Thank you. Good morning and welcome to the Alameda County Board of Supervisors Health Committee meeting. Supervisor Carson, who is chairing, is going to be running about 15 minutes late. So I'll turn it over to TISA for a quick roll call since I'm the only one here. Supervisor Carson, excused. Supervisor Tam, present. Let's start with the first item. It's the information item on the Measure A Citizens Oversight Committee for the 21-22 report we're catching up. And I understand Rebecca from the Measure A Committee is gonna be making the presentation? I am good morning, supervisor Tam. I'm Rebecca Rosen. I'm the Regional Vice President for the Hospital Council in the East Bay and a past chair of the Measure A Oversight Committee. I'm standing in for Susan Howard this morning who's not feeling well. So I'm going to do my best. I realize I, while I have looked at this presentation as a member of the committee, I haven't prepared necessarily for today. So bear with me. Do you need me to advance slides? Okay. So let's go to the next slide, please. Yes, perfect. So I think as you know, Supervisor Tam in 2004, 71% of the county voters passed measure A, the Essential Healthcare Services Tax Ordinance, to increase the sales tax by half percent and is required by the ordinance. The measure A funds are used exclusively for providing emergency hospital, inpatient outpatient public health and behavioral health care services to our populations noted on this side. We really are multiple and vulnerable populations. And in 2014, County Voters passed measure A-A, which extended our tax to 2034. Next slide. So per the ballot measure, the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the to the ordinance. In our role we are supported by Alameda County Health and in particular James Wen who's not here today but Rika Asperidan who is and I just want to thank her on behalf of the committee for all her support in our meetings. It's very, very helpful. We currently have 13 of our 17 seats on the citizen oversight committee filled with pending appointments in two of the seats representing Supervisor Royal Districts. I was here about maybe two years ago when I was the chair. We had many more vacancies and I just really want to thank this committee's Leadership and also the board's leadership for helping us fill our seats. It's very helpful for doing our work And we'll start with our overall conclusion from the committee And looking at the reports we received from organizations who received measure A funds, we found that Alameda Health System and the other recipients of the sales tax revenue spent the funds and compliance with the provisions of measure A. We did not find any organizations that did not in this particular round. A few highlights for you and anyone watching today. In fiscal year 21-22, approximately $182 million in measure A funds were allocated to provide essential health services in Alameda County. Of that total 75% of the revenues by ordinance goes to Alameda Health System, which represented around 143.6 million, and the remaining 25% of the Measure A revenues for 38.7 million were allocated by the Board of Supervisors to a host of organizations that provide health services, and the Measure A committee as a way to review all of the organizations that receive funds. We divide them into broad categories, public health, primary care, behavioral health, and then hospital and tertiary care. And so we have the breakdowns on this slide. Next one, please. The overall impact of measure A funding is profound. The funds serve Alameda County residents across the county and within all five supervise oil districts. Alameda Health System alone reported serving more than 125,000 residents. The measure A funds allocated by your board went to 87 organizations that provided health services through more than 330,000 encounters. And Measure A recipients reported that they leveraged their allocations to receive over $239 million in funds from other sources. So as this is fiscal year 2122 report, this reporting period also continued to coincide with the COVID-19 pandemic. And we did ask, measure a recipients, how they responded and use their funds. And we learned that they continued to expand innovative efforts to respond to the COVID-19 challenges. Some examples include providing essential health services via telehealth, either phone or video, virtual classes, health resources. There were efforts to deliver groceries, meals to families in need, administer COVID-19 tests and vaccinations. And in the next few slides, I'll also go through some other notable highlights reported by our recipients of measure 8 months. Starting with Alameda Health System, which received 75% of the funds. Measure A funding was instrumental in helping them meet many of their key initiatives, including improving patient satisfaction in the time it takes to move a patient from Highland Hospital's emergency room to an impatient bed, as well as a reduction in workplace injuries. And we have a few other measures up there that they shared with us. Our other hospitals receiving measure A funds include UCSF Benioff Children's Hospital Oakland and St. Rose Hospital and UCSF Benioff Children's Hospital Oakland had over 2,000 health encounters at their school-based health clinics, and St. Rose Hospital improved their decision to admit to time-admitted time, which is a life-saving measure for individuals experiencing health emergency. In the area of behavioral health, measure A funding help to support the county's detoxification services, improve the ability of county staff to provide mental health services and assessments for individuals in jail and connected individuals to substance use disorders to treatment faster. In the area of primary care, Alameda Health Consortium served over 15,000 low-income Alameda County health residents enrolled in health pack. The Multicultural Institute provided outreach for healthcare referrals and patient navigation to over 800 day laborers and other low-income clients. And 91% of students who sought care at our school-based health centers reported that the school health center helped them to get healthy food when their families didn't have enough. And in public health, 12.5 million in measure A funding supported over 26 organizations providing public health services throughout to county to some of our most vulnerable populations, including youth, families, the unhoused, and seniors. A few examples here. Lucklinnica provided food pharmacy distribution to 4,400 children, adults, and seniors. Lifelong medical care provided community health events, and other health-related information were made for over 1,300 community members. And spectrum community services provided nutritious balance meals to over 19,000 seniors and supervisor oral district two. Some other examples of what we're going to do is to get a full-time job. We're going to do a full-time job. 19,000 seniors and Supervisor Oil District 2. Some other examples around public health. The Alameda County Social Services Agency contracted service providers who were able to provide over 400,000 home delivered meals to senior clients through the countywide plan for seniors program. The Center for Early early intervention on deafness dispensed over 200 hearing aids and ear molds to patients and the Alameda County Health Health and Homelessness Services led street health outreach teams provided services to almost 200 individuals. As part of our report development, the committee receives many stories from providers in terms of how measure funds, measure A funds directly impact the lives of county residents. And we've included a few of these stories in today's presentation to share with the board. And I'll just share this one with you and the rest of there for the committee's information. But this is a story about Sam who struggled with addiction unemployment and became estranged from her family and son. She was admitted, she admitted herself to the Cherry Hill, the D-toxification Services Program. And with the support of a case manager, Sam received counseling and graduated from a rehab program. She continued her road to recovery by applying for employment with Horizon Services as a driver and registering as an addiction counseling intern, and Sam is applying for admission to merit college to work toward state certification. A true success story. We can just move to the final slide I think here. So in terms of findings of the Measure A oversight committee for the board, the committee continues to recommend that the county maintain a policy to ensure adequate reserve to sustain base funding allocations. Should revenues received in a future year be lower than anticipated, then the board has the ability to minimize service impacts to the community. That was our only finding. And I think that's the end of my presentation. So I'm behalf of the committee. I I think that's the end of my presentation. So I'm behalf of the committee. I'd like to thank the Board of Supervisors Health Committee for your continued support. We are working on completing our fiscal year 2022-23 report should have that available for you next year. So we are getting caught up. And I'm happy to answer any questions that you may have. Thank you very much for that presentation. And this is an impressive report card, especially since we were coming out of COVID. I just had some questions and observations and maybe our Almea County Health Director can also help respond. When we talked about lessons learned in some of the programs that came out of COVID, like with meal deliveries, I thought we already did that, and was that funded by measure A prior to COVID as well? Yes, meal deliveries were definitely and was that funded by measure a prior to COVID as well? Yes, meal deliveries were definitely provided prior to COVID. I think what changed is people were not able to, well, in the beginning of the pandemic, we weren't delivering directly to people's homes. We were providing pickup sites for individuals. And I don't know at what point during the pandemic that may have reverted back. Good morning, supervisor Tam Colleen, job director of Alameda County Health. I believe and I don't know if that was a social services contract because it is. Yeah. So it supplements the work that social services is already doing around meal delivery. Many of the programs that we support through measure A don't support a program in its entirety. It's supplemental funding for our work already happening. So this is in this case, it's for the social services agency to continue their meal delivery program. Okay the reason I was asking is because I see as one of the examples was the was the support for the spectrum community service in terms of providing 19,000 nutritious meals in Supervisorio district due I know that the county when I last looked at the contracts, had like a $1.7 million contract with Spectrum just this past budget cycle. And so was the fact that they were providing meals in district two, something they didn't do in the past, and it just was something that became more pronounced string COVID and then subsequently we're looking at some allocations that included spectrum. I my I our staff folks are here and I might defer to them. I also don't know if any of these data are from district allocations for Mejure is that what the case is here. So each Supervisorial district gets, Supervisors Office gets an allocation for Mejure and given that this is focused on district two, it's because the district two office funded this particular service in that year. So with their own measure A allocation. Okay. That's helpful. Thank you. In terms of the proportionality, $182.3 million dollars for FY21 and 22. Have you, because you've been on the measure oversight for several years, has it been fairly stable or have you seen deviations within a certain range in terms of the total funds that are allocated. Well, the finance staff can answer that best, but as the committee member, I think what we do look at the measures received every year, we do compare it to the previous years. They're fairly stable, but within, I don't know, $20, $30 million of each others. We don't see huge spikes in huge, you know, it doesn't seem to go up a huge amount or down a huge amount, but it does vary year to year. As you would expect, because it's based on sales tax. So how it's based on how much people have. I mean, they're just trying to figure out whether we're talking about a 10% deviation one way or the other or we're talking about something more significant. When you look at the measure A revenues overall, what do you like to do? I'll let the finance people. I'm in there. Good morning, Supervisor Tam, I'm not a good person. I'm not a good person. I'm not a good person. I'm not a good person. I'm not a good person. I'm not a good person. I'm not a good person. I'm not a good person. I'm not a good person. I'm not a good person. I'm not a good person. I'm not a good person. I'm not a good person. I'm not a good person. we'll have more information about what specific average we are seeing in terms of increase. I can say for fiscal 2122 in terms of receipts, it was an unusual year statewide for sales tax. And so we'll see, I don't have the chart in front of me, unfortunately, but you'll see once we do present a big spike that year. And then what we see in subsequent years is more of a regression. So we are taking that into account as we're determining any additional funds available. Thank you. The reason I'm asking is because of your final recommendation to basically develop a reserve to deal with the ups and downs in terms of making sure that we have some level funding sources, right? And I think you'll be probably making some recommendations along those lines based on the fluctuations over time. The last question I had had to do with the Alameda Health Systems, they get like 79%, 80% of the measure A funding, which is very important to keep our safety net hospitals open and accessible. We have heard from the CEO, James Jackson, that this past year, they had to close a hundred million dollar deficit. I didn't know what it was in FY 2021 and 2022, but does AHS typically factor into measure A funds into their operating deficit? Because having a structural deficit implies that operating revenues are never going to meet operating expenses. So I'm trying to understand how much of that offset is coming from his array. I'll let you in. Mideys' role is really just to understand that the funds were spent in accordance with the ordinance. So I that's not a question I can really answer. Yeah I'm not sure I can answer it either, but I will say that their organization is around 1.5 billion dollars. Is that right? So the measure a funding represents a relatively small proportion of their overall budget. So $143 million out of a $1.5 billion budget? Yes. Okay. Those are all my questions. And just in time, supervisor Carson has arrived to allow for the next item. Thank you so much. So the second item is the also an informational item on the Health Tech Form Medicaid program. Good morning. I'm just going to have a time around. Maybe. Amazing. My name is Adamica Arthur and I run a nonprofit organization called Health Tech for Medicaid. We do national work but I want to at least pause by saying today many people celebrate indigenous people's day and so I want to honor that as well as many Italian Americans who celebrate Columbus Day. I also wanted to say that I started my public health career at the CDC and came to Alameda County to the health department over 20 years ago, so it's a bit like coming back home. So thank you for having me. Next slide. So Health type for Medicaid is a national advocacy organization. And we basically are in a mission to radically change the pace of innovation and Medicaid. As many of you may be aware, there's over 95 million individuals on Medicaid of which we have more than 16 million individuals here in California, and well over 500,000 individuals here in Alameda County. Our purpose is really to further the quality, equity and access to care for Medicaid recipients. Their caregivers, which ultimately make up many other family members and the communities at large. Because of Medicaid re-determination, we now count through CMS that there's about 82 million individuals on Medicaid. We spend a great deal of time making sure that products, services, delivery systems, and capital markets are geared towards a narrative change to help individuals on Medicaid themselves by enabling technology. And we do that really with an eye on underrepresented founders across the US. And companies really interested in serving the Medicaid market. Next slide. So how do we do that work? We do a lot of ecosystem building, both on the national level, the federal level, state-wide level. So we do work in all 56 entities where Medicaid is administered through a state and federal partnership. And then more recently in the last several years, more on a local level. We believe a lot in equitable and inclusive design of products and services. So it's not as much as having products available for people on Medicaid, but that those individuals on Medicaid or from vulnerable populations get an opportunity to bi-directionally indicate what helps work for their lives. We consider ourselves to be an innovation catalyst and we do a lot of local, state and federal policy and advocacy influence. Next slide. I don't think I need to tell this to this particular group, but as you can imagine, COVID-19 really changed the makeup of the Medicaid population, and we are still in a process of disenrollment. And I would imagine you guys have spent a lot of time in the last year and a half talking about Medicaid re-determination. Next slide. I think the important thing to think about is almost one in four Americans are on Medicaid. It's a little bit higher in California. We have almost one in three individuals. And to think about how it is that we can better leverage their quality and duration of life. So we spend a great deal of time with a lot of early stage entrepreneurs who have products that we believe will help extend lifespan. Next slide. I want to focus a little bit on Alameda County and also on the state, but I also want to be respectful of the fact that I don't want to repeat to you guys the work that you do every single day So I might just spend a little bit of time highlighting and then open it up for More local work that we could be doing together and also just questions. Next slide So obviously California has been a leader and Medicaid and I actually say that having been a part of the 1115 waiver in 2005 We received about 40 million dollars here in Alameda County and that really started the National Movement around Medicaid expansion in the country. I don't know if many people know that but California was at the helm of that that work In Alameda County, we were one of the ten counties selected to do that work in Alameda County, we were one of the 10 counties selected to do that work. That has turned into, you know, now more than 40 states. Last year, two states expanded Medicaid. And so it's really great to see that, you know, almost 19 years later, we have really tremendously contributed to so many lives being saved across the country. So the unwinding of continuous enrollment is a very significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant and a significant committee about a year ago when social services and Alameda Alliance were working very closely together to figure out how we can reduce those disenrollments. The federal government has extended that particular timeline through next year. So I'm very hopeful that many of the folks here in our county continue to receive adequate medical services. This, the state did a tremendous amount of new work in medical, this year. You can go to the next slide. And I did a quick Alameda County example. One with the Permanent Clinical Residency allows for many immigrants and refugees to become eligible full-fled Medicaid coverage and that will deeply impact our demographics and the individuals who live in Alameda County. As we know, there has been a transition to manage care across the state and that will deeply impact Alameda County with Elimita Alliance taking the majority of the individual's care from a payer perspective. The removal of the asset limit test really, this sounds like it's not that big of a deal, but for many families who have property and are trying to actually keep that property in their community and their home, but they have a family member who has a tremendous life-threatening challenges or at the end of their life. They don't now have to sell that piece of property. It's a huge way to keep assets in communities over time and not have money being taken away from very hardworking families. And then the biggest issue, which I hope that you guys have spent a lot of time on really, is the Medicaid expansion for justice involved individuals. Just knowing what I know about the demographics of Alameda County, both an emigration of individuals going into the correctional facilities and an immigration of them coming back into our community. Having healthcare for family members is critically important. And so I'm looking forward to seeing what the Public Health Department, the Health System and the Alliance are doing in regards to just to involve individuals. Next slide. I think a lot of these changes you probably deeply know in Medi-Cal, so I'm gonna skip through a lot of the larger California Medicaid changes. The biggest one is a big contract through Kaiser, which really doesn't impact us too much. Next slide. Keep going. One more. Thanks. I think though one thing I'm looking forward to is seeing how Alameda County is able to leverage the CalAIM money. I know through behavioral health care, there's been a tremendous amount of work in health care for the homeless and for resettling of using social determinants of health and social needs, sinking for social needs throughout the state, but really eager to look at how the CalA money is impacting the county directly. Next few slides we can probably skip through. And I think you guys are probably very familiar with CalA. There isn't a lot of Alameda County specific services coming through the CalAIM TA marketplace and I thought that to be very interesting so I hope that our community-based organizations are getting an opportunity to leverage and take advantage of the CalAIM money that is available. You can go to the next slide. Keep going. A lot of this is just technical detail and ex-slutting. Keep going. One more. I did wanna layer up that while CalAIM is big in California, it also ladders with many other states. There's about 23 progressive states across the country that are doing similar work to, and so California is really being looked at to help with health equity and longer term sustainability of local and state funds. Next slide. Keep going. All right, let's go through one more. So we spend a great deal of our time really focusing on focus areas, dual eligible, as you know, individuals that are both medical and Medicare funded, over 65 but qualify for medical, which we have quite a few here in Elimita County, looking at all the determinants of health, social, economic, environmental, ecological, sexual reproductive birthing and maternal health, which is a great concern across the nation if you look at indigenous black and Latinx births and looking at telehealth and how we've been able to increase the uptick of telehealth since the pandemic. Next slide. We do a lot of work through national and local campaigns and so these are some examples. Some of the biggest work we've been doing here is working nationally with the Federal Qualified Health Centers, which there are many here in Alameda County through the Consortium and Asian Health Services. It's one that we'll be highlighting next week at a large national meeting. As we look at educating the venture community, both impact investing, venture and private equity to better understand Medicaid, to invest in our communities. Next slide. I think that this is pretty much about it. We do a lot of advocacy work. Our biggest event is at JP Morgan Health Care Week, which is in San Francisco, in early January, always looking to highlight, I think in the past we've had lots of national leaders who've made a way in a state, but started in Alameda County like Dr. Tony Eiton, right last year or many others. I do think we have a slide on underrepresented founders and I do want to make sure we at least highlight that and the amount of youth in fellowship programs. Thanks. So one thing that we have anchored on since our inception which we started about six years ago was really making sure that underrepresented founders get an opportunity to be a part of the innovation marketplace. And that is because oftentimes individuals that are women, LGBTQIA, people of color often don't get the funding necessary to get their products and services, but they have the lived experience and have real understanding of some of the challenges that are coming up through their communities. So we've spent a great deal of time. We have one of the largest underrepresented founders databases in the country. And then the next slide is really around making sure that we have a pipeline for future Medicaid leaders across the US. And that is really important. I don't think Medicaid is often talked about in the way that it should be as a lifeline to care. It's the largest insured population in this country and provides much of our community with the healthcare resources that they need. And I think that's it. Any questions? I'm going to go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and go ahead and But when we looked at CalAIM because we're looking at a whole person care and the innovation is obviously in looking at housing. And when we, that the board basically passed a contract last week with the former CEO of the Almean Alliance for Health. It was to work specifically with justice involved individuals to get them the kind of health care that they need. And I thought that was just the start. We needed to kind of figure out what the program would look like. How do we get people registered and get them the basic health care plan that they need. So when this started in 2023, we haven't seen anything yet, right? We are still trying to develop that program. Sure. I have a couple things to say. One, while Kelley shouldn't specifically only be around housing, but I think that there is a great emphasis on making sure that the highest cost populations have access to more flexible Medicaid dollars, right? And housing is a great way for folks to address some of the huge barriers to care. I think one of the things I, you know, housing, food insecurity, employment, those are the things that I would want to see anchored and it's interesting that the previous CEO of the Alameda Alliance has kind of moved into a different area that has a way to maximize federal funding and state waivers. I hope that we really do anchor on making sure that there is value-based payment and that people get access to being a part of the economic engine as well. And I think that that's a big part of what we push at Health Tech for Medicaid is making sure that as we have products and services or new joint ventures that are coming about, that people are anchored on employing individuals on Medicaid. Not everyone on Medicaid is there because of income qualification. But there is a great deal of individuals and certainly when you look at California that if we allowed them to have access to a living wage, they no longer would require those sorts of resources. So I think the leadership that Alameda County has done in behavioral health care integration, leveraging kind of technology in equity and in housing. So I really encourage you guys to embrace the trends that you guys are seeing on a statewide and hopefully access those resources here at the county level. What is the name of the investment that you guys have made in the housing for justice involved individuals? Is it public? No, we were looking at the totality with what CalAIM can do particularly for those that are just as involved being released getting them that health care plan, getting them the housing, getting them the workforce training that you just talked about. And so I'm just trying to understand where that program is now since essentially just started last year. Yeah, I could provide some additional context. So the planning for the pre-release justice involved initiative under CalAIM is underway. It's been convened by Scott Coffin, who was referenced earlier. Mr. Coffin is under contract with the Sheriff's Office to help with that pre-release planning. It's, CalAIM has been phased in, and so not all of the pieces are required or to be implemented all at the same time, and the state is continuing to provide guidance on the various pieces that are yet to be implemented. So this is one that's not required of counties at this time, but the planning is underway so that we are ready when it is. Okay, thank you very much. Do you know the share of resources that Alameda County is looking to get out of that justice involved population? When you say the amount of money, yeah, a Calam resources. I don't know what they're planning on. I don't. Okay. You have any other questions? So how have you been health tech for Medicaid been engaged in Alameda County? Or who have you been kind of conversing with in Alameda? Yeah, I mean, it's a really good question. I think we've spent some time trying to work with Alameda Alliance. We've gotten, I mean, we are a nonprofit entity, and so it's by choice that folks work with us. We spent a lot of time with many counties in California, but haven't made as much traction since the transition at Alameda Alliance. We do a lot with IHP, with San Francisco Health Plan, with LA Care. So looking forward to spending more time locally. I live here and have contributed to the healthcare community here for a very long time. So. Okay, great. We have a number of ongoing efforts that are taking place. I mean, we've used the health committee since the beginning of this year to make sure that we re-engage and bring updated information to the health committee from all of our very partners. We've been having very intensive three and a half hour meetings with a lot of our providers, including the alliance. And others, as we kind of even look towards Calam, just finished a three and a half hour on Thursday, I think it might have been Wednesday or Thursday of last week. And that includes our justice involved, a community that provides service on multi-layers, because we wanted to make sure that the hardest to serve was a part of not only updating, but helping us to think and plan as we continue to look into the integration of Cal Ames here. That's also included Kaiser. You know, they're carved out on their own. It's included them as well as the Alliance. And so maybe we can make sure that on the Medicaid part, especially we can figure out how to better communicate around that so that to the extent that we can share and leverage informational resources as well as financial resources, especially with respect to your funders' database. There's a number of our emerging small focused providers that may not necessarily be part of the federally qualified health center network, but they're out doing the kind of work that helps us to reach and engage and form the hardest to serve, the hardest to reach community in that. So we'll look at doing that. I bumped into you at other states, I think, or other locations out of Mika. And I know your presentation is one that's important and you can figure out how to tighten this up. Yeah, thank you. I think that, you know, Alameda County has traditionally been a real leader throughout California. So it's very exciting to see, you know, how we're continuing to participate in, you know, improving people's quality and duration of life. And I think that those are generalizable lessons that, you know, the rest of the state and the rest of the country can certainly learn. Yeah, we want to make sure that we're maximizing all opportunities. Great. We'll do that. Any other questions? Any questions online? I have no speakers for this item. Okay, thank you. Thank you. I don't believe we have any other business before this committee. I appreciate supervisor Tam for starting us off. I thought she was going to take us all the way to the end, but thank you very much for starting us off with that we're adjourned. Thank you. Thank you.