Good afternoon and welcome to the Alameda County Board of Supervisors personnel administration and legislation committee. May I have a roll call please? Supervisor Fortinato Bass. Supervisor Tam. President. Let's start with the federal legislation update please. Thank you supervisors so both chambers are out of session this week. They will be out of session for two weeks and will not return until the last week of April. The big ticket item last week is of course the adoption of the budget resolution in Congress. Last week just before the Easter recess, both the House and the Senate passed a compromise budget resolution. The House approved it by a narrow margin, 216 to 214 with only two Republicans, Victoria, Sardin, Indiana, and Thomas Massey of Kentucky voting against it. The resolution moves Congress one step closer to advancing President Trump's legislative agenda through the budget reconciliation process. The revised budget allows for the extension of $4 trillion in tax cuts from the 2017 tax cut and jobs act, along with an additional $1.5 trillion in new tax cuts in total. that's $5.3 trillion in tax cuts in the Senate package, the Senate package. The Senate plan also directs the committees overseeing Medicare and Medicaid to find at least $4 billion in savings for comparison. The House's version called for $2 trillion in spending cuts the targets in the Senate bill are intended to be seen as minimums, giving lawmakers flexibility as they negotiate the final amounts. This adoption was broadly seen as a compromise between a verbal agreement between a Senate majority leader, John Thune, and members of the House Freedom Caucus in the Senate. Of course, the House Freedom Caucus want to see the Senate reach that $2 trillion number in spending cuts, but Mr. Thune said that he agreed with the target in theory, but did not go as far to say that he would commit to that $1.5 trillion. This essentially moves the entire package down the line, but has not settled the overall disagreement on the level of spending cuts that will ultimately be decided between the House and the Senate versions of the bill. The Senate package also proposed raising the debt ceiling by up to $5 trillion. This is $1 trillion more than the increase in the house plan, which agreed to a $4 trillion increase. The key question now is whether the Senate parliamentarian will allow Congress to extend the expiring tax cut provisions without officially increasing the deficit by using what they call the current policy baseline. If permitted, this could reduce the pressure on committees to make deep cuts to programs like Medicaid or other social safety net programs, though it would still increase the deficit overall. Within the Republican conference, there's still a significant disagreement about whether it's possible to achieve the house's ambitious $880 billion in savings. That's assigned to the House Energy and Commerce Committee without cutting Medicaid benefits. Some Republicans are exploring alternatives such as targeting waste-front and abuse within the program, though it's currently undefined what waste-front and abuse actually means. They're also targeting the provider tax, which is used by nearly every state to increase payments to the Medicaid program. But it's highly unlikely that any of these alone will account for the required savings without impacting state budgets or beneficiary services. What's possible is that the house will need its $800,000,000,000 in savings through its package. And the Senate will do its business not coming close to $800, $80 billion. And instead reaching a more compromised package without really affecting Medicaid benefits. That seems to be the overall mood in the Senate when talking to some of those members that they believe that the House is going to basically do its thing. And then Senate is going to broadly ignore it and then jam the House later in the process. As is typical, the House will be going first with the Senate then reacting. The House Energy and Commerce Committee is expected to begin marking up its section of the broader Republican bill as soon as the week of May 5th, leaving only a few weeks to identify that $880 billion in spending reductions. The House leadership is also pushing for the Ag Committee to mark up that week as well, as a reminder, the House Budget Resolution ordered the committee to cut $230 billion within its jurisdiction, and that will largely come from conservation program within the USDA, USDA RD, World Development, and the SNAP program. And then finally, I'll just add that in addition to Medicaid, the Congress must also extend the Affordable Care Act's advanced premium tax credits, which are set to expire at the end of the year. These credits were made more generous during the COVID pandemic to help lower monthly insurance premiums, and they are set to expire at the end of the year, and most Congress actors renew them, though given the current push to offset new tax credits with spending reductions, it's increasingly unlikely that these enhanced premium tax credits are extended. Instead, they will probably be further reduced. In addition to the actions in Congress last week, the president also issued an executive order instructing the attorney general to renew and takes to review rather and take steps to halt the enforcement of state laws related to climate change and other environmental initiatives, the executive order specifically targets California's cap and trade program. It criticizes it from posing what it calls unrealistic limits of carbon emissions. And according to the order, those limits force businesses to purchase costly carbon credits to comply with what they deemed to be radical requirements. The order must also impact, may also impact California's authority to enforce straight tailpipe mission standards as part of its efforts to promote electric vehicles. Under this executive order, Attorney General Pambondi has 60 days to identify which state climate laws are affected and she's also required to report back to the president on a list of these laws. Detail the actions taken and offer recommendations for further legislative staff to prevent their enforcement. It's important to note that this executive order does not immediately overturn a block any state local laws. Instead, it just initiates a review process by the attorney general, which will broadly inform an ongoing regulatory and legislative process. So I'll just stop there and answer any questions that you all might have. Thank you for that insightful update. Supervisor Ford, not a bass. We're all shaking our heads. Well, at least they are on recess, so they'll be less damage this week. Can we can regroup, I suppose? Thank you for the update. I agree. You can use the break. So I guess more out of curiosity. Do you know how much they think they can save from waste fraud and abuse out of the $880 billion dollars are trying to get in savings? It really depends on what they determine to be waste fraud and abuse. I mean, it's such a broad term that they could just group everything that they don't like. As waste fraud and abuse, I expect that there will be some sort of provision that they will include on prohibiting undocumented immigrants from receiving Medicaid benefits. They could consider that to be broad. The able-bodied adults or abods is going to be a common target. So adding additional work requirements to the Medicaid program. It's interesting that they are going to go down this path considering that New Hampshire tried to go down this path during the first type of administration and came up to the wire and implementing it and then ultimately pulled back because they found that it didn't actually cause any savings and just ended up kicking people off the rolls, leaving them to go to uninsured, which would only increase costs on hospitals because they would have to pay for uncompetited care. So even the kind of work requirement route, which is a salient political point for many Republicans, is a pretty damaging policy point, especially in the health space, when there's so many rural hospitals and rural areas that are going to be affected by this. The other provisions are, like I said earlier, the provider tax requirement, provider taxes that are implemented by states that tax individual hospitals. So, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to be able to, to then deliver that back, redistribute that tax income back to hospitals depending on basically the number of government payers that they have. They are targeting that as what they deem to be fraud as well. They think that it is improperly admanaged by the states. They want to limit the ability for states to do that, which are ultimately going to impact state budgets because instead of using the provider tax, to augment Medicaid, they're going to have to either come from the general fund, which states not have the flexibility to absorb that funding, or come up with a new sort of individual attacks in order to compensate the managed care plans in the Medicaid program. So when Republicans talk about this waste fraud and abuse kind of catch all, it's kind of, I think that we should kind of just think of it as that is things that they don't like in the Medicaid program, not necessarily something that they can identify as broad. Otherwise, that would be identified by MacPAC, which is the nonprofit, the federally chartered nonprofit that provides recommendations and analysis of the Medicaid programs to Congress or through the inspectors general, which have broadly been fired by this administration. So, you know, a lot of this comes down to politics and let's say on the policy side of things. But we'll see what the House comes up with first. And then we'll also see if the Senate goes for it. Just based on conversations that have had with Senate staff on both sides of the aisle. They seem to be taking the house very skeptically and whatever they produce, understanding the politics are very different between the two chambers. A very good point. Waste, fraud and abuse could be in the eye of the builder. In terms of the house vote, can you give us a sense of the California delegation, especially the House Republicans from California that have rural hospitals in their districts. Where are they on this? You know that there have been a lot of names that I could throw out that are maybe's on the overall legislation is going to decide on the impact that they have on their individual districts. Mr. Valadeo, I think is the number one target for Democrats to pull to their side voting against the bill broadly because of the impact on the Medicaid program. So I know that, I mean, we spoke to him fairly recently. He understands the impact that any sort of reductions to the Medicaid program will have on the residents of his district. Young Kim is also another one that has been seen as sort of on the fence, though she has consistently voted with Republican leadership on many of these items. As has been sphong. You know, the other Republicans, Mr. Calvert Kevin Kylie, Jay Oprah null tea and Doug Lamolpha are highly unlikely to vote against this legislation. So we don't really anticipate them breaking ranks. They're much more much safer congressional districts though, you know, Calvert did have a right, a pretty significant race on this last go around, but it's kind of unclear whether or not he'll have the same sort of challenger for a third time, considering Will Rollins will likely not be running in this next go around. So he's also a cardinal is, you know, much closer to Republican leadership. So we'll see. Sorry, Mike. Are there laptops? Is restarting right now, but that pretty much sums it up. Okay, thank you very much. Are there any public comments on this item? I have no speakers for this item. Thank you again for that very insightful information on the state legislative front. We have Amy. Hi, how is everyone? Amy cost with full moon strategies with your state legislative reports. Similar to our federal compatriots, the legislature is on break this week for their spring recess. They actually will reconvene on Monday, the 21st. But before that break, they had a busy week last week. The California Department of Social Services has published their in-home supportive services statewide collective bargaining report. They released this report to the legislature. It was directed in the 2023 Budget Act for the Department of Social Services to conduct an analysis of the potential cost and benefits of shifting IHSS collective bargaining responsibilities from the county to the state. And so a dedicated work group was convened kind of within the county family as well as IHSS provider unions and consumers. Rather than offering a recommendation, the report really presents an in-depth examination of key fiscal and policy issues that would be associated with the state level bargaining structure. The topics analyzed include projected cost of wage increases, effects on realignment, a funding framework, implications for workforce recruitment and retention and possible funding strategies. We had another busy week on the state budget front on Thursday before they broke the legislature passed AB 100 that the governor actually signed it a lot earlier today. It was a bill that modified both the 2023 and 2024 budget acts to enable early budget action prior to the May revise. The centerpiece of the bill which we've talked about previously was that it provided an additional 2.8 billion in additional spending authority to address unexpected medical expenses in the current fiscal year. As you recall, this is the second time that they've made an adjustment to pay for the higher projected costs in the medical program to date. The bill also included some provisions related to wildfire recovery efforts in Los Angeles, such as backfilling the lost property tax revenue for both the current and upcoming budget years. It also allocated $2 million in general fund to support the foster family home and small family home insurance fund administered by the Department of Social Services. I think interestingly enough, both during the Florida Bay, as well as in the committee, members really talked quite extensively about MediCal and the impacts of that increased projected caseload. I think generally Democrats have viewed it as a good problem to have, meaning that with the expansion of the MediCal program, it's a good thing that we're seeing more caseload, meaning that we're able to serve more vulnerable Californians. Republicans not surprisingly didn't quite take that tack, and instead were really concerned about the enrollment projection growing so quickly, so fast. And I think one of the more interesting comments came from the Department of Finance Official Erica Lee, the Chief Deputy, who stated that while the administration shares the legislature's goals about continuing to provide quality health care and ensuring that all eligible Californians are enrolled in Medi-Cal, they recognize that the problem costs are higher than the state can sustain without adjustments being made to the program. So stay tuned, but certainly seemed that they might have been telegraphing that they may have to some changes to medical as part of the May revise. As John mentioned, the Trump administration did release an executive order that specifically called out the state's cap and trade program. There had already been discussions about extension of the cap and trade program, and many believe that now because of the tight fiscal environment that the state is operating in that the governor may actually release a cap and trade extension as part of the May revise because they can utilize the increased revenue from the extension to backfill some of the programs that are being pressurized in the general fund. We also reported last week that there were some news reports that California had missed a key deadline related to Proposition 35 or the Managed Care Organization tax and that because of that they had risked losing some of the federal funding. I would know that the Department of Healthcare Services actually clarified that no deadlines have been missed and no federal funds forfeited. And the proposition had required for DHCS to consult with a specific stakeholder group. And now all of the appointments have been made and the committee is actually meeting for the first time today. And so we'll have a link to the agenda of that hearing and our notes for anyone who is interested. And then lastly, when the legislature reconvenes, there'll be many bill hearings of no, our county sponsor bill AB or excuse me, SB617 has been scheduled for April 30th and it will be held in the Senate Labor Public Employment and Retirement Committee. So we will work with staff on that measure. With that that I'm happy to answer any questions. Thank you. Much better report. Survivor Fort nav ass. Thank you chair Tam. Just one question regarding the 2.8 billion for MediCal. Do we have a sense yet of how that will be rolled out and implemented across the state? So really, this is what we would call a caseload adjustment, which means that they didn't have enough expenditure authority in the program right now to cover kind of what they're seeing on the caseload side. A couple of things have come up through the hearing process that are driving kind of this increased caseload. As you can imagine, the Republicans are trying to say that a lot of it is attributable to the undocumented expansion. However, what the administration has testified to is that we changed the senior asset test last year, which is one of the driving factors of caseload, and that we're experiencing higher cost overall in the program as is, you know, all the states in the nation, specifically in the pharmaceutical side of the program. And so this is really just giving them the expenditure authority to make it until the beginning of the next fiscal year based on their most recent caseload projections. Thank you. Once again, thank you for that report. It's good to know the state legislature is thinking ahead in terms of what might happen at the federal level and obviously understanding that rates may have to change with medical with AB100. The question on the IHS's, I guess, negotiations, do you have a sense of the timing on that? Like, would that be concluded before a potential may revise? I don't think so. I wouldn't know if there is a bill that's been introduced on this topic by Assembly Member Haney, AB 283 that bill was passed already by the Assembly Public Employment and Retirement Committee and is now with the Appropriations Committee. So it seems like they're running a policy bill to address this issue. I would note that there's likely some cost associated. So the May revise may impact the conversations. You know, if the budget doesn't look particularly bright, you know it may impact, you know, how far the bill can make it. Okay, because SEIU 2015 has been in our board chambers and I think this affects them very, very directly. The other question I had is, what do you think the executive order on pausing the enforcement of state law related to climate change would have on like our climate action plan implementation. Is it tied to grant funding or is it more that obviously there's some separation between our ordinances, state law, and the federal executive order. Well, I'll say the governor's comment after the executive order came out was he called it quote, a glorified press release and did not really take it particularly seriously. I think in Sacramento, what people were seeing is there was a debate brewing in the legislature about whether or not they would just reauthorize cap and trade the program as it stands now, or whether or not they might seek some reforms in the program. A lot of advocates within the environmental justice space want to make sure that the free allowances provided to the oil industry are reduced in the next iteration of cap and trade. I think, strangely, what most people viewed in Sacramento was that the executive order helped coalesce all the Democrats around the need to actually extend Captain Trade. So it may have actually given a little bit more fired policymakers, bellies to go ahead and pass it. And as I said, I think for the state anyway, it remains to be seen. Certainly, and we've other areas, you know, they do link it to federal funding sources and use that as a leverage point. But I would know it's worth billions of dollars in the state budget through the greenhouse gas reduction fund. And so there could be some economic imperatives that are pushing policymakers to extend it so that they can backfill some general fund losses with the fund. That's good to know. That's they're being preemptive about this. Are there any other questions or other comments on this item? I have no speakers for this item. Thank you very much Amy. I appreciate that update. There's been a request from supervisor Miley to support AB 564 to repeal the cannabis excise tax rate. There's also a request from supervisor Miley to support AB 762 regarding this disposable battery embedded vape inhaling machine or devices prohibit them. There's been a request from supervisor Nikki fortune out of bass to support AB 1261 from Assemblymember Bonta on on immigration and unaccounted, unacpanied Documented Minors for the right to have counsel. There's been a request from Alameda County Health to support, I'm sorry, oppose SB 16, the Housing Homeless Assistance and Prevention Program. And there's been a request to support SB 81 from Senator Eriegeen for healthcare facilities and information sharing. And there's been a request to oppose SB 554 on immigration law enforcement, supervisor Nikki fortune out of pass. Are there any comments or questions on these items? I have no speakers for those items. Okay, I am fully supportive of the recommended positions and we will advance them with the recommendation to the full board. Yes. Thank you, Chair Tam, for advancing these items. I did just want to speak briefly to the ones that my office is bringing forward as we as a county are working to ensure that our residents have their constitutional rights protected. I think Assemblymember Bonta's bill 1261 is very important to ensure that right to council to an accompanying minors and similarly Senator Erragine's bill SB 81 is really critical in terms of making sure that all of our residents are not fearful of going to the hospital or staying enrolled in our county managed health care plan or other plans that they might be enrolled in. And regarding SB 5554, Again, this is important in terms of upholding our state law that currently exists that is really working towards having a distinction between local law enforcement and federal immigration enforcement and ensuring that our residents all feel safe and protected, especially if they may need to downline one or seek law enforcement support. And I did have an opportunity to touch base with a sheriff about this as well. So I'm pleased that we'll be able to move these forward to the full board. Thank you. Thank you for bringing those legislation to the Pell Committee's attention and we are Going to advance it based on the positions that are recommended and I think These positions Particularly during this time is very critical so Are there any public comments on items that are not on today's agenda? I have no speakers for public comment. Okay thank you everybody for your participation. For those online would you identify yourselves? I'll be a curoga, Alameda County, Treasure Text Collector's Office. Good afternoon, Valerie Arkin, supervisor, Myle's office. Jessica Blakemore, Alameda County Health. Good afternoon. Thank you all for your participation. Meeting is adjourned. Thank you.