All right, good morning everyone. We're going to go ahead and get this morning's very important session started. I am Council Member Gabe Alvernos, chair of the Health and Human Services Committee. I am joined by Council Member Sales and Council Member Lutki. And we are about to go through a very comprehensive discussion and conversation about the Department of Health and Human Services' very important operating budget. I wanted to say a few things to sort of set the context and the stage for the discussion we're gonna have over the next several days and probably extend into the following week as well. So this is my 17th budget, they've all been different, they've all had their own set of unique challenges. This one is unlike I think, not just me, but anybody who's been doing this for a long time has ever really seen before. Because of all of the unknown factors both at the state and federal level, notwithstanding the growing needs of our constituents, the number of people who are suddenly becoming unemployed and not having supplemental health insurance, and the drastic reductions that are being discussed at the health and human services level at the national level. So this is obviously an unprecedented time. We continue to express our deepest, deepest appreciation and respect for the work of the Department of Health and Human Services, our nonprofit organizations, the primary care coalition, our hospitals, everybody who is contributing to our public health infrastructure here in the county. But we have to have our eyes very much wide open over the looming fiscal challenges ahead. The state has obviously done both the good end challenging thing. The challenging thing was adding to the county's budget challenges with some pass-throughs, but also potentially gave us a little bit more flexibility in how to be able to gain revenue to help offset some of the challenges before us ahead. And thanks to this and previous councils, we do have healthy reserves that are meant to be used for rainy days. And it's raining now, it's going to be pouring soon. And so we have to acknowledge that. We've also got a 3.5-cent tax increase that has been presented by the executive, which helps fund a number of the programs that we have here before us today and what we will be discussing in other committees. But, you know, there are some understandable reservations among myself, as well as my colleagues, about the ability for us to be able to do that at this particular moment. So there are a lot of moving pieces within this budget that are irregular. And what we all absolutely agree on is the growing need and are doing our best to address that need and feeling good about the infrastructure that we have which we've been investing in for some time. So last two points before turning it over to the team to go through the packet is that every budget process set forth by our council president is unique and understandably taking feedback from previous fiscal years, particularly last years. There's an intent on making even more real-time decisions related to line items at the committee level as opposed to putting as many things as we have in the past on the reconciliation list. And so difficult decisions are always have to be made in committee, but that will be particularly true this year. So I just wanted to sort of set that expectation. We are going to do our best to methodically go through each line item, but there will likely be follow up. And we will not be able to likely get to everything in the designated times that have been set for it. So I ask for everyone's flexibility. And we all have to be flexible because we never know what the next piece of information is going to be at the federal level that impacts the conversations we're having today. So thank you all very much for being here today and thank you as always to the team for doing all of your incredible work and with that I will now turn it over to the the team now to sort of set the stage, go, we're first the overall Department of Health and Human. incredible work and with that I will now turn it over to the team now to sort of set the stage go over first the overall Department of Health and Human Services budget but before we get started Dr. Bridgers I did want to give you an opportunity to make some opening comments on behalf of the department and then turn it over to the team to walk us through the packet. Good morning again and Thank you, HHS Chair and Councilmember Albrino's Councilmember Sales and Councilmember Luki who is joining us online. I also want to thank our amazing team that you see behind me for all the work that they do day in and day out. This is my six-budget session and my third as a director. So I took a little time, this time, to do some research, to look at federal and state and even possible local level budget impacts. So I'm just going to share with you some remarks that I prepared for today's initial budget round discussion. Montgomery County Department of Health and Human Services is a critical lifeline for our most vulnerable residents. It offers health care access, behavioral health, crisis intervention, housing stabilization, food security, child welfare, reproductive health, early education and senior care services. These services functions like a rubik cube. Now I brought my rubik cube because of some of partner at Montgomery County Public School system used a magic wand. I don't have a magic wand. I have a rubik's cube. It's multifaceted and interconnected. Shifting one block or reducing one program disrupt the alignment across the whole HHS enterprise and system, disproportionately impacting at risk community. Many of our programs have racial equity and social justice impact, which the county executive elected not to reduce given the harm that a reduction may cause to the community. Since September of 2024, our department has proactively engaged in multiple what if budget reduction scenarios. The department submitted 12 supplementary budget requests and FY 25 would force still pending and yes, there are only two months left in this budget cycle, but you could see the level of effort that we continue to provide and support of our community. Many are designed to preserve core services or strengthen our enterprise billing and reimbursement systems. And we know that there's a threat to Medicare and Medicaid at the federal level as you indicated, Councilmember Alvernos, but directly these budget approaches through this enterprise that directly support the county's general funds and most of you know me and all the work that I did in COVID and looking at the research and all of the long nights I could have probably gotten another terminal degree or such. But looking at evidence-based risk of budget reductions, and I understand that there may be cuts or real diamonds of some budgets. But a 10% cut in healthcare funding is correlated with a 3 to 5% drop in patient satisfaction and a 2% rise in mortality rates. We have our behavior health, Christy Services team up first and then followed by a public health service team. And you will hear some of this echoed again. When we talk about our education and public safety systems, we've historically seen a four to five percent performance reduction. We saw this in COVID when we didn't have access. And school children were out of school and looked at it and increased inequities following the cuts. And lastly, a reduction in culturally competent and bilingual staffing risk eros the trust that we built as a community, as an agency, as a partnership to services for immigrants and communities of color. I'll simply in and will not share all of the notes because I paired it down, but I want you to consider some of my comments this morning as you listen to our team. And as they go through that granular level crosswalk to provide this committee and the council as a whole With the justification that we submitted to the county executive in which he Indores but many of those what-of-scenarios that I talked about Articulated earlier in my opening remarks really had racial equity and social justice impacts So when when you think about a threat, Martin Luther King said, and justice in one community is a threat to injustice to all. So in with that, thank you for allowing me just a little more time this time to provide those opening remarks because I really felt strongly that they needed to be said this morning. Thanks, Dr. Readers. All right, we're gonna turn it over now to Ms. Clemens Johnson and Ms. Nicaragua. He said none this to go through the packet. Good morning and thank you. Can you hear me? Yes. Okay. I can hear my mic is on. Thank you so much. My name is Tara Clemens Johnson, but I represent our team in this overview packet. Ms. Nicole Rodriguez Hernandez, and Nancy Gulsayo, who is at a committee presenting on another budget item. So this is the overview packet as Councilmember Arbano's laid out, Chair Arbano's, excuse me. So we will start with this packet and on page two, you will see the committee schedule to discuss the service areas. So it will be a busy week and we will all be engaged. So we will start that the county executive has recommended an increase of 43.7 million or 8.5 or 8.56 percent increased from the FY25 approved operating budget of this 35.3 million is in the general fund, 8.3 million is in the grant fund. There is a total increase of 65.62 FTEs recommended for DHHS, an increase of 3.3%. I will skip down to the next bullet and say the executive's general fund recommendation includes a nine million dollar increase for the FY26 compensation adjustment and a $5.2 million increase to annualize the FY25 compensation increases. We will talk about the operating budget tool on, I believe, page four of the packet, so I won't highlight that. And then also we will be reviewing three CIP amendments. I believe are we discussing one today? And then the schedule is incorrect as we had some scheduling changes. But one will be discussed today. And so we will go with that. There are two budget items that we will be discussing that are on page nine of your packet that are not tied to one service area. So we will address them today in the overview. I will skip to page three and highlight the budget details. I will not read over these but there are details in the charts of both charts, table table three and table four of the changes in the approved budget. For table four we will highlight that you know the biggest increase in FTEs that we're seeing is in public health and that is actually related to the end of some grant funding and that needed to be replaced with general funds and so it's actually paying for the reimbursement at FTEs. So it looks like FTEs are added but it's actually just transitioning funding. I will move on to page four of your packet that there were three days of public testimony, April 7, April 8 and April 9th there was significant testimony received on the HHS budget for the different service areas and so as we go through those packets we will highlight those especially those that were representative of our BCC's like the Commission on Health the Montgomery Care Advisory Board and so on. Chair Albernol's highlighted the council's president's approach to the FY by26 operating budget, which does change every year. I will note that we talk about that. I think the one that's most key for everyone to understand is the reconciliation list. So the proposed committee reductions or new additions to the recommended budget will go on the reconciliation list. So if the committee agrees with the county executive's recommendation, that item will just be approved and it will not go on the reconciliation list. So it only changes to what the executive has recommended or any additions the committee has or any reductions the committee will have will go on the reconciliation list. And the inflationary budget and the inflationary adjustment for nonprofit providers will be discussed by the full council. Majority of that is in the HHS budget, but there was the recommendation or lead by the council president that it will be discussed at full council. I won't go through the department background. I think our director did a great job of that. And we wanted to highlight the recent committee work sessions that we have had. A number of the work sessions lately have been joined as the topics have truly crossed service areas. So I will commend the committees for working together to discuss all of these topics and issues. In terms of the operating budget, equity tool and assiluses, each of the departments within government had to go through and issues. In terms of the operating budget equity tool analysis, each of the departments within County Government had to go through an analysis. The Obed analysis for DHHS demonstrated that they had a commitment across all areas of the GARE framework, which is the Government Alliance on Brace Equity Framework, which it looks at points to normalize, organize, and operationalize. And so there are several strengths across the department that they discuss, including their equity work group. They have two FTEs dedicated to equity language access and community engagement, and they have at least 1500 staff across the HHS that have voluntarily attended trainings to learn more about various equity topics. And so, DHHC is an opportunity for them to continue to engage in dialogue, would be on the core team, and then highlight their community engagement efforts. We know that a lot of the work of the department is done through contracts. So I think it's like, how do the work in this racial equity aspect through their work at the department to their contractors as well. So I will talk about the next topic is that during the FY25 budget work sessions, we at the same time during the overview, there was a discussion of contracts because there are over 700 contracts within DHHS with over a third of them being competitive contracts. I asked the department to provide a little detail and update on that. And so that DHHS noted that they are working on approximately 52 solicitations in different stages currently. That typically DHHS has worked on three to four RFPs per contract per contract matter for a total of around 25 to 30 RFPs next year a DHHS plans to bid out 20 non-competitive contracts depending on their bandwidth and They know that some of the 151 contracts might be informal solicitations and could be processed in addition to the trony contracts that will bid out. And so there are no contracts, there are no new contracts yet as the process takes like 10 to 11 months and there were eight contracts that were bid out this year. And so we, as we go through the service areas, you will see there are recommended reductions to contracts and that is part of this exercise that the Council and DHHHS has undertook. And so Council staff has recommended that as DHHBizout contracts that the Council be notified so that you are aware of how it is affecting them nonprofits, what services may be reduced or shifted and how that will really impact our community. I'll see if there are any questions. Okay, keep moving. The next is the department's vacancies. As of right now, there are 184 vacancies, 118 in the general fund and 66 grant funded. The chart details the vacancies below and then as we go through each of the services, we will actually talk about what those vacancies are, the positions and number of vacancies. We see the greatest number of vacancies and child welfare OESS and school health positions. So that is usually in behavioral health crisis. I will say it's kind of par for the course of what we have seen over the last few years. A lot of the vacancies are with social work positions and child welfare and behavioral health and crisis. And so those have always been challenging positions for the department to fill, and I don't think that has changed. And so, but I will highlight that, the department does stress that it doesn't mean that the work isn't being done. When there are vacant positions, they are using their contractors to fulfill those needs and make sure those services are still being provided. If we could just pause there for a little bit. At a high level, obviously the world has changed in the last three months with regards to hiring and employment in the DMV in particular. Are we seeing Dr. Bridgers, especially over the last two months, with so many qualified outstanding federal employees, more interest in the job market locally for these in other positions, or is it too early to tell? Great question, Council Member Albuenos Yes, we are seeing an increase. We, the agency, along with other partners participated in a job fair. Last week and we had over 40 individuals to inquire about jobs that we had specifically about clinical work and other work that we've had challenging challenges in supporting. And so the short answer is yes. However we continue to work with our Office of Human Resources to identify and target those areas specifically looking at those individuals at the federal level who may have been displaced but can welcome we join our team. But there's also of course nonprofit organizations that receive federal funds that are no longer receiving those funds I know of too that just notified me over the weekend that they're no longer they've lost big federal contracts. So I think there that's another area that we'll have to explore. The challenging news of course course, is that hurts our infrastructure as a whole. But in the short term, I would assume, as you said, that it does mean we're going to have a larger candidate pool. Sure, that's a great comment as well as follow-up. So we have been working with our nonprofit Montgomery provider, Network System, as well as WorkSource Montgomery, to help fill some of these positions. So we've taken a full throttle approach to recruiting and getting many great Montgomery County citizens who may have been displaced to come into the county and I only for HHS but other agencies as well. And I guess that could impact the budget and in the past we've anticipated lapse because of the large number of physicians because it has been so challenging I don't think we can make those same assumptions moving forward So we'd love to hear just a little bit from OMB from your perspective Specifically with regards to labs how we're taking that into account for budgeting moving forward Debra Lambert from the Office of Management and Budget my colleague Grace Pederson actually did the lapse analysis for HHS. There was a lapse assumption made in this budget. It was also made before a lot of was known about the federal strategies. So it will be re-evaluated on an ongoing basis during the fiscal year. But there is a laps assumption. Jason, do you want to expand on it? No, I would just say the same thing. I think the laps adjustment is less than the laps adjustment last year. Acknowledging how hiring has been, we've made great progress and hiring positions, but all of the assumptions is, you know, the budget process. We're submitted before the current administration and before all of the impact. So we will be working hand in hand with OMB if there's any adjustments needed during the year and how that sort of shakes out. Yeah, when I've talked to stakeholders, we've reached out to all of our offices advocating for important programs and organizations. I've described this budget as sadly a little bit of a to-be continued budget because whatever we pass in May likely will have to be adjusted in some form or fashion. Hopefully we won't have to do as many supplemental as we had to this year, but I think we can all anticipate these unforeseen challenges. Thank you. Turn it back to you, Ms. Clemens Johnson. or did colleagues have any questions? No. OK. OK. So we will just move through to the next section, which is H, H at the FY26 budget review. So we will start with the Medicaid Medicare reimbursement. Council staff just noted that there was an increase in revenue of 15% of 3.3 million. However, the estimated FY25 amount where we will in the year at was 1.9 million, almost a million dollars less than the budget revenue amount. So we asked the question why revenues are down. And so DHH just shared that they had been examining all level of revenues where they could be enhanced. One area was the greatest revenue enhancement was in FFP instead of Medicaid Medicare as they were originally expecting it. So they just ended up being different than what they expected. So for FY26, revenues are expected to increase primary related to the new infrastructure positions, which will be present for FY26. So, Council staff notes that the HHS committee is planning to receive a briefing on the new infrastructure positions in January, 2026, which we will include an update on the Medicaid, Medicare, Revenue, Generated, especially with the change what's happening at the federal level, and if rates change, if that will impact how much revenue the department receives. If we could cause there. So this is infrastructure visits. I mean, you talk about there's going to be some really eligible candidates who are directly going to be coming from HHS at the national level. So I anticipate that could be especially beneficiary to have folks from the inside. So if you just care to comment on that, Dr. Bridgers, do you anticipate that as well? Sure, thank you Council Member Alvin. Yes, we anticipate that this will strengthen our infrastructure. We're also looking at those areas that we know where we have increased billing capacity, which has unfortunately impacted, as we mentioned earlier, any lapseable. We the our workforce strengthening again, we have ongoing conversations weekly with OHR internally, especially with out of the office of the chief operating officer where we are targeting and specifically looking at how we can respond. So the short answer again is yes. Jason, wanna answer that? Yeah, and I would say also, while we have specific positions that will help with the billing specifically, our whole infrastructure and system affects the billing. That when we have extra vacancies, when we have people trying to do multiple jobs at once or trying to provide administrative roles in addition to their primary roles, it affects the billing, right? People can only do so much, they can be distracted, there can be more errors in it. We have a team that has been doing really well, we took some time to fill up the positions, and we are looking for these additional infrastructure positions to help strengthen the whole network so that we can really focus on it. And this slight shift of where the billing cap in this year, some of it as we look at what's the low hanging fruit, What's the easiest area or what's the area that makes the most sense to focus on? We don't necessarily always know that until we get the people in the low hanging fruit, what's the easiest area, or what's the area that makes the most sense to focus on. We don't necessarily always know that until we get the people in, the sort of people reviewing the codes, reviewing the information, seen where we can enhance, but we've seen a great success so far, and we expect it to continue. Okay, thank you. Okay, number two, number one point two. Are the 41% increase in fees that noted in the budget, going from 1.6 million to 2.3 million. DHHS shared that that projected increase is attributed to billing for the 24 hour crisis center for therapists at the Rockville and Tacoma Park locations. So the billing started in FY25, but was not reflected in that budget. And so the full year of the full year's billings are assumed in the FY26 budget. So this is something we will monitor as well. Number two is just highlighting the proposed, required changes, things that are, so we highlighted the compensation adjustment, the lapse as we talked about, motor pool printing. So those details are included there. It is a net change of 7.4 million. So we will go into the first budget item for the committee to weigh on and provide a vote. So we will in your packet on page 9 you will see there is a chart with two items. The first item we will discuss is the salary equity adjustment for $994,000. $34.00. The county executive is recommending a salary equity adjustment at originating from a MOA with McGeo for a Saladee Equity Review. It was determined that the $994,000 is the FY26 impact of that MOA for DHHS, specifically for social worker and therapist positions. There are 127 positions or persons in the department that will receive the adjustment. We do note that this is a one-time adjustment. Any salary change will be part of the FY27 annualization and affected individuals would have a different salary because of this change. So staff's recommendation was to concur with the CE's recommendation as this was a required change based on the MOA But we did want to provide additional details as this was a new a new budget item Without objection, I think customer Lutki. Does that do you have any questions about this particular item? Yep without objection great Okay, and the next item is the annualization of infrastructure positions approved by supplemental 25-34-35. In April 2024, the HHS committee reviewed the county executive's budget committee. I'll say the joint's community's community's community. Do you know, and HHS? Well, HHS reviewed it too. But 11 FTE infrastructure's positions to be offset by Medicaid revenue. I will go through the background, but recently the committee did recently make a decision about these positions. There are 11 FTEs, I think DHHS is in the process of hiring those positions, filling them on an average of once a month in FY25. The new rules are projected to bring in at least $1 million in additional revenue. The council approved the supplemental on January 21st, 2025. So the executive is recommending $1.3 million to continue to support the 11 FTEs. The supplemental supported positions are projected to start June 1st and DHHS is on track for them to begin around that time. The recommendation was to concur with the CEE's recommendation, supporting the council's decision that was made in January to add the positions. Because we went through this so deliberately a few months ago, I believe it's without objection, but I'll just note, and Jason mentioned it in his comments, that it's not just about the reimbursement. This helps with the cascading, overwhelming burden that you all are facing. So I think moving forward, we have funded the positions, but in addition to tracking the revenue, talking about how that's offsetting some of your infrastructure challenges moving forward, that would be really helpful. We don't have to do it right now, but in future sessions and conversations, how it's alleviating some of the impact and the workload. And that concludes the overview packet. Great. So then we're moving on then to behavioral health. Great, Miss. We have a presentation, I believe, on this one. Is that correct? Yes. Great. So Mr. Rodriguez and Nendez, if you want to T.S. up, and then we will watch the presentation. All righty. Good morning, everyone. As the chair mentioned today, the committee will also be reviewing the County Executives recommended FY26 operating budget for behavioral health and crisis services. Before we start with the presentation from our chief, I will note that the County Executives recommended budget includes an increase of about $4.9 million or 8% from the FY25 approved operating budget. In addition, the increase includes about $780,000 in programmatic and staffing enhancements, which we will walk through each item for the committee's review. And the executive's recommended budget includes decreases of about $1.1 million, primarily in grant funding. That was one time allocated for fiscal year 25 that we will also discuss. We just received the DHS overview presentation and so that committee has already reviewed the Office of Racial Equity and Social Justice's operating budget equity tool analysis and compensation adjustments. And in addition, the committee will also be reviewing FY 25 to 30 capital improvement program amendments for the Diversion Center project including including FY25 Supplemental Propriation and Amendment 4, the FY26 Capital Budget. So now I'll turn it over to the Chair and Chief Martin for the presentation. Good morning. It's great to be here this morning for the Record of Mon, chief of behavioral health and crisis services. I wanted to thank Council staff and the Council HHS Committee for giving me the opportunity just to highlight a couple of things. It's not an overview of programmatic updates for the year in general. We would be here very long time if I were to go into all that. But given some of the issues I already discussed this morning in the HHS overview of the budget, I wanted to, you can go ahead and go to the next slide, please. I wanted to make sure that you're a little bit more about where we are with the Behavioral Health Workforce Landscape, nationally, regionally, locally here, and then where we are here as a Behavioral Health and services workforce. So in terms of the landscape I think some of you are aware that our Maryland Health Care Commission released a report at last fall and it's titled invested investing in Maryland's behavioral health talent and it gave us some some grim and stark statistics that were not surprising to those of us on the behavioral health workspace, but that I think are important for all of us to reflect on. And you have some of those here listed on the slide. I'll speak to some of them a little bit more detail, but unfortunately, 45% of the state's behavioral health professionals are expected to retire in three years or less. Our wages here for behavioral health professionals in Montgomery County, as well as a state of Maryland, they lag neighboring states still when adjusted for the cost of living. So thank you for approving the earlier item on salary equity that applies to some of those professionals here in our service area. We have about a 70% postgraduate migration rate, if you will. So those getting master's degrees or graduate degrees and social work or clinical counseling psychology, they really primarily go onto work out of state or in other industries or not working a year after graduation. If perhaps they are not able to attain licensure and we see some equity differentials there in the demographics of those who sometimes do not attain licensure that quickly. Here in Montgomery County we have 168 approximately professionals for 30,000 residents. So that places us 9th statewide and that's out of all 24 jurisdictions here all counties in the city of Baltimore. And I think we can certainly do better than that, hopefully moving forward. In terms of representation mattering because we know it does. Here Montgomery County we're one of the two counties with the highest underrepresentation of Latino behavioral health workers. It's about 10% of our workforce compared to 21% of the population. You know, I moved to Montgomery County in 1999 and I was the first Latino of Hayber Health professional in a large nonprofit organization focused on behavioral health work around the Baltimore, Washington region. And I see so much progress and a lot of that being with homegrown, right, residents here in Montgomery County who who have stepped into the behavioral health space, but we're still way behind. And then in Asian underrepresentation as well, and counseling and social work roles, we have a significant gap there, despite Asian Americans making up about 16% of our county's population. So the bottom line is here as a county right now, not even looking to the future. We would need to expand behavioral health staffing by about 50% to meet current demands. So I share that because I ask you and anyone listening to engage with us, engage with myself as a chief of behavioral health and crisis services in a commitment to work across healthcare, education and the government sector to implement recommended strategies outlined in this report. Even in the absence, perhaps likely of the investment in that mayerland behavioral health workforce investment fund that was established through the legislature that created the demand for this report. So looking at still options for paid internships and increasing retention for hired demand rules, all of those things. I'm happy to say that our behavioral health crisis leadership collaborative, which has representation from our corrections and fire rescue and hospitals in particular, we've had some presentations, a couple of discussions around this, and we're going to be diving more deeply into this specifically and thinking about the long-term future and not just the near term as well. In terms of next slide please, our behavioral health and crisis services workforce here, we have some unique challenges here related to grant funding especially in this climate where we do have more challenges recruiting for term positions that have end dates in terms of when those grant terms end. And then we continue to experience an extreme gap and pay equity for psychiatrists in particular for doctors. But having said that, we've had successes and they do predate some of the increase in applications that we have had as a result, unfortunately, of the federal sector layoffs. And some of those are related to the implementation of Neoga. We've had some more success in FY25 and affiliate administrative and clinical positions, allied positions as well. We continue to use internships as a recruitment tool for employment. We hadn't been using that so much with medical schools because it hasn't been as successful, but we're looking at doing that with psychiatric nurse practitioner type candidates. And I ask you to join me in knocking on the look because we have for the first time ever, well, first time, not ever. It just feels like ever with my tenure here so far in this service area. But the first time in over a year last week I heard we had more interviews, scheduled, than actual openings for the crisis center. So please stay tuned and we'll give you enough data on how that goes. Next slide please. The next thing I wanted to do is make sure that we're celebrating our accomplishments. I thank you for your support of our mission, especially in this climate that can be quite demoralizing and I want to make sure we pause to celebrate what we've done well and what we need to continue doing well to continue moving the needle forward on behavioral health wellness for residents in Montgomery County and as Dr. Bridgers I'm just gonna follow and suit because I just have to point over to this amazing leadership team over right there in that corner. They're all lined up in a row because as I go through this, you're going to see elements of their work that they manage at very high levels and embedded in what supported some of these results. So thanks to the dedicated efforts of HHS, our community partners, our first responders, our fatal overdoses here in Montgomery County, dropped by 40% in 2024 compared to 2023. You'll see here on this chart that includes a 48% decrease from 2023 for those overdoses involving opioids. And as a subset of that, 52% for fentanyl specifically. That's, it also includes a decline of 18% for overdoses involving alcohol. And this drop is steeper than the national average, a CDC provisional data in March. Suggest a nationally that's about 24% for 2023. And it is also a steeper decline than the state average of 38% just by a bit, but we're still going to celebrate that. Overall, it's a lowest number of fatal overdoses among Americani since 2015 and that decline was driven mostly by age groups younger than 40 years old and especially those that were 22 and younger so making some great gains with youth in particular. Next slide. In terms of additional supporting information to be aware of our emergency room visit Due to opioid overdoses to climb by 30% in 24 again. That's the first major decrease in the onset of the COVID-19 pandemic and in our Maryland Public Behavioral Health System we had over 5,300 County clients experience experiencing substance related disorder. Now these are those in our public system that utilize Medicaid for their insurance or maybe do not have insurance. But out of that 5,300 over that actually that we're sort of an FY 24 we had a corresponding expenditure of close to 30 million, 29 and a half million. And that represents a 5% increase over the previous year, 5% increase of the client count, 20% increase of the expenditures. The growth in the expenditures was driven by the increased costs of substance related disorder, partial hospitalization, outpatient services, intensive outpatient services, labs, opioid maintenance, treatment services, basically all pointing to the fact that more county clients receive community-based substance-related disorder treatment in lieu of the emergency room or inpatient services to support recovery in their community. So that data really underscores the importance of outreach of the peer recovery work we've done, the psychoeducational work we've done with family members and caregivers in supporting individuals' choices to engage in treatment and save their own lives as well. Next slide. So I want to highlight some of the expanded prevention efforts led by our service area and our partners significantly increased Narcan and N lock zone training and distribution. Quite a significant jump from FY22, 67% increase for us across those two years of individuals trained by our teams and an 81% increase in doses distributed. I know some of you had heard updates from us previously in session around the evidence-based curriculums and presentations. At this point, those that are geared towards youth have reached close to 6,500 students in FY24 and the first two quarters of FY25. We've had community grantees also implement some pilot projects and a continued increase in participation in our Be the One Youth Ambassador program. We now have 60 young people from MCPS and also independent schools in the area that are doing that peer leadership work. Next slide. In terms of harm reduction and treatment initiatives led by behavioral health crisis services and partners in 2024 our steer program stopped triage educate, and rehabilitate program, serve close to 600 county clients, considered high risk of overdose, and 82% of those clients completed screenings, 52 of those received referral treatment, and 57% engage in treatment. Those are very high numbers, considering the nature of the disorder of substance of substance abuse in general, also considering that our steer professionals, our peer recovery support professionals are engaging with individuals in a moment of crisis where the individual has not requested that service. They've not said, I'm ready to start my recovery. So they're getting an intervention at a time where. They're not asking for it, and yet still, these are the outcomes that we're seeing. Our crisis stabilization room, which you know opened in September 2023, it admitted over 400 individuals in 2024, and of those 70% presented with substance use concerns. And the stabilization room would provide it some timely intervention and connection recovery. And then as you know, our youth emergency response pilot in the Aspen Hill Glenmont Wheaton area, which has now expanded with a new contract sign just in March across the county to support youth and young adults in getting very immediate timely intervention and support and connecting to treatment. Next slide. Other contributing factors, of course, were the reopening of the Youth Residential Substance Abuse Treatment Center at Mountain Manor, operated by Maryland Treatment Centers, and doubling our recovery support for incarcerated individuals. So Mountain Manor has been open since September, and it's for seven months of operation. It's had 65 youth engaging treatment there and this is high intensity, medically monitored detox withdrawal support of those 65 youth 38 have been from Montgomery County and for individuals that are incarcerated they face a much higher rate of overdose risk upon release specifically, 40 to 129 times. The regular population, the general population, and our treatment team served double the number of individuals and made sure they were trained in the use of Narcan and had Narcan with them upon release. Next slide. Finally, I just had to take this opportunity to make sure you're aware of the fact that we're on an ongoing basis engaged in efforts to spread community awareness, raise awareness around the stigma mental health, fight that stigma, and to work with our partners to do so. So we invite you to join us on April 30th, when it's April 30th and Denham Day. We are currently in the month of sexual assault awareness month. And if you have not heard about Denham Day before, it's a powerful act of solidarity. And it's a global moment really. It's part of an international campaign to raise awareness about sexual violence, challenge harmful myths, and support survivors. It began in 1999, after the Italian Supreme Court overturned a rape conviction, reasoning that because the survivor was wearing tight jeans, she must have helped remove them, therefore, implying consent. So, in response, women in the Italian parliament specifically, they wore jeans to work in solidarity with the survivor, and they sparked international attention and the launch of done in day So you can send your pictures if you are able to wear your jeans that day and support us, whether you're working remotely or on site. And May is coming up, which is Mental Health Awareness Month and Montgomery County will be going green and will light up the memorial plaza from May 12 through 18. Next slide, please. We continue to fight stigma through the use of language and affirming language that supports everybody's knowing that it's OK to not be OK. And also, everybody learning more about the right language you use to support your loved ones who feel like they are not OK. I need mental health or substance abuse treatment support. Finally, I need to put in a plug for our 2025 spring form. This is presented by our Montgomery County BCCs that support the Bay of Old and Crisis Service area, so the alcohol and other drug addiction advisory council and the Mental Health Advisory Committee. This year it's in partnership with our Montgomery County East County Education Center, our very new center out there, and our Montgomery County DHHS youth ambassadors. So please come for a Saturday morning. Grab a quick grab and go breakfast, get to some sessions. There'll be sessions in English and Spanish, but they will focus on achieving and maintaining strong mental health, the dangers of fentanyl, alcohol and other substances, information to keep loved ones safe, school and community-based resources, and what insurance is required to cover. So people know about that, especially in this climate, where people may be transitioning their insurance providers due to what's happening nationally. So thank you for the opportunity to just share those highlights. Thank you for that. Gonna be wearing jeans next Wednesday. So, geez, I don't even know where to start. First of all, Miss Martin, you're doing a fabulous job truly. I just can't thank you enough for it. You and your team, I think we have this organic behavioral health in everything approach now where it crosses over into so many different disciplines organizations. We're all feeling it. I talk often about the fact that in the public health survey they came back most recently administered via public health team, behavioral health remains the number one issue of concern of our county residents from a health perspective. And frankly, that's only going to get worse. Our especially vulnerable populations, our immigrant community, our LGBTQ plus community, our minority communities, our aging community, everyone is going to, and is already feeling the weight of what's happening in the anxiousness and the anxiety in the market and when there are significant disruptions to our economic perspective and what's happening economically in our community that stress comes home. So could you talk a little bit about at a high level? Obviously we've got individual line items and programs and services and partnerships and alliances, but this is an opportunity for you at a 30,000 foot level because I know you're thinking about this a lot, talking about how we are preparing and are strengthening the infrastructure that we have now, especially knowing what's happening and what will be happening in the near future. Thank you for that opportunity to comment on that as well. Absolutely, we've all been feeling the impact of the new federal policies and actions for some time. I already mentioned, again, we need to keep highlighting what we're doing well and keep doing more of it because it can be quite a demoralizing time. I focus on the behavioral health workforce piece in opening today's presentation because I think it's a time that it might get tougher in some ways to recruit. Here we're talking about some recent, you know, surge in applications, but over the long haul as more people experience more of their own trauma, be a feeling attacked by the actions of this administration, be that again, a loss of financial security, the impact of these actions on their communities, the communities that they love, their family members, it becomes tougher to take care of yourself to be available to support critical life-saving work and taking care of others sometimes during those times. So that's why I feel incredibly fortunate again to have this amazing leadership team here and the support of Dr. Bridgers with this team. Having said all that, our residents are our primary, of course, focus supporting them. I've seen some shifts related to, for example, parents of children coming into our patient clinics asking or opting to be seen through telehealth as opposed to in person when they were coming in person regularly for a child or family therapy because they are concerned about being out and about the community more because of the ICE activity that is occurring or that they're concerned will be occurring as well. We have had outreach from some folks that have lost their jobs through the federal sector. For the most part, we are directly overseeing services and supports within our public behavioral health system. And we are the ultimate safety net in that system, which includes so many private partners, right? We're very concerned, very, very, very concerned about the impact of potential changes to Medicaid and Medicare. And our grant sources, some of those block grants from the federal government coming to the state or some directly coming from the state, they can price close a 20% of our overall budget, if you will. So I do think it's just a vital time. You're gonna have so many difficult decisions to make we all do during this time to ensure that we consider behavioral health as a core priority because the impact of all of this is only going to get worse if we don't do that. I just want to point to add thank you again Ms. Martin for all that you do in our great behavioral crisis services team. Just want to remind those that are watching any of our committee sessions or the council sessions that we operate a very robust, Christy service center that numbers 240-777-4000. I have so many numbers going in my head, but I have that one specifically, 240-777-40000. It doesn't matter if there's a job loss or if you are experiencing financial loss. We have very trained professionals available and I just wanna say that in support. Since we're having this session on behavioral health and crisis services, it's not noted as often as it should be. And so it will be a repeated message to help those who are in need the most. Thank you Dr. Bridges. If I can just, you know, add on to that. That's one of the reasons sometimes we don't hear from folks is because, oh, I have my co-bruffer now where I'm doing what I'm doing with this or this or that. But we, the other message I want to make sure we win here is that I'm Dornie Hill or senior administrator for crisis and taking trauma services as our mantra. She repeats it all the time is, we don't define what crisis is you do. So if you feel like you're in crisis or even if you're not in crisis, but you're concerned that it's coming, please reach out, call that number. We have mobile crisis and outreach teams that can come to you. We can talk to you over the phone. We have 988 available to you so we'll make sure to keep all the advertising and communications and awareness campaigns to make sure our community knows we're here for you. That's from Rootkey. Thank you. Just want to say first, thank you all for all that you do and give a shout out to Dornay sitting back there for always putting the person first and recognizing the need for that. And you all do a phenomenal job of spreading the word about the services we have. One of the things that I have seen in recent weeks is an uptick in stigmatizing language for those who may be suffering from a mental behavioral health condition or substance use disorder, quite a lot of it. And wondered, you know, knowing that that has sort of ramped itself up at a time when we had made really good progress on destigmatizing things and getting people to better understand with attention to cultural competencies in different communities. What might we be doing moving forward as HHS to help myth bust as it were? What, you know, that this is not make someone a dangerous person because you have depression or anxiety disorder. How can we, through the work that we do in public health help to combat what we're now seeing as a rise in that type of horribly stigmatizing language? Thank you for mentioning that, Council Member Lugies. It's not a surprise in this again, federal climate of othering and division and those kinds of messages that support hate, honestly, in many situations that you would see them. It's very unfortunate. I would say reach out to us because I think, you know, just like with any public health and origin, we can do do the mass campaigns and the messaging and what have you. But what's very important is that we're there in the moment that the community has experienced that, whether that community is defined as an individual that's impacted by this, or a household, or a neighborhood, or a school, whatever that is, whether it's IR team directly or amazing partners at, you know, non-mean Federation for Families and so many other partners that we have their experts in doing this work, that you call and let us know how we can support directly because we're going to be concerned first and foremost in the moment about who's impacted by that. It's hateful really. Right? Right? Right. Red, right? Right. Direct. Because we don't want that to be triggering and traumatizing in a way that leads to more acute symptomology and takes someone down the road of needing more intensive crisis supports. However, of course, we're also available for the general community to make sure we help to spread the word. That's why you have the flyer on there on on the impact of that language so that those that may not be aware, right? Whether they are not but may not be aware of the significant impact of that are hearing directly around. What did thank you this? That's from your sales. Thank you for the updates and to the team It takes a village to address this problem that was one of the top issues on our most recent By annual survey So thank you for all of the work that we are continuing to do Are you familiar with the newly? I guess the coming freedom center that's coming to the county? So we're familiar, our local behavioral authority, right, is the local entity that does get notification when there's any private provider that intends to seek a accreditation or licensure from the state for any billable service in a public payable health system or even if they're not choosing to participate in the public payable health system. So they are aware that they have applied. Okay, so and they currently operate in Montgomery County doing outpatient work. Yes, yes. Is there a way to share that information on a regular basis when a new center comes online to the county with the council? So I am, the center is not online. What we've received is a notification of intent to apply for licensure and a co-carnation. The state is in charge of actually issuing licensure and accreditation. And in terms of information available our local behavioral authority maintains a directory of all licens and accredited programs in the county and that director is updated at any time. And I'm happy to share that QR code. But I'm gonna defer over here to our director of our local health authority, Sarah Rose, to learn, it's not par for the course for us to announce necessarily as I'm aware. New programs as they come online, because again, it is a state function to actually issue those licenses and accreditation. So if you have any additional comments, Sarah? Hi, I'm Sarah Rose. I'm the director of Montgomery County's local behavioral health authority. So yes what the process is currently is that when a provider has received accreditation which is required for outpatient levels of care as well as residential levels of care across the state then they apply they send a notification that they are interested in receiving state licensure for operating that service. And it goes to each jurisdiction has local behavioral health authority. And so we review the application. And as long as they have met those standards that are required from the state, then forward that on. We provide signature and then that gets sent to the state that the provider submits for request for licensure. So how long ago was that submitted back to the state from the county? So it's been a couple months I'll say say. And then the state, you know, depending on their timeline, it can take several months for the processing. And it's up to the state too if they choose to accept or deny. Okay. Yeah, I think moving forward, it would be helpful, given how important this issue is. Anytime a new resource may be coming online and available, even the potential, it would be helpful for us to be updated if that's not too much of a lift. So we can make sure to let the committee know when there's an update to the director. I will say they're pretty regular and they drop on and off. I will also just in support of Sarah and her team. We don't have the bandwidth to update that on a daily basis. Just no. No. So, so when we're able to update that and which does happen on a regular basis, but I don't want to commit over commits to the team to that frequency, we can share that. It's updated in real time when it happens again. There's a QR code, there's a web page to go to, and you have access to it. Oh, good. It would be helpful to have access to that QR code. And then going back to page four, can you share more about the grant shift from adult forensic services to the specialty and come remember sales will walk through the entire packet and can dive in a little bit deeper into that section and at that point in time. So okay. Any yield? Thank you. Great. Perfect segue. So let's go through the line items. Already. Okay. Starting on page two, we have a summary of the FY26 recommended budget, which shows you the FY25 approved and compared to the FY26 recommended for the general fund, grant fund and the opioid abatement fund. Starting with the behavioral health and crisis service vacancies, which we've touched on already, currently as of March 2025, there are approximately 40 position vacancies in BHCS, 35 are funded with general funds and 5 are funded with grant funds, and almost half of those are within the 24 hour crisis center. However, at that time, 3-quarters of their vacancies were already in the interview stage, and a majority of all BHCS vacancies are in the process of hiring a final candidate. Of the 40 vacancies, 19 are for therapists, but again, 16 either in the interview stage or have selected a candidate as of March 2025. And the table on page three gives you the vacancies by the BHCS program area for your information. For multi-programme adjustments we asked DHHS to provide additional information for any program area that has a 10% or greater change in multi-program adjustments. And so the table on the top of page four provides that information. And here's where we can dive in a little bit more. So we're looking at adult forensic services has about a $1.3 million decrease, but that's just to reflect the grant reallocation to specialty behavioral health services program area within BHCS and that's related to the state opioid response grant and on March 6th the committee received additional information on the SOAR grants as well. The local behavioral health authority has about a $2.4 million increase which is related to compensation and grant changes. Throughout patient behavioral health services child, there's a $1.1 million increase related to compensation and the infrastructure positions that were discussed in the overview. And then the speciality behavioral health services, that's where we'll see the increase for the SOAR grant reallocation into this program area. And for trauma services, we're seeing changes also related to compensation and a shift internally from what what was services always provided in trauma services but were loaded into the access to behavioral health services section is now just properly correct in the budget as well. And then treatment services has a small $40,000 increase per compensation changes. So Council Member Sales, if there are any other additional questions. Council Member Sales, just going back to your question about the local behavior health associate, local behavior health authority resource directory, Ms. Martin just looked and it's posted on our website at our LBHA website and it was updated for 925. So just for public record. Great, I don't think. And it will be a projection. Then to this first group. I didn't know if council member sales still had a question on the grant. Yes, so I would, few can just share a bit more about the shift of grant funds from the adult forensics to specialty behavioral health. Looks like there's a $71,000 difference. So that is reflecting in the multi-program adjustments that originally that grant was allocated under the adult forensic services, but is being properly placed into the specialty behavioral health services program area. So that funding is not necessarily new, it's just a shift internally from their budget. Correct. So it's actually our specialty behavioral health division that operates our jail-based medication assisted treatment program. So it was initially allocated under Delta Forensic Services because they do the bulk of the work with our incarcerated individuals. The specialty behavioral health does our substance use disorder treatment work. So it's just a shift to align with program. I thought it was a new position that came about. The infrastructure position? There is a new infrastructure position in our jail-based medication assisted treatment program. It's a for a supervisory therapist that again is going to support increased capacity and oversight for billing as well. Thank you. All right. Continuing with the opioid abatement funds, council staffs included some programmatic updates from DHHS on it. And in addition, just note that DHHS facilitates the overdose prevention team, which provides the funding prioritization for the use of these funds. And the table 4 on the bottom of page 4 through page 5 shows the multi-se this state-required team. And some updates to share with you all is including the substance use disorder prevention intervention program that targets youth and young adults who are actively using substances, as well as the reopening of the Mountain Manor Youth Residential Treatment in Baltimore, Maryland. BHS is also implementing a culturally inclusive media and advertising targeted towards male African-Americans and Latinos who have a higher rate of substance related disorders, as well as community grants and expansion of botfin life skills training to help increase the number of outreach facilitators during the work through the opioid abatement funds. As Thomas Johnson mentioned we received the council received public hearings on the FY26 operating budget on April 7th, 8th and 9th. And it's specifically several organizations and individuals testified in support of DHHS's mission, wanted to highlight that every mind, the Latino Health Steering Committee, and the Asian American Health Initiative Steering Committee, also testified in support. The table on page seven provides summarized descriptions of each BHCES program area and the comparison of the FY25 approved to the FY26 recommended for each of the 10 program areas within BHCES. And as I just mentioned, the committee recently held a committee session on March 6 to review two state-related grant FY 25 supplemental appropriations for the state opioid response grants as well as a behavioral health crisis stabilization center and mobile crisis team pilot. And that the operation or the operating budget equity tool analysis was also provided during the review session. And so now we can start going through the specific enhancements and changes in the executive budget. So the first is $107,500 to comply with the state requirement that necessitates county staff to assume abuse intervention program services. So currently the county is a state recognized comprehensive domestic violence service provider and as part of that certification is required to provide certain delivery services, including the 24 hour hotline, the emergency shelter for victims and children, counseling services for victims, and the Abuser Intervention Program. Currently at this time, DHS has determined to have the domestic violence shelter as the outsourced element and part of this provider recognition is that all services but one are provided in-house. So the domestic violence shelter is the outsourced item and to be able to bring the abuser intervention program which helps individuals who use abusive behavior by teaching non-violent and controlling tools to address relationship issues in-house, this funding will help the transition from what is currently an outside revenue generating organization to DHHS. The total cost is approximately the same as FR-25 but this helps not only the transition but also an adjustment from the internal loading of where the funds were originally allocated and trauma services to the correct location of access to behavioral health services. I don't have any questions. So you have just a customer, Loukey. I just had one quick question, and this is sort of more general, but somewhere in the packet, and I don't want to scroll because then I am not in the right chart. But it mentioned sort of the, we're having less no shows predicted for this year than we had had in the past for different, you know, community-based provider appointments. Have you been able to discern are they evenly distributed amongst our community providers? Is there a particular cause of the no shows? And so with my leadership team, I get back to to you. Oh, thank you. That's something we've been able to do to throw analysis on, but thank you. I did have one question. Are these state requirements in the first line item new or are they ongoing? So the state requirement may not be new, but it was brought to our attention this year's, but have a new manager of trauma services who's been in the place for about a year and a half. And who has really overhauled everything and just went an excellent job of improving service delivery and ensuring that we've got sustainability moving forward. I will say that the current operator for the Abuser Intervention Services is not a nonprofit entity, it's a for-profit entity. So this would be a service that bringing in house not only helps us to meet the mandate of the state and the certification as a domestic violence service provider that's eligible for ongoing grant funds that other providers may not be eligible for, but also create some synergies and flexibilities within our trauma services program so that we actually would have the capacity to serve more individuals across both abuser intervention and victim services. All right. The second item is also related to the county's status as a comprehensive domestic violence service provider which is a $425,000 increase for the domestic violence shelter. So as just mentioned the domestic violence shelter is the only outsourced component within the comprehensive domestic violence service provider, provider certification is recognized by the state. And DHS is currently undergoing the procurement process due to a recompetition to secure a provider for the upcoming fiscal year and the continued operation of the shelter. DHS had originally announced the first request for proposal cycle with the FY25 approved operating budget of about $1.5 million. At that time, they received notice that the current provider has indicated that they would not be rebitting to continue operating the service, and unfortunately no bids were received at that time at the FY25 approved amount. DHHS met with potential providers and determined the approved budget did not meet the current true cost-operated shelter and the true needs by survivors and their children. A second RFP announcement was released and a potential vendor was selected but negotiations rely of course on the FY26 approved budget amount. And in their conversation, the increased amount with the $425,000 that was included in the executives recommended budget is reliant upon the potential vendor moving forward as serving as the operator of the domestic violence shelter. If the shelter, if this enhancement is not included and a vendor is not being able to be selected for this domestic violence shelter. Of course, there would be cuts to the workforce and services, serving fewer clients and or the risk the complete elimination of the service. And if the shelter is not in session, the county would have a gap in the shelter services become in compliant with the state's comprehensive domestic violence shelter provider certification status, risking those grant funding opportunities that Chief Martin mentioned, and would become the only county in the state without a comprehensive domestic violence shelter. Provider status. Chief Martin, any comments on this? I know that was a great overview, but just in terms of need, capacity, and ensuring that the contract is in line with the realities of the financial realities on the ground. Yeah, that's exactly council stuff. You know, did an excellent job giving you the overview, as you said. That's exactly what we have to do this. I know it's listed as an enhancement. And there were just a lot of developing pieces to this across the year, as executive budget was being developed. So, you know, after the fall is when we had to be compete this for a bit anyhow that was going to be happening regardless this year. And in that process, it was affirmed for us as HHS had already assessed with the existing operator that this service due to the acuity of needs, some increase in utilization as well, but primarily the acuity and complexity of the needs coming in for victims of domestic violence and human trafficking as well required that we just have to resource it better just to be able to operate it into justice by our residents who need these emergency services. This is a 60-day emergency shelter service. It really does prioritize those individuals that have the highest and lethality risk in terms of potential either homicide or serious assault if they don't have an undisclosed safe location to go to with their children. And so we thank you if I don't mind me so well, thank you in advance for supporting this because we just cannot have a cap in the service of all we don't want to see anybody. Honestly, it just dies or it's a little a result of not having this available to them. Thank you. I think without objection. Yeah. So the third final increase as part of the executives recommended budget that we will be reviewing today, is $249,194 for the annualization of the Tacoma Park Therapist and the Crisis Center, which will be fully offset by revenue from the city of Tacoma Park. Currently, the city has co-located two county crisis center therapists at the Tacoma Park Police Department to support the redirection of officers, service calls to the behavioral health clinicians when appropriate. And while the positions were originally funded through a county fiscal year 24 supplemental appropriation, per the memorandum of agreement between the county and the city, the city is reimbursing the county as the salary costs are incurred. Currently one position is filled and active recruitment is ongoing for the second position and both are term positions as related to the MOA and dependent on the annual review and agreement signed by the city and the county for this service. The city notes that current funding should be sufficient for fiscal year 26 and that the proposed budget change annualizes the positions for FY 26 and future annualization impacts will be dependent, of course, on the M.O.A. and an accounting compensation changes. It makes a heck of a lot of sense. I'm just curious, do we have similar arrangements with the other municipalities? Yeah, this effort was modeled after the one we haven't placed with the City of Rockville. Correct. Perfect. Any questions? No. Now I'm moving into the recommended decreases, again mostly focused on grant funding changes. So the first is $206,414 from the annualized reduction of federal grant for the mobile crisis outreach teams as it's now replaced with full year funding and FTE build to the general fund. So in fiscal year 25, the executive recommended and the council approved $1.5 million for the replacement of the MCOT to federal grant funding with general funding to both maintain the existing services and to add to additional teams for seven teams total. Currently, there are five teams up and running for the MCOTs with the goal to increase to seven as soon as the hiring for the selected therapists and community services aid candidates are finalized. So that is in process. In fiscal year 25 the M-COTS were still grant funded for the first three months of the fiscal year prior to the shift to the general fund and so the proposed change reflects the reduction of the grant funding utilized in fiscal year 25, as general funds will be fully utilized for the fiscal year 26. And the FR 26 general fund and realizations are reflected in the multi-programme adjustments of the 24-hour crisis center for the same amount of 206,414 dollars. That objection. Okay, the second change is the elimination of the ARPA Substance Use Services grant. The state provided a one-time ARPA grant of $555,400 for the screening, brief intervention and referral services for substance use at hospitals. Of course, this was set at the expectation for the ARPA grant funding to be utilized for the specific pandemic in limited time needs and services. And so these funds are not being assumed in the general fund. However, DHHS notes that this is a billable service that hospitals can continue to offer at their own discretion. Great. And then the last is the elimination of one time fiscal year 2980 grants. So the county's national.88 suicide and crisis lifeline and the Montgomery County hotline counselors both serve as the supporting listening lines, risk assessment facilitators and connectors to additional resources as needed with the vendor and counselors answering the line for both, answering the calls for both lines. Table 8 on page 12 provides you the FY 25 funding amounts for the 98 service. And in fiscal year 25 the council had approved the county executives recommended increase of $1.3 million in the 98 crisis hotline services grant funds which included the replacement of $320,000 in general funds. As this is one-time funding, and the local behavioral health authority, which oversees the contract for these services, has not received the final FY26 State Award estimates. The expected, there are no expected service impacts related to this reduction, and they're expecting similar amount of funding for fiscal year 26. So this is just reflecting the one-time nature of that grant funding. Reduction. All right. And so that is the conclusion of the operating budget line items for review by the committee and the next is for the CIP amendment. All right. So moving into the CIP FI 25-30 capital improvements program, the executive had transmitted four amendments to the FI-25 to 30 CIP for the diversion center project. In March 2025, the executive transmitted an FI-25 supplemental appropriation, so that's for fiscal year 25. And relatedly, in January, March and April of this year, transmitted FI-26 capital budget requests for the Diversion Center project. So the committee and the council will be reviewing two versions of the Diversion Center Project description form. The first is for that March 2025 fiscal year 25 supplemental appropriation. And then the second is for the April 2025 FY26 Capital Budget Request and Amendment change. and just forget the record, the council will be holding a public hearing on the executives April 2025 CIP and amendment on tomorrow April 22nd. So the DHS diversion center facilities support the implementation of the county's crisis now model as alternatives to the hospital emergency department or criminal jail detention for individuals experiencing a behavioral health crisis. The project originally primarily focused on the construction for the diversion center project on Seven Locks Road in Rockville, Maryland. In this location we'll specifically provide an alternative to the incarceration for individuals 18 and older who have committed minor non-violent offenses and are experiencing a behavioral health-related issue. Currently, that design is expected to complete in spring 2025 with construction ending in spring 2027 and the entire project completed in spring 2028. The FY25 supplemental appropriation and amendments that were transmitted are relating to the new Maryland code of Maryland regulation requirement for a stabilization unit Which allows the walk-in and youth serving Capabilities that we discussed on March 6 as well related to grant funding for that as well So looking at the first fiscal year 25 supplemental appropriation The executive transmitted in the amount for 650,000 dollars which would advance the authority and and usage of $338,000 in GeoBonds and $312,000 in state aid from fiscal year 2027 to 26. So that's not an increase in the total amount awarded for this project, but just shifting friends forward. The county is currently utilizing a Maryland Department of Health Community Health Facilities Capital Grant for the Diversion Center project and in order to accompany the scope change for the stabilization unit expansion for the walk-in site and youth serving spaces. And to eventually hopefully receive Medicaid compliant and Medicaid billing eligibility, the scope change required the Board of Public Works approval on the advancing of those funds. And so this change would reflect the 52% match per the terms of the agreement, which is the $338,000 in GeoBonds and the $312,000 in state aid. So for this project description form and the FY25 supplemental appropriation, we're looking still at the same 6-year total of 21 million, however, there is a shift of funding from 27 into 26 of $650,000. Make sense without objection. Without objection. All right. Relatedly, the amendment from April 2025 for the Divergent Center project reflects specific changes as following. So in January 2025, the original amendment reflected a shift of $253,000 from the through FY24 column into fiscal year 25 and beyond as FY24 actuals were lower than expected and is mostly expected to be utilized in this fiscal year. In March 2025 the FY 26 amended reflected the FY 25 self-pulmantle appropriation we just reviewed. And so showed both the January shift and the $253,000 shift and the $650,000 advancement from 27 to 26. The April 2025 amendment, which is the version that the committee will be specifically reviewing today, includes the January shift, the FY25 supplemental appropriation, and fortunately, $500,000 in new state aid funding. The executive notes that the $500,000 in the state aid must specifically support the new stabilization unit that we've just been discussing. And that will serve as the primary resource for the required renovations with the shift of supplemental, the FI25 supplemental appropriation, helping to cover the additional costs and will be continued to utilize for the other parts of the diversion center facility project. The stabilization unit is expected to be completed in this calendar year 2025. And so the amendment shows the increase of the $500,000 in addition to the shifts. That is the customer's looking. Thank you for highlighting in the packet that we had discussed and touched upon. walk-in services and youth servings, circuses, sometimes they are. Services at our March 6th session and you noted that it's required because the code of Maryland annotated regulations was updated in 2024, which meant the the state says you have to offer these as part of this. Does anybody know where in Comar that is? I mean, I know it's just, you know, Comar's lengthy. So, or is that something you could get to us? Because I believe our offices had received some questions related to those services and I wanted to be able to provide them with the appropriate reference in the state law. We'll do this specific regulation. Great, thank you. Thank you. All right, and to conclude, so I don't believe there was a committee vote on the first increase for the FY26 operating budget on complying with the state requirement for the Abuser intervention services program, so I just wanted to. Yep, without objections. Okay. All right, so at this time I have without objection and support for all of the operating budget changes, enhancements and reductions as well as the CIP amendments for FY 25 supplemental and the FY 26 amendment for the diversion center project. That's correct. And just to note that all other items in the county executive recommended operating budget are recommended for approval as well. Great. All right, moving on. Ready? Yep. We can move to the next item. We will ask that the staff your military background. As you said, at ease. All right, welcome to our public health team. Thank you all so much. I think we're going to continue some of the conversations we had downstairs earlier this morning in addition to reviewing the broader context of what's been recommended. I'll turn it over to, Ms. Clemens Johnson. Okay. So we are discussing the public health services budget. The county executive has recommended an increase of $661,000 or 6% from the FY25 approved amount. FTEs are recommended to increase by 26.25 positions or 4.3%. There are 5.6 million in programmatic and staffing enhancements that are included in part of the public health services budget. There will be eight items that we are discussing that are listed on the front page of your packet and we will go through each item in detail. The executive but recommended decreases equate to 67,000. Those are actually two contracts that we will discuss. Move on to page two. The general, there's the chart lays out the changes that we just talked about. In terms of vacancies, as of April 1st, there are 13 vacancies of the 13. Three positions are grant funded and 10 are funded through the general fund. As you can see here, the only one of the positions has been vacant longer than a year. There are three community health nurses positions, two dental assistants. I think dental came in presented last time and talked about the challenges within the market for the dental assistants and those rates. So I think we're seeing that and also there is a recommendation for dental as we go into the packet so perhaps the department can detail what's happening and provide an update on the program. In terms of multi-programme adjustments there the packet lists those with changes over 10%. I will note the first one in public health admin there is a 6.7 million dollar reduction that is an error in program for the Arper Food Review item. So that's an item from FY24. That was accidentally loaded into the budget and FY25 under the multi-program adjustments. So this is correcting that error. So, imagine your money. So public health cancer in tobacco. This reflects compensation changes and grant changes. And then in public health and planning there is a reduction of a 1.8 million grant, the ELCEED expansion grant. Public testimony, there were several testimonies about different items within the public health services budget that are available on our website. I did want to note that our Montgomery Care Advisory Board and the Health Centers Leadership Council and the Primary Care Coalition have requested support of additional enhancements for the health care for the uninsured program. The detailed detailed information is listed in your packet, but I will highlight a few items as we discuss the budget items. On page three of your packet, page three and four is the comparison of the different program areas within public health services, just detailing the recommended amounts of change and the FTEs that are recommended as well. So, we can move to programmatic updates. I wanted to highlight mobile health clinic. There have been lots of discussion. There was a focus HHS session that where we talked about mobile health, I was happy to see that when the information came over that the mobile health van is here, I wanted a picture and like highlighted, but I didn't get my picture. So they just noted that the 38 foot RV has been delivered to the team and they will receive training from the, they will receive training in April. There are three operating, operating rooms for primary care, dental and mental health services on page five of your packet. They have talked about since the initial launch, the number of screenings that they have done, which is 1,638. And there are some demographic details that are included for reference. So we will start with item E, going through our budget discussions, as mentioned, there are eight items. We will start with the first item, but I will provide a little narrative about the healthcare for the Uninture Pay Pack Program. Excuse me. So on page five, just to list out the different budget details. And then on page 6, I did want to highlight as we talked about in the supplemental discussion this morning, the Access to Care Act which began in April in 2024. I did review the economic and actual aerial analysis completed by the state and the 2026 estimated enrollment for newly eligible residents 250% of FPL in below is 34 individuals in the state So we I think that's clear to say that it will not impact the Montgomery cares program And so we will not see a reduction So I hopefully in the future there would be changes that will be provide greater Flexibility and be more affordable for our residents so that they can have health insurance. But as of right now I do not foresee that impacting the Montgomery CARES program. So there are two budget items that we are discussing. The first is the primary care reimbursement rate. So the executive is recommending $963,361 to raise the reimbursement rate of the clinic. Based on 77,000 encounters, we will talk about the budgeted number of encounters in the next section. But in a budget of 77,000 encounters would be a change from 72 to 77. But based on the amount that the executive provided, this would be a $12.51 per encounter increase. Because there is an indirect administrative fee to the clinics, the actual amount that would go to the increase, that would go to the clinic per encounter, would be $11.35 and the indirect fee is $1.16. The total reimbursement rate to the clinics would be $113.50 per encounter. So I have included a charge so that you could kind of see the rate history over the past 10 years. I will note that the advocates have requested for the encounter increase to from 102, 15 to 175 as ideally whether the program would like to reside to address workforce shortages, reduce patient wait times and maintain essential services. So this would be a significant increase adding around 6.16 million to the budget if we were to fulfill that request. Council staff's recommendation is that based on the Council President's guidance on affordability, the committee can consider splitting this into tranches. So each tranche includes the direct and indirect costs. So for example, tranche one would just be a $6 increase, so that would mean it would move from 102 to 10815. So if the committee recommends the rate at what the executive has recommended, then nothing will go on the reimbursement list. If you choose that you want to do, maybe trunch one and trunch two, we will include those as a, on the on the recommend, on the reckless as an increase, and then you could identify one as a decrease. So I present those options so that the committee can consider that. I did want to note that the advocates have strongly expressed the dire need for increased race to maintain operations, as it is related to support for staffing and operations of the clinic. It should be noted that all the Montgomery cares clinics do not receive the inflationary increases because they are not directly the county's contractor. They are a subcontractor of the county. So the organization will receive any inflationary but the clinics do not. So I did want to highlight that as part of this discussion and I can answer any questions. Thank you. So I was just going to speak for myself to start. I feel like this is a second bite of the apple. This is one of my major regrets from last year's operating budget that we did not fully fund as had been requested and recommended by the executive reimbursement rate for our Montgomery cares. So I heard loud and clear from my primary care clinics that we're struggling before all of this and before the change in administration. The recruitment and retention challenges among staff, the deeper needs of the clients they are serving, and they are significantly part of the infrastructure of our public health ecosystem that is tied at the hip with our health and human services team. And in many instances can go even further than the county because they do offer unique sets of cultural, competent, and appropriate services that although we do a great job, we just can't go as deep as some of these clinics do. And it's going to only get worse. It's going to only get worse. And so while I 100% respect and appreciate the recommendation from staff to look at this in tranches because we do have to face very stark fiscal realities. This is one of those that I feel personally strongly, I think we need to go with the full recommendation of the executive, which as acknowledged falls way short of what the clinics are even asking for. This is sort of the floor. And so for those reasons, I'll be supporting in this light night I'm fully funding the executives recommended budget. But I will yield the colleagues for your thoughts and there's no, we have tough choices to make here. So I fully respect whatever my colleagues have to say and however they feel about this and anything we discuss. I'll start with council members sales followed by council member Lutky. Thank you, Mr. Chair. I totally agree with you. This was one department. I didn't want to see any additional cuts. I know that the need is growing across all aspects. We celebrated minority health month, public health week, Black Maternal Health Week, so I'm glad to see some of these addressed in the county executives recommended budgets, so I fully support. Thank you, Council Member Leuky. So I'm gonna be even the minority here, not because I don't believe in it, but because I do believe in what the Council President asked us to do, and I do think that this is one opportunity where we could tranche the items so that we're able to look at them flexibly in the context of the other priorities. have both within our public health space and within our other types of services we're providing to those in need in our social safety net. And so because of that, I would prefer to have the flexibility of tronching those items so that we can have a more robust discussion at full council. Okay, so we've got, I guess let's just do it officially. So we've got those in favor of moving forward the executive's recommendation of not tranches, but full funding, please raise your hands. Okay, that's two. And then there's me. And then the second, and that's one objection. And then if you want to go ahead and move funding the staff recommendation for the tranches. And I'll second it, because just to make sure it's on the record. Yeah. So I would like to move that we tranche the three different amounts so that we can consider all or some in the context of our full budget discussion. So I'm seconding it to move it to vote, but all those in favor of that just can't remember Luki and opposed. That's two. So the staff packet will reflect that when we go before full council. Correct. Thank you. We'll do. Okay. I will move on to the next item which is to maintain the Montgomery Care's enrollment growth and expansion to a new clinic. The executive is recommending 900, 3632 to maintain the enrollment growth. The program has seen the past two fiscal years and add a clinic to the Montgomery Care's program Council staff asked DHHS about the process of adding providers to the program and they provided this information in the bullet below. I will note that they said the DHHS assessed clinic utilization, patient volume trends, provider and provider feedback to determine where additional support was most needed. The ICM is being added to help alleviate pressure on the existing clinics and enhance access to care populations. I did ask the department and maybe they can provide additional detail about how adding a clinic affects the network because some of the clinics may would like to have more capacity and serve more patients. So if we're expanding the network, I wanted to ensure that that conversation was clear with those other clinics who may or may not want to expand the work that they're doing as part of the Montgomery Care Apps program. So joining the network is not a competitive process, there's not an RFP or anything that is connected to this process. DHHS has explored criteria for adding clinics in the future and is committed to implementing a competitive transparent process. In the first year, the new clinic is expected to serve 267 patients and generate 720 encounters. The FY26 budget includes the other contractual services like behavioral health, and specialty care. So, DHHS says that the current capacity of the Montgomery Collarist clinics was a key consideration in this decision. So council staff is recommending that this, that the committee not make a vote on this today. Additional information was needed on the line item budget, particularly as it was related to the ICM. I generally understood about the addition of the page of the the 6,000 budgeted encounters. But more information was needed about the detail of how ICM was joining and how that budget was reflected. I think Dr. Rogers noted in a supplemental discussion that it seems as though there's a different methodology that's being used to conduct what the primary care budget rate should be. So if that methodology is changing, there was a mention of 2.7 patients times x, y, and z. That detail really needs to provide to council because that would be changing the way that we have done it previously. So previously is the number of encounters based on whatever the rate is and that gets us to our budget number. But if we are using a different methodology of 2.7, which is the average patient rate time something else, that detail needs to be provided to the council so that they can weigh in. You'll do the executive branch, please chime in. Thank you council member Alvin O's and HHS chair. So the agency needs to really spell out what the recommendation is and how the addition of the clinic would be used to strengthen not only the cultural competency of the community, but the services that it provides based on their formula. So we need to really flesh that out and present it to council. We know that there is a need. We know that there is a need to expand, especially come out of COVID, our safety net provider capacity. And so this is one area where we thought that based on data, based on utilization based on patient volume and all the things that Ms. Clemens Johnson articulated in the packet that we were presented to council as we presented it to the county executive. So this is one of those items that if in fact the committee tables, the recommendation of the vote, we can come back in a follow-up session and provide all the data information that you need. I would appreciate that, Dr. Argers, did you want to mention it? Yes, thank you. So I just wanted to clarify, so the department agrees with council of staffs. Now that we have a little bit more time. So the department worked with the primary care coalition to come up with a budget for ICM based on projections of how many people they would possibly see and how much that would cost us when the primary care line. In order to arrive at that number, ICM has projected to serve 267 patients for the remainder of the FY25 fiscal year. And then we have to say, well, how many visits will each person have? Each person would have at least 2.7 primary care visits. And so in order to do the math, we had to do 267 times 2.7, which ultimately at the rate of $100, 2015, which which ultimately got us at the $73,640. Separately, Council staff is correct. We are, the program is allowed at a primary care budget. And so based on that primary care budget, that dollar amount, we divided by the number of encounters to arrive at the reimbursement rate. And so the department is in agreement with Council staff on how we actually get at a reimbursement rate historically. So then we've got five sessions, but four more after this one, but two are joint education and culture sessions. The April 28th is exclusively HHS. Do you think you have enough time between now and then to present and, you know, the, as requested and as identified by council staff? Right. Yes, I don't give you enough time. All right, so then we will defer that table, that particular line item until the 28th, so we can have a more full conversation. But again, to our friends and ICM, we just want to let you know, we deeply appreciate and respect your work. We just need to better understand from HHS's perspective how exactly this fits within the ecosystem and so that there's, we maintain a level of consistency so we don't unintentionally impact other clinics that are doing work as well. Okay, and we will discuss on the 20. Thank you so much. The next section is on Care for Kids. The Care for Kids program was established in 1992 and it's been a long-standing program which has been dedicated to serving uninsured children in our community. Many of the Care for Kids children stay in the program for years and so it really has an impact that translates throughout the community. And the Care for Kids program also leverages over 1 million in pro bono primary care in its partnership with Kaiser and other independent practices. So the budget, we don't talk about that as much, but the program leverages a lot of services in the community. Table six highlights the Care for Kids Enrollment, which has been increasing over the years. FY 23 to FY 24 for a full year went from increased around 10,000 visits, almost seeing the 11,000 patients. And this year they're on track to see around 11,000 patients as well. The first item for Care for Kids consideration is the growth that they're seeing in the program of specialty care, behavioral health, primary care and pharmacy services. This is for $33,785. So, earlier this year, the council approved supplemental 2534, recognizing the need for additional funding federal government, the federal government, the federal government, the federal government, the federal government, the federal government, the federal government, the federal government, the federal government, the federal government, the federal government, the federal government, the federal government, the federal government, next year. And the staff's recommendation is to come and carry with the county executive's recommendation. Without objection? Yep. Okay. And then the next recommended item is the improved access to reproductive health services in the care for kids program for $180,000. DHHS says these services would be offered through a phased approach for a comprehensive reproductive health and family program for all youth enrolled in the care for kids program. Services would be wide ranging and continuing counseling, contraceptive options, and follow-up care. This will also include children at Kaiser and School Bates Health Center. Council staff did recommend splitting this into two chances. This will allow the program to maybe begin providing the services. It is Council staff's understanding that similar surfaces are also available at Title X clinics, recipients in the community. So there is a link to the reproductive health options on the Council's website. Excuse me, the county's website. I concur with the staff recommendation on this to give us some options. Obviously, it's critically important, but that would give us some options. Okay. Out of objection. Yes. Okay, and then for the next item, this is not an executive recommended increase. I do want to highlight that and note that. I just, but I did want to call into attention one of the recommendations from the Montgomery Care Advisory Board. And that is a $6,750 to support behavioral health co-pays. So this would be for care for kids, clients. This would ensure approximately 450 care families would have no out of pocket cost for behavior health visits. Council staff recommends that the city can consider adding this budget to the reconciliation ised to in support of the behavioral health needs of care for kids. As I said, it's not an executive recommended item, but it is something I wanted to bring to your attention for your consideration. Appreciate that I think without objection. Okay. We will move on to the next item in communicable disease and epidemiology. They want to continue core staffing for the HIV, AIDS, hepatitis B and other STI services based on grant reductions. This is a $848,709 request and it is supporting 6.3 FTEs. So all of these positions are currently existing and they were previously grant funded but cannot longer be supported with grant funds. So it is 6.3 that are listed there. The program highlighted, especially the community health nurse position and the immunization and perinatal hepatitis B program. If the position isn't funded, there will be a decrease in vaccination clinics and no coordination and oversight of the state's perinatal hepatitis B program, which ensures that no required vaccination of infants born to mothers with hep B is completed. So if the positions aren't funded, it would be a decrease in clinical services and they would likely need to, like not likely, they would need to close the German town clinic, which they recently opened, I believe last year, which is a high need area. So council staff recommends that the committee seek clarity on the total funding for the, no, no, no, no, no. This is an error. So, council staff does recommend that this be supported. Council member Luki. Yeah, and I'm wondering if what I was looking at was my, what, call it your eye, just then. So, there some sort of discrepancy on the, it was like a $15,000 difference on the, what the county executive had put in and what staff had noted based on the actual cost of the position. So the actual cost of the position in the packet was 833,169 to keep everything going. Yes. Correct? Yes, I can just clarify what it is. With that extra amount is the amount that will be loaded in IT for the access to electronic health records, that type of stuff. So it's not the personnel, but it's the associated IT costs for the people to work for the county. So the total total is correct based on what they, okay, yes. The amount of detection given that. Thank you. Yes. Absolutely. I see it without objection. Okay. Okay. County Dental Services. There is a recommendation for $300,000 to partner with community dental practices to serve 300 East County residents without access to dental services. So, DHS priority is delivery of phase one dental treatment for residents in the East County, which is like prevention and elimination of disease. Phase two treatment would be crowns, things like crowns and dentures, and will be provided on priority and the availability of funding DHHS has highlighted how they would identify patients and they also have identified partners for this pilot including private practices and community based safety net clinics The department has a list of partners who have verbalized interest in the past, but Dia just wants to wait to have those conversations until the funding is approved. So staff has concurred with the county executive's recommendation. All right. Without objection. Okay. And continue phase two of the dental program conversion to merit staff due to performing the same function as county permanent staff. This would be $154,227 at five FTEs. So the dental program has been transitioning SPAT's contractual staff positions from contractual two merits since FY24. There were nine positions, transition in FY24. And there are five FTE principal administrative aids that are recommended for FY 26. They were recommended last year but was not approved. So, Merritt Employment will allow the assignment of staff to priority needs areas. And it also creates purity and equity amongst the staff that are working hand in hand. Where you have Merritt employees and county employees, Merritt employees and contract employees doing the same services, but they have different ways that they're reimbursed and, you know, and structures. So this process will align all of the dental positions as merit positions. So staff has listed the staff compliment and our recommendation is to concur with the county executive's recommendation. I just had to have one question on this one. So we noted earlier in some of the vacancies hiring for dental positions continues to be a challenge. What are we doing? What strategies are we using to make sure we're able to fill these? Besides making them full time. That's a great question. So actually the two dental assistant positions that vacancy closed April 10th. So we're just waiting for those eligibility lists to actually come through to the hiring managers. When we were here to talk a little bit and give you guys a dental program update a few months ago, we had shared some of the challenges with the hygienist positions. We have been working with OHR and our colleagues. So the per the collective bargaining agreement, the union gets to decide which positions are gonna be up for a classification study. I'm happy, and that is what the holdup was for those hygienist positions. We did receive notification about a month ago that the hygienist positions are on the list this year for reclassification. So hopefully that will get moving and then once that moves will be in a position to actually hire those. But as a reminder for everybody, we have to reclassify them because given what's happened in the dental hygienic landscape and just the dental field overall, our reimbursement, our salaries are much lower and so we really struggled to be able to recruit and compete with the private market. So once that classification study is done, and we are able to bring those salaries up to a more competitive market value, then we'll be able to post those positions, and the ball should be rolling on that in short order. That makes a heck of a lot of sense. I guess just knowing a thing or two about classifications that there's often a little bit of a cascading impact is then that impacts the program managers and the other folks that are affiliated within the unit. So but the classifications critical and that's the first step. So totally support and endorse that but it may mean other classifications as a result of it. Yeah, absolutely. Thank you. Great without objection. Okay. The next recommendation is support for the American Diversity Group's free medical clinic, $202,600. The American Diversity Group requests funding to continue operating its free medical clinic, which serves underserved and vulnerable communities. This funding will help ADG to maintain the quality and scope of services they currently offered. DHHS shared that the ADG's free medical clinic plays up vital role in addressing health disparities in the county where many individuals face barriers as such as lack of insurance. This item is considered one time funding. Council staff did want to recommend to the committee that you could identify this as a potential reduction. Based on the council president's guidance on affordability, Council staff recommends consider placing this item on the reconciliation list. This would be a new contract for DHHS, providing similar services to other medical services provided by the department, other medical services, meaning Montgomery cares. But I pose that as a reduction based just on affordability guidance. So just a couple of questions, because it brings up this strategic issue that came up as we're discussing ICM, which is also so important, and navigating this, again, public health care ecosystem. I guess I, and we'll be discussing ICM specifically, but you can't talk about ICM without talking about the system as a whole. And we know the system as a whole is complex, got a lot of layers to it. Every clinic has its own set of challenges. But it would be helpful to explain how you all derive these recommendations and how they're interconnected amongst themselves. Obviously, the primary care coalition is a tremendous partner, a treasure, an asset, and you all work closely with them, but I think it would be helpful to provide that context before discussing this item specifically. Yes, so we have our safety net system, which is Montgomery Cares, our safety net clinics, our local FQHCs, but then as you guys know, we have a number of community partners that are also providing safety net services outside of our Montgomery CARES clinics and all together everybody kind of paints their piece of the picture for what our safety net looks like. I would define ADG as one of those community partners that is also serving vulnerable populations. I know Sean and I went and did a site visit with my New York and Dr. Davis to ADG services and unlike our Montgomery CARES clinics which really service kind of primary care and a medical home for lack of a better word. The supports that are provided by ADG are what I would call more one-off or acute and that might not be a totally fair comparison. But if you just want, happen to want to know what your numbers are, you can pop in, get your testing done, and then show up and they can connect you to an endocrinologist if you have high diabetes levels, right? And they operate off of a very kind of volunteer model. So, my lawyer, Moody, has made connections with community providers and his network that are kind of willing to provide these pro bono services to clients. So I would say I would view these really as an Sean and Dr. Rogers feel free to weigh in as well as kind of additional supports are benefits but not necessarily a kind of primary care medical home and kind of the networking system that we see with Montgomery Cares. And they see ADGC's folks regardless of their insurance status. And we also know from the site visit that ADG also sees folks who, for many reasons, which I think we can all understand, may not feel comfortable signing up for Montgomery Cares even if they're eligible because they're too afraid to be in the system for lack of a better word. So that's kind of how I would I would view it almost as supportive. They offer a helpful service and a useful service and benefit as we think about the totality of our safety.. So I would also add council member Arvernos, after COVID we saw, you speak specifically about the HHS ecosystem and we saw a need for more support mechanisms to be in place to not only provide that physical care, that clinical care, that mental health care. And so there's still a need in the community that may resonate outside of that safety net provider network. The American Diversity Group is one of those components of that ecosystem. And as Dr. Ashford indicated, there may be specialty care. More often than not, a lot of these clinics provide the services in kind Pro Bono. This is supplemental support to enhance or expand those services So when you talk about this the diversity and the lens that you look through Regarding enhancing cultural competency. This is one of those spaces where we look at the ecosystem. Now all the council members on the committee session this morning have talked about and or discussed the threat. So this is one pool at that fabric for that threat in response to that threat. So just wanted to add that as well because this is what we see in our spaces leaders in the Department of the Human Services. Yes, thank you. I agree with those comments. I was just having me one of two things. We should be proud of the Montgomery Care Network because over the years I know the primary care coalition has worked without partners to develop very robust standards. until all of our clinics must meet minimally essential requirements. And unfortunately, not all our partners can. Right, but that doesn't mean that our partners don't have a way of reaching the community, providing culturally competent care, that is quality care based on the needs of the community. And so we saw in the Network Advocacy Study that there's opportunities to expand access to care by offering weekend and evening hours. And so ADG, I know one of the strengths has been they have not able to meet the minimum standards because of resources, mainly a resource capacity, and credit to ICIUM because they have made tremendous strides. And I'm insuring that they meet the minimum standards in Montgomery Cares. So what ADG does in addition to the comments from Dr. Bridges and Dr. Asher, it provides another access point in the community based on the needs and how file patients based on the quality of care that they can offer without actually meeting some of the minimum standards requirements such as being able to submit data for heat as measures. We know heat as measures are important, but does heat as measures determine whether or not a clinic has a pulse on a community cannot actually offer hours that meets the community needs? Not necessarily. You have to dig a lot into the research in order to make that justification. So we believe that this funding is included in a CES budget for that reason as well. How many referrals did it E.G. make this year or last year? How many patients did they see? I can get back to you on that. I don't have that off the top of my head, but we can follow up with that information. Okay. And I acknowledge the diverse community that they are serving, which is fantastic. Breaking that out would also be helpful in terms of, you know, more specific demographic information. I'd also be very curious as to age. And where are they located? Yes, cool. They're actually located in East County. If you know where we did the COVID vaccine event at the giant, they're right across in that business park area over there. Close to the hospital. Yes, yep. And I sort of, I ran into Dr. Esquirtha, who's been a phenomenal partner and a member of our Latino Health Initiative. It was a very sad conversation. She is shutting down the clinic that she has established, primarily pro bono, because she just has not garnered the support that she needs financially to be able to keep it going. In fact, she used her life savings to get this clinic off the ground. She's having to move out of the area and it's a tremendous loss on many levels. So I guess my other question is, how do we decide? How is HHS deciding? Because there's a lot of great work that's happening in the community for sure. But how are we deciding, and it sounds like EDGs doing great work as well, so as ICM, in addition to the conversations with PCC, what criteria are you all using internally to make these decisions? Good question, Council Member Albinos. As we responded to county council staff questions in the budget here and proceeding this, joining the Montgomery kids network this time was not a competitive process in the recent addition of. We also added care for your health, as you know, and we also added Casa Rubin and these comments also apply to those clinics as well but we have explored criteria in adding clinics in the future dating back to when we were considering bringing on both care for your health as well as Casa Rubin until as we state it you know we will ensure that there's fairness and equity going forward as we add additional clinics. So thank you again, Council Member Hournos, it's it's multivariate. I mean we use community health and use assessment. We use key stakeholder engagement as you said you talked to Dr. E. Scaddle and some of the work that she's done, we looked at the Montgomery County State of Health. I got you I'm just running through the gamut you know performance, planned due study active evaluation model so it's just not one selection And then we talk about what the service is, the impact, the clinical or mental health impact that it will have to the community. And then we identify. And then, you know, before, you know, we've really moved away from zip code analysis and census track data. So all of the demographic things that you highlight, we use those and just look at the impact and outcomes that that particular organization would bring. And then we look at regional data. And if there are things that we could do to enhance our services and bring those, because some of our providers actually cross jurisdictions. And we look at the impact and see if there is a lateral impact or some other nuance that we could include in some of our assessment. And so these are some of the variables that we bring into our discussions and identify. And then as I indicated in my opening remarks, we constantly do what if scenarios? One thing that we haven't talked about is those federal and state level fiscal impacts that we only touched on. So we've been doing this analysis before the current administration got into play because we knew that it would have an adverse reaction to the work that we do. And so many of our providers, our community partners, are impacted. So how would that lessen the burden and minimize and mitigate risk to the community? So those are some of the things that our team goes into. And I know that Dr. Rogers and Dr. Ashford and Dr. Davis, who is constantly in touch with the state, get tired of me asking those same questions. So all that to say is it's just not one one view in that prism going back to that rubric cube, you know, we're constantly trying to realign and change that of that makes sense. Yeah, of course, customer looking. Oh, I didn't realize my mic's been on this whole time. Sorry. It doesn't light up. The lights broken. Sorry. I just wanted to point out, because I know we discussed where ADG is located. And physically, they are located in East County. But they serve the South Asian community, and they do a lot of events that are in Up County actually. So they do things in Germantown and Clarksburg. So, you know, they're not really geographically limited in where they are providing services and in addition to the sort of the things that Dr. Ashford mentioned. They also do like just overall wellness programs for folks too, which is part of how you prevent other things from happening. So I know from the staff packet that they of course would have liked an increase in funding this year, which is, you know, that's not something I think we can realistically do. But I personally would like to approve what the county executive recommended, which was the level funding for that entity for the FY26 budget. I appreciate that. I'm not quite there yet. I'd love to, similar to ICM, just have a little bit more demographic background, a little bit more information than what's been provided in the packet. And I think we can discuss this on the 28th. I certainly understand it's being a need, getting text messages from a colleague who represents this region who's providing useful information in real time. And we don't have to make this decision right now We have three more sessions and so I'd like to come back to this on the 28th as well if that's okay with colleagues. Okay. Okay. Okay. Okay. We will proceed. The next items are items recommended for reduction. So the stroke prevention information contract due to duplication of services, this would be a reduction of 20,624. The contract would be eliminated. This funding currently provides stroke information to low income, Montgomery County residents, health education presentations, and various languages on diabetes, blood pressure, cholesterol, heart disease, and stroke. So DHS has stated that this work is duplicative of existing DHS programs. They provided an example of AHP in the Office of Community Affairs, focuses on some of these same topics and also provide similar services like outreach, health education, support groups, and nurse case management. The committee, the council staff is recommending to concur with the county executives' recommendations, but the committee would want to be sure about how DHHS is notifying the contractors about if that contract will be potentially reduced so that they have time to prepare. As we talk about any contract that's going to be eliminated or reduced. Come on down. Dr. Rogers. That's right. You saw it, you heard that. Dr. Rogers. Yes, that's a great question. So all contract monitors work under the guidance of our contract monitoring team to formally notify a vendor that their contract may not be up for renewal if there are any deductions. And that's through a formal email communication. And to my knowledge, that has been done with this particular contractor about several weeks ago, once the budget was released, and it was time for the department to prepare for FY26 contract renewals. Go ahead, Dr. Fertey, first. And I was just gonna note, these were originally community grants that then got added into the base budget as non-competitive contracts. And so as we were going through, given the tight fiscal environment, looking for opportunities to ensure we're not duplicating effort or we're not duplicating services that are being met somewhere else, that was one of the reasons that these were identified. So just to add, Councilmember Seals, as you indicated, you know, the HHS budget is very unique and complex. And as you noted, Councilmember Alvinos and Councilmember Luki looking at all of the program service area. I know Bayray Health was first and Public Health is up next. But what you will hear the next couple of days is how we looked at those services that were duplicated or where there was overlap. And so that was one of the strategies Councilmember Alvinnos said we use when we look at that multi-area approach. So these are examples that you see that while notification, and I want to thank all the partners who may be listening today. But when we're looking at a budget that represents our current work, these are some places that we could realign as opposed to eliminate some of those funding or some of the funds that could support and maybe strengthen other areas for FY26. Now FY27, it may be a different picture on the landscape, but this is the reality of HHS, and I wanted to add that as well. That's Member Seals. I just had a quick question about the services. AHP is already providing these services and so how are you notifying the people that are enrolled in the original stroke prevention program? Let us take that back to the contract monitor and ask them how they have worked with the contractor to make that notification so we can bring it. So how many people are currently participating in the program? How many are participating in AHPs and do they have the capacity to absorb the additional? Thank you. That Ms. Clemens Johnson finish making her note. Yeah, okay. So I think without objection then. Yeah, the support. And we will provide the information that comes from the sales as requested. The next is a elimination of another contract for health education due to duplication of services. This would be a reduction of 46,977. These services are being provided, the service is being provided with these funds, provide six physical and behavioral health education workshops and host one community-based health fair for disadvantaged county families, primarily serving the Latino community in the county per contract year. So the services are similar to services being provided by the Latino Health Initiative. One specific event that they would like to highlight is the Amatuvida Fair and Annual Community Health Fair offering free health screenings and community health resources. LHI also has the health promotors outreach and education program that provides vital health and wellness information to Latinos in the community. So the staff's recommendation was to concur with the county executive recommendation. We may have similar questions that's based on the conversation we just had as well. Councilor Murmyself. Same question regarding, you know, who's currently being served and how they'll be absorbed into the new program and communication. Julie, note it, and going forward for future sessions, we will make sure that we include that level of detail and the impact on the community and notification. All right. All right. So I will summarize a few C page 15 for the increase in the Montgomery Cares primary rate. We know that the vote was two to one and that the amount will be fully funded so it will not be broken out into chances and not included on the reconciliation list. For the maintenance of Montgomery Cares Enrollment Growth and Discussion of the Islamic Center of Maryland, we will defer that decision to the April 28th HHS work session to have a full and broader discussion at that time. We will also add the care for kids $6,750 to pay for a behavioral healthpays to the list in the final HHS packet, noting that the committee has fully supported that item. We will also consider the support for the American Diversity Group's free medical clinic on April 28th and we will provide additional information from the department. We will trunch out the reproductive health item for care for kids into for 90,000 and 90,000 which will be included on the reconciliation list. And we will obtain more information on the reduction of the contracts related to the questions posed by the committee. And that will conclude our public health services area. All right, so thank you all. This was part one. We look forward to seeing each other often the next few weeks, but with that, we are adjourned for this morning. Thanks a lot.