because if I look at last year's numbers, if I looked at previous projected deficit, if I look at previous projected income, just from what I see, it looks like the picture today is better than it was this time last year.

I think the two-year deficit number is better, yes.

And seeing that the federal cuts, which are major weren't maybe what some of us might have thought in the worst case scenario, how are we not in a better shape?

I want to be clear than we were last year.

Pardon me.

Um I didn't mean to interrupt.

Um I think it's a really important question.

And it is something that we spend a lot of time thinking about ourselves, kind of like what does this mean?

We have not yet seen what the actual impact of the HR1 cuts is, right?

We have made estimates and then we are working incredibly hard to make sure that everybody who used to have a waiver, for example, or who used to be eligible, like we are flooding HSA and DPH with the resources to be able to keep as many people eligible as possible.

Um not just for the revenue, although that is important, but for the care of of the vulnerable San Franciscans that depend on Medi-Cal or CalFresh, for example.

Um but we have not seen like we've made estimates and that we've kind of kept with those estimates for the past six months, um, but we won't see the actual effect of what happens on last year's HR one until we kind of see how much success we've had in keeping people eligible uh starting in December.

Well, I I just want to make sure that we are honest with ourselves, honest with the public, um, because obviously we have to balance the budget by the end of June.

And I also want to make sure that we can save as many services, save as many jobs as we go through the process.

So I I just want to make sure we're being real about what's in front of us.

Yep.

And making sure that I also understand what was in front of me, because from my standpoint, from what I see, looking at former forecasts, looking at all the numbers from the previous year, and looking at what's happening now, hearing what I'm hearing from the state, knowing the May revises coming, it seems we are in better position than we were last year.

And so I hope as we go into budget that we take that into account as we look at where we need to make changes so that we balance the budget and also do everything we can to address the deficit.

Thank you.

Thank you.

Thank you.

And Vice Chair Dorsey.

Thank you, Chair Chan.

I want to just explore a little bit um HR1 implications.

You had mentioned that we are now doing a better job as a city of getting um reimbursements for Medi-Cal.

Yes.

I'm just wondering, is there work that we can be doing with our Medi-Cal beneficiaries on meeting work satisfying work requirements or re-upping supporting people to re-up every six months so that we can just do a little more a little extra work that would be penny wise to keep people on benefits.

Absolutely.

That's exactly the right question, Supervisor.

Um and we've undertaken a number of things over the last seven months.

For example, the mayor's office of innovation has been working very closely with HSA to figure out how to I'm going to use a word that would I get would get Fox News to pounce on us, so I'm trying to think of a better one.

That would help people who might not otherwise hold down a day-to-day job.

Find a way to meet the work requirements.

So for example, how can we get people to participate in their community in a community cleanup in a volunteer service?

How can they participate in food distribution and with what sort of regularity do they need to do that in order to creatively meet the work requirements?

And so that is a combination of thinking about like what the legal structure of the work requirement is, how we can bring more people to sign up for that, how we make sure that that counts towards the work requirement, and how we make sure that they are ensuring that the city understands that they are doing that work so that they do maintain eligibility.

At the same time, we are looking at the forms that are required and kind of like all of the paperwork that goes into re-upping eligibility and trying to make sure that that is as user-friendly and as streamlined as possible so that it is much less of a burden and is kind of like a same information click and just resubmit every six months rather than having to go back and recheck, you know, like how basically how do we make that as fast and as as frictionless as possible.

Um and then finally, we are um exploring adding eligibility workers at HSA.

We've been making sure that they are not a part of our hiring slowdown so that we have as many eligibility workers as possible, particularly on CalFresh and Medi-Cal, so that we can wrap our arms around individuals who do need help managing working walking through that system.

And that's kind of been the approach to date is thinking through every piece of how that works and keep as many people eligible as possible.

And then simultaneously on the health side for the for the UIS, as they call them, the unsatisfactory immigration status.

Um how do we make sure that our social safety net is set up to continue to um welcome them into preventative care so that we do not see an an undue upside on emergency services, for example.

I think there were details that weren't clear after the passage of HR1.

In particular, I recall here talking to someone um from the drug policy realm about whether and to what extent this would affect people who are in drug treatment, who may not be in a situation where they could work if they wanted to.

It's just and and my understanding at the time was that there might be some details that the code of federal regulations is gonna work out.

Do we have any more clarity on some of that?

I would imagine the Department of Public Health does.

Um that is not something I'm familiar with.

That seems like it would hit the the disability waiver and kind of who falls into the disability waiver.

I would be delighted to get you that information and come back.

Okay, that'd be great.

Thanks.

Thank you.

Um just kind of want to make sure if there's anything that the controller likes to add for this presentation.

If not, I'm moving on to the people's coalition on budget presentation.

Okay.

All right.

Thank you, Chair Chan, and uh members of the budget and appropriations committee.

We are really grateful to have the opportunity to share a little bit more about the community perspective and the CBO and provider perspective on what's happening with the state and federal cuts and how that is impacting our local response to these.

And we have a perspective to share and are really grateful to the city and to DPH for doing phenomenal work at trying to help us solve this budget deficit that in many ways a lot of these effects are now being um, as we said, worsened by these Trump impacts.

So want to appreciate a lot of the work that has gone into that.

And we do want to uplift and share the community provider perspective on the city's response and maybe highlight some gaps that you might not be hearing in other areas of how this is landing, that we appreciate that the Department of Public Health and that the city has been responsive to hearing and hope that you, as supervisors are also nice and responsive to hearing how these things are landing with us on our end.

So we're here with the People's Budget Coalition.

I'm Anya Worley Ziggman.

I'm their coalition coordinator, and we do analysis of budget cuts with regard to equity impacts is our most important part of the budget and how we analyze this.

So we know of that from the community side that our community members are feeling the effects of cuts as in Medicare and SNAP and food access and HIV prevention and research, and that this is targeting immigrants.

On the local level, where our budget really analyzed, where we do have the power to make these decisions on the local level, we are also seeing reduced access to health care to harm reduction services that replicate the cuts that are happening from the federal level.

We're also seeing workforce development cuts, which ties into this SNAP and food access, benefit access.

That if folks are not able to find employment, they're not able to access these benefits anymore.

And we are seeing HIV services, particularly with regards to capacity building and equity access are also being impacted at the local level.

And finally, reducing that immigrant services safety net that although legal services remains funded in this city, a lot of the other supports that wrap around families when they arrive here and that reach those emergency needs, those supports are going to be badly hurt in the budget that is approaching us.

So this is our analysis on how this will impact the equity of San Francisco.

This is just an analysis on the proposed cuts so far.

We know that the proposed cuts that we know already represent maybe a third of the cuts that are coming.

But we can look to this to see what direction are we going in as a city.

And I do want to highlight and point out that for our Filipino communities and for our Pacific Islander communities, both communities respectively expect to lose what makes up about 20% of all of the grant funding to CBOs for those communities will be cut this year.

So 20% of all dedicated funding to CBOs for these communities will be cut.

It is on the table proposed to be cut at this time.

Similarly, if we look at what's happening with transgender and LGBT services, we'll touch more on this in a bit.

And on the right-hand side is a list of some of the cuts that are also being seen in more specific detail.

But similarly, 20% of all CBO funding for transgender communities will be cut in this budget.

And this is just what's proposed so far.

This is just about a third of the cuts that we are facing.

And these are cuts coming from MOHCD and from DPH, and in many ways, our responses to what's going on at the federal level, even if also responses to our local budget deficit.

Finishing up here, this is one of the most dire things that we have found in our analysis with MOHCD and with DPH is that 60% of these CBO cuts will impact immigrants directly.

So 60% of all of the budget reductions, 100% of these budget reductions, will impact extremely low-income and low-income families.

That's 100% of the services that is a part of their requirement.

And 60% of those folks will be immigrants.

So those could be undocumented immigrants, they could be documented immigrants, but they will feel the massive brunt of these.

And so this is our analysis on the cuts so far to say that of course we want solutions to this budget crisis that are not budget cuts.

But when we do have to make budget cuts, we have to take into account equity.

And for us, we represent the community.

We represent the people who receive these services from our CBOs, and the community is scared, and they're not just scared at what's happening on the federal level or on the state level.

They're scared of the decisions that you folks will have to decide on in June.

And they're scared of how that is going to impact them as well.

And so with that, I'm going to pass it to Laura Scheckler from the California Primary Care Association.

Thank you.

Hi everyone.

As Anya said, my name is Laura Sheckler.

I'm with the California Primary Care Association, which is the statewide association for community health centers across California.

We represent 2300 clinical sites across the state and serve one in three Medi-Cal beneficiaries.

And it includes many of the federally qualified health centers and community health centers here in California in our membership as well.

So for me, I just wanted to take a moment and ground this conversation in the larger statewide context.

Because the conversation that's happening here in this building is this a very similar conversation that's happening in every city and county chamber across the state and across the country right now.

We're seeing very similar patterns about which uh which communities are ultimately impacted by both the federal cuts, the state cuts, and then coming down to the city and county government decisions as well.

So I know you've had lots of conversations about HR1, but really the way I think about that is this is a cost shifting exercise.

It's shifting the cost from the federal government onto the state, and then the state is making budget decisions that often are shifting those costs onto the county and city governments.

And then ultimately your decisions are really about you know, do those costs get passed on to your community-based organizations and the communities that they are serving.

So both at the state and local levels, this the key question here is will these costs be absorbed or will the benefits and funding and services be cut?

And what are the creative options you have available for really thinking through that?

I want to stress really quickly that for organizations like health centers and other community-based organizations who are receiving federal funding, the impacts are really compounding here.

So, along with the trickle-down impacts, they are also facing changes to things like their grants agreements that are looking to restrict how they serve certain populations and services, and particularly for care that is highly politicized in this moment.

I'm sure that will be no surprise to folks in this room that that is particularly impacting communities that are being tires tirelessly targeted by the federal government.

So trans communities, immigrants, uh reproductive health services, and harm reduction services, as just a few of those.

And then the further you get down the food chain here, the more those impacts are amplified.

So now we're really at a moment where the real risk here is that the most harmful impacts of HR1 are being passed on to our critical safety net providers and then the communities that they serve, and those communities are already navigating daily attacks on their well-being.

Then the last thing I want to say really quickly here is that I want to highlight that there are some other counties who are really leading the way right now in this space to make sure that there are uh they're specifically finding ways to ensure that these communities and their services are protected during these times.

So across the Bay over in Alameda County, for example, the Alameda County Board of Supervisors has voted to set aside five million dollars over the next five years for gender-affirming care and trans communities specifically.

Uh Sonoma County is currently proposing 1.5 million in the coming year to support trans and immigrant communities to backfill these cuts.

And the Los Angeles Board of Supervisors earlier this year passed a motion to place a temporary half cent sales tax on the June 2026 ballot with a spending plan to make sure that it goes to safety net providers, and that will is estimated to generate $1 billion annually.

So there really are creative options here for thinking about how do we make sure that we're able to preserve care and services.

And yeah, I think the last thing here is before we move on to the specific providers, is really the question that's in front of you as the board of supervisors, along with your counterparts statewide and nationally, is how will you respond?

Who are you going to protect, and which values are you going to uphold in this particular budget?

Thank you.

Thank you.

And with that, I'll that's the end of our slides, but I'll pass it to our next couple of speakers who will be Laura Thomas from the SF AIDS Foundation and the HIV AIDS Providers Network.

Thanks, Sanya.

Good afternoon, supervisors.

I'm Laura Thomas with the San Francisco AIDS Foundation and a resident of District 10.

Um I want to highlight some of the ways in which cuts to HIV services are happening at the federal level, what we're trying to do to mitigate that at the state level, and then what's potentially happening at the local level that could undermine some of that work.

So the core of our HIV services for people living with HIV here in the city is the Ryan White Care system.

And Ryan White is a federal legislation that was designed and created here in San Francisco, which we're very proud of.

And it is a sort of a disaster relief model that sends federal dollars to urban areas hardest hit by HIV.

San Francisco, for a number of reasons.

At one point we were receiving 40 million dollars a year.

There were changes in the formula at the federal level.

Now we're down to about $15 million a year in federal dollars.

But in large part because of our commitment to people living with HIV here in this city, and fierce advocacy from people living with HIV, the city has seen its way clear to backfill those federal cuts year after year.

And so now we have a Ryan White system that is a mix of federal and local general fund dollars.

It is it is designed and intended to be the safety net services, so it is designed and created for people who are not on Medi-Cal, for example, who don't have private insurance, who are uninsured and underinsured.

We know the current administration is making changes again to the formula, and we are facing a loss of about 20% of the Ryan White dollars over the next five years.

We know that now.

We can see it coming, uh, and we need to be ready and prepared to figure out how we are going to backfill and hold that system of care together.

Again, this is the system of care that we have created for people who don't have Medi-Cal and private insurance.

We know, as you've heard uh before, and as you know well, um, that people are going to be pushed off of Medical for a variety of different reasons.

The Ryan White Safety Net needs to be there to catch them.

That's what it's intended and created for.

We are hearing that there may be an additional, there may be a 5% cut locally to HIV health services this year.

We're very concerned, uh, it doesn't make any sense to be setting aside money to provide for folks who are falling off of Medi-Cal when we've got a system while also cutting the system that we created for that same population that already exists, that already is in place that individuals already know and trust.

One of the other things that's been happening in the HIV world starting early last year with a series of executive orders from the president around gender ideology and around DEI.

Um, a whole lot of HIV research was eliminated under those.

Um, my organization, the San Francisco AIDS Foundation, along with the San Francisco Community Health Center, the GLBT Historical Society, and a number of other organizations around the country banded together, and we filed a lawsuit against the Trump administration, SFAF v.

Trump.

That has against the executive orders on gender ideology and DEI.

That is continuing to work its way through the courts, but so far it has protected us from cuts for those reasons.

Um we are still waiting to see how that plays out in court.

It's been uh combined with another set of lawsuits, but our legal folks at Lambda Legal have been fantastic in helping with that.

So that's a pending cut that is currently being stopped at the court level.

There's a similar set of cuts to HIV prevention that the federal administration tried to put through a few months ago.

Um it was cuts to California, Colorado, Illinois, and Minnesota.

Um HIV prevention sort of got caught up in that because we had grants there.

Uh it included around $10 million in cuts to San Francisco, $8 million directly to the Department of Public Health.

Again, San Francisco AIDS Foundation, San Francisco Community Health Center, and UCSF made up the rest of that.

That has also the attorneys general for those four states have filed suit, and that is currently those cuts are being held, and that is going through the court process.

One of the challenges for us as a community-based organization, even though our money is still continuing to flow, we are not actually covered under the attorney's general lawsuit, and so we are concerned that we may still get those cuts, and those are HIV prevention cuts, particularly for the trans community and for the gay bi and trans men who have sex with men communities here.

We are also hearing that some of the grants that we have with the Centers for Disease Control and Prevention when they come to the end of their cycle under a normal administration, they would be renewed.

We're hearing either that they may not be continued at this under this administration, or they may be continued with language that makes them essentially unimplentable, such as not being able to serve trans people, which is not something that is acceptable, let's just say.

So that's some of the context around HIV funding, and I'm certainly happy to answer other questions, but I know there are a number of other important uh issues that need to be raised.

So I will hand it over to my next colleague.

Thank you, Laura.

And the next up will be JM Jaffe from Lionmark Community Health Services to speak to gender affirming career.

Hello, everyone.

My name is JM Jaffey.

I use they, them pronouns, and the executive director of Lion Martin Community Health Services here in San Francisco.

We are in the mission district and have been around for about half a century providing primary care and mental health services to low-income, queer, trans, intersex, and other marginalized communities.

As a federally qualified health center lookalike, we do this regardless of ability to pay or insurance status, and we actually often absorb the uncompensated costs of care for people all over the state of California for gender affirming care.

Today, that care system and our people's very livelihood is under attack by the federal government.

This is not just about funding cuts, it's a coordinated effort targeting transgender people, one that is already destabilizing to our local health care infrastructure and our personal ability to obtain health care, use a bathroom, obtain education, employment, play with our peers, and ultimately our right to be our authentic selves.

At Lion Martin, we have been forced to withdraw from or avoid applying to federally sourced grants, and that's not just federally administered grants, but also state and city grants that are federally sourced because of the legal and financial risk of liability.

That means fewer dollars are coming to San Francisco's primary care and mental health safety net and to your trans populations residing here.

Even as we secured new state investment investments to expand gender affirming care this year, especially to youth, we simultaneously are set to receive a cut of the same amount per year from the city of San Francisco and possibly more to come, effectively canceling out that deliberate investment from the state.

Unfortunately, the need is rapidly increasing as hospitals and larger systems begin scaling back or eliminating gender affirming care, especially for use for youth.

We are seeing the network collapse.

We're estimating that at least 10,000 young people in California have already lost access to their gender affirming care provider and need a new one.

We are trying our best to fill that gap.

These patients are coming here to San Francisco, to Lion Martin, to places that are already operating at capacity.

Currently, you are set to undermine an initiative to save access to gender affirming care in this city, in this state, and given that people are coming to us from other states, the nation.

Without intervention, this will result in further delayed care, worsening health outcomes, increased premature preventable death for the trans population, and significantly higher costs to the city over time in ER and admission visits.

I also just want to say that you'll probably have a lot of public outrage about this, given the lack of action to impede an ongoing genocide and public health crisis against your trans communities here at home.

San Francisco has long been called itself, long called itself a sanctuary.

Now is the time to act.

Backfill the federal funding losses, reinvest in your local trans affirming care providers, and fund the infrastructure and capacity needed to meet this surge in demand.

Our communities are not abstract.

They are here and they are counting on you.

Thank you.

Thank you.

I'd like to pass it to Katya Padilla from the Latino Task Force.

Good afternoon, supervisors.

I'm gonna I'm gonna read it off because I know I can go on for hours, but my name is Katia Padilla.

I stand here representing communities across San Francisco in collaboration with the PBC, but I can't help to mention I'm also the COO of Latino Task Force, which is an advocacy body that sees exactly how the immigrant population is carrying the weight of these deep systemic inequities.

What we are seeing today is not just a budget issue.

It is a direct threat to immigrant communities who rely heavily on these systems to thrive.

At the federal and state levels, we are seeing cuts to essential programs like Medi-Cal, CalWorks, Food Assistant, and Housing Support.

These are not abstract programs.

These are the lifelines that immigrant families depend on to stay healthy, housed, and fed.

With stricter eligibility requirements and reduced funding, many immigrants, especially mixed status families, will be pushed out of access entirely, leaving thousands without health care and basic support.

We're also seeing the elimination or weakening of programs that support children, youth, and working families from WIC and workforce development to education and housing programs.

These cuts will not just impact individuals, they will destabilize entire communities.

And here in San Francisco, as you saw the numbers that Anya just shared, 60% cuts to the immigrant community.

When government systems pull back, community-based orgs are expected to fill that gap without the resources to do so.

I'm living it right now.

Organizations like the ones we represent here become the front line, providing food, health access, workforce support, and safety.

And y'all know LTF, we had to do that for COVID.

But we cannot do that if city funding is also being reduced at the same time, these needs are increasing.

This moment requires to be clear.

These cuts do not eliminate the need.

They shift the burden onto the most vulnerable communities and the organizations that serve them.

If we are serious about equity and public health in San Francisco, then we must protect and invest the very systems that immigrant communities rely on.

Let's be honest, these cuts don't reduce the need.

They push our people deeper into survival mode, and we refuse to stand by while our communities are forced to struggle just to exist in a city that they help sustain.

Thank you.

Thank you.

I'm proud to be able to pass it to Marnie Regan from Largan Street Youth Services.

Hi, Supervisors.

My name is Marnie Regan.

I'm a division director at Lorkin Street Youth Services.

I'm also chair of the Homeless Emergency Services Provider Association.

I'm here to talk about SNAP and Medicaid work requirements that begin June 1st and what they mean for San Francisco's most vulnerable residents, people experiencing homelessness.

Work requirements are often framed as promoting self-sufficiency, but without access to job training, stable wages, or workforce case management, these requirements don't create opportunity, they create barriers.

Unhoused and unstably housed people need workforce programs not because they're unwilling to work, but because homelessness creates structural barriers to unemployment, to employment that most traditional job markets and training systems are not designed to address.

As of June 1st, SNAP and Medicaid recipients will have to prove they are working or in training programs for at least 80 hours a month in order to retain food and health care.

Without investments in workforce programs to ensure folks can comply with this, people will lose food and health care, period.

This is utterly inhumane.

In San Francisco, we already know the data.

Most homeless individuals want to work, and many have worked in the past.

What they lack is not motivation, it's support.

And for transitional age youth who are experiencing the highest rate of unemployment across the country, about 10%.

They lack experience and entry-level opportunities.

When benefits are conditioned on work, but workforce pathways are under resourced, the result is deeper poverty, worsening health outcomes, and more people cycling through emergency rooms, jails, and shelters at far greater cost to the city.

This is entirely preventable.

That's why we're urging the city to please act proactively.

If these work requirements are the reality, then the city has a responsibility to invest in workforce programs that actually make compliance possible.

That means low barrier paid job training, sustainable wages, and supported work programs.

What does this take?

Strong coordination between HSA, HSH, and OEWD.

I wish they were here today, and providers who know what clients need.

We can choose a punitive approach that pushes people off life-saving benefits, or we can choose a smart, humane response that invests in pathways to stability.

San Francisco is always led with innovation and compassion.

Now is the time to do so again by pairing work requirements with real workforce opportunities, especially for people low income and experiencing homelessness.

I will now turn it over to my friend and colleague, Colleen Rebecca from TNDC.

Thanks.

Hello, supervisors.

My name is Colleen Rebecca.

I'm the director of community organizing policy and planning for Tenderline Neighborhood Development Corporation.

Affordable and permanent supportive housing providers are concerned about the impacts of HR1 on our tenants.

The city estimates estimates that due to new work requirements and restrictions on immigrant eligibility.

25,000 to 50,000 San Franciscans could lose Medicaid eligibility, and 21,000 could lose CalFresh nutrition benefits.

It wasn't stated yet, but I do want to point out that the day that the so-called unsatisfactory immigrant population lose CalFresh benefits has already passed.

It was April 1st last week.

And the day that work requirements kick in is less than two months away.

The impacts of HR1 will be felt by the city in terms of reduced revenues, larger share of cost, and increased need for city eligibility workers to meet new administrative burdens.

These are not just impacts the city must bear.

The impact of federal and city budget decisions will be felt acutely by San Franciscans who are newly ineligible for federal benefits at a time when the city is proposing cuts to city funded services that support them.

Cuts to city funded workforce development programs are being proposed while people are at risk of losing health and food benefits due to work requirements.

Cuts to city-funded immigrant services are being proposed while immigrant populations face the loss of health and nutrition benefits.

Holes in the federal health and nutrition safety net threaten our tenants' overall stability, making it harder to afford rent and to meet other basic needs.

The first line of support with these challenges are our social workers.

The social workers that work in our housing.

As more tenants need additional support due to benefit cuts, cuts to city funding meet fewer community services available.

There are no additional resources being proposed to support housing-based social workers and case managers as they try to help tenants maintain their housing as they lose access to health and food benefits, and as they contend with stricter eligibility benefit rules, and they face decreased community resources due to city cuts.

Stone Thomas is a permanent supportive housing resident and a member of the Supportive Housing Providers Network Advisory Board.

And next he's going to discuss impacts of cuts from a tenant's perspective.

Good afternoon, supervisors.

My name is Stone Thomas Selseth.

I'm a public service trainee for DPW and Human Resources, a volunteer for SFPD, and the chairman of the resident advisory board for permanent supportive housing provider network.

I'm here today because I am still navigating the very system I work to improve.

We are not here to do we are here to discuss snap cuts, but we cannot talk about food without talking about the benefit maze.

When benefits are cut, residents are forced into food pantries that often serve moldy and expired food.

Now that I'm employed by the city, I've hit a new barrier.

Benefits.

Offices are open only during the exact hours I am required to be at work.

We are effectively creating a system that disincentivizes the very economic mobility we claim to want.

Support of housing caught my free fall after our neighbor's fire left me homeless, and I'm grateful for it.

But gratitude shouldn't mean accepting instability.

Currently, city mandates force radiators to run on a fixed schedule regardless of the outside temperature, pushing my room to 85 degrees, and forcing me to buy an AC that has never negatively impacted my health.

The solution isn't just more rooms, it is dignity in the rooms we have.

We need to update outdated city mandates to allow for weather responsive heating.

We must prioritize capital improvements like modern HVAC and soundproofing.

If a resident cannot find physical rest due to the heat, noise, or smoke, they cannot find the stability required to hold down a job.

When we fix these barriers, we unlock massive potential.

The tenderloin is full of people with potential, some with more degrees than many in this room, but trauma doesn't care about your resume.

The Support of Housing Provider Network is a reservoir of untapped economic growth.

Mathematically, one person with a job paying rent accounts for up to three people who cannot.

We need to stop thinking about SNAP and housing benefits as handouts and see them as the floor of an economic engine.

In my free time, I've learned to code and I'm partnering with the SF Housing Accelerator Fund to launch a beta program to help residents navigate these complex systems.

If I have someone working in HR for the city, still find the system nearly impossible to navigate.

Thank you.

Thank you.

And that's all for our presentation.

I hope that you heard that we are your partners in addressing these cuts that are coming from the state and the federal level.

We are your partners, and we need you and we need that your support.

Every person who spoke here and looking around the audience as well, I can see almost every single person here is facing a cut from the Trump administration from the state, but all of them facing here today are getting cut by the city and getting cut in a budget that you are going to decide on in June.

We have no choice of what Trump decides to do.

We have a choice on how we respond.

And we are here today because the response that we are hearing so far, we are grateful that the city is trying and making an effort, and we are here to say we need to be partners in this together.

You are never gonna get it right on your own.

We are the people that interact day to day with San Franciscans.

We are the people who serve the community.

We are your partners in this and finding a solution, and you can't cut the budgets of the people who you are gonna turn to for questions, for advice, for problem solving.

We can't solve this alone, and it's gonna take all of us together.

And so we look forward to working with you in this budget season, and we appreciate your time and for listening to us.

And we are all, as always, in people's budget available for any questions.

And the beautiful part of People's Budget Coalition being 150 member orgs and individuals, there's an org that you care about.

And our issue and the your top issue that you care about is represented by one of our amazing members, and we are happy to connect with you and grateful for all of you, and thank you especially, Chair Chan, for the opportunity.

Thank you.

Thank you.

Um I don't see any name on the roster right now, so I'm just gonna ask uh sort of how do we move this forward.

I mean, just granted, like giving this is uh another year, a difficult year.

We've been through a lot of difficult years already.

Just kind of wanted to see if you know, from the mayor's office in terms of approach to frankly, it's not just to the cuts, but yeah, I think in the cross, like all across in general, like we understand um there's challenges with I think as recent as the mayor has announced like 127 layoffs, and just kind of wanted to understand what is the mayor's approach of this budget in terms of process, besides you know, what his departments are already doing, which every department has to have like their budget presentation publicly, but is there any other specific instruction or um approach that the mayor has for this year's budget uh in terms of partnership?

In terms of so I I have an answer to everything but the last part, and I would love to dive in further on that.

Um, a couple things that we are trying to do differently this year is we have been um trying to meet with community organizations earlier.

Um we had a number of workshops in the fall to kind of really understand how we like the mayor has been very clear on what his priorities are, and I think we really wanted to hear from um from community-based organizations and community coalitions how they think about those priorities.

For example, the mayor always says, you know, public safety, public safety, public safety.

Um I think there is a very clear understanding after our workshops that public safety does not always just, you know, and I this shouldn't come as a surprise to anyone, but public safety does not just mean fund the police.

It means how do we make sure every individual feels safe walking down their street?

Um, that's everything from um gender-based violence response to um safe routes to school, um, kind of having much more of a community-led approach, and I think that that's those have been really helpful meetings for us.

Um, we have been uh sitting down with the coalitions as early and often as possible.

We are setting up office hours for every organization to come meet with us.

And then I think as we identify um program cuts uh through kind of the end of April and the beginning of May, we're gonna start having some of those conversations so that people don't feel caught off guard when we get to July.

Um I do think, or to June rather.

Um given kind of the shape of the deficit that we talked about earlier, how we have kind of a much smaller number in year one and a larger number in year two.

I think in the event that we need to make some really tough decisions about kind of our most vulnerable communities, we would try and shift those cuts to year two so that um our organizations can have some planning time to um we can figure out like where a service might continue to exist.

We can kind of move the redirect clients if appropriate.

I mean, I think we don't cherish any of this, and and I think our hope is to really be very thoughtful about not trying to kind of like double hit particular communities.

Um another thing that we have set up is kind of making sure that as we are evaluating proposals from departments, um, looking not just at that in the silo of that department, but thinking about all right, this organization has a grant here, here, here, here, and here.

Um, while they might be contracted for different things, they do tend to serve kind of the same last mile population.

How do we make sure that we aren't cutting the same organization in every place?

Um I think that is something that we have had, we have additional data this year that the mayor's budget office has not historically had access to.

Um so we're kind of being a little bit more, we're able to be a little bit more thoughtful and have a little bit more transparency into the grant end of it rather than the high level program budget.

Um so those are some of the things we are thinking through, and I think that's it's a combination of better data, more meetings, hopefully more listening.

Um, hopefully people will feel listened to.

But I think the you know the outcome will probably it is in a mitigation, not a we can't save everything.

Oh, absolutely.

I think it is a tough and challenging times.

Um, what I I think that similarly we have discuss and talk about with the public service employee and making sure that you have early and frequent or at least regular um communications.

I think today I'm I'm gonna ask and urge the consideration of having um frequent and regular set communication with the budget that with the people's um budget coalition and and from here and on out prior to June, uh I think will help ease a lot of anxiety, but also create some potential um a better transition or strategy, I should say, transitioning from the first year for fiscal year to the second, especially if we're seeing more cuts for the second one, and to kind of help us mitigate a bit better about what that could look like.

I I think that I'm gonna I'm gonna be in the space where since we have really in the last two fiscal years, sort of with the recognition of just the uh that the previous at back process just no longer exists, really, because there's no money, like there's no additional funds that like we can actually really um allocate, and what end up with is the the ways that like what other ways that the board can come through and find savings and be able to put things on reserve or to be able to put those dollars, like shift the spending of the dollars, but then not necessarily having more dollars, I should say.

And so I think we've been doing the best we can our last two fiscal years to shift some of the spending that again meet the balance between what the mayor has proposed, but also what the board collectively wants, and then also meeting demands of um really on behalf of safety net organizations and services that the people um budget coalition has brought forth.

I think this year, what I am going to add, I think after you know, it my comment is that I'm gonna urge the mayor's office to consider frequent and regular communications from this point on out in the next few weeks, um, leading to June, leading to your proposal, final proposal in June, that we have some conversation starting already instead of waiting with waiting until June.

Welcome it.

Thank you.

Thank you.

Um, I'm gonna bring back the people.

Oh, if I may, just really quick, like the last dot, I'm gonna bring back the people's um budget coalition and and just kind of want to ask this very same question.

You mentioned you know, a partnership.

What does that look like?

But we'd be happy to share as well of what this looks like for our organizations, and we've seen this pretty successfully with DPH as well.

But when um when partners are approached to talk about cuts, it's very difficult to respond to how should we cut your budget is kind of the framing in which many of these conversations happen.

And it's not something that we're really able to respond to, but proposals we are able to respond to.

But the difficulty is is when those proposals are late in the game or last minute, as it's understandable that they could be, but it makes it a little difficult, and then it's not obvious once the announcements come out, how we are able to respond.

And then it's not obvious once the announcements come out, how we are able to respond.

So our avenue that of course we use is to communicate with the supervisors with yourselves to help us facilitate a conversation about next steps, but it's not an obvious conversation about how we can proceed with next steps.

But I think it's a really valuable conversation that we should have and have more frequently with our community partners and be very proactive that we should be having these cut conversations all year round.

Of constantly we should be in conversation between granting departments and with grantees on how can we reduce these budgets, how can we get these costs down?

It needs to be a long-term conversation that doesn't happen just during budget season, but it needs to be year-round.

If nobody is going to be very comfortable with sharing of we want to, we can cut in this way, we can cut XYZ, but people are ready in a way that I have not seen before.

If the option is on the table between this program goes away and your community will no longer be served, or can we make this a slow, a slower process?

Can we find other funding sources in the meantime?

I think folks would be happy to have that conversation.

It's not yet obvious how we have that conversation.

How about this?

I can I ask just for more specific dens, and let's actually like uh get this process pro, you know, just kind of transparent.

I I I don't think that it is any to anybody's benefits, both from the mayor's office or from uh for us to draw it down to very specific like grantees to that details for dollars amount.

What I do about like what I do expect is that the conversation should in categories um and dollars of uh both in budgeted dollars and categories of services and programming, but not to a point of grantees, because that's just not going to be the way it's gonna work.

I think whatever it is for the process, it will always have to go through an RFP and what that could look like.

Um maybe there's conversation could be about existing contract, but I I I think that to sort of should be a budget priorities and just not specific about grants and grantees.

Um does that work?

Yeah, that sounds about right as well.

And when it comes to that bigger picture of many of these departments, is community is feeling a sense of loss and a sense of confusion when it comes to MOHCD and OEWD in particular, and even HRC to some extent of these have been community homes for certain programs, and it's not clear what the direction is going to be from the mayor's office as we decrease community development, workforce development, and many of the programs out of HRC.

It's not clear what the home is or what the vision is that we should be adapting to for us to respond to as well.

Great.

I'm gonna I'm gonna actually catch on with that specifically about workforce in agreement with that.

You know, I I think that I want to uh better understand the workforce development peace um in terms of spending and which city departments will be responsible for those programming and how much are we thinking that how much does the mayor think about you know investments in these programs would look forward to kind of see some kind of breakdown prior to June.

So I I would assume that is like I'm suggesting.

I know that there's a lot of thinking behind it and a lot of work around it, but I think that this is probably just one example, and then I'm gonna give another example like tenants um protection programming or you know, um programming and that is specifically serving LGBTQ community and in the category and which city departments would be involved and the kind of funding that we're thinking that the mayor is gonna be proposing, like a roughly dollar amount.

This is for example, you know, the mayor is gonna invest amount in LGBTQ, you know, programming and services that is involving human rights commission, involving um Department of Public Health, involving DCYF, just for thoughts about how we could continue to like communicate uh in the next few weeks.

Um it's my suggestion.

And we'll see how that how that works out.

Vice Chair Dorsey.

Thank you, Chair Chan.

I want to thank everyone for their participation today.

Um thing I heard and that I agree with, and I think we've talked about we're in a time when there are vulnerable communities that I mean, let's just be honest.

There are Trump-targeted communities where we have a situation where even philanthropies and foundations and private support, they don't want to target on their back either.

And I think that really elevates the urgency for the city government to prioritize those communities because there's no cavalry coming for the trans community or immigrant communities or any sort of DEI kinds of things.

If it's not us, it's not going to happen.

So I hear and and share that your your feelings about that.

There was one that was mentioned that I hadn't considered, and that was um I I'm not sure who brought it up about abortion access and reproductive rights.

I suppose that makes sense, but I don't know if that one, I don't know if if that gets federal funding anyway, or if that's a state-funded kind of priority.

But could somebody just elaborate what what we should be thinking about in terms of reproductive access that it's new and different now?

Yeah, so um, I mean, in the post-ROWE world, right?

We're seeing that people have to travel great distances to get abortions these days.

Um, and Planned Parenthood has been fighting their own federal funding court case for a really long time.

Um a lot of that is still up in the air.

And so we have seen clinics closing.

Um and federally qualified health centers are less free, are less freely able to provide abortion.

It is not um something that you're able to use federal funding for.

And so the state has created a state uh-based mechanism to pay for that via Medi-Cal.

And we're advocating for a similar thing for gender affirming care, actually, because that system that was created to protect abortion care was very successful, and they've also created grants, right?

Um, but we're seeing that people from all over the country are coming to California or coming to San Francisco in order to get care, even just along the states, you know, alongside California.

Um and so we're you know, we provide abortion at Leia Martin.

We do um specifically gender-affirming abortions, uh, which can't be accessed at Planned Parenthoods everywhere necessarily.

Um but we are seeing that people are coming to us more often, need more transportation support to get to us, and we're absorbing all of those costs as well.

Great.

And then I also just if it would be okay.

I don't know if Laura, if I could ask about Ryan White funding.

Um I want to get a just a sense of where it's one of my favorite topics.

I'm always happy to answer.

Yeah, I so I I don't um I feel like I'm not sure why I thought this, but I thought the federal it wasn't as endangered at the federal level, even though there's threats that it was it seems to be something that Congress is sort of still funding.

So I want to know what what how endangered is Ryan White funding at the federal level and what do we need to do?

Yeah, um that's a very good question.

And there's sort of two things, well, there are three things going on.

It's currently still funded at the federal level, and it up until uh in the president's budget last year, they proposed cuts to some of the components of Ryan White, but not the main, like the part A that comes to the cities or part B, which includes the AIDS drug assistance program.

They didn't propose any cuts to that.

And the president's budget um for this year that just came out like a last week, um included didn't include cuts to part A or Part B, but did uh eliminate all the other parts, including the Part C that goes to community health centers, D includes dental services, a few other things.

They did propose eliminating all of those, eliminating the ending the HIV epidemic money, which is sort of add-on money on top of those, and eliminating a lot of the HIV prevention money.

Again, that's the proposed budget from the president.

Ryan White, um, as you're as you know, is been very it's been a bipartisan popular uh program from for funding in previous iterations of Congress.

So it's we're gonna see what happens in Congress, but the president is definitely proposing to reduce the funding for that.

The other part of it is that our award in San Francisco is going down.

And so that's sort of independent of the total amount as the HIV epidemic has shifted in other places as San Francisco has done a better and better job of preventing new HIV infections.

And again, this is absolutely a result of our um our success and our effectiveness at preventing new HIV cases here.

Um and HIV has been uh you know continued to grow in the South and other parts of the U.S.

Uh the money has been shifted there.

And so the the particular formula change that happened this past year um is based on no longer uh previously you were counted for purposes of Ryan White where you were first diagnosed with HIV.

And for many, many years, San Francisco, like people would be diagnosed in Oklahoma, moved to San Francisco.

And what we know is that we're gonna see a 19% cut over the next five years.

So we we know that we can plan for that that's been in the Federal Register.

But you know the thing is also that we are doing an exceptionally good job of keeping people alive here in San Francisco.

San Francisco is also very expensive place to live to provide health care.

So we're gonna continue to need to provide services for all the folks who are living with HIV here and that's not going down even if our federal dollars are going down.

Does that answer your question?

Okay.

Thank you.

Hey thank you I very much appreciate this it is a very tough situation.

I don't think any of us like it at all but I I also wanted to um say this in the context of um the presentation today that this is also how I'm viewing the upcoming budget for all of us in conversation that I the way I view this it's in two scenarios when it comes to the budget.

I think that there's one scenario that truly is with the Trump administration cut as we can see from the presentation today but also based on the projection that there's a really a real threat from the Trump administration.

And there's a it's been a real threat uh for many and that in when it comes to the cuts and that with the further cuts to the city uh when we talk about it's not just city cuts to the program but really the city too receiving or getting cuts from the federal funding that we currently you know receive I think that scenario is very detrimental but it's not just detrimental to San Francisco but it's detrimental to California and I would say entire nation.

So let's just pin that for for thought.

I think what we're also seeing though from the projection that we're the outlook in terms of around hotel tax, business tax we also see a city that is we're we're we're actually in a positive direction and positive trajectory.

And then the way I see it is that we are already better off than we were uh during pandemic as I have seen that those some of the projections versus the what we are seeing now both in projection but in actual um but I also what I'm also seeing is that is not a uh projection that is a significant tax revenue increase a significant um uh or of of increase of any type uh and then we actually do see cost uh of doing business we see that you know uh health care costs and those are actually continue to on the rise so it it it means that I don't see that we're out of the woods I don't see that we're somehow better off than we were and that we will be in in the immediate term in the next two fiscal years even the next five fiscal years we're gonna be better off and I'm gonna be in the position to say this to everybody in this room which actually I think that a lot of you in this room really have been driving the budget for the last you know through three fiscal years and I really hope with the expectation that this is also the same some some same leadership that will be driving that conversation in next two fiscal years for the very least that I I think that we want to be um meeting the demands of San Francisco with also the reality of San Francisco's like finances and and those need to come in in sync.

But as we all see that the service needs gonna continue to increase especially under Trump so I I am asking everyone to think outside the box and be creative.

Um, but in the same at the same time, let's see what the state government is going to do too.

Like there's actually there's other impacts um that I I am I think that we need to evaluate.

So all which is to say I think that I while I do appreciate this update.

I feel like there's still a lot of work that needs to be done in the coming weeks for all of us here in this room, and I urge you all to stay at the table and and to be committed to having conversation and having the commitments that we will work this out.

Um so with that, let's go to public comment on this hearing, and it is my goal to file have this hearing file and heard and file.

Yes, we're now opening public comment on this item number one.

If we have any members of the public who wish to address this committee.

And I'll be timing each speaker at two minutes.

First speaker, please.

First speaker, my tech, mic, okay.

Good afternoon, supervisors.

My name's Paloma Flores.

I'm a community member, San Francisco resident, small business owner, and for the past 15 years, I've been fighting the good fight on behalf of the American Indian Alaska Native intertribal community here in the city.

Most notably within the behavioral mental health, education, and policy making space.

We've been here before.

We've talked about budgets, but we've never been here at this time, of this time of the collective experience.

When we're talking about budget, we're talking about money, we're talking about lives, not numbers.

When you look at the budget, it's important to understand how crucial it is for adequate sustainable funding for all the people that call this city home.

Any additional cuts to funding for these already deeply impacted communities?

It doesn't make sense.

The argument's clear.

Because by reducing the funding with these respective communities who already are fighting the good fight for food, health care, housing, and jobs, does nothing for anyone, especially our young people.

Isn't that my time?

Okay.

And with that being said, our youth and families deserve more.

We are a city built by the people, the people of the world.

So please consider how this budget will impact said communities that you see representing the city of San Francisco as the world beyond.

But without those communities, Native community, Pacific Islander, Latinx, African American, and so forth.

This city will not be the city that it's known for in the future that we're going collectively because we have the solution.

Thank you.

Thank you much, Paul uh Paloma Flores for addressing this committee.

Next speaker, please.

Thank you, Supervisors.

Hello, I'm William Ryland, 17-year resident of District 5 and the contract manager for the Justice and Diversity Center of the Bar Association of San Francisco.

Last year the mayor sold the HR1 reserve on the idea that the bill's impact to the city's revenues could be as high as 400 million dollars per year.

Now we estimate the impact at 226 million dollars per year.

We also just heard that HR1 in HR1's impact will mostly be felt through reductions in Medi-Cal reimbursements, so the Department of Public Health.

Meanwhile, DPH is preparing to announce enormous cuts to spending next year, eliminating services and supports that our poorest neighbors rely upon.

Many of the same San Franciscans who are now expected to be kicked off Medi-Cal by by HR1.

This is the exact situation that the HR1 reserve was created to address.

The HR1 reserve is intended to backfill HR1 impacts.

HR1 is impacting DPH, and yet DPH is making huge cuts.

Why?

The HR1 reserves to be released to backfill HR1 HR1 impacts of DPH and prevent the historically devastating cuts that DPH plans to announce in the next two weeks.

Thank you.

And thank you much for your comments.

Next speaker.

But I'm originally from Southwest Georgia.

I moved here.

I'm a gay man.

When I came here, I was younger after I had gotten kicked out of my house.

I was uh depending on the social safety net in order to establish myself in the city.

I came here because it was a safe haven for queer people.

It was a shining city on the hill.

It was a beautiful place where I could find community and real connections and um uh just more stability in my life, right?

And that's partially because of the community that was built here by our communities um and the beautiful services uh and culture that we've built up here in San Francisco.

Um and now I'm afraid of uh what a lack of a social safety net would mean for people who are young now trying to flee violence in whatever other part of the country who come here seeking refuge and haven to no longer be supported.

And just to hit this home, the decisions that we're making um really do reverberate, right?

They send messages to our community.

I just had a conversation with uh recent friend who's a trans woman who told me that unfortunately she lost someone in her community who's a good friend of hers to suicide just in the past week.

And this is because of the threats and the assaults that we've been seeing at the federal level from this rising authoritarianism, authoritarian far-right movement.

We have to hold the line here in San Francisco and show that there is hope that we value the dignity of every single person through the decisions we are making to support people to not just survive but thrive in the midst of all that this moment entails.

Thank you.

And thank you, Anthony Stone.

Next speaker.

Good afternoon, supervisors.

Uh, my name is Sofia Sabina Rias Durantes.

I am the deputy director at El Aparat Latinas, the only organization run and led by trans and intersex people in the city and county of San Francisco, California.

I want to express uh our deep concern regarding the local budget cuts while federal policy proposals directly treating the stability of our Translatina and immigrants community.

Our community faces unique and is and complex challenges that require strong and consistent support.

These cuts will drastically reduce essential services for the survival and development of our members, such as housing, health care, your training programs, legal assistance services, and more and more.

These services are not luxury.

These services are fundamental lifelines for our historically vulnerable population.

We also observe with alarm the federal government policy proposals that target transgender and immigrants' communities.

These matrix are not only discriminatory, but they also force acclimate of fair and hated that you are disease the safety and well-being of our communities.

Given this situation, we want you to prioritize prioritize funding for health, wellness, and social support services that translatinas and immigrant communities recognizing this embedment as essential for social equality.

Thank you very much.

Hello, thank you very much for having me today.

My name is Irania Delamora, and this is my first time here at the San Francisco City Hall meeting.

I've been to Richmond City Hall in Oakland City Hall, and I see you guys are very lonely here, so I'll be sure to keep y'all company in the near future.

Um concern that I have is um I was hearing the lady here, Miss Chu say that how she wants to raise taxes and ways that did not obviously say she wants to raise a lot of taxes.

I think raising taxes at this time in San Francisco is very wrong and close to immoral.

And also, I know I noticed you were saying horrible things about Trump.

And I voted for Trump, and I know a lot of people in California don't like him.

I can only imagine why the reasons are.

But I like Trump, and I think he brought to back our economy.

We were close to all impoverished while Biden was president.

Okay?

We could have all just ended, probably been conquered by a different country, probably been conquered by China, who knows.

Thank God Biden, uh thank God Biden is gone, and we have Trump now, saving our country, saving the American values, bringing back to life the pride in the American flag, which was greatly lost during the time of Biden.

Okay, going back to raising the taxes, please do not do that.

San Francisco is barely coming to back to life.

Many businesses didn't have any work for about five years.

They were most of them, like half of the business of San Francisco went bankrupt and are gone.

The ones that are here have been here for a very long time and were only able to survive COVID because they've been here for a very, very long time.

And they were barely making it.

And if you give them more taxes right now when they're barely bouncing back, that is evil.

You're gonna take all their money away that they're making now?

Please don't do that.

And you gave them more time, so I'm gonna take more time.

So another thing is I think it's very wrong to raise taxes.

So people from the HBQ community or transsexual community can have transplants.

So if a man wants to be a woman, you want to give them more money so they can do that?

No, don't do that.

Do not raise our taxes for surgeries because a man wants to be a woman or a woman wants to be a man.

That is a waste of money and not the priority right now when businesses are barely bouncing back.

If you do that, you're evil.

Thank you very much.

Thank you much, uh Randy Delar for addressing us, Committee.

Next speaker.

Hi, uh good afternoon.

My name is Peter Murphy.

Uh I uh I wanna uh in a way I want to applaud um on Anya and the uh People's Budget Coalition.

I I I'm with the Mental Health Association of San Francisco, I'm also a member of the 12 step community, and uh I'm also a San Francisco native.

And uh one thing I learned from Anya is our budgets, our budgets are show us where what are our priorities are and and and I really feel like we need to maintain the priorities that San Francisco I feel like has always been known for.

Um and that means compassion for those for those that need our need our support.

Um where I work at the mental health association in San Francisco, we're also facing cuts.

And uh it's just the general the atmosphere.

We have we have a um we have a state-run uh warm line.

It's it's also been financed by the uh Department of Public Health here in San Francisco at different times.

Uh but it's now a state run service, but we're we're having to cut back our our services for that.

Um 12 step programs, even though we're we're we're self-supporting.

Uh the cost of living in San Francisco has, I believe, affected our our ability to um to have a lot of those programs in San Francisco for the community that really needs them.

So but again, I wanna I I wasn't sure if I was gonna speak today, but um I'm here to support the uh the groups that have that have um spoken out today, and and I really want to I want to thank Anya as well from the uh People's Budget Coalition, and I want to thank all you all the supervisors, so thank you very much.

And thank you, Peter Murphy.

Seeing no other speakers, madam chair that completes our queue.

See, no more public comments, public comment is now closed.

Colleagues, I am gonna speak for myself, even though I think maybe all of you would concur, but I'm gonna speak for myself that I will always stand in solidarity with the LGBTQ community, uh, as well as um just recognizing the importance of reproductive care uh and gender affirming care uh and that I perhaps and this is sometimes we will be in a policy disagreement that I always am going to be that one policymaker uh affirmatively believe in progressive taxation, that um the people who can pay uh should be paying for their fair share uh and what I see the poverty and challenges that we face in this country and also in our city is because of the wealth gap um that constantly we see that the the have and have nots.

But that's just me.

Uh and with that, um colleagues again.

I want to encourage everyone to continue this conversation.

Uh and I urge the both the mayor's office, the controllers, but really the mayor's office as well as the people's um budget coalition to continue this ongoing conversation.

I look forward to a robust discussion in June.

Um, but I I again just think that um anyways.

This is all I'm gonna say.

Uh and with that, uh I would like to make the motion to have this uh hearing heard and filed second and uh and uh sorry I do need a second for a motion when it comes to the five people committee.

We're we're we're we're getting hang of it.

Um and with that, a roll call, please on that motion.

And on that motion, uh that this hearing be heard and filed.

Uh moved by Chair Chan, seconded by Vice Chair Dorsey and Vice Chair Dorsey.

Dorsey, I member Soder.

Sawter, aye, member Walton, Walton, absent, member Chen.

Chen, I Chair Chan.

I Chan, I we have four eyes with Member Walton absent.

The motion passes.

And Mr.

Clark, do we have any other business before us today?

Uh Madam Chair to concludes our business.

The meetings adjourned.