[8. Consider presentation on the Proposed 2025-26 Budget for the Health Services Agency, including any supplemental materials, and take related actions, as outlined in the referenced budget documents, and as recommended by the County Executive Officer]

BUDGET HEARINGS, UH, WITH ITEM NUMBER EIGHT, HEALTH AND HUMAN SERVICES.

CONSIDER A PRESENTATION OF THE PROPOSED 2025-26 BUDGET FOR THE HEALTH SERVICES AGENCY, INCLUDING ANY SUPPLEMENTAL MATERIALS, AND TAKE ALL RELATED ACTIONS AS OUTLINED IN THE REFERENCE BUDGET DOCUMENTS, AND IS RECOMMENDED BY THE COUNTY CEO.

- GOOD AFTERNOON. I KNOW WE'VE HAD A VERY BUSY MORNING, SO WE'LL TRY TO GET THROUGH THIS.

UM, WE'VE HAD THE LUXURY, AN OPPORTUNITY TO MEET WITH ALL OF YOU INDIVIDUALLY, UM, IN TERMS OF OUR PROPOSED, UH, BUDGET THAT WE HAVE HERE BEFORE YOU TODAY.

UM, I DO WANNA START OFF WITH A COUPLE OF, UH, COMMENTS, ONE IS JUST REALLY THANKFUL FOR ALL OF OUR TEAM, UM, THAT CAME TOGETHER TO PUT THIS BUDGET PROPOSAL IN FRONT OF YOU.

AS YOU CAN IMAGINE, IT DOES TAKE A LOT OF BRAINS COMING TOGETHER TO DEVELOP A BALANCED BUDGET FOR YOU, AND IT'S DEFINITELY A VERY TOUGH TIME FOR US.

UM, AND I THINK BECAUSE OF THAT, I KNOW OUR STAFF HAVE BEEN LOOKING AT EVERY POSSIBLE PENNY THAT WE HAVE, EVERY POSSIBLE GRANT AN OPPORTUNITY TO ENSURE THAT WE DO OUR JOB AND PRESENT TO YOU A BALANCED BUDGET, ALTHOUGH A LITTLE BIT PAINFUL, UM, AT LEAST WE WERE ABLE TO BRING TO YOU SOMETHING THAT WE THINK IS PROBABLY THE BEST IN TERMS OF THE OPPORTUNITIES AND OPTIONS THAT WE HAVE.

UM, A COUPLE OF JUST REMINDERS.

RIGHT NOW IT'S JUST AN OVERVIEW OF OUR PROPOSED BUDGET.

ON JUNE 10TH, YOU WILL HAVE A COMPREHENSIVE PRESENTATION ON LAB AND X-RAY SPECIFICALLY, UM, OR WE WILL DIVE INTO THE DETAILS OF THE IMPLICATIONS, THE OPPORTUNITIES, UM, AND THE CONS AS WELL.

AND AT THAT MEETING, TOWARDS THE END OF, AFTER THAT PRESENTATION WE WILL THEN TAKE THE, UH, NEEDED HOPEFULLY STEP TO APPROVE THE BUDGET AT THAT POINT.

SO FOR US RIGHT NOW, IT'S JUST PROVIDING YOU WITH SOME INFORMATION, OBVIOUSLY HAVING A DIALOGUE WITH YOU ABOUT SOME OF THE DETAILS THAT YOU MIGHT BE, UM, WONDERING ABOUT.

I ALSO WANNA JUST KIND OF GIVE YOU A HIGH LEVEL OVERVIEW.

[03:05:04]

UM, JEN HERRERA IS THE ASSISTANT DIRECTOR, AS YOU KNOW, I WILL BE TRANSITIONING.

SO SHE WILL BE YOUR INTERIM DIRECTOR AND, UH, TO YOU AND TO OUR COMMUNITY, UH, AS OF TOMORROW.

BUT HER AND I WILL BE REVIEWING THIS.

UM, WHAT YOU HAVE IN FRONT OF YOU IS JUST A HIGH LEVEL OVERVIEW OF WHAT WE'VE HAD TO PUT TOGETHER CONSIDERING THE CHANGES THAT HAVE BEEN LOOMING, UH, HONESTLY, PROBABLY FOR THE PAST 12 MONTHS.

PRIOR TO THE ADMINISTRATION AT THE FEDERAL LEVEL, WE HAVE SENSED THAT THERE IS GONNA BE POLICY AND, UH, FUNDING CHANGES.

AND YOU GUYS HAVE SEEN THAT BECAUSE OF COVID, WE'VE SEEN A REDUCTION IN GRANTS, AND THAT'S WHAT YOU'LL SEE REFLECTED IN THIS PROPOSAL.

WHAT YOU ALSO SEE IS JUST, UM, YOU KNOW, STRUCTURAL DEFICITS THAT SOME OF OUR, UH, DIVISIONS LIKE CLINICS HAVE BEEN STRUGGLING WITH.

AND WE'VE BEEN LUCKY ENOUGH IN THE PAST TO BE ABLE TO OFFSET IT WITH INTERGOVERNMENTAL, WHAT WE CALL GRANTS.

AND BECAUSE OF THE POLICY CHANGES, UM, AND THE FUNDING CHANGES, WE NOW ARE AT A IMPASSE WITH SOME OF THE KEY, UM, FUNDING DECISIONS THAT WE HAVE TO REALLY LOOK INTO.

BUT I THINK FOR NOW WHAT I WANNA DO IS HAND IT TO JEN SO SHE CAN REALLY DIVE INTO THE DETAILS AND THEN WE'LL BE HERE TO ANSWER YOUR QUESTIONS.

- GREAT. THANKS, MONICA.

SO, GOOD AFTERNOON.

UH, WE ARE GRATEFUL TO BE HERE TODAY TO PRESENT OUR PROPOSED BUDGET FOR HEALTH SERVICES AGENCY.

OUR PRESENTATION WILL COVER WHO WE ARE, WHAT WE DO, THE CURRENT DRIVERS THAT INFORM OUR FINANCIAL SITUATION, UM, OUR PROPOSED BUDGET AND EMERGING ISSUES WHICH INCLUDES THE ANTICIPATED IMPACTS FROM STATE AND FEDERAL POLICY, WHICH AS YOU'RE AWARE, IS NOT ACTUALLY COUNTED IN THIS PROPOSAL AT THIS TIME.

SO OUR MISSION.

HSA MISSION IS TO PROMOTE AND ENSURE A HEALTHY COMMUNITY AND ENVIRONMENT BY PROVIDING EDUCATION, OUTREACH, AND COMPREHENSIVE HEALTH SERVICES IN AN INCLUSIVE AND ACCESSIBLE MANNER.

THIS IS OUR ORG CHART.

WE ARE THE LARGEST COUNTY DEPARTMENT, AND HAVE A DECENTRALIZED STRUCTURE WITH FIVE DIVISION DIRECTORS AND ASSISTANT DIRECTOR AND ACCOUNT AND THE COUNTY HEALTH OFFICER.

OUR DIVISIONS INCLUDE HEALTH CENTERS, BEHAVIORAL HEALTH, ENVIRONMENTAL HEALTH, PUBLIC HEALTH, AND ADMINISTRATION.

EACH DIVISION SUPPORTS A VARIETY OF PROGRAMS SUMMARIZED HERE.

AS YOU CAN SEE, WE PROVIDE A FULL SPECTRUM OF HEALTH SERVICES FROM PUBLIC AND ENVIRONMENTAL HEALTH PREVENTION EFFORTS TO PATIENT CARE AND CRISIS EMERGENCY SERVICES.

OUR PROGRAMMING CONSISTS OF DIRECT PATIENT LEVEL SERVICES TO SYSTEM LEVEL SERVICES, ALL OF WHICH SUPPORTS OUR VISION OF A HEALTHY, SAFE, AND THRIVING COMMUNITY FOR ALL IN SANTA CRUZ COUNTY.

THIS IS US BY THE NUMBERS.

LAST FISCAL YEAR, UH, IN ENVIRONMENTAL HEALTH, OUR CONSUMER PROTECTION AND HAZMAT PROGRAMS PROVIDED REGULATORY OVERSIGHT AND SUPPORT FOR THOUSANDS OF FACILITIES AND PRACTITIONERS.

WE MANAGED 74 ENVIRONMENTAL CLEANUP CASES, SUPPORTED 103 WATER SYSTEM, REGULATED OVER 36,000 PARCELS THROUGH OUR LAND USE PROGRAM.

IN PUBLIC HEALTH, WE PROCESS OVER 2,000 BIRTH CERTIFICATES AND 10,000 DEATH CERTIFICATES.

WE SERVED OVER 13,000 PATIENTS THROUGH OUR HEALTH CENTERS, AND IN BEHAVIORAL HEALTH, WE PROVIDED SPECIALTY MENTAL HEALTH CARE TO 3,500 ADULTS AND OVER A THOUSAND YOUTH, AND PROVIDED SUBSTANCE USE DISORDER SERVICES FOR 1700 ADULTS AND 167 YOUTH.

THOUGH WE HAVE A WIDE VARIETY OF PROGRAMMING WITH VARIOUS GOALS AND OBJECTIVES, WE HAVE PRIORITIZED THESE THREE HEALTH GOALS BASED ON THE PUBLIC HEALTH NEEDS IN OUR COMMUNITY.

MENTAL HEALTH, OPIOID OVERDOSE, AND HOMELESSNESS.

OVER THE NEXT FEW SLIDES, I'LL DIVE INTO, UM, OUR WORK IN THESE SPECIFIC AREAS.

FIRST, WITH OPIOID OVERDOSE.

THIS GRAPH SHOWS THE RATE OF OPIOID RELATED OVERDOSES SINCE 2017.

THE BLUE LINE INDICATES FATAL OVERDOSES, THE ORANGE LINE, NON-FATAL OVERDOSES.

IN RECENT YEARS, OUR COMMUNITY HAS EXPERIENCED A RISE IN OPIOID RELATED OVERDOSES DRIVEN BY FENTANYL.

WE HAVE ONE OF THE HIGHEST RATES IN THE STATE, THOUGH PRELIMINARY WE ARE SEEING A DROP IN OVERDOSE RATES LAST YEAR.

HSA IS INVOLVED IN MANY COMMUNITY OPIOID INITIATIVES.

WE PROVIDE MEDICATION ASSISTED TREATMENT OR MAT THROUGH OUR HEALTH CENTERS SERVING OVER 8,600 PATIENTS SINCE 2016.

PUBLIC HEALTH HAS BEEN LEADING IN AN INTERNAL COUNTY INITIATIVE INVOLVING SEVEN DEPARTMENTS TO WORK TOWARDS PREVENTING OPIOID MISUSE.

BEHAVIORAL HEALTH HAS MANAGED OUR COMMUNITY'S OPIOID SETTLEMENT FUNDS OR OSF PROGRAM RECENTLY AWARDING OVER $800,000 TO SEVEN COMMUNITY-BASED ORGANIZATIONS.

AN HSA PAR- PARTICIPATES IN THE ANNUAL SAFE RX DRUG TRENDS COMMUNITY MEETING HOSTED BY THE HEALTH IMPROVEMENT PARTNERSHIP OF SANTA CRUZ COUNTY.

ANOTHER PROGRAM WE IMPLEMENT IS A SAFE USE AND OVERDOSE PREVENTION PROGRAM OR SUOPP, FORMERLY KNOWN AS THE- THE COUNTY SYRINGE SERVICES PROGRAM.

[03:10:02]

THIS PROGRAM PROVIDES HARM REDUCTION SERVICES FOR PEOPLE CURRENTLY USING DRUGS, INCLUDING THE EXCHANGE OF CLEAN SYRINGES AND SUPPLIES, WHICH DECREASES THE COMMUNITY'S RISK OF BLOODBORNE, UH, DISEASE TRANSMISSION, SUCH AS HIV AND HEPATITIS C.

THE PROVISION OF CLEAN SUPPLIES BASED ON THE PARTICIPANT'S NEEDS OR NEEDS BASED ALIGNS WITH EVIDENCE-BASED BEST PRACTICES.

THE STRATEGY SUPPORTS ENGAGEMENT WITH PEOPLE MOST LIKELY TO EXPERIENCE AN OVERDOSE, CONNECTING THEM WITH EDUCATION RESOURCES LIKE NARCAN AND NON-JUDGMENTAL SUPPORT.

THROUGH THIS INTERVENTION, WE ALSO ANTICIPATE INCREASED SAFE DISPOSAL OF SYRINGES AND LESS SYRINGE LITTER.

THIS CHART SHOWS THE AMOUNT OF SYRINGE LITTER, THE BLUE LINE COMPARED TO SYRINGES SAFELY DISPOSED, THE DOTTED GREEN LINE.

OVER THE PAST FOUR YEARS, THERE HAS BEEN AN INCREASE IN SYRINGES SAFELY DISPOSED, WHICH INCLUDES THOSE DISPOSED AT PUBLIC KIOSK AND EXCHANGE IN PERSON BY A SUOPP.

OUR LOCAL DATA AND THE EVIDENCE BASE SHOW THAT SYRINGE LITTER DECREASES WHEN THERE'S AN INCREASE IN SAFE DISPOSAL OPPORTUNITIES.

MOVING ON TO MENTAL HEALTH, SOME OF THE WORK THAT WE'RE DOING IN MENTAL HEALTH FROM THIS PAST YEAR.

IN THIS CURRENT YEAR, WE HAVE IMPLEMENTED THE 24/7 MOBILE CRISIS RESPONSE PROGRAM.

THIS GRAPH SHOWS A NUMBER OF CALLS AND ENCOUNTERS WE'VE HAD SINCE OCTOBER.

IN RECENT MONTHS, WE'VE SEEN AN INCREASE IN UTILIZATION OF THE SERVICE AS IT BECOMES MORE KNOWN IN THE COMMUNITY.

AND WITH EACH ENCOUNTER, WE DO ANOTHER FOLLOW-UP WITHIN 24 TO 72 HOURS.

BUILDING THIS PROGRAM HAS BEEN A KEY INVESTMENT THIS PAST YEAR AND SUSTAINING AND REFINING IT WILL CARRY OVER TO NEXT YEAR.

OTHER PROJECTS THAT WILL CONTINUE TO NEXT YEAR INCLUDE THE CAPITAL PROJECTS INCLUDING MENTAL HEALTH.

THE BEHAVIORAL HEALTH BRIDGE HOUSING PROGRAM WILL PROVIDE A LOW BARRIER HOUSING NAVIGATION CENTER FOR 32 INDIVIDUALS AND THE CHILDREN YOUTH CRISIS CENTER WILL HAVE EIGHT CHAIRS FOR CRISIS SERVICES AND 16 RESIDENTIAL BEDS.

THESE PROJECTS EXPAND OUR MENTAL HEALTH SYSTEM CAPACITY AND WILL ALLOW OUR COMMUNITY TO HEAL WITHIN THEIR HOME COUNTY.

AN ONGOING PROGRAM THAT WE'VE MAINTAINED IS OUR HOMELESS PERSON HEALTH PROJECT, OR HPHP, WHICH PROVIDES PRIMARY HEALTHCARE FOR PEOPLE WHO ARE UNHOUSED.

OVER THE PAST FEW YEARS, WE HAVE SEEN AN INCREASE IN THE NUMBER OF VISITS AND UNIQUE PATIENTS IN THIS PROGRAM INDICATING THE CONTINUED NEED FOR THIS TYPE OF HEALTHCARE SERVICE FOR THIS UNIQUE POPULATION.

WE WILL CONTINUE TO FOCUS ON WAYS TO SUSTAIN THIS PROGRAM TO ENSURE THAT PEOPLE WHO ARE UNHOUSED STILL HAVE ACCESS TO HIGH QUALITY HEALTHCARE.

SO ALL OF THE ACTIVITIES WE JUST REVIEWED ARE A MIX OF FUNDED AND UNFUNDED SERVICES.

SOME ARE MANDATED, SOME ARE NOT MANDATED.

ALL OF THEM ARE MEANINGFUL FOR THE COMMUNITY.

AS THIS CHART INDICATES, UH, WHICH SHOWS OUR REVENUES OVER THE PAST 10 YEARS, OUR BUDGET HAS GROWN SIGNIFICANTLY TO MEET THE NEEDS OF OUR COMMUNITY.

OUR STUDY INCREASE IN REVENUES PRIMARILY DUE TO NON COUNTY REVENUE SOURCES, SUCH AS GRANTS AND REIMBURSABLE SERVICES, INCLUDING AND DURING THIS TIMEFRAME THIS ALSO INCLUDES THE ONE-TIME PANDEMIC FUNDING THAT WE RECEIVED.

HOWEVER, THIS UPCOMING FISCAL YEAR REFLECTS A BREAK IN THIS UPWARD TREND, NOTING A REALISTIC AN- ANTICIPATION OF REVENUE DECREASES DUE TO A VARIETY OF DRIVERS.

THIS INCLUDES AN INCREASE IN OPERATIONAL COSTS OUTPACING OUR REVENUE GENERATION, MOST NOTABLY IN OUR HEALTHCARE DELIVERY SYSTEMS. THIS CHART SHOWS THE INCREASE IN SALARIES FOR OUR HEALTH CENTER'S DIVISION.

OVER THE PAST FIVE YEARS, STAFFING LEVELS IN THIS DIVISION GREW BY OVER 50%, AND COSTS HAVE ALMOST DOUBLED.

HOWEVER, OUR REIMBURSEMENT RATE HAS NOT INCREASED, AND THE GROWTH IN HEALTH CENTERS HAS OUTPACED OUR REVENUES LEADING TO A STRUCTURAL DEFICIT.

SERVICES AND SUPPLIES HAVE ALSO GREATLY INCREASED AGAIN, OUTPACING OUR REVENUES.

THESE COSTS GREATLY...

THESE COSTS INCREASE GREATLY DURING THE PANDEMIC AND HAVEN'T GONE DOWN.

THE DECREASE IN THE CURRENT YEAR IN THE ADOPTIVE BUDGET REFLECTS, UM, THE PROPOSED CHANGES TO LAB AND RADIOLOGY.

EXCUSE ME.

UH, AND IN BEHAVIORAL HEALTH, OUR LARGEST DIVISION, WE'VE HAD RISING EXPENSES OVER THE PAST FEW YEARS.

THE ORANGE LINE INDICATES SERVICES AND SUPPLIES, WHICH INCLUDES THE INCREASED REIMBURSEMENT IN THE CURRENT FISCAL YEAR TO OUR BEHAVIORAL HEALTH AND SUDS CONTRACTED PROVIDERS.

THIS INCREASED EXPENSE RELATED TO OUR CALAIM, THE- THE CALAIM BEHAVIORAL HEALTH PAYMENT REFORM.

AND THESE CHARTS KIND OF SHOW THE COMPARISON OF, UM, THE IMPACT OF THESE BEHAVIORAL HEALTH PAYMENT REFORM.

SO OUR RATES ARE FAR BELOW ADJACENT BAY AREA COUNTIES.

THE DOTTED RED LINE SHOWS HOW OUR COUNTIES RATES COMPARE TO THE HIGHER RATES THROUGHOUT OUR REGION, MAKING IT DIFFICULT FOR US TO REMAIN FINANCIALLY VIABLE, OR COMPETE FOR OUR WORKFORCE.

THE IMPACT OF THIS NEW REIMBURSEMENT MODEL HAS CAUSED A STRUCTURAL DEFICIT FOR OUR BEHAVIORAL HEALTH SYSTEM, WHICH IS INCLUSIVE OF OUR COMMUNITY-BASED PROVIDERS.

ANOTHER FINANCIAL DRIVER FOR OUR BUDGET HAS BEEN THE REAL IMPACTS OF RECENT FEDERAL POLICY SHIFTS.

[03:15:01]

DUE TO OUR RELIANCE ON FEDERAL FUNDING AND POLICY, WE DEVELOPED AN INTERNAL RESPONSE STRUCTURE TO TRACK FEDERAL AND STATE IMPACTS.

EARLIER THIS YEAR, WE RECEIVED EARLY TERMINATION OF FEDERAL FUNDING AFFECTING OVER $400,000 AND 5.7 STAFFING STAFF POSITIONS.

WE WERE ABLE TO PIVOT AND MAINTAIN OUR OPERATIONS AND STAFFING THROUGH OTHER FUNDING SOURCES.

HOWEVER, DUE TO OUR OTHER STRUCTURAL DEFICITS MENTIONED EARLIER, WE WILL NOT HAVE THE ABILITY TO PIVOT RESOURCES IF WE HAVE ANOTHER UNANTICIPATED BUDGET SHIFT.

SO, IN SUMMARY, THE FACTORS DRIVING OUR BUDGET DEFICIT INCLUDE LOSS OF GRANT FUNDING, LOWER CLINICAL REVENUE, LOW REIMBURSEMENT RATES FOR BEHAVIORAL HEALTH DUE TO THE PAYMENT REFORM, RISING EXPENDITURES OUTPACING OUR REVENUES.

WE'VE IMPLEMENTED NEW MANDATED SERVICES SUCH AS A 24/7 MOBILE CRISIS RESPONSE PROGRAM, WHILE MAINTAINING MANY NON-MANDATED SERVICES.

AND THE FEDERAL POLICY SHIFTS FROM HEALTH EQUITY CREATES FURTHER RISK FOR OUR FINANCIAL SUSTAINABILITY.

WITH ALL OF THESE FACTORS IN MIND, WE ARE PROPOSING A BUDGET THAT PRIORITIZES RESOURCES FOR OUR MANDATED SERVICES, AND I'LL TURN IT BACK TO DIRECTOR MORALES.

- THANK YOU, JEN.

ON THIS SCREEN, UM, THIS SLIDE JUST REALLY HIGHLIGHTS THE CHANGES IN OUR BUDGET.

AS YOU CAN TELL, BOTH REVENUE AND EXPENDITURES HAVE DECREASED.

UM, SPECIFICALLY WHEN WE LOOK AT REVENUES, WE'VE SEEN A CHANGE ABOUT SIX, UM, $0.6 MILLION.

UH, THAT REFLECTS ABOUT A 2% REDUCTION FOR US IN OUR OVERALL REVENUE COMPARED TO THE PREVIOUS YEAR.

UM, OUR EXPENSES, AS YOU CAN SEE, THERE'S, THERE'S STILL, YOU KNOW, TRICKLING UP, UM, AND WE SEE ALSO SHIFTS THERE ABOUT 1.4%.

UM, LUCKY FOR US, WE DID GET AN ADDITION OF, UH, $400,000 FROM MEASURE K, AND THAT'S TO SUPPORT OUR BEHAVIORAL HEALTH PROGRAM.

UM, AND WE SAW AN INCREASE OF ABOUT $2 MILLION FROM GENERAL FUND, AND THAT JUST TAKES INTO ACCOUNT THE INCREASE IN, UH, FOR SALARIES AND BENEFITS THAT, UH, YOU KNOW, THE CAO HAS CONTRIBUTED TO, UM, OUR STAFFING LEVELS.

WHAT YOU'LL ALSO SEE TOWARDS THE BOTTOM IS THE CHANGES IN STAFFING.

THIS IS PRETTY DRAMATIC FOR US.

UM, WE'RE BASICALLY SEEING A REDUCTION OF 74.4 STAFF.

NOW GRANTED, UH, THE MAJORITY OF THEM WERE VACANT POSITIONS BUT EVEN NOT HAVING THAT FLEXIBILITY OF HAVING VACANT POSITIONS IF WE WERE TO LEVERAGE A NEW GRANT, WE WOULD HAVE TO COME TO YOU AND GO THROUGH AN ENTIRE PROCESS THAT TAKES ANYWHERE BETWEEN LIKE SIX TO EIGHT MONTHS TO JUST GET THE STAFFING IN PLACE FOR THAT GRANT.

SO IT DOES DEFINITELY, I THINK, PUT US IN A CORNER JUST LOSING THOSE VACANT POSITIONS AS WELL.

AND AS YOU'RE AWARE, WE DO HAVE ABOUT 12 POSITIONS THAT ARE CURRENTLY FILLED THAT WE'LL BE DISCUSSING WITH YOU IN MORE DETAIL.

THIS IS A VISUAL THAT WE REALLY LIKE TO SHARE WITH YOU AND OUR, UM, COMMUNITY BECAUSE IF YOU JUST LOOK AT THE HIGHLIGHTED AREAS THAT ARE, FOR EXAMPLE, IN THE DEEP BLUE, YOU'LL SEE THAT THAT REPRESENTS BEHAVIORAL HEALTH AND ALL THE REVENUE THAT THEY'VE GENERATED OVER THE PAST COUPLE OF YEARS, WHICH IS THE LARGEST, AND THEN THAT IS FOLLOWED BY OUR HEALTH CENTERS, WHICH IS THE LIGHTER GRAY.

FOR US, THIS JUST BASICALLY SHOWS YOU THAT THEY ARE THE LARGEST, UM, DIVISIONS IN OUR DEPARTMENT AND SO WHAT HAPPENS TO THEM HAS AN IMPACT ACROSS OUR ENTIRE DEPARTMENT AS WELL.

SO WHAT YOU'LL SEE IN THE PROPOSED BUDGET, UM, IS REALLY DECREASES AS YOU CAN, UM, SEE HERE ABOUT $2.3 MILLION, YOU KNOW, IN OUR HEALTH CENTERS, UH, FEES, THERE'S ABOUT A 4.7 DECREASE DUE TO SOME, YOU KNOW, GRANT CHANGES ON OUR MENTAL HEALTH SERVICES ACT AND OTHER FEDERAL REVENUES THAT COME IN.

UM, AND YOU'LL SEE INCREASES AS WELL, RIGHT? IN TERMS OF, UM, YOU KNOW, FINES AND ASSESSMENTS THAT WE GENERATE REVENUE FOR.

UM, A LOT OF IT ALSO IN ENVIRONMENTAL HEALTH LICENSES AND PERMITS AND PROPERTY TAX.

BUT OBVIOUSLY THEY'RE REALLY SMALL, RIGHT? THESE AMOUNTS ARE SMALL COMPARED TO, UM, THE LOSSES THAT WE'RE SEEING IN OUR BUDGET.

WE ALSO SEE THE DECREASE OF THE SALARIES AND BENEFITS REFLECTED BECAUSE OF THE, UM, SALARIES, EXCUSE ME,

[03:20:01]

POSITIONS THAT WE'RE HAVING TO UNFORTUNATELY ALSO CUT FROM THE BUDGET.

ALL, UM, IN SUMMARY, YOU KNOW, WE'RE LOSING ABOUT $6.6 MILLION OF REVENUE.

UM, WHEN YOU KIND OF LOOK AT THE MONEY COMING IN AND THE MONEY THAT WE'VE LOST, IT'S A NET REDUCTION ABOUT $4.5 MILLION.

IT MIGHT NOT SEEM A LOT, BUT FOR A DEPARTMENT THAT'S PRIMARILY, UM, YOU KNOW, SELF-SUSTAINED, WE ONLY LEAN ABOUT 6% OF GENERAL FUND.

THE REST OF OUR MONEY IS THROUGH GRANTS, AND, UH, MAINLY MEDI-CAL REIMBURSEMENT OF SOME, UH, SHAPE OR FORM.

SO THE REDUCTION, AS I MENTIONED, IS 74.4 POSITIONS WITH 11.6 OF THEM BEING FILLED POSITIONS PRIMARILY IN BEHAVIORAL HEALTH, UM, AND OUR HEALTH CENTERS, AS WELL IN PUBLIC HEALTH.

SOME OF THE PAIN POINTS FOR US AS WE'RE HAVING THE DISCUSSION WITH YOU IS REDUCTIONS IN OUR CLOSURE OF LAB AND X-RAY BEING PROPOSED, AS WELL AS KEY COMMUNITY PROGRAMS, SOME SUCH AS MHCAN, GEMMA AND THE SUICIDE PREVENTION PROGRAM.

AND KEEP IN MIND, I'LL TALK A LITTLE BIT MORE ABOUT THE IMPACTS, UM, TO WHAT WE SEE AT THE STATE AND FEDERAL LEVEL.

SO RIGHT NOW, THE BUDGET IN FRONT OF YOU IS DISCUSSING REDUCTIONS BASED ON WHAT WE KNOW NOW.

UM, I ALSO WANTED TO SHARE SOME OF THE, UM, IMPACTS THAT WE ARE ALREADY STARTING TO KIND OF PLAN AROUND BASED ON THE GOVERNOR'S MAY REVISE.

ON THE BEHAVIORAL HEALTH, WE DO HAVE SOME PRELIMINARY INFORMATION THAT WE SERVE ABOUT 200 UNDOCUMENTED INDIVIDUALS IN OUR SYSTEM.

THAT'S ABOUT 3% OF OUR CLIENTS.

NOW KEEP IN MIND, WE'RE STILL MANDATED TO PROVIDE SERVICES, RIGHT? SO WHAT THIS MEANS FOR US IS THAT WE WILL NO LONGER BE ABLE TO BILL FOR THESE 191 INDIVIDUALS.

WHAT THAT MEANS IS THAT WE WOULD HAVE TO NOW CONSIDER THEM INDIGENT, AND WE WILL HAVE TO FIND A WAY IF THEY COME TO SEEK SERVICES TO PAY FOR THESE SERVICES OUTSIDE OF MEDI-CAL REIMBURSEMENT.

ON THE RIGHT SIDE, YOU'LL SEE THE PRELIMINARY IMPACTS THAT WERE ALSO DOCUMENTED FOR OUR HEALTH CENTERS.

ABOUT 30% OF OUR, UM, CLINIC CLIENTS, UM, IDENTIFY, OR WE'VE BEEN ABLE TO KIND OF TRACK AS UNDOCUMENTED.

THAT'S ABOUT 5,500, SO THAT'S A LOT OF FOLKS IN OUR COMMUNITY.

I THINK YOU HEARD DONNA YOUNG FROM SALUD PARA LA GENTE ALSO TALK ABOUT THE IMPACT TO HER.

SO WHEN YOU LOOK AT THE BASICALLY SYSTEM OF CARE OF THE FEDERALLY QUALIFIED HEALTH CENTERS, YOU'RE GONNA SEE ABOUT THE MAJORITY OF THE MEDICAL POPULATION, UM, BEING IMPACTED WITH THE FQS IN OUR COMMUNITY.

THERE ARE THREE ADDITIONAL LINE ITEMS THAT WE'RE TRACKING THAT WAS BASED ON THE MAY REVISE.

ONE IS ACUPUNCTURE.

SO THE MAY REVISE IS PROPOSING ELIMINATING REIMBURSEMENT FOR ACUPUNCTURE UNDER THE MEDI-CAL PLAN.

THAT WOULD BE ACROSS ALL CLIENTS OF, YOU KNOW, WHETHER YOU'RE UNDOCUMENTED OR DOCUMENTED.

RIGHT NOW, WE'RE ESTIMATING ABOUT ALMOST A MILLION-DOLLAR IMPACT FOR THE HEALTH CENTERS.

NOW THAT'S BASICALLY WHAT WE'RE ABLE RIGHT NOW TO GENERATE IN BILLABLE SERVICES FOR ACUPUNCTURE.

THE SECOND ONE IS DENTAL.

AS YOU PROBABLY SAW, THE MAY REVISE ALSO CALLS FOR THE ELIMINATION OF DENTAL CARE FOR THE UNDOCUMENTED COMMUNITY.

UM, WE'RE ESTIMATING ABOUT A $770,000 IMPACT RIGHT NOW FOR US.

AND THEN FINALLY, ELIMINATION OF THE PROSPECTIVE PAYMENT IS JUST A METHOD OF PAYMENT THAT THE CLINIC HAS UTILIZED.

AND THAT'S, UM, WE'RE ESTIMATING ABOUT $2.7 MILLION IMPACT.

NOW, YOU WILL KNOW THIS VERY SOON AS OF NEXT MONTH WHETHER OR NOT THIS IS GONNA MOVE FORWARD.

IN ADDITION TO WHAT, YOU KNOW, UNFORTUNATELY WE HAVE IN TERMS OF THE CUTS IN FRONT OF YOU.

SO IT IS GONNA BE FOR ME SOMETHING THAT I JUST HAVE TO REMIND YOU, THESE ARE NOT EASY TIMES.

WE'RE TRYING OUR BEST TO BRING PROPOSALS TO YOU THAT, UM, WE KNOW WILL HAVE AN IMPACT, BUT AT LEAST, UH, STAY FOCUSED ON PROVIDING PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES, UM, PER THE MANDATES, OR PER THE NEED IN THE COMMUNITY.

AT THE FEDERAL LEVEL, YOU'VE HEARD, UM, JENNIFER DISCUSS WE HAD ABOUT A HALF A MILLION DOLLAR IMPACT ALREADY IN THE SPRING.

WE'RE ANTICIPATING THAT WE WILL SEE ADDITIONAL IMPACTS TO MEDI-CAL.

SO IN ADDITION TO, UH, APPROXIMATELY, I WOULD SAY $4 MILLION THAT WILL LAND IN JUNE, UM, AT THE FEDERAL LEVEL, WE'RE ANTICIPATING AN ADDITIONAL REDUCTION BASED ON MODIFICATIONS TO CALAIM.

WE KNOW THAT IT'S STILL CURRENTLY IN THE BUDGET,

[03:25:01]

BUT WHAT WE HEARD IS THAT THEY'RE GONNA MODIFY THE CRITERIA FOR WHAT QUALIFIES UNDER CALAIM.

IF THEY'RE GONNA BE ABLE TO COVER ALL CURRENT, UM, 14 IDENTIFIED KIND OF SOCIAL DETERMINANTS, IT SOUNDS LIKE THEY'RE GONNA BE MODIFYING THOSE.

SO WE WILL SEE SOME CHANGES TO THAT.

IN ADDITION, YOU'VE HEARD US TALK A LOT ABOUT PROVISIONS TO GENDER AFFIRMING HEALTHCARE AND REPRODUCTIVE HEALTH ALSO IMPACTING, UM, SERVICES.

WE NEED TO SEE HOW THE STATE'S GONNA REACT TO THAT, BECAUSE IN CALIFORNIA, WE HAVE OTHER MANDATES TO ENSURE THAT GENDER AFFIRMING CARE AND REPRODUCTIVE CARE IS IN PLACE.

WE JUST DON'T KNOW WHO'S GONNA ACTUALLY PAY FOR THAT CARE IF THE FEDERAL GOVERNMENT IS NO LONGER GONNA REIMBURSE US FOR THAT.

SO HOPEFULLY THAT'S NOT GONNA COME TO THE COUNTY AS WELL.

THOSE ARE JUST A FEW OF ADDITIONAL RISKS THAT WE'RE NOTICING AND KIND OF TRACKING AT THE FEDERAL LEVEL.

YOU DID ASK FOR US TO COME BACK AND MAYBE POTENTIALLY CONSIDER WHAT OPPORTUNITIES DO WE HAVE TO PREPARE FOR THESE CHANGES SPECIFICALLY TO THE MEDI-CAL POPULATION.

I WANTED TO REMIND THE BOARD THAT YOU DO HAVE MEDI-CRUZ.

IT'S BEEN A PROGRAM THAT HAS BEEN IN PLACE FOR MANY YEARS IN THE COUNTY.

IT DOES PRIMARILY SUPPORT, UM, SPECIALTY CARE, BUT WE DID HAVE IT PRIOR TO THE ACA.

IT IS BASED ON A CRITERIA.

SO CURRENTLY ANYONE MAKING LESS THAN 160 OF THE FEDERAL POVERTY LEVEL, WHICH IS ABOUT $25,000 A YEAR OR $2,000 A MONTH CAN QUALIFY.

YOU DO HAVE TO GET REFERRED BY YOUR PROVIDER TO GET THIS CARE.

CURRENTLY, THE PROGRAM IS, WE HAVE ABOUT A $3 MILLION BUDGET FOR THE PROGRAM.

UM, IT GOES QUICKLY.

I THINK WE'VE BEEN ABLE TO SERVE ABOUT 350 OR 25 CLIENTS.

I DO ANTICIPATE WITH JUST THE NUMBERS THAT I'VE SHARED WITH YOU ABOUT THOUSANDS OF FOLKS LOSING COVERAGE, THAT THIS MIGHT BE A POTENTIAL OPTION FOR YOU GUYS TO CONSIDER AND GROW.

OBVIOUSLY, IN ORDER FOR THE FUND TO GROW, IT REQUIRES ADDITIONAL FUNDING FOR THIS.

UM, WE HAVE MET WITH THE DIFFERENT FQS IN THE COUNTY TO START THE DISCUSSION BECAUSE IT ALSO IMPACTS THEM.

THEY REFER INTO THIS PROGRAM AND OTHER ENTITIES REFER INTO THIS PROGRAM.

BUT I ADVISE THE BOARD TO REALLY TAKE A LOOK AT THIS AS AN OPTION AS YOU MOVE FORWARD AND CONSIDER LEVERAGING ADDITIONAL DOLLARS FOR THIS VERY IMPORTANT PROGRAM THAT YOU ALREADY HAVE.

UM, JENNIFER WILL BE WORKING WITH OUR TEAM INTERNALLY AND WITH THE OTHER HEALTH CENTERS TO TRY TO UNDERSTAND, YOU KNOW WHAT WOULD IT LOOK LIKE, WHAT DID IT LOOK LIKE BEFORE, AND A POTENTIAL PROPOSAL FOR YOU MOVING FORWARD.

AS YOU MOVE FORWARD, I'VE SAID THIS DURING OUR ONE-ON-ONES AND JUST REPEATING IT AGAIN, THAT UNFORTUNATELY WE'RE IN A STATE WHERE IN ORDER FOR US TO REMAIN FLEXIBLE, IT DOES MEAN YOU HAVE TO TIGHTEN DOWN.

IN ORDER FOR US TO BE PREPARED, IT MEANS THAT YOU HAVE TO START PLANNING NOW AND TAKING, YOU KNOW, ACTION NOW.

WE HAVE TRIED OUR HARDEST.

THESE ARE VERY DIFFICULT, UM, TIMES.

NO DIRECTOR WANTS TO COME TO YOU WITH CUTS.

I WILL TELL YOU THAT.

IT'S NOT SOMETHING THAT WE, YOU KNOW, TAKE THE ROLE, AND ARE VERY, UM, CAUTIOUS WHEN WE BRING THESE PROPOSALS TO YOU.

BUT I DO KNOW THAT WE HAVE TO DO OUR JOB AND BRING YOU A BALANCED BUDGET.

AND SO THAT'S WHAT YOU SEE HERE.

WE ARE PRIORITIZING MANDATES.

UM, WE'RE ALSO LOOKING AT PROGRAMS THAT PREVENT MORBIDITY AND MORTALITY.

UM, AND WE HAVE TO PRIORITIZE THOSE BECAUSE WE KNOW WE ARE THE SAFETY NET AS WELL IN THIS COMMUNITY.

AS WE CONTINUE ON OUR JOURNEY, WE CONTINUE TO LOOK FOR INNOVATION, EFFICIENCIES AND QUALITY.

AS I MENTIONED TO YOU BEFORE, BOTH BEHAVIORAL HEALTH AND THE CLINICS HAVE BEEN WORKING ON PRODUCTIVITY STANDARDS, ON QUALITY IMPROVEMENT STANDARDS, ON DIFFERENT WAYS TO REALLY ENSURE THAT WE DON'T COME BACK TO YOU WITH ADDITIONAL, YOU KNOW, PROPOSALS TO REDUCE STAFF FOR PROGRAMS. UM, WE DO REMAIN EQUITY AND CLIENT CENTERED.

THAT'S VERY IMPORTANT FOR US BECAUSE IF YOU SEE THE PROPOSALS, THEY HURT MAINLY FOLKS THAT ARE ALREADY ON THE MARGINS.

THEY'RE NOT HURTING THOSE THAT, YOU KNOW, WE DON'T HAVE THE MEANS TO ACTUALLY GET THE CARE THAT THEY NEED.

AND YOU WILL BE FACED WITH MAKING TOUGH CHOICES OF THOSE THAT ARE ALREADY ON THE MARGINS WITH THE LITTLE BIT THAT YOU DO HAVE, WHO WILL YOU BE PRIORITIZING? AND SO I'VE ASKED THE TEAM TO LEAN ON DATA, TO LEAN ON THE BURDEN OF HEALTH IN OUR COUNTY, AND TO PRESENT THAT TO YOU, UM, AS IT COME UP WITH ADDITIONAL RECOMMENDATIONS.

AND FINALLY, I CAN'T LEAVE WITHOUT PITCHING.

I'VE TALKED, UM, WITH SOME OF YOU, AND ESPECIALLY THE CEO'S OFFICE ABOUT THIS.

WE DO NEED ALTERNATIVE SOURCES, UM, SPECIFICALLY FOR BEHAVIORAL HEALTH.

AND OBVIOUSLY FOR ALL OF THE PROGRAMS,

[03:30:01]

BUT WE, UM, ALWAYS SEEM TO GET CUT WHEN THERE'S NEW POLICY, WHEN THERE'S NEW CHANGES AT THE FEDERAL AND STATE LEVEL.

THIS IS NOT JUST HAPPENING TO US, THIS IS HAPPENING STATEWIDE AND NATIONALLY.

AND IT'S JUST SO UNFORTUNATE HOW YOUR SAFETY NET HAS TO KIND OF RIDE ALONG WHATEVER POLICY DECISION IS BEING MADE.

WE KNOW WE ARE, UM, IN MANY WAYS A KEY FACTOR TO THE ECONOMIC VIABILITY TO THIS COMMUNITY.

WE JUST DON'T GET TREATED LIKE THAT.

AND SO I'M URGING YOU TO REALLY CONSIDER, UM, AS OUR LEADERS, TO THINK ABOUT ALTERNATIVE WAYS.

AND ONE OF IT IS A POTENTIAL BALLOT MEASURE TO TRY TO SUSTAIN HEALTH SERVICES.

WITH THAT, UM, THAT CONCLUDES OUR PRESENTATION ON JUNE 10TH.

IT WILL BE OFFICIALLY APPROVING OUR PROPOSAL, BUT FOR NOW THIS IS, YOU KNOW, WHAT WE HAVE FOR YOU, AND WE'RE HERE TO KIND OF TAKE YOUR QUESTIONS AS WELL.

- THANK YOU FOR THE THOROUGH PRESENTATION AND WE'LL HAVE ONE EVEN MORE THOROUGH ON THE 10TH.

I'M GONNA OPEN IT UP FOR THE PUBLIC FOR ANY PUBLIC COMMENT.

- HELLO AGAIN.

UM, I WOULD JUST- LAURA CHATHAM.

I JUST WANT TO ADDRESS THE ELEPHANT IN THE ROOM IS THE INCREASE IN THE SHERIFF'S BUDGET AT THE EXPENSE OF HEALTHCARE.

IT SEEMS EVERYTHING GETS CUT EXCEPT THE SHERIFF'S BUDGET, AND THAT GOES UP EVERY YEAR.

SO WE ASK FOR CARE, NOT CAGES.

THE CHIEF AT THE JAIL TELLS US THAT IT IS ROUTINELY ABOUT 70% CAPACITY AND JUVENILE HALL HAS EIGHT INMATES, BUT RUNS AT CAPACITY FOR 40.

IT SEEMS TO ME THAT THERE'S PLENTY, THERE'S ROOM AND I APPRECIATE THE PRESENTATION QUITE A BIT.

AND I ESPECIALLY APPRECIATE WHAT YOU SAID AT THE END THAT WE NEED TO LOOK AT INSTEAD OF PAYING, UM, THE SHERIFF DEPUTY TRAINEES $11,000 A MONTH, WE COULD PROBABLY PAY, UM, A FEW MORE OF THE PEOPLE THAT WE NEED FOR THE HEALTHCARE.

WE DO NEED ROADS, ESPECIALLY I WANT MY ROAD FIXED TOO.

WE DON'T NEED MORE JAILS AND WE DON'T NEED MORE OVERPAID DEPUTY TRAINEE SHERIFFS GETTING, AS I SAID, $11,000 A MONTH WITH ONLY A HIGH SCHOOL DIPLOMA.

PLEASE CONSIDER FINDING THE FUNDS FOR HEALTHCARE AND CUTS TO THE SHERIFF.

I'M SORRY, WE'RE SEEING IT ON TWO DIFFERENT DAYS BECAUSE I THINK THAT IT WOULD BE REALLY CLEAR IF YOU- IF YOU TOOK A LOOK.

WE DON'T NEED MORE SHERIFFS, MORE PEOPLE TO STAND AROUND AND MAKE PROBLEMS FOR PEOPLE.

THANK YOU.

AND THANK YOU FOR ALL YOUR HARD WORK, EVERYBODY IN THE ROOM.

- THANK YOU, COME UP.

- HI, GOOD AFTERNOON.

MY NAME IS TYLER STARKMAN.

I'M THE EXECUTIVE DIRECTOR OF MHCAN AND I URGE YOU GUYS TO CONTINUE FUNDING US.

WE'RE THE ONLY PEER RUN MENTAL FACILITY IN THE COUNTY.

SO WE DO NEED THE FUNDING DESPERATELY.

THESE ARE NOT JUST PROGRAMS, THEY'RE LIFELINES.

MHCAN, WE PROVIDE SOMETHING THAT OTHER SERVICES OFTEN CAN'T, COMMUNITY UNDERSTANDING AND SUPPORT FROM PEOPLE WITH LIVED EXPERIENCE.

AND THAT PEER CONNECTION SAVES LIVES.

LET ME SHARE YOU MY STORY.

I WAS DIAGNOSED WITH BIPOLAR TYPE 1 AND LIVING ON THE STREETS.

AND ABOUT 15 YEARS AGO, CAUGHT IN A CYCLE OF REPEATED HOSPITALIZATIONS AND CRISES.

THE SUPPORT THAT I FOUND, THE STABILITY OF OUR PEER-RUN SERVICES AT MHCAN HELPED ME GET TO WHERE I AM TODAY.

TODAY, UM, I'M NO LONGER HOMELESS AND FULLY EMPLOYED.

UM, THAT TRANSFORMATION DIDN'T COME FROM AN EMERGENCY ROOM.

IT DIDN'T COME ANYWHERE ELSE FROM THE JAIL SYSTEM.

IT CAME FROM COMMUNITY, COMMUNITIES SUCH AS MHCAN.

UM, DESPITE THE SUCCESS, UM, OF ANOTHER FACILITY SUCH AS THE PEER RESPITE FACILITY AT SECOND STORY, UM, WE WERE DEEMED UNNECESSARY WHEN THEY SOMEHOW ARE DEEMED NECESSARY.

WE PROVIDE VERY SIMILAR SERVICES THAT ARE NOW CONSIDERED DISCRETIONARY WHEN THERE'S NO REAL GIVEN REASON AS TO WHY OURS ARE DISCRETIONARY AND OTHERS AREN'T.

BECAUSE THOSE ARE SERVICES HAVE BEEN CONSIDERED MANDATED.

PLEASE, PLEASE DON'T TREAT PEOPLE WITH MENTAL ILLNESS UNFAIRLY.

WHEN YOU SINGLE OUT MHCAN, YOU'RE- YOU'RE CREATING MORE STIGMA AND YOU STRIP PEOPLE FROM THE SUPPORT THAT THEY NEED TO RECOVER ON THEIR OWN.

IN RESPONSE TO CERTAIN THINGS THAT I HEARD TODAY, MHCAN ALSO RECOGNIZES THAT THERE ARE FISCAL CONSTRAINTS THAT THE COUNTY IS FACING.

IN THE SPIRIT OF COLLABORATION AND SUSTAINABILITY, I WAS WILLING TO REDUCE OUR EXPENSES BY 22% WHILE CONTINUING TO PROVIDE THE SAME CONTRACTED MANDATED SERVICES THAT WE PROVIDE, BUT I WAS NEVER RECEIVED ANY RESPONSE.

UM, WE'RE ACTIVELY TRYING TO APPLY FOR GRANT TWO FUNDING THROUGH THE DHCS, UM, ROUND TWO.

[03:35:01]

AND WE WILL CONTINUE DOING THAT AS NECESSARY.

ADDITIONALLY, WE'RE PREPARED TO SHIFT AND ALIGN OUR RESOURCES TOWARDS HOUSING. THANK YOU.

- CAN YOU HELP HER BRING THE MIC DOWN? - HELLO AGAIN, BOARD OF SUPERVISORS.

MY NAME IS BLAIR VERACIOUS ONCE AGAIN.

AND, UH, THOUGH I'VE SPOKEN EARLIER, I WOULD ACTUALLY LIKE TO LEAVE YOU GUYS WITH A QUESTION.

WITH THE PROPOSED CUTS TO THE BUDGET AND THE DEVASTATION AND HOLES THAT WILL BE LEFT IN THE SOCIAL SAFETY NET, I WOULD LIKE TO ASK WHAT WILL WE REPLACE THESE THINGS WITH? BECAUSE MY CONCERN IS ROOTED IN HISTORY.

I DON'T LIKE BRINGING UP THE NAZIS.

I DON'T WANT TO TALK ABOUT HITLER EVERY TIME SOMETHING HORRIBLE HAPPENS.

BUT WHEN YOU REMOVE COMMUNITY OR OTHER LONG-ESTABLISHED THINGS, INEVITABLY THAT CREATES A VACUUM OF POWER, WHICH BRINGS IN SOMETHING HANNAH ARENDT CALLS PARALLEL INSTITUTIONS.

THESE INSTITUTIONS ARE NOT ROOTED IN THE COMMUNITY AND THEY OFTEN END UP USURPING POWER FROM THOSE COM- FROM THOSE COMMUNITY RESOURCES WHICH DO NOT, AND THOSE PARALLEL INSTITUTIONS DO NOT HAVE ANY CONNECTION TO THE COMMUNITY OR ANY CARE FOR ITS WELL-BEING.

AND I UNDERSTAND THAT YOU GUYS ARE IN A TOUGH POSITION BECAUSE IT IS NOT YOU THAT IS CREATING THIS VACUUM OF POWER, NOT ON PURPOSE.

YOU'RE DEALING WITH A FEDERAL BUDGET THAT IS SLASHING OUR ABILITY TO HAVE SERVICES.

BUT I ASK YOU TO CONSIDER AT THE VERY LEAST COLLABORATING MORE WITH THE PEOPLE THAT ARE PROVIDING THESE SERVICES BEFORE YOU MAKE ANY SERIOUS DECISIONS.

BECAUSE WHAT IS GOING TO HAPPEN IS THERE'S GOING TO BE A LOT OF DESTRUCTION AND DEATH ON THE BACK OF THIS.

SO I WILL DO WHATEVER I CAN TO HELP BRIDGE THE GAP PERSONALLY BETWEEN WHAT WE HAVE NOW AND WHAT WE STILL NEED TO MAINTAIN IN THE FUTURE.

BUT I'M ASKING YOU TO BE TRANSPARENT WITH THE PUBLIC AND GIVE US A BIT MORE INPUT.

THANK YOU.

- GOOD AFTERNOON. I'M MIKE BEEBE.

I'M THE PRESIDENT OF THE BOARD FOR NAMI.

AND I'VE HAD SOME COMMUNICATIONS, I THINK, WITH MOST OF THE PEOPLE UP HERE AROUND THE CHOICES, UH, WE'RE FACED WITH.

THE POINTS I'D LIKE TO MAKE IS, UH, FIRST, THE HSA DEPARTMENT IS BEING HELD TO A DIFFERENT STANDARD.

THEY NEED TO- THEY NEED TO COVER THEIR OWN BUDGET, BUT NO OTHER DEPARTMENT DOES.

THEY HAVE MOST OF THEIR EXPENSES COVERED BY REVENUE.

YET FOR THE WHOLE COUNTY, THEY'RE THE ONLY DEPARTMENT GETTING CUT.

SO OUT OF 2,700 PEOPLE, THERE'S NO CUTS IN ANY OTHER PART OF THE COUNTY AND I DON'T THINK THAT'S EQUITABLE.

WHAT WE'VE HEARD THIS MORNING IS THE NEEDS FROM THE COMMUNITY WHICH ARE REALLY STILL NOT COVERED TODAY.

WHEN WE LOOK AT OUR TREATMENT BEDS, THE TREATMENT BEDS WE HAVE ARE THE MOST EXPENSIVE.

WE HAVE THE ACUTE CENTER AT THE PUF.

WE SEND HALF TO TWO THIRDS OF OUR PEOPLE OUT OF COUNTY, WHICH IS AT TWICE THE COST.

WE HAVE NO STEP-DOWN FACILITIES AND WE JUST LOST TELOS.

SO WE DON'T HAVE A COST-EFFECTIVE RANGE OF TREATMENT SERVICES.

WE CAN SAVE THE MONEY IF WE DID GET THOSE SERVICES IN TOWN BY JUST NOT SENDING THE PEOPLE OUT OF COUNTY.

SO I WOULD ASK YOU TO THINK ABOUT THE NEED THAT'S NOT BEING COVERED.

HOW THESE CUTS ARE GONNA FURTHER DIMINISH THOSE NEEDS AND HOW IF WE'RE GONNA MANAGE THE BUDGET, WE SHOULD DO IT ON AN EQUITABLE BASIS WHERE EVERYBODY TAKES A CUT ACROSS THE COUNTY.

WHY SHOULD THEY BE THE ONLY STANDARD THAT HAS TO MANAGE THEIR BUDGET WHEN EVERYONE ELSE IS SUPPORTED BY THE GENERAL FUNDS? AND SO, YOU KNOW, THERE'S A LOT OF NEED IN THE COMMUNITY AND I THINK WE NEED TO BE CREATIVE IN TERMS OF HOW WE ADDRESS THAT AND NOT TAKE IT ALL ON THE SHOULDERS OF THE ONE TEAM THAT'S REALLY SUPPORTING OUR COMMUNITY.

NOT THAT THE OTHERS ARE, BUT THIS IS REALLY A CRITICALLY NEEDED SERVICE.

THANK YOU.

- HELLO, MY NAME IS HOLLY FORCIER, I'M HERE AGAIN.

UM, ONE THING THAT I REALLY THINK IS IMPORTANT TO EMPHASIZE ABOUT, UM, COMMUNITY ORGANIZATIONS, PEER SUPPORT, UM, IS COST EFFECTIVE.

IT PREVENTS EXPENSIVE MENTAL HEALTH CRISES.

AND, UM, I KNOW YOU'RE STRUGGLING WITH, YOU KNOW, URGENT SITUATIONS, UM, IN TERMS OF THE BUDGET, IT'S REALLY TIGHT.

UM, BUT IN THE LONG RUN, THINKING OF THE COST OF, UM, MENTAL HEALTH PATIENTS NOT HAVING A PLACE TO GO WHERE THEY FEEL THAT THEY BELONG, THEY KNOW EACH OTHER, THEY SUPPORT EACH OTHER.

[03:40:02]

IT REDUCES EXPENSIVE BEHAVIORAL HEALTH CRISES.

THANK YOU.

- IS THERE ANYONE ONLINE? - YES, CHAIR.

LINDA, YOUR MICROPHONE'S NOW AVAILABLE.

- GOOD AFTERNOON, SUPERVISORS.

THANK YOU FOR THE OPPORTUNITY TO SHARE MY PUBLIC COMMENT ABOUT THE COUNTY'S PROPOSED HUMAN SERVICES AGENCY BUDGET.

MY NAME IS LINDA ALVES.

I AM THE COO AT ENCOMPASS COMMUNITY SERVICES AND A MEMBER OF THE PAJARO VALLEY COLLABORATIVE.

ENCOMPASS IS THE ONLY PROVIDER OF STEP-DOWN MENTAL HEALTH RESIDENTIAL SERVICES FOR PEOPLE WITH MEDI-CAL IN SANTA CRUZ COUNTY.

ENCOMPASS HAS ALREADY BEEN FORCED TO CLOSE ONE OF OUR THREE MENTAL HEALTH RESIDENTIAL FACILITIES, TELOS, AND I'M HERE TO URGE THE BOARD TO RECONSIDER THE COUNTY'S PROPOSED RATE CUT, WHICH WILL FORCE US TO CLOSE YET ANOTHER MENTAL HEALTH RESIDENTIAL CENTER, CASA PACIFIC IN SOUTH COUNTY.

THIS NEXT FISCAL YEAR, THE COUNTY HAS PROPOSED A REDUCTION IN RESIDENTIAL MENTAL HEALTH ROOM AND BOARD FUNDING FROM $125 TO $75 PER CLIENT PER DAY.

OUR ROOM AND BOARD COSTS ARE $162 PER PERSON TO OPERATE.

ADDITIONALLY, WE WILL NOT RECEIVE MEASURE K FUNDING THIS FISCAL YEAR, WHICH IS A LOSS OF $471,000.

THIS FUNDING PREVIOUSLY HELPED FILL OUR FUNDING GAPS.

THE ONLY PATH FORWARD IS TO CLOSE ANOTHER FACILITY.

THE 2023 CIVIL GRAND JURY REPORT FROM SANTA CRUZ COUNTY WAS CLEAR, OUR COUNTY LACKED STEP-DOWN CAPACITY AND HAS URGENT BEHAVIORAL HEALTH STAFFING AND ACCESS CHALLENGES.

CUTTING FUNDING NOW DIRECTLY CONTRADICTS THOSE FINDINGS AND WILL ONLY DEEPEN THIS CRISIS.

I URGE YOU TO PLEASE RECONSIDER THIS REDUCTION.

THE BUDGET IS A REFLECTION OF OUR COUNTY'S PRIORITIES.

THIS REDUCTION DOES NOT PRIORITIZE OUR COMMUNITY'S BEHAVIORAL HEALTH.

IF CASA PACIFICA CLOSES, THERE IS NO ALTERNATIVE FOR THIS LEVEL OF CARE.

CLOSURE WILL FURTHER EXACERBATE BOTTLENECKS AT OUR LOCAL EMERGENCY ROOMS, PSYCHIATRIC HOSPITALS, AND OTHER RESIDENTIAL BEHAVIORAL HEALTH TREATMENT FACILITIES IN OUR COMMUNITY.

THANK YOU SO MUCH FOR YOUR CONSIDERATION.

- KATHY, YOUR MICROPHONE'S NOW AVAILABLE.

- HELLO. UM, THIS IS KATHY LASSE.

I AM IN APTOS, CALIFORNIA AND I'M HERE TO ECHO WHAT'S BEEN SAID BY PEOPLE IN PUBLIC COMMENT ABOUT, UH, HEALTH AND, UM, SERVICES AGENCY ALWAYS NEEDING TO DEFEND AND BALANCE THEIR BUDGET WHEN OTHER DEPARTMENTS DON'T HAVE TO.

SO I REALLY WOULD LIKE US TO REEXAMINE HOW WE'RE SPENDING OUR GENERAL FUNDS AND, UM, ASKING OTHER DEPARTMENTS TO TAKE THE HIT ALSO IN THE... IN THESE HARD TIMES.

UM, WE KNOW THAT, UM, WE JUST HEARD HOW, UM, THE REIMBURSEMENT FOR MENTAL HEALTH BEDS IS GOING FROM 125 TO $75 AND INCARCERATION COSTS SO MUCH MORE.

THESE ARE AREAS WE CAN SCRUTINIZE TO SEE WHERE WE CAN SAVE MONEY BY LOOKING AT HOW AND WHEN WE INCARCERATE PEOPLE AND LOOKING AT HOW WE CAN SAVE MONEY, UM, IN THAT RE... ARENA AND SHIFT IT TO OUR, UM, HEALTH AND HUMAN SERVICES.

SO I, UM, I- JUST TO FINISH, I'D LIKE TO REEXAMINE THE- HOW WE, UM, HOW WE ALLOCATE THAT MONEY AND MAKE SURE THAT WE HAVE REALLY LOOKED- LIKE LOOKED UNDER EVERY ROCK FOR EVERY PENNY BY SHARING THE- THE BURDEN OF THIS... OF THESE TIMES.

THANK YOU.

- WE HAVE NO FURTHER SPEAKERS, CHAIR.

- WITH THAT, I'LL BRING IT BACK TO THE BOARD FOR ANY, UH, COMMENTS OR QUESTIONS.

I'LL START TO MY RIGHT WITH, UH, SUPERVISOR DE SERPA.

- UM, THANK YOU.

SOMEBODY BROUGHT UP SOMETHING A LITTLE EARLIER THAT I WANTED TO, UM, FOLLOW UP ON.

THEY SAID THAT THE PSYCHIATRIST POSITION IN SOUTH COUNTY WAS, UM, SET FOR ELIMINATION.

UM, I'M WONDERING IF YOU COULD SPEAK TO THAT A LITTLE BIT.

SO THAT WILL LEAVE ONE, IT SOUNDS LIKE PSYCHIATRIC NURSE PRACTITIONER TO MANAGE THE ENTIRE SOUTH COUNTY POPULATION.

- YEAH. SO, THE 77, I'M SORRY, LET ME BACK UP.

THE CUTS THAT, UM, ARE HIGHLIGHTED ALSO INCLUDE NON-ACTUAL FTES THAT WORK IN THE COUNTY LIKE LOCUMS AND SO THAT'S WHAT WE'RE TALKING ABOUT.

IT'S A LOCUM POSITION.

- AND WILL THAT LEAVE JUST ONE PSYCHIATRIC PROVIDER THEN? - I WILL INVITE, UH, THE DIRECTOR OF CLINICS, AMY PEELER TO COME AND DISCUSS THAT WITH US.

JUST FOR THE REST OF THE BOARD MEMBERS, LOCUMS TEND TO BE TWICE THE EXPENSE, UM, WHEN YOU BRING THEM IN.

UM, AND SO THAT'S ALSO SOMETHING FOR US TO KIND OF LOOK INTO A LITTLE BIT MORE.

- SURE. SO WE HAVE AN INTEGRATED BEHAVIORAL HEALTH DEPARTMENT THAT HAS FOUR, I BELIEVE FOUR PSYCHIATRIC NURSE PRACTITIONERS

[03:45:01]

AND A PSYCHIATRIC MEDICAL DIRECTOR AND THEN THERAPISTS UNDER THAT.

SO WHAT WILL END UP HAPPENING IS WE WILL TRY TO SERVE THE ENTIRE COUNTY WITH A LITTLE BIT LESS, UM, FINDING BILINGUAL CLINICIANS IS NOT EASY.

UM, BUT WE WILL CONTINUE TO TRY TO DO THAT.

AND WE DO HAVE SOME, SO IT, IT WILL BE LESS.

AND LIKE DIRECTOR MORALES SAID, IT IS NOT CUTTING AN FTE.

IT'S ACTUALLY CUTTING, UM, UH, AN A CONTRACTOR.

- OKAY.

DO WE KNOW WHAT OUR PANEL IS OF PSYCHIATRIC PATIENTS NEEDING MEDICATION MANAGEMENT IN SOUTH COUNTY? - WE DO. I DON'T HAVE THAT NUMBER OFF THE TOP OF MY HEAD, BUT...

- OKAY.

- CERTAINLY WE, I COULD GET IT FOR YOU.

- AND, AND THE LITTLE GIRL, THAT LITTLE GIRL...

THE YOUNG WOMAN THAT SPOKE EARLIER, WHO'S THE PSYCHIATRIC NURSE PRACTITIONER, UM, IS SHE WORKING IN THE CLINIC OR SHE'S WORKING IN THE INTEGRATED SIDE? - UM, THE INTEGRATED BEHAVIORAL HEALTH IS PART OF THE HEALTH CENTERS.

- OH, OKAY. RIGHT.

- SO SHE DOES WORK IN THE HEALTH CENTERS.

- OKAY. YEAH, I'D LIKE TO BRING HER, UM, EXTRA RELIEF.

IT SOUNDS LIKE IT'S PROBABLY TOO MUCH FOR SOUTH COUNTY AND IF WE'RE NOT SERVING, I, I MEAN I, I'VE BEEN DOWN THERE, I'VE BEEN IN THE CLINIC THERE, THERE'S THE NEED IS GREAT.

- CERTAINLY.

- YEAH. UM, OKAY. THAT WAS ONE QUESTION.

UM, THE NEXT QUESTION I DID HAVE WAS I WAS GONNA ASK ARE, UM, DO WE HAVE ANY PER DIEM HELP, WHICH IS LOCUMS, UM, BUT IN TERMS OF MAYBE NOT THE PSYCHIATRY, BUT IN TERMS OF, UM, PROVIDING EXTRA HELP, BRINGING PEOPLE IN IN THAT WAY WITHOUT BENEFITS? - YEAH, SO, SO SOMETHING THAT WE ALWAYS TRY TO WALK AND BE VERY CONSCIOUS ABOUT IS WE DO PARTNER WITH OUR UNIONS AND WE- WE REALLY TRY TO HONOR, UM, OUR AGREEMENTS WITH THEM.

AND SO ONE OF THE AGREEMENTS, UH, FOR THE BOARD TO KEEP IN MIND IS IF YOU BRING IN LOCUMS AND YOU'RE LAYING PEOPLE OFF, UM, IT ALSO CREATES AN INEQUITY FOR US IN TERMS OF PRIORITIZING OUR, UM, CURRENT STAFF.

SO PART OF THE DANCE FOR US IS HOW DO YOU, UH, PROPOSE CUTS AND THEN ALSO BRING LOCUMS THAT ARE TWICE AS EXPENSIVE, FOR EXAMPLE.

UM, SO FINANCIALLY, IT DOESN'T MAKE SENSE.

I THINK IN TERMS OF OUR PARTNERSHIP WITH THE UNION, IT DOESN'T, UM, ALSO MAKE SENSE.

SO IT'S- IT'S A FINE DANCE.

AND WHEN WE CAN THOUGH, WHEN WE DO SEE, UH, THE OTHER CATEGORY, JUST BRINGING IN FOLKS THAT ARE NOT LOCUMS EXTRA HELP, THEY DO TEND TO BE CHEAPER.

YOU DON'T PAY FOR BENEFITS, BUT FOR THE CLINICAL WORK THAT WE HAVE TO DO, UM, IT'S HARD TO BRING IN PART-TIME STAFF THAT ARE NOT LOCUMS. - OKAY.

AND THEN ANOTHER QUESTION I HAD WAS, UM, REGARDING, UM, PEOPLE WHO MAY BE LOSING THEIR MEDI-CAL AND, UH, I UNDERSTAND ABOUT MEDICRUZ, BUT DO WE HAVE ANY, UM, ARE WE DOING ANY PLANNING AROUND HOW WE'RE GONNA GET PEOPLE THEIR MEDICATIONS THAT THEY MIGHT NEED? BECAUSE THAT'S LIKE TYPICALLY A SEPARATE BENEFIT? - YEAH. IN, IN HEALTH CENTERS, WE DO HAVE, UH, A PROGRAM THAT ENSURES THAT WE GET MEDICATION AT A LOW RATE OR DEPENDING ON A SLIDING SCALE OF INCOME FOR FOLKS.

UM, SO IF MY ADVICE WOULD BE RIGHT, STRENGTHEN THE MEDICRUZ, IF IN FACT, THE MAY REVISE LEANS IN THAT DIRECTION IN THE FEDERAL ADMINISTRATION AND LEVERAGE THE CURRENT MEDICATION KIND OF MODELS THAT THE CLINIC CURRENTLY HAS.

UM, I WILL ALSO, YOU KNOW, AS I MENTIONED, DIRECTOR PEELER IS HERE, SHE CAN TALK TO YOU GUYS A LITTLE BIT MORE ABOUT WHAT WAS DONE PRIOR TO ACA, BUT THAT WAS, UM, A SIMILAR CONCEPT THAT WAS IN PLACE.

- OKAY. AND THEN, UM, FINALLY REGARDING THE RATE CUT, UM, FOR RESIDENTIAL, 75 IS REALLY NOT ENOUGH TO COVER THE COSTS.

AND I'M WONDERING IF YOU COULD JUST SPEAK A LITTLE BIT ABOUT WHY THAT IS HAPPENING AND IF THERE'S ANY RESOLUTION THAT COULD BE BROUGHT IN FRONT OF US LATER.

- SO OUR STAFF, UH, DID AN ASSESSMENT STATEWIDE TRYING TO UNDERSTAND WHAT OTHER, UM, COUNTIES WERE DOING WITH ROOM ON BOARD, AND THEY WERE AVERAGING ABOUT $50.

UM, AND SO WHEN WE LOOKED AT WHAT OUR, UH, OBVIOUSLY IT'S MORE EXPENSIVE IN SANTA CRUZ, RIGHT? SO WE KNEW WE HAD TO, UM, CURTAIL THAT COST.

AND SO WHAT WE WERE TRYING TO DO IS NOW GO TO 50 WHAT THE AVERAGES IN THE STATE WOULD BE MORE REALISTIC ABOUT WHAT IT COSTS HERE IN OUR COUNTY AND WE LANDED ON 75.

WE HAVE OTHER PROVIDERS ALSO THAT ARE MOVING FORWARD WITH THIS.

AND THEY SEEM, AT LEAST THE FEEDBACK THAT WE RECEIVE FROM THEM, THAT THEY WILL BE ABLE TO ACTUALLY, UM, MAKE THE RATE WORK.

- THANK YOU. - YEAH.

- SUPERVISOR CUMMINGS.

- THANK YOU VERY MUCH.

UM, WE'VE HEARD A LOT AND SEEN A LOT ABOUT THE BUDGET AND HOW CHALLENGING IT IS FOR HSA AND, UM, I APPRECIATE THE RECOMMENDATION ON A SALES TAX MEASURE OR SOME TYPE OF REVENUE MEASURE BECAUSE IT WOULD HELP A LOT,

[03:50:03]

UM, TO MAINTAIN SOME OF THESE SERVICES.

I'M GONNA KEEP MY QUE... I HAVE A FEW QUESTIONS, THEN I HAVE SOME COMMENTS, AND THEN WHEN THE TIME COMES, I DID HAVE SOME ADDITIONAL DIRECTION TO PROVIDE.

I KNOW WE'RE NOT GONNA APPROVE THE BUDGET TODAY BUT I THINK THAT, UM, THERE'S SOME CONCERNS THAT I HAVE AND MAYBE THERE'S SOME OPPORTUNITIES TO HELP SUPPORT CERTAIN PROGRAMS. UM, SO THE FIRST WAS, UM, I WAS JUST CURIOUS WITH THE LITTER JUST THE, THE, UM, THE SYRINGE LITTER DISPOSAL SLIDE THAT WAS- IT WAS REALLY GREAT TO SEE THAT THE AMOUNT OF LITTER, THE AMOUNT OF SYRINGES BEING COLLECTED ON THE GROUND VERSUS THOSE BEING DISPOSED, UM, HAVE THAT KIND OF INVERSE, UM, RELATIONSHIP WHERE, UM, AS WE'VE HAD MORE RECEPTACLES, IT SEEMS LIKE IT'S GONE.

THE- THE SYRINGE ALERT HAS GONE DOWN.

SO I'M JUST WONDERING WHAT HAS LED TO THAT SUCCESS, BECAUSE IT WAS A REALLY, UM, A BIG CONTRAST.

- UH, YES, I, WELL, ONE OF THE, UM, OTHER THINGS THAT HAPPENED DURING THIS TIMEFRAME IS OUR MOBILE PILOT.

SO WE DID HAVE AN INCREASED PARTICIPATION AND ENGAGEMENT WITH PEOPLE OUT IN THE FIELD.

UM, THAT INCREASED ENGAGEMENT, WHICH WE, UH, WHICH WAS PRESENTED TO, TO THIS BOARD, UM, A FEW WEEKS, A FEW BOARD MEETINGS AGO, UM, SHOWS THAT WE HAD THAT- THAT...

THOSE ENGAGEMENTS MEANT THAT THERE WERE MORE OPPORTUNITIES FOR SAFE DISPOSAL, WHETHER DISPOSING OVER, UM, WITH THE- WITH OUR PROGRAM STAFF, OUR SWAP STAFF, OR, UM, EVEN BEING PROVIDED A PERSONAL SYRINGE, A SAFE SYRINGE, UH, RECEPTACLE FOR THEM TO USE.

- THAT'S GREAT. AND IT'S JUST I KNOW THERE'S A LOT OF CONCERN ABOUT HAVING THOSE KIND OF MOBILE PROGRAMS, BUT AS, YOU KNOW, UH, DATA SHOWS AND NOW AS DATA HERE SHOWS THOSE PROGRAMS ARE REALLY HELPFUL AND EFFECTIVE AT NOT ONLY REACHING THOSE CLIENTS, BUT ALSO REDUCING SYRINGE LITTERS.

SO IT'S JUST GREAT TO SEE THAT, UM, POSITIVE RESPONSE FROM THAT PROGRAM.

UM, I, WHEN THE- WHEN THE SLIDE CAME UP ABOUT THE 24/7 MENTAL HEALTH CRISIS RESPONSE, I WAS JUST CURIOUS, WHERE ARE THE MAJORITY OF THOSE CALLS TAKING PLACE? OR DO YOU ALL HAVE THAT INFORMATION? - I DON'T HAVE THAT INFORMATION WITH ME.

UM, I DON'T THINK DIRECTOR, YEAH, WE DON'T HAVE THAT, BUT WE WILL GET THAT FOR YOU, SUPERVISOR.

- YEAH. IT'D BE GREAT TO SEE WHERE IN THE COUNTY THOSE, UM, THOSE CALLS ARE TAKING PLACE.

- WE TRACK THEM SO WE'LL BE ABLE TO REPORT BACK TO YOU ON THAT.

- OKAY.

GREAT.

UM, AND THEN I GUESS I'LL, I HAVE A COUPLE COMMENTS AND THEN I'LL COME BACK WITH, UM, AT THE END I GUESS, OR WHEN IT'S APPROPRIATE WITH, UH, SOME ADDITIONAL DIRECTION.

BUT I DO, UM, REALLY HAVE SOME CONCERNS AROUND THE ELIMINATION OF MHCAN.

AND, UM, WE HAD A MEETING WITH THE CITY OF SANTA CRUZ LAST WEEK AS WE NORMALLY DO ON ISSUES RELATED TO HOMELESSNESS, AND THEY SHARE CONCERNS AROUND THE LOSS OF MHCAN, THE LOSS OF GEMMA HOUSE, UM, SYRINGE SERVICES.

AND, UM, AND WE THINK THERE MIGHT BE AN OPPORTUNITY TO PARTNER WITH THE CITY OF SANTA CRUZ, AND I'M OBVIOUSLY SPEAKING SPECIFICALLY WITH MY DISTRICT, UM, TO MAINTAIN THOSE SERVICES IN SOME CAPACITY.

UM, AND SO WHEN THE TIME COMES, I'M GONNA HAVE A LITTLE BIT OF, UH, EXTRA, UM, DIRECTION TO CONSIDER.

AND, AND HOW THIS HAS WORKED FOR THE NEW MEMBERS IS THAT, YOU KNOW, WE'RE NOT, SINCE WE'RE NOT MAKING A, SINCE WE'RE NOT PASSING THE BUDGET TODAY, THESE ARE JUST OPTIONS FOR CONSIDERATIONS FOR WHEN WE DO HAVE THE BUDGET COME TO US.

UM, AND SO, AND, AND AGAIN WITH, UM, I, I SHARE SIMILAR CONCERNS THAT, UH, SUPERVISOR DE SERPA SAID AROUND PSYCHIATRIC SERVICES.

ALSO CONCERN- I'VE MET WITH THE LAB AND RADIOLOGY FOLKS AND SHARE SOME OF THE CONCERNS AROUND THAT AND HOW THAT'S GONNA... HOW THOSE SERVICES WILL BE MAINTAINED SO THAT PEOPLE DON'T FALL THROUGH THE SYSTEM.

UM, AND SO I'LL END MY COMMENTS FOR NOW, AND THEN WHEN THE TIME COMES, I HAVE SOME LANGUAGE THAT I'D LIKE TO PROPOSE.

- I'M GONNA GO TO MY FAR LEFT OVER HERE WITH, UH, SUPERVISOR KOENIG AND BRING IT IN.

- THANK YOU, CHAIR.

UM, FIRST, UH, JUST WANNA POINT OUT THAT, I MEAN, IT WAS BROUGHT UP BY MEMBERS OF THE PUBLIC THAT WE SHOULD BE LOOKING AT GENERAL FUND MONIES TO SUPPLEMENT THE DEPARTMENT IN ORDER TO AVOID CUTS.

BUT WHAT I'M SEEING HERE IS THAT ACTUALLY, I MEAN, THAT'S PRECISELY WHAT WE'RE DOING, RIGHT? I MEAN, WE'RE SEEING AN 11% INCREASE IN THE BUDGET FOR HSA AT LEAST AS FAR AS THE GENERAL FUND CONTRIBUTION.

SO, UM, I MEAN, WE ARE ACTUALLY ADDING $2.75 MILLION OF GENERAL FUND MONEY FOR THE DEPARTMENT'S FUNDING.

AND WHAT WE'RE REALLY, THESE CUTS ARE BEING DRIVEN BY AS YOU- AS YOU EXPLAINED, UM, THE CALAIM RATES AND CHANGES TO, UM, YOU KNOW, PARTICULARLY BEHAVIORAL HEALTH REIMBURSEMENT.

IS THAT- IS THAT RIGHT? - WELL, JUST TO CLARIFY, WE'RE GETTING $2 MILLION FROM GENERAL FUND, UM, MORE THAN LAST YEAR, BUT THAT'S TO COVER THE SALARIES AND BENEFITS.

SO YOU DO THAT ACROSS ALL DEPARTMENTS FOR THAT FUND.

IT'S NOT AN ADDITIONAL BOOST TO, YOU KNOW, AND IN ESSENCE IT DOES COVER SALARIES, BUT IT'S NOT AN ADDITIONAL BOOST TO PROGRAMMING.

WE ARE GETTING 400,000 FROM MEASURE K, AND THAT IS FOR BEHAVIORAL HEALTH, UM, ESPECIALLY FOR THE ROOM ON BOARD ASPECT OF- OF THE GAP THAT WE HAD.

UM, I WOULD SAY WHEN YOU LOOK AT THE GENERAL FUND AS A WHOLE, I MEAN, I THINK YOU KNOW WHERE I'M GOING.

[03:55:01]

I, I... IT'S ABOUT 250 MILLION AND WE'RE GETTING 20 MILLION SO.

- MM-HMM. SURE. YEAH.

I MEAN, THE SHERIFF'S DEPARTMENT IS INCREASING IN 2% VERSUS 11%.

SO, I MEAN, IN TERMS OF TRYING TO SUPPORT ALL DEPARTMENTS, I DON'T SEE, LIKE, DOESN'T SEEMS TO ME LIKE THAT WE'RE SHORTING HSA AS FAR AS OUR GENERAL FUND CONTRIBUTION.

THAT'S MY OPINION.

UM, YOU KNOW, ONE- ONE BIG QUESTION IS, YOU KNOW, WHY WEREN'T WE ABLE TO FILL THE 74 VACANT POSITIONS THAT WE'RE GETTING RID OF TODAY? - I'M SORRY, CAN YOU REPEAT THAT? - SO WE'RE- WE'RE GETTING RID...

WE'RE ELIMINATING A BUNCH OF UNFILLED VACANT POSITIONS, RIGHT? AND I SEEMED TO RECALL WHEN THESE WERE ESSENTIALLY CREATED LARGELY DUE TO SOME OF THE, UM, THE COVID RESPONSE REVENUES AND JUST BASICALLY INVESTMENT IN OUR HEALTHCARE SYSTEM AT THAT TIME.

UM, AND, YOU KNOW, WE WERE... WE HAVEN'T BEEN ABLE TO FILL THEM AND THE- THEREFORE, THEY WERE NEVER GENERATED REVENUE, THEY NEVER PAID FOR THEMSELVES AND WE NEVER KIND OF CREATED THAT UH, SELF-PERPETUATING SYSTEM.

WHY WEREN'T WE ABLE TO FILL THESE POSITIONS? - UH, SO FOR SOME OF THE POSITIONS, UM, PARTICULARLY IN PUBLIC HEALTH WHERE WE HAD LIMITED TERM, UM, AND, UH, SOME OTHER VACANCIES, A LOT OF THOSE WERE ACTUALLY PLANNED OVER.

WE'VE HAD MULTI-YEAR GRANTS AND SO WE WERE PLANNING TO HAVE SOME SORT OF TRUE UP ONCE WE KNEW WHAT OUR SUSTAINABLE FUNDING PICTURE LOOKED LIKE UM, FOR PUBLIC HEALTH.

AND A LOT OF THOSE POSITIONS AREN'T REVENUE GENERATING.

UM, SO THAT'S- THAT'S JUST ONE SNAPSHOT OF, UM, THOSE POSITIONS.

- YEAH. I'LL ALSO ADD, UM, IN SOME OF THESE AREAS SO THE BEHAVIORAL HEALTH POSITIONS, IT'S VERY DIFFICULT TO RECRUIT.

YOU GUYS HAVE HEARD THE STORIES.

YOU'VE MADE INVESTMENTS IN, YOU KNOW, METHODS TO TRY TO INCREASE RECRUITMENT.

SO THAT ALSO HAS SOMETHING TO DO WITH IT.

UM, AND, YOU KNOW, AND AS, UM SOMETIMES IT'S WHEN YOU DON'T HAVE THE FLEXIBILITY, UM, NOT NECESSARILY THE FUNDING, YOU WANNA KEEP THOSE POSITIONS BECAUSE WHEN YOU GET NEW GRANTS, IT'S JUST EASIER TO FILL THEM IN AND INSTEAD OF COMING TO YOU AND REQUESTING THEM AND IT TAKES EIGHT MONTHS.

SO YES, WE'VE HAD MULTIPLE KIND OF STRATEGY BEHIND IT BUT A LOT OF IT IS RECRUITMENT, UM, THAT IT'S HARD TO FILL THESE POSITIONS.

UM, YOU KNOW, I THINK ESPECIALLY RIGHT NOW WHAT I, I'M SENSING IS FOLKS ARE A LITTLE SCARED ALSO TO COME TO GOVERNMENT JUST BECAUSE OF EVERYTHING THAT'S HAPPENING AT THE FEDERAL.

AND NOW WITH THE CUTS, UM, IN COUNTIES IT'S MULTIFACETED ISSUE WE'RE FACING.

- DOES THE MATH STILL WORK PARTICULARLY ON THE BEHAVIORAL HEALTH SIDE? I MEAN, WITH THE CALAIM REIMBURSEMENT RATES BEING WHAT THEY ARE, I MEAN, IF WE WERE ABLE TO HIRE ANOTHER PSYCHIATRIST, WOULD THEY BE REVENUE GENERATING OR WOULD IT BE A NET COST... NET COUNTY COST? - YEAH, I, I CAN, UM, SHARE WITH YOU HIGH LEVEL AND THEN DEFINITELY WANNA INVITE, UM, OUR NEW DIRECTOR, MARTY TO KIND OF SHARE WITH YOU.

WHEN IT COMES TO PSYCH, YES, WE BELIEVE THAT THE REVENUE IS, IS HIGH ENOUGH FOR US TO GENERATE, UM, THE RATE IS HIGH ENOUGH TO GENERATE REVENUE.

WITH SOME OTHER POSITIONS, IT MAKES IT A LITTLE BIT HARD.

SO WITH CALAIM, YOU GET PAID, UM, ALSO BY YOUR LICENSE.

SO IF YOU ARE A PSYCHIATRIST, YOU'RE GONNA GET DIFFERENT THAN LIKE, UH, SOMEONE THAT'S NOT LICENSED WHO GETS PAID AT A LOWER RATE.

AND SO IT DOES CREATE THIS PERPETUAL UNFORTUNATE, UM, SYSTEM WHERE YOU'RE REWARDING FOR THE POSITIONS THAT ARE LICENSED BUT IT'S JUST HARDER TO RECRUIT FOR THEM.

AND SO WE'RE STUCK WITH UNLICENSED POSITIONS WITH LESS REVENUE.

AND SO IT'S A DANCE THAT I THINK ALL COUNTIES ARE FACED WITH AND WE KIND OF TRY TO PLAY WITH.

BUT I'M NOT SURE IF, UM, DR. SUMMER WANTS TO ADD ANY- ANY ADDITIONAL COMMENTS.

- HI, GOOD AFTERNOON.

I THINK, UH, DIRECTOR MORALES DID A PRETTY GOOD JOB OF SHARING WITH YOU SOME OF THE CHALLENGES WITH PAYMENT REFORM.

HERE IN SANTA CRUZ COUNTY, UM, THE MEDICAL PROVIDERS WITHIN OUR BEHAVIORAL HEALTH SPECIALTY MENTAL HEALTH SYSTEM ACTUALLY DO FALL UNDER THE FEDERALLY QUALIFIED HEALTH CENTER.

SO WE'RE ACTUALLY NOT EVEN ABLE TO LEVERAGE, UH, THROUGH THE CALAIM SYSTEM FOR MEDI-CAL REIMBURSEMENT FOR OUR MEDICAL PROVIDERS 'CAUSE WE'RE LEVERAGING THAT THROUGH THE FQS.

SO, I MEAN, THERE IS- THERE'S PROS AND CONS TO DOING THAT.

UM, PSYCHIATRY PROVIDERS ARE UNDER MEDI-CAL FOR SPECIALTY MENTAL HEALTH, THE HIGHEST PROVIDER REIMBURSEMENT TYPE.

SO THERE'S SOMETHING THAT WE COULD LOOK AT THERE, BUT WE HAVE BEEN ABLE, I THINK, IN HISTORICALLY TO REALLY BENEFIT BY UTILIZING THE FEDERALLY QUALIFIED HEALTH CENTERS FOR OUR MEDICAL SERVICES.

THERE IS CHALLENGE AROUND THE OTHER PROVIDER TYPES, UH, WITH FOLKS WHO ARE UNLICENSED.

AND YOU MAY KNOW WITHIN THE BEHAVIORAL HEALTH SYSTEM, IT'S VERY, VERY HARD.

WE'RE AT A NATIONAL CRISIS FOR RECRUITING MENTAL HEALTH WORKERS AND REALLY WE WANNA GROW OUR WORKFORCE.

AND SO THAT MEANS REALLY HAVING INTERNSHIPS AND BRINGING PEOPLE THAT AREN'T YET LICENSED INTO THE FOLD BUT THEY REALLY DO HAVE MANY MORE DEMANDS ON THEIR TIME FOR SUPERVISION, FOR TRAINING,

[04:00:01]

WHICH REDUCES THE NUMBER OF HOURS THAT ARE AVAILABLE FOR DIRECT BILLABLE SERVICES.

SO THE REIMBURSEMENT MODEL UNDER PAYMENT REFORM DOESN'T REALLY FACTOR OUT WHEN YOU ACTUALLY LOOK AT THE REALITY OF A SYSTEM THAT HAS TO BE A TRAINING ORGANIZATION.

SO, SO THERE'S SOME CHALLENGES THERE.

UH, YOU KNOW, WE'RE NOT ALONE IN THIS.

THIS IS AN ISSUE IN EVERY COUNTY.

UM, CERTAINLY OUR STATE ASSOCIATION IS WORKING WITH THE DEPARTMENT OF HEALTHCARE SERVICES TO KIND OF REEVALUATE AND ADVOCATE FOR THE REALITY THAT THE REIMBURSEMENT MODEL THAT REALLY DID COME OUT IS NOT HELPING ANY COUNTY AT THIS POINT TO BE WHOLE.

SO MORE INFORMATION TO COME BUT IT'S A CHALLENGING LANDSCAPE RIGHT NOW.

- GOT IT.

THAT KIND OF ANSWERED MY NEXT QUESTION OR I CAN GUESS, UM, WHICH IS, I MEAN, WHAT WE'RE HEARING FROM, UM, WE HEARD FROM THE PRESIDENT, UM, OF NAMI THAT THEY'RE SENDING... THAT WE'RE SENDING PEOPLE OUT OF COUNTY BECAUSE OF A LACK OF BEDS THAT WE, AND THAT WE THEN LOSE ABOUT 50% OF THE REIMBURSEMENT DOLLARS WHEN THIS HAPPENS, IS- IS THAT IN FACT THE CASE JUST BECAUSE WE HAVE A SHORTAGE OF CARE OPTIONS LOCALLY? - SO BEING SLIGHTLY NEW, RIGHT? A FEW WEEKS IN, WHAT I HAVE NOTICED IS THAT THERE IS A VERY, UM, BIG GAP IN THE FULL CONTINUUM OF CARE FOR OUR SPECIALTY MENTAL HEALTH SERVICES.

AND THERE'S A VERY LOW NUMBER OF BEDS FOR OUR HIGH NEEDS CLIENTS.

AND SO I REALLY WANT TO DIG IN WITH THE TEAM AND UNDERSTAND WHAT HAVE BEEN THE LOCAL CHALLENGES AROUND THAT.

UH, SOME OF THAT CERTAINLY MUST BE FISCAL, I MEAN, OUR- OUR PARTNERS AT ENCOMPASS CAME TO US YESTERDAY AND REALLY SHARED THE DILEMMA THAT THEY'RE STRUGGLING WITH.

AND SO FOR ME TO HAVE A REALLY CLEAR ANSWER FOR YOU, I NEED TO DIG INTO WHAT THE CURRENT CONTRACTS LOOKS LIKE, WHAT THEIR BUDGET LOOKS LIKE, WHAT KIND OF EXPENDITURES ARE THEY DEALING WITH, LIKE WHAT'S THE REALITY OF THE COST TO OPERATE THE FACILITY? AND HOW DOES THAT FACTOR INTO WHAT WE ACTUALLY HAVE AVAILABLE TO REIMBURSE PROVIDERS FOR, AND THEN FIGURE OUT WHAT'S GONNA BE A MODEL THAT MAKES SENSE TO START TO EFFECTIVELY GROW THAT CONTINUUM HERE LOCALLY.

SO THAT'S NOT A QUICK OR EASY ANSWER, BUT I FEEL LIKE IT'S AN HONEST AND REALISTIC ONE.

- OKAY.

DIRECTOR MORALES, DO YOU HAVE ANYTHING YOU WANNA ADD TO THAT OR? - IT'S, UM, WHAT WE LEARNED WITH THE CHILDREN'S FACILITY THAT IS SCHEDULED TO OPEN, UM, IS, IS THAT IT TAKES A LOT MORE FOR US TO PENCIL OUT THAN JUST FILLING THAT FACILITY.

IT COSTS US $27 MILLION AND THE CONTRACTOR WE'RE GONNA BE WORKING WITH, I THINK IS ABOUT $8 MILLION.

UM, SO WE'RE GONNA BE, UM, YOU KNOW, THE ESTIMATES RIGHT NOW, EVEN IF WE HAVE A REGIONAL MODEL.

WHICH MEANS WE BRING OTHER, YOU KNOW, YOUTH FROM, UM, OUR NEIGHBORING COUNTIES, WE WILL STILL BE IN THE HOLE ABOUT FOUR TO $5 MILLION.

SO WE DO DEFINITELY NEED TO PENCIL OUT.

WE, WE THOUGHT LIKE, OKAY, YOU KNOW, KEEPING BUILDING IT LOCALLY HAVING THE KIDS HERE LOCALLY, IT'S STILL BENEFIT TO THE COMMUNITY.

WE KNOW THAT.

ABSOLUTELY THERE'S NO QUESTION ABOUT THAT.

BUT FINANCIALLY WE ALSO NEED TO THINK AS A SYSTEM, YOU KNOW, WHAT ARE GONNA BE THE MAINTENANCE PLANS FOR THESE BUILDINGS? UM, BECAUSE THEY DO, EVERY YEAR THEY GO UP, FACILITIES JUST INCREASE.

AND SO IT'S, I THINK, SOMETHING FOR US TO CONTEMPLATE AS WELL AS WE'RE THINKING ABOUT ADDITIONAL FACILITIES.

WE HAVE A LOT OF FACILITIES FOR SUCH A TINY COUNTY, AND MY STRESS HAS BEEN HOW ARE WE GONNA MAINTAIN THESE? BECAUSE AS CEO, UH, PALACIOS SAID, YOU KNOW, THEY PAY US TO BUILD THEM, BUT THEY'RE NOT PAYING US TO SUSTAIN THEM, AND THEN WE'RE GOING TO GET DINGED FOR NOT HAVING, YOU KNOW, THAT CONTINUITY OF CARE.

SO IT'S A TRIPLE EDGED SWORD.

IT'S NOT EVEN A DOUBLE EDGED SWORD, WHAT WE'RE FACED WITH RIGHT NOW.

- OKAY, THANK YOU.

UM, AND YOU TALKED ABOUT MEDICRUZ A LITTLE BIT AS SORT OF A LAST BEST OPTION IF WE SEE THESE, UM, MAJOR CUTS TO MEDI-CAL.

UM, I MEAN, DO I UNDERSTAND CORRECTLY THAT'S PRETTY MUCH JUST A HUNDRED PERCENT LOCALLY FUNDED OPTION OR HOW DOES THAT WORK? - IT WORKS THROUGH WHAT WE CALL REALIGNMENT DOLLARS THAT COME INTO THE COUNTY.

UM, AND SO WE GET ABOUT, I WANNA SAY $3 MILLION OF REALIGNMENT RIGHT NOW TO SUPPORT THESE SERVICES.

AND THOSE ARE, UH, YOUR REGISTRATION, UH, TO YOUR CAR VEHICLE FEES THAT YOU PAY AND THERE'S ANOTHER ONE THAT I'M FORGETTING, I THINK IT'S SOME KIND OF, I DON'T HAVE IT ALL MEMORIZED.

BUT IT'S BASICALLY STATE DOLLARS THAT WE USE TO SUPPORT THE INDIGENT CARE IN OUR COMMUNITY.

IT'S JUST NOT- WHAT WE KNOW FROM JUST THE PREVIOUS MODEL IS THAT THE TWO TO $3 MILLION WE HAVE NOW IS NOT ENOUGH.

IT USED TO BE LARGER AND I ANTICIPATE WITH, UH, RIGHT NOW BEING ABLE TO SERVE ABOUT 350 WITH THAT AMOUNT, UM, AND THE CHANGES OF ABOUT 7,000 PEOPLE NOT BEING NOW COVERED THROUGH MEDI-CAL, YOU'RE GONNA HAVE TO CONSIDER GROWING THAT FUND IF, YOU KNOW, YOU CHOOSE TO CONTINUE, UM, ON THAT PATH.

- RIGHT. SO IF WE WERE GONNA GOING TO GROW IT, I MEAN, I ASSUME THE REALIGNMENT DOLLARS ARE LIMITED.

- YES. YEP.

- GROWING IT WOULD REQUIRE A HUNDRED PERCENT LOCAL MONEY.

- THAT'S CORRECT. - RIGHT.

[04:05:02]

UM, OKAY.

IF WE WERE ABLE TO FIND, UM, AN ADDITIONAL I DON'T KNOW, TWO TO $5 MILLION FOR THE DEPARTMENT, HOW WOULD YOU INVEST IT? - THAT'S A GREAT QUESTION.

UM, YOU KNOW, I, I HAVE TO PUT MY HAT ON AND THINK ABOUT, UM, WHAT WE THINK WILL PAY DIVIDENDS IN THE LONG RUN OR WHAT'S GONNA BE THE ROI.

UM, I THINK UNFORTUNATELY WE'RE IN A SITUATION WHERE WE DO HAVE TO THINK ABOUT CUTS, AND SO I WOULD TRY, UM, YOU KNOW, TO ENSURE THAT THE CURRENT SERVICES ARE FULLY, UM, COVERED THAT WE HAVE, UH, CURRENTLY IN PLACE.

WHAT I ANTICIPATE IS YOU'RE GONNA SEE MORE CUTS.

SO I WOULD STILL CONSIDER MOVING FORWARD WITH WHAT WE SHARED WITH YOU, THAT USING THAT FUNDING SO I DON'T HAVE TO COME TO YOU OR MS. HERRERA WON'T HAVE TO COME TO YOU IN SIX MONTHS AND SHARE WITH YOU THAT THERE'S ADDITIONAL CUTS FOR YOU GUYS TO CONSIDER.

I DON'T THINK YOU'RE GONNA GET OUT OF THIS.

I REALLY DON'T.

I'VE LOOKED AT IT EVERY SHAPE, WAY AND FORM.

UM, WHAT WE'RE TRYING TO DO IS WHAT IS THE LEAST PAINFUL.

YOU CAN DEFINITELY, YOU KNOW, CHOOSE NOT TO, UM, AND KIND OF POSTPONE IT, BUT IT WOULDN'T BE WISE OF US.

JUST LIKE WE DON'T ENCOURAGE PEOPLE TO MAX OUT THEIR CREDIT CARDS AND NOT PAY THEIR MORTGAGE, RIGHT? OR THEIR RENT OR SO FORTH.

YOU'LL HAVE TO MAKE REALLY BOLD CHANGES, UNFORTUNATELY.

SO IF YOU HAVE MONEY, LET'S KEEP IT FOR NEXT YEAR TO MAKE SURE THAT WE DON'T HAVE TO COME BACK TO YOU IN A FEW MONTHS.

- OKAY, THANK YOU. AND THEN JUST ONE LAST QUESTION.

UM, FIRST ALL, FIRST OF ALL, I WANNA SAY, UM, I'M REALLY SORRY THAT WE'RE LOSING YOU.

AND, UM, YOU KNOW, I THINK YOU'VE DONE AN INCREDIBLE JOB WITH YOUR SHORT TIME WITH THE COUNTY AND MADE A HUGE IMPACT.

UM, AND, UH, I THINK YOLO IS REALLY LUCKY THAT THEY'RE GONNA BE GETTING YOU.

UM, I ALSO UNDERSTAND THAT YOLO ACTUALLY HAS A COMBINED HEALTH AND HUMAN SERVICES DEPARTMENT, UM, AS TO A NUMBER OF OTHER COUNTIES THAT ARE RELATIVELY CLOSE IN SIZE TO SANTA CRUZ.

UM, BUTTE COUNTY IS ABOUT 200,000, SHASTA, CLOSE TO 200,000 PLACER IS MORE LIKE 400,000.

BUT THESE ARE JUST A FEW EXAMPLES OF, UM, COUNTIES THAT COMBINE HEALTH AND HUMAN SERVICES.

NOW, UM, I UNDERSTAND THERE MIGHT NOT BE LIKE A HUGE AMOUNT OF COST SAVINGS IN A- A COMBINED DEPARTMENT, BUT DO YOU THINK THAT THERE'S OPPORTUNITIES FOR AT LEAST IMPROVED SERVICE DELIVERY WHERE, YOU KNOW, THERE'S- MAYBE THERE'S LESS, LESS OF- LESS SILOS BETWEEN THE TWO DEPARTMENTS? - THANK YOU FOR PUTTING ME ON THE SPOT.

THAT'S A GOOD QUESTION.

[LAUGHS] I WOULD SAY, UM, LIKE ANYTHING, IT SHOULD BE EXPLORED.

I THINK THE LEVEL OF ACUTENESS THAT WE HAVE IN OUR COMMUNITY THOUGH IS PRETTY HIGH.

UM, WE HAVE HIGHER HOMELESSNESS, UM, YOU KNOW, RATES COMPARED TO THOSE COUNTIES THAT YOU'VE OUTLINED.

WE HAVE HIGHER SUICIDE, WE HAVE HIGHER CRISIS, AND SO, UM, TO ALL FALL UNDER ONE DIRECTOR MIGHT BE TOO MUCH IN THIS COUNTY.

BUT I WILL SAY, LIKE ANYTHING, IT SHOULD BE EXPLORED BECAUSE WE JUST DON'T KNOW IF, IF THERE'S WAYS, UM, THAT WE CAN INCREASE, UM, INTEGRATION.

I WILL SAY THOUGH, MY MOTTO HAS ALWAYS BEEN, AND THIS IS ME PERSONALLY, LIKE YOU CAN INTEGRATE NO MATTER WHAT PART OF THE CORNER OF THE BUILDING YOU'RE IN, RIGHT? IT'S ABOUT LEADERSHIP AND IT'S ABOUT, UM, WANTING TO PARTNER.

AND WE HAVE THAT PARTNERSHIP IN THIS COUNTY, WHICH IS REALLY NICE BETWEEN THE AGES.

UM, BUT YOU KNOW, I THINK IT SHOULD BE EXPLORED.

- OKAY. THANK YOU.

- SUPERVISOR MARTINEZ.

- THANK YOU FOR THE PRESENTATION AND FOR ANSWERING MY COLLEAGUES' QUESTIONS.

UM, I, I MADE A NUMBER OF COMMENTS EARLIER DURING MY OPENING STATEMENT ABOUT, UM, MY COMMITMENT TO SUPPORTING THE SAFETY NET AND SUPPORTING THOSE PARTICULARLY, UM, THOSE WHO ARE AT RISK OF LOSING THEIR HEALTHCARE BENEFITS, UM, BOTH FOR, YOU KNOW, THEIR HEALTH AND QUALITY OF LIFE AND THE QUALITY OF LIFE OF OUR COMMUNITY, AND ALSO JUST FRANKLY, FOR REVENUE IN OUR CLINICS AND WITH OUR CBOS.

UM, BECAUSE IT'S GONNA... I ANTICIPATE THERE WILL BE HARDER DECISIONS TO MAKE AND SOME PRETTY, UM, DIFFICULT, IF NOT DEVASTATING CONVERSATIONS TO HAVE IN THE COMING MONTHS, UNFORTUNATELY.

UM, AND IT ISN'T LOST ON ME THAT EACH DECISION DOES IMPACT HUMAN LIVES, RIGHT? I THINK THAT'S WHAT MAKES THIS BUDGET HEARING HARDER THAN MAYBE OTHERS MIGHT BE.

UM, BECAUSE WE'RE TALKING ABOUT PEOPLE.

AND, UM, AND SO IT TAKES, SO I TAKE IT VERY SERIOUSLY AND I'M TRYING TO HOLD MY VALUES OF COMPASSION AND EQUITY AND ALSO, UM, BEING RESPONSIBLE AND PLANFUL FOR WHAT'S COMING.

[04:10:03]

AND SO WE CAN BE AS STRONG AS WE CAN FACING THE NEXT COMING YEARS.

UM, I APPRECIATE WHAT I, WHAT I APPRECIATE ABOUT WHAT YOU'RE BRINGING TO US IS THAT I HEAR YOU TRYING TO DO SOME RIGHT SIZING, RIGHT? THAT THERE'S SOME STRUCTURAL DEFICITS DESPITE WHAT'S HAPPENING AT THE STATE AND FEDERAL LEVEL THAT NEED TO BE ADJUSTED, ESPECIALLY BECAUSE OF WHAT'S HAPPENING AT THE FEDERAL AND STATE LEVEL.

AND THAT, YOU KNOW, THERE ARE SOME UNFORTUNATE RUNAWAY COSTS A LOT OF THINGS THAT ARE OUTSIDE OF OUR CONTROL, OUR REIMBURSEMENT RATES, OUR COST OF LIVING, YOU KNOW, CHALLENGES OF RECRUITMENT, RIGHT? A LOT OF THINGS OUTSIDE OF OUR CONTROL, BUT HAVE CONTRIBUTED TO SOME RUNAWAY COSTS IN SOME OF OUR DEPARTMENTS.

AND IN ORDER TO BE RESPONSIBLE, WE HAVE TO MAKE SOME DIFFICULT DECISIONS AND RIGHT SIZE THOSE PROGRAMS. UM, ONE THING THAT IS, I HAVEN'T QUITE, UH, WRAPPED MY HEAD AROUND YET, AND SOME OF IT'S COMING FROM THE FEEDBACK THAT WE'RE HEARING FROM THE PUBLIC TODAY, WAS THAT A LOT OF THE RIGHT SIZING THAT WE TALKED ABOUT PRIOR TO TODAY'S HEARING WAS AROUND, UH, FTE AND KIND OF THE NUMBER OF FTES THAT BE CHANGED.

BUT NOW I'M HEARING FOLKS TALK ABOUT THE CLOSURE OF BEDS AND SORT OF, UM, YEAH, LIKE, LIKE CLOSING OF BEDS AT TELOS, PERHAPS CASA PACIFIC.

AND I JUST, I HAVEN'T PUT IT IN MY MIND IN THE CONTEXT OF THE CUTS THAT WE'RE PROPOSING WILL LEAD TO A REDUCTION OF BEDS.

UM, AND SO I'M JUST WONDERING IF MAYBE, MAYBE IT'S DR. SANDOVAL OR IT'S, UM, YOU, DIRECTOR MORALES, WHO COME AND JUST TALK TO US ABOUT THE IMPACT OF THIS BUDGET IN THE NET NUMBER OF BEDS AVAILABLE IN OUR COMMUNITY.

- KAREN OR MARNIE.

- THANK YOU FOR THE QUESTION.

FIRST, I DO WANT TO, UH, BRING IT TO THE ATTENTION OF THE BOARD THAT, AS OF YESTERDAY WAS THE FIRST THAT WE WERE INFORMED OF ENCOMPASS'S PROPOSED CLOSURE OF THE FACILITY.

SO THIS IS VERY BRAND NEW INFORMATION FOR US.

SO I THINK THAT'S VERY IMPORTANT THAT YOU, THAT YOU KNOW THAT.

UM, SO WE ARE DEFINITELY GONNA TRY TO LOOK AT THAT.

TELOS CLOSED. UM, RIGHT NOW, OUR HOPE IS THAT, THAT WE DON'T HAVE TO CLOSE CASA PACIFIC, BUT WE'RE HAVING TO DIG INTO THAT.

THAT'S BRAND NEW.

AS FAR AS THE NUMBER OF BEDS, KAREN CAN PROVIDE THE DETAILED INFORMATION ON THE NUMBER OF BEDS IN THE FACILITIES.

- YEAH, SO FOR MENTAL HEALTH, WE'VE ONLY EVER HAD 38 AVAILABLE OPERATING AROUND 36 DEPENDING ON WHETHER OR NOT, UM, EACH FACILITY, UH, FILLED EVERY BED.

UM, ENCOMPASS RUNS ALL OF- OPERATES ALL OF THE MENTAL HEALTH RESIDENTIAL IN OUR COMMUNITY.

UM, EL DORADO CENTER, WHICH IS, UM, IN UNINCORPORATED MIDTOWN, WITH LIVE OAK, UM, IS A 16 BED FACILITY, CASA PACIFIC IS 12, AND TELOS WAS 10, OPERATING AROUND EIGHT.

SO THAT IS IT FOR MENTAL HEALTH RESIDENTIAL AT THE NON-INPATIENT OR LOCKED CARE LEVEL.

IN OUR SUD CONTINUUM, WE HAVE CURRENTLY 94 BEDS, UM, WITH THE NEW INVESTMENTS FROM THE BOND BEACH AT GROUND ONE, ALL OF THOSE FACILITIES WERE SUD FACILITIES SO 30 MILLION WENT TO THE CITY TO BUILD A CAMPUS AT, UM, CORAL STREET.

UM, ALMOST 4 MILLION WENT TO ENCOMPASS TO EXPAND THEIR CURRENTLY EXPANDING [INAUDIBLE], WHICH IS REALLY GREAT IN WATSONVILLE TO ADD MUCH NEEDED, UM, WITHDRAWAL MANAGEMENT SERVICES.

AND THEN JANICE WON A $44 MILLION AWARD TO BUILD A RECOVERY CAMPUS AT THE SITE OF THE ROADWAY IN, IN WATSONVILLE.

SO, REALLY GREAT TO HAVE THAT INFUSION OF SERVICES IN WATSONVILLE.

ALSO, SOMETHING THAT WE'VE BEEN WORKING ON IN BEHAVIORAL HEALTH.

HOWEVER, THAT WILL EXPAND OUR SUD CONTINUUM.

AS YOU'VE HEARD TODAY, OUR MENTAL HEALTH CONTINUUM IS SHRINKING.

PART OF THE REASON THAT OUR INPATIENT COSTS ARE SO HIGHER THAT WE RELY ON THE INPATIENT UNIT, MORE SO IS THAT WE DO NOT HAVE A BROAD CONTINUUM OF CARE FOR MENTAL HEALTH SERVICES IN OUR COUNTY.

UM, THE- THE TYPICAL CONTINUUM OF CARE WOULD ALLOW FOR ENOUGH RESIDENTIAL BEDS TO BE ABLE TO STEP PEOPLE INTO, FOR EXAMPLE, EL DORADO CENTER AS A CRISIS RESIDENTIAL, UH, VERSUS SENDING SOMEBODY TO THE HOSPITAL.

IF THAT INTERIM LEVEL OF RESIDENTIAL IS NOT AVAILABLE, THEN THE ONLY THING LEFT IS FOR PEOPLE TO PRESENT AT THE CSPN CRISIS, UH, BECAUSE BASICALLY WE'VE BEEN, WE HAVEN'T BEEN ABLE TO SERVE THEM BEFORE THE CRISIS, AND SO THEY END UP IN THE CRISIS.

I'LL ALSO JUST FOR, UM, JUST FOR EDUCATION'S SAKE, ABOUT 46% OF THE PEOPLE GOING INTO OUR MENTAL HEALTH RESIDENTIAL ARE EXPERIENCING HOMELESSNESS AT THE TIME THEY ENTER.

AND I WANNA SAY IT'S ABOUT 52% FOR SUD.

SO A LOT OF THE INDIVIDUALS THAT WE SERVE AT THE RESIDENTIAL LEVEL FOR BOTH SUD AND MENTAL HEALTH, UM, DON'T HAVE ANYWHERE TO GO.

ONCE THEY GAIN SOME STABILITY AND SOME HEALING,

[04:15:04]

UM, THEY END UP GOING RIGHT BACK TO THE STREET BECAUSE WE AREN'T ABLE TO SOLVE FOR THE HOUSING.

SO IT'S A VERY COMPLICATED PICTURE.

UM, HOWEVER, IT'S DEFINITELY THERE HAS BEEN A LACK OF INVESTMENT IN OUR MENTAL HEALTH SYSTEM OF CARE.

AND I, I DON'T, I... WHEN I GOT HERE, WE HAD THE THREE, UH, MENTAL HEALTH RES.

I'M NOT EXACTLY SURE, UH, I'M NOT EXACTLY SURE HOW THAT CAME TO BE OR WHETHER HE HAD, I UNDERSTAND THERE WAS MORE BEFORE THAT THAT CLOSED DOWN.

WE ALSO HAD RIVER STREET SHELTER THAT CLOSED DOWN.

SO, UM, WE HAVE SEEN A SHRINK OVER THE YEARS.

UM, I THINK THAT WE HAVE BEEN, UM, SINCE DR. SANDOVAL GOT HERE REALLY THINKING ABOUT CREATIVE WAYS TO SOLVE THAT PROBLEM.

ONE OF THE ISSUES WITH MENTAL HEALTH RESIDENTIAL, THAT DOESN'T EXIST FOR SUD RESIDENTIAL IS THAT MENTAL HEALTH RESIDENTIAL IS SUBJECT TO THE IMD RULE, WHICH MEANS THAT YOU CANNOT HAVE MORE THAN 16 BEDS IN ANY MENTAL HEALTH RESIDENTIAL FACILITY.

UM, THAT DOES NOT INCLUDE FACILITIES THAT ARE, LIKE, FOR EXAMPLE, OUR FRONT STREET FACILITIES, WHICH ARE MORE OF A BOARD AND CARE, THEY'RE LICENSED AS ADULT RESIDENTIAL FACILITY.

SO IT'S A DIFFERENT TYPE OF LONGER TERM USUALLY CARE.

FOR THAT SOCIAL REHAB OR CRISIS RESIDENTIAL, WE ARE LIMITED TO THAT 16 BED PER FACILITY.

UM, WITH THE RATES THAT WE HAVE, ESPECIALLY FOR THE SOCIAL REHAB IT DOESN'T PENCIL OUT FOR OPERATORS TO, UM, REALLY, BE ABLE TO INVEST IN THE, UH, CLINICAL PROGRAMMING THAT IS, UM, REQUIRED FOR THE LEVEL OF CARE THAT'S PROVIDING.

SO SOCIAL REHAB, WHICH IS HOW CASA PACIFIC IS, UM, LICENSED.

AGAIN, ONLY 12 BEDS THERE.

THE RATE IS 200 AND SOMETHING.

I CAN'T REMEMBER OFF THE TOP OF MY HEAD.

UM, CRISIS RESIDENTIAL, ON THE OTHER HAND IS 400 AND SOMETHING.

SO YOU'RE GETTING A MUCH HIGHER RATE, BUT THE RESPONSIBILITY IS TO PROVIDE, UM, A MUCH MORE ROBUST CLINICAL PROGRAMMING IN, UM, AT THAT RATE.

SO, I DON'T KNOW. I DON'T HAVE AN ANSWER FOR YOU AS TO WHY, BUT THESE ARE SOME OF THE THINGS THAT WE FACE WHEN WE'RE TRYING TO REALLY EXPAND THE MENTAL HEALTH, UM, RESIDENTIAL SORT OF LEVEL OF CARE, AS WELL AS, HONESTLY, DAY TREATMENT, WHICH IS ALSO LACKING IN OUR COUNTY.

THAT WOULD PROVIDE LIKE FIVE HOURS A DAY OF TREATMENT, FIVE DAYS A WEEK, OR EVEN THREE HOURS WITH, UM, WITH A LESS INTENSIVE LEVEL.

WE DON'T HAVE THAT EITHER.

SO WE'RE HAVING PEOPLE BASICALLY LEAVE RESIDENTIAL AND HAVE PROGRAMS LIKE MHCAN, WHICH IS HONESTLY WHY MHCAN IS SO VALUABLE TO US BECAUSE PEOPLE HAVE A PLACE TO GO AND GET SUPPORT DURING THE DAY.

UM, SO ANYWAY, IT'S A, IT'S A, IT'S A MESS.

- WELL, WE REALLY JUST NEED TO TAKE THIS NEXT YEAR, AND REALLY FIGURE OUT HOW DO WE ACTUALLY SOLVE THE DILEMMA OF THE GAPS IN THE COMMUNITY CARE? AND WE'RE NOT GONNA BE ABLE TO SOLVE THAT BY OURSELVES.

WE NEED TO ACTUALLY BRING IN THE COMMUNITY AND REALLY TALK TO THE COMMUNITY PROVIDERS.

THERE'S PROBABLY GONNA BE SOME RFPS IN OUR FUTURE, RIGHT? - YES.

- THERE'S A LOT THAT WE NEED TO DO THAT CAN'T HAPPEN OVERNIGHT BUT THIS IS A GLARING, GLARING ISSUE FOR US.

SO YOUR QUESTIONS ARE RELEVANT, THEY'RE IMPORTANT.

UM, WE WILL HAVE MORE CONVERSATIONS.

- YEAH.

- THANK YOU FOR THAT OVERVIEW.

UM, AND SORRY, IT'S A MESS.

[LAUGHS] - MAYBE THAT'S THE WRONG WORD TO USE PUBLICLY.

- I WOULD SAY IT'S AN OPPORTUNITY TO REALLY SHIFT HOW WE TACKLE THINGS.

- YEAH. - RIGHT.

- THE THING THAT I WOULD ASK, UM, WE'RE NOT ADOPTING THIS BUDGET TODAY, IT'S GONNA COME TO THE LAST DAY, IS THAT IF IT APPEARS THAT THE BUDGET THAT'S PROPOSED WILL REDUCE THE NUMBER OF RESIDENTIAL BEDS THAT EXISTS TODAY TO PLEASE COMMUNICATE THAT OR LET US KNOW THAT IS ON THE TABLE FOR LAST DAY BUDGET HEARINGS.

THAT WOULD BE HELPFUL.

- YEAH. - THANK YOU.

UM, LET'S SEE, MOVING ON JUST A LITTLE BIT. UM, I DO...

I'VE HEARD THAT THERE MAY BE SOME SUPPORT, UM, FROM MY COLLEAGUES ON THE BOARD TO RESTORE FUNDING FOR MHCAN AND GEMMA PROGRAM.

UM, THAT IS SOMETHING THAT I WOULD BE SUPPORTIVE OF.

I HAVE A, UM... WHEN I GO BACK TO WHAT I WAS ORIGINALLY SAYING WHICH IS WE REALLY NEED TO PRESERVE THE SAFETY NET.

WE NEED TO MAKE SURE THAT THERE'S SPACE THAT DOESN'T ALLOW PEOPLE TO FALL THROUGH THE CRACKS, RIGHT? WE NEED TO CATCH FOLKS BEFORE THEY FALL THROUGH THE CRACKS.

I, I BELIEVE AND KNOW THAT MHCAN IS ONE OF THOSE OPTIONS, AND SO, UM, I WOULD BE SUPPORTIVE OF, OF A MOTION THAT WAS IN SUPPORT OF THAT.

UM, MOVING ON TO A COUPLE OF OTHER, UM, LESS MAYBE LOADED ITEMS ON THE AGENDA.

UM, THANK YOU FOR BRINGING BACK THE ITEM TO, UM, ALIGN OUR EXCHANGE PRACTICES OF SYRINGE SERVICE PROGRAM WITH THE RECOMMENDED PRACTICES AT THE CENTER FOR DISEASE CONTROL.

THAT'S SOMETHING THAT I SUPPORT, AND SO I WAS REALLY GLAD TO SEE IT ON THE AGENDA TODAY.

SO, THANK YOU FOR THAT.

AND FINALLY, THERE ARE TWO OTHER PARTS OF YOUR DEPARTMENT THAT ARE REALLY IMPORTANT AND REALLY MEAN A LOT TO MY DISTRICT, IN PARTICULAR.

UM, AND THAT'S UNDER, THEY'RE BOTH UNDER ENVIRONMENTAL HEALTH.

UM, ENVIRONMENTAL HEALTH HAS BEEN DOING A LOT OF WORK TO SUPPORT MY OFFICE IN SOME OF THE DISASTER,

[04:20:03]

MORE COMPLEX DISASTER REBUILDS, PARTICULARLY AS IT RELATES TO SEPTIC ISSUES.

I KNOW YOU'RE STRUGGLING WITH SOME STAFFING CHALLENGES, UM, AND REALLY APPRECIATE YOUR EFFORT TO HELP US STREAMLINE THE PROCESS FOR PEOPLE WHO DO IN- INTERACT WITH YOUR DEPARTMENT THROUGH, UM, UH, THEIR REBUILDS AND PLEASE KEEP ME IN TOUCH IF THERE'S SOMETHING ELSE THAT MY OFFICE CAN DO TO SUPPORT THAT.

AND THEN FINALLY, UM, IN THE SAME PART OF YOUR DEPARTMENT, THE WATER RESOURCES DIVISION, UM, YOU HAVE SOME LEADERSHIP UNDER THAT DIVISION THAT'S REALLY BEEN HELPING US ON SOME OF THE WATER QUALITY ISSUES IN THE SAN LORENZO VALLEY, PARTICULARLY, UM, IN BIG BASIN AREA.

AND, YOU KNOW, BEEN A BIG STRUGGLE.

SO I WANNA THANK YOU FOR DEDICATING SOME RESOURCES TO HELPING ENSURE THAT OUR RESIDENTS HAVE ACCESS TO CLEAN AND RELIABLE WATER, UM, WHICH IS A BASIC HUMAN RIGHT, IN MY OPINION.

SO, UM, THANK YOU VERY MUCH, AND, UM, I'M GONNA RESERVE ANY COMMENTS RELATED TO THE LAB AND RADIOLOGY FOR THE TIME YOU BRING BACK A MORE THOROUGH, UM, REPORT ON THAT, WHICH WILL BE A WEEK FROM TODAY.

THANK YOU.

- THANK YOU AND THANK, THANK YOU FOR ALL THE STAFF.

UH, YOU KNOW, I THINK THAT SOME OF THE THINGS I WANNA MENTION, UH, STAFF KIND OF HIT THE NAIL ON THRERE ABOUT LOOKING AT RFPS DIFFERENT, LOOK AT DIFFERENT STRATEGIES, BUT IT'S ALSO AN OPPORTUNITY TO EXPLORE DIFFERENT FUNDING SOURCES.

WHAT I REALLY MEAN IS TO FACILITATE WITH OTHER AGENCIES OR CITIES THAT WOULD BE WILLING TO ADOPT SOME OF THESE PROGRAMS, UH, SERVICES LIKE MHCAN, GEMMA.

SUPERVISOR CUMMINGS MENTION HIS MEETING WITH CITY OF SANTA CRUZ.

YOU KNOW, IF I HEARD RUMORS OF JANICE HAVING SOME INTEREST.

SO IT'S A GOOD OPPORTUNITY FOR US TO ALSO EXPLORE THAT, UH, AS WELL.

UM, I, I AM GONNA MENTION SOME STUFF ABOUT LABS AND X-RAY, UM, 'CAUSE I HAD THE OPPORTUNITY TO MEET WITH THEM, AND IT WAS A FAIRLY LONG MEETING WITH THEM, UM, BUT I DID THE SOUTH COUNTY CENTER, UH, THE FREEDOM CENTER, SORRY.

AND SO, FROM-FROM STAFF THERE, FROM LABS, X-RAY, FROM, UH, NURSING PSYCHE- UH, PSYCHIATRIC PRACTITIONER.

UM, SEVERAL DOCTORS CAME IN, UH, TO SPEAK WITH US, BUT THEY'RE TALKING ABOUT HOW THEY COULD POSSIBLY, UH, LOOK AT WAYS TO BETTER STREAMLINE PRODUCTIVITY AND, UH, ADDING ADDITIONAL, UH, I GUESS THINGS THEY AIN'T BILLED THAT THEY SHOULD BE BILLING.

UH, SO I DON'T KNOW IF IT'S TRAINING WITH THE BILLING SYSTEM BUT THEY'RE SAYING THAT THEY, THAT NUMBER ONE, THEY'RE, THEY COULD BE MORE PROFITABLE AND MORE PRODUCTIVE IS WHAT THEY'RE SAYING.

UM, SOME OF THE OTHER THINGS THAT THEY MENTIONED IS, UM, WELL, I'LL LEAVE IT LIKE THAT FIRST, RIGHT? I WANNA ASK, LIKE, CAN WE ASK BILLING? LIKE WHAT IS, LIKE, I HAVE A AUDIT OF WHAT COULD BE BILLABLE THERE TO MAKE, YOU KNOW, MAKE IT MORE, IF NOT PROFITABLE, AT LEAST TO SUSTAIN ITSELF, RIGHT? UM, IS THAT A POSSIBILITY THAT WE'VE LOOKED INTO, SOME SORT OF AUDIT AND WHAT IS BILLABLE AND TRAINING FOR THEM HOW TO BILL ON CERTAIN THINGS? - YEAH. THANK YOU FOR THAT QUESTION, SUPERVISOR HERNANDEZ.

UM, YES.

IN FACT, OVER THE PAST PROBABLY YEAR AND A HALF TO TWO YEARS, WE'VE SPENT, UM, A LOT OF TIME LOOKING AT THE PRODUCTIVITY LEVELS, AND, UH, BILLING AND HOW THINGS ARE GOING.

I WILL SAY OVER THE PAST YEAR, WE'VE SEEN AN IMPROVEMENT.

UH, YOU'RE RIGHT, THERE'S OPPORTUNITIES STILL FOR US TO DO BETTER.

AND YES, IT WOULD, IT- IT'S ALREADY IN THE MOTIONS IN TERMS OF- TO ENSURE THAT, YOU KNOW, OUR PHYSICIANS AND OUR CLINICAL STAFF DO A LOT WHEN THEY SEE PATIENTS.

AND SO, ARE WE MAXIMIZING ALL THE POTENTIAL BILLING CODES? ARE WE MAKING SURE THAT THEY'RE GETTING TRAINED ON THAT? ARE WE MAKING SURE THAT IT'S ALSO GETTING ENTERED INTO THE SYSTEM THAT NEEDS TO GET ENTERED? UM, ALL OF THAT WORK HAS STARTED.

OBVIOUSLY, WE CAN STRENGTHEN THAT.

UM, I WILL DEFINITELY LEAN ON, UH, THE CHIEF OF CLINICS, AMY PEELER, TO COME BACK AND REPORT TO YOU GUYS ON HOW THAT'S GOING.

THAT ALSO INCLUDES OUR PRODUCTIVITY LEVELS.

UM, THERE'S A LOT OF ROOM IN OUR PRODUCTIVITY LEVELS.

UM, WE'VE SEEN IMPROVEMENTS ABOUT 20% OVER THE PAST COUPLE OF MONTHS, BUT I BELIEVE DEPENDING ON THE BUSINESS UNIT THAT THERE'S STILL OPPORTUNITY FOR US TO, UM, YOU KNOW, INCREASE PRODUCTIVITY.

IT DOES REQUIRE PARTNERSHIP WITH THE UNION.

SO WE HAVE BEEN MEETING WITH THE UNION, FOR EXAMPLE, ON IBH, TO TALK ABOUT PRODUCTIVITY AND THEN ON-ON OUR SIDE, RIGHT? MAKING SURE THAT WE HAVE PROPER PROCEDURES AND PROTOCOLS, MAKING SURE THAT WE HAVE CANCELLATION POLICIES, OR NO-SHOW POLICIES, MAKING SURE THAT WE HAVE DROP-IN HOURS.

SO ALL OF THESE DIFFERENT FACTORS IS PART OF THE WORK THAT WE'VE BEEN DOING, UM, WITH THE LEADERSHIP IN CLINICS.

[04:25:02]

- AS YOU KNOW, I'VE WORKED IN UNIONS BEFORE, BUT THIS PRODUCTIVITY DISCUSSION IS, I MEAN, FROM THE WORKERS THEMSELVES AND FINDING WAYS THAT THEY CAN STREAMLINE THEIR- THEIR PROCESS AND, YOU KNOW, UM, ADD MORE BILLABLE, I GUESS, SERVICES.

THE OTHER THING THEY MENTIONED WAS ABOUT, UH, THERE'S CERTAIN INSURANCE THAT'S NOT TAKEN, UH, LIKE BLUE SHIELD, AND I KNOW THAT A LOT OF THE CANNERIES THERE ARE BLUE SHIELD.

I THINK THE SCHOOL DISTRICT IS BLUE SHIELD.

UM, BUT THEY'RE SAYING THAT IT'S NOT BILLABLE THERE, THAT THEY CAN'T TAKE THAT MONEY OR BILL IT. RIGHT? UH, IS THERE A REASON WHY THAT...

- YEAH, I'LL TRY, I'LL TRY TO ANSWER THAT AND THEN I-I WELCOME, UH, AMY PEELER TO KIND OF DO A MORE DETAILED FOLLOW UP.

UM, SO WE ARE NOT A-A KAISER, RIGHT? WE'RE NOT, UH, YOU KNOW, ANTHEM.

WE ARE A CLINIC THAT OUR WHOLE MISSION IS TO PROVIDE CARE FOR THE INDIGENT, RIGHT? AND SO IT DEFINITELY HAS A DIFFERENT, UM, MODEL THAN WE DON'T JUST TAKE KIND OF ANYONE.

OUR PRIORITIES, FOLKS THAT ARE MEDI-CAL OR DON'T HAVE ANY, UH, OTHER HEALTH HOME.

BECAUSE OF THAT, UH, ABOUT 85% OF OUR PATIENTS ARE MEDI-CAL.

UM, THE REMAINING LIKE 10% OR 11% ARE INDIGENT, AND THEN THERE'S A TINY AMOUNT- I WOULD, YOU KNOW, LEAN ON AMY TO CORRECT ME ABOUT 3% THAT FALL OUTSIDE OF THAT.

BUT THAT'S A-A LOT OF THE REASON WHY, YOU KNOW, WE HAVE A-A VERY FOCUSED MISSION ON WHO WE SERVE, AMY? - SURE. SO WE ARE SORT OF THE OPPOSITE OF THE PRIVATE SECTOR.

SO WHEN WE SEE PATIENTS WHO HAVE MEDI-CAL, WE GET A HIGHER RATE THAN PRIVATE PROVIDERS IN THE COMMUNITY.

AND WE GET THAT RATE BECAUSE IT IS OUR FEDERAL MANDATE TO SEE PEOPLE REGARDLESS OF THEIR ABILITY TO PAY.

SO FOR US, MEDI-CAL IS OUR BIGGEST FUNDER.

THAT IS THE PER VISIT.

WE GET THE MOST MONEY FROM PEOPLE WHO HAVE MEDI-CAL.

OTHER INSURERS ARE MUCH LOWER THAN THAT FOR US.

AND WE FOCUS OUR EFFORTS ON, UM, THOSE WHO ARE UNINSURED, UNDERINSURED, AND LIKE DIRECTOR MORALES SAID, THE MAJORITY OF OUR PATIENTS ARE EITHER MEDI-CAL OR MEDICARE AND MEDI-CAL BOTH.

- SO THE REASON I BRING THIS UP IS BECAUSE I MENTIONED THAT WE SHOULD LOOK AT THIS AND TRIAGE IT, RIGHT? AND I THINK TAKING CARE OF OUR STAFF IS PROBABLY ONE OF THE, MY HIGHEST PRIORITIES.

UM, ONE OF THE OTHER THINGS THEY DID MENTION THOUGH IS, UH, BRINGING IN THE POSSIBILITY OF BRINGING IN COMMUNITY PARTNERS LIKE SALUD PARA LA GENTE, CLINICA DEL VALLE, UM, CLINICA PLAZITA, AND SORT OF BRINGING IN WHATEVER SERVICES THAT THEY MIGHT NEED FROM THESE CLINICS TO THEIR, TO-TO THERE, TO THE, UH, FREEDOM CENTER TO THE LABS AND X-RAY, BECAUSE MOST OF THEM ARE BILLABLE.

THERE'LL BE, UH, MEDICARE, UH, MEDICRUZ, MEDI-CAL.

IS THAT A POSSIBILITY? - AMY? I'LL LEAN ON AMY ON THIS ONE.

UM, I DON'T RECALL IF THERE'S SPECIFIC, UM, PARAMETERS.

SO I'LL LEAN ON...

- STATE, MANY, MANY YEARS AGO LOOKED AT ALL OF OUR-OUR COSTS TO PROVIDE THE SERVICES, AND THEN THEY ASSIGN US A RATE, AND THAT RATE IS INCLUSIVE OF-OF ALL OF THE SERVICES THAT WE CAN PROVIDE.

SO IF A PATIENT COMES INTO OUR CLINIC AND THEY HAVE STOMACH PAIN AND THEY GET AN X-RAY ORDERED AND A LAB ORDERED AND THEY GET A REFERRAL, UM, WE GET THE SAME AMOUNT FOR THAT.

WE DON'T GET TO BILL EXTRA FOR LAB OR FOR X-RAY.

SO THOSE ARE TWO DEPARTMENTS WHERE WE DON'T HAVE REVENUE, RE-REGARDLESS OF HOW WE BILL.

WE COULD BILL THOSE FOR THE STATE AND THE STATE WOULD SAY, NO, WE'RE NOT PAYING YOU FOR THAT.

UM, SO IT IS AWFUL.

IT IS AWFUL TO BRING THIS FORWARD BECAUSE WE KNOW IT'S NOT THE BEST FOR OUR PATIENTS, BUT THEY ARE TWO AREAS WHEN WE ARE LOOKING AT EVEN MORE CUTS COMING WITH, UM, HOW OUR STATE WILL TREAT UNDOCUMENTED FOLKS THAT ARE HIGH COST AND VERY LOW INCOME.

- AMY, CAN- CAN YOU DISCUSS IF OTHER FQS CAN USE OUR LAB AND X-RAY FACILITIES? - THAT, OUR OTHER FQS, FQHCS, UM, DO NOT HAVE IN-HOUSE LAB OR X-RAY EITHER.

AND SO THEY HAVE WAYS TO GET THEIR PATIENTS THOSE SERVICES.

THOSE SERVICES ARE FOR OUR RATE, UM, FOR OUR PATIENTS.

AND WE DON'T HAVE THE BANDWIDTH OR THE PEOPLE TO BE ABLE TO, UM, CREATE MORE AND MORE, UM, OF THOSE VISITS.

[04:30:04]

BUT WE COULD CERTAINLY LOOK AT THAT.

- THANK YOU. AND THAT KIND OF SEGUES INTO THIS EQUITY COMPONENT THAT THEY BROUGHT IN.

FIRST, I WANNA GO BACK THAT WHEN I DID MY ONBOARDING, UH, TOUR OF THE-THE ALL THE FREEDOM CENTER, THEY SAID, THEY WERE TELLING ME LIKE A LOT OF THE DISCUSSION WAS ABOUT THAT FREEDOM CENTER WAS THEIR MOST PROFITABLE CLINIC AND THEY HELPED SUSTAIN EMELINE.

SO I HEARD A LOT OF THAT DISCUSSION ON MY ONBOARDING WHEN I WENT TO THE FREEDOM CENTER.

AND IT CAME UP AGAIN, UM, WHEN I WENT TO GO TOUR WITH, YOU KNOW, BY THAT TIME SEIU WAS GONE.

THIS IS JUST WORKERS, UH, ABOUT THIS EQUITY PIECE THAT-THAT, YOU KNOW, THE FREEDOM CLINIC IS MORE PROFITABLE, THAT WHY CAN'T, YOU KNOW, THAT FREEDOM HELPS EMELINE SUSTAIN ITSELF.

UH, AND THAT IF WE LOOK AT IT THROUGH THE LENS OF EQUITY, WE'D- WE'D ALLOW FREEDOM CLINIC TO FUND, YOU KNOW, THEMSELVES AND FUND THE-THE X-RAY AND LABS THERE IN SOUTH COUNTY WHERE THEY, WHERE THEY, UH, WHERE THEY'RE AT.

IS THAT, I MEAN, I GUESS WHAT I WOULD WANNA KNOW IS LIKE, DO WE KNOW HOW PROFITABLE THESE LABS AND X-RAY ARE IN THE DIFFERENT LOCATIONS? UM, IS THAT AVAILABLE? THAT INFORMATION IS AVAILABLE? - A LITTLE BIT OF THAT INFORMATION NOW AND THEN WE CAN RUN A THOROUGH ANALYSIS AND...

OH, GOOD, AMY'S STILL HERE.

SO, WHAT I HAVE RIGHT NOW, IN TERMS OF THE COST FOR LAB AT EMELINE, IT'S ABOUT, UM, $800,000.

UH, THE COST FOR LAB IN WATSONVILLE IS ABOUT $500,000.

THE COST, UH, FOR X-RAY AT EMELINE, IT'S ABOUT $226,000, AND THE COST FOR X-RAY IN WATSONVILLE, IT'S ABOUT $210,000.

IT IS ALSO TRUE THAT FREEDOM CAMPUS IS A-A HIGH GENERATOR OF REVENUE FOR CLINICS.

AND WE DO, UM, LEAN ON THEM FOR, UM, YOU KNOW, BALANCING THE REST OF THE ENTIRE BUDGET AS A WHOLE.

BUT THAT-THAT IS SOMETHING THAT WE'VE DONE.

YOU KNOW, WE JUST KIND OF TREAT IT AS AN ENTERPRISE VERSUS INDIVIDUALLY.

- IT'S HARD WHEN YOU'RE MAKING THESE SPECIFIC CUTS, RIGHT? WHEN EVERYBODY TAKES THE-THE BRUNT AND I GUESS AS A, AS AN ENTIRE AGENCY, UH, HEALTH SERVICES IS-IS ALSO TAKING A BIG HIT OF THE BRUNT.

BUT, YOU KNOW, GOING IN-IN THESE SPECIFIC DEPARTMENTS, IT-IT REALLY FEELS INEQUITABLE TO THEM.

AND THAT, YOU KNOW, THAT'S WHAT THEY EXPRESS TO ME.

ALL OF THEM FROM DOCTORS, NURSE, UH, NURSE PRACTITIONERS, UH, STAFF, UH, OFFICE STAFF.

THEY ALL EXPRESS THE SAME THING.

- WE CAN COME BACK, UH, SUPERVISOR HERNANDEZ, ON THE 10TH WITH, UH, AN ANALYSIS FOR YOU ON THESE NUMBERS SO YOU KIND OF HAVE THEM, UM, SO YOU GUYS CAN, YOU KNOW, MAKE THE DECISIONS THAT YOU NEED TO BASED ON THE DATA IN TERMS OF THE EXPENDITURES IN THE REVENUE AND, UM, FOR EACH OF THE CLINICS.

AND THEN YOU CAN BASICALLY... I JUST WANNA MAKE SURE WE ARE FULLY TRANSPARENT WITH YOU GUYS 'CAUSE WE KNOW THESE ARE VERY DIFFICULT DECISIONS FOR YOU GUYS TO MAKE.

AT THAT POINT, YOU CAN DIRECT OBVIOUSLY US, UM, IN DIFFERENT DIRECTIONS.

- THAT'D BE HELPFUL TO, YOU KNOW, SEE ALL THOSE INCOME LEVELS HOW SHORT THEY ARE.

YOU KNOW, ONE OF THE MOST INTERESTING THINGS THAT I THINK CAME UP OF THE, THAT TOUR WITH THEM IS THAT THEY WANTED TO FORM A COMMITTEE WITH BILLING, AND THEY'RE ALL EXCITED TO DO THIS, UH, TO FIND OUT WHERE THEY CAN FIND, UH, YOU KNOW, THIS IS WHAT CAN STREAMLINING PROCESSES, BUILD MORE STUFF.

AND, YOU KNOW, I-IS THAT SOMETHING THAT WE COULD STILL EXPLORE WITH THEM? I'M SAYING THIS BECAUSE IF WE CAN, YOU KNOW, WE'RE WAITING FOR THE- FOR THE FEDERAL GOVERNMENT, TO SEE SOME CHANGE IN THE FEDERAL GOVERNMENT IN THE NEXT TWO YEARS OR A YEAR AND A HALF, TWO YEARS.

UM, IF IT'S SUSTAINABLE, IF WE'RE ABLE TO MAKE IT SUSTAINABLE OR PROFITABLE, SUSTAINABLE, UH, FOR THE NEXT TWO YEARS.

- SO YOUR FIRST QUESTION, UM...

- THE COMMITTEE, YEAH.

- YEAH. THE CO- YOUR QUESTION ON THE COMMITTEE.

YEAH, ABSOLUTELY.

THAT-THAT CAN STILL FOR US, UM, I BELIEVE IN-IN TRANSPARENCY, WE'VE DONE THIS IN BEHAVIORAL HEALTH, RIGHT? YOU KNOW, THREE YEARS AGO IT WAS A WHOLE DIFFERENT LEADERSHIP.

THE NEW LEADERSHIP IN THERE WAS REALLY TRANSPARENT ABOUT BUDGETS.

IT'S SOMETHING THAT I KNOW THAT CLINICS IS STRIVING TO ALSO DO.

WE'RE STARTING RIGHT NOW WITH CREATING MONTHLY KIND OF FINANCIAL REPORTS FOR EACH OF THE CLINIC LEADERSHIP, RIGHT? UM, BUT I DON'T SEE ANY REASON WHY WE CAN'T ALSO MAKE SURE THAT THE MANAGERS IN EACH CLINIC ARE SHARING SOME OF THIS INFORMATION.

SO, WE ARE NOTING THIS, AND WE'LL MAKE SURE TO REPORT BACK ON THAT.

- THANK YOU. AND, YOU KNOW, GOING BACK TO MY FIRST COMMENT, IT WAS MORE OF A COMMENT, NOT A QUESTION, BUT THE IDEA OF EXPLORING DIFFERENT CITIES OR AGENCIES

[04:35:01]

THAT CAN ADOPT SOME OF THESE PROGRAMS THAT LIKE MHCAN AND GEMMA.

IS THAT A POSSIBILITY? - YEAH, I-I WILL SHARE WITH YOU, BECAUSE I'VE BEEN DOING A LOT OF RESEARCH WITH OTHER COUNTIES, UM, A-A LOT OF COUNTIES, UM, THEY'RE FOCUSED ON PROVIDING THE CLINICAL REIMBURSABLE CARE AND A LOT OF, UM, KIND OF THE COMMUNITY, WHAT THEY CALL, THEY CALL IT THE COMMUNITY SUPPORT AS DONE BY CBOS THROUGH THEIR OWN KIND OF, UM, FOUNDATION WORK GRANTS THAT THEY APPLY FOR OR, YOU KNOW, UM, ENDOWMENTS THAT THEY'RE ABLE TO CREATE.

SO, UM, UM, UNFORTUNATELY, YES, IT CAN BE DONE, RIGHT? UM, I THINK IT'S A MODEL THAT WE SHOULD EXPLORE.

I DID MEET WITH SOME OF THE LOCAL FOUNDATIONS IN THE COUNTY TO KIND OF PITCH AND PUT A SEED THAT, YOU KNOW, WOULD BE GREAT FOR US TO CONSIDER STARTING SOME FORM OF ENDOWMENT AROUND BEHAVIORAL HEALTH IN THE COUNTY.

IN ADDITION, OBVIOUSLY, TO A POTENTIAL MEASURE.

UM, 'CAUSE I THINK IT'S GONNA TAKE MULTIPLE, UM, YOU KNOW, FUNDING SOURCES FOR US TO SUSTAIN THESE VERY IMPORTANT CBOS.

I WILL SAY, AND SORRY-SORRY, JUST ONE LAST THOUGHT IS THAT THIS STATE ALSO HAS BEEN LEANING ON THIS, RIGHT? OR THEY WERE MOVING TO WHAT USED TO BE FUNDED BEFORE THROUGH GRANTS AND REALLY THEY WERE EVEN PUSHING PUBLIC HEALTH.

FIND ANYTHING THAT YOU CAN DO THAT IT'S REIMBURSE- I'M SORRY.

AND THE SERVICES THAT YOU'RE DOING THAT CAN BE REIMBURSED AND FIGURE OUT A WAY TO GET REIMBURSEMENT THROUGH MEDI-CAL.

SO IT'S NOT JUST SOMETHING THAT FOR US TO EXPLORE IS THAT THE STATE HAS ACTUALLY BEEN PUSHING FOR THIS WHEN I WORKED THERE.

AND SO IT'S DEFINITELY, UM, IT'S CATCHING UP TO US NOW.

- THANK YOU. I'LL BRING IT BACK TO THE BOARD FOR...

- BEFORE WE MOVE ON, I DID HAVE ONE, UM, LAST THING I JUST WANTED TO BRING UP SINCE...

- GO AHEAD.

- ONE LAST COMMENT BECAUSE OF BROWN ACT ISSUES AND JUST, UM, AND SO WHEN WE COME BACK ON JUNE 10TH.

I HAVE RECEIVED SOME CONCERN FROM THE FARMER'S MARKET DIRECTOR.

UM, THEY HAD... IN THE PAST, THEIR RATES HAVE BEEN PRETTY LOW IN TERMS OF WHAT THEY'VE BEEN CHARGED.

AND NOW THOSE RATES ARE INCREASING AND THEY'RE BEING CHARGED FOR THE SAME OPERATOR WHO OPERATES.

THE FIVE DIFFERENT ONES ARE BEING CHARGED AT EACH OF THE MARKETS WHERE THEY-THEY HOLD FARMER'S MARKETS.

AND SO, UM, THERE'S GONNA BE A PROPOSED FEE CHANGE, UM, FOR CERTIFIED FARMER'S MARKET INCREASING FROM $905 ANNUALLY TO 941 ANNUALLY.

AND THE PROPOSED FEE FOR TEMPORARY FOOD FACILITIES OF FARMER'S MARKETS, IT'S INCREASING FROM 528 TO 549 ANNUALLY, WHICH WOULD MEAN THAT, UM, THE FEE WOULD BE, UM, WITH THE FIVE MARKETS GOING UP TO $7,450 A YEAR.

AND THAT'S UP FROM ABOUT $2,000, UM, THAT THEY'VE BEEN, UM, PAYING IN THE PAST.

AND SO I THINK IT'D BE GOOD FOR US TO CONSIDER SOME KIND OF MIDDLE GROUND AND I'LL, I'D BE HAPPY TO BRING FORWARD SOME, UM, LIKE A RECOMMENDATION FOR THAT.

BUT, YOU KNOW, HAVING, UH, THE-THE OPERATOR PAY THE SAME FEES THAT EACH OF THE DIFFERENT MARKET WHEN IT'S THE SAME OPERATOR JUST SEEMS A LITTLE REDUNDANT IN TERMS OF THE FEES THAT THEY'RE PAYING AND REALLY EXPENSIVE FOR THE OPERATORS.

BECAUSE ULTIMATELY WHAT THAT'S GONNA DO IS JUST DRIVE THE COST OF FOOD AT THE FARMER'S MARKETS UP AND THE RATE PAYERS END UP ABSORBING THOSE COSTS.

SO, UM, SO JUST WANTED TO BRING THAT UP 'CAUSE IT'S COME TO MY ATTENTION FROM THE-THE FARMER'S MARKET DIRECTOR.

UM, WITH THAT BEING SAID, WE CAN HAVE MORE DISCUSSION ABOUT THAT, UM, AT THE, AT THE JUNE 10TH MEETING, UNLESS YOU ALL WANNA RESPOND.

- SUPERVISOR, I WOULD RECOMMEND IF YOU HAVEN'T, AND I'M SORRY, I DON'T KNOW IF YOU HAVE THAT YOU'VE TALKED TO OUR STAFF AS WELL, SO YOU CAN GET BACKGROUND ON THIS AND IF YOU HAVE, I'M OBVIOUSLY NOT BEHIND.

- I BELIEVE THAT WE HAVE AT SOME POINT, BUT WE'RE HAPPY TO TALK TO THEM FOR NOW, BUT...

- I THINK IT'S JUST IMPORTANT FOR YOU TO GET THE BACKGROUND ON JUST THE HISTORY WITH THE FARMER'S MARKET.

BUT HAVING THAT INFORMATION, I THINK, AVAILABLE TO YOU-YOU CAN MAKE, YOU KNOW, THE PROPER, UM, RECOMMENDATION OR DECISION.

- OKAY. ALL RIGHT.

SO I'M GONNA MOVE THE STAFF RECOMMENDATION WITH THE FOLLOWING ADDITIONS.

FIRST, DIRECT THE CEO TO WORK WITH MHCAN AND THE CITY OF SANTA CRUZ ON A PLAN TO MAINTAIN DAY SERVICES AND RETURN WITH RECOMMENDATIONS ON THE FINAL DAY OF BUDGET HEARINGS.

TWO, DIRECT THE CEO TO WORK WITH THE CITY OF SANTA CRUZ ON A PLAN TO EITHER MAINTAIN THE DOWNTOWN OUTREACH WORKER PROGRAM OR IDENTIFY AN ALTERNATIVE THAT CAN MAINTAIN SIMILAR SERVICES AND TO EXPLORE OPTIONS TO MAINTAIN SYRINGE LITTER COLLECTION SERVICES WITH THE DOWNTOWN STREETS TEAM AND RETURN WITH RECOMMENDATIONS ON THE FINAL DAY OF BUDGET HEARINGS.

THREE, DIRECT THE CEO TO MAINTAIN FUNDING FOR GEMMA HOUSE SERVICES UNTIL A CONTRACT WITH AN ALTERNATIVE SERVICE MODEL'S ENTERED INTO, IF AN ALTERNATIVE SERVICE CONTRACT DOES NOT ENTERED INTO, RETURN TO THE BOARD FOR ADDITIONAL DIRECTION.

AND THEN FOUR, DIRECT THE CEO TO RETURN WITH THE OPTIONS FOR LAB, RADIOLOGY, AND PSYCHIATRIC SERVICES

[04:40:03]

AND CONSULTATION WITH STAKEHOLDERS.

I'M HAPPY TO EXPLAIN SOME OF THOSE.

- SO, THAT LAST LINE INCLUDES SOME OF THE STUFF I MENTIONED? OKAY. PERFECT.

- CAN I JUST- I'M SO SORRY.

CAN I CLARIFY SOMETHING BEFORE YOU-YOU- OKAY.

- YES.

- UM, I COMPLETELY FORGOT TO BRING THIS UP 'CAUSE I JUST WANNA MAKE SURE IT'S ON RECORD.

WE DID SPEAK TO JANICE, UM, THE CEO THERE, AMBER WILLIAMS. AND IT'S MY UNDERSTANDING THAT IN FACT THEY ARE WORKING WITH NEW LIFE TO ENSURE THAT THERE'S A SMOOTH TRANSITION BETWEEN, UM, THE ORGANIZATIONS, YOU KNOW, WITH JANICE TAKING OVER THE PROGRAM.

I JUST WANNA MAKE SURE IT'S ON RECORD SO OUR COMMUNITY ALSO KNOWS.

- WHICH PROGRAM? - GEMMA.

- GEMMA. GREAT. - YES.

- SO WE HAVE A MOTION.

- UM, CAN I MAKE A COMMENT? - SURE.

- UM, MHCAN, SUPER IMPORTANT.

IT IS COMPLETELY ONLY SERVING NORTH COUNTY RESIDENTS.

WE HAVE PEOPLE MID AND SOUTH COUNTY WHO NEED SIMILAR SERVICES, RIGHT? UM, SO IF THERE'S ANY WAY WE COULD TAKE THE MODEL THAT THEY HAVE DELIVERED SO BEAUTIFULLY IN NORTH COUNTY AND SOMEHOW EMULATE IT DOWN IN SOUTH COUNTY, I THINK THAT WOULD BE, WOULD MAKE ME FEEL BETTER ABOUT APPROVING CONTINUING FUNDING, UM, FOR SERVICES THAT ARE NOT JUST SERVING THE NORTH PART OF OUR COUNTY.

- YEAH, JUST VERY...

- NO, YOU- YOU CAN'T, I'M SORRY. NO.

- SURE. IN CASE I MISSED SOMETHING.

I JUST WANNA MAKE SURE BEFORE YOU CONTINUE DISCUSSION, WAS THERE A SECOND ON THE MOTION? - WELL, I SECOND IT.

- OKAY.

SO THERE'S A SECOND ON THE MOTION.

SO WHAT I'M UNDERSTANDING THE MOTION TO BE IS BASICALLY YOU'RE ASKING STAFF TO COME BACK WITH MORE INFORMATION ON THE FOUR CATEGORIES OF, UM, OF TOPICS THAT YOU LAID OUT THERE FOR CONTINUING DISCUSSION AT THE JUNE 10TH MEETING.

IS THAT RIGHT? - CORRECT. AND-AND I CAN EXPLAIN IF-IF IT'S NECESSARY.

SO LIKE THIS WILL BE HELPFUL FOR THE BOARD.

- GO AHEAD. COULD YOU BRIEFLY...

- I-I THINK I UNDERSTOOD EVERYTHING, BUT CAN YOU EXPLAIN...

- YEAH, I UNDERSTOOD, UH...

- THE FOURTH, UM, I'M SORRY, ABOUT OPTIONS FOR, UM, MAINTAINING FOR BOTTOM END.

- YEAH. THAT'S RIGHT. YEAH.

I JUST KNOW THAT, UM, AND I WAS GONNA ELABORATE ON THAT ONE A LITTLE BIT, IN PARTICULAR, BUT I KNOW WE'VE HEARD SOME CONCERNS ABOUT PSYCHIATRIC SERVICES AND LOSS OF THOSE, UM, THE LAB AND RADIOLOGY, YOU KNOW, IF THOSE WERE TO COME TO AN ABRUPT STOP, UM, I THINK IT COULD HAVE DISRUPTION WITH DELIVERY OF SERVICES.

AND SO IS THERE AN OPPORTUNITY TO EXTEND SOME OF THOSE SERVICES EVEN LONGER? OR MAYBE IF IT'S, YOU KNOW, IF WE, IF WE SOMEHOW FIND SOME, SOME POT OF GOLD, CAN WE KEEP RADIOLOGY AND MAYBE GET RID OF LAB OR KEEP LAB VERSUS RADIOLOGY? I MEAN, I JUST WANNA MAKE SURE THAT WE'VE EXPLORED ALL OPPORTUNITIES, UM, BECAUSE, YOU KNOW, SOMETIMES AS WE START DIGGING INTO DIFFERENT FUNDING SOURCES, YOU KNOW, IT TURNS OUT THAT THERE MIGHT BE SOME FUNDING LEFT OVER FROM ONE PROGRAM VERSUS ANOTHER THAT CAN BE COBBLED TOGETHER TO HELP PROVIDE, YOU KNOW, ADDITIONAL SERVICES IN THE NEXT YEAR'S BUDGET.

SO I JUST WANNA MAKE SURE THAT WE'RE EXPLORING ALL OPTIONS.

- RIGHT. SO ON THAT, ON THAT TOPIC, YOU'RE GONNA HAVE A FULL HEARING UNDER THE BILLINGS ENACT ON THE MORNING OF- OF JUNE 10TH.

AND THEN IN THE AFTERNOON, YOU'RE GONNA HAVE, UH, CONTINUING ACTIONS ON THE BUDGET.

SO THERE'S GONNA BE TWO OPPORTUNITIES TO RECEIVE INFORMATION ON THAT.

- GREAT.

- COMMENTS? - UM, I HAVE A, A QUESTION WHICH I MAY ADD A, SEE IF I CAN ADD A FRIENDLY AMENDMENT.

UM, JUST FOR CLARITY ON THE EXISTING MEDICRUZ PROGRAM, DOES IT NEED ANY INFRASTRUCTURE TODAY TO BE USED AS A CONTINGENCY FUND IF THROUGHOUT THE REST OF THE BUDGET HEARINGS WE IDENTIFY SOURCES FOR THAT? - OFF TOP OF MY HEAD, I'M GONNA SAY YES, BECAUSE RIGHT NOW WE'RE, UM, WE ARE ABOUT 350 CLIENTS THAT WE'RE SERVING.

SO I ANTICIPATE ANY, ANY, UM, INCREASE IS GONNA DEMAND MORE BILLING FOR US. RIGHT? MORE MANAGEMENT, ADDRESSING THE REFERRALS, SCREENING, ALL THAT GOOD STUFF.

SO, YES.

- SO, UM, JUST FOR THE BOARD, WHAT I'M THINKING ABOUT IS, UM, HOW TO START PREPARING THAT MEDICRUZ MAY BECOME AN OPTION, ASSUMING THAT COME FALL WHEN WE HAVE AN UPDATE ABOUT THE STATE AND FEDERAL BUDGET, WE'RE GONNA NEED TO DO MORE TO SUPPORT THAT POPULATION.

SO, UM, I WOULD LIKE TO ADD A FRIENDLY AMENDMENT TO COME BACK WITH OPTIONS TO, OR COME UP WITH, COME BACK WITH A PROPOSAL TO, UM, STRENGTHEN THE INFRASTRUCTURE OF MEDICRUZ SO THAT WE WILL BE READY TO ROLL IT OUT IF NEEDED IN THE MIDDLE OF THIS FISCAL YEAR.

- UM, JUST FOR CLARIFICATION, DOES THAT MEAN BY TUESDAY OF NEXT WEEK? NO. RIGHT? [LAUGHS] - ANY IDEAS? ANY, YEAH, ANY IDEAS WOULD BE APPRECIATED.

I WOULD JUST LIKE TO ADD IN SUPPORT OF WHAT YOU'RE SAYING IS THAT ONE DAY IN AN ICU COULD COST UPWARDS OF A MILLION DOLLARS.

AND IF THERE'S ONLY $3 MILLION IN THAT ACCOUNT RIGHT NOW

[04:45:01]

TO SUPPORT PEOPLE IN THE COMMUNITY, I MEAN, HEALTHCARE IS SO, SO EXPENSIVE. RIGHT? - SO WHAT, WHAT I WOULD, I THINK I SAID THIS IN OUR ONE-ON-ONE ROUNDS, UM, WHAT I WAS PROPOSING AT THE, THE STAFF COME BACK AND GIVE YOU BACKGROUND 'CAUSE IT'S ONLY FOR SPECIALTY.

IT'S NOT FOR ANY PRIMARY OR INPATIENT OUTPATIENT.

SO, OR EVEN MEDICATION.

THIS IS JUST FOR SPECIALTY, FOR EMERGENCIES.

UM, SO I'M, I, WHAT I WOULD PROPOSE IS THAT WE COME BACK AND GIVE YOU AN OVERVIEW OF THE PROGRAM, THE CRITERIA, HOW IT WAS USED, WHERE WE'RE AT, WHAT WE ANTICIPATE.

AND IF THAT CAN BE DONE, UM, AFTER THE 10TH, THAT'LL BE EASIER FOR US TO BETTER PREPARE YOU.

- SO IF SOMEBODY NEEDS CHEMOTHERAPY, FOR EXAMPLE, THAT'S A SPECIALTY THAT'S THOUSANDS OF DOLLARS.

- YEAH. IT, IT'S NOT THE SPECTRUM.

IT THERE'S, THAT'S WHY I THINK A BACKGROUND ON WHAT THIS IS, UM, AND WHAT IT COVERS WILL BE VERY BENEFICIAL TO YOU GUYS.

YEAH.

- I THINK SO. SORT OF WHAT A PRELIMINARY, PRELIMINARY PLAN WOULD LOOK LIKE TOO.

VERY BASIC, RIGHT? I'D TO ACCEPT THAT.

- I JUST WANNA PULL IT SEPARATE FROM THE DEADLINE OF JUNE 10TH 'CAUSE THAT WOULD BE A LITTLE BIT- - THAT'S NEXT WEEK.

- YEAH, I THINK I'M OKAY WITH THAT.

I THINK, UM, SO YOU HEAR WHAT I'M... - YES.

- WHAT I'M GOING FOR IS I, IF WE IDENTIFY TWO TO $5 MILLION TO FUND A GAP. [LAUGHS] UM, AS SUPERVISOR KOENIG SUGGESTED, THAT MIGHT BE A A, A GOOD FUND TO PUT THAT IN, RIGHT? SO WHATEVER WORK NEEDS TO HAPPEN TO ENSURE THAT WE'D BE READY FOR THAT.

IF WE CAN IDENTIFY IT BEFORE JUNE 10TH OR AFTER.

- ABSOLUTELY.

- SOUNDS GOOD. IF I WIN THE SUPER LOTTERY.

SUPERVISOR CUMMINGS, WILL YOU ACCEPT THE FRIENDLY AMENDMENT.

OKAY. ME TOO.

- AND JUST, SO, SO THERE'S SORT OF A GENERAL DEADLINE FOR THAT.

UH, I MEAN, WHEN- AFTER JUNE 10TH? - AFTER JUNE 10TH, - WE CAN COME BACK IN, UH, IN AUGUST.

- OKAY. DOES AUGUST WORK FOR YOU? OKAY, GREAT. THANKS.

- THAT'S PERFECT. THANK YOU.

- ALRIGHT. TOTALLY SUPPORTIVE OF EVERYTHING THAT'S BEEN SUGGESTED SO FAR.

I'D LIKE TO OFFER ONE ADDITIONAL FRIENDLY AMENDMENT AT THE, YOU KNOW, RISK OF MAKING THIS TOO MUCH OF A GRAB BAG.

BUT, UM, IT WOULD BE TO ADD ADDITIONAL DIRECTION FOR HSA, HSD AND CEO STAFF TO EXPLORE OPPORTUNITIES TO IMPROVE SERVICE DELIVERY AND ENHANCE EFFICIENCY BY COMBINING HSA AND HSD FUNCTIONS AND TO RETURN WITH THE REPORT NO LATER THAN THE MID-YEAR BUDGET REVIEW.

WE HAVE PLENTY OF TIME ON THIS ONE, UH, WITH OPPORTUNITIES.

- SURE.

- ALL RIGHT. SO WE GOT A MOTION.

AND, UH, SECOND, UH, THE MOTION FROM SUPERVISOR CUMMINGS.

SECOND FROM, UH, SUPERVISOR HERNANDEZ.

- SUPERVISOR DE SERPA.

MOTION, UH, MOTION PASSES UNANIMOUSLY.

NEXT, WE HAVE ITEM NUMBER...

- CHAIR, BEFORE YOU MOVE ON, I THINK THAT WE WERE HOPING TO SPEND A MOMENT TO SAY THANK YOU TO DIRECTOR MORALES.

AND WHAT I UNDERSTAND IS THIS MIGHT BE HER LAST DAY, SO I'M GONNA KICK IT OFF WITH, UM, SUPERVISOR DE SERPA.

- SO, MONICA, THIS IS, I MEAN, SO MANY PEOPLE HAVE ALREADY SAID TODAY WHAT I WAS GONNA SAY, WHICH IS THAT, UM, YOU'VE MADE WATSONVILLE PROUD.

LIKE THERE ARE SO MANY PEOPLE IN THE COMMUNITY THAT REACHED OUT TO ME AND TALKED ABOUT, UM, WHAT A AMAZING, POWERFUL, COLLABORATIVE LEADER YOU'VE BEEN, AND THAT, UM, YOU GROWING UP IN WATSONVILLE AND SORT OF LIKE RISING UP AND BECOMING THE DIRECTOR THAT YOU ARE, WAS VERY, UH, MEANINGFUL, UH, FOR THE POPULATION IN SOUTH COUNTY.

AND SO, JUST, MONICA AND I WANTED TO TAKE THIS MOMENT TO REALLY THANK YOU FOR YOUR SERVICE.

WE REALLY, LIKE SUPERVISOR KOENIG'S SAID, WE'RE REALLY GONNA MISS YOU AND WISH YOU ALL THE BEST, UH, IN YOUR NEW JOB IN YOLO COUNTY.

I HAVE SOME FLOWERS FOR YOU FROM MY GARDEN, SO MAYBE WE COULD TAKE A MOMENT AND HAVE LIKE A PICTURE OR.

- WELL, IF YOU COULD CONTINUE THE COMMENTS, GO AHEAD.

- YEAH, I WAS JUST GONNA SAY, AND, UM, JUST REALLY, UM, HONORED TO BE, BE ABLE TO WORK WITH YOU, WHICH HAS BEEN SO IMPRESSED OVER THE YEARS OF ALL THE PRESENTATIONS YOU'VE BEEN ABLE TO GIVE TO MY OFFICE, AND MY STAFF, AND THE QUESTIONS THAT WE'VE BEEN ABLE TO ANSWER, WHICH HAS REALLY PREPARED US WITH BACKGROUND KNOWLEDGE AS WE'RE COMING INTO THESE MEETINGS AND MAKING WHETHER DIFFICULT DECISIONS ON BUDGETS OR JUST LEARNING ABOUT NEW PROGRAMS THAT ARE GONNA ROLL OUT AND USING BEST PRACTICES, UM, WHICH MAY BE DIFFERENT THAN WHAT MOST COMMUNITIES HAVE DONE IN THE PAST, OR MAYBE IT MAKES SOME PEOPLE NERVOUS, BUT REALLY TRYING TO, YOU KNOW, BE PROACTIVE AT STAYING ON TOP OF, YOU KNOW, WHAT IS THE BEST, UM, RECOMMENDATIONS COMING OUT OF THE FIELD TO PROVIDE THE BEST SERVICES HAS BEEN, UM, JUST SO IMPRESSIVE.

AND WHEN I HEARD THAT YOU WERE LEAVING, I WAS REALLY BUMMED OUT.

UM, BUT TOTALLY UNDERSTAND, YOU KNOW, THAT, UM, SANTA CRUZ IS ALSO REALLY CHALLENGING LIKE, FINANCIALLY CHALLENGING PLACE TO LIVE.

AND THERE'S, YOU KNOW, AND THIS IS WHAT WE WORRY ABOUT A LOT, IS THAT WE HAVE REALLY GOOD STAFF AND THEY GET A BETTER OPPORTUNITY SOMEWHERE ELSE AND THEY GET PULLED AWAY.

BUT, YOU KNOW, I THINK WE'RE JUST FORTUNATE TO HAVE HAD YOU ALL THESE YEARS AND TOTALLY SUPPORT YOU MOVING ON

[04:50:01]

TO YOUR NEXT ENDEAVOR AND JUST WISH YOU THE BEST.

AND, AND DON'T FORGET ABOUT US DOWN HERE IN SANTA CRUZ.

- MONICA, I JUST WANNA SAY THAT, UH, YOU KNOW, NOT ONLY DO WE ALL APPRECIATE ALL THE WORK THAT YOU'VE DONE HERE AT THE COUNTY, BUT IT SEEMS LIKE THE ENTIRE COMMUNITY, AND IT SHOWED TODAY, RIGHT? YOU GOT KUDOS FROM THE NONPROFITS AND, YOU KNOW, THE, UH, DIFFERENT FOLKS IN, IN THE DIFFERENT AGENCIES.

BUT NOT ONLY THAT, I'VE HEARD THOSE KUDOS COME FROM PEOPLE THAT WE NORMALLY DON'T INTERACT WITH, OR AT LEAST DEPARTMENTS, YOU KNOW, WITH LIKE CITY OF WATSONVILLE, THE SCHOOL DISTRICT.

EVERYBODY WAS JUST, YOU KNOW, SO EXCITED WITH ALL THE WORK THAT YOU'RE DOING AND, YOU KNOW, I KNOW IT'S GONNA CONTINUE WHEREVER YOU GO.

AND HOPEFULLY ONE DAY YOU'LL FIND YOUR PATH BACK TO WATSONVILLE, SANTA CRUZ COUNTY.

[LAUGHS] - YEAH. UM, MONICA, IT, IT TAKES A REALLY SPECIAL PERSON TO, UM, YOU KNOW, DEDICATE YOUR, YOUR BRILLIANCE AND YOUR TALENTS TO SERVING THE HEALTH OF OUR COMMUNITY.

AND WE'VE BEEN SO FORTUNATE THAT YOU'VE GIVEN THAT TO OUR COMMUNITY FOR THE TIME THAT YOU'VE BEEN HERE.

UM, I AM ALSO PUTTING OUT ENERGY THAT MAYBE SOMEDAY YOU'LL FIND YOUR WAY BACK HERE AND, UM, JUST TRULY HAVE APPRECIATED THE OPPORTUNITY TO WORK WITH YOU.

GOOD LUCK IN YOLO COUNTY.

- YEAH, MONICA, AS I'VE ALREADY SAID, IT'S BEEN A PLEASURE WORKING WITH YOU.

UM, I UNDERSTAND THAT YOU MAYBE NOT NECESSARILY MOVING ON TO A BETTER OPPORTUNITY, BUT JUST KIND OF KEEPING A BETTER HOUSE.

UM, SO IT SEEMS LIKE IF WE'RE GONNA GET YOU BACK SOMEDAY, UH, IT'S A GREAT INCENTIVE TO BUILD BETTER HOUSING HERE IN OUR, IN OUR COUNTY.

UH, AND I'LL KEEP THAT AS A GUIDING LIGHT.

THAT IS WHAT'S GONNA BRING MONICA BACK.

- THANK YOU. THANK YOU.

[LAUGHS] THANK YOU. THANK YOU. THANK YOU.

I JUST, UM, WANNA THANK YOU GUYS FOR LETTING ME GROW HERE.

AND, UM, I LOVE, I LOVE MY COUNTY. I LOVE IT.

IT'S A, IT'S A HARD DECISION, BUT, UM, I GOTTA THINK ABOUT MY BABIES AND I DO HAVE A 8-YEAR-OLD AND 11-YEAR-OLD THAT ARE WAITING FOR ME.

SO APPRECIATE YOUR PATIENCE WITH ME AND EVERYTHING THAT WE'RE DOING TOGETHER, YOU ARE ON THE RIGHT PATH.

AND I WILL CONTINUE TO KEEP AN EYE ON ALL THE GREAT WORK THAT'S HAPPENING HERE.

AND I WILL CONTINUE TO CALL YOU GUYS AND ADVOCATE FOR HEALTH.

SO, THANK YOU. THANK YOU.

- OH.

- SHOULD WE TAKE A TWO-MINUTE BIO BREAK? - RECORDING STOPPED.

[04:57:46]

- RECORDING IN PROGRESS.

- WE'RE READY? OKAY.

[9. Consider approval of the Proposed 2025-26 Budget for the Human Services Department, including any supplemental materials, and take related actions, as outlined in the referenced budget documents, and as recommended by the County Executive Officer]

WE'LL CONTINUE THIS MEETING WITH, UH, ITEM NUMBER NINE.

CONSIDER THE APPROVAL OF PROPOSED 2025-2026 BUDGET FOR HUMAN SERVICES DEPARTMENT, INCLUDING ANY SUPPLEMENTAL MATERIALS, AND TAKE ALL RELATED ACTIONS AS OUTLINED IN THE REFERENCE BUDGET DOCUMENTS AND AS RECOMMENDED BY THE COUNTY CEO.

- OH, MY CUE? - YES. - OH, OKAY.

UM, SO I'M RANDY MORRIS, THE COUNTY'S HUMAN SERVICES DEPARTMENT DIRECTOR, AND GOOD AFTERNOON, CHAIR HERNANDEZ AND MEMBERS OF THE BOARD.

I'M JOINED BY KIMBERLY PETERSON, WHO IS THE DEPUTY DIRECTOR OF OUR DEPARTMENT.

SHE'LL BE CO-PRESENTING WITH ME AND ALSO WITH, UH, KIMBERLY IS TRISH DANIELS.

I WANT TO TAKE A MINUTE TO RECOGNIZE TRISH.

SHE IS THE DIRECTOR OF OUR ADMIN SERVICES DEPARTMENT, WHICH OVERSEES OUR BUDGET OFFICE.

THIS HAS BEEN AN EXTRAORDINARY YEAR.

WE HAVE BEEN ASKED ALMOST EVERY DAY FOR ANALYSIS OF IMPACTS TO PROPOSE CUTS TO OUR BUDGET.

AND TRISH AND HER FISCAL OFFICE HAVE BEEN MANAGING EVERYTHING THAT WE BROUGHT UP IN FRONT OF YOU TODAY WITHOUT OUR LEAD CHIEF FISCAL OFFICER WHO RETIRED AND OUR NUMBER TWO WHO GOT A WELL-DESERVED PROMOTION.

SO TRISH AND HER ENTIRE FISCAL TEAM DID A LOT OF WORK AND I WANTED TO THANK HER FOR HER.

AND SHE IS ALSO HERE FOR ANY SUPER DIFFICULT QUESTIONS YOU ASK US ABOUT THE BUDGET.

SHE'S OUR EXPERT.

UM, SO IF WE COULD PULL UP THE POWERPOINT.

I'LL JUST SAY ON THE HEELS OF GOING AFTER THE HEALTHCARE AGENCY, I THINK I WANNA NOT ONLY RECOGNIZE HOW WONDERFUL IT HAS BEEN FOR ME, I'VE BEEN HERE FIVE YEARS WORKING WITH MIMI HALL, AND THEN MONICA.

WE HAVE A RELATIONSHIP HERE IN SANTA CRUZ COUNTY.

BECAUSE I TALK WITH ALL MY PEERS ACROSS THE STATE THAT IS UNIQUE, IT'S VERY SPECIAL.

IT'S, UM, NOT ALWAYS BEEN THIS WAY.

I UNDERSTAND A DECADE OR MORE AGO IT WAS NOT.

BUT WE ARE VERY CLOSE.

WE WORK TOGETHER ALL THE TIME.

WE HAVE RECURRING MEETINGS, AND I COULD NOT BE HAPPIER TO HAVE TO CONTINUE WORKING WITH, UH, JEN HERRERA, WHO WE'VE WORKED WITH AND DID WONDERFUL WORK, UM, DURING COVID.

SO JUST PLEASE KNOW, BOARD AND COMMUNITY.

WE'LL CONTINUE TO BE REALLY CLOSE PARTNERS AND WORK REALLY WELL TOGETHER WITH OUR HEALTHCARE PARTNERS.

SO, UM, I WILL GIVE A QUICK OVERVIEW OF WHAT WE ARE GONNA COVER TODAY.

JUST REMIND YOUR BOARD AND THE COMMUNITY WHAT OUR MISSION IS.

[05:00:02]

GIVE A QUICK SUMMARY OF HOW WE ARE ORGANIZED AND HOW THE SERVICES WE PROVIDE ACHIEVE THAT MISSION.

I'M GONNA THEN TURN IT OVER TO KIMBERLY, WHO'S GONNA GIVE A BIT OF A BUDGET OVERVIEW AND WHAT IS ACTUALLY IN FRONT OF YOU TODAY, WHICH UNLIKE OUR COLLEAGUES IN HEALTHCARE, IS ACTUALLY PENDING FUTURE STATE AND FEDERAL CUTS, A PRETTY STATUS QUO BUDGET.

WE DON'T HAVE ANYTHING MAJOR THAT'S CHANGED UNTIL THE FUTURE.

SO IT'S REALLY A STATUS QUO, UM, ASK OF YOUR BOARD TO APPROVE WHAT'S IN FRONT OF YOU.

AND THEN I WILL CLOSE IT OUT WITH A SUMMARY OF THE RISKS THAT WE ARE TRACKING AT BOTH THE FEDERAL, STATE LEVEL AND ALSO SOME OTHER EMERGING ISSUES THAT ARE VERY, UM, SIGNIFICANT THAT SORT OF OVERLAY WITH ALL THE ACTIVITIES HAPPENING AT THE FEDERAL AND STATE LEVEL.

AND THEN CLOSE WITH ANY QUESTIONS YOU HAVE FOR US.

SO AS A REMINDER, UM, OUR DEPARTMENT, UH, OUR MISSION IS TO STRENGTHEN THE COMMUNITY BY PROTECTING THE VULNERABLE.

WE HAVE A NUMBER OF PROTECTIVE SERVICES PROGRAMS PROMOTING SELF-SUFFICIENCY, ALLEVIATING POVERTY, AND IMPROVING QUALITY OF LIFE FOR ALL.

AND THIS IS A QUICK LOOK AT THE FOUR DIRECT SERVICE DIVISIONS THAT WE ADMINISTER.

AND I WANNA TAKE A MINUTE TO JUST HIGHLIGHT THE SCOPE AND THE REACH OF OUR DEPARTMENT.

IF YOU LOOK AT THE BANNER AT THE BOTTOM, OUR DEPARTMENT SERVES ONE IN THREE COUNTY RESIDENTS.

THAT'S A VERY WIDE REACH.

I WANNA SUMMARIZE WHAT THAT LOOKS LIKE.

IN OUR ADULT AND LONG-TERM CARE DIVISION, THE VETERAN SERVICE OFFICE HAS HELPED 2,374 VETERANS, AND THEIR SURVIVORS SECURE $8.9 MILLION OF BENEFITS TO WHICH THEY'RE ENTITLED.

ARGUABLY, WITHOUT THE SUPPORT OF THIS OFFICE WOULD NOT BE SECURED.

WE ALSO PROVIDE 3,900 PLUS SERVICES TO AGED, BLIND, AND DISABLED RESIDENTS OF OUR COMMUNITY WHO WITHOUT IN-HOME CARE PROVIDERS, WOULD ARGUABLY NOT BE ABLE TO STAY IN HOME.

AND AS WE LOOK AT A GROWING POPULATION, OUR ADULT PROTECTIVE SERVICES DEPARTMENT IS GROWING WITH A GROWING NUMBER OF REFERRALS.

AND WE RECEIVED OVER ALMOST 2,200 REFERRALS TO OUR APS PROGRAM.

AND THIS DATA IS ALL FROM A, A, A PAST YEAR LOOK BACK.

IN OUR TRIAL WELFARE DIVISION, WE REFER TO AS FAMILY AND CHILDREN'S SERVICES, UH, AT THE TOP, WE RECEIVED IN THE, UH, CHILD ABUSE HOTLINE UH, OVER 2,300 REFERRALS IN A 12 MONTH LOOK BACK THAT RESULTED IN 846 INVESTIGATIONS.

WHAT THAT MEANS IS MANY OF THE CALLS ARE EITHER NOT APPROPRIATE FOR US, REFERRED TO COMMUNITY-BASED ORGANIZATIONS OR INFORMATION REFERRAL.

AND OF THOSE 846 INVESTIGATIONS, THERE WERE 182 CHILDREN OR YOUNG ADULTS.

THERE IS A PROGRAM BASED ON FEDERAL AND STATE LAW THAT YOUNG ADULTS, 18 TO 21, CAN VOLUNTARILY STAY IN CARE UP TO 21 IF THEY CHOOSE WHO WE SERVED IN THE LAST YEAR.

IN OUR LARGEST DIVISION, AND THIS IS THE ONE THAT, OF COURSE, WE WILL TALK ABOUT MORE BECAUSE THIS IS THE ONE FACING THE LARGEST FEDERAL AND STATE PROPOSED CUTS, OUR EMPLOYMENT AND BENEFITS SERVICES DIVISION, SOMETIMES REFERRED TO AS PUBLIC ASSISTANCE OR SELF-SUFFICIENCY.

THE SINGLE LARGEST PROGRAM WHICH GOT MUCH DISCUSSION BY OUR HEALTHCARE AGENCY IS OUR MEDI-CAL PROGRAM.

85,000 PLUS SANTA CRUZ COUNTY RESIDENTS ON MEDI-CAL, JUST TO TAKE A MINUTE TO EXPLAIN THE INTERCONNECTEDNESS WITH THE HEALTHCARE AGENCY.

FEDERAL LAW MANDATES THAT ONLY A PUBLIC SERVANT CAN DETERMINE ELIGIBILITY FOR MEDICAID.

CALIFORNIA LAW HAS AN OVERLAY.

IT'S NOT UNIQUE TO CALIFORNIA, BUT NOT ALL STATES HAVE THIS, THAT ONLY A COUNTY HUMAN SERVICES ELIGIBILITY EMPLOYEE CAN DETERMINE ELIGIBILITY AND RENEWAL FOR MEDI-CAL.

THAT MEANS WE ARE LOCK AND STEP CONNECTED TO THE HEALTHCARE AGENCY AND THE HEALTH SAFETY NET.

SO MUCH OF WHAT WE ARE GOING TO BE DOING THIS NEXT YEAR AS CHANGES COME FORWARD IS CONTINUE TO WORK LOCK AND STEP WITH THE HEALTH AGENCY AND THEIR PARTNERS BECAUSE EVERYTHING WE DO IMPACTS OUR PARTNERS.

SO JUST WANTED TO GIVE THAT AND THAT'S WHY I GAVE MY PREAMBLE AT THE BEGINNING.

WE HAVE A GREAT RELATIONSHIP WITH HEALTH.

THE SECOND LARGEST PROGRAM, HALF THE SIZE ALSO, UM, UNDER TIGHT SCRUTINY BY THE FEDERAL GOVERNMENT IS AT THE FEDERAL LEVEL SNAP OR CALFRESH, FORMERLY FOOD STAMPS, 44 PLUS THOUSAND PEOPLE, UM, WHO ARE ELIGIBLE FOR FOOD STAMPS.

AND CAN I PLEASE RECOGNIZE OUR PARTNERSHIP WITH THE FOOD BANK, LONG STANDING PARTNERSHIP THERE AND THEY ARE GETTING FEDERAL CUTS.

SO TOGETHER, THE FOOD BANK CUTS AND OUR CUTS ARE A SIGNIFICANT ISSUE AROUND FOOD INSECURITY.

AND THEN LAST, BETWEEN TWO PROGRAMS IN THIS DIVISION, BOTH THE WORKFORCE DEVELOPMENT BOARD AND THE CALWORKS PROGRAM, WE HAVE SERVED OVER 1,600 PEOPLE GETTING EMPLOYMENT SERVICES TO HELP THEM RETAIN GAINFUL EMPLOYMENT.

AND LAST, THE HOUSING FOR HEALTH DIVISION.

WE HAVE TWO NEW BOARD MEMBERS HERE, SO I JUST WANNA MAKE SURE TO MAKE SURE THE FULL BOARD AND THE COMMUNITY KNOWS WE HAVE BEEN GIVING FULL REPORTS TO THE BOARD EVERY SIX MONTHS.

THE LAST DIRECTION WE GOT WAS TO SHIFT THAT TO ONCE A YEAR, AND WE WILL BE UP IN FRONT OF YOUR BOARD IN SEPTEMBER WITH THE NEXT YEARLY REPORTING.

BUT I WANNA HIGHLIGHT SOME, I THINK, VERY IMPRESSIVE STATISTICS.

WE- IT INCLUDES THE WHOLE COUNTY COMMUNITY, CITY PARTNERS, AND YOUR BOARD FOR SUPPORT GROWING THIS DIVISION.

THE HOUSING FOR HEALTH DIVISION, ITS STAFF AND OUR CBO PARTNERS HAVE TOUCHED OVER 4,600 PEOPLE

[05:05:02]

IN A 12 MONTH LOOK BACK.

SOME OF THAT ARE SOFT TOUCHES, SOME OF OUR DEEP CASE MANAGEMENT TOUCHES.

AND THEN THIS IS PARTICULARLY SIGNIFICANT, 01,384 PEOPLE HOUSED THROUGH A MULTITUDE OF DIFFERENT PROGRAMS. BUT THE GRAND TOTAL IS THIS IS A VERY LARGE NUMBER OF PEOPLE, SOME OF THEM WERE UNSHELTERED, SOME OF WHOM WE CAME IN WITH RENTAL ASSISTANCE AND KEPT THEM HOUSED, BUT THAT'S A LARGE NUMBER OF PEOPLE WHO ARGUABLY COULD HAVE BEEN UNHOUSED OR STAYED UNHOUSED WITHOUT THE SUPPORT THIS LAST ONE I WANT TO PAUSE AND MAKE SURE THIS IS VERY CLEAR.

THIS NUMBER IS OUR PARTNERSHIP WITH THE LOCAL SANTA CRUZ HOUSING AUTHORITY.

THE HOUSING AUTHORITY RECEIVES ALMOST 5,200 FEDERAL HOUSING VOUCHERS.

WE USE DIRECTLY IN AN MOU WITH THE HOUSING AUTHORITY ABOUT 20% OF THOSE.

AND THE 80% BALANCE ARE PEOPLE WHO OTHERWISE WOULD NOT BE ABLE TO AFFORD THEIR RENTAL MARKET RATE COSTS.

SO THEY ARE HELPING A LOT OF PEOPLE WHO DO NOT HAVE TO FALL IN THE SAFETY NET.

SO WE WANTED TO SORT OF GRAND TOTAL RECOGNIZE THE GREAT WORK AND THE PARTNERSHIP WE HAVE WITH THE HOUSING AUTHORITY AND THEIR REACH.

AND WHEN YOU GET TO PROPOSE FEDERAL CUTS, WHY WE'RE SO WORRIED ABOUT SOME OF THE PROPOSED CUTS.

SO BY EXTENSION, I WANNA TAKE A MINUTE TO TALK ABOUT SOME OF OUR ACCOMPLISHMENTS THIS PAST YEAR.

THIS IS, UM, WE HAVE THE FOUR DIRECT SERVICE DIVISION AND WE HAVE TWO ADMINISTRATIVE DIVISION.

SO WE JUST SELECTED ONE THAT WE'RE PARTICULARLY PROUD OF.

WE WANTED TO BE MINDFUL OF THE GLOOM AND DOOM AND THE ANXIETY OF WHAT'S COMING.

TAKE A MINUTE TO SAY WE HAVE DONE SOME REALLY IMPORTANT THINGS.

IN OUR SELF-SUFFICIENCY DIVISION, THERE'S BEEN A LOT OF DISCUSSION ABOUT MEDI-CAL ELIGIBILITY FOR THE UNDOCUMENTED IMMIGRANT POPULATION.

MY UNDERSTANDING IS WE ARE JUST SIX MONTHS BEHIND OREGON IN BEING THE SECOND, ALMOST FIRST STATE IN THE NATION THAT MADE ALL UNDOCUMENTED IMMIGRANTS ELIGIBLE FOR MEDI-CAL AND SORT OF COHORT ROLLOUT.

WE HAVE A VERY CLOSE PARTNERSHIP WITH COMMUNITY-BASED ORGANIZATIONS BROADLY AND COMMUNITY ACTION BOARD SPECIFICALLY THAT YOUR BOARD HAS APPROVED A CONTRACT TO HAVE COMMUNITY DO OUTREACH TO THE UNDOCUMENTED IMMIGRANTS TO HAVE THAT VERY DIFFICULT CONVERSATION ABOUT WHO YOU WANT TO CONSIDER PUTTING YOUR NAME IN A GOVERNMENT DATABASE TO GET THE BENEFIT OF HEALTHCARE, WHICH UNDER THE CURRENT FEDERAL ADMINISTRATION IS VERY TRICKY GIVEN A LOT OF THE FEAR MONGERING AROUND IMMIGRANTS.

WE HAVE SUCCESSFULLY, IN PARTNERSHIP, GOT OVER 8,000 PEOPLE ENROLLED IN MEDI-CAL, WHICH MEANS THEY HAVE A PAYMENT SOURCE FOR ALL THE SERVICES.

AND THIS WE'LL TALK ABOUT LATER, IS AT RISK.

IN THE HOUSING FOR HEALTH DIVISION, I PARTICULARLY WANNA SHARE THIS WITH THE BOARD, BECAUSE THIS BOARD LITERALLY IS FIVE NEW PEOPLE FROM MY FIRST YEAR.

AND THERE WERE DECISIONS THAT WERE MADE EACH SUCCESSIVE BUDGET YEAR WHEN YOU LOOK BACK OVER THE FIVE YEAR PERIOD.

THIS PROGRAM MOVED WHEN IT WAS TWO ANALYSTS IN THE CEO AND THEN CAO OFFICE, TWO HUMAN SERVICES, IT IS NOW 20 PEOPLE.

THAT IS ONLY BECAUSE THIS BOARD AND THE CEO HAS SUPPORTED BUILDING UP THIS PROGRAM.

I WANNA TELL YOU OUR SUCCESS PAYS OFF.

WE HAVE 20 STAFF.

THAT HAS BEEN ABOUT $3 MILLION OF GENERAL FUND OVER THOSE FIVE YEARS YOU'VE GIVEN TO US.

WE LEVERAGE THAT THROUGH CLAIMING.

SO WE'RE GETTING FEDERAL AND STATE MONEY TO ALMOST DOUBLE THAT MONEY.

IN THE LAST FOUR FISCAL YEARS, WE'VE SECURED $67.5 MILLION IN FEDERAL AND STATE GRANTS.

IF YOU DO THE MATH, WE ARE GETTING A OVER NINE-TIME RETURN ON INVESTMENT FROM BUILDING UP THIS PROGRAM AND SECURING AS MUCH MONEY AS WE CAN.

NOW, LET ME PAUSE FOR A MINUTE.

I THINK, UM, OUR AUDITOR IS LISTENING OR WITH TRISH, THIS HAS BEEN A BIG LIFT ON OUR SHOULDERS.

IT'S A LOT OF WORK FOR CONTRACTS, OUR AUDITOR, OUR FISCAL TEAM, BUT WE'RE DOING IT.

AND I JUST WANT TO HIGHLIGHT AND THANK THE BOARD AND THE COMMUNITY FOR INVESTING IN US.

IT HAS BROUGHT GREAT RETURNS.

UM, NEXT, FATHER ENGAGEMENT.

SOME OF YOU ON THIS BOARD ARE VERY FAMILIAR WITH PUBLIC CHILD WELFARE.

IF YOU DON'T KNOW, BASED ON STATE LAW, ALL PUBLIC CHILD WELFARE SYSTEMS HAVE TO HAVE A SYSTEM IMPROVEMENT PLAN.

AND THAT IS A PARTNERSHIP WITH COMMUNITY PARTNERS.

AND WE LOOK AT WHAT WE WANNA DO TO IMPROVE OUR WORK.

AND FIVE YEARS AGO, WHEN WE STARTED THE NEXT FIVE-YEAR CYCLE OF OUR SYSTEM IMPROVEMENT PLAN, WE FOCUSED ON FATHER ENGAGEMENT.

IT IS A, UNFORTUNATELY, I THINK A MOTHER-CENTRIC PROGRAM.

THAT MAKES SENSE BECAUSE SOME OF THE DATA, BUT IT, UNFORTUNATELY, THE PUBLIC SYSTEM OFTEN MISSES THE VERY IMPORTANT ROLE OF FATHERS AND THEIR EXTENDED FAMILY.

SO THERE IS REAL INTENT TO FOCUS ON FATHERS.

AND WE SEE IN OUR DATA THAT WE HAVE A 10% INCREASE IN THE NUMBER OF OUR CASE PLANS THAT HAVE FATHERS BUILT INTO THE WORK WE DO.

SO TO THE FATHERS IN THE ROOM AND I, ONE MYSELF, I THINK THIS IS GOOD WORK THAT WE'RE DOING IN THE DIVISION.

THE NEXT IN OUR AGING AND LONG-TERM CARE DIVISION WANT TO RECOGNIZE THAT OUR GOVERNOR IN CALIFORNIA MANDATED THROUGH AN EXECUTIVE ORDER THAT ALL COMMUNITIES IN CALIFORNIA DEVELOP A MASTER PLAN FOR AGING TO PREPARE FOR A RAPIDLY AGING POPULATION THAT HAS LANDED HERE OVER THREE YEARS AGO WITH THE COMMITTEE THAT INVOLVES ALL FOUR CITIES, MULTIPLE COUNTY DEPARTMENTS.

WE PLAY A LEAD ROLE IN PARTNERSHIP WITH THE CEO.

[05:10:02]

AND THEN OF COURSE, OUR NONPROFIT PARTNERS THAT ADMINISTER THE OLDER AMERICANS ACT, FEDERAL OLDER AMERICANS ACT, AREA AGENCY ON AGING, AND THAT SENIORS COUNCIL.

AND WE ARE WORKING TOGETHER ON A REGULAR BASIS, TRYING TO FIND A WAY TO WORK TOGETHER TO PREPARE FOR AN AGING POPULATION.

AND NOW TO THE TWO ADMINISTRATIVE DIVISIONS.

I WANNA HIGHLIGHT, AND THIS IS ALSO UNDER TRISHA'S LEADERSHIP SHE NOT ONLY OVERSEES THE FINANCE OFFICE, BUT SHE OVERSEES THE CONTRACTS OFFICE.

WE HAVE 346 CONTRACTS AND PURCHASE ORDERS IN HSD TOTALING $46.8 MILLION.

SO THERE IS A LOT OF WORK WE DO IN CONTRACT AND PARTNERSHIP WITH VENDORS AND COMMUNITY-BASED ORGANIZATIONS.

AND WHEN YOU ADD HEALTH PARTNERSHIPS, WE HAVE A VERY BROAD REACH OF COMMUNITY PARTNERS THAT WE WORK ON THE SAFETY NET TOGETHER WITH PARTNERS.

AND THEN FINALLY, WHAT IS ALL THIS DOING? I WANT TO DISCLOSE TO THIS BOARD, MY FIRST MONTH IN THE JOB, EVERY BOARD MEMBER I MET WITH, WHO WAS YOUR PREDECESSORS, SAID, PLEASE KEEP THOSE AMAZING DATA DASHBOARDS GOING THAT YOUR DEPARTMENT RUNS.

MY PREDECESSOR GETS THE CREDIT, BUT WE HAVE AN AMAZING DATA TEAM AND WE EVEN REFRESHED OUR DATA DASHBOARDS RECENTLY.

WE DID A PRESS RELEASE ON IT.

WE ARE TRYING AS WE GEAR UP FOR COMPLICATED TIMES TO HAVE AS MUCH TRANSPARENT DATA AS POSSIBLE AND HAVE IT REALLY ACCESSIBLE TO THE PUBLIC.

SO VERY PROUD OF THAT WORK AS WELL.

SO NOW I TURN IT OVER TO KIMBERLY WHO WALKED THROUGH SOME OF THE DETAILS OF THE BUDGET THAT'S IN FRONT OF YOU.

- GOOD AFTERNOON, BOARD.

SO WHAT YOU'RE LOOKING AT HERE IS OUR PROPOSED BUDGET COMPARED TO LAST YEAR'S ADOPTED BUDGET.

AND WHILE IT MAY SEEM LIKE THERE'S LARGE DECREASES IN REVENUES AND EXPENSES, THIS IS REALLY A STATUS QUO BUDGET, AS THE SHIFTS THAT YOU SEE ARE MOSTLY IN OUR HOUSING FOR HEALTH DIVISION, AND I'LL WALK YOU THROUGH THOSE IN JUST A MOMENT.

I WILL ALSO NOTE, YOU'RE PROBABLY NOTING THE CHANGE IN STAFFING FROM 583 TO 580 EMPLOYEES.

AND WHAT THIS IS, IS REALLY AN ADMINISTRATIVE SHIFT.

THERE WERE THREE FTES WITH PERSONNEL CLASSIFICATIONS THAT HSD PAYS FOR, AND THAT HAVE SAT IN HSD'S BUDGET.

FOR ADMINISTRATIVE CLEANUP, WE'RE ACTUALLY, WE'RE STILL PAYING FOR THE POSITIONS, BUT THEY WILL NOW SIT IN PERSONNEL'S STAFFING BUDGET FOR FUTURE YEARS.

SO IT'S NOT REALLY A CHANGE OF OVERALL STAFF, JUST WHERE THEY'RE GONNA SIT IN THE- THE COUNTY.

AND THEN I WILL NOTE AS IT RELATES TO THE GENERAL FUND AS THAT'S BEEN TALKED ABOUT IN PRIOR PORTIONS OF THIS MEETING, UM, THE INCREASE IN GENERAL FUND CONTRIBUTION TO OUR BUDGET THAT YOU SEE IS PARTIALLY FOR SALARY AND BENEFITS AS DIRECTOR MORALES DESCRIBED EARLIER, AS WELL AS ABOUT A MILLION IN MEASURE K FUNDING, AS WELL AS ABOUT TWO MILLION TIED TO, UM, A STATE PASS THROUGH THAT I'LL TALK THROUGH IN THE NEXT COUPLE OF SLIDES.

SO HERE ARE MAJOR REVENUE CHANGES.

YOU'LL NOTICE, UM, THE PRIOR SLIDE HAD A DECREASE OF ABOUT 13 MILLION IN REVENUE.

AND HERE YOU CAN SEE WHAT'S BEHIND THAT.

ALMOST 500,000 IN, UM, IS A DECREASE FROM CDSS GRANTS.

AND THAT REPRESENTS THE ENDING OF TWO PROGRAMS, BRING FAMILIES HOME AND HOME SAFE GRANT PROGRAMS. AND THEY'RE PHASING OUT AT THE END OF THE YEAR.

AND THEN $8 MILLION WAS REALLY A ONE TIME STATE FUNDING PASS THROUGH FOR A PERMANENT SUPPORTIVE HOUSING PROJECT ON THE HOUSING MATTERS CAMPUS NEAR HARVEY WEST PARK IN SANTA CRUZ.

AND THEN WE ALSO HAD SOME TIME LIMITED HSTAP TARGETED STRATEGIC INVESTMENT FUNDS FROM THE STATE THAT NEEDED TO BE ENCUMBERED BY THE END OF JUNE OF 2025.

AND THOSE COULD BE USED FOR INVESTMENTS IN RENTAL SUBSIDIES.

NEXT SLIDE, PLEASE.

SO WHEN WE LOOK AT THE MAJOR EXPENSE CHANGES, YOU'LL SEE SOME OVERLAP BETWEEN THE REVENUES THAT WERE CALLED OUT IN THE PRIOR SLIDE AND THE EXPENSES.

THAT $8 MILLION PASS THROUGH FROM THE STATE, UM, IT WILL SUPPORT HARVEY WEST STUDIOS CONSTRUCTION.

AND THEN THE $4.2 MILLION HDAP TSI, UM, INVESTMENT THAT YOU SAW FROM THE PRIOR SLIDE WILL LARGELY SUPPORT ONGOING RENTAL SUBSIDIES AT THE PERMANENT SUPPORTIVE HOUSING SITE.

AND THEN YOU SEE A MILLION, UM, DOLLARS IN INCREASED, UM, HOUSING SUPPORT FOR MEASURE K.

THOSE FUNDS WILL BE USED TO SUPPORT TWO OF THE LOW BARRIER NAVIGATION CENTERS THAT THE COUNTY'S DEVELOPING, AS WELL AS SUPPORT ENCAMPMENT STREET OUTREACH.

AND THEN YOU'LL SEE, UM, 1.5 MILLION FOR NAVIGATION CENTERS AND SOUTH COUNTY PREVENTION SERVICES.

THAT'S AN INCREASE FROM THE $1.5 MILLION OF CORE FUNDING THAT YOU SUPPORTED TO GO TOWARDS HOUSING FOR HEALTH SERVICES.

AND THEN LASTLY, UM, THE BOARD SUPPORT OF A $1.25 NEGOTIATED

[05:15:01]

IHSS PROVIDER WAGE INCREASE IS REFLECTED HERE WHICH WHEN YOU COMBINE THE BOARD'S WAGE INCREASE WITH THE STATE MINIMUM WAGE INCREASE, UM, THIS YEAR, IHSS PROVIDERS RECEIVED AN ALMOST 10% PAY INCREASE, WHICH IS JUST PRETTY GREAT FOR THEM.

- NOW, I SHARE A LITTLE BIT OF THE GLOOM AND DOOM.

THIS IS A CROSSWALK OF WHAT IS IN THE GOVERNOR'S STATE MAY REVISION TO HIS JANUARY PROPOSED BUDGET, UM, THAT WOULD IMPACT HUMAN SERVICES IF THE LEGISLATURE CHOOSES TO PASS THIS.

AND THIS AGAIN IS BEFORE THEY HAVE A SPECIAL SESSION IN THE FALL AND THEN I WILL END WITH THE FEDERAL PROPOSED CUTS.

UM, BECAUSE THAT'S EVERYTHING WE'LL BE TALKING THROUGH, WHICH WILL LEAD UP TO WHEN WE RETURN TO YOU, DEPENDING ON WHAT CUTS ARE EFFECTUATED THAT WE THEN HAVE TO ABSORB AND COME BACK TO YOU.

SO THE STATE MAY REVISE FOR HUMAN SERVICES TWO AREAS IN MEDI-CAL THAT IMPACT US.

FIRST, THIS IS A LITTLE BIT OF A NICHE ISSUE FOR THOSE WHO ARE CLOSE TO THIS, YOU WILL HEAR ABOUT THIS FROM CONSTITUENTS.

SO I WANNA JUST TAKE A MINUTE TO EXPLAIN THIS.

CALIFORNIA, AS OFTEN CALIFORNIA DOES, WANTED TO HELP MAKE MEDI-CAL HELPFUL TO THE MOST VULNERABLE IN OUR COMMUNITY.

THOSE WHO ARE DEEMED AGED, BLIND OR DISABLED, THAT'S A MEDI-CAL AID CODE OVER TWO, TWO SUCCESSIVE LEGISLATIVE ACTIONS HAD AN ELIMINATION OF WHAT THE FEDERAL LAW MANDATES, WHICH IS AN ASSET TEST.

AND WHAT THAT MEANS IS IF SOMEBODY AGED, BLIND, AND DISABLED HAS INCOME BELOW THE FEDERAL POVERTY LEVEL, BUT THEY HAVE ASSETS OVER $2,000, THAT'S IT.

THEY'RE INELIGIBLE FOR MEDI-CAL.

THE STATE PAID FOR THE BALANCE OF REMOVING THAT ASSET TEST.

THAT MEANT EVERYBODY WHO WAS AGED, BLIND, AND DISABLED IN CALIFORNIA WHO HAD LOW ENOUGH INCOME COULD GET ON MEDI-CAL WITHOUT, AND THEY COULD KEEP THEIR ASSETS.

THE STATE MAY REVISE, THOSE ARE TO REINSTATE THAT.

AND WHAT THAT MEANS IS PEOPLE WILL NOT BE ABLE TO STAY ON MEDI-CAL ANYMORE OR THEY WILL HAVE TO SPEND DOWN THEIR ASSETS.

AND THAT WILL BE VERY SIGNIFICANT FOR THIS POPULATION.

SO IT'S A NICHE ISSUE, BUT IT'S VERY SIGNIFICANT FOR A VERY VULNERABLE POPULATION.

AND THEN THE SECOND, WHICH HAS BEEN DISCUSSED ABOUT A GREAT LENGTH IS UNDOCUMENTED IMMIGRANTS.

THERE'S MULTIPLE ACTIONS IN THE PROPOSED MAY REVISE.

THE MAIN ONE IS EFFECTIVE JANUARY 2026 TO FREEZE ELIGIBILITY FOR 19 YEAR AND OLDER UNDOCUMENTED IMMIGRANTS.

WE BELIEVE THERE COULD BE A THOUSAND OR MORE PEOPLE IN THE COMMUNITY.

SO WE WILL HAVE THAT DELICATE CONVERSATION AND PARTNERSHIP WITH THE COMMUNITY.

WE HAVE A MEETING NEXT WEEK ABOUT IT WITH COMMUNITY BASED PARTNERS ABOUT HOW TO TALK TO FAMILIES TO MAKE AN INFORMED CHOICE ABOUT SIGNING UP FOR MEDI-CAL KNOWING THEIR NAME GETS IN A GOVERNMENT DATABASE GIVEN THE FEARS OF ICE.

AND THAT'S A TRICKY ISSUE, BUT WE WANT TO GIVE AND EMPOWER FAMILIES TO MAKE THEIR OWN DECISIONS.

AND THERE'S SOME OTHER ISSUES THAT ARE IN THE MAY REVISE, WHICH I COULD TALK ABOUT IF YOU HAVE QUESTIONS.

IN THE BOTTOM LEFT, THE IN-HOME SUPPORTIVE SERVICES PROGRAMS, THERE WAS A COUPLE OF CUTS TO PROVIDERS' ABILITY TO GET OVERTIME AND TRAVEL COSTS REIMBURSED.

UNDOCUMENTED IMMIGRANTS LOSE ELIGIBILITY.

WE HAVE ABOUT 55 UNDOCUMENTED IMMIGRANTS GETTING IHSS.

THEY WOULD LOSE ELIGIBILITY FOR THIS PROGRAM IF THIS MAY REVISE GOES FORWARD.

AND THIS LAST ONE, IT'S VERY, VERY NICHE FOR WHAT WE DO, BUT I WANNA SHARE IT WITH YOU AS AN EXAMPLE OF COUNTIES HAVING TO ABSORB A LOT OF FEDERAL AND STATE DECISIONS.

OVER 40% OF OUR CASELOAD IN IHSS IS THIS PROGRAM CALLED COMMUNITY FIRST CHOICE OPTION.

IT HAS A RICHER REIMBURSEMENT RATE FROM THE FEDERAL GOVERNMENT, 56% ON THE DOLLAR INSTEAD OF 50.

THAT 6% TRANSLATES TO MILLIONS AND MILLIONS OF DOLLARS.

THE STATE OF CALIFORNIA IS OUT OF COMPLIANCE.

COUNTIES ARE OUT OF COMPLIANCE WITH OUR MANDATES IN THIS PROGRAM, AND THE MAY REVISE PROPOSES THE COUNTIES HAVE TO ABSORB THOSE COSTS, UM, THOSE FEES.

SO WE ARE LOOKING AT HAVING TO ABSORB PENALTIES IN THE FUTURE IF THIS GOES FORWARD, WHICH COULD IMPACT OUR STAFFING LEVELS.

IN THE CHILD WELFARE SPACE, UM, TWO PROGRAMS ARE PROPOSED FOR ALMOST 50% REDUCTION.

THESE ARE BOTH PROGRAMS THAT SUPPORT CAREGIVERS.

UM, FURS IS AN ACRONYM FOR AN URGENT RESPONSE SYSTEM THAT HAS A 24-HOUR PHONE LINE FOR FAMILIES WHO NEED SOME SUPPORT WITH THE CHILD THEY'RE CARING FOR AND A MOBILE RESPONSE AS WELL.

AND THERE'S ALSO EMERGENCY CHILDCARE FOR CAREGIVERS OF OUR FOSTER CHILDREN THAT WOULD BE REDUCED SIGNIFICANTLY.

AND THEN LAST ON THE STATE MAY REVISE IN THE HOUSING FOR HEALTH SPACE, KIMBERLY MENTIONED IT IS ACTUALLY IN THE BUDGET.

THERE'S A PROPOSAL IN WHAT'S IN FRONT OF YOU A REDUCTION OF THIS, BUT LOOKING FORWARD TO COMPLETE ELIMINATION IN THE STATE BUDGET OF TWO GRANTS.

AND THAT'S IN THE APS SPACE AND THE CHILD WELFARE SPACE.

OUR CEO, MR. PALACIOS MENTIONED IN HIS PRESENTATION STILL EVERYTHING CONTINUES TO BE ONE-TIME FUNDING, WHICH IS ALMOST IMPOSSIBLE, BRAID TOGETHER A LONG-TERM SOLUTION TO KEEP THESE PROGRAMS OPERATING THAT ARE BEING SUCCESSFUL.

AND UNFORTUNATELY, OUR GOVERNOR CONTINUES WITH A NARRATIVE THAT, UM, THE PROBLEM WITH HOMELESSNESS IS A COUNTY NOT BEING RESPONSIBLE, AND HE IS ADDING MORE AND MORE ADMINISTRATIVE BURDEN TO US,

[05:20:01]

UM, THAT WE ARE HAVING TO TRACK AND REPORT SAYING WE ARE NOT BEING ACCOUNTABLE TO DO OUR JOB WELL.

AND I DISAGREE WITH THAT, BY THE WAY, FOR THE RECORD.

OKAY, FEDERAL FUNDING RISKS.

IT WAS SAID IN THE CEO'S PRESENTATION, A THIRD OF THE STATE BUDGET IS FEDERAL.

SO THAT'S WHY THE CASCADING EFFECT OF WHAT HAPPENS IN THE FEDERAL BUDGET AFTER THE STATE BUDGET IS ADOPTED HAS A RIPPLE EFFECT.

AND IN OUR DEPARTMENT, HUMAN SERVICES, 43% OF OUR BUDGET IS FEDERAL.

SO THE IMPACT OF FEDERAL CUTS COULD BE SIGNIFICANT, WHICH LEADS TO US COMING BACK DURING THE FALL.

YOU'VE HEARD A LOT ABOUT MEDICAID.

IN ADDITION TO ADDING WORK REQUIREMENTS, I WANNA REMIND THE BOARD AND THE COMMUNITY, MOST PEOPLE ON MEDI-CAL IN CALIFORNIA WORK.

THEY HAVE PART-TIME JOBS, THEIR JOBS DON'T PAY ENOUGH TO BE- THEY'RE STILL UNDER THE FEDERAL POVERTY LEVEL.

THIS IS A ACTION TO TRY TO DISCOURAGE AND KEEP PEOPLE OFF OF MEDI-CAL AT THE FEDERAL LEVEL.

CALIFORNIA IS FACING A 10% PENALTY OF FEDERAL FUNDS.

IF CALIFORNIA CONTINUES TO PROVIDE ANY MEDI-CAL TO ANY UNDOCUMENTED IMMIGRANT, WE WOULD LOSE REIMBURSEMENT FROM THE FEDS AS A PENALTY.

AND THEY'RE ALSO ADDING RENEWAL RESPONSIBILITIES IN OUR MEDI-CAL PROGRAM, WHICH WOULD BE A SIGNIFICANT WORKLOAD FOR US AND A SIGNIFICANT BURDEN ON PEOPLE ON MEDI-CAL TO HAVE TWICE A YEAR TO GO THROUGH THE ONEROUS PROCESS OF RENEWING THEIR ELIGIBILITY.

IN THE HOUSING SPACE, THIS WAS MENTIONED EARLIER, AND I LINK IT TO THE HUGE VOLUME OF HOUSING VOUCHERS WE HAVE.

THE FEDS, THE PRESIDENT HAS PROPOSED AN ALMOST 50% REDUCTION IN SPENDING AND HUD, A LOT OF WHICH IS RENTAL ASSISTANCE PROGRAMS. AND LAST BUT NOT LEAST, THE STATE DOES NOT PROPOSE ANY CUTS OR CHANGES TO THE CALFRESH PROGRAM, WHICH AT THE FEDERAL LEVEL IS SNAP, BUT THE FEDERAL GOVERNMENT'S PROPOSING DRAMATIC CUTS TO SNAP, WHICH BASICALLY SHIFT COST BURDEN TO THE STATE.

AND AS I SAID TO YOU ON MAY 20TH, UM, IT IS ESTIMATED THAT IF THESE FEDERAL CHANGES GO FORWARD, THE STATE WILL HAVE A THREE TO $6 BILLION HOLE TO FILL BY HAVING TO ABSORB THE STATE SHARE OF COSTS FOR THE SNAP PROGRAM.

I'M GONNA END WITH A COUPLE OF EMERGING ISSUES THAT ARE NOT TIED TO ALL THE STATE AND FEDERAL PROPOSED CHANGES.

ONE IS IT WAS MENTIONED IN THE CEO'S BUDGET PRESENTATION AND IT CERTAINLY TRANSLATES IN HUMAN SERVICES.

WE HAVE A GROWING NUMBER OF PARTIALLY AND COMPLETELY UNFUNDED MANDATES THAT WE'RE MANDATED TO DELIVER, BUT WE HAVE NO FUNDING STREAM FROM THE STATE.

AND IT'S JUST THE CUMULATIVE EFFECT OF THIS OVER THE YEARS IS SORT OF BREAKING OUR BACKS.

AND THIS IS AN ISSUE WE NEED TO WORK ON IN CALIFORNIA POLITICS 'CAUSE IT'S- THESE THINGS NEED TO BE FUNDED.

UM, IT WAS SAID EARLIER, IT WAS EVEN SAID IN THE GOODBYE TO, UM, MONICA MORALES AND THE LEVITY FROM SUPERVISOR KOENIG.

UH, HOUSING COSTS ARE UNAFFORDABLE EVEN FOR DIRECTORS, UM, BUT THE UNSUSTAINABLE HOUSING COSTS AS A REMINDER, THERE'S A YEARLY REPORT THAT COMES OUT AND I THINK THREE YEARS AGO WE ECLIPSED SAN FRANCISCO AS THE MOST EXPENSIVE RENTAL MARKET IN THE UNITED STATES OF AMERICA.

AND THIS HAS IMPACTS ON WORKFORCE AND THIS CERTAINLY HAS IMPACTS ON OUR WORK IN THE SAFETY NET TO HELP PEOPLE WHO ARE LOW INCOME AND WHO ARE UNSHELTERED.

A LITTLE BIT OF A BRIGHT LIGHT.

THIS WAS MENTIONED CALAIM.

THIS IS A FEDERAL WAIVER THAT THE STATE HAS AND WE ARE WORKING CLOSELY WITH HEALTHCARE ON THIS.

I JUST WANNA HIGHLIGHT FOR US, UM, GOING INTO EFFECT IN JANUARY IS A SIX MONTH TRANSITIONAL RENT SUBSIDY FOR PEOPLE ON MEDI-CAL WHO ARE BEHAVIORAL HEALTH CLIENTS THAT WOULD HELP THEM WITH SIX MONTHS OF BRIDGE, UM, RENT ON THE CALAIM PROGRAM.

SO WE'RE REALLY EXCITED ABOUT THAT AND THAT'S SOMETHING WE'LL BE ROLLING OUT NEXT YEAR.

I ALREADY MENTIONED THE SECOND TO THE LAST BULLET IS THE RAPIDLY AGING DEMOGRAPHIC.

UM, CALIFORNIA IS PROJECTED TO HAVE ONE IN FOUR RESIDENTS BE OVER 60, AND CALENDAR YEAR 2030 SANTA CRUZ IS ONE IN THREE.

WE HAVE A, A MUCH, UH, OLDER POPULATION THAN THE AVERAGE.

I WANNA END WITH, UM, TRANSPARENCY AND COMMUNICATION.

A LOT OF THE DIRECTION I HEARD YOUR BOARD, AFTER HEALTH SPOKE, IS ABOUT WORKING IN PARTNERSHIP AS PUBLIC SYSTEMS WITH COMMUNITY PARTNERS.

I HEARD SOME OF OUR COMMUNITY PARTNERS CALL IN AND SAY, CAN WE WORK IN COMMITTEES WITH EVERYBODY? WE ARE COMMITTED TO WORKING WITH EVERYBODY BEING REALLY OPEN.

THIS IS COMPLEX STUFF AND I THINK HALF THE CHALLENGE IS JUST EXPLAINING IT SO PEOPLE UNDERSTAND WHAT IT IS AND KNOW WHAT TO REACT TO AND WE ARE COMMITTED TO DOUBLE DOWN IN THE NEXT THREE, FOUR MONTHS TO WORK IN PARTNERSHIP WITH PUBLIC SYSTEMS, CITY PARTNERS, AND OUR NONPROFITS TO WORK TOGETHER TO FIND COMMON SOLUTIONS.

AND THIS, THIS IS SOMETHING WE DO HAVE SOME CONTROL OVER AND WE ARE COMMITTED TO.

UM, THIS LEADS ME TO THE, UM, CLOSING SLIDE, WHICH IS, I HOPE TO YOU BOARD MEMBERS, SO MUCH LESS DRAMATIC THAN HEALTH.

UM, THAT IS NO BYPRODUCT OF OUR WORK, JUST THE DUMB LUCK OF OUR PROGRAMS. UM, AS KIMBERLY SAID, THIS IS A STATUS QUO BUDGET.

UM, WE ARE ASKING FOR YOU TO APPROVE THE PROPOSED BUDGET AND THE DETAILS ARE LISTED IN THE BULLET POINTS.

AND WITH THAT, UM, CHAIR HERNANDEZ, I CLOSE.

THANK YOU FOR THE OPPORTUNITY TO PRESENT AND WE ARE HERE FOR ANY QUESTIONS.

- THANK YOU. I'LL OPEN IT UP TO, TO THE PUBLIC FIRST TO SEE IF ANYBODY WOULD LIKE TO COMMENT ON THIS ITEM.

SEEING NONE, ANYONE ONLINE? - I SEE NO SPEAKERS ONLINE, CHAIR.

- OKAY. WE'LL BRING IT BACK TO THE BOARD.

ANY COMMENTS, ANY COMMENTS, QUESTIONS, OR, UH, MOTION?

[05:25:05]

SUPERVISOR DE SERPA.

- THANK, THANK YOU. THANKS FOR THE PRESENTATION.

UM, I HAVE A QUESTION ABOUT THE HW.

UM, MONEY THAT IS, I GUESS, ENCUMBERED OR EMBARGOED I DON'T KNOW, I CAN'T REMEMBER WHAT YOU SAID EXACTLY FOR THE HARVEY WEST, UM, BUILD OUT.

UM, SO THAT PROGRAM TYPICALLY SERVES PEOPLE WITH DISABILITIES.

SO EVERYONE WHO WILL GET THE RENTAL SUBSIDY THERE, IS SOMEBODY THAT IS ON SOCIAL SECURITY AND DISABLED? - TO BE ELIGIBLE FOR HW, YOU WOULD HAVE TO BE DISABLED.

I, I DON'T WANNA SAY ABSOLUTELY THEY WOULD GET SOCIAL SECURITY BUT I'M GUESSING LIKELY, MOST LIKELY SO.

- OKAY. AND DO WE KNOW ABOUT HOW LONG THAT 4,250,000 WILL LAST IN TERMS OF THE SUBSIDY? - IT'S ANTICIPATED THAT THAT FUND WILL LAST A MINIMUM OF 15 YEARS.

- OH, THAT'S GREAT.

- MM-HMM. - OKAY.

THAT'S GREAT NEWS.

UM, OKAY, ANOTHER QUESTION I HAD WAS ABOUT, UM, LONG-TERM CARE REDUCTION OR ELIMINATION, UM, FOR MEDI-CAL FOR PEOPLE THAT ARE UNDOCUMENTED.

I'M WONDERING DOES THAT INCLUDE ELDERDAY SERVICES? - UH, SO JUST TO BACK UP, THIS IS, AND THE STATE MAY REVISE, IT HAS A NUMBER OF PROPOSED IMPACTS TO UNDOCUMENTED IMMIGRANTS AND FOR THOSE WHO ARE ON MEDI-CAL AND ELIMINATION OF LONG-TERM CARE SERVICES AND IHSS.

FOR HSD, WE ADMINISTER IHSS.

SO I KNOW FOR SURE THEY'RE INELIGIBLE.

I DON'T KNOW THE SPECIFIC ANSWER OF THE SPECTRUM OF LONG-TERM CARE SERVICES IF THAT INCLUDES ELDERDAY OR OTHER UNDER THAT UMBRELLA, BUT WE CAN TRACK THAT.

AND WHEN WE COME BACK TO YOU OR MEET WITH YOUR OFFICE LET YOU KNOW.

'CAUSE THAT WILL BE PART OF WHAT COMES OUT IN THE STATE'S, UH, FINAL BUDGET JUNE 15TH.

- I JUST CAN'T TELL YOU HOW MANY PEOPLE THAT I'VE PLACED INTO ELDERDAY THAT HAD NO OTHER OPTION.

AND IT WAS HUGELY HELPFUL 'CAUSE THEY GOT TO SEE A NURSE EVERY DAY, GET THEIR MEDICATIONS DISPENSED, HAVE TWO MEALS, SOCIALIZATION.

IT REALLY MADE A HUGE DIFFERENCE FOR PEOPLE THAT WERE UNDOCUMENTED THAT I COULDN'T GET INTO ASSISTED, COULDN'T REALLY GET INTO ASNF 'CAUSE THEY DIDN'T QUALIFY, BUT THEY WERE ON THE STREET.

- I THINK USUALLY FOR MEDI-CAL, UH, LONG-TERM CARE SERVICES HAS BEEN, HAS MEANT SKILLED NURSING FACILITY SERVICES BUT WE'LL CONFIRM, AS RANDY SAID.

- OKAY.

UM, AND THEN, UH, ON THE CHILD WELFARE AREA, SO I DID THE MATH, I THINK I DID IT RIGHT, THAT WE GOT 800, NO, 2,334 REFERRALS OF THOSE 846 INVESTIGATED, SO THAT'S LIKE 36.2% WERE INVESTIGATED.

SO, UM, SOME WERE DIVERTED, RIGHT, INTO DIFFERENTIAL RESPONSE OR WHATEVER WE'RE CALLING IT NOW, AND DID GET SOME SERVICES, I'M GUESSING.

AND THEN DO WE KNOW ABOUT HOW MANY WERE EVALUATED OUT, OR.

- SO...

- THAT'S DID... AND, AND IS THAT...

- YEAH. - MY REAL QUESTION IS DOES THAT NUMBER FOLLOW SORT OF A BENCHMARK, UM, STATEWIDE OR HOW, HOW, HOW DO WE...

- WITHOUT EVEN LOOKING BACK, GLORIA CARROLL, OUR CHILD WELFARE DIRECTOR IS HERE AND SHE CAN, AND MAYBE YOU CAN SAY SOMETHING ABOUT FFPSA IN DIFFERENTIAL RESPONSE 'CAUSE THAT'S INSIDE BASEBALL THAT ONLY SUPERVISOR DE SERPA MIGHT KNOW.

- SURE. I AM GLORIA CARROLL, CHILD WELFARE DIRECTOR, AND NO, IT DOESN'T REALLY TRACK THE STATEWIDE AVERAGE.

WE'RE STILL GETTING OVER REPORTS OF ABUSE AND NEGLECT, WHICH KIND OF SPEAK TO, UM, SOME ADDITIONAL EDUCATION WE NEED TO DO IN THE COMMUNITY ABOUT NOT ALWAYS CALLING THE HOTLINE BECAUSE THERE'S A PERCEPTION OF ABUSE.

BUT TRULY KNOWING WHAT ABUSE IS AND WHAT IT ISN'T, SO THAT WE CAN USE SOME OF OUR COMMUNITY PROVIDERS TO PROVIDE SUPPORT TO THE FAMILIES WHO MAY HAVE NEEDS, BUT THAT LITERALLY DON'T MEET THE DEFINITION OF ABUSE AND NEGLECT.

SO THAT WORK IS STILL UNDERGOING.

WE HAVE A NUMBER OF OTHER COMMUNITY AGENCIES IN OUR CHILD, YOUTH, AND FAMILY WELLBEING CABINET THAT ARE SORT OF WORKING WITH US TO KIND OF CREATE A COMMUNITY REFERRAL PATHWAY SO THAT WE CAN SERVE THE FAMILIES, BUT NOT ALWAYS HAVE THEM BE SYSTEM INVOLVED.

- RIGHT. SO THE 36.2%, IS THAT ABOVE THE STATE AVERAGE IN TERMS OF INVESTIGATION RATE? - I THINK WE'RE ABOUT IN THE MIDDLE.

- IN THE MIDDLE.

- YEAH. DEPENDING ON THE COUNTY.

SOME COUNTIES JUST TEND TO OVER-REPORT.

SOMETIMES IT'S SMALLER COUNTIES, SOMETIMES IT'S THE LARGER COUNTIES BECAUSE THERE'S A FEAR IN THE PUBLIC THAT THE CHILDREN WILL KIND OF FALL THROUGH THE CRACKS.

BUT, UM, IT'S SOMETHING THAT WE'RE ALL KIND OF CHILD WELFARE AGENCIES ARE STRUGGLING WITH THAT LENS OF EDUCATION ABOUT WHAT ABUSE IS, AND IT ISN'T BECAUSE PEOPLE STILL HAVE A BIT OF A LIABILITY LENS, WHEN IN DOUBT, CALL THE HOTLINE, BUT LITERALLY THE MESSAGE IS NOW CHANGING FROM MANDATED REPORTING TO COMMUNITY SUPPORTING.

SO INSTEAD OF CALLING CHILD WELFARE, CALL A COMMUNITY AGENCY.

- THANK YOU VERY MUCH.

AND THEN ONE FINAL QUESTION, THE CF- CFCO, THE PENALTIES.

WHAT DOES CFCO STAND FOR AGAIN? - IT IS, UH, COMMUNITY FIRST CHOICE OPTION.

[05:30:04]

IT IS THE HIGHEST NEEDS IHSS CLIENTS.

THE STATE OF CALIFORNIA ABOUT 10 YEARS AGO APPLIED TO THE FEDERAL GOVERNMENT FOR A WAIVER.

THE FEDERAL GOVERNMENT MADE THIS, UM, AN OPTION FOR STATES THAT HAD IN-HOME CARE PROGRAMS. THE WAIVER ALLOWS MEDICAID TO PAY FOR IN-HOME CARE PROVIDERS.

FOR CLIENTS THAT HAVE PARTICULARLY HIGH NEEDS, THEY WERE WILLING TO PAY A HIGHER REIMBURSEMENT RATE, NOR- CASES THAT AREN'T THIS HIGHER LEVEL ARE 50% FEDERALLY FUNDED, CFCO IS 56%.

BUT WHAT'S HAPPENING IN CALIFORNIA IS NOT ALL CASES ARE GETTING RENEWED ON AN ANNUAL BASIS TO REDETERMINE THEIR ELIGIBILITY.

SO THE FEDERAL GOVERNMENT IS DINGING THE STATE AND NOT PAYING THEIR REIMBURSEMENT RATE IF THE CASE HAS NOT BEEN RENEWED.

THE STATE HAS BEEN EATING THAT COST FOR THE 10 YEARS THIS HAS BEEN RUNNING AND FOR REASONS I HAVE TO SAY, I UNDERSTAND THE STATE IS SAYING THIS IS ON YOU AND IT'S A LITTLE BIT OF A FIGHT 'CAUSE WE DON'T THINK WE'RE FUNDED ADEQUATELY, ET CETERA, ET CETERA.

BUT SO WHAT THIS WILL MEAN IF IT PASSES IS EVERY SINGLE ONE OF OUR CASES THAT IS OVERDUE FOR RENEWAL, WE WILL INCUR THE PENALTY AND THAT DIRECTLY IMPACTS OUR ADMINISTRATIVE BUDGET, WHICH DIRECTLY IMPACTS OUR STAFFING LEVELS.

SO IT DOUBLES DOWN OUR NEED TO TALK ABOUT PRODUCTIVITY WITH OUR WORKFORCE BECAUSE WE HAVE TO BE IN COMPLIANCE WITH THE EARLY RENEWALS WHERE WE WILL FACE FISCAL SANCTIONS FOR IT.

- OKAY. WELL, WE CAN TALK ABOUT IT OFFLINE.

THANK YOU VERY MUCH.

- SUPERVISOR CUMMINGS.

- AND I JUST WANTED TO THANK YOU ALL FOR THAT PRESENTATION.

UM, LOOKS LIKE YOU GUYS ARE LUCKY FOR NOW WITH JUST HAVING A STATUS QUO BUDGET.

BUT, UM, IT'S JUST REALLY DEPRESSING TO HEAR, YOU KNOW, ABOUT THE STATE AND FEDERAL CUTS, AND WHAT THAT'S GOING TO LIKELY MEAN, TO ALL THE AMAZING WORK THAT Y'ALL ARE DOING IN OUR COMMUNITY.

AND I JUST WANT TO CALL OUT IN PARTICULAR THE HOUSING FOR HEALTH DIVISION.

I MEAN, THIS IS SOMETHING THAT PEOPLE IN THE, THE CITY, WELL, IN THE COMMUNITY AS A WHOLE, ESPECIALLY WHEN I WAS ON CITY COUNCIL THAT WE'RE DEMANDING WE NEED TO DO MORE.

WE NEED TO DO MORE AND, AND I THINK THE COUNTY HAS HEARD THAT LOUD AND CLEAR ALONG WITH, I'LL SPEAK TO THE CITY OF SANTA CRUZ SINCE THAT'S MY DISTRICT AND THE AMOUNT OF INVESTMENTS THAT THEY'RE PUTTING INTO HOMELESSNESS.

UM, BUT SEEING, YOU KNOW, THE DEPARTMENT GROW FROM JUST TWO STAFF ANALYSTS TO 20 MEMBERS AND YOU KNOW, THE AMOUNT OF RETURN WE GET ON OUR DOLLARS, IT'S DEFINITELY WORTH THE INVESTMENT IN OUR COMMUNITY.

SO JUST HOPE WE CAN CONTINUE TO SHARE THE STORIES OF THE AMAZING WORK THAT'S BEING DONE AND HOW WE'VE INVESTED IN THIS, IN HOMELESSNESS AS SOMETHING THAT'S, UM, YOU KNOW, REALLY IMPORTANT TO US, UM, ALONG WITH THE OTHER SERVICES THAT WE PROVIDE IN THE COMMUNITY.

AND SO, I'LL LEAVE MY COMMENTS THERE 'CAUSE I KNOW IT'S, IT'S BEEN A LONG DAY.

THANK YOU.

- SUPERVISOR MARTINEZ.

- THANK YOU FOR THE PRESENTATION.

UM, AND I'M GONNA BE A LITTLE BIT OF A BROKEN RECORD IN THAT, UM, IN HEARING YOUR REPORT, I CONTINUE TO HAVE A LOT OF CONCERN ABOUT THE IMPACTS THAT WE'LL BE SEEING AT THE FEDERAL AND STATE LEVEL.

UM, YOU KNOW, WE DON'T HAVE ENOUGH INFORMATION TODAY TO ADJUST, RIGHT? 'CAUSE THE FINAL DECISIONS HAVEN'T BEEN MADE YET, AND WE CAN HOPE THAT THE DECISIONS THAT ARE MADE WILL BE MORE SUPPORTIVE OF THOSE WHO ARE MOST VULNERABLE.

UM, BUT WITHOUT THAT, YOU KNOW, I'M GONNA BE APPROACHING THIS BUDGET HEARING, UM, AND FUTURE CONVERSATIONS WITH CAUTION BECAUSE WE'RE GONNA BE NEEDING TO LOOK AT OUR CONTINGENCY AND OUR ABILITY TO SUPPORT FOLKS WHO ARE NO LONGER ELIGIBLE FOR THINGS LIKE CALFRESH OR FOR, UM, YOU KNOW, OTHER JUST BASIC SAFETY NET SERVICES THAT WE'VE BEEN TAKING.

I MEAN, WE'VE BEEN, WE'VE BEEN FORTUNATE TO HAVE AND MAYBE TAKEN FOR GRANTED FOR SOME TIME.

SO, UM, SO THAT'S MY OVERALL PERSPECTIVE.

I DO, YOU KNOW, MAYBE THIS IS JUST, UM, COMING OFF OF SUPERVISOR CUMMINGS COMMENTS THAT HOUSING FOR HEALTH IS AN AREA THAT IS VERY IMPORTANT TO OUR COUNTY'S VALUES AND TO OUR INVESTMENTS.

AND I'M, I'M NOT VERY CLEAR ON HOW SOME OF THE PROPOSED CUTS OR CHANGES MAY IMPACT THE WORK OF HOUSING FOR HEALTH, UM, PARTICULARLY WHEN WE'RE PARTNERING WITH CITIES OR OTHER JURISDICTIONS TO ACCOMPLISH SOME GOALS.

SO DO YOU HAVE ANY SENSE OF WHAT WE MIGHT BE THINKING ABOUT OR PLANNING FOR, UM, AS IT RELATES TO OUR COMMITMENTS TO OUR PARTNERS OR OUR SERVICES? - UM, BROADLY, YES.

I FEEL LIKE I WANNA REPEAT WHAT I SAID EARLIER, WHICH IS WE WILL BE, WE, MYSELF AND DR. RATNER WILL BE IN FRONT OF YOU PENDING ANY CHANGES FROM THE BOARD OR THE CHAIR, SEPTEMBER 30TH TO GIVE A- OUR YEARLY OVERVIEW WHERE WE CAN GO DEEPER ON THIS.

AND I THINK WE'LL HAVE A LOT MORE INFORMATION THEN.

UM, I, I WANNA PICK UP ON SOMETHING, UM, OUR CEO SAID EARLIER, WE ACTUALLY HAVE A LOT OF THINGS IN MOTION THAT HAVE SHORT TERM FUNDING STREAMS. WE'RE BUILDING UP THINGS WE HAVE, WE HAVE WAYS TO OP FUND THE OPERATIONS OF IT.

THE ISSUE IS WHAT TO DO IN ABOUT ONE OR TWO OR THREE YEARS FROM NOW.

SO I THINK WE'RE TAKING SOME THOUGHTFUL RISK BECAUSE WE MUST, IT'S CRITICAL, AND I THINK WE'VE DONE A REALLY GREAT JOB.

WE COLLECTIVELY, THAT INCLUDES CITIES TO REALLY START ROWING IN THE SAME DIRECTION NOT REACT TO CRISIS ONLY,

[05:35:02]

BUT HAVE A STRATEGIC PLAN, WHICH THE BOARD HAS APPROVED, AND WE'RE SEEING THE BENEFITS.

YOU HAVEN'T SEEN THE POINT IN TIME COUNT THAT'S GONNA BE RELEASED RELATIVELY SOON, BUT WE ARE MOVING IN THE RIGHT DIRECTION BUT THAT IS BASED ON EVERYTHING WE'VE BEEN BUILDING OVER THE LAST FIVE YEARS.

SO, SUPERVISOR MARTINEZ, THE BIG PICTURE CONCERN IS REGRESSION.

SO I THINK WE'RE GONNA HAVE TO COME FORWARD AS CREATIVE AS WE CAN TO TRY TO FIGURE OUT HOW TO HOLD EVERYTHING TOGETHER AS MUCH AS WE CAN.

YOU KNOW, LITERALLY PROBABLY PENDING MIDTERM ELECTIONS AT THE FEDERAL LEVEL TO SEE IF ANY CUTS CAN GET RESTORED.

SO I THINK WE'RE REALLY TRACKING BIG, BIG PICTURE ISSUES.

UM, BUT I, YOU KNOW, WE'RE, WE'RE VERY ANXIOUS AS WELL AND I DON'T WANNA HAVE THAT ECLIPSE THE CELEBRATION AND APPRECIATE THE COMMENT.

'CAUSE OH MY GOSH, WHEN I FIRST GOT HERE, IT WAS JUST NONSTOP.

EVERY BOARD MEETING WAS A DIRECT OF THIS.

EVERYONE'S MAD POINTING FINGER, I MEAN, WE'RE MEETING, WE'RE TALKING, WE'RE WORK- WE'RE GOING IN THE RIGHT DIRECTION.

WE HAVE A LOT MORE TO DO, BUT YES, IT COULD GET WORSE IF THESE CUTS LAND HARD.

- GREAT. WELL, THANK YOU FOR THAT.

UM, AND THANK YOU FOR YOUR PRESENTATION TODAY.

- SUPERVISOR KOENIG.

- THANK YOU, CHAIR. THANK YOU, DIRECTOR MORRIS AND TEAM.

UM, OF THE 5,198, WELL, I SHOULD SAY, YEAH, I MEAN.

GREAT, FANTASTIC WORK.

RIGHT? AND, AND PARTICULARLY THE HOUSING FOR HEALTH DIVISION.

WE'VE SEEN, I MEAN, THANKS TO, UM, THE, THE, THAT WORK, WE'VE SEEN THE LARGEST DROP IN HOMELESSNESS IN OUR, YOU KNOW, COUNTY'S RECORDED HISTORY.

SHORT... RELATIVELY SHORT, I THINK 2011 WAS THE FIRST YEAR WE STARTED MEASURING, BUT, UM, UH, THE NUMBER OF FOLKS EXPERIENCING HOMELESSNESS IN OUR COMMUNITY.

UM, AND A LOT OF THAT WAS THANKS TO THE EMERGENCY HOUSING VOUCHERS THAT WE, WE SAW, I WANNA SAY IT WAS IN THE NEIGHBORHOOD OF LIKE THREE TO 500.

I KNOW WE KIND OF GOT RE-UPPED A COUPLE OF TIMES BECAUSE WE WERE SO GOOD AT GETTING THEM OUT.

IS THAT... FIRST OF ALL, IF YOU KNOW THE RIGHT NUMBER, PLEASE CORRECT ME.

AND IS THAT INCLUDED IN THE 5,198 VOUCHERS YOU MENTIONED OR ARE THOSE SEPARATE? - KIMBERLY HAS THAT, I THINK..

- [CHUCKLES] UH, SO YEAH, SUPERVISOR KOENIG.

EMERGENCY HOUSING VOUCHERS ARE INCLUDED IN THE NUMBER THAT RANDY PROVIDED EARLIER, AND WE CURRENTLY HAVE 276, UH, EMERGENCY HOUSING VOUCHERS BEING UTILIZED.

- AND MY UNDERSTANDING IS THAT PROGRAM HAS ACTUALLY ALREADY, BEEN CUT OR THE HOUSING AUTHORITY HAS RECEIVED NOTICE THAT IT'S- THEY'RE BASICALLY ENDING AND THEY'RE TRYING TO GET PEOPLE ONTO KIND OF THE REMAINING VOUCHERS AS THEY OPEN UP.

- YEAH, THAT'S EXACTLY CORRECT.

THE EMERGENCY HOUSING VOUCHERS, UM, ARE ENDING IN THE DECEMBER 2026 AND SO THEY'RE TRYING TO, UM, MOVE PEOPLE TO OTHER MORE PERMANENT SOLUTIONS.

- RIGHT, I MEAN, ISN'T IT'S LIKE FIVE YEARS EARLIER THAN THEY WERE SUPPOSED TO END OR SOMETHING LIKE THAT, I MEAN.

- THAT PART I ADMIT, I DON'T, I'M NOT SURE.

- AND WE CAN SPEAK TO THIS IN SEPTEMBER. - SURE.

- 'CAUSE THIS IS...

AND, AND I DO WANNA JUST TO CONNECT THE DOT FOR PEOPLE.

WE WERE ONE OF THE HIGHEST PER CAPITA SUCCESSES IN CALIFORNIA AND NATIONALLY IN HELPING PEOPLE WHO ARE IN PROJECT ROOM KEY HOTELS, NOT EXCLUSIVELY, BUT PREDOMINANTLY FORMERLY UNSHELTERED.

AND WE ARE ABLE TO MOVE THEM OUT BECAUSE OF THIS PARTNERSHIP.

VOUCHERS SERVICES AND WE HELPED A LOT OF PEOPLE NOT HAVE TO GO BACK TO THE STREETS.

VERY PROUD OF THAT AND WHAT'S AT RISK IS IF THIS TERMS AND WE DON'T HAVE A BACKUP, THE WORST CASE SCENARIO, BACK UNSHELTERED.

- DO YOU SEE THAT, I MEAN, THE CALAIM, SIX MONTHS OF TRANSITIONAL HOUSING SUBSIDY SEEMS LIKE IT'S MAYBE CAN HELP BRIDGE THE GAP FOR SOME PEOPLE.

I MEAN, ARE WE...

WHAT DO YOU SEE AS THE POTENTIAL OF THAT PROGRAM? - WELL, YES, AND I WANNA... I THINK OUR, OH, OUR BEHAVIORAL HEALTH LEADERSHIP IS HERE, AND THIS IS THIS IS THE, THIS IS AN EXAMPLE OF THE PARTNERSHIP WITH HEALTH, PARTICULARLY BEHAVIORAL HEALTH.

THIS- THIS IS A ABSOLUTE PARTNERSHIP WITH HOUSING FOR HEALTH AND BEHAVIORAL HEALTH IS STILL HERE AND IT IS BEHAVIORAL HEALTH CLIENTS ON MEDI-CAL.

AND YES, AND AS YOU KNOW, THIS IS SOMETIMES THE MOST COMPLICATED POPULATION FOR US TO HELP GET HOUSING, AND THIS IS THE TARGET POPULATION, SO WE'LL BE WORKING VERY CLOSELY WITH HEALTH, BEHAVIORAL HEALTH IN PARTICULAR ON THE ROLLOUT OF THIS.

- OKAY, GREAT.

UM, YOU MENTIONED THE UNFUNDED MANDATES.

ARE THERE A FEW THAT ARE TOP OF MIND FOR YOU AS THE MOST EXPENSIVE OR PROBLEMATIC? - UM, WELL, LET ME JUST GIVE YOU, UH, JUST WHAT'S TOP OF MIND AND IT'S BECAUSE SUPERVISOR DE SERPA ASKED ME A QUESTION ABOUT IHSS AND SHE KNOWS THE PROGRAM SO WELL.

UM, OUR STATE ASSOCIATION WAS EFFECTIVE IN NOT GETTING OUR PROGRAM FULLY FUNDED, BUT GETTING STATE LEGISLATION THAT EVERY YEAR THE STATE HAD TO PUT OUT A REPORT OF WHAT THE FULL COST OF RUNNING A COUNTY IHSS PROGRAM ARE.

AND IN THE STATE MAY- MAY REVISE IT CAME OUT THAT WE ARE UNDERFUNDED ACROSS CALIFORNIA BY OVER $200 MILLION.

YET WE STILL HAVE TO RUN THE PROGRAM, EVEN THOUGH IT'S PUBLIC INFORMATION INSIDE BASEBALL, THAT MOST PEOPLE DON'T TRACK THAT IT'S ON RECORD, THAT WE ARE UNDERFUNDED.

WE DON'T HAVE ENOUGH FUNDING, WE DON'T HAVE ENOUGH STAFF TO COMPLY WITH THE MANDATES, YET THE STATE DOESN'T HAVE THE MONEY.

SO IT'S LIKE A, AN EXAMPLE.

AND MOST OF OUR PROGRAMS ARE LIKE THIS.

OUR WAIT LINES AT THE CALL CENTERS AND OUR LOBBIES AND OUR SOCIAL WORKERS HAVE TOO MANY CASES TO DO THE BEST JOB THEY'D LIKE TO DO AND THAT'S ALL A BYPRODUCT OF KIND OF NOT FULLY FUNDED SERVICES.

[05:40:03]

UM, AND SOME OF THE UNFUNDED MANDATES ARE THINGS IN THE HOUSING FOR HEALTH SPACE THAT OVERLAP WITH OUR PARTNERS IN BEHAVIORAL HEALTH.

AND THE ONE THAT'S, YOU KNOW, QUITE CONCERNING TO ME IS SB 43.

UM, AND AS I'VE TALKED WITH SOME BOARD MEMBERS, UM, IT IS A UNDERSTANDABLE GOOD PROGRAM TO HELP PEOPLE WHO ARE UNSHELTERED, WHO HAVE SIGNIFICANT ISSUES IF YOU HAVE TO, TO CONSERVE THEM TO GET THEM TREATMENT.

BUT THERE'S ZERO FUNDING, ZERO NEW FUNDING FOR THE ADMINISTRATION OF IT AND- - SURE. - AND AT ONE POINT, ZERO NEW FUNDING FOR NEW SERVICES.

SO IT'S A LITTLE BIT OF A NEW DOORWAY TO AN UNFUNDED, NOTHING WITH A LOT OF HOPE THAT GETS RAISED AND A LOT OF RHETORIC FROM OUR GOVERNOR.

I'VE SOLVED THE PROBLEM, IT'S TALK, BUT THERE'S NO FUNDING BEHIND IT AND WE HAVE TO ADMINISTER IT AND THEN DEAL WITH THE REACTION AND KIND OF EXPLAIN THIS STUFF.

SO FROM SMALL, UNDERFUNDED TO COMPLETELY UNFUNDED, PROP 36 WAS MENTIONED EARLIER THAT WILL OVERLAP WITH OUR HOUSING FOR HEALTH WORK.

IT'S JUST THE CUMULATIVE EFFECT OF ALL THESE THINGS.

- GOT IT.

UM, I'LL ASK YOU A TOUGH QUESTION.

YOU KNOW, WE COULD...

AND THIS IS NOT SOMETHING WE HAVE TO ANSWER TODAY DEFINITIVELY, BUT SORT OF A, UM, SOMETHING TO START THINKING THROUGH.

UM, YOU KNOW, PARTICULARLY IF WE'RE COMING BACK IN SEPTEMBER OR OCTOBER AND WE'RE, YOU KNOW, FACING SOME OF THE MASSIVE CUTS YOU'VE TALKED ABOUT AND WE'RE TRYING TO FIGURE OUT WAYS TO JUST FEED PEOPLE OR MAKE SURE THEY HAVE SOME BASIC HEALTH SERVICES.

AND IT'S QUITE LIKELY THAT WE COULD START, YOU KNOW, GOING TO ALL DEPARTMENTS AND SAY, HEY, WHAT...

HOW, HOW WOULD YOU ABSORB A 1%, 2% CUT, 3% CUT? UM, HOW, I MEAN, HOW DO YOU SEE, LIKE YOU WOULD MANAGE THAT IN THE DEPARTMENT? ARE THERE, I MEAN, I'M ASSUMING YOU'RE ALREADY NOT BUYING PREMIUM PAPER.

UH, AND YOU KNOW, WE'RE NOT GONNA SAY THAT SOMETHING'S AS EASY AS THAT, BUT, I MEAN, CAN YOU JUST TALK TO ME A LITTLE BIT ABOUT SOME OF THE TRADE-OFFS THAT YOU MIGHT THINK ABOUT AND IF THAT YOU WERE TALKING ABOUT A CUT LIKE THAT? I MEAN, ARE WE, YOU KNOW.

- WELL, YEAH, I THINK I UNDERSTAND AND I, I HEARD YOU'RE PREAMBLE THIS HARD QUE- I THINK IT'S THE RIGHT QUESTION FOR HEALTH AND HUMAN SERVICES.

UH, UH, MY ANSWER IS A PROCESS ANSWER, WHICH IS OUR BUDGETS ARE REALLY COMPLICATED.

SO I THINK THE FIRST ANSWER IS TO BE REALLY CLEAR AND TRANSPARENT ABOUT WHAT THE IMPLICATIONS ARE OF A CUT.

SO FOR EXAMPLE, SOME PROGRAMS, IF YOU CUT GENERAL FUND, YOU'RE LEAVING 90% FEDERAL AND STATE MONEY ON THE TABLE.

WE NEED TO BE VERY CLEAR ABOUT THAT.

OTHER PROGRAMS YOU CUT, THERE'S NO FEDERAL AND STATE MONEY.

SO I THINK JUST KIND OF EXPLAINING WHAT THE IMPLICATIONS ARE.

UM, I THINK THAT'S THE STARTING POINT.

UM, I THINK IF I'M TRACKING WHAT YOUR QUESTION IS, IF THE FEDERAL GOVERNMENT EFFECTUATES MANY OF THEIR IMPACTS ON OUR SAFETY NET, THE RIPPLE EFFECT TO THE STATE, IT'LL BE A DIRECT LINE TO US, AND THEN WE'LL HAVE TO EXPLAIN TO THE BOARD AND THE COMMUNITY WHAT DOES THAT MEAN.

I THINK FOR HUMAN SERVICES, MOST OF WHAT WE DO IS FEDERALLY AND STATE FUNDED AND REGULATED.

SO THE WIGGLE ROOM FOR A COUNTY IS REALLY ON THE MARGINS TO JUST HOLD TOGETHER OR CUT A LITTLE BIT.

THAT ALL LEADS TO MY MAIN RECOMMENDATION WOULD BE TO NOT CUT ANY GENERAL FUND THAT WOULD LEAVE FEDERAL AND STATE MONEY ON THE TABLE.

AND THEN WHAT'S LEFT, FIGURE OUT WHAT TO DO AND JUST HAVE TO EXPLAIN THE MENU SO THAT THE BOARD CAN MAKE AN INFORMED DECISION.

SO I HOPE THAT'S ON POINT. IT'S A PROCESS COMMENT.

- YEAH.

- OUR FUNDING IS NOT LIKE ONE BIG BUCKET OF MONEY WHERE WE UP HERE AS THE LEADERSHIP GET TO ASK YOU AS OUR ELECTEDS, PICK WHAT YOU WANT TO CUT BECAUSE IT'S ALL BASED ON THESE LIKE 67 DIFFERENT REVENUE STREAMS. AND WE HAVE TO KIND OF UNPACK WHAT THE IMPLICATIONS OF EACH ONE ARE.

- ALL RIGHT, WELL, THANKFULLY NOT A CHOICE IN FRONT OF US TODAY AND I'M HAPPY TO APPROVE THIS STATUS QUO BUDGET.

- I HAVE NO QUESTIONS, BUT THANK YOU FOR THE PRESENTATION.

I'LL TURN IT TO MY BOARD FOR A MOTION.

- I MOVE THE RECOMMENDED ACTIONS.

- SECOND.

- WE HAVE A MOTION FROM SUPERVISOR KOENIG AND A SECOND FROM SUPERVISOR DE SERPA.

IF WE CAN PLEASE TAKE ROLL CALL.

- SUPERVISOR DE SERPA. - AYE.

- CUMMINGS. - AYE.

- MARTINEZ. - AYE.

- KOENIG. - AYE.

- AND HERNANDEZ. - AYE.

MOTION PASSES UNANIMOUSLY.

[10. Consider approval of the Proposed 2025-26 Budget for Capital Projects, including any supplemental materials, and the 2025-2030 Capital Improvement Plan, as outlined in the referenced budget documents, and as recommended by the County Executive Officer]

NEXT WE HAVE CAPITAL PROJECTS, ITEM NUMBER 10.

CONSIDER APPROVAL OF THE PROPOSED 2025-2026 BUDGET FOR CAPITAL PROJECTS INCLUDING ANY SUPPLEMENTAL MATERIALS AND THE 2025-2030 CAPITAL IMPROVEMENT PLAN AS OUTLINED IN THE REFERENCE BUDGET DOCUMENTS AND AS RECOMMENDED BY THE COUNTY CEO.

- HELLO EVERYONE.

GOOD TO SEE YOU.

LAST ITEM OF THE DAY.

OUR FINAL ITEM IS AN OVERVIEW OF THE PROPOSED CAPITAL PROJECTS BUDGET FOR THE NEXT FISCAL YEAR.

JOINING RYAN AND I, OUR LEADERSHIP FROM OUR KEY CAPITAL BUILDING DEPARTMENTS, GSD, PARKS, AND CDI.

SO REBECCA, MICHAEL, AND MATT WILL ALL BE PART OF THIS CONVERSATION.

LET ME SEE. YOU'VE GOT THE CLICKER, RIGHT? - I DO.

- THANK YOU, SIR.

SO IN OUR PRESENTATION TODAY, WE WILL PROVIDE AN OVERVIEW OF OUR APPROACH TO CAPITAL BUDGETING AND WE'LL TALK ABOUT THE ACTUAL ANNUAL, THIS PROPOSED CAPITAL BUDGET RECOMMENDATION FOR YOUR CONSIDERATION AND THE CAPITAL IMPROVEMENT PROGRAM.

[05:45:04]

A NEW...

WE'RE BRINGING THAT BACK.

IT'S NOT BEEN IN PLACE FOR QUITE A WHILE.

WE'LL PROVIDE A PREVIEW OF OUR PROJECT PORTFOLIOS AND THEN WE'LL CLOSE WITH EMERGING ISSUES AND RECOMMENDED ACTIONS.

SO VERY BRIEFLY, THE MISSION OF OUR CAPITAL, UH, OUR CAPITAL BUDGETING PROGRAM IS REALLY TO PRESERVE AND ENHANCE THE COUNTY'S PUBLIC INFRASTRUCTURE, FACILITIES, PARKS, UH, AND, AND REALLY DO SO IN A WAY THAT MAKES THEM RESILIENT, COST-EFFECTIVE, AND RESPONSIVE TO COMMUNITY NEEDS.

WHAT YOU SEE ON THIS SLIDE IS COUNTY FACILITIES.

THAT'S LIKE OUR BUILDINGS, LIKE THIS BUILDING RIGHT HERE.

AS WELL AS PARKS AND OPEN SPACE.

AND THERE'S A PIECE THAT'S MISSING.

THAT'S REALLY THE PUBLIC WORKS PIECE.

AND I WANT TO DESCRIBE WHY WE WILL TALK ABOUT THAT, BUT WHY IT'S NOT ON THIS SLIDE.

THESE ARE THE, UM, THE, THE PROGRAM AREAS IN THE CAPITAL BUDGET THAT SIT IN THE PLANT FUND.

MOST OF THE, THE CDI RELATED INFRASTRUCTURE, WHETHER IT'S SANITATION, ROADS, UM, OR SOLID WASTE THAT SITS WITHIN THE CDI BUDGET, BUT IS CERTAINLY PART OF THE CAPITAL PROGRAM.

SO THAT'S WHY THERE'S A LITTLE BIT OF A- OF A NUANCE HERE.

AND IT'S QUITE FRANKLY, THE LARGEST PART OF THE CAPITAL PROGRAM.

SO I'M GONNA GO TO THE NEXT SLIDE.

SO, IN- KEY INNOVATION OF CEO PALACIOS WAS THE ESTABLISHMENT OF THE CAPITAL PROJECTS REVIEW COMMITTEE IN 2021.

AND I CHAIR THAT COMMITTEE.

THIS IS A CROSS-DEPARTMENTAL TEAM THAT MEETS GENERALLY TWICE A MONTH TO PROVIDE BROAD OVERSIGHT AND REVIEW OF THE COUNTY'S CAPITAL PROJECT PROGRAM FROM PROJECT CONCEPTION THROUGH PROJECT DELIVERY AND CLOSEOUT.

WE ALSO, WE PROVIDE OVERSIGHT FOR REAL PROPERTY TRANSACTIONS, INCLUDING ACQUISITIONS AND MAJOR LEASES.

THE CROSS-DEPARTMENTAL MEMBERSHIP AND THE DIVERSE, UM, THE DIVERSE EXPERTISE THAT WE BRING TOGETHER REALLY PROVIDES, UM, CROSS DISCIPLINE, EXPERTISE, AND PERSPECTIVE TO GUIDE PROJECT DELIVERY AND SELECTION.

SO WE HAVE, YOU KNOW, OUR FOLKS THAT DO PROJECT DELIVERY, WE HAVE MARCUS, WE HAVE NICOLE, WE HAVE A GROUP OF PEOPLE WHO CAN ALL COME TOGETHER TO TALK ABOUT WHAT ARE WE DOING, WHY ARE WE DOING IT, AND HOW DO WE DO IT MORE EFFICIENTLY AND EFFECTIVELY.

SO I KNOW THERE'S SOME CURIOSITY ABOUT HOW DO WE PICK CAPITAL PROJECTS TO PROPOSE TO YOU ALL.

AND AS PART OF THE BUDGET DEVELOPMENT PROCESS, WE HAVE WHAT'S BASICALLY CALLED A PROJECT CONCEPT, UM, APPLICATION THAT WE ASKED DEPARTMENTS TO FILL OUT DESCRIBING WHAT THEIR BUSINESS NEED IS.

UM, AND THEN WE SCORE THOSE, THEY'D ANSWER A BUNCH OF QUESTIONS, AND THEN WE SCORE THOSE UTILIZING THIS RUBRIC.

I'M HAPPY TO GO INTO DETAIL ABOUT IT, BUT I KNOW WE'RE REALLY SHORT ON TIME, BUT SO WHEN WE HAVE A NEW PROJECT PROPOSAL FROM A DEPARTMENT, WE ASK THEM TO REALLY BE ABLE TO TALK ABOUT HOW IS THIS ADVANCING EQUITY? AND WE HAVE VERY SPECIFIC ELEMENTS THAT THEY NEED TO ADDRESS.

HOW ARE THEY LOOKING AT LEVERAGING OTHER FUNDING SOURCES? WE'VE TALKED- HEARD A LOT TODAY ABOUT MANY OF OUR CAPITAL PROJECTS ARE FUNDED THROUGH GRANTS.

HOW DOES THIS ADDRESS HEALTH AND SAFETY IN THE WORKPLACE? WHAT- WHAT DOES THIS DO IN TERMS OF FORWARD-FACING COMMUNITY SERVICES? AND THEN HOW DOES IT ALIGN WITH OUR- OUR VISION? WHETHER IT'S THE STRATEGIC PLAN, THE CAP, WHERE DOES IT ALIGN WITH THE WORK THAT WE SAY THAT'S SO IMPORTANT IN SO MANY OF THOSE PLANS? SO WE [COUGHS] EVALUATE THAT.

AND THEN THAT'S HOW WE, WE PRIORITIZE THE VERY LIMITED CAPITAL DOLLARS THAT WE GENERALLY HAVE AVAILABLE.

WE ALSO, IN ADDITION TO NEW PROJECT CONCEPTS, THE CPRC REVIEWS WHAT'S CALLED THE FACILITY CONDITION INDEX.

ABOUT 18 MONTHS AGO, I WANNA SAY, UM, GSD UNDERTOOK WITH FUNDING RECOMMENDED BY THE CPRC, A COMPREHENSIVE ASSESSMENT OF COUNTY BUILDINGS.

SO WE HAVE CLARITY ABOUT WHAT OUR DEFERRED MAINTENANCE OP- DEFERRED MAINTENANCE OPTIONS ARE, OUR DEFERRED MAINTENANCE BACKLOG IS, THE RISKS ASSOCIATED WITH THOSE DIFFERENT KINDS OF, UM, BUILDING SYSTEM PROBLEMS, WHEN THOSE THINGS NEED TO BE ADDRESSED SO WE HAVE AN ANALYTICAL TOOL TO HELP US REALLY IDENTIFY WHERE OUR LARGEST FACILITY RISKS ARE.

SO THAT'S THE OTHER PIECE WHEN WE'RE LOOKING AT THE LIMITED DOLLARS THAT WE HAVE.

WHAT'S NEW TO REALLY ADDRESS PUBLIC NEEDS AND HOW DO WE ACTUALLY TAKE CARE OF WHAT WE HAVE TODAY? SO I WANNA REALLY BRIEFLY, THIS IS NOT ALL OF OUR CAPITAL PROJECT ACHIEVEMENTS FROM

[05:50:02]

THE LAST YEAR, BUT IT GIVES YOU A NICE SAMPLE OF HIGHLIGHTS.

YOU'LL NOTICE THESE INVESTMENTS SPAN PARKS, PUBLIC SAFETY FACILITIES, OUR LIBRARY SYSTEM.

AND I JUST WANTED TO HIGHLIGHT A REALLY BIG PIECE OF WORK THAT WE ALL DID LAST YEAR WAS THE PROJECT LABOR AGREEMENT PILOT.

AND WE, WE EXPECT TO BE ACTUALLY TESTING THAT OUT IN THIS COMING YEAR.

SO THAT IS OUR ACHIEVEMENTS AND I'M GONNA NOW PASS IT TO RYAN TO TALK ABOUT THE DETAILS AND THE NUMBERS.

- [CHUCKLES] COOL, ALL RIGHT.

SO, BEFORE WE GET INTO, UM, THE MEAT OF THE CAPITAL BUDGET, UM, I THINK IT'S IMPORTANT TO TALK A BIT ABOUT CAPITAL BUDGETING OR CAPITAL BUDGET MATH.

CAPITAL BUDGETING WORKS DIFFERENTLY, HAS DIFFERENT MECHANICS THAN THE OPERATING BUDGETS THAT WILL BE PRESENTED BEFORE YOU DURING THESE BUDGET HEARINGS.

SO TO WALK THROUGH IT AT A VERY HIGH LEVEL, WE REALLY START WITH WHAT'S GOING ON IN THE CURRENT YEAR.

SO THE CURRENT YEAR, THERE'S AN $86.2 MILLION PROJECT PORTFOLIO WHICH SPANS COUNTY FACILITIES AND PARKS.

SO THAT'S EVERYTHING FROM THE NEW JUVENILE HALL PROJECT THAT'S JUST GETTING STARTED.

THAT'S CHILDREN'S CRISIS CENTER.

THAT'S BEHAVIORAL HEALTH BRIDGE HOUSING.

ALL THOSE PROJECTS ARE HERE, UM, UH, REPRESENTED AS WE ARE CURRENTLY STANDS TODAY.

AS THE YEAR PROGRESSES THROUGH, WE SPEND DOWN THOSE FUNDS, WE EXECUTE THOSE PROJECTS.

ANY DOLLARS LEFT OVER THAT WE HAVEN'T SPENT RELATED TO THOSE ACTIVE PROJECTS, WE ROLL INTO THE NEXT YEAR UNTIL THE PROJECT IS COMPLETED.

WHAT IS BEFORE YOU TODAY AND WHAT THE BOARD APPROVES EVERY YEAR IS OUR PROPOSED BUDGET, WHICH ADDS NEW FUNDS TO NEW PROJECTS OR AUGMENTS CURRENT PROJECTS.

SO IF A PROJECT THAT IS CURRENTLY ON THE BOOKS NEEDS ADDITIONAL FUNDING, THIS IS WHERE IT GETS PROPOSED HERE.

OR IF THERE'S NEW PROJECTS THAT WE WANT TO PUT INTO THE PLAN, IT'S HERE AS WELL.

SO WE'LL BE FOCUSING MAINLY TODAY ON THAT YELLOW DOT HERE WITHIN CAPITAL BUDGET EQUATION THAT I LIKE TO SHOW HERE.

AND THEN THEY JUST ROUNDED OUT WHAT WE DO IS WHEN THE ADOPTED BUDGET IS CONSIDERED BY THE BOARD IN THE FALL, WE MIX TOGETHER BOTH THE CARRYOVER DOLLARS THAT ARE BEING CARRIED OVERACTIVE PROJECTS, PLUS THE PROPOSED THAT'S BEING EVALUATED TODAY.

AND THAT'S WHAT WE USED TO GO FORWARD AND THE CYCLE CONTINUES.

OKAY, SO FOR 25-26, WE HAVE A TOTAL RECOMMENDED BUDGET OF ABOUT $7.6 MILLION.

THAT IS OFFSET BY $2.7 MILLION IN REVENUES, $1 MILLION IN RURAL FUND CONTRIBUTION REALLY AIMED AT COUNTY FACILITIES AND SOME USE OF PRIOR FUND BALANCES THAT HAVE BEEN BUILT UP OVER TIME TO BE ABLE TO ACTIVATE A FEW PROJECTS THAT HAVE BEEN PLANNED RELATED TO PARKS OF ABOUT $3.8 MILLION.

UM, SO THIS, AND THESE SUPPORTS NEW PROJECTS COMING FORWARD AS WELL AS AUGMENTING CURRENT PROJECTS THAT ARE CURRENTLY ON THE BOOKS.

AND I'LL TALK A LITTLE BIT MORE ABOUT WHAT THOSE ARE.

SO THE SCHEDULE HERE BEFORE YOU, AS WE ZOOM IN IS A SCHEDULE OF NEW AND AUGMENTED PROJECTS THAT I TALKED ABOUT.

THIS LIST WAS VETTED BY THE CPRC AND IT'S CONSISTENT WITH THE FACILITIES CONDITION INDEX AS WELL AS THE PARKS CAPITAL AND STRATEGIC PLANS AS WELL.

UM, IT INCLUDES AUGMENTED FUNDING FOR THE MAIN JAIL ADMINISTRATIVE UNIT HVAC SYSTEM, WHICH HAS BEEN AN ONGOING PROJECT THAT NEEDS ADDITIONAL FUNDS..

IT ALSO INCLUDES THE FINAL TRANCHES OF FUNDING NEEDED FOR THE BOMER STREET PARK AND SIMKINS WATER SLIDE UPGRADES AS WELL.

AND IT ALSO HOSTS A FEW CRITICAL FACILITY NEEDS, WHICH ARE SOME NEW PROJECTS HERE ON THIS LIST.

ADDITIONALLY, AND I WANNA CALL ATTENTION TO, THIS LIST ALSO INCLUDES SOME SET-ASIDES FOR SOME EMERGENT PROJECTS OR EMERGENT REPAIRS.

THINGS BREAK THROUGHOUT THE YEAR.

YOU CAN ASK DIRECTOR BEATON ALL ABOUT IT.

AND SO WE LIKE TO KEEP A LITTLE BIT OF FUNDING OFF TO THE SIDE TO BE ABLE TO HAVE IMMEDIATE RAPID RESPONSE TO SOME OF THOSE CRITICAL FACILITY SYSTEMS THAT DO FAIL THROUGHOUT THE YEAR.

ADDITIONALLY, IT'S A BIT DIFFERENT THIS YEAR IS BECAUSE OF THE VOLATILITY AT THE FEDERAL LEVEL WHEN IT COMES TO TARIFF POLICIES AND HOW THAT IMPACTS MATERIAL PRICES FOR BUILDINGS.

WE'RE ALSO RECOMMENDING A SET ASIDE OF SOME FUNDING TO HEDGE AGAINST ON POTENTIAL COST OVERRUNS FOR SOME OF OUR ACTIVE PROJECTS.

WE DON'T WANT TO SEE DELAYS JUST BECAUSE SOMETHING WENT UP IN PRICE.

SO WE'RE PUTTING MONEY OFF TO THE SIDE FOR THAT OR RECOMMENDING TO PUT SOME DOLLARS OFF TO THE SIDE FOR THAT.

ALL RIGHT. I'M GOING TO SWITCH GEARS A LITTLE BIT, UM, BECAUSE WE TALKED ABOUT THE SNAPSHOT YEAR OF THE 25-26 BUDGET BUT I WANT TO ZOOM OUT AND TALK ABOUT OUR 25 TO 2030 CAPITAL IMPROVEMENT PLAN.

SO IF THE PROPOSED BUDGET REPRESENTS ONE YEAR SNAPSHOT OF THE FINANCIAL RESOURCES NEEDED TO MOVE PROJECTS FORWARD, IT'S REALLY PART OF AN ONGOING CONTINUUM OF CAPITAL INVESTMENTS.

THE FIVE-YEAR CAP IS THE DETAIL OF THAT FIVE YEAR- OF THAT CONTINUUM OF CAPITAL INVESTMENTS.

WE'VE UPDATED IT, UH, WITH, UH, IN PARTNERSHIP BETWEEN THE CEO'S OFFICE WITH CDI PUBLIC WORKS, WITH GENERAL SERVICES, WITH PARKS DEPARTMENT.

WE'VE OVERHAULED THE DOCUMENT ITSELF.

WE MADE IT A NEW ONLINE INTERACTIVE PUBLICATION.

WE'VE ALSO ALIGNED IT WITH OUR BUDGET.

SO WHERE THESE TWO DOCUMENTS ACTUALLY HAVE A MUCH STRONGER

[05:55:03]

RELATIONSHIP BETWEEN THE TWO.

UM, ALL FOR BETTER PLANNING AND BETTER TRANSPARENCY WHEN IT COMES TO CAPITAL PLANNING.

THE PLAN ITSELF, UH, IDENTIFIES OVER $396 MILLION IN CAPITAL INVESTMENTS OVER THE NEXT FIVE YEARS.

AND IT'S SUPPORTED BY 45 DISTINCT FUNDING SOURCES THAT WE'VE CATALOGED.

THE FOCUS OF THIS ITERATION OF THE CIP IS ON ACTIVE CAPITAL PROJECTS, STUFF WE'RE WORKING ON RIGHT NOW.

AND AS SUCH, WHAT'S NOT IN THAT PLAN ARE THINGS THAT OR, OR EFFORTS THAT ARE BEING EVALUATED FOR FEASIBILITY, FOR PROJECTS THAT ARE STILL IN CONCEPT.

SO WE'RE IN THAT PRE-PROJECT PHASE AND THAT PLANNING PHASE.

SO THOSE PROJECTS ARE NOT IN THIS PLAN.

AND WHAT THE RESULTS IS YOU SEE A 360- $396 MILLION NUMBER OF THAT'S NOT TRULY REPRESENTATIVE OF THE FULL CAPITAL NEEDS OF THE COUNTY.

SO I JUST WANNA BE VERY CLEAR THAT THIS IS JUST A STARTING PLACE.

THIS IS WHAT WE CALL THE FLOOR, NOT THE CEILING OF WHERE WE ARE IN OUR- IN OUR CAPITAL NEEDS.

I ALSO WANT TO CALL THE ATTENTION TOO, THAT THE CIP DOES OUTLINE A LOT OF PROJECT COSTS.

SO YOU'LL SEE A LOT OF DOLLARS, THAT $396 MILLION I TALKED ABOUT WHEN YOU DIVE INTO THE PLAN, YOU'LL SEE A SPECIFIC PROJECT BUDGETS FOR THE LIFE OF THOSE, UH, FOR THE LIFE OF THOSE PROJECTS.

BUT WHAT THEY ARE IS THEY ARE NOT A BUDGET, THEY ARE A PLAN.

AND WE WANT TO BE VERY, VERY CLEAR THAT THE CIP REPRESENTS A MULTI-YEAR PLAN.

WHEREAS THE CAPITAL BUDGET THAT'S APPROVED OF THE YEAR, THAT'S THE ACTUAL SPENDING AUTHORITY USED TO EXECUTE PROJECTS.

AND THERE'S- THERE'S A DIFFERENCE BETWEEN THE TWO.

UM, HAVING SAID THAT, THE CIP PLAYS A CRITICAL ROLE IN BUDGET DEVELOPMENT.

IT ALSO HELPS US IDENTIFY FUNDING NEEDS, ANTICIPATE FUNDING GAPS, UM, LOOKS FOR OPPORTUNITIES TO ADDRESS THOSE GAPS, UM, AND THEN PROVIDES FOR SOME LONG-TERM PROJECT COORDINATION ACROSS OUR DIFFERENT CAPITAL-INTENSIVE DEPARTMENTS.

AND DIVING IN A LITTLE BIT DEEPER INTO THE PLAN, UH, THE PLAN IS OUTLINED ACROSS THREE DIFFERENT PROJECT PORTFOLIOS.

AS I MENTIONED, WE HAVE PUBLIC INFRASTRUCTURE, WHICH IS MANAGED BY CDI PUBLIC WORKS.

WE HAVE GOVERNMENT FACILITIES MANAGED BY GENERAL SERVICES.

THEN WE HAVE PARKS AND OPEN SPACES MANAGED BY, YOU PROBABLY GUESSED IT, PARKS AND OPEN SPACES.

WITH THAT, THERE'S 126 PROJECTS IN THE PLAN THAT WE'VE CATALOGED.

ACTIVE WORK THAT WE ARE WORKING ON, 126 PROJECTS.

ABOUT 52% OF THOSE ARE PUBLIC WORKS PROJECTS.

ANOTHER THIRD OF THOSE ARE RELATED TO PARKS.

AND THEN LASTLY, LAST 17 OR SO PERCENT IS RELATED TO GOVERNMENT FACILITIES.

SO AS IN TRADITION, WHEN WE PRESENT THE CAPITAL BUDGET EVERY YEAR, WE INVITE, UM, OUR FRIENDS FROM OUR CAPITAL IMPROVEMENTS DEPARTMENTS UP TO, TO JOIN US HERE.

SO, UM, AS ELISA MENTIONED, WE HAVE, UM, OUR DEPARTMENT LEADERS FROM CDI, FROM GENERAL SERVICES, AND FROM PARKS.

AND SO I'D LIKE TO PASS THE MIC OVER TO MATT MACHADO, WHO'S THE DEPUTY CEO AND DIRECTOR OF CDI TO TALK A LITTLE BIT MORE ABOUT PUBLIC INFRASTRUCTURE.

- ALL RIGHT. THANK YOU, RYAN.

AND GOOD AFTERNOON, UH, CHAIRMAN, SUPERVISORS.

SO AS YOU'VE HEARD, THE, UH, THE CIP REALLY DOES REFLECT A COORDINATED COUNTY-WIDE APPROACH TO, TO, UH, CAPITAL PLANNING.

THE PUBLIC INFRASTRUCTURE SECTION, WHICH I'LL COVER, FOCUSES ON MAINTAINING AND IMPROVING THE COUNTY'S CORE SYSTEMS SUCH AS ROADS, BRIDGES, STORMWATER SYSTEMS, SANITATION, SOLID WASTE, AND OTHER ESSENTIAL PUBLIC WORKS.

THESE INVESTMENTS AIM TO ENHANCE SAFETY, PROMOTE CLIMATE RESILIENCE, PROTECT THE ENVIRONMENT, AND SUPPORT THE EFFICIENT MOVEMENT OF PEOPLE AND GOODS THROUGHOUT THE REGION.

SO THE PUBLIC INFRASTRUCTURE SECTION INCLUDES 91 PROJECTS VALUED AT OVER $200 MILLION IN TOTAL PLANNED INVESTMENT.

AND THE SLIDE BEFORE YOU IS A SUMMARY OF THESE PLANNED PROJECTS.

I WILL ADD THAT IN FUTURE ITERATIONS, WE WILL BUILD ON THIS FOUNDATION BY INCORPORATING EMERGING NEEDS AND FUTURE PROJECT CONCEPTS ALIGNED WITH LONG-TERM COMMUNITY GOALS.

AND THAT WRAPS UP OUR PUBLIC INFRASTRUCTURE SECTION.

I WILL HAND THE BATON OVER TO MICHAEL BEATON, WHO WILL COVER GOVERNMENT FACILITIES.

- THANK YOU.

UH, TO START OFF WITH GOVERNMENT FACILITIES, I DO WANNA KIND OF DO A LITTLE STEP BACK AND TALK ABOUT WHERE WE'VE BEEN, UH, IN TALKING ABOUT CAPITAL PROJECTS AND GOVERNMENT FACILITIES THROUGH THE VISION OF OUR CEO PALACIOS, AND THE LEADERSHIP.

UM, IT HAS SIGNIFICANTLY CHANGED.

THE DEVELOPMENT OF THE CPRC AND REALLY INVESTING STRATEGICALLY INTO OUR COUNTY FACILITIES HAS BEEN A HUGE IMPROVEMENT.

WHAT YOU HAVE TODAY IS A 25 PROJECTS FOR THE GOVERNMENTAL FACILITIES.

A LOT OF THESE PROJECTS WERE DETERMINED BASED ON OUR FACILITIES CONDITION ASSESSMENT THAT WAS DONE.

AND THAT HAS BEEN REALLY OUR ROADMAP.

THAT FACILITIES CONDITION ASSESSMENT WILL DO EVERY FIVE YEARS, UH, AND TO REFRESH THE DATA AS THINGS COME UP AND REPRIORITIZE

[06:00:01]

HOW WE DO OUR STRATEGIC INVESTMENTS IN THE FUTURE.

WITH THE 25 PROJECTS AND ROUGHLY $68 MILLION THAT WE HAVE HERE THAT WE'RE CURRENTLY WORKING ON.

SOME OF THE MAJOR PROJECTS OBVIOUSLY ARE THE JUVENILE HALL PROJECT, WHICH I HAD TO SAY AFTER 12 YEARS, UH, THIS WAS A PROJECT PRIOR TO MY EVEN EMPLOYMENT WITH THE COUNTY OF SANTA CRUZ.

SO IT'S KIND OF NICE TO HAVE THAT OFF THE GROUND.

UH, THE BRIDGE- BRIDGE PROJECT, UH, SIG- SIGNIFICANT UPGRADES FOR SAFETY CODE, ENERGY EFFICIENCY AND MODERNIZATION, UM, INCLUDED IN THE GOVERNMENT'S FACILITIES, CAPITAL PROJECTS COMPONENT.

SO I'M GLAD TO SAY THAT WE ARE 10 TIMES BETTER THAN WE WERE, UH, 12 YEARS AGO, AND IT JUST KEEPS GETTING BETTER AND HONORED TO BE PART OF THE TEAM.

I DO WANT TO GIVE A BIG SHOUT OUT TO ERIC FRIEDRICH FOR HIS WORK ON THE CIP.

UH, IT'S REALLY, UM, CUTTING EDGE. SO, THANK YOU.

WITH THAT, I'LL PASS IT OVER TO REBECCA HURLEY FOR PARKS AND OPEN SPACES.

- GOOD AFTERNOON, BOARD.

UM, SO I WANT TO EXPLAIN A LITTLE BIT.

THERE'S A COUPLE OF SLIDES BACK, THERE WAS A GRAPHIC AND IT SHOWED THAT PARKS TOOK UP ABOUT A THIRD OF THE CIP BUDGET.

I JUST WANNA EXPLAIN THAT THAT'S BECAUSE PARKS IS LEAD ON THE RAIL TRAIL PROJECT FOR SEGMENTS 10 AND 11.

AND THAT PROJECT IS BUDGETED AT $111 MILLION.

SO WE DON'T REALLY HAVE THAT MANY PARK PROJECTS, UM, FOR PLAYGROUNDS AND SUCH, JUST TO CLARIFY.

UH, AS WELL AS SINCE THIS CAPITAL PROJECTS BUDGET IS INCLUDED IN WHAT IS COMPOSED OF THE FIVE-YEAR CIP, UM, SOME OF THE PROJECTS THAT WE HAVE INCLUDED IN THAT WE'VE ACTUALLY COMPLETED.

SO WE CLOSED OUT FLORAL PARK PLAYGROUND.

WE ALSO JUST DID A RIBBON CUTTING FOR HIDDEN BEACH RESTROOM.

SOME OF THE UPCOMING PROJECTS THAT WE HAVE IS WE ARE GONNA BE WORKING ON THE AFFORDABLE ACCOMMODATIONS PROJECT AT GREYHOUND ROCK.

I'M REALLY HAPPY TO SEE THAT COMING ABOUT AS WELL AS A NEW REPLACEMENT RESTROOM AT BROMMER STREET PARK.

I WANNA CLARIFY DUE TO SOME COMMENTS MADE EARLIER, THE- THE FUNDING FOR BROMMER STREET PARK FOR MOST PARKS PROJECTS IS THROUGH GRANTS OR PARK DEDICATION FEES OR IMPACT FEES, AND THEY'RE NOT INTERCHANGEABLE WITH SALARIES FOR STAFF.

UM, AND ULTIMATELY, I WANNA ALSO HIGHLIGHT THAT WE'RE GONNA BE DOING IMPROVEMENTS AT APTOS VILLAGE PARK AND, UM, MANY OTHER PROJECTS TO COME.

SO WE'RE REALLY EXCITED TO SEE THE CIP LAUNCH FOR THE FIVE-YEAR PLAN.

AND I AGAIN WILL ECHO WHAT MICHAEL SAID AND THANK YOU TO RYAN FOR TAKING THE LEAD.

BACK TO YOU.

- THANKS YOU GUYS.

- OKAY, JUST A ROUND OF PRESENTATION.

WE DID WANT TO BE CONSISTENT WITH OUR OTHER DEPARTMENTS IN TALKING ABOUT EMERGING ISSUES THAT ARE IMPACTING CAPITAL PROJECTS.

FIRST, AS WE'VE HEARD BEFORE, JUST THE DEFERRED MAINTENANCE BACKLOG, AND THAT'S ACROSS ALL OF OUR PORTFOLIOS OF CAPITAL- CAPITAL NEEDS, PUBLIC INFRASTRUCTURE, GOVERNMENT FACILITIES, PARKS AS WELL.

UM, ONE NOTE THAT I CAME TO THAT THE FCI EFFORT WAS, AND THIS IS ONE OF MY FAVORITE STATS, IS THAT 70% OF COUNTY FACILITIES WERE CONSTRUCTED BEFORE 1990.

UM, I'D JUST LIKE- I'D LIKE TO SIT WITH THAT SOMETIMES.

WE ALSO HAVE OTHER EMERGING ISSUES AROUND, UH, OUR ENERGY USAGE AND NEEDS AND HOW OUR FACILITIES IMPACT CLIMATE.

UM, AS WELL AS CLIMATE IMPACTS ON OUR PUBLIC INFRASTRUCTURE.

WE'VE TALKED A LOT ABOUT THAT OVER THE PAST 18 MONTHS OR SINCE THE 2023 STORMS. AND THEN, UH, LASTLY, THE MARKET VOLATILITY, INFLATION AND, UH, TARIFF, UH, IMPACTS THAT WE ARE ACTIVELY MONITORING EVERY DAY TO SEE HOW THEY ARE IMPACTING POTENTIAL COSTS, UM, MOVING FORWARD.

SO WITH THAT, OUR RECOMMENDED ACTIONS ARE TO APPROVE THE PROPOSED BUDGET FOR CAPITAL PROJECTS, INCLUDING THE 2025 TO 2030 CAPITAL IMPROVEMENT PLAN.

BY ANY SUPPLEMENTAL MATERIALS AS WELL.

AND YOU CAN SEE ALL THE BULLETS BELOW.

AND WE'RE HAPPY TO TAKE ANY QUESTIONS.

- WITH THAT, I'LL OPEN IT UP TO THE PUBLIC, SEE IF ANYONE WOULD LIKE TO COMMENT ON THIS ITEM.

SEEING NONE HERE, ANYBODY ONLINE? - WE HAVE NO SPEAKERS ONLINE, CHAIR.

- OKAY, WE'LL BRING IT BACK TO THE BOARD.

DOES ANYBODY HAVE ANY QUESTIONS, COMMENTS? - I DO.

- SUPERVISOR DE SERPA.

- UM, IN THE CAPITAL PROJECTS BUDGET, AND I CAN'T FIND THE SLIDE NOW, I'VE BEEN LOOKING ONLINE, BUT THERE WAS A COUPLE OF PROJECTS THAT WERE INCORRECTLY ATTRIBUTED TO D2.

AND I WAS LIKE, OH, WAIT A MINUTE.

DID THOSE GET CORRECTED? - YEAH, WELL, WE'RE PROVIDING AN UPDATE LATER THIS EVENING, UM, WHEN WE SORT OF BLAST THINGS OUT SORT OF IN A BIG TRANCHE OF, OF LITTLE UPDATES HERE.

SO, YEAH, THANK YOU FOR YOUR STUFF FOR, UH, FOR POINTING OUT THOSE TWO LITTLE- LITTLE ERRORS.

- OKAY, THANK YOU SO MUCH.

- SUPERVISOR CUMMINGS? NO.

SUPERVISOR MARTINEZ? - THANK YOU FOR THE PRESENTATION.

UM, IT'S JUST A REALLY GOOD TIME FOR THE BOARD AND ALSO THE PUBLIC TO SEE THE TYPE OF INVESTMENT THAT YOUR DEPARTMENT IS DOING, YOUR DEPARTMENTS ARE DOING ON OUR PUBLIC INFRASTRUCTURE.

SO I REALLY APPRECIATE THAT.

UM, I WOULD SAY WATCH IT WITH YOUR SHOCK ON THINGS CREATED BEFORE 1990 BECAUSE I WAS CREATED BEFORE 1990.

IT'S NOT THAT OLD.

[LAUGHS] - I WANTED TO FIND BEFORE 1986, WHICH IS THE YEAR I WAS BORN.

[06:05:03]

- OKAY. - SO, YEAH.

[LAUGHS] - UM, JUST ONE THING, YOU KNOW, UM, I KNOW WE'RE TACKING ON THE FIVE-YEAR PLAN TO THIS AGENDA ITEM AND, UM JUST CURIOUS HOW FIXED THAT PLAN IS.

SO, UM, YOU KNOW, I LOOKED AT IT AND I THINK IT LOOKS GREAT, BUT I, I FEEL LIKE I HAVEN'T HAD A CHANCE TO SORT OF TALK ABOUT DISTRICT PRIORITIES OR ANYTHING LIKE THAT.

AND IF THERE'S AN OPPORTUNITY, I WAS JUST WONDERING IF THERE'S AN OPPORTUNITY TO, YOU KNOW, TALK ABOUT THAT OR CONTRIBUTE OR GIVE FEEDBACK BEFORE I'M LOCKED IN FIVE YEARS OF PROJECTS.

- SO THE WAY THAT, UM, CAPITAL IMPROVEMENT PLANS WORK AND, AND THEY'RE VERY COMMON THROUGHOUT EVERY JURISDICTION, COUNTY, CITY, UH, THROUGHOUT THE STATE, THROUGHOUT THE COUNTRY, IS THAT THEY'RE TYPICALLY UPDATED ANNUALLY.

SO IT'S A ROLLING FIVE YEARS OF, OF PLANNING.

SO, UM, WHAT WE HAVE DONE IN PAST PRACTICES ALIGN IT WITH THE ADOPTED BUDGET.

UM, AND IN REVIEW OF THE KIND OF BEST PRACTICES AROUND THE STATE ALIGNING IT WITH THE PROPOSED BUDGET WAS, UH, WE FELT BETTER ALIGNED SO THAT WE CAN HAVE A BETTER RELATIONSHIP BETWEEN, YOU KNOW, WHAT WE'RE APPROVING FOR US FOR OUR SPENDING AUTHORITY EVERY YEAR AND OUR OVERALL PLAN, HOW IT FITS IN CONTEXT OF THE BROADER PLAN.

SO WE'RE HAPPY TO TAKE DIRECTION TODAY, UM AND BRING THINGS BACK FOR LAST DAY OR AT A FUTURE DATE.

BUT WHAT WE'RE TRYING TO DO, UH, IS ALIGN IT WITH THE- WITH THE PROPOSED BUDGET CYCLE.

- SO MY UNDERSTANDING THAT THEN NEXT YEAR, IT'LL BE ANOTHER FIVE-YEAR PLAN, BUT IT'LL BE LIKE THE NEXT FIVE YEARS.

- IT'LL BE 2026 TO 2031.

- GOT IT. OKAY. - EXACTLY.

- ALL RIGHT. THANKS. I DIDN'T UNDERSTAND THAT.

SO I APPRECIATE THAT.

- IF I CAN ADD ONE THING TO THAT, UH, AS WE TALKED ABOUT, IN WHAT'S BEFORE YOU TODAY IN TERMS OF THE CIP, THOSE ARE ACTIVE PROJECTS THAT HAVE COME FORWARD IN SOME SHAPE OR FORM TO YOU ALREADY.

SO IT'S AS MATT TALKED ABOUT, IT'S NOT THE, THE WISH LIST, IT'S WHAT'S ACTIVE.

AND, AND THERE'S INTERESTING PRACTICE CONVERSATIONS AROUND, DO YOU PUT THE NOT FUNDED BUT WOULD LIKE TO HAVE SOME DAY ON THERE? SO I MEAN, THAT'S DEFINITELY A CONVERSATION WE WOULD WELCOME HAVING WITH ALL OF YOU, BUT THERE'S JUST PROS AND CONS OF DOING THAT AND HAPPY TO DO A STUDY SESSION AT SOME POINT, YOU KNOW, IN THE NEXT FISCAL YEAR TO DIG MORE INTO THAT.

THANKS FOR THAT CLARITY.

ALL RIGHT, WELL, I APPRECIATE THE PRESENTATION.

- YEAH, SO- - YEAH, JUST AS FAR AS SORT OF, WISHLIST VERSUS WHAT WE'RE ACTUALLY FUNDING AND MOVING FORWARD WITH, UM, I MEAN, LIKE IN PERUSING THE, THE LARGER PLAN AND WISH LIST, I SEE THAT LIKE ROCKVIEW COASTAL ACCESS IMPROVEMENTS IS ANTICIPATED TO HAVE, UM, $342,000 IN EXPENSES IN 2026.

I MEAN, BUT AT THE SAME TIME, THAT'S OBVIOUSLY NOT IN THE BUDGET, RIGHT? THAT'S SORT OF STILL A WISHLIST PROJECT.

SO IT SEEMS LIKE MAYBE THERE'S SOME OPPORTUNITY TO GO BACK AND STILL UPDATE THE PLAN.

I'M ASSUMING THAT MAYBE IT HAS BEEN IN THERE FOR A LITTLE WHILE AND NOT UPDATED? - YEAH, THE- THERE'S DEFINITELY, UH, AN ART TO THIS AS WELL, WHERE THERE'S WHAT'S TRULY BUDGETED AND THEN THERE'S LIKE FUTURE COMMITMENTS WHERE WE'VE COMMITTED FUNDING.

LIKE WE WORK WITH ALL OF YOUR OFFICES ON, YOU KNOW, DISTRICT LEVEL FUNDS WHERE WE'RE GONNA COMMIT TO A CERTAIN PROJECT THAT MAY TAKE A YEAR OR TWO BEFORE IT ACTUALLY HAPPENS.

AND SO THOSE ARE SUPPOSE GRAY AREA POINTS THAT WE TRY TO KEEP TRACK OF, WE DO KEEP TRACK OF, UM, AND ALLOCATE THEM IN AS, AS NEEDED.

AND SO WE ADDED- WHAT THIS PLAN DOES IS IT ALLOWS FOR THAT FLEXIBILITY TO SAY, WELL, WE KNOW, UH, PROFESSIONALLY SPEAKING THAT WE WERE GONNA COMMIT A CERTAIN AMOUNT OF FUNDING TO A- TO A PARTICULAR PROJECT, BUT WE HAVEN'T ACTUALLY RECOGNIZED IT INTO THE SPENDING AUTHORITY ACTUAL BUDGET YET.

IF THAT MAKES SENSE.

- MM-HMM.

SO IT'S SORT LIKE A POSSIBILITY THAT WE WOULD RECEIVE FUNDING FOR THAT PROJECT THIS YEAR AND WE JUST, JUST CURIOUS.

- SO WE DO HAVE, UM, FUNDING ALLOCATED TOWARDS IT AND WE PREVIOUSLY BEFORE THE STORMS THAT REALLY DEVASTATED THE COAST, WE WERE WORKING ON TRYING TO GET FINALIZED PLANS FOR SOME SORT OF ACCESS POINT THERE.

HOWEVER, WE HAD TO PRIORITIZE DAMAGES BEFORE THAT AND WE HAVEN'T GONE BACK TO THAT PROJECT.

THERE ARE PLANS TO DO SO AND IT WILL NEED ADDITIONAL FUNDING, UM, BUT WE'D LIKE TO GET SOMETHING READY SO THAT WE COULD THEN SEEK OUT THAT FUNDING.

- YEAH.

UM, WELL, I'LL ALSO JUST TAKE A MOMENT TO CELEBRATE THE FACT THAT, I MEAN, THESE PROJECTS REALLY DO MOVE FORWARD AND IMPROVE THE QUALITY OF LIFE FOR ALL OF OUR RESIDENTS.

I MEAN, AND IT'S REALLY AN IMPRESSIVE NUMBER OF PROJECTS THAT WERE COMPLETED LAST YEAR.

UM, I MEAN, CERTAINLY THE ONES THAT I USE EVERY DAY LIKE THE ONE I'M LOOKING AT HERE, FLORAL PARK, AT THAT PARK AT LEAST ONCE A WEEK WITH MY DAUGHTER, SHE LOVES IT.

UM, AND THEN THE LIBRARY ANNEX, ALSO FANTASTIC, AT, AT THE, UM, SWIM CENTER THERE.

AND THEN OF COURSE, I MEAN, FACILITIES LIKE THE DNA LAB, WHICH ARE JUST TRANSFORMING, UM, OUR ABILITY TO ACTUALLY PROSECUTE CRIMES.

SO, INCREDIBLE WORK AND EXCITED THAT WE'RE CONTINUING TO MAKE THESE INVESTMENTS.

[06:10:02]

THANKS.

- I TURN TO MY BOARD FOR A MOTION THEN.

- I MOVE THE RECOMMENDED ACTIONS.

- I'LL SECOND.

- MM-HMM.

- I'LL SECOND, I'LL SECOND BUT I HAD ONE QUESTION REAL QUICK.

UM, AND DID WANT TO ALSO APPRECIATE NOT ONLY ALL THE HARD WORK BUT WITH THE NORTH COAST, THE RAIL TRAIL THAT'S MOVING ALONG VERY QUICKLY.

AND WE'VE GOT A BATHROOM ON PANTHER BEACH NOW.

AND SO WE'RE HOPING TO SEE MORE, UH, GOOD STUFF LIKE THAT, BUT I DID HAVE A QUESTION FOR PARKS.

I WAS WONDERING IF THERE'S BEEN ANY UPDATE ON THE $5 MILLION FOR GREYHOUND ROCK FROM- THAT WAS NEGOTIATED THROUGH THE COASTAL COMMISSION.

- UM, I KNOW THAT WE CHECKED WITH THE CITY AND THAT, UM, THE, THE PERMIT CONDITIONS THAT WILL APPLY THAT $5 MILLION TOWARDS THE CONSTRUCTION WILL START ONCE THAT'S ACTUALLY BEEN COMPLETED, SO, OR, I MEAN TURNED IN, AND I HADN'T HEARD THAT IT HAD BEEN TURNED IN YET.

- OKAY.

- SO, UM, TO ME, THAT TIMELINE HASN'T STARTED YET, BUT WE ARE WELL AWARE OF IT.

- I WAS CURIOUS, 'CAUSE I KNOW BACK WHEN THE DEVELOPERS FIRST TALKING ABOUT MOVING THAT PROJECT, THEY WERE GONNA PULL PERMITS LIKE IN MARCH OR APRIL.

AND SO IT MIGHT BE WORTH CHECKING IN TO SEE WHAT THE STATUS OF THAT IS.

- YEAH, I APPRECIATE THE UPDATES FROM YOUR OFFICE.

AND THE LAST TIME WE SPOKE, I THINK ABOUT A MONTH AGO, WE CHECKED IN AND IT HADN'T YET, BUT WE'LL CHECK AGAIN.

- OKAY, COOL.

- ALL RIGHT, WE HAVE A MOTION FROM SUPERVISOR KOENIG AND A SECOND FROM SUPERVISOR, UH, CUMMINGS.

WE TAKE A ROLL CALL VOTE.

- SUPERVISOR DE SERPA. - AYE.

- CUMMINGS. - AYE.

- MARTINEZ. - AYE.

- KOENIG. - AYE.

- AND HERNANDEZ. - AYE.

MOTION PASSES UNANIMOUSLY AND THAT WAS THE FINAL AGENDA ITEM.

- WE HAVE 10.1.

SORRY.

[15. Approve the Proposed 2025-26 Budget for the County Executive Office, including any supplemental materials, and take related actions, as outlined in the referenced budget documents, and as recommended by the County Executive Officer]

YEAH, SO 10.1, UM, WAS ITEM NUMBER 15, WHICH IS THE APPROVE THE PROPOSED '25-'26 BUDGET FOR THE COUNTY EXECUTIVE OFFICER, INCLUDING ANY SUPPLEMENTAL MATERIALS AND TAKE RELATED ACTIONS AS OUTLINED IN THE REFERENCE BUDGET DOCUMENTS AS RECOMMENDED BY THE COUNTY EXECUTIVE OFFICER.

UM, I PULLED THIS ITEM BECAUSE WE'VE BEEN RECEIVING EXTENSIVE COMMENTS AND REQUESTS FROM MEMBERS OF THE COMMUNITY TO MAINTAIN THE FUNDING FOR, UM, SUSAN GREEN WITH THE JUSTICE AND GENDER COMMISSION.

AND, AND I JUST WANTED TO POINT OUT THAT, YOU KNOW, WHEN I GOT ON THIS BOARD, AND WE HEAR FROM MANY COMMISSIONS, UM, AND THE JUSTICE AND GENDER COMMISSION HAS BEEN REALLY EFFECTIVE AT HELPING US ADVOCATE FOR GETTING THINGS, UM, YOU KNOW, THAT THE COMMUNITY WANTS ACTUALLY IMPLEMENTED AND THEY'RE REALLY INSTRUMENTAL WITH GETTING BLAINE STREET REOPENED.

UM, THEY'RE REALLY INSTRUMENTAL WORKING WITH MY OFFICE WITH ADVOCATING FOR IN-PERSON VISITATIONS AFTER COVID SO THAT PEOPLE COULD HAVE FACE-TO-FACE VISITATION WITH THEIR CHILDREN IN THE JAILS AND, YOU KNOW HER QUALIFICATIONS AS A RESEARCH ASSOCIATE FACULTY AT UCSC REALLY POSITIONS HER TO BE REALLY EFFECTIVE.

AND I KNOW THAT SHE'S BEEN COMMITTED TO DOING THIS WORK AND $51,000 IS A VERY SMALL AMOUNT OF MONEY WHEN WE REALLY THINK OF THE OVERALL BUDGET.

SO, UM, I REALLY WANT THE BOARD TO CONSIDER WHETHER WE CAN MAINTAIN THAT FUNDING FOR THAT POSITION.

AND, UM, SO THAT'S WHY I PULLED THIS ITEM.

SO IF YOU WANNA OPEN UP THE PUBLIC COMMENT OR IF YOU WANNA- - DID YOU WANT TO OPEN? - SURE, I'LL START. [LAUGHS] GOOD AFTERNOON, CHAIR HERNANDEZ, MEMBERS OF THE BOARD.

SO I'M MELODY SERINO, I'M THE DEPUTY CAO.

I CONSTRUCT THE BUDGET FOR THE COUNTY EXECUTIVE OFFICE IN CONSULTATION WITH ALL OF OUR STAFF, OF COURSE.

UM, AS YOU HAVE HEARD ALL DAY, IT'S CRITICAL FOR THE COUNTY TO MAKE RESPONSIBLE AND EQUITABLE BUDGET DECISIONS AMONGST SO MANY COMPETING PRIORITIES, AND STILL UNKNOWN THREATS FROM THE FEDERAL GOVERNMENT.

AS PART OF OUR COST CONTAINMENT EFFORTS IN OUR BUDGET, DECISIONS WERE MADE TO REDUCE OVER $700,000 WORTH OF PROFESSIONAL SERVICES FROM THE CEO BUDGET.