Okay, good morning.

I'm at large council member Christina Henderson, Chair of the Committee on Health.

Today is Monday, May 4th, 2026.

The time is 9:35 a.m.

We are in room 500 of the John A.

Wilson building.

This hearing is being broadcast live on Cable Channel 13.

I'm calling this hearing of the Committee of Health for a part two of the oversight on the proposed fiscal year 2027 budget for DC Health to order.

The committee has heard from over 60 public witnesses on Tuesday, April 28th, and the recording of that hearing is available on the council's website as well as on my YouTube page.

Witnesses voiced their support for many DC Health critical public health programs, including healthy food access, early childhood and rodent control programs, and expressed concerns about proposed cuts to programs across the agency.

I will reference the public testimony as well as the agency's budget chapter and written responses in the committee's prehearing questions in today's hearing.

You can find all of those materials also on the council website.

This morning we'll hear from the director of DC Health, Dr.

Ayana Bennett, as well as her team.

DC Health provides uh programs and services with the ultimate goal of reducing the burden of disease and improving opportunities for health and well-being for all district residents and visitors.

DC Health does this through a number of mechanisms that center around prevention, promotion of health, expanding access to health care, and increasing health equity.

With over 900 FTEs, DC Health is organized into six administrations.

Dr.

Bennett, before you begin with your testimony, I need to swear you and your team in.

So if everyone can raise their right hand.

Everyone who might speak.

There you go.

All right.

Do you swear or affirm under penalty of law that the testimony you're about to provide to the council of the District of Columbia and this committee is the truth, the whole truth, and nothing but the truth.

Great.

All right, Dr.

Bennett, when you're ready.

You do have to turn your mic on.

So long and yet still still new, still fresh.

Um, good morning, Chairperson Henderson.

Um, staff of the committee on health, all of you.

I want to first introduce, I'm with my CEO, COO this morning, um, Michelle Blake Smith and our AFO Adrena Dean, who are gonna help me with some of your questions this morning.

Um, I am here, of course, on behalf of Mayor Muriel Bowser.

I'm going to read my not very long testimony.

Um, I'm pleased to be here before you today to talk about our proposed budget for fiscal year 2027.

Going into FY27, the district was facing a 1.1 billion dollar shortfall caused by both the anticipated $700 million reduction in revenue and a $450 million increase in cost.

In spite of this challenging budget environment, I'd like to thank Muriel Mayor Bowser for her continued investment in social determinants of health, including education, public safety, housing, and economic development through her Grow DC FY 2027 proposed budget.

Notably, these investments include $350 million modernization of the district's first responder fleet, a $9 million benefit increase for basic health plan and alliance recipients, and an additional $2.4 million in funding to strengthen the district's workforce through the advanced technical centers.

DC Health has continued to receive significant investment across all five of our administrations.

This includes the community health administration, who successfully transitioned the school health program in-house.

The proposed FY27 investment of $25 million will permit DC Health to continue its efforts to improve the quality of school health services.

Additionally, DC Health has begun directly operating these um five school-based health centers and looks forward to the remaining um to becoming operational in FY27.

Our HIV AIDS hepatitis SDD and TB administration continues to achieve positive outcomes with HIV transmission rates remaining below 200 for the second straight year.

The DC Health and Wellness Clinic has played an important role in achieving this success through their prevention testing and treatment services across sexually transmitted and other diseases.

There is 7.9 million, a mixture of federal grants and payments and local dollars budgeted for prevention and intervention services in FY27 that will support our ability to administer PrEP and PEP, initiate patients on rapid HIV and retroviral therapy, and provide assistance with benefit navigation.

I'd like to thank the council for your focus on this area and your investment in expanding the ability availability of this important health care access point to the community.

Our environmental health administration continues to work diligently to keep our communities safe, including through our division of food.

This team, which is made up of 17 inspector of sanitarians and food technologists, conducts over 7,000 inspections in fiscal year 25, covering restaurants, school cafeterias, grocery stores, and more.

The proposed 2.2 million investment in food safety in FY27 allows us to continue this work to protect district residents.

Given these larger budgetary constraints, DC Health is making strategic adjustments to ensure we'll continue to achieve these results for all district residents.

The demands on the public health system are increasing, not decreasing.

For example, in FY26, DC Health has engaged in an increasing number of investigations of potential outbreaks following a resurgence in measles cases nationally.

The Center for Policy Planning and Evaluation supported hundreds of contract trace cases to limit any potential disease spread.

One just recently.

When there was an increase in cases of hand, foot and mouth disease, our team coordinated with pediatric health care providers and parents to drive down the number of serious cases.

Similarly, as cases of tuberculosis emerge among the district's most vulnerable populations, including those experiencing homelessness.

DC Health is equipped to monitor and ensure people receive the needed treatment.

In FY27's proposed budget, invest 11.4 million from federal grant funding into our epidemiologic capacity, something that is critical when responding to emergencies like the Potomac Interceptor Collapse.

DC Health supported the response efforts by carefully monitoring hospital discharge data for any signals of health impacts, including gastrointestinal disease.

These efforts closely aligned with DC Health's public health emergency preparedness work, which is proposed funding at $6.6 billion million dollars for FY27 within our health systems and preparedness administration.

As we approach several significant events this summer, including the nation's 250th anniversary, our team is coordinating with other agencies and partners to develop emergency plans and conduct trainings.

To ensure residents and visitors remain safe.

Despite funding challenges, DC Health will continue to carefully monitor federal developments to ensure we continue to prior prioritize the health and well-being of district residents and visitors.

I'd like to remind council that as in previous years, approximately 60% of DC Health budget is federally funded.

This reliance on federal resources has presented an unprecedented challenge given the instability occurring at the federal level.

This includes not only significant reductions in investments across key health areas, including HIV and chronic disease prevention, but also continued uncertainty of long-term funding.

DC Health is carefully monitoring these developments, and we've done significant contingency planning to prepare for changes.

While we've accounted for what we know through this proposed budget, we anticipate further changes.

We are looking closely with working closely with our regional and national partners to advocate for continued public health investment.

Throughout these challenges, DC Health staff, grantees, and partners have worked tirelessly to improve and protect the health of district residents.

I'd also like to acknowledge their continued effort as we continue to pursue public health solutions that improve outcomes for all district residents and visitors.

I appreciate the opportunity to talk to council and committee about an overview of DC Health key investments for the upcoming fiscal year.

I'm here with my team of experts to answer any questions you may have.

Thank you.

You know?

That's so short.

I learned year after year.

I'm a learner, I'm a learner.

Um I'm just not prepared.

I thought I had like four more minutes.

Okay, no worries.

Wonderful.

All right.

Um well, thank you so much, Dr.

Bennett.

And um I especially appreciate sort of the last piece of what you said in your testimony around, I guess the acknowledgement that we've tried to control for what we know.

Yeah.

But every day is a new day.

Yes, it is.

And every day is sort of like whack-a-mole.

Um, and so um, you know, for those who get very frustrated, it is we all share in that frustration of um not necessarily knowing.

Um, I'm gonna start with school health, and we'll kind of go from there.

That's okay.

All right.

So um uh the DC Health chapter um in the proposed FY27 budget describes a $600,000 reduction um from the school-based health center's budget.

But DC Health and OCFO have confirmed that this funding is not related to Unity Healthcare operations of the two um school-based health centers that they currently operate at Cardozo and at Woodson, which is flat funded at 500,000.

So, what's the source of the $600,000 reduction and what's being cut?

I don't think anything's being cut out of school health.

We're moving money around.

Um, but go ahead, you can explain that.

Good morning.

Good morning.

The 600,000 reduction in school-based health centers was really just moving it from one call center to another call center.

Okay.

So it wasn't a true reduction.

Okay.

So we anticipate that operations um should look the same for next school year.

And so we're still ramping up in the other health centers, so we're not making major changes.

All right.

So the school-based health centers that now only have 12 hours of coverage per week.

Um, how have DC Health adjusted the staffing for the health suites on those campuses?

So they have um staffing.

We're gonna bump between the two of you.

We they have staffing of um a staff member for basic school health functions.

They don't have clinic staff for those.

Are you talking about the school-based health centers?

Yeah.

That are now okay.

So I'm basically saying like there used to be a time where school-based health centers had far more hours.

Yes.

We've reduced those, and so I'm wondering, have we adjusted on the other side?

Does that mean they have um I'd have to look up the high schools, but they have coverage over on the health suite side, which is not in that same column.

So the number of days the clinics open is not equivalent.

Go ahead.

If you could just introduce yourself for the right.

I mean, I know who you are, but you know.

Good morning, Clover Varnes, SCD of Hasta.

So the before the school-based health centers were run by contractors, so there were separate health suite staff from the school-based health center staff.

Now that is one staff.

So the nurse that is there is there all the time.

It's the provider that comes in and out to have more services available for the clinic hours.

So there is um school health staff, nursing staff there all the time.

So we we were sort of interchange in terms of snaff for staff versus nurse, et cetera.

Do our comprehensive high schools have nurses or do they have health techs?

For the most part, they have nurses.

There is one school that has a nurse and a health tech, actually.

Okay.

All right.

Um at the performance oversight hearing in February, DC Health testified that 11 there was an 11% vacancy rate for school health services program would soon decrease because you guys were about to onboard 25 folks, yet the vacancy rate has remained consistent at that 11%.

So what happened between February and now?

Um, so we uh did hire some people, we lost some people, so it's been dynamic, but we did bring some staff on.

Okay, how many is some?

Because you told me 25 in February.

Did we bring on 25 people and then like 20 people quit?

What happened?

I don't know the number exactly.

I can ask Sarah if you remember exactly.

Okay.

But we did bring those people on.

Um I think we've shifted a little bit in terms of where they are.

Um good morning.

My name is Sarah Beckwith, and I'm the SDD for the community health administration.

Um we we have um lost about 16 staff due to different reasons.

Um attrition choosing to leave.

Um and however, um we do have um, so we're currently we have two LPNs that are in progress to be on boarded by May 18th, and we have eight school health technicians that should be on on board by May 18th.

So I think as we've um made the transition to the Department of Health, and we started to um strengthen implementation of our policies and procedures.

There have been some team members that have chosen to leave and go.

Okay.

What are these folks do over the summer?

A lot of schools stay open for summer school, and so they are placed there.

If they don't we have a a core of staff who actually really want to work 10 months, we don't have that kind of mechanism at the moment, so they'll be put in different positions.

So they'll be put in different positions.

Some of them that is when they will take their vacation time.

So we're right now just getting the details about where who's going to be where, but as a large number of schools remain retained some programming over the course of the summer.

So we will have staff at most of the schools.

Okay.

So I mean, school health suite coverage has not changed, even with this new model.

We still only have about 50% of schools that have 40 hours a week of coverage, 25% of the schools with 24 hours a week of coverage.

We are going to have to rebalance between where staff are.

So we're looking at shifting staff around a little bit differently.

But they are they are not evenly distributed for good reason.

So if you look at the schools that small number of schools who have very few hours, those schools average one kid per day or less.

The schools that are at the other end have somewhere around 12 kids per day.

So there is a very wide range across the schools about how much they are actually utilized.

And schools vary in size pretty significantly.

So we're saying school as if there were a kind of distinct unit that was clear, but we have very small charter schools with a small number of kids and no kids with treatment needs, or if they had a treatment need, we would switch the staffing.

But you have a school with no kids who need medications or have a severe illness of any kind.

When I have staff that I need to move to places, I need to put them at the staff at the schools where we're gonna have high utilization or kids have high needs.

Okay.

We had a resident who submitted written testimony about her child with epilepsy not receiving required care because there was no trained staff in the building when her daughter needed her medication.

Is epilepsy not considered a medical condition that would merit a full time?

It is.

So there should have been trained staff because each school has both their health suite coverage plus multiple AOM staff.

Yeah.

The one AOM trained staff at her school was not at work that day.

There should be two.

So we'll we'll look at that why there weren't two at that school.

Okay.

Um but this person, even if they are um so it is a system that is meant to do as much as is we can.

So is it possible that a kid at some hour of the day it is during that person's lunch?

So are if we have a staff person where there was no staff person at that school all day long and there was no AOM at that school all day long, that is a quality improvement issue for me because we should have been alerted and move someone there.

So let me know the person in the school after the hearing, and I will absolutely look into it because that should not have been possible.

Okay.

I mean, I think that you know, this particular parent, um, we've had other parents who come to testify.

This is kind of one of their worst nightmare scenarios where like your child needs something and there's literally nobody in the building who can help them except for now, you know, the front office staff having to call 911 and it's either FEMS or well, no, it like it's a fire truck or ambulance that shows up to deliver the medication.

That's not efficient for anybody.

Um so this is what I'm sort of talking about in terms of like I know that we have a healthcare workforce sort of um, I'm not gonna call it a shortage, but like people are being sort of pulled in multiple directions for the multiple facilities, et cetera.

But when I talk to say a hospital, they have a they they got a recruitment strategy, and I don't know that we have that.

Do we have a recruitment strategy?

We have had it, we kept salaries high.

Um, that was one of our recruitment strategies was to retain everybody who was at children's at the time, and we did a very successful job at retaining them.

Those who didn't want to move didn't want to move for very particular reasons, but we kept the salary as high as it was, which we had to do some adjustments in how the district paid in order to do that.

And then once we had those people, we have been very actively recruiting folks for those positions.

And what we've seen is attrition, um, which is not different than the program has had over years, which is why it's it's always been a little bit difficult when children was running it, and we see some of the same problems.

It is somewhat the nature of the job, but by expanding the number of um types of people we've been able to hire, we've been able to keep people on board um with more consistency.

We are just adjusting from the children's staff to more stable staffing.

Okay.

Uh we had several representatives from uh some public charter schools that recommended that DC Health launch a pilot very similar to what Department of Behavioral Health has in terms of school-based clinicians where they are essentially well, I'll describe how it happens on this on the DBH side.

But on the DBH side, um, when a CBO is not able to find someone to assign for that particular school, DBH essentially gives the school a grant to allow for them to hire someone.

Um the theory sort of being that um sometimes there are other benefits that the school can offer, um, whether it be I don't know, healthcare, et cetera.

Um and it gives them this ability of sort of being at one site.

And their recommendation is that DC Health try that in terms of nurses as well, because we already have a number of public charter schools who um they don't participate in the school uh nurse program, they hire their own persons and yeah at performance oversight.

We talked about this, and you said that you would be welcome to discuss the idea.

Yeah.

I never no one came to discuss the idea with me.

They should come to me.

Okay.

So I'm more than happy to talk about the idea.

Here is what my question will be.

How will they guarantee coverage?

Um, it is one thing if I with um a staffing contract and staff at lower utilization schools to pull from.

If there is a child at that school who actually needs someone to be there to do treatments every day, what will they do when their nurse calls in sick, has a family bereavement, what's their backup plan?

So we um I I don't pretend that we get it every time, but I have multiple layers of backup plan for that not to happen, so which is why I really want to hear about that school, because that shouldn't happen because we should be able to balance between the schools in terms of intensity, in terms of um the scheduling of the need.

If you have one school, that is incredibly difficult to do.

So if that were something we were gonna do, I would they would have to do some real planning and let me know what it is they were going to do.

So then we have to recheck every year to make sure the level of student need that was there.

So for the public charter schools who don't participate in the program, do you have oversight there?

I do not.

Okay.

So I've got I don't know, eight or so public charter schools who are hiring their own nurse.

Why would then we require that folks have coverage full-time on this side?

Even if someone were to call in sick.

So if we want to give them a grant and then have no responsibility for them, and I am therefore not going to see that anything is done there, then um I that's a different way to approach it.

Okay.

But if I give a grant to you, I don't think of myself as having no responsibility anymore.

No, no, no.

You're not gonna be suggesting covering my responsibility.

I'm just sort of thinking, like the pilot on the DBH side is a little different because there are any number of types of licensure that you can have to sort of fill that position, right?

Social work, clinical, etc.

needs are also different.

Right, right.

But I'm also saying that um the licensure side of like either you're an LPN or an RN it's pretty black and white.

Like there's no, you know, it's not as though we would say, oh, you're allowed to hire like a community health worker or something to that effect, right?

It there were clear standards, but um it's interesting to know that no one came to you, even though that they have been asking.

Did anyone come to you?

I've never heard of that.

Okay.

Yeah.

Okay.

Okay.

Um so at uh performance oversight hearings, DC Health testified that the agency was working closely with DCPS and the public charter school board to address uh the fact that four schools with zero AM, sorry, there are four schools that had zero uh AOM trained staff, and then that there were 29 who only had one AOM trained staff member, even though all schools are required to have two.

Um, what progress have you all made in terms of increasing compliance amongst the DCPS and public charter schools?

Go ahead, Sarah.

Um we can get back to you with those exact numbers.

Um we were just meeting with the Office of the State Superintendent of Education to check in on um the percentage of schools who have completed their undesignated emergency medication plan, how many schools have two AOMs?

So we have those numbers and we can get back to you with that.

We meet regularly with our colleagues at DCPS, at the DCPS Charter School Board, at the DC Charter Alliance, so that we can provide updates on our AOM classes we offer and be utilizing our education sector partners to recruit within the schools.

We don't have any wait lists within our AOM classes.

So do we offer AOM during the summer?

We do, yes.

Okay.

So there's an opportunity for folks to I don't know, take a day or two.

Yeah.

Not during the school year.

Okay.

You also stated during performance oversight that DC Health would initiate a conversation with Aussie about updating the universal health certificate and discussing how much data needs to be collected and how often.

Has this any progress been made there?

We have had those conversations, yes.

And we've had internal conversations.

How can we um shorten the universal health certificate so that it's um less burdensome on the provider, but we still get the essential information that we need.

Um so we can um we can get back to you on that too with um had we been able to shorten it.

I don't care, I don't know if shorten is the I just don't want to have to give a paper form four times to the school.

Like there's gotta be a way for the information to get to from the provider to you guys without us having to photocopy and then some nurse having to sit during their nurse time because I think you guys often say somebody's not practicing at the highest point of their license, and I don't know how data entry is practicing at the highest point of your license.

Well, we don't we try to have other staff do that, not them, not the RNs, but they um but still like it's 2026, and it's almost like I still got the little tattered yellow card that my mom had when I was in school, which she still has, by the way, because mamas don't ever throw anything away.

We're working on it.

I don't know.

Um I I think this is a question.

I also too um, as we kind of go through this process, I would love for you all to reassess the purpose and value of the oral assessment form, which also what value?

Well, the requirements are aussies, and we need to discuss with them.

I know, but you guys are the health people.

Aussie is great.

Yes.

And also they're the school people and their school requirements.

So we don't make every kid who doesn't go to school need one, right?

Babies don't have them, but we do want to be part of the conversation with them about what they want the information for, what we use it for, which are not necessarily the same thing.

Do you guys use it?

Do you guys get it?

The oral form, I think we do, yeah, of course.

What do you use it for?

We use it when we're um bringing on oral health providers into the school to look at where there's high need.

So we track oral health.

It's one of the key indicators for school health.

Okay, but that form is like poultry.

So it's certainly not telling you how many cavities a kid has.

It'll tell you who's been to some degree.

It's an imperfect system.

I know, but we could get who's been from healthcare finance in part.

In part.

And we know from the Medicaid claims data, a lot of people ain't going.

Yeah.

So I and I'm pushing this because providers charge families for these forms that then nobody uses.

And while it might not seem like a large expense, but $10 to fill out a form to hand to the school that goes to the Aussie that might come to you to, you know what I'm saying?

Like, well, I am not opposed to getting ready for forms at any point.

I'm always trying to get things to be more efficient.

And so we will continue to talk to Aussie about how to change this if we do want to change it.

I do think there is still a conversation to be had, um, and the requirements are theirs in their system.

So it is it is really a shared decision at best.

Okay.

I um it's also fresh for me because my kids' summer camp required the oral health form.

Why do you need a oral health form summer camp?

They're only there for eight weeks.

Like it's not that, but I digress.

Okay.

There is a proposed subtitle in the Budget Support Act that repeals the current requirements that a registered nurse staff at each health suite for at least 20 hours a week and um replaces it with a registered nurse, a licensed practical nurse, or a school health technician.

Um why does the subtitle not describe the current cluster model with at least one RN overseeing each cluster of schools or LPNs and health techs in that cuss cluster?

Um I think it was just trying to clarify a point about what we meant by present.

So it does not do that, but that is the current state, and we plan to continue it.

Okay.

Um the definition of school health tech that you all wrote in the subtitle is quote, a person authorized to deliver developmentally appropriate health care to students in a school setting, end quote, but it does not state what entity makes that authorization.

Would that be DC Health?

It would.

Okay.

What standards would you use to determine whether that to authorize the health tech?

Do they need to hold a certification?

Do they need to have the training?

We're looking for people who would otherwise be practicing under the oversight of a nurse in other clinical settings.

So we have multiple different um staff who would qualify under that.

They are assist as essentially nurse assistant personnel and that level.

So they some of them could be emergency medical technicians.

It it does extend a little bit further than that definition of nurse assisted personnel, but that is the category generally.

Okay, what if anything would this subtitle change about your current practice?

It wouldn't.

So why is it necessary?

The what it helps us do is just to be clear about um how the staff can be arranged.

They are always under oversight.

They have huddles daily to talk about what students have needs.

They um have uh an oversight system that includes the nurses, so it would not change it, but it would allow us to be clear about what the legal requirement is.

Okay.

The subtitle seems to imply that DC Health is no longer aiming to meet the 40 hours a week of coverage through the cluster model.

Is that correct?

That is not correct.

Okay.

So what's our current goal?

Is 40 hours still the goal?

Yes, of oversight from a nurse at each school.

You have to leave a little room there for you know, training in the morning, things like that, but yes.

All right.

So it's probably more like 37, but yeah, full day at each school.

Okay.

Um, I want to talk a little bit about food access.

Sorry, Sarah.

We're just gonna run through Cha and then we'll get to every that would be.

Sorry to everybody else.

They're doing it.

Don't worry.

Everybody will have their moment in the sun.

Um, okay.

Um, so you know, we heard significant testimony from public witnesses about the mayor's proposal to repeal the food policy council as well as the Office of Food Policy within the Office of Planning.

Obviously, you're not the director of the Office of Planning.

I'll go to that hearing at another time, but um it is very clear to me that Office of Planning is not where food policy council should sit any longer.

It's clear the visions are no longer aligned.

Um and I don't know, we're looking for a new home.

I think that there might be some synergies on the Food Policy Council and the work that community health is already doing in terms of really talking about systems and the public health work from that.

Um often does DC Health currently collaborate with the Food Policy Council and the Office of Food Policy?

Um we attend all of their monthly meetings.

We are co-chairs on one of the committees.

Um and we're we were in um regular communication with the food policy council staff.

Okay.

Um I don't know if you can answer this, but I'm gonna ask the question.

Like, do you feel like this would be a compliment or a duplicative of the work that you guys are already doing?

So I don't think I do think the Food Policy Council does its own work.

I don't think it's duplicative of what we do.

Um systems is always part of public health because for anything that we touch, there is um real prevention involves change to the system and prevention is what we what we strive to be doing.

And from the way the um systems organized now, this is really in another cluster, so we're not necessarily part of that conversation, but we have been engaged.

We um we serve at the pleasure, and we're we're more than happy to do what's needed to make a good food system for the for the district, but for right now it's not really in in my wheelhouse to do.

Okay.

Um the proposed FY27 budget reduces the farmers market support grants that the committee funded with recurring funds.

Do you know how hard recurring funds are to come by?

But okay.

Um you guys awarded 250,000 in grants this year, and then you're gonna reduce it like let me ask it a different way.

Um if the council restored the grants to 250 and FY27, would DC Health anticipate spending down the money?

Yes.

Okay.

Um, in terms of the did the number of applications for this year exceed what you had available?

For the farmers market support.

Yes.

Do you remember by how much?

I would have to get back to you on that.

Okay.

Some of the applicants didn't demonstrate readiness, which is why we did not delight them.

Yeah, let's set those folks to the side.

I'm just sort of sometimes we get folks where like they're good applications, the request is just it far exceeds what is available.

So that's what I was sort of asking.

Not necessarily could we fund everybody, but could we fund could we meet the need of all of those that were really solid applications?

Yeah.

Um we we can get back to you on that.

Okay.

Um, so DC Health reported to the OCFO that the cost for implementing the Farmers Market Support Amendment Act of 2025 included 100,000 for marketing and supplies.

Um the council provided this amount in the FY26 budget in order to implement the legislation only for you all to um sweep those funds this year.

So is marketing and supplies no longer necessary for implementation.

Yeah, so um I will let you speak in a moment, Sarah.

We it's this in this kind of budget year, our local funds are limited in the kinds of things they fund.

So we have school health, we have food delivery, we have a limited number of things, we have lots of lots of federal things in little pockets, but limited number of local things.

And so it has to come from somewhere, and so something where we may feel like it's necessary for the uh optimal success of the program may not be something that we can protect when we've got other things that are ongoing programs that feed or have or do other things for current residents.

So that was one of those things.

We protect other things, and we had to give that up.

But my point is that you guys are able to implement continue to implement the legislation without this 100,000 for marketing and supplies.

Not as well as we would have thought we could, but we will continue to implement it.

Okay.

I wish everybody approached business with that same sort of fiscal conservative value.

We've done a lot of contingency planning this year with with lots of threats to our budget.

We've done lots of contingency planning.

We've got uh lean versions of lots of things.

Is that the version we would like to run that we think is the best thing for the residents?

Not necessarily.

I know, but y'all submit to CFO your hopes and dreams, not what is actually needed.

And this is not for you.

This is compounded for the rest of your friends in the cluster who every time we have a bill, they want two FTEs.

Well, I don't usually envision doing things badly.

Okay.

I'm an optimist and a perfectionist, so what it takes to do it well.

DC Health uh didn't include funding for the grocery access pilot that the council has funded for the last two years.

Um the data that you guys have from the pre-hearing responses shows that you know we're anticipating to fill all of the slots um for this year.

I I do have a question though from a funding standpoint.

So we provided funding for this current fiscal year, so FY26.

And then we also you all have funding for FY25, but the program didn't start until now.

Um is that money from still available to you, or are we only running on FY26 money?

Yeah.

So we are still distributing memberships from that FY25 tranche of money.

Okay.

Um, but we are on track to spend all of that money and spend all of the FY26 money by September 30.

Okay.

All right.

Umce someone is in the program, so let's say, for instance, that they don't get the code um to sign up until July.

Do they still get July to July?

Yeah.

Or it's the full year.

All right.

Um, Medstar has gotten IRB approval to study the impact of this program, which is very exciting.

Um, what metrics will they be tracking and when how long will they be looking at this for?

They'll be um tracking metrics for the full 12 months, and they're tracking um chronic disease management, like blood pressure, diabetes.

Um they're also tracking um through the data we get from our um food partner um food purchasing.

So can we see any changes in their food purchasing behaviors?

Um, as well as we will um administer some survey so we can look at is there food consumption changing?

Are they preparing healthier meals?

Okay.

Um DC Health stated that the agency will identify federal funding to ensure that some of the activities can be continued.

Um confident are you in that?

It's a hard year to say I'm confident of any funding from the feds, but so this is a pilot, right?

So and and I think us doing the Med Star um research will sort of help kind of determine.

I guess we're trying to understand whether some would some funding in FY27 help.

Does that make sense?

So, like I feel like a thousand spots is a very good incise for us to like sort of evaluate a pilot, but so you may not need to bring on a whole nother cohort that might not be necessary.

Um, or there might be a hey, what happens if we did for some people um gave them funding to do this for a second year?

Yeah, I think it is reasonable um to do a year and see what impact that had.

Okay.

Um we generally would expect that 12 months is a good enough time to see some shifts in food buying behavior if we were going to get them.

So I do think that that is a good enough time to say I you know, in in food to say I gave you more vegetable access and did you eat more vegetables?

I don't know that a second year of that same person tells you a different story, it does give you longer if you think it's working for that person to get the benefit, but right now we're still in the storytelling stage of trying to figure out is this a thing that's worth doing?

Okay.

And when folks sign up, we're communicating to them that this is a pilot, like this is not a permanent benefit entitlement, et cetera.

Okay, great.

All right.

Um so in FY26, the council um included one-time funding to partially restore the federal cut to the local food cooperating purchasing grants.

Um this helped to ensure the uh smooth opening of the Mary and Berry Avenue market and Ward 8.

Um, does CC Health believe the continuation of this local funding would strategically support more local food distribution and low food access areas?

I'm gonna let Janice in.

Um if um and we also um determined um I got some information with the Farmers Market Support Act, we received um 10 eligible applications and we awarded six.

Okay.

Um if I had um because the food system it is it is complicated, um, any any um investment is going to help create a more um equitable food system in a tight budget environment, and if we're looking at prioritizing funds and where are the highest impact, um distribution of food tends to be where we look at the most impactful.

So yeah.

Okay.

That um I mean, I hear you on that.

And then also I'm looking at a 98,000 dollar reduction in home delivered meals, a $50,000 reduction in joyful food markets, a $50,000 reduction in produce plus.

Uh I'm willing to lean in on the food access piece because I also know what's happening in another committee with cuts to all of the social programs, right?

I've got snap cuts, I've got TANF cuts.

Um in January, there'll probably be some folks who lose their Medicaid as well because of um some of the work requirement stuff.

So I kind of feel like on the local side, then we should be padding our food access, recognizing there is going to be an increased demand.

No?

We are squeezed on both sides.

Okay.

So I think that is the reality.

And if there is where there are things that we can do um to improve people's access, we should.

I do think there are some things that we want to try to do on the snap and TANF side to try to help our medically fragile folks who may not be able to prove that.

So there are other things that we can do.

I think we have more than one lever to go after, and not all of them are funding related.

Okay.

Just to sort of close the loop on the local food cooperating purchasing grants.

How many other grantees used that program when it was under federal funding?

In the district?

Yeah.

We worked with Capital Area Food Bank, Martha's Table, and Dreaming Out Loud.

Okay.

So all right.

Let's talk about maternal health really quickly.

So DC Health competitively bid out three 100,000 grants in FY26 to new organizations to implement the parents as teachers model, but plans to continue none of these grants awards in FY27.

Despite several of the grantees not starting their services until Q3 or Q4.

I have two questions.

So one, let's say I got my funding in 26.

I didn't start until Q4.

Do I get to keep going or do I have to cease activities?

So we are continuing those grants.

All of those organizations received both local and federal.

So their local funds were reduced, but their federal funds are intact.

Got it.

Okay.

Is that um for these grantees?

Is that enough?

Is the federal funding enough for them to continue with the model?

Like what percentage of the grant amount was federal?

It was about 50%, I believe.

They received about $300,000 in local and $300,000 in federal.

Okay.

Okay.

The proposed budget also decreases the funding for you all's uh new in-house home visiting model.

Sage care augmented.

Oh, safe.

Okay, sorry.

Safe.

It's a sage.

Safe.

Safe care.

Safe care.

Um by 182,000, even though the program has not started yet.

Well, it started.

It hasn't provided any um results at this point.

Are we eliminating this or just reducing it?

Reducing the local funds.

So we still have our federal funds.

Okay.

So this is one of those two.

All right.

Okay.

In FY26, DC Health changed the $735,000 grant for teen pregnancy prevention.

Sorry, you changed it to a competitive grant.

Um and then sent an award notification to the new grantee in January of 26.

Um at the FY26 budget hearing, you testified that quote, we know prevention in this space is really important right now, and I want to make sure that organizations can compete for this funding.

And then FY27, we propose zeroing out this entire grant line.

Are we feeling more confident in our teenage pregnancy rates?

That we have to prioritize between problems, and we have a large um cuts already in a lot of essential areas, and that was one that I thought we could use other funds to support that area.

So we do do things in that space, it's just not this particular large grant on a yearly basis.

Okay.

Um so what are what are is our public health agency not doing teenage pregnancy prevention in fiscal year 27 at all?

Is it or is it happening someplace else?

It so we have um as we're investing more in the school-based health clinics and we're moving those with the um introduction of Hosta into that space to be more actively working in that area.

We are investing in teen pregnancy prevention pretty heavily.

Doing that in um terms of big individual grants to subgrantees, it's just not something we can afford this year.

Okay.

The proposed FY27 budget zeroes out the 1.31.35 million in local funding for healthy steps.

DC Health rationalized this by saying that healthy steps providers can still bill Medicaid under the collaborative care model.

There was also a policy paper published in 24 by zero to three, citing significant challenges for healthy steps to bill under this model because it's focused on prevention rather than treatment.

And as you know, under Medicaid treatment is really where the focus is.

No, um we had a narrow window and a large cliff to a large hill to climb.

And so looking at where we thought there were possible ways to fill a need in another way, um, we did in order to preserve the funds that we had for things where we didn't have that option.

So it'll be a a it'll have to be a very rapid process of trying to train and get what um what looks like a viable model up and running, and it may have some bumps in the initial implementation.

Uh, we're hoping that for particularly the kids who are in the highest tier who actually do have notable problems already, that those would be the easiest to use a treatment-based model like Medicaid to make sure that they do continue services.

The prevention side um, while it is as important, it will be um we're hoping that the impacts will be soft enough that it'll give us a little time to work that part out.

And so we are right now talking to Medicaid, talking to the providers, okay, trying to work out how we might be able to do that.

Sure, but if a health center doesn't have a psychiatrist, then what are we doing?

Well, psychiatrists exist, so let's work on what our options are.

Okay.

Um we also reduced the birth to three programming by cutting a 103,000 dollar grant for lactation certification preparation training.

Um how many people were being trained through this grant?

That's I would need to get back to you on that number.

I think it's in the 15 to 20 range.

And they were um trained, they were prepared to take the exam to become uh international board certified lactation consultant.

Okay.

Um DC MAP, which trains primary care providers to treat behavioral health conditions, was um transferred to or sorry, was transferred from Department of Behavioral Health to DC Health and FY26.

Um and right now there are currently no plans to provide local funding for this program at FY27 unless DC Health is awarded funding from HERSA.

Is my understanding?

When do you all expect to hear back from HERSA regarding this funding?

This is our um our HERSA Pediatric Mental Health Care Access Grant, um, which we currently have.

We're in year five, and so we use those um HERSA funds to support the grantee.

Um we've been in conversation with HERSA.

Um, and so we should be receiving the application um within the month.

The application to apply federal application, yes.

Okay.

For continuation.

Um, so if the federal funding doesn't come through, how would we continue to operate DC MAP?

That would um be a conversation that we would have to have with DPH with leadership.

Okay.

Um this was kind of a painful section because taken all together, that's a three million dollar reduction in maternal and early childhood from our public health agency.

Um yeah.

I mean, I know that DC Health had had like 60% of its funding from the feds, but we still have priority and critical initiatives that we're trying to do.

And so when the federal funding doesn't come through, we just not do them anymore.

I mean, like I'm I don't see where our local investment is in maternal health in this budget.

Yeah, we um I will say I think for the most part we try to match up federal priorities and then use our local funds where the federal priority is not as strong as we would like it to be and sort of expand things that the feds otherwise won't pay for.

That is the way our budget is, I think, functioned.

There are lots of investments we would like to make.

I think it is not um while the budget is uh attempting to meet our priorities in a year like this where we know we don't have enough funds to cover all of our priorities, we're having to make some hard choices and choose between what feels most urgent, where do we not want to lose an investment that we think we might be able to continue to go forward, where can we shift something to federal dollars?

So it was a lot of um small and large decisions went into it, and none of them were I think our our best choice.

Did you guys add any money anywhere in the agency?

Or did everybody just get cut?

Everything got cut.

Okay.

If I could also add, we do have a um seven million dollar maternal child health block grant.

So that is flexible funding that if we experience a loss in some domain, we could look at how can we use that source of funding to fill that gap.

Okay.

Well, I mean, I would love to hear more about how you are, because clearly you've lost funding in some places, um, which I thought were critical programs that were really helping and and supporting.

Um I would hate for our numbers to sort of hustle in a different direction because we're not making any local investment.

Well, I will say a year off.

I don't think my budget was before any cuts full of things that we thought were not good or were not helping people.

They're only there because we thought those were needs that needed um to be addressed.

Some of them we have partners in addressing them, and we think that there's room for somebody else to take some of that um uh burden and maybe we can still get a benefit.

Some of them we have other sources of where it we know it's a federal priority, where we know a federal priority is continuing, and we know we might have a loss, we do shift to it.

So it is it has not been a simple process, but it has been one where we had a very clear um guideline and we we did our best to meet it.

Okay.

Um we heard from the Potomac River Clinic last week, um, and also I guess in February too, they testified about um the number of um infants who are lost to follow-up after not passing their audiology exams after birth.

And um, have you all met with them about how to you know they have um their particular proposal around the mobile clinic?

That's one thing, but um another thing that they talked about was just sort of like the system of organization where by um we rely heavily on providers to do the follow-up, but if you can't get a um appointment at some of these specialists, how you're kind of lost, and they sort of say that there are other jurisdictions who do this better.

Have we talked to them yet?

We meet um regularly through our early hearing detection intervention program.

So we work with the birthing hospitals with the audiology diagnostic centers, which are at um Gallia Debt University, Children's Hospital, Georgetown Hospital, and then River Clinic.

Um, and then all of our pediatric um facilities so that we can follow infants and ensure we we have near universal newborn hearing screening.

Um so then if an infant does not pass that hearing test, then they need to be navigated to an evaluation at one of those four diagnostic centers, and then if they have some type of hearing um issue, then we want to um navigate them into early intervention services.

So that navigation piece is where we work with all of our partners to improve.

Okay.

How much of the funding has been spent down to date?

That I would need to get back to you, but I think we've we're on a draft.

Did a good job.

Yeah.

Okay.

Have there been any challenges in spending the funds?

We provide funds to DCPS for an education manager.

We have a mass media campaign.

We provide funds for two retail inspectors.

And youth engagement.

We have a grant that's issued for to build capacity of our youth.

Okay.

There's a proposed subtitle called the Tobacco Permit Fees Amendment Act of 2026, which would require all businesses to obtain a tobacco sales permit to sell tobacco or tobacco products at wholesale or retail locations in addition to a license.

The OCFO estimates that this will generate a whopping $15,000 and additional resources for the tobacco use cessation fund.

Now when you all proposed this, did you all compare the district's regulatory framework to those in neighboring jurisdictions such as Maryland and Virginia?

If so, where does the district fall in terms of permitting light tobacco retailers and wholesalers in addition to requiring them to be licensed?

So what we're trying to do is shore up a hole that was created by getting rid of the endorsement for which for reasons.

So in licensing now, there isn't a particular thing that makes you a tobacco retailer.

Yeah.

Um, which is definitely not modern practice in public health, at least in this country generally, that there should be some cost and some monitoring if you're going to provide tobacco because we recognize it as being a health issue.

Right.

I don't recall DC Health testifying about this in 2022 when we we did a whole bill to like change um the licensing for businesses.

This could have been something that was raised then.

I think it was in some way.

Um I think it maybe wasn't noted till after the fact, but I was I'm getting history.

So that predates you.

It does.

What I will say though is now it's been noted, and we would like there to be some regulatory um framework that includes a fee for doing this activity.

So this is the first step in doing that.

Okay, but my question still stands.

What is happening in our neighboring jurisdictions?

Because oftentimes, and I know you're speaking of this from a public health standpoint, but I've also got to think about it from a business and economic standpoint, which is that the DC DC is a very hard place to do business because of our additional rules and regulations.

So when we did the best act in 2022, that was our attempt to sort of streamline and also increase our competitive competitiveness with our neighbors.

Do they require a permit fee or an endorsement fee on top of the license?

Carl, do you remember the research for this topic?

We did this research.

Okay.

But I do not off the top of my head.

We may have to get back to you with it.

Okay.

You'll have to get back to her due.

Okay.

None of us remember.

It was some time ago.

Okay.

Um, I kind of need to know by tomorrow because the council is having a conversation about BSA subtitles.

And my recommendation right now is is the juice worth the squeeze.

Uh, I do think it is worth a squeeze to have something in place.

Um, we can we're we're starting at a low level.

I don't I don't plan that we'd ever be burdening people, but it is a choice to sell tobacco.

You don't have to sell tobacco.

I believe that we are putting ourselves in line with our neighboring jurisdictions, but I will have to confirm that for you.

Okay.

It is not um, we're definitely putting ourselves in line with every other big city.

What are our neighboring counties doing?

I believe we looked, but I will have to find that for you.

Okay.

Um, my also um trepidation here, and I think this also predates you too, is that um a number of years ago the council did a flavor uh flavor tobacco bill, and it was through that bill process that we found out that all of these businesses who were doing indoor smoking, none of them were actually doing what they were supposed to do with DC Health.

Partly because number one, nobody can find the information on the website, and number two, the application wasn't simple.

It was a convoluted sort of process to kind of and as such, we've got a lot of folks who were doing indoor smoking without having gone through the appropriate process.

I don't want that to be this, where it's like something in name only, but nobody's actually doing it because it's either a hard to implement or B difficult.

Did you guys consult with DLCP on this?

So we um this is happening through my environmental health administration, which is always in very close collaboration with DLCP because they um that is also where restaurants and and all of the other inspectors are.

We deliberately have it over there.

It moved from um CHAW over to environmental health so that it would become part of that regulatory framework where we have our our other inspection programs.

So I I'm fairly confident that they'll be able to work with the LCP, let people know this is required, and then work through the paperwork.

Okay.

Um so let's follow up on that, just so I can be smart for my conversation with my colleagues tomorrow.

Um in the chronic disease world, um, the proposed budget cuts um 168,000 from the chronic illness initiative, which at last year's hearing you described as important for funding the Howard Sickle Cell Center as well as the poison control center and the cancer screenings program.

Um what will the impact of this cut be for those three initiatives?

The the cut will be experienced in terms of marketing and promotion of sickle cell treatment services.

Um we did I identify additional funding source for poison control.

Um, and then in terms of breast and cervical cancer screening, it will mean that fewer uninsured and underinsured women receive um mammograms, PAP tests.

Okay, so that particular part was funding actual screenings.

It is supporting our CDC uh early detection breast and cervical cancer program.

How okay, how much was that program specifically?

Um that is a million dollars-ish.

It's a multi-part grant um that supports breast and cervical cancer screening, our cancer registry, and uh comprehensive cancer program that supports our cancer coalition, some of our fibership work, and the total grant is 1.7 million.

So part of that is for the breast and cervical cancer screening.

Okay, so the total grant for the chronic illness initiative was the 1.7?

It was the 239,000 that we used as um, I don't know if the term is flexible funding, but like if we had a new initiative or priority or pilot, we could use that chronic that local pot.

Okay.

To support it.

I guess how much is left?

Nothing.

73,000.

73,000.

Yeah.

Okay.

Um in the chronic care, it also reduces the budget for the team-based care for chronic conditions grant by 225,000.

At last year's budget hearing, you described this grant um as supporting FQHCs improving how they deliver primary care services.

Um much is left.

Um that's about 1.4 million.

So that might be all right.

Um just to go back.

Have you guys talked to Howard?

Did you tell them?

We we have.

Um, and we're um we're looking at can we find some other source of funds?

Okay.

Um, yeah.

The Sico Cell Center is really good.

I think we pay support a lot there.

Uh so wanna like we want people to go to um something that we helped um build out in terms of the research there.

Um I will say this is one of those areas where for the most part patients are being referred from other, they're not we do have people who are not in care.

So it's just like um those flexible funds, we know their holes, so we never people's lives are complicated.

So that program works great for women who's got insurance and we're improving their lives.

There's gonna be somebody who is disconnected, we want to be able to rescue them into the system.

This is that money.

Yeah.

So we're the core is going to be there, the core is going to be there for the sickle sales services.

Are we gonna have that extra funds to be able to find the folks who weren't referred from their doctor and have moved here, but have so it's it's how do you make the the system complicated enough to fit all of the people who would otherwise fall out of it, and we're losing some of that complexity at the edge.

Okay.

Um, I'm going to CPPE.

So the largest reduction in the DC Health budget is the sunset of a COVID era federal funding for the epidemiology and laboratory capacity.

Um in the pre-hearing responses, DC Health explains that the 15 FTEs whose terms will end, have provided a broad range of services, including investigating the impacts outbreak in 22, um, several measles exposure events, foodborne infections, healthcare associated infections.

Um I mean, I'm assuming that pre-COVID, well, I know this pre-COVID, we had epidemiology.

Yeah, um, and there were some that was there.

So I guess in if there's a future outbreak insert here.

I'm not gonna put all that bad juju in the universe, but where we are kind of in 2026, we might should expect.

Um would we just use contingency funds to address the public health needs here?

So well, it we have a um a measles response plan that'll work for several things.

And part of the way you think that through is how big will it be?

Um, so we you know, we try to do what we can to find our vulnerabilities and shore them up so that we can guarantee ourselves it won't be big.

Yeah, but if depending on its size, we know where we're going to get full staff from other parts of the department.

We're cross-training staff who do other things to be able to pull into whatever outbreak comes.

So we again in that contingency plan where we weren't sure what money we were getting from the feds, we've done a lot more to be able to do what we can with what we have and be able to flex ourselves to meet the need.

We're back to where we were pre-COVID.

So it's not, it's not that the whole system's disappearing.

We just had a lot of capacity that was really useful.

Um, and now we're trying to figure out what does it look like to use what we have to meet nearly that same level of capacity.

It won't be the same, but we think we can do it.

Yeah, I um funny enough, I uh was reading this article that uh was talking about how um South Carolina got their measles outbreak under control, um, which I had just been in South Carolina, so don't you know?

And um, turns out getting vaccinated.

Yeah, look at that.

That is how you get out of a measle.

That that was that was the number one thing, and I was like really the only way.

What a headline, the thing that we already knew, but sometimes people gotta touch the stove to know it's hot.

Get vaccinated, people.

Okay.

Um, all right.

You guys, CPPE was doing a lot of great work in terms of um data transparency efforts, etc.

Do you have the funding to be able to continue to work on the planned dashboards that you all had?

Um, or we're planning to sort of roll out.

Yes, we do have the funding to be able to continue to work on the dashboards, and we're making some modifications and some changes to them now to try to make them even more effective.

Okay, so which um what new funds should we anticipate coming?

So it's not any new funding.

No, no, no, not funding, new fun, data, fun, lots.

Yeah.

There'll be lots.

Um yeah, lots of new and exciting things.

Um, we're working on some things in the maternal health space right now.

So some maternal dashboards merging some of our preterm birth and other information together to try to make it a little bit more effective for users.

Okay.

All right.

Um, that's my short one for CPPE.

I will say we do have our public health infrastructure grant, which looks like it's going to continue from the CDC that allows us some core operational funds for things like dashboards or so it doesn't feed anybody and it doesn't deliver direct services, but it does allow us some flexibility to figure out some of these um core capacities that we want to be sure we continue.

Okay.

All right, I'm going to Hosta.

So in the pre-hearing responses, um DC Health explained that the apparent $5.2 million reduction to the federal HIV surveillance and prevention grant is not actually reduction.

Um since DC Health was notified after the budget submission that the funding will continue.

Is this correct?

I gotta ask you on the record.

That is correct.

Okay.

As far as we know.

All right.

So what were there any other federal funds that Hasta was expecting to lose in FY27 that I guess in between the budget submission and now you've gotten some new insight on?

I mean, weeks ago.

It wasn't even between the budget submission and now it was within the last couple of weeks.

Oh, we've gotten word.

Okay.

Yeah.

Is there anything else?

No.

Okay.

But this is it.

Yes.

Okay.

Yes, it is.

It's a big one.

Super excited.

Okay.

In the performance oversight responses, you guys stated that you were in the process of onboarding an FTE that the council funded to implement the Child Behavioral Health Services Dashboard Amendment Act.

Is this position fully onboarded now?

Yes.

Okay.

All right.

There appears to be a vacant bureau chief position that is swept in the FY27 budget.

Now, lots of positions get swept in vacancy savings, but a bureau chief seems a bit important to me.

It is.

Okay.

And I have requested that that not be swept because I need that position.

Okay.

What's the impact of this cut on the HIV prevention?

Like where does this position kind of sit in the infrastructure?

That's the leader of the HIV prevention group.

Help set strategy and program implementation.

Okay.

Can't make any promises, but you know, unless y'all want to point us to a line.

I got you.

Okay.

All right.

The proposed AIDS drug assistance fund amendment act of 2026.

So this is in the Budget Support Act for folks who are listening at home.

Uh changes the name and the structure for the communicable and chronic disease prevention fund.

Um it also narrows the purpose to collect and spend monies associated with the federal AIDS drug assistance program.

Um my understanding is that this change is necessary to meet federal grant requirements.

Is that correct?

Correct.

Okay.

Can you elaborate on what requirements the agency must meet to um comply with the federal grants associated with this?

Sure.

This is for the Ryan White uh Part B grant.

Okay.

And it is the funding that supports services to residents of the District of Columbia who are living with HIV and supports our AIDS drug assistance program.

As part of that program, we are allowed to access 340B pricing, which gives us uh pharmaceutical rebates that go back into a fund, um, the fund that you just discussed.

But those the requirement of receiving those funds is that the funding has to go back into the same purposes as the Ryan White grant.

I see.

So it can only be used to support people living with HIV in the district of Columbia.

Oh, I see.

So when um EOM tries to sweep it, we gotta put the money back.

Got it.

Okay.

The why does the subtitle remove current language in the DC code that authorizes the monies to carry over to the next fiscal year?

Was that intentional?

No, that shouldn't.

We have rules from the Feds on how it carries over, so it should be able to carry over fiscal years.

Okay.

Um Clover, you can follow up.

We we likely have to be able to because it's so irregular when the rebates come.

The rebates could all arrive at the end of a fiscal year, and that would be the money you were supposed to use for the next fiscal year.

No, it was confusing to us.

That's why we were asking whether or not we're gonna do that.

We'll have to look into that because I actually that wouldn't work.

We're happy to update that language um thank you in the BSA.

Just because I don't want us to get into a we'll end up in a compliance problem, and it's such a huge issue for us in terms of how much it finances that I think we should be careful.

That's why I'm doing this.

Um also be helpful for us to know is um how many individuals did the pharmacy benefits program provide um medication to in FY26 and um FY25 and 26 to date, and then how much did you all spend on medication?

Okay, but follow up to whether or not there was a wait list for the program.

There's no wait list at this time currently.

Okay.

All right.

Um so there have been um recent federal proposals to restructure the 340B drug prices programming, um, including the 340B Access Act, which would impose new requirements on covered entities, restrict contract pharmacy arrangements, and require that a greater share of the 340B savings be passed on directly to patients.

Um are you all actively monitoring this legislation and conducted any analysis on how these proposed changes would impact the district's ability to generate um and use the 340B revenue?

Yes.

So we are constantly looking at this along with some of our federal partners who do it from a national landscape.

Right now, the district isn't affected.

We don't charge our ADAP clients for their drugs.

So there would be the drugs come to them free of charge as part of the program.

But as things change, it would might change the number of rebates we're able to collect, which would change how much we're able to do in the program, the capacity of the program.

This is one of those areas where it's important for us to maintain active advocacy, and I think this is what a lot of our associations are for because these reforms are not directed at public health departments for the most part.

They're directed at hospitals who then use those funds for other needs they have as a corporation.

So we just need to maintain real awareness so that they don't inadvertently write us our purposes out while trying to control the uses by other entities.

So we're active in the advocacy space on this and we'll continue to be.

Okay.

So in the grant spreadsheet that we all um we all that the council received it indicates that Joseph's house is currently receiving two grants from DC Health, one for 90,000 and then one for 250,000.

The spreadsheet indicates that the first grant, that's the 90,000, had no expenditures and is being canceled.

Is that accurate?

I need to check that.

Okay.

I'll get back to you.

Okay.

Um we also just kind of wondering what was the purpose of the $90,000 grant for them as well.

Okay.

Uh the PrEP DC Amendment Act of 2026 creates a new special purpose revenue fund within DC Health to collect the revenue from the Health and Wellness Center billing.

Um, this isn't law yet.

It's like law in like two and a half weeks.

Um but uh has the center started billing?

Not yet.

We are working on the infrastructure.

Okay.

So we are in the process of um setting up all the things that are required for billing.

Okay.

Are you all working with the CFOs to ensure that like once this is law, the fund will be set up so that I guess over the course of the summer, it is possible for you all to begin billing, receiving revenue, et cetera.

Like I guess as you're setting up the infrastructure, what's your goal date to sort of being online for this?

That's a great question.

Some of the things are outside of our uh locus of control, but our goal is is by the end of summer to be able to bill.

Okay.

So once the legislation is there, we can push forward and submit the um documentation required to create that that fund.

It shouldn't take too long to have it created.

Okay.

All right, but it's got to go into effect first.

Okay.

Um can I go back to Joseph's house real quick?

Sure.

Um, they're funded under Ryan White Part A for home and community-based services.

Um that's the 90,000.

And that's oh, that's their Ryan White funding.

Okay.

Housing opportunities for people with AIDS is the name of the program.

Okay.

But the Ryan White funding has been canceled.

The Ryan White grant uh year just changed over in April.

Okay.

So it may just not be in the system yet.

Okay.

Because the grant year runs April 1st to March 31st.

Okay.

Uh going to HISPA.

All right.

So DC Health has been testifying for the last year that revisions to your enforcement and fine structures are coming.

Um, this has been raised as a limitation that you all have in terms of the ability to enforce noncompliance for health facilities related to patient safety and uncompensated care.

What's your status update?

So we have a final version of the rulemaking that does make those changes, those necessary changes.

Um, and we anticipate that being put out for public comment or initiated through the public comment process because it has to go up to EOM and OAG for review.

Uh likely by the end of this month.

I know that we had the I looked at it last time last week, and we were we had the final words on it that we wanted to add.

I appreciate you being so um hopeful here, but the idea that it will get through a OAG and EOM.

They've seen it twice already.

They've seen it twice already.

We're in the extensive tweaking process.

Yes.

Okay.

All right.

End of the month.

It's not the first time they've seen it.

So we're hoping that it will make corrections.

Yes.

And they're looking at their correction.

Um the pre-hearing responses indicate that um DC Health cut 700,000 from the criminal background checks for how health professional licensing to meet um the mayor's mark, but included it.

Oh okay.

But you guys said you needed it.

Are you expecting to get that money back?

No.

So go ahead, Carl.

I mean I'm so used to Carl being right next to me.

Yeah.

So currently the way our criminal background check process works is you pay the Department of Health the criminal background check fee, and then we pay the vendor for the criminal background check.

Yep.

Our plan is to transition that process where you would pay the vendor directly for the criminal background check as other states do.

So you would pay them directly, and there wouldn't be this pass-through of money that comes through us.

Okay.

It would be a vendor of your choice, not a vendor of the applicant's choice.

So there are only there are a limited number of vendors that are eligible to actually do the federal criminal background checks.

Yep.

But we would use vendors that are able to submit the results directly to our system.

So currently there is one vendor, but if there are other vendors that are interested in building out the API that could submit those results, we would open that up.

But currently it would be filled print.

Do you anticipate um any impact on the application processing timeline by like doing it this way?

So I it shouldn't impact the application processing timeline necessarily because they are just going to be paying the vendor directly.

Um it may actually make things a little bit smoother because what we have found out is that there are some people we have a code, a single code.

And so what we have found out is there are some people who are sharing said single code.

And so they will try and get ahead of the game by going to do the criminal background check using our code before they've submitted the application.

So they haven't paid for said background check, but DC Health must pay for said background check because you're using our code.

Oh, I see.

Yes, so it gets problems.

Needlessly complicated for us to pay on the back end.

So this will smooth out it'll maybe catch some people who have caused who who as by trying to use it have caused themselves some problem.

So it's most people's thing goes smoothly anyway.

But there are people who when they get in trouble, we have a hard time resolving things and are too slow in that process.

So this is one of the many things we're doing to be able to fix problems when they occur.

Okay.

All right.

Um so I had the opportunity to join the long-term care association um spring meeting a few weeks ago.

You were there.

Um you stated, well, I mean, you didn't state, but you stated at Performance Oversight that um the final rules for the CNA requirements um were going to be published in April.

Yep.

It is May 5th, 4th.

May the 4th be with you.

I mean, they're we're waiting on processes.

They're not in our shop.

They're IOM.

Yeah.

Yes, ma'am.

Okay.

Well, hey, there um you know how it works.

The CA knows that I will come to him and be like, hey, they tell me it's on your desk.

Now there's sometimes he comes back to me and he says, Christina, I don't know what you're talking about, and they're just using me.

But I'm just gonna assume that you guys are like, we are not.

So if I talk to him about this, yeah, he's gonna be able to do that.

We want them to be finalized as well.

Okay.

Um would this be final publication, or is there like another step?

This would be a comment period.

After this, then there's a comment period.

There, yes.

There is a 30-day comment period after this, yes, ma'am.

Okay.

Try to get this done before the summer.

It'd be nice.

So that I've got facilities who are like, how should I hire?

We're kind of in this very um limbo period.

Okay.

And we've done we've done we have deliberately tried to increase the amount of communication about this particular issue so that people understand what the changes are going to be and how it's going to look.

For instance, that meeting that you and I were at for leading age, making sure that we are going to those meetings and talking about what the in state will look like so that people there aren't surprises.

We want to try and communicate about it, even though we haven't gotten through all of the processes.

We anticipate it being much like what we see, what we submitted.

Okay.

Um the proposed FY27 budget uh zeroes out the high needs healthcare career scholarship and loan repayment program.

Um, as you guys know, this was championed by the former chair of this committee, uh, Vince Gray.

Um, and it was funded by the committee in in fiscal year 2024.

Um pre-hearing responses, you noted that you proposed the reduction before data was available for the program, but since then updated data does indicate that strong program participation.

Um I just want to say this for the record.

This includes a 220% increase in emergency medical technician students either trained or in process, and a 102% increase in certified nurse aid students either trained or in process in FY26 to date in comparison to FR25.

Um, I think my understanding of this program was that uh how we fund it is sometimes weird.

And so that there actually might still be some people who are currently in the program on the funding.

Um is that accurate?

And this the FY27 budget would be for like new participants, not current people who are currently in the process.

Okay, how many people are currently in the enrolled?

Have that number right here.

Okay.

These are my cuts.

I think we're gonna get back to it.

Yeah, what's that?

We're gonna get back to it about it.

Okay, go ahead.

Keep going.

Okay.

Um I actually have a sort of a follow-up.

I guess um, when folks paid for the licensure, the funding for the criminal background check.

Was that in addition to your application, or was the fund like the cost of the background check sort of wrapped up in whatever application fee that we had, or was that separate?

It was an additional fee.

It was lined out.

I mean, you could see that that's okay.

So, like a hundred dollars for the application, yes, $50 for the background check, and then XYZ.

Okay, all right.

Um the reason I'm sort of asking it is sort of twofold, one for interest, but also um, you know, the DC Dental Society continues to their advocacy around our dental assistant registration fees being much higher than um surrounding jurisdictions.

So for dental assistant, right?

Not a dentist, just the assistant, even level one, it's 240 dollars.

Where it's 20 in Maryland and it's a hundred dollars in Virginia.

So you know, when we talked about this in February, you all acknowledged that this fee was likely too high.

Why can't we change it?

It's uh larger question about all of our fees to making sure they're all there's parity and equity across all of our fees.

So it isn't that we don't want to change it, it is do we want to make a change here and then a change here and a change here uh piecemeal, or do we want to go through and do a fee analysis on all of our fees?

So that's what we are looking at is chapter 35 of our regulations to make sure that the fees do line up.

Are they there are some fees that weren't even listed on there that we you know were talking about executing and they weren't listed on the actual fee structure, so we are making sure that everything is listed out, and then there are fees that are listed there that we don't charge anymore.

Um so the applicant's not seeing the fee, but the rules give us authority to administer the fee.

Yeah, and it's because we don't use that process anymore.

So it is a larger question, and that's something we are going through line by line of chapter 35 to go through those fees.

I know, but like is that gonna be another year and a half, maybe?

I hope to goodness not.

Um the plan is, I mean, they are actively going through that right now.

I know that there is a working document that goes through every fee uh within the HISPA group within the health professional licensing group.

Yep.

I anticipate that hopefully by the end of the calendar year, we will have something moving through that process.

Okay.

I I think this is super important.

I guess even sort of from the recruitment of uh staff health workforce perspective, it just is like okay.

For the high for the dentist, that's one thing.

For the dental assistant was this is like an entry-level position into the career and 240.

Let's say I'm making minimum wage as a dental assistant.

Let's say I'm making $18 an hour, because not all dental assistant positions are salaried.

Like I gotta work essentially the whole week or so.

If I'm let's say if I'm doing it full time, I don't even know if I'm doing part-time or whatnot, just to even pay for the license.

It's like an investment on top of everything else.

So I just I wish that when we are bringing in when we are making changes to the fee structure or even introducing new fees or licenses, like we do the analysis on the front end as opposed to on the back end because we broke out levels of assistance, and then we didn't change anything about the fees.

So I feel like that should have been combined when we did the Hora.

That would have been a good exercise to kind of do as we're bringing more in.

Okay.

Uh does the proposed budget include any cuts to the staff responsible for health professional or facility licensing?

Not at this time, no, ma'am.

Okay.

And I do have your answer.

There's 120 students enrolled right now.

Okay.

80 of those are EMT students, and 40 of those are CNA students.

Okay.

So are we making the commitment that these 120 students will be able to complete the program?

They were budgeted on the 26 funding, so yes, ma'am.

Okay.

Um food safety.

Well, environmental health altogether, I guess.

For all the things.

Um the proposed budget um has a cut to a vacant supervisory sanitation.

Oh, not sanitation.

Sanitarian position in the food safety division.

Um, yeah, you know, we had a we have we've had some fun conversations about food safety and our our inspectors and sanitarians.

Um a supervisor position seems like a pretty important piece though.

Like, what's the impact of this?

Yes, so um, Arian Gibson, SDD environmental health administration.

Um, so there is an impact, but we have a planning for it.

So we are combining a couple of things.

Um, we're also working with um for some of the administrative tasks because this position is only part-time in the field.

So some of the administrative tasks that this uh individual would do, we're partnering with um Office of Risk Management with their return to work uh program as well as DOES.

Um, they have a program where um they sponsor someone and we we train them on what we do so that they can learn skills to get in the workplace.

So we are doing those sort of things for some of our um positions that we lost.

Okay.

I'm putting it all together.

So not all of the pieces, because correct me if I'm wrong, the sanitarian like it requires you can't just hire anybody.

Yes, so for the supervisory sanitarian, it's um it's mainly administrative, so is assigning the work, responding to complaints.

Typically they go out in the field if there is like a high priority issue that this did the sanitarian needs help with.

Okay, and they go on the field for um quality assurance just to make sure that the sanitarians they do um quality assurance checks to make sure the sanitarians are doing what they're supposed to or citing what they're supposed to do, that sort of thing.

Okay, so you're talking about for some of the administrative tasks, yes, someone else doing that, but then what about the field piece?

Is that just gonna be picked up by everybody else or so?

For the field piece, we have we we have another supervisory sanitarian as well as a supervisory sanitarian in um the division of community hygiene who picks up some of that slack for the field piece.

Okay.

It's like we got one person doing two, three jobs.

Um I think we talked about this a little bit at performance oversight, but this has come up now that the weather is getting warmer.

Is it your I think it's your team that partners with DLCP around the food truck?

Yes.

Um has that like I know that we had some challenges in terms of what does enforcement look like and also um getting the trucks to actually move once they've been ticketed, et cetera.

Um have we made any progress there?

Yes, it's still it's still a challenge.

Um I'm assuming you're talking about right behind us.

Oh, yeah.

Yeah, yep.

Um so they're still a challenge.

So they will move when we're out there.

Um unfortunately we don't have the resources to be out there all the time.

So as soon as we leave, they come back.

Um we are there is a work group with DLCP, um park police and some other agencies um to try to tackle this issue.

Um, but essentially when we go out there do enforcement, they move.

Um and then as soon as we leave, they come back.

Just saying.

Some visitor from Indiana gonna get food poisoning one day, and then they're gonna talk that it was our fault.

Yeah.

Which I they are not in div, it is not a solely a collection of little individuals running their individual food truck.

These are organized groups with spotters, and it is um a national problem.

We talked to some of our other big cities, we're in a work group with them about how this has become an issue across the country.

So it is it is complicated, but the only method that seems to work is to work with law enforcement and licensing and sort of go from all sides.

Okay.

So we're trying.

I think what we have going on, particularly around our national mall area is uh is different.

It is.

Um and also I think highly predatory in what they charge for a bottle of water or an ice cream can.

Um but you know, the visitors, they don't know that $15 for a Mr.

Softie is you're paying way too much, lady.

But like your kid wants one, nonetheless, here we are.

Um actual budget.

Um the prehearing responses indicate that the animal care and control contract funding is flat.

Um however, on the grant spreadsheet that we have, there appears to be a 1.37 million dollar increase.

So can you guys clarify?

Is it flat or are we giving them more money?

It's flat in the sense that we did a reprogramming in FY26 from animal services positions to cover contract services work.

So in the FY27 budget, it was just right size.

The funding was moved from um PS to MPS to cover the contracts.

Okay, so should it be a total of 8.9 million?

Yes, it's the same.

And also when we moved to fiscal year, it also created a one-time little awkward moment.

Okay.

Because it was a December to December contract.

Um the most common complaint the committee receives regarding the animal care and control contract has been the um lack of timely response to stray dog calls, um, particularly those that are outside of normal business hours.

Um the contractor testified last week that um in response to those concerns, they have recently brought the after hours hotline in-house.

Um are you all monitoring um to ensure that this transition is actually improving response times to after hour calls?

We we have increased monitoring of that contract significantly with the new contractor, and we have a much improved relationship.

I'll let you describe the system you're using.

Yes.

Um we do increased monitoring.

We're over there several times a day.

They send us weekly reports.

Um so this switch has only occurred, I guess, the last month or so.

But um, at least with us, those complaints, we haven't received as many complaints um since they brought that in-house.

Okay.

Um the pre-hearing responses indicate that in 2025 the current contractor housed about 2,600 straight animals, which is a 40% decrease from the previous contractor in 2024.

What do you guys think is driving this decrease?

Um our ability to see which animals were DC Health's animals was uh very poor before.

In fact, our estimates were uh we had little confidence in because there were two locations, and in fact, the Old Thorpe location that was not DC Health was actually the bigger of the two.

Yeah, and the numbers were not separated.

So the ability to tell what actually we as a municipality were doing was not great.

We think these are the accurate numbers.

It's not a decrease.

It's this is if you look, it's an increase from what was actually housed at New York Avenue because some were at New York Avenue, some were at Oglethorpe.

It was um there the rigor was not there anymore.

If it had been in the beginning, it was not there anymore.

And so this is our first year of having good data on what comes in.

Okay.

Um the current contractor has made an over um 91% live release rate and has euthanized 230 animals in the FY26, well, in FY26 compared to 420 animals that were euthanized in FY2024.

Um do you see these as improvements under the contract?

Or is the decrease euthanasia related to housing less animals?

Um the the rate is better.

I do think there is legitimately an improvement in how they are able to manage the animals that we have.

Um we again, because this is our first year that we have what we feel like is is good consistent data.

I think it will take time, but part of why we pick them was because they had nationally had good live release rates, and this is an improvement that I think is true.

That you want to um and so uh another reason why we picked them is they really focus on um providing support to the community.

So if someone uh comes in and maybe they can't afford um some sort of health care or what have you, um they try to find ways and work with their partners to help them out.

So um it's a good thing that we are getting less strays because they're providing more support to the pet owner.

Okay.

Um Dr.

Bennett, we've been here for about two hours.

Do you want to take a break?

Are we gonna do another two?

Do you think?

Or no?

Then let's go.

Okay.

All right.

I appreciate it.

That was very nice.

Yeah.

Uh okay.

So uh, well, I'm gonna put no with an asterisk because I don't know.

Yeah, you know, in the next 30 minutes.

We're in partially in control.

Yeah.

Okay.

All right.

Um BSA.

So there's a BSA subtitle called Commercial Pet Facilities and Pet Food Registration, which requires manufacturers to pay a $50 registration fee for every pet food product sold in the district and authorizes the mayor to increase this fee through rulemaking.

The um fiscal impact statement for the subtitle estimates that the fee could generate up to 425,000 annually for the animal education outreach fund.

Now, um, this does seem like a significant undertaking for the um agency, and I think of all of the subtitles that is within the cluster, this one received the most testimony from folks.

Um, my question is why was the decision made to pursue this?

Now I know what the animal education outreach fund does, so it is important, and that work is important as well.

But why do we why did you all decide to go the pet food route as opposed to um say increasing fees for veterinary clinics, veterinary license, commercial pet care facilities, or other entities which we already have a way to collect revenue from?

One, I don't think it'll be as challenging as it sounds.

I I'm gonna let um myself talk about that.

And two, um this is a way to generate those funds that puts us level with our surrounding jurisdictions.

So this already happens in all of our surrounding states.

It also is um so minimal to almost no burden on pet owners that it wouldn't have a negative impact on uh pets who might otherwise, if there were pressures, not get to stay in the home.

So we want to minimize pressures on pet owners whenever possible.

All of those other mechanisms, because there's a much smaller group of pet owners involved would be, I think, more potentially burdensome.

No, this is not about the dog licensing fee.

We'll get to that.

This is about our relationship with a pet food manufacturer manufacturers.

Yes.

Um, I mean, why would you all why do you all feel so confident that um the manufacturers will just say, yeah, okay, we're not gonna sell in the district anymore.

That because of a 25 cent per customer per year fee that they would either pass it on to the customer or decide not to sell at all.

I just think it makes no logical sense.

You don't want to make $10 because you have to pay $10.3.

The fee is pretty small.

It is.

But it also this is the thing, right?

In the comparison to where I think about this.

Um see, look at that.

You manifested it.

Um that Maryland, Virginia have departments of agriculture.

So it's not just pet food, they're looking at a variety of other things.

This would only be pet food.

Yes.

Not live feed, not you know, all of the other pieces as well.

Um we would essentially be standing up in a whole new infrastructure for this, no?

Or do you have the somehow have the expertise already in house?

Yeah, so we do we already review uh labels for the food program.

We review labels for our a betting and upholstery program.

So we we already do that.

Um and if I can for a second, I can kind of go through go through the math.

Okay.

So let's pretend that uh so our fee is proposed fee is $50.

So let's pretend um Henderson's cat food, canned cat food, right?

And you have 200 loyal customers.

So we would then um multiply that 200 times 52 because that's 52 weeks.

So that gives us um 10,004 400, right?

So then you just divide 50 by 10, 400, and that gives us about 50 percent of a penny per purchase for that customer.

And if you multiply that times 52, that's 25 cents a year.

Yeah, but okay, so me, Henderson cat food company, why wouldn't I just tell my loyal customers unfortunately you're just gonna have to get it from me online?

Well, um whether you if you're selling in a district, whether it's online or in stores, you we still have to pay that fee.

And I would like to add that I saw the testimony, uh and they stated it only a few states.

47 states already do this in some form or fashion.

So in including all of the ones in our region, so West Virginia, Virginia, Maryland, um, New Jersey, Philadelphia, all of the ones in our region already have this.

Yeah, but it's not just pet food alone.

For that pet food manufacturer, it may be.

So they it's for the government, it is not pet food alone, but for the pet food manufacturer, it may in fact be, depending on what it is they sell.

And many of them, that is what they sell.

Okay.

How many new Fs?

It's not new for them.

How many FTEs is this gonna take?

Um two.

Just one of the things.

Are you joking with me?

Yeah.

One for enforcement and then one for processing.

Okay.

Because it it is it is to process it, it it it is a lot, even though we already have that expertise on working on the labels to process it um with the amount of pet foods there are, it'll be a lot.

So the two we are implementing something that is going to cost us in two FTEs about what you expect to bring in.

So how is the idea that the two FTEs will be funded out of the fund?

Yes.

So that's what I'm saying.

Like, okay, if the FIST says this fee could generate up to 425,000, and you got two FTEs, which around I I don't know what you're gonna grade them, but like let's just say we're calling two FTEs 100 grand perfect and fringe.

So that's 200,000 that's already sort of taken up.

Okay.

I I've just I'm I'm again juice worth the squeeze.

Um, but we've been joined by my colleague, uh, Councilmember Wendell Felder from Ward 7.

Councilmember Felder, um.

They've been here for a bit, but we're glad to see you.

Um Tim Mineral, is that okay?

Or do you need a little bit more?

Okay, great.

All right.

When are you ready?

Uh thank you, madam chairperson.

Uh Director Bennett, members of your senior leadership team, it's always good to see each and every one of you guys.

Uh I'll just jump right into my questions.

Um full access and access to um health equality remains to be a top priority for me is Ward 7 uh as the Ward 7 council member.

Well, we're seeing uh, or rather, we're seeing reductions in food access programs despite clear indicators of on that needs, including longer wait lists and persistent food uh in that insecurities in Ward 7 and 8.

My question, Director, is how does cuts to food access program align with the district's state goals around health inequity and chronic disease prevention?

So we would love to be able to fund.

I don't think we do anything that's not important.

So we would love to be able to fund everything.

Where we had to make hard decisions, we tried to lean into things where we thought there were other supports and we had other funds, or we thought we could stretch, or that there would be a definable limited impact.

We did the best we could with the um cuts that we needed to make, and we are going to do our best to make sure that we can limit the impacts wherever possible.

Okay.

So we have all of my other programs also support people's health equity in the district or are an essential service that no one else does that I cannot really adjust.

Okay.

Well, could you speak to with the elimination of SNAPAD?

Uh what is the plan to replace nutritious education services that reach over 40,000 DC residents?

Well, that was a program that was eliminated in HR 1 by the Congress.

So we were did have to sunset our staff in that programming.

Sarah, do you want to say what you guys are going to do on health education?

Yeah, sure.

Um all of our USDA food programs at DC Health and at the Office of the State Superintendent of Education.

Um they offer some kind of nutrition education.

So if you think about the school lunch program, the school breakfast program over at Aussie, um, our women, infants and children program, which serves women, infants and children, commodity supplemental food program, they all have a nutrition education component.

As well, we've made it a requirement of our locally funded food access initiatives.

So there's some type of nutrition education happening.

Uh thank you for that.

Uh talk to me about the Produce Press program, which has a waiting list of over 2,000 residents.

Uh how many individuals uh will now go unserved.

So I believe last year um we had a wait list of 2,000 individuals.

So that was after we'd spent all of the $2 million.

Um then we had a $600,000 enhancement to address the wait list, and this is a very successful popular initiative.

So then we still had two thousand individuals that did not receive benefits.

Uh thank you for that.

I'm gonna shift gears to uh maternal health.

Uh given the disproportionate burden of maternal mortality, the district has made maternal uh health equity a top priority, yet this budget proposes reductions to home visits and community-based matern maternal health providers.

Director, could you speak to how were decisions made regarding reductions to provide um to providers like uh Mamatoto Village and similar community-based organizations?

So, what we um like I said, what we've done is we have looked at what we have in our portfolio, and we are supporting maternal health across the spectrum.

So there's um perinatal quality program, there are other programs that are directed at pregnancy or young mothers.

We are preserving those programs, and part of that means that we have to figure out where we can cut programs that we think we are either funding in some other way or we are um supporting at a different part of the spectrum.

And so we are maintaining our support during pregnancy and early pregnancy, and we are losing some of our home visiting dollars.

We have other home visiting dollars, so by doing that, we're not eliminating that resource from the community, but it is definitely going to shrink the pool of people who have access to that service.

Well, thank you for that.

Now, uh this budget includes the elimination of transition of several programs before uh full implementation or evaluation, rising concerns about continued uh health.

Uh what could you speak to what safeguards are in place to ensure residents do not lose access to services as programs are eliminated or transition to new funding models?

Now this budget includes the elimination of transition of several programs before full implementation or evaluation rising concerns about continued uh health uh what could you speak to what safeguards are in place to ensure residents do not lose access to services as programs are eliminated or transition to new funding models for example um or you you have programs like the healthy steps um could you speak to what happens if Medicaid reimbursements do not materialize as expected for providers well those are all providers of care already so those are their patients in their services whether or not they would be able to augment those services with this particular kind of screening I think is something we're hoping to preserve but we're this was not the um core service of any of those providers they are that person's health care provider and this is an additional service so I my hope would be that they would maintain that role as that person's core health care provider and use the referral pathways that exist to try to get services it will be less um less support for navigation but continued support for them as care providers got you could you speak to why the grocery access grant pilot was eliminated before full enrollment and how did you guys evaluate the elimination of the program I'll let you speak to that Sarah it won't be eliminated before full enrollment it's going to continue throughout this fiscal year and we will complete enrollment at that point all of those one year memberships will continue to be in effect for that year and that's what we will be evaluating.

So no one's cut off we're going to continue over the course of the summer to enroll people and they will have the year once they get their membership okay and then how is DC health tracking whether service gaps emerge during these transitions well I'll let you speak to that Sarah I will say these are all of our partners so these are our long-term partners so we would we count on them in the many ways in which we convene with them for them to let us know when they're going to have trouble we're trying to meet with all of them beforehand to sort of plan out where they can already see that they will have some challenges and plan out how we'll respond to them.

Do you want to talk about the healthy steps in particular for this?

Yeah so um with healthy steps um we are meeting with the Department of Health care to put together a timeline and then we will partner with the children's laws center and use their healthy steps collaborative meetings with all of the current so that we can support them to meet that October 1st deadline thank you for that now across this budget we're seeing a pattern of reductions to prevention focused programs particularly in nutrition maternal health and community based services while demands for these supports is increasing.

Yeah what we've done is maintain programs that are direct service programs for people who have current needs as well as continue all of our prevention programs that are federally funded with these local funds augmenting them so where we can preserve funds and we had a choice we have preserved what we could that is keeping the system available to people but we were in a position to make cuts from somewhere and this is uh the choices that we made thinking that those would be the the ones that would preserve the system but also allow for the most need to be covered.

Very briefly could you speak to what prevention programs were protected and what criteria differentiated them from those that were reduced or eliminated so we looked at what are those essential programs either where DC Health is the the only agency in in town that is delivering those services programs that provide services like um that are essential um food access um early childhood development perinatal health and we we looked at how do we reduce the impact to residents so I may look at well if we have marketing dollars outreach supplies then that's where I might make cuts and try to preserve um direct distribution of food provision of mammograms PAP tests so it was um it's it's not a position that anyone wants to be in the thank you for that

So I may look at well, if we have marketing dollars, outreach, supplies, then that's where I might make cuts and try to preserve direct distribution of food, provision of mammograms, PAP tests.

So it was it's it's not a position that anyone wants to be in.

Uh thank you for that.

Madam Chair, the floor is yours.

All right.

Thank you.

Thank you.

Uh Councilmember Felder.

Um to pets.

Look, you guys wrote the subtitle, I gotta ask questions about it.

Okay.

So the subtitle in question also modifies the amount um of each dog license fees that goes into the education outreach fund from $2 to 20% of each fee.

The fees are currently $15 for a neutered or spayed dog and $50 for other dogs.

Um let me ask you this.

How many dogs are currently licensed in the district?

So I don't have that off the top of my head.

I I can get back to you on that.

We can get it before we leave here.

How does one's pet go about getting registered?

And what is the purpose of said registration?

Yes.

So we have an online portal that they can uh register.

Um many people do register actually at this at the shelter, um, so they can register at the shelter when they adopt their actually they have to register at the shelter when they adopt their animal.

Um the second part of your question was I'm sorry.

Uh which was still how many, I mean I'm a dog owner.

This was news to me that you need to license the dog.

Yeah, okay.

My dog was rescued in Virginia.

So where would they have gotten such information about needing to register in the District of Columbia?

So it it is on our website, but um, we can do a better job of getting that message out.

Um, doing maybe do a campaign to try to get people to register their pets.

That's my question.

Like, we're gonna raise the fee, but like I'm I'm going to guess that compliance is very low.

Yes, yes, correct.

Okay.

Kind of reminds me of um back in the day, D dot had this um you had to register your bicycle.

Not electric bike, just the one with two wheels.

Yeah.

How many people?

Not very many.

Um so I think if we're gonna increase the fee, then I feel like you have to like increase your strategies to um improve compliance.

That people even know.

I mean, I that's what I'm saying.

Like there are lots of people who they rescue dogs from Maryland and Virginia from other jurisdictions.

How would they know now you gotta register?

They rescued them through the municipal system.

They should have gotten them licensed.

They they should have received the pet license because that's common practice for shelters, and then that license expires.

I'm less concerned um that they are licensed here than that they are licensed at all, where someone has looked to see that they have gotten a rabies vaccine, that they have um been checked for health issues and and that they are um part of a system.

So we can talk to our counterparts about having people be informed about needing to register in the district, but I'm more concerned that they maintain all of that, all of the things that the license is meant to check.

So we can work with veterinarians and others to encourage that.

And just a point of clarification, I believe that the subtitle just changes the percentage of the fee that goes to the fund and not the actual fee changing.

Um no, yeah, that's what I said.

The the fees are currently $15 and $50 for other dogs, but yeah, it increases it, it's currently $2 and it would go to 25% of that fee, each fee.

Right.

But it's remaining $50.

Yeah.

What one of the main complaints that we hear from our stakeholders is about the low-cost spay neuter.

So we're trying to get more into that fund so we can actually provide these preventative and emergency services.

No, I hear you on that.

I just also, I mean, you know, if we're using the other context of like we had on the law for so long, you gotta register your bike.

What was the point of that?

Because nobody was doing that.

Also, no one knew that that was like also a requirement.

And it feels like um there is a different way to kind of do this, but it also requires CC help to have a strong relationship with your veterinary facilities because most of these pets are going to the vet.

That is a um what guaranteed, well, not guaranteed, but like for the one the the responsible pet owners, it's happening at least once a year where you're taking your um pet to the vet, and that's like a way to kind of do it.

Brandywine recommended in their written testimony that um we modernize dog licensing through microchip based systems to increase compliance and return to owner rates.

Um is that a strategy that you all are considering?

Yes.

So we have been in conversations with Brandy Wine about that.

Okay.

Um I'm all for us increasing the amount of funding that's available for the low-cost bay neuter piece.

Um I think during performance oversight, there were a couple of witnesses who testified that this should just be free.

And I was like, well, we can't do that for everybody because then we would be spay and neutering the entire region.

Um, right.

Maryland and Virginia have some cost, and so fine.

We need to keep that, but also having funds available.

So I can appreciate you guys trying to be creative and sort of thinking about um ways to generate ongoing revenue for this particular fund.

I just want to make sure that we're not doing all this work to get nothing out of it.

Like again, on pet food, I feel like y'all are gonna be standing up a whole new like line of work um in EHA to get maybe 200,000.

That's if the CFO's estimate is correct.

Okay.

I will say that's 200,000 for a need that is not one we're currently funding a lot, because that's also for pet owner support.

So it's not just how much money, it's what money we have for that kind of need.

Okay, but is not uh low-cost uh spay neuter services not part of the animal control contract?

It is for the animals that they house.

It's not for it they don't have an unlimited pot for the entire community.

So the need for low-cost spay neuter services is large, as is the other sliding scale veterinary care.

So we want people to keep their pets.

We don't want them to not have their pet because the pet is too expensive to take care of.

And so having a designated amount of money from various things that doesn't require me to take it from some other essential need because it's hard for this to win.

Okay.

Um the subtitle requires commercial pet care facilities to obtain um the basic business license and then authorizes the mayor to establish standards for these facilities, including inspections and ensure safe conditions for pets and people in the facility.

What was the impetus for this particular requirement?

Um, like did we have pet care facilities that were not getting their basic business license?

That seems like so this is it's to give us authority.

So think of the um gosh, I can't remember, but on Rhode Island Avenue, remember on Rhode Island district dogs, like that that type of situation, we didn't have authority for that.

Um so this is to get us authority to to do those type of doggy daycares and oh we you guys didn't have you currently don't have the authority to inspect a pet care facility?

Yeah, so like the doggy daycare facility if we have it for veterinary facilities, that's it, but for all the other type of facilities, no.

Got it.

Okay.

Okay.

Just curious, what kind of schedule would they be put on?

Knowing that we, you know, on food, we we rank for high risk to low risk.

Would they would this be like an annual inspection type deal or that's correct?

Yes, annual.

Okay.

And we more so we we we defin we want to be able to review their plans, like the emergency response plans and and things of that nature.

Okay.

Um all right, let's talk rodents, because everybody else is talking about them too.

Um now we heard very positive feedback about the mayor's plan to roll out essentially fertility control, aka birth control for the rats.

However, comma, birth control alone is um not a strategy for containment.

There are other things that are also um needed.

So how do we start moving on some of the other recommendated recommendations that come out of Rat Academy and everything else?

So I'm really happy about the quality improvement work that's happened in this area.

So can you talk about what's happening?

The we're using the pilot, which by the way includes fertility control among other things.

So it is not only fertility control, it's fertility control along with some of our usual methods and adjustments.

So this is in Adams Morgan, yeah?

Yes.

Okay.

We've done some quality improvement work on the whole program in anticipation of that.

Can you describe what's happened so far?

Wait, I'm sorry, hold on one second.

But just for clarification, though, um when the mayor sent out the press release about fertility control, it was only for Adams Morgan.

It wasn't across the city.

Because I thought it was it's oh, we're doing a pilot, which we are going to um use metrics to evaluate, and it will be tracking power, it's not fertility control alone.

We are using multiple methods and a time sequence of trying to go back in a generational way to get them as they're yeah.

So I really hate talking about rats.

I'm sorry, I really can't.

Um so we're gonna it is part of public health.

It is a it is using rat biology, it is both um some of our usual rodenticide methods along with fertility control for those who escape those methods, along with um looking at harborage, water, and food access with the neighborhood in conjunction with the ANCs and the bids.

So it's a it's a total program.

We cannot do that everywhere all at once.

And so knowing how much um coming back repeated times to the same area in a short period of time, we're gonna do that in a sequenced way.

Okay.

And it's gonna take a lot of extra time and effort.

So we're gonna see how that works as opposed to going around and just doing inspections and going where people complain.

This is different than that.

There's this looking at the where the data points us as a hotspot and then approaching it more proactively.

Okay.

So what to what extent did you ever get buy-in from the commercial businesses on this?

Yes.

Um, so just to elaborate a little bit, like Dr.

Bennett stated, is three main factors that attract rodents, um, harbors area, food, and water.

Um, so this program is more uh is is a multifaceted program.

So one of the main uh portions is education, outreach, and community involvement, um, because it doesn't matter how much we go and do our part, um if we don't have that interaction with the community, if there's still trash overflowing, they have sources of food, um if the your grass is knee high where they can hide and and live at, it doesn't matter what we do.

Um we're not gonna solve the problem.

So um, for instance, um we are meeting with the community, both the bids, the A and C's, we've done community events to to educate to try to partner with them for this Adams Morgan.

And we're gonna do this.

Um the pilot is Adams Morgan, um the Eastern Market Barracks Row area, and then the Chinatown.

Um if we deem it successful, then we're going to extrapolate it throughout the city.

Okay.

Um and what Dr.

Bennett was saying is it's not just uh fertility, it is also basically three weeks, and we're going to use three different methods.

The first, the first week is the most toxic uh method in which they ingest it is a is a meal bait that they ingest that's going to be actually placed in the borough, the borough is going to be covered up with with dirt um and they eat that and they die immediately.

The second week is our traditional method of tracking powder.

It gets that gets pumped into the burrows, covered up, gets on their fur, they groom each other, and they they ingest that and they um they die.

And then the third week is the fertility portion.

Now I will say with the fertility portion that it won't stop there, just like um if we were on birth control, we have to it has to be a continuous thing.

So we will go back and continuously bait for fertility.

I'm sorry, I didn't mean to get to uh too much into the details, but you asked.

It's true.

There's some parts of this I'm like, I'm not mature enough for this, but we're gonna be mature about this conversation because it is important.

Yes.

Okay.

To what extent are the other agencies supporting you in this work?

Because you can do all the rat burrowing uh things, but if um the commercial haulers are not coming in time, if the business's trash bins are not large enough for theirs, if DPW is not doing its part in terms of picking up um the trash on time, then it's like it's like whack-a-mole.

We're trying one thing, but they're just gonna scurry out another hole.

Yeah, I will say that we have partnered, we we work very closely with DPW all the time, and they are very on board with this.

So, for example, our Adams Morgan pilot is scheduled to start uh tomorrow.

Um we're doing our inspection and DPW is out there right now doing the doing um cleaning that alley that we're gonna work on.

Um and if I could back up for a second, part of our inspection is we have like a rubric in which we um those three factors I talked about Harbridge um water and food, we go by and to see because if it we'll be just spinning our wheels if the alley isn't in such a condition or the street isn't in such a condition, um, disproductive.

So um if there is an issue, then we'll just back it up a couple days, work with the biz to help clean that area up, work with DPW to help get it ready for the pilot program to be successful.

So they worked with the chief performance officer and the chief data officer to set up a metric system so that they can grade and they're gonna use that grading system to look at um everywhere they look to to move that into our normal process to have a sense of is what's the problem here, so that we're not just doing NOIs, which sometimes take quite a long time to go through, yeah, but giving a sense that we can give back to the neighborhood about what's the source of your problem here.

You are scoring much higher than everybody else in terms of availability of food, or you've got water sources that other folks don't have.

Why is it bad here?

So that we can sort of get a sense for people about when they're making progress, what we think is needed.

Okay.

And if I if I may, it's um to answer to go back to your previous question.

There about approximately 2800 active dog licenses.

2800.

Okay.

Um I we should check back in on the pilot.

I'll be interested to see.

I mean, I think on obviously there's your portion of it, uh, for my part, I've been pushing DPW around, like you gotta actually pick up the trash.

Like that's step one.

Oh, also we need a new trash can because our current ones is like a little buffet.

Um it is, and um other jurisdictions have been moving to more secure um methods to be able to sort of help.

So like you could do all this all day long, but um if the rat can just like climb right into the trash can and keep eating.

Yeah.

Yeah, if they have a choice between our bait and a pizza, they're gonna choose the pizza.

It's it's curious y'all chose Adams Morgan.

I'm just from a pizza perspective, right?

Like they've got whole uh receptacles just for pizza boxes on Adams Morgan, which is very unique, and I'm glad that they've established those.

Um this is also really good interesting timing because I was just like seeing a bunch of pictures from Adams Morgan porchfest yesterday.

They have like thousands of people who are out.

Um, and my thought, of course, was like, whoo, when does street sweeping come through?

Because I have to imagine that it's a little dicey in Adams Morgan right now.

Um, so I'll be interested to check back in and see how this um is going.

Do you guys also work with Department of Buildings?

I guess if there's like a um apartment building that's in the area, which it would be pretty common for Adams Morgan.

Yep.

Okay.

And it's only one alley.

Um we're starting with that alley.

Um this runs, I guess, parallel to 18th Street.

That's because that's the biggest problem alley in the area.

Um is behind 18th Street.

Which side?

It's where was it?

Marie Reed where Marie Reed is.

Yeah.

Yeah.

Okay, so that alley.

Okay.

All right.

I don't necessarily want to go on a tour.

I know what he's talking about.

Yeah.

But I will I will say that even though we're focusing on that alley for the blitz, we do have other team members doing our traditional baiting in the surrounding areas.

So we're not just doing that alley alone.

Okay.

Okay.

All right.

Well, we'll check back in.

This this issue isn't going away.

Yeah.

Um, right.

It feels, and I don't know if it's the case, are you seeing it in the data, but especially from like 311 calls and others?

I feel like rodent activity is up.

Is it up?

Do you guys get the three one?

You get the three one requests.

We geo map them.

Yeah.

So it's about on brand for this time of year, um, springtime.

We always see an increase.

Okay.

Um, all right.

Uh still on environmental.

Um, there were some reductions or proposed reductions in the indoor environmental program for the proposed budget.

Um is this cutting the healthy homes program?

We haven't gotten a direct answer.

No.

No, it's not cutting the healthy homes program.

Um it we we have to reallocate the work a little differently, but it's not it's not cutting the program.

Okay.

So what impacts will be specifically?

Um, so it essentially how fast we can get out to certain complaints.

So we really have to take a look on how we prioritize complaints.

Um that's gonna be the major impact.

Okay.

Um capital budget, you guys only have one uh item, which is fleet replacement.

Um it is a uh for FY27, it's about 246,000, but you don't have any other things in the out years.

Um we approaching fleet replacement in a like year by year capacity, because I have to imagine that you're gonna have some vehicles in your fleet that will reach its usable lifespan between 2028 and 2032.

Yes, um, you are correct.

Um, but for the most part, we've done a lot of replacement to last fiscally or replace several vehicles.

Okay.

Um also for some of our vehicles that are approaching their useful life, we do um few mileage, um, very little mileage.

So um we do maintain some of them beyond that point.

Um I don't have a list of what those are, but I know that we don't have any crisis right now in terms of cars that aren't functioning.

Okay.

I think for the I'm asking the various functions of whether it be rodent control or other things, like I think of all of our agencies in the cluster, you actually use your fleet.

We do um probably more than everybody else.

So I want to make sure that you know you have vehicles to get around in and get out there.

Okay.

Um can I just go back really quickly, Dr.

Bennett?

Um, so we did a medical debt bill um and the FIS for the medical debt bill uh included costs for um two FTEs.

If we let's say we found the funding for two FTEs, is is this uh full time just working on medical debt, or would you be splitting them amongst some of the other FTE needs?

Um if we put them for this, it'd be meant to be full-time for this.

It probably would need to ramp up, but we'd also probably need time to hire them.

So I can't say that exactly they'll have their full-time job um set up when they come on board, but that would be my expectation.

Okay.

Okay.

Um hold on.

Okay, we have some follow-ups we'll send.

Okay.

Um is there anything you want to say for the record that I haven't asked?

Um no, I will say that we've tried to plan for all contingencies.

It's not necessarily possible, but we are always trying to be sure that we are keeping a core set of services and that we plan ahead for both local and federal um restrictions with as they come.

And this year has been very complicated, but we welcome whatever resources we're given, and we will do our best for the residents of DC.

Okay.

Well, thank you so much, Dr.

Bennett.

Um, I want to thank you and your team for providing testimony and information to the committee.

Uh, we'll certainly reach out if we have additional questions, which we will, and I want to um sincerely thank all of the public witnesses who testified in person um and submit submitted written testimony online.

Um as you noted, this is a very challenging time in public health, um, not just for the district, but also across the country.

Um, and so I want to express a deep appreciation to all of the dedicated DC health employees, um, healthcare providers, organizations, residents, et cetera, who are doing um this critical work to protect our health care infrastructure, um, to prevent and treat diseases, as well as to address some of these additional social determinants of health.

Um, I think anybody listening to this hearing, it's not just DC Health and Asilo.

There's so many interconnections across the government.

Um this does conclude today's hearing.

Um, if anyone would like to submit additional written testimony, the record will remain open until Tuesday, May 12th.

So that's next week.

Um you can upload your testimony on the hearing management system site on the DC council website.

Oh, hold on.

There was an additional question I needed to ask.

Sorry, because I didn't forgot.

I just got this email.

And this came up during performance oversight too.

But this is actually a question for Sam Hurley.

Um, but it is one that needs to be uh asked on the record because we are still getting in time uh emails from health professionals who are very upset about the non-prorated licensing.

Yeah.

Um this one is from uh let's see, RN.

Yeah, A P R M.

Um she was born in January of an even year.

She will pay to renew her license in June of 26th that will expire in January of 28.

She's paying the full cost of a license, but it would only get good for 18 months.

As you know, there's some other um we had a witness who testified about this before as well.

Um I mean, do we have any good solutions in terms of individuals who would be paying to renew a license that in a year or a year and a half, they would no longer they would have to do it again.

Yes, so there was no efficient way to to change the law in order to be able to prorate.

We're not allowed to prorate.

We would have had to change it.

Rather than wait that long before making this change, because it was necessary in order to try to get some reasonable efficiency in the system.

35,000 people renewing all at once, so it's taxed year every few months was not a good use of staff time, and it left anybody who had a problem without that problem resolved in any kind of timely fashion.

So if it went through, it went through.

If it didn't go through, we were having a very hard time pulling in the resources to actually fix any of those.

So getting everybody level set so that we get roughly four or five thousand a month on a regular basis is going to improve the system for everybody, but there is going to be an adjustment period in order to compensate those people and make something in their lives easier to compensate for the six months less license she's going to have.

She has 50% of her CEU um requirement has been decreased.

So all of the boards got together and made this agreement.

So she will have 50% fewer hours that she has to put in for continuing education this one time.

And then it'll go back to normal.

She'll have her normal licensed period and her normal CEUs.

But that is a decent number of hours of her life back.

So I think it's a decent trade.

And I haven't heard any complaints when people realize the trade has happened.

Okay.

When someone goes to the website, do they see that this trade has happened?

Or like, did we inform people?

That is on every board's um page.

Okay, great.

Um, but we as part of their minutes because every board had to approve it individually.

Okay.

Um we can increase the messaging.

We did have a message, a letter that went out to all individuals.

We can send another letter out.

We are perfectly fine doing that.

I don't know if that's necessary.

Like me, they don't read the emails that come from.

What I was gonna say though, I think that because we do have some folks who um like I got this, but I don't know, six or seven of my colleagues are on this as well who may not have had the information.

If there's information that you want we can let you know.

Share with us that we can share with you around like what the options are.

Okay, all right.

Now for real, we're ending.

Okay.

Excuse me.

Um the next hearing for the committee on health is on Wednesday, May 6th.

Um, we'll be discussing the FY27 proposed budget for the DC Health Benefit Exchange Authority.

All right.

It's 1208.

This hearing is adjourned.

Thank you.