County of Santa Clara Board of Supervisors Budget Workshop - May 11, 2026

Supervisor Lee: HI, GOOD AFTERNOON, EVERYBODY. TODAY IS MONDAY, MAY 11th. AND LET'S CALL THIS BUDGET WORKSHOP TO ORDER. IF I COULD PLEASE ASK OUR CLERK TO CALL THE ROLL.

Clerk: CERTAINLY. GOOD AFTERNOON. SUPERVISOR ABE-KOGA. SUPERVISOR DU'O'NG.

Supervisor Du'o'ng: HERE.

Clerk: SUPERVISOR YOU WOULD BERG.

Supervisor Ellenberg: I AM HERE.

Clerk: VICE PRESIDENT ARENAS.

Supervisor Arenas: AM HERE, AND.

Clerk: AND PRESIDENT LEE.

Supervisor Lee: GOOD AFTERNOON. PRESENT.

Clerk: WE HAVE FIVE PRESENT.

Supervisor Lee: GREAT. CLERK, WOULD YOU PLEASE READ THE ANNOUNCEMENT REGARDING INTERPRETATION, PLEASE.

Clerk: IF WE COULD PLEASE HAVE THE INTERPRETERS TRANSLATE THE FOLLOWING INTO SPANISH, THEN VIETNAMESE. IF YOU ARE IN CHAMBERS OR REQUIRE SPANISH OR VIETNAMESE INTERPRETATION, INTERPRETATION DEVICES ARE AVAILABLE AT THE BACK OF CHAMBERS. THE DEPUTY CLERK CAN ASSIST YOU WITH SET UP. TRANSLATION IS ALSO AVAILABLE IN ZOOM USING THE INTERPRETATION BUTTON. ADDITIONALLY, AS A GENTLE REMINDER TO PUBLIC COMMENTERS, STAFF, AND THOSE ON THE DAIS, PLEASE SPEAK CLEARLY AND DIRECTLY INTO THE MICROPHONE TO IMPROVE THE ACCURACY OF TRANSLATION. SANTACLARACOUNTY.GOV SPEAKING [SPEAKING SPANISH] SPEAKING VIETNAMESE.

Supervisor Lee: THANK YOU VERY MUCH. AND THE NEXT, MAY I ASK VICE PRESIDENT ARENAS TO PLEASE LEAD US IN THE PLEDGE OF ALLEGIANCE.

Supervisor Lee: I PLEDGE ALLEGIANCE TO THE FLAG OF THE UNITED STATES OF AMERICA, AND TO THE REPUBLIC FOR WHICH IT STANDS, ONE NATION UNDER GOD, INDIVISIBLE, WITH LIBERTY AND JUSTICE FOR ALL. THANK YOU. NEXT IS ITEM UMBER 3, WHICH IS PUBLIC COMMENT. THIS IS THE ITEM RESERVED FOR MEMBERS OF THE PUBLIC TO ADDRESS THE BOARD ON ANY ITEMS NOT ON THE AGENDA OR THE THREE DAYS OF OUR BUDGET WORKSHOP. AND, BEING, IT'S ABOUT THE BUDGET. SO ANY PUBLIC WHO WISH TO ADDRESS THE ISSUES NOT ON THE BUDGET, AND NOT ON THE AGENDA, THIS IS THE TIME THAT YOU SHOULD SPEAK AT THIS TIME. SO PLEASE FILL OUT A SPEAKER CARD AND RETURN IT TO THE CLERK. WE'LL CALL OUT 30 NAMES AND THE REMAINDER WILL BE CALLED AFTER THE AGENDA. IN-PERSON FOLLOWED BY ZOOM. NO FURTHER REQUESTS TO SPEAK WILL BE ACCEPTED UNDER THE CONTINUED PUBLIC COMMENT. REMINDER FOR THE PUBLIC ON ZOOM, AS SOON AS THE FIRST SPEAKER IN THE CHAMBERS STARTS SPEAKING, THERE WILL BE NO MORE SPEAKERS TAKEN IN THE QUEUE IN THE ZOOM. RESPECT EVERYONE'S COMMENTS. WE ACTUALLY DO NOT ALLOW APPLAUSE OR BOOS. SO TO SHOW YOUR SUPPORT, YOU CAN RAISE AND CHANGE YOUR HANDS QUIETLY. TYPE SAY THANK YOU FOR YOUR COOPERATION IN ADVANCE TO KEEP OUR MEETING MOVING ORDERLY. OKAY. THANK YOU. SO, YEAH. HOW MANY SPEAKERS DO WE HAVE TODAY?

Clerk: I HAVE 13 CARDS IN CHAMBERS. AND 12 HANDS ON ZOOM. SO A TOTAL OF 25.

Supervisor Lee: OKAY, GOOD. LET'S GO AHEAD AND DO ONE MINUTE EACH FOR THE SPEAKERS. AND IN PERSON FIRST.

Clerk: OKAY, WE ARE NOW CLOSING THE QUEUE TO INDICATE YOU WISH TO SPEAK. WE'LL BEGIN WITH THE IN-CHAMBERS SPEAKERS. AS I CALL YOUR NAME, PLEASE APPROACH THE PODIUM. I HAVE CHARLES ROTHSCHILD, MARK TROUT, ANDREA CARTER, GUILLERMO MUNIZ, MARISSA SIMON, KATLYN BLUE. AND WE'LL PAUSE THERE.

HI. I AM CHARLES ROTHSCHILD, A RESIDENT IN DISTRICT 5. AND WITH SILICON VALLEY ALLIED FOR THE COMMON GOOD. A BROAD-BASED INSTITUTION OF 21 CONGREGATIONS AND OTHER INSTITUTIONS REPRESENTING MORE THAN 30,000 RESIDENTS OF SANTA CLARA COUNTY. LAST FALL I PERSONALLY HAD A SUSPECTED HEART ISSUE AND WE WENT TO EL CAMINO. WHILE I GOT GREAT CARE, I ALREADY SAW A SYSTEM UNDER STRESS. THE WAITING ROOM WAS OVERFLOWING SO I WAITED OUTSIDE FOR SIX HOURS. AND THAT WAS BEFORE ANY CUTS. NEXT YEAR IT WILL BE WORSE. MEDI-CAL REDUCTIONS AND PROGRAM CUTS ARE ALREADY PUSHING PEOPLE TO LOSE COVERAGE. I UNDERSTAND THE CURRENT PLAN DIRECTS ALL MEASURE-A RECEIPTS TO HEALTHCARE BUT SIMULTANEOUSLY CUTS $70 MILLION FROM COUNTY SUBSIDIES. THAT'S NOT WHAT VOTERS INTENDED. WE WANTED THE ENTIRE MEASURE-A NET REVENUE TO OFFSET THE OVER $1 BILLION IN FEDERAL CUTS FROM HR1. PLEASE.

Supervisor Lee: THANK YOU VERY MUCH.

DO NOT MAKE IT WORSE BY CUTTING AN ADDITIONAL 70 MILLION.

WELL, JESUS GAVE A PARABLE ABOUT THIS WIDOW THAT WE WANT TO THE UNJUST JUDGE. AND IN THIS PARABLE HE WAS ENCOURAGING HIS FOLLOWERS TO KEEP ON PRAYING AND DON'T QUIT. AND SHE CAME TO HIM AND SAID AVENGE ME OF MINE ADVERSARIES AND HE WOULDN'T LISTEN TO HER BUT SHE KEPT COMING BACK AND BACK AND BACK. AND THIS IS NOW MY FIFTH SPEECH. EVEN GIVEN ASK YOU TO GIVE YOUR EAR TO THE DOCUMENTARY BY DELL VICTORY. I HOPE YOU GOOGLE ANINCONVENIENTSTUDY.COM AND IT'S QUITE REMARKABLE HOW THESE SHOTS ARE KILLING PEOPLE, MAIMING THEM AND DESTROYING THEIR LIVES. AND ONE GUY WHO HAD GIVEN THE. IT'S CALLED THE DTP VACCINE IN WEST AFRICA. HE ADMITTED THAT HE ADMITTED THERE WERE NO STUDIES AT ALL. AND HE WENT BACK 30 YEARS LATER AND FOUND OUT I BELIEVE FIVE TIMES MORE PEOPLE DIED FROM THE VACCINE. SUPPOSEDLY.

GOOD AFTERNOON WORLD. I AM SUPERVISOR AM ANDREA CARTER. I AM HERE REPRESENTING THE 16 MEDICAL UNIT CLERKS WHOSE POSITIONS ARE PROPOSED FOR DELETION. MEDICAL UNIT CLERKS PLAY A CRITICAL ROLE.

Supervisor Lee: SORRY, TO INTERRUPT. THIS SECTION FOR PUBLIC COMMENT IS FOR ITEMS NOT ON TODAY'S AGENDA.

THANK YOU.

Supervisor Lee: EITHER GO OFF THE AGENDA IDEA. WE WILL TALK ABOUT THAT LATER. JUST. SORRY, I WANT TO MAKE SURE THAT WE ARE NOT TALKING ABOUT SPECIFIC ITEM. THANK YOU.

I JUST WANT TO CLARIFY. I AM HERE TO COMMENT ON THE BUDGET CUTS, SHOULD.

Supervisor Lee: JUST WAIT. ON THE SPECIFIC ITEM BUDGET CUT THAT YOU WANT TO TALK ABOUT, WE'LL BE CALLING THOSE LATER.

OKAY, THANK YOU.

Supervisor Lee: THANK YOU.

OKAY.

Clerk: I'LL CONTINUE CALLING NAMES. WITH THAT INFORMATION IS APPROXIMATE. IF YOU ARE NOT SPEAKING ON THE BUDGET, PLEASE STEP FORWARD TO THE PODIUM. I DID CALL GUILLERMO. I DID CALL MARISSA SIMON. AND KATLYN BLUE. IF YOU ARE GOING TO SPEAK ON THE BUDGET, WE'LL HANDLE THAT ITEM LATER. I ALSO HAVE CYNTHIA CORTEZ, TRACEY CORNER, TYRUS WASHBOARD FORD, JENNY RAMÍREZ, CRYSTAL. ANY OF THOSE SPEAKERS NOT SPEAKING TO THE BUDGET THAT'S COMING LATER? OKAY. THE REMAINING IN-SPEAKER CARDS BLARE BEEFY, DÍAZ. ANY SPEAKERS NOT SPEAKING TO THE BUDGET? OKAY. THAT CONCLUDES ALL IN-PERSON SPEAKERS. WE ARE GOING TO MOVE TO OUR ZOOM. AND WE DO HAVE SEVERAL HANDS WHO HAVE DROPPED. THE FIRST SPEAKER WITH THEIR HAND RAISED AT THIS TIME GUADALUPE. PLEASE ACCEPT THE UNMUTE AND YOU MAY BEGIN YOUR COMMENTS.

HI, I AM ALSO HERE FOR THE CUTS.

Clerk: OKAY. PLEASE MAKE SURE TO RAISE YOUR HAND WHEN WE GET TO THAT ITEM IF YOU WISH TO SPEAK DURING THAT TIME. WE HAVE PAUL. PAUL PLEASE ACCEPT THE UNMUTE.

THANK YOU, PAUL BRAVO HERE. GOOD AFTERNOON, COUNCIL MEMBERS. PAUL BRAVO WITH NEVER WATT. I AM HERE ABOUT A NO UPFRONT CAPITOL ENERGY INFRASTRUCTURE OPPORTUNITY FOR SANTA CLARA VALLEY MEDICAL CENTER THAT CAN ADDRESS DEFERRED MAINTENANCE, IMPROVE RESILIENCE, AND HELP SAVE THE COUNTY MILLIONS. IT APPEARS TO BE LOST SOMEWHERE IN CAPITAL PROJECTS WITH NO CLEAR COMMUNICATION ON ITS STATUS. SANTA CLARA VALLEY MEDICAL CENTER APPEARS TO HAVE SPENT $600,000 ON A 2023 AUDIT IDENTIFYING WE HAVE ROUGHLY $42 MILLION IN UPGRADES. I LATER COMPLETE A SIX-MONTH AUDIT AT NO COST TO QUALIFY SANTA CLARA VALLEY MEDICAL CENTER FOR A PG&E SUPPORT PROGRAM. PG&E IS READY TO SUPPORT MILLIONS IN L.E.D. AND H-VAC UPGRADES WITH NO UP-FRONT COUNTY ONE. COUNCIL CAN COUNCIL DIRECT THIS STAFF TO DETERMINE WHAT'S NEXT AND WHO OWNS THIS. THANK YOU.

Clerk: THE NEXT SPEAKER IN THE QUEUE IS BEN-Z. PLEASE ACCEPT THE UNMUTE.

YES, HELLO, GOOD AFTERNOON. I WANTED TO SAY THAT I DON'T WANT ANY MEASURE HA FUNDS TO GO TO THE DISTRICT ATTORNEY'S OFFICE.

Supervisor Lee: AGAIN, THIS IS ABOUT THE BUDGET CUT ISSUES. YOU NEED TO TALK ABOUT THAT LATER. JUST RESERVE THE COMMENT AND WE'LL GET TO YOU LATER. THANK YOU.

Clerk: THAT CONCLUDES THE SPEAKERS THAT HAVE TURNED IN A SPEAKER CARD AND RAISED THEIR HAND IN ZOOM.

Supervisor Lee: THANK YOU VERY MUCH. SO THEN WE MOVE TOWARD OUR NEXT ITEM, THE BIG ONES, ITEM NUMBER 4, WHICH IS THE COUNTY EXECUTIVE OVERVIEW FOR THE RECOMMENDED BUDGET AND THE ECONOMIC OUTLOOK. BEFORE WE START, I DO HAVE A QUICK OPENING STATEMENT TO TALK ABOUT. BEFORE HANDING THINGS OVER TO OUR COUNTY EX, EXECUTIVE AND OUR ONE HE DIRECTOR, I WANT TO THANK THEM AS WELL AS MANY COUNTY DEPARTMENTS AND EMPLOYEES FOR THE TREMENDOUS WORK THEY HAVE DONE IN TO DEVELOPING THIS YEAR'S RECOMMENDED BUDGET. THIS YEAR'S BUDGET PROCESS COMES AT A VERY SIGNIFICANT FISCAL CHALLENGE, DRIVEN LARGELY BY THE FEDERAL AND STATE FUNDING CHANGES THAT HAVE MAJOR IMPACTS ON THE COUNTY ACROSS CALIFORNIA, INCLUDING US. SANTA CLARA COUNTY THIS YEAR WE ARE FACE A DEFINITE SITUATION DRIVEN PRIMARILY BY UNPRECEDENTED FEDERAL FUNDING CUTS UNDER HOUSE RESOLUTION RH1, THE SO-CALLED BIG AND BEAUTIFUL BILL. AND COUPLED WITH THE LOWER, SLOWER PROPERTY TAX GROWTH AND RAISING OPERATIONAL AND LABOR COSTS, WITHOUT INTERVENTION, THAT DEFICIT IS PROJECTED TO GROW TO NEARLY $1 BILLION A YEAR. I CAN'T EMPHASIZE ENOUGH THE CHALLENGE THINGS WE ARE FACING AS A RESULT OF THE DECISIONS MADE AT THE FEDERAL LEVEL THAT'S NOT AT ALL CAUSED BY THE COUNTY. THE ACTIONS WE ARE TAKING NOW ARE HELPING US AVOID EVEN MORE DIFFICULT DECISIONS THAT OTHERWISE WOULD BE INEVITABLE. AS COUNTY EXECUTIVE JAMES WILLIAMS HAS OUTLINED, THIS NBA, THIS BUDGET, OUR COUNTY HAS PURSUED A THREE-PRONGED STRATEGY: LOCAL SUPPORT THROUGH MEASURE-A THAT WE ARE VERY FORTUNATE TO HAVE PASSED, PARTNERSHIP FROM THE STATE, AND REDUCING COSTS SOMEWHERE IT'S POSSIBLE. UNFORTUNATELY, AS WE HAVE RECENTLY LEARNED, THE STATE SUPPORT IS FALLING SHORT OF WHAT IS TRULY NEEDED. AND TO ME, THAT HIGHLIGHTS A NEED TO EXPAND OUR APPROACH AND EXPLORE STRONGER OTHER STRATEGIES LIKE PUBLIC-PRIVATE PARTNERSHIPS. AND THE COUNTY WITH SO MUCH WEALTH AND INNOVATION, WE SHOULD BE LEVERAGING THOSE RESOURCES TO HELP SUPPORT THE RESIDENTS WHO NEED IT THE MOST. THESE CUTS ARE ESPECIALLY DEVASTATING BECAUSE THEY TARGET HEALTHCARE AND SAFETY NET PROGRAMS THAT SO MANY RESIDENTS RELY ON EVERY DAY. MEDICAID OR MEDI-CAL IN CALIFORNIA, THE COUNTY'S SINGLE LARGEST FEDERAL SUPPORT OPPORTUNITY, SUPPORTS OUR PUBLIC HOSPITAL AND HEALTH SYSTEM, INCLUDING OUR FOUR PUBLIC HOSPITALS, 15 HEALTH CENTERS THAT PROVIDE CARE TO OUR COMMUNITIES ACROSS SANTA CLARA COUNTY. THANKS TO THE VOTERS, MEASURE-A PASSED AND IS ABLE TO GENERATE $330 MILLION REVENUE TO HELP ADDRESS THE GROWING BUDGET GAP ANNUALLY. OUR RESIDENTS UNDERSTOOD THE IMPACTS OF THE FUNDING CUTS WOULD BE FELT ACROSS THE ENTIRE COMMUNITY AND WE ARE DEEPLY GRATEFUL FOR THAT SUPPORT. BUT EVEN WITH THAT, DIFFICULT BUDGET DECISIONS STILL LIE AHEAD. WE MUST BALANCE A NUMBER OF URGENT PRIORITIES WHILE REMAINING COMMITTED TO PROTECTING CRITICAL SAFETY NET SERVICES AND SUPPORTING OUR MOST VULNERABLE RESIDENTS. SO THROUGHOUT THIS PRACTICE, HE IS, COMMUNITY VOICES WILL PLAY AN IMPORTANT ROLE IN SHAPING THESE DECISIONS AND RESIDENTS WILL HAVE OPPORTUNITIES TO SHARE FEEDBACK DURING THE WORKSHOPS. ADDRESS OF THE JUNE HEARING, THESE WORKSHOPS ARE AN OPPORTUNITY TO DISCUSS AND DELIBERATE ON THE PROPOSED BUDGET. WHILE THE JUNE HEARINGS WILL BE THE TIME WHEN THE BOARD ACTUALLY TAKES FORMAL ACTION AND CASTS THE VOTES. NOW I'LL DID HE EVER FOR JAMES WILLIAMS THE COUNTY EXECUTIVE, EZEKIEL DOG VEGA OUR COUNTY BUDGET DIRECTOR TO TRUE PORTLAND SLIDE OVERVIEW FOR THE 26/27 RECOMMENDED BUDGET. THANK YOU.

MR. WILLIAMS: THANK YOU, PRESIDENT LEE, MEMBERS OF THE BOARD AND THE PUBLIC. THIS IS A CHALLENGING BUDGET TO BRING FORWARD. WE'LL TAKE A FEW MINUTES AT THE OUTSET HERE TO WALK THROUGH AT A HIGH LEVEL THE BIG PICTURE OF WHAT WE ARE FACING AS A COUNTY ORGANIZATION. IN OUR FOURTH YEAR NOW OF BUDGET REDUCTIONS, THIS YEAR BRINGS AN UNPRECEDENTED LEVEL OF REDUCTIONS. IN FACT, A GREATER GAP THAN THE PRIOR THREE YEARS COMBINED. WE ARE GETTING INTO A POSITION WHERE AS A COUNTY ORGANIZATION, WITH EACH SUCCESSIVE BUDGET CUT, IT IS HARDER TO BRING FORWARD THE RECOMMENDED BUDGET. I TAKE NO PLEASURE AT ALL IN BRINGING BEFORE THE BOARD A BUDGET THAT INCLUDES CUTS TO SERVICES AND PROGRAMS, BUT AS WE'LL EXPLAIN, WE HAVE TRIED TO DO SO ON IN A THOUGHTFUL AND VIABLE MANNER. AND ARE GRATEFUL TO THE SUPPORT OF OUR COMMUNITY AND TO THE MANY IN OUR COUNTY ORGANIZATION WHO HAVE WORKED HARD TO IDENTIFY A NUMBER OF REVENUE-BASED SOLUTIONS TO HELP AVOID FURTHER CUTS. LET'S START WITH THE LANDSCAPE IN FRONT OF US. WE WERE ALREADY FACING A SIGNIFICANT GENERAL FUND DEFICIT THAT WE FORECASTED PRIOR TO THE START OF THIS CURRENT FISCAL YEAR. AND THEN JUST DAYS INTO THE START OF THIS FISCAL YEAR, THE REPUBLICAN CONGRESS AND PRESIDENT TRUMP SIGNED INTO LAW ON JULY 4th, AN UNPRECEDENTED WITHDRAWAL OF FEDERAL FUNDING FOR TWO OF THE MOST ESSENTIAL THINGS THAT WE NEED TO SURVIVE: HEALTHCARE AND FOOD. AND FOR OUR COUNTY ORGANIZATION, THESE CUTS HAVE DEVASTATING IMPACTS. OVER A BILLION DOLLARS A YEAR IN ANNUAL REVENUE LOSSES. AND THEY WILL CONTINUE TO GROW OVER TIME. AND SO THE RECOMMENDED BUDGET ATTEMPTS, AS BEST AS WE CAN, TO BRING FORWARD SOLUTIONS TO ADDRESS THE GAP THAT WAS FOISTED UPON US. AND UNLIKE THE FEDERAL GOVERNMENT, WHOSE DEBT NOW EXCEEDS THE ENTIRE OUTPUT OF OUR U.S. ECONOMY, YOUR COUNTY GOVERNMENT MUST PRESENT A BALANCED BUDGET AND CANNOT BORROW TO COVER OPERATING COSTS. NEXT SLIDE, PLEASE. THIS RECOMMENDED BUDGET IS A STRUCTURALLY BALANCED SPENDING PLAN. IT ADDRESSES 787 MILLION IN ONGOING SOLUTIONS TO DEAL WITH THAT GAP THAT WAS CREATED, AGAIN, LARGELY BY HR1 CUTS. AND WE ARE BRINGING FORWARD A STRUCTURALLY BALANCED BUDGET BECAUSE WE KNOW WE FACE A DIFFICULT OUTLOOK IN THE YEARS AHEAD AND WE'LL GET TO WHAT THAT PICTURE LOOKS LIKE IN A LITTLE BIT. NEXT SLIDE, PLEASE. THE $787 MILLION GAP HAS BEEN OVERWHELMINGLY ADDRESSED THROUGH REVENUE-BASED SOLUTIONS. AND HERE I WANT TO TAKE A MOMENT, BECAUSE WE ARE GOING TO FOCUS ON THE REST OF THESE WORKSHOPS, IN CONVERSATIONS ABOUT WHAT'S BEING CUT. BUT CONTEXT MATTERS. AND WHAT YOU DON'T SEE IS WHAT'S NOT BEING CUT. THANKS TO THIS COMMUNITY STEPPING FORWARD, BECAUSE OF 2025 MEASURE-A, $337 MILLION OF THIS GAP IS ADDRESSED THROUGH THAT EMERGENCY GENERAL SALES TAX MEASURE. BUT THAT'S NOT ALL THAT HAS HAPPENED SINCE THE PASSAGE OF RH1. AS PRESIDENT LEE HEADED TO, WE PUT FORWARD A 3-PART STRATEGY TO DEAL WITH THE MAGNITUDE OF IMPACTS THAT WE FACE. ONE PIECE WAS MEASURE-A AND WE'LL TALK ABOUT THAT IN A MINUTE. BUT THE SECOND PIECE WAS DIFFICULT WORK TO RESTRUCTURE SERVICE LINES TO EXPLORE OTHER REVENUE OPPORTUNITIES TO PULL EVERY LEVER AND PUSH EVERY BUTTON THAT WE CAN IN ORDER TO PRESERVE SERVICES. AT MIDYEAR, THIS AREA, LARGELY AFFECTING OUR HEALTH SYSTEM. WE BROUGHT FORWARD A SERIES OF BOTH CUTS AND SERVICE LINE CHANGES, BUT LARGELY REVENUE-BASED AND OPERATIONAL CHANGES THAT GENERATE REVENUE IN THE HEALTH SYSTEM, TO TACKLE THE CURRENT YEAR GAP CREATED BY HR1. AND THOSE SOLUTIONS THAT THIS BOARD ADOPTED AT MIDYEAR PLAY A PIVOTAL ROLE IN ADDRESSING THIS GAP. AND THEREFORE REDUCING THE MAGNITUDE OF IMPACT THAT WE HAVE TO GRAPPLE WITH IN THIS BUDGET PROCESS. YOU SEE AFTER THAT THAT WE HAVE CONTINUED TO PUSH ADDITIONAL REVENUE-BASED SOLUTIONS, INCLUDING ACROSS GENERAL FUND DEPARTMENTS TO THE TUNE OF $18 MILLION. AND WITHIN SANTA CLARA VALLEY HEALTHCARE TO THE TUNE OF AN ADDITIONAL $77 MILLION. WE'LL TALK LATER TODAY, BUT I WANT TO SAY THESE ARE NOT THINGS THAT JUST MAGICALLY APPEAR. EACH OF THESE INITIATIVES, AND THERE ARE MYRIAD, EACH OF THESE INITIATIVES REQUIRES CHANGING HOW WE DO WORK. REQUIRES CONCERTED AND FOCUSED EFFORT. AND REQUIRED MOVING MAJOR PROJECTS AND INITIATIVES FORWARD. AND INDEED, THERE IS EXTRAORDINARY RISK AND UNCERTAINTY IN WHETHER WE WILL ULTIMATELY REALIZE SOME OF THESE REVENUE PROJECTIONS. AND SO AT THE OUTSET, I JUST WANT TO NOTE FOR THE BOARD'S AWARENESS, THIS IS AN AGGRESSIVE RECOMMENDED BUDGET THAT WORKS VERY HARD TO SEEK TO MINIMIZE SERVICE IMPACTS, IMPACTS TO OUR WORKFORCE, IMPACTS TO OUR COMMUNITY PARTNERS WHO DELIVER CRITICAL SAFETY NET SERVICES, BY MAKING A LOT OF VERY AGGRESSIVE MOVES TO IMPLEMENT AND EFFECTUATE A NUMBER OF REVENUE-BASED MEASURES THAT WE VERY FERVENTLY WILL COME TO YOU AND CONTINUE TO MONITOR AND TRACK BECAUSE IF THEY DON'T, WE ARE OBLIGATED TO BALANCE OUR BUDGET AND THEN WILL BE FORCED TO MAKE UP THAT GAP IN THE FORM OF SERVICE REDUCTIONS. THAT ALL SAID, THERE ARE CUTS PRESENTED IN THE BUDGET AS WELL TO CLOSE THE REMAINING GAP. WE WILL SPEND THE BULK OF THE REMAINING DAYS OF WORKSHOP FOCUSED ON WHAT THOSE ARE, BUT THIS CONTEXT IS PIVOTAL BECAUSE OUR COMMUNITY COLLECTIVELY HAS MOVED MOUNTAINS TO TRY TO MINIMIZE THE MAGNITUDE OF THAT GAP. THERE IS A LOT MORE WORK WE MUST DO TOGETHER, PARTNERSHIP WITH THE STATE, TO MOVE MANY MORE MOUNTAINS TO ADDRESS THAT GAP. NEXT SLIDE, PLEASE. ONE PIECE IS USING MEASURE-A FUNDING. RESPONDING THE THIRD IS STATE PARTNERSHIP. NEXT SLIDE. LET'S START WITH WHAT WE ARE PROPOSING AS OUR RECOMMENDATIONS REGARDING 2025 MEASURE-A. INCREDIBLE LEADERSHIP FROM THE PART OF THIS BOARD AND HUGE GRATITUDE TO THE COMMUNITY. WE NOW KNOW OTHER COUNTIES ARE SEEKING TO GO DO OTHER MEASURES. ABOUT YOU WE MOVED SWIFTLY WITH URGENCY TO ADDRESS THE FISCAL CRISIS WE FACE. MEASURE-A WILL BRING IN $337 MILLION IN THE UPCOMING FISCAL YEAR. AND THE RECOMMENDED BUDGET DOES ALLOCATE THIS FULL AMOUNT TO SANTA CLARA VALLEY HEALTHCARE TO OFFSET MEDICARE CUTS. YOU'LL SEE A SECTION IN THE BUDGET BOOK IN THIS SLIDE, PLEASE, THAT HIGHLIGHTS THE SPECIFIC AREAS IN WHICH WE RECOMMEND ALLOCATION OF THAT. TURNING FULLY COMMITTED TO TRANSPARENCY REGARDING THIS. THE BOARD HAS ESTABLISHED A COMMITTEE TO REVIEW WHAT HAPPENS WITH MEASURE-A FUNDING AND THIS WILL BE THE SUBJECT OF ONGOING REPORTING TO THE ADMINISTRATION AND THE COMMITTEE AND HERE AT THE BOARD. THESE ARE SOME OF THE VERY CRITICAL SERVICE LINES THAT ARE ESSENTIAL OBVIOUSLY FOR MEDI-CAL RECIPIENTS, BUT ALSO FOR THE WELL-BEING OF OUR ENTIRE COMMUNITY. AND ITEMS THAT WERE CERTAINLY AT THE FOREFRONT OF OUR CONVERSATIONS OF WHY SANTA CLARA VALLEY HEALTHCARE IS SUCH AN ESSENTIAL SERVICE FOR EVERY RESIDENT IN SANTA CLARA COUNTY. NEXT SLIDE, PLEASE. AS I SAID, WE ARE PUSHING ON MYRIAD OPERATIONAL CHANGES. AND THESE ARE CHALLENGING. THEY REQUIRE OUR STAFF TO DIG DEEP. THEY REQUIRE SHIFTS IN HOW WE DO OUR WORK. THEY REQUIRE MOVEMENT OF SERVICES AND PROGRAMS AND PEOPLE. THEY REQUIRE CHANGES IN HOW WE STRUCTURE CONTRACTS AND SERVICE DELIVERY. MANY OF THESE INITIATIVES ARE, OF COURSE, FOCUSED IN OUR HOSPITAL SYSTEM. WHY? BECAUSE WE ARE VERY FORTUNATE THAT ABOUT 88 CENTS ON THE DOLLAR IN OUR HOSPITAL SYSTEM IS REVENUE BACKED. AND SO WE HAVE OPPORTUNITIES WITHIN OUR HEALTHCARE DELIVERY SYSTEM IN HOW WE THINK ABOUT THE SERVICES THAT WE DELIVER TO ACTUALLY BETTER AND MORE EFFICIENTLY OR EFFECTIVELY GENERATE REVENUES. AND TO TAKE ADVANTAGE OF THINKING ABOUT OUR SYSTEM MORE BROADLY AS A BROADER ENTERPRISE. AND YOU'LL HEAR MORE ABOUT THAT LATER THIS AFTERNOON WHEN WE GET TO THE SCVH PORTION OF THE DISCUSSION. NEXT SLIDE, PLEASE. HERE ARE SOME EXAMPLES BEYOND JUST THE HEALTHCARE SYSTEM, ALTHOUGH A FEW OF THOSE ARE ON HERE. BUT THE NUMBER OF PROPOSALS IN OUR BEHAVIORAL HEALTH DEPARTMENT, SOCIAL SERVICES AGENCY AND ELSEWHERE THAT ACTUALLY BRING OR ENHANCE REIMBURSEMENT RATES OR REVENUES TO HELP MITIGATE AND CLOSE THIS GAP. NEXT SLIDE, PLEASE. NOW I WANT TO TALK ABOUT THE THIRD PRONG. BECAUSE THIS IS ABSOLUTELY ESSENTIAL. AND YOU'LL SEE IN A FEW MINUTES OUR FIVE-YEAR FORECAST AND PROJECTIONS, LARGELY BASED ON HR1-RELATED IMPACTS AND HOW THOSE ACCUMULATE. NOW, I WAS IN SACRAMENTO WITH SOME OF OUR BOARD MEMBERS LAST WEEK, AND THE MAY REVISE WILL COME OUT LATER THIS WEEK. AND WE WILL DISCUSS THE MAY REVISE AT NEXT WEEK'S BOARD MEETING. BUT THE WORD THAT WE ARE HEARING IS NOT GOOD. IT'S NOT GOOD AT ALL. THE RECOMMENDED BUDGET AS IT STANDS TODAY ASSUMES NOTHING POSITIVE OR NEGATIVE OFF OF THE CURRENT BASELINE FROM THE STATE. WE ARE, OF COURSE, VIGOROUSLY SEEKING FOR THE STATE TO DO ITS PART TO ENSURE THAT THE 6% OF HOSPITALS IN CALIFORNIA THAT ARE PUBLIC, AND UPON WHICH ALL CALIFORNIANS RELY, GIVEN THAT THOSE 6% OF HOSPITALS OPERATE HALF OF THE STATE'S TRAUMA AND BURN CENTERS AND TRAIN MORE THAN HALF OF THE STATE'S PHYSICIANS, THAT THE STATE DO ITS PART TO ENSURE THAT THOSE 6% OF HOSPITALS CAN REMAIN OPEN AND OPERATING. BUT WHAT WE ARE INSTEAD HEARING FROM SACRAMENTO IS THAT THE MAY REVISE IS LIKELY TO BRING A LITANY OF STATE-IMPOSED CUTS TO MEDI-CAL, THINK PARTICULARLY THE STATE-ONLY PROGRAM, INCLUDING SHIFTS IN HOW THAT PROGRAM IS OPERATED, AWAY FROM A MANAGED CARE MODEL TO A FEE-FOR-SERVICE MODEL. NOW, THIS COMPLICATED TECHNICAL LANGUAGE IN ALL OF THAT. BUT THE BOTTOM LINE IS SIMPLE. WHAT WE ARE HEARING IS THAT THE MAY REVISE MIGHT BRING AN ADDITIONAL MORE THAN $200 MILLION ONGOING REVENUE HIT TO OUR COUNTY HEALTH SYSTEM. SO WE WILL KEEP OUR EYE ON THAT. AND WE ARE GOING TO FIGHT VIGOROUSLY. BUT WE WANT THE COMMUNITY TO KNOW THAT WE NEED TO BE FOCUSED ON WHAT'S HAPPENING IN SACRAMENTO. BECAUSE WE CANNOT ADDRESS THESE GAPS ALONE. AND THE STATE CANNOT AFFORD TO ALLOW SYSTEMS LIKE OURS TO GO WITHOUT ESSENTIAL AND CRITICAL SUPPORT. THERE ARE PRECIOUS REGIONAL ASSETS THAT NOT ONLY SAVE THE LIVES OF RESIDENTS HERE IN SANTA CLARA COUNTY BUT ARE ASSETS BEYOND OUR OWN COUNTY BORDERS. WE'LL HAVE MORE UPDATES NEXT WEEK ONCE THE MAY REVISE IS PUBLISHED. BUT WE ARE FACING VERY SIGNIFICANT HEADWINDS BASED ON WHAT WE ARE HEARING AT THE STATE LEVEL. NEXT SLIDE, PLEASE. NOTWITHSTANDING THE REALLY SIGNIFICANT DEFICITS THAT WE ARE FACING AND THE GAPS THAT WE HAVE TO BRIDGE, THE RECOMMENDED BUDGET CONTINUES TO PRESERVE AND PROTECT CORE SAFETY NET SERVICES AND, INDEED, FUNDS EXPANSIONS AND CERTAIN HIGH-PRIORITY AREAS CONSISTENT WITH THE BOARD'S POLICY PRIORITIES. I'LL SHARE JUST A COUPLE OF CONCRETE EXAMPLES. THE BEHAVIORAL HEALTH PAVILION AT OUR SANTA CLARA VALLEY CAMPUS IS A SIGNIFICANT CAPITAL INVESTMENT FOR THE FIRST HAVING IN-PATIENT PSYCHIATRIC BEDS FOR CHILDREN AND ADOLESCENTS RIGHT HERE GEOGRAPHICALLY IN OUR COMMUNITY. THIS BUDGET FUNDS THOSE POSITIONS AND THE OPENING OF THAT PAVILION. SIMILARLY, TARGETED INVESTMENTS IN EXPANDED SERVICE LINES WITHIN THE HEALTH SYSTEM, CONTINUED INVESTMENTS IN CRITICAL PUBLIC SAFETY SERVICES, INVESTS IN SUPPORT OF HOUSING, INCLUDING EXPANDED HOUSING NAVIGATORS TO ENSURE WE PROVIDE SUPPORTING HOUSING SERVICES FOR THE CONTINUED 2016 MESH OR-A PROJECTS COMING ONLINE. NEW FUND TO GO ESTRTPs FOR CHILD WELFARE SYSTEM. THERE ARE SEVERAL ITEMS LIKE THAT AS WELL AS CONTINUED COMMITMENT TO CRITICAL C.B.O. AND COUNTY-BASED DELIVERY SERVICES THAT IMPACT THE MOST VULNERABLE IN OUR COMMUNITY. YOU'LL FIND THOSE RECOMMENDATIONS THROUGHOUT THE LENGTHY BUDGET DOCUMENT. I WANT TO SPEAK TO THE IMPACT OF THE COUNTY WORKFORCE. WE ARE BLESSED TO HAVE OVER 25,000 DEDICATED PUBLIC SERVANTS WHO WORK DAY IN AND DAY OUT TO DELIVER CRITICAL SERVICES ACROSS EVERY MANAGEABLE DOMAIN HERE IN OUR COMMUNITY. AND WE HAVE TAKEN EXTRAORDINARY STEPS, INCLUDING THROUGH CAREFUL VACANCY MANAGEMENT WITH OUR COUNTY-WIDE HIRING FREEZE TO ATTEMPT TO MINIMIZE IMPACTS ON OUR OWN COUNTY WORKFORCE. AND AS A RESULT, FOR ABOUT NINE-NINE PERCENT OF OUR WORKFORCE, THEY WILL SEE NO IMPACT AT ALL AS A RESULT OF THE RECOMMENDATIONS INCLUDED IN THE RECOMMENDED BUDGET, WITH A NET REDUCTION OF 464 POSITIONS. THAT ACTUALLY MASKS THE FACT THAT IT'S REALLY 655 POSITIONS BEING REDUCED ON UNONE HASN'T AND GENERAL FUND. THE MAJORITY OF THE FILL POSITIONS IMPACTED, 70% THE SAME CLASSIFICATION LANDING SPOT, WHICH IS AN EXTRAORDINARY EFFORT. AND I WANT TO GIVE A LOT OF THANKS, NOT JUSTIFY TO THE DEPARTMENTS BUT TO OBA AND TO OUR ESA TEAMS WHO WORK ON THIS LITERALLY EVERY WEEK IN ORDER TO MAKE THIS AT ALL POSSIBLE. IT'S NOT SOMETHING THAT HAPPENS BY MAGIC. IT'S SOMETHING THAT HAPPENS WITH A LOT OF DILIGENCE AND EFFORT. THAT BEING SAID, FOR THE REMAINING HANDFUL OF DOZENS OF POSITIONS, WE ARE COMMITTED, OF COURSE, TO NOT JUST FOLLOWING OUR COUNTY LABOR CONTRACTS, BUT TO DOING EVERYTHING WE CAN TO OFFER IN-PLACEMENT OPPORTUNITIES TO OTHER VACANT POSITIONS THAT EXIST ELSEWHERE IN THE COUNTY ORGANIZATION. THIS IS A CORE VALUE THE COUNTY HAS ALWAYS MAINTAINED. IT BECOMES HARDER EACH YEAR. IT BECOMES HARDER IN PART BECAUSE THE NUMBER OF VACANCIES IS LOWER AND BECAUSE SOMETIMES THEY ARE NOT IN THE RIGHT PLACES. FOR INSTANCE, IT'S NOT EASY, FOR EXAMPLE, TO MOVE PEOPLE INTO A VACANT CORRECTIONAL DEPUTY POSITION, JUST AS A WAY OF ONE EXAMPLE. BUT A LOT OF EFFORT IS SPENT TRYING TO MAKE THIS POSSIBLE. NEXT SLIDE, PLEASE. WE HAVE ALSO DONE A LOT OF WORK, AGAIN, A LOT OF CREDIT TO ESA, TO ENSURE THAT WE ARE PROVIDING TIMELY INFORMATION BASED ON WHAT WE DO KNOW. AND WE DON'T KNOW EVERYTHING. FOR EXAMPLE, WE CAN'T KNOW THE FULL IMPACTS TO INDIVIDUAL EMPLOYEES UNTIL WE MOVE THROUGH ALL OF THE VARIOUS PROCESSES THAT OCCUR. BUT WE DO HAVE A WEBSITE ON OUR SHAREPOINT FOR OUR CONNECT SITE, SORRY, FOR OUR COUNTY EMPLOYEES WITH AS MUCH INFORMATION AS WE DO HAVE AVAILABLE, INCLUDING TIMELINES, ALONG WITH A WHOLE SERIES OF OTHER INFORMATION THAT WE MADE AVAILABLE TO OUR COUNTY WORKFORCE COLLECTIVELY. NEXT SLIDE, PLEASE. THIS IS A DIFFICULT RECOMMENDED BUDGET TO BRING FORWARD. WE ARE TRYING TO PUT A LOT OF DIFFERENT PUZZLE PIECES TOGETHER. I HAVE OFTEN SAID THE COUNTY BUDGET ISN'T JUST ONE BUDGET. WE HAVE TO LOOK AT DIFFERENT REVENUE STREAMS AND FUNDING SOURCES. WE HAVE DEPARTMENTS LIKE PARKS AND THE LIBRARIES THAT ARE NOT GENERAL FUND THAT ARE GROWING AT THE SAME TIME THAT WE HAVE CORE GENERAL FUND DEPARTMENTS FACING AN UNDERLYING STRUCTURAL DEFICIT COMPOUNDED BY HR1 IMPACTS. AND THAT CAN BE CHALLENGING WHEN YOU LOOK OUT ACROSS THE BROADER COUNTY ORGANIZATION. WE HAVE TRIED TO PUT ALL OF THOSE PUZZLE PIECES TOGETHER. WE UNDOUBTEDLY HAVE NOT GOTTEN IT DONE PERFECTLY. THAT'S WHY WE HAVE LOTS OF OPPORTUNITY AND 48 DAYS OF PUBLIC COMMENT AND INPUT AND INFORMATION AS WE GRAPPLE WITH PUTTING A FINAL BUDGET TOGETHER FOR THE BOARD TO ULTIMATELY ADOPT. AND THE BUDGET IS A LIVING DOCUMENT. IT WILL CONTINUE TO NEED TO CHANGE, INCLUDING MOST SIGNIFICANTLY, WE WILL NEED TO ADDRESS WHATEVER COMES OUR WAY FROM THE STATE, POSITIVE OR NEGATIVE. AND WE WILL HAVE TO KEEP OUR EYE ON THAT LONG-TERM HORIZON AND WHAT'S HAPPENING IN SACRAMENTO THROUGHOUT THIS PROCESS, EVEN THOUGH THOSE ARE NOT IMPACTS WE'LL BE ABLE TO ACCOMMODATE IN THE ADOPTION OF THIS BUDGET ITSELF. THOSE ARE VERY REAL IMPACTS THAT WE WILL HAVE TO ADDRESS IN THE UPCOMING FISCAL YEAR. NEXT SLIDE, PLEASE. BEFORE I TURN IT OVER TO EZEKIEL TO GO THROUGH THE FORECAST AND OUTLOOK AND HIGHLIGHT SOME OF THE KEY DRIVERS AFFECTING THE BUDGET PROCESS, I THINK TO SHARE A COUPLE OF OTHER THOUGHTS WITH THE BOARD. WE ARE AN ORGANIZATION THAT AT OUR CORE DELIVERS SERVICES TO THOSE WHO ARE MOST IN NEED IN OUR COMMUNITY. WE ARE AN ORGANIZATION THAT AT OUR CORE, UNLIKE THE FEDERAL GOVERNMENT, BELIEVE IN THE POWER OF GOVERNMENT AND GOVERNMENT SERVICES, BELIEVES THAT THEY MAKE A DIFFERENCE IN PEOPLE'S LIVES, BELIEVES IN THE VALUE AND WORTH OF PUBLIC SERVICE, BELIEVES IN PARTNERSHIP WITH OUR MANY COMMUNITY-BASED ORGANIZATIONS. WE SEE THE INCREDIBLE NEED IN THE COMMUNITY AND WE ARE PAINED BY UNMET NEEDS THAT WE DO NOT HAVE RESOURCES TO ADDRESS. AND SO WE WILL CONTINUE TO STRIVE AS A BROADER COUNTY ORGANIZATION TO ADAPT AND DO EVERYTHING THAT WE CAN TO PRESERVE THOSE MOST CRITICAL SERVICES, EVEN IN A TIME OF UNAVOIDABLE, UNAVOIDABLE AND SUBSTANTIAL FISCAL IMPACTS. AND THOSE FISCAL IMPACTS COME WITH VERY REAL OPERATIONAL AND ORGANIZATIONAL IMPACTS TOO. WE DON'T MINIMIZE THOSE, WE RECOGNIZE THOSE. BUT WE HAVE TRIED TO LAY OUT A STRATEGY TO ADDRESS THEM TOGETHER. AND I JUST WANT TO ACKNOWLEDGE, AND WE HOPE WITH THE BOARD'S INDULGENCE, TO DO SOMETHING MUCH MORE FORMAL AT THE BEGINNING OF THE BUDGET HEARING, BUT LAST WEEK, WE HAD A VERY IMPORTANT FIGURE IN OUR COUNTY ORGANIZATION WHO WAS PART OF 32 OF OUR COUNTY BUDGETS PASS AWAY. AND I JUST WANT TO ACKNOWLEDGE SOMEONE WHO REALLY HAS BUILT A FISCAL FOUNDATION FOR OUR COUNTY, THAT IS OUR FORMER CHIEF OPERATING OFFICER AND BUDGET DIRECTOR GARY GRAVES. HE CAME TO OUR COUNTY ORGANIZATION IN 1984 AS BUDGET DIRECTOR AND LEFT AS CHIEF OPERATING OFFICER IN 2016. HE PASSED AWAY LAST WEEK. AND LIKE I SAID, WE WILL DO SOMETHING FORMAL TO HONOR HIM AT THE BUDGET HEARINGS. BUT HE WENT THROUGH MANY DIFFICULT BUDGET CYCLES AND OFFERED MUCH ADVICE, AND WE HAVE TRIED TO TAKE THOSE LESSONS LEARNED AS WE HAVE ENCOUNTERED THESE LAST SEVERAL YEARS OF BUDGET CHALLENGE. SO WITH THAT, I WILL TURN IT OVER TO EZEKIEL, OUR COUNTY BUDGET DIRECTOR.

THE BUDGET PROPOSED BEFORE YOU IS BALANCED, BUT WE DO ANTICIPATE THAT WE'LL HAVE SIGNIFICANT CHALLENGES AHEAD FOR THE NEXT FISCAL YEAR, DRIVEN MOSTLY BY. I WILL BE DISCUSSING SOME EXTERNAL FACTORS THAT IMPACT THE COUNTY'S REVENUES AND COSTS AND ALSO SOME INTERNAL FACTORS RELATED TO THE BENEFITS AND COSTS OF SERVICES THROUGHOUT THE ORGANIZATION. SO AS YOU CAN SEE THE SLIDE IN FRONT OF YOU, WE ARE PROJECTING, UNFORTUNATELY, A SIGNIFICANT DEFICIT FOR FISCAL YEAR '28. EVEN THE BUDGET AS IT IS TODAY IS BALANCED FOR FISCAL YEAR '27. IN EXCESS OF $500 MILLION DEFICIT INTO FISCAL YEAR '28, AND THAT IS PROJECTED TO GROW TO APPROXIMATELY 928 MILLION INTO FISCAL YEAR 30-31. MOST OF THE IMPACT TO THE COUNTY IS DIRECTLY RELATED TO THE IMPLEMENTATION OF HR1. AND THAT CREATES CHALLENGES FOR US BECAUSE IT IS SOMETHING WE DON'T CONTROL. IT'S GOOD TO RECOGNIZE THAT'S THE IMPACTS THAT WE'LL HAVE COMING DERIVING FROM HR1. BUT THERE ARE OTHER FACTORS AS WELL THAT WILL BE IMPACTING THE COUNTY AS A WHOLE. SO THE STRATEGY THAT WAS OUTLINED BY EXECUTIVE WILLIAMS TODAY, RELATED TO STATE ADVOCACY, WILL BE CRITICALLY IMPORTANT TO ENSURE THAT AS WE PLAN IN THE FUTURE YEARS, THAT WE CONTINUE ADVOCATING ON A STATE LEVEL TO ENSURE THAT WE MINIMIZE THOSE IMPACTS THAT MAY BE EXACERBATED AT THE STATE LEVEL AS WELL. SO WHEN YOU LOOK AT THE REVENUE FOR THE COUNTY FOR THE FISCAL YEAR 26/27 BUDGET, IN THE CONTEXT OF THE CHALLENGES THAT WE WILL HAVE INTO THE UPCOMING FISCAL YEAR, IT IS IMPORTANT TO RECOGNIZE THAT A LARGE PORTION OF REVENUE WE RECEIVE COMES FROM CHARGES FOR SERVICES, AND THOSE CHARGES FOR SERVICES ARE DIRECTLY IMPACTED IN MANY WAYS BY ACTIONS THAT ARE TAKEN AT THE FEDERAL LEVEL THAT WILL IMPACT MEDI-CAL AND MEDICARE REVENUES. THIS REPRESENTS APPROXIMATELY 42% OF THE OVERALL REVENUE FOR THE ENTIRE ORGANIZATION. EVEN THOUGH WE ARE DISCUSSING THIS IN THE CONTEXT OF THE SERVICES PROVIDED IN THE GENERAL FUND, THESE REVENUES ARE IN AGGREGATE FOR THE ENTIRE ORGANIZATION. ANOTHER IMPORTANT ASPECT OF THE REVENUE PIE THAT YOU CAN SEE IN FRONT OF YOU AS WELL, IS THE MAJORITY OF THE DISCRETIONARY REVENUE THAT IMPACTS THE GENERAL FUND IS PROPERTY TAXES, AND THAT REPRESENTS APPROXIMATELY 19% OF THE OVERALL REVENUES FOR THE COUNTY. THAT'S THE NEXT BIGGEST SLICE OF THE TOTAL REVENUE THAT THE COUNTY RECEIVES IN ORDER TO PROVIDE SERVICES. SO YOU'LL SEE SOME OF THAT AS WELL AS WE GO THROUGH SOME OF THE SLIDES WHY THIS IS IMPORTANT AND SOME OF THE ECONOMIC CONDITIONS THAT ARE CURRENTLY IN PLACE LOCALLY AND AT THE NATIONAL LEVEL THAT ARE IMPACTING HOW THIS REVENUES COULD PERFORM INTO THE FUTURE. WHEN YOU LOOK AT THIS SLIDE RELATED TO INFLATION, I THINK IT'S A VERY PARTICULAR SLIDE TO UNDERSTAND HOW THE UNDERLYING ASSUMPTIONS THAT WILL AFFECT THE PERFORMANCE OF REVENUE INTO THE FUTURE, BUT NOT ONLY THE REVENUE, BUT ALSO THE OVERALL COSTS OF THE PROVISION OF SERVICES. AS YOU WELL KNOW, WE ARE A SERVICE-ORIENTED ORGANIZATION AND THE PERCENTAGE THAT WE PROVIDE ARE DIRECTLY RELATED OR PROVIDED BY EMPLOYEES WITHIN THE COUNTY AND ALSO THROUGH CONTRACTED PROVIDERS IN THE COMMUNITY. AND AS IT COSTS MORE TO HIRE INDIVIDUALS AND BE ABLE TO RETAIN THEM AND FOR THEM TO BE ABLE TO PROVIDE QUALITY SERVICES IN THE COMMUNITY, IT WILL BE MORE AND MORE DIFFICULT FOR THE COUNTY TO CONTINUE TO DO THAT IN AN ENVIRONMENT WHERE INFLATION IS PROJECTED TO GROW AT A SIGNIFICANT RATE. EVEN MORE SO NOW WITH WHAT IS HAPPENING IN THE MIDDLE EAST AND THAT PROLONGED CONTINUED FLICK, THAT IS CREATING SIGNIFICANT CHALLENGES EVERY DAY AT THE PUMP WHEN WE TRY TO FILL UP FOR GAS FOR OUR VEHICLES AND ALSO FOR JUST BASICALLY DAY-TO-DAY BASIS. GIVEN THAT ENVIRONMENT, WE ARE PROJECTING INFLATION TO GO IN THE SHORT-TERM BEFORE DECLINING. SO FOR FISCAL YEAR '27, WE ARE PROJECTING A HIGH LEVEL OF RISK FROM INFLATION AT 3.2%. AS A REFERENCE, THE FEDERAL GOVERNMENT TYPICALLY TARGETS 2% TARGET TO AIMED AT CREATING A HEALTHY ECONOMIC ENVIRONMENT. AND RIGHT NOW, WE PROJECTING 3.2%. THAT'S A SIGNIFICANT VARIANCE FROM WHERE WE NORMALLY WOULD HAVE PROVIDED IN NORMAL TIMES. FOR EXAMPLE, IF WE DO NOT HAVE THE CURRENT INFLATIONARY FACTOR WITH THE CONFLICT IN THE MIDDLE EAST AND TARIFFS AND OTHER ECONOMIC POLICY BUYS THE FEDERAL GOVERNMENT, WE WOULD BE PROVIDING AN INFLATION FACTOR OF APPROXIMATELY TWO, 3%. THAT'S A 1% DIFFERENCE BETWEEN WHERE WE WILL BE PROJECTING UNDER NORMAL CIRCUMSTANCES AND WHAT WE ARE TODAY. THAT WILL CONTINUE TO STRAIN THE COUNTY FOR PROVIDING QUALITY SERVICES AS THINGS WILL COST MORE TO PROVIDE THOSE QUALITY SERVICES ON AN ONGOING BASIS. WE ARE PROJECTING THAT FEDERAL EMPLOYMENT IN THE BAY AREA CONTINUES TO BE STAGNANT. THINK YOU CAN SEE THAT DURING THE COVID YEARS THAT FEDERAL UNEMPLOYMENT PLUMMETED AND THEN YOU CAN SEE THAT IT RECOVERED AFTER THAT. BUT YOU HAVE SEEN THIS, YOU CAN SEE THIS LANE THAT IT CONTINUES TO BE AROUND THE SAME LEVEL YEAR AFTER YEAR. AND WE CONTINUE TO PROJECT THAT THAT TREND WILL CONTINUE UNFORTUNATELY. YOU CAN SEE THAT A.I. ADOPTION IS HELPING THE DOMESTIC PRODUCT TO GROW THE OVERALL ECONOMY FOR THE NATION. IT'S NOT TRULY REFLECTED IN THE CREATION OF MORE JOBS BECAUSE WHAT IS HAPPENING IS THAT COMPANIES ARE INVESTING SIGNIFICANTLY IN THE INFRASTRUCTURE TO BE ABLE TO DEVELOP A.I. MODELS AND SYSTEMS, BUT THAT IS RESULTING IN SIGNIFICANT REDUCTION IN JOBS IN THE AREA. SO THE GDP CONTINUES TO GROW AND IT'S STRONG, BUT UNFORTUNATELY THAT'S NOT BEING REFLECTED OVERALL ON THE OVERALL POCKETS OF THE INDIVIDUALS IN THE COMMUNITY. AND AT THE SAME TIME, IT'S CREATING CHALLENGES AND WE ANTICIPATE THAT GIVEN THAT JOBS ARE NOT GROWING, THIS IS GOING TO CREATE A BIGGER STRAIN IN THE LABOR MARKET OVERALL THROUGHOUT THE REGION. ANOTHER KEY INDICATOR IS HOW THE ECONOMY IS DOING LOCALLY AND NATIONWIDE, IS THE HOME VALUE INDEX. THE HOME VALUE INDEX IS IMPORTANT BECAUSE IT GIVES YOU AN INDICATION WHETHER OR NOT LOCAL BUSINESSES ARE HIRING, WHETHER THE DEMAND FOR SERVICES IS STRONG, AND ALSO IT GIVES AN INDICATION OF WHETHER OR NOT THE ECONOMY IS EXPANDING. AND AS YOU HAVE SEEN IN THE PREVIOUS SLIDE, IT LOOKS LIKE THE JOB MARKET HAS BEEN STAGNANT AND IT'S NOT GROWING. AND WE ACTUALLY SAW A DECREASE EVERY FALL IN THE HOME VALUE INDEX FOR THE LAST YEAR, WITH A SMALL REBOUND GOING INTO THE NEXT FISCAL YEAR. IT'S A CRITICAL FACTOR FOR US BECAUSE IT'S A KEY INDICATOR OF WHAT WE COULD POTENTIALLY SEE ON THE VALUES OF PROPERTY WITHIN THE COUNTY. AND AS WE MENTIONED EARLIER, PROPERTY TAXES IS ONE OF THE SECOND LARGEST REVENUE SOURCES FOR THE COUNTY IN ORDER FOR US TO PROVIDE SERVICES. AND WHEN THIS METRIC IS STAGNANT OR NOT CHANGING, IT MEANS THE PROPERTY TAXES IS NOT GROWING AS STRONGLY AS IT WOULD HAVE BEEN IN THE PAST. IF YOU RECALL FISCAL YEAR 25/26, WE PROJECTED A PROPERTY TAX GROWTH THAT WAS NOT MET FOR THE FISCAL YEAR. AND FOR FISCAL YEAR 26/27, WE ARE SEEING SOME SIGNIFICANT CHANGES THAT ARE POSITIVE, BUT NEVERTHELESS, WE HAVE TO CONTINUE TO WATCH THIS METRIC BECAUSE IT IS REALLY IMPORTANT TO THE OVERALL REVENUE GENERATION FOR THE COUNTY. ANOTHER KEY INDICATOR RELATED TO PROPERTY TAXES IS RESIDENTIAL PERMITS. NOT ONLY INDICATES THE POTENTIAL REVENUE FOR PLANNING FEES FOR THE COUNTY, BUT ALSO GIVES US AN INDICATION OF THE POTENTIAL FOR PROPERTY TAXES THAT WE WILL BE ABLE TO GENERATE. AS WELL AS WE KNOW PROPERTY TAXES ARE MAINLY CAPPED AT 2% THROUGH PROP 13 ON AN ANNUAL BASIS FOR GROWTH. IF THERE IS ECONOMIC ACTIVITY RELATED TO NEW CONSTRUCTION OR IMPROVEMENTS OF THE EXISTING BUILDINGS, THEN THAT WILL GIVE YOU AN INDICATOR BEFOREHAND THAT PROPERTY TAXES COULD INCREASE OR NOT. AND AS YOU CAN SEE FROM THIS TREND, WE HAVE SEEN A DECREASE LAST FISCAL YEAR. AND WE ARE PROJECTING THEN A SMALL GROWTH INTO FISCAL YEAR '2G CALENDAR YEAR AS WELL. WHEN IT ALL COMES TOGETHER, PROPERTY TAX IS BEING PROJECTED CONSERVATIVELY FOR FISCAL YEAR AS 4.5%. CURRENTLY WHEN WE LOOK AT THE APPOINTMENTS WE ARE AT 4.36% AS OF THE FIRST WEEK IN MAY. THAT MEANS THAT WE ARE VERY CLOSE TO THAT TARGET OF 4.5%. SO WE ARE FAIRLY CONFIDENT THAT WE WILL BE ABLE TO MAKE THE 4.5% TARGET FOR FISCAL YEAR '27 THAT WE ARE PROJECTING. BUT THE BAD NEWS IS, YOU LOOK AT THAT PROJECTION INTO THE FOLLOWING FISCAL YEAR, IS THAT WE ARE ANTICIPATING A DECLINE IN THE OVERALL GROWTH OF PROPERTY TAXES FROM 4.5 TO 2.9% IN THE FOLLOWING YEAR. SO THAT IS PART OF THE REASON WHY YOU SEE THE DEFICIT WE ARE PROJECTING INTO THE NEXT FISCAL YEAR. SO SO FAR WE HAVE TALKED ABOUT A LOT OF EXTERNAL FACTORS THAT HAVE AFFECTED REVENUE. NOW WHEN YOU START LOOKING AT THIS SLIDE THAT IS IN FRONT OF YOU, WE ARE GOING TO START LOOKING AT SOME OF THE ASPECTS RELATED TO COST AND SOME OF THE OBLIGATIONS OF THE COUNTY WILL HAVE IN THE LONG-TERM THAT WILL AFFECT THE OVERALL ABILITY FOR THE COUNTY TO PROVIDE SERVICES IN THE COMMUNITY. ONE OF THOSE SIGNIFICANT FACTORS IS LIABILITY FOR RETIREMENT COST. AS YOU CAN SEE FROM THE CHART IN FRONT OF YOU, THERE IS A PERSONAL. BASED ON THE PERSONAL OF THE PLAN THAT IS FUNDED FOR RETIREMENT BENEFITS COSTS, THE COUNTY OF SANTA CLARA HAS ELECTED TO INVESTMENT THROUGH CALPURSE, AND CALPURSE MANAGES THIS FOR THE COUNTY. BUT AS YOU LOOK AT THE TREND OVERALL OF THE CHANGE IN THE FUNDING PERSONAL, IN ESSENCE, IT HAS REMAINED ALMOST THE SAME FROM FISCAL YEAR '13 THROUGH '24. THAT'S IN THE MIDDLE OF AN EXPANDING ECONOMY WITH THE STOCK MARKETS WHERE MOST OF THESE FUNDS ARE INVESTED ACTUALLY HAS DONE REALLY WELL IN MOST YEARS. EVEN WITH THAT, THAT LIABILITY, THAT FUNDING RATIO HAS NOT SIGNIFICANTLY CHANGED. I BELIEVE THIS WILL BE A SIGNIFICANT CHANGE FOR THE COUNTY AND WE HAVE TO PLAN NOW TO ADDRESS IT BECAUSE IT IS GOING TO CONTINUE TO REPRESENT A SIGNIFICANT PORTION OF THE COUNTY'S ANNUAL OBLIGATION IN THE BUDGET BECAUSE ALSO THE SIGNIFICANT GROWTH OF THAT UNFUNDED LIABILITY. AS YOU CAN SEE FROM THE THIRD BULLET POINT ON THE SLIDE, OVERALL COUNTYWIDE UNFUNDED IS ESTIMATED $6.1 BILLION. THAT'S A SIGNIFICANT AMOUNT.

MR. WILLIAMS: I WANT TO ADD SOMETHING HERE. THIS IS PROBABLY OUR SINGLE. THIS IS OUR SINGLE-LARGEST LIABILITY AS AN ORGANIZATION, $6 BILLION. THE THING THAT CONCERNS ME, NOTWITHSTANDING AS EZEKIEL SAID, THE SIGNIFICANT POSITIVE GROWTH IN THE STOCK MARKET FOR THE LAST MANY YEARS, AND WITHOUT A RECESSION, WE ARE NOT SEEING THE FUNDED RATIO GO UP. AND WE SHOULD BE SEEING IT GO UP BECAUSE THAT'S THE THEORY BEHIND THE ANNUAL PAYMENTS THAT WE ARE MAKING TO CALPERS. AND SO THAT CONCERNS ME. WE ARE PAYING OUR FULL ANNUAL TO PERS. WE ARE PAYING THE FULL BILL BUT NOT SEEING THE PROGRESS THAT WE NEED TO BE SEEING TO DIMINISH THE UNFUNDED LIABILITY. THERE IS NOTHING IN THE RECOMMENDED BUDGET THAT ADDRESSES THIS, BUT THIS IS A VERY SIGNIFICANT RISK FOR US AS AN ORGANIZATION. AND ONE SHARED BY OTHER ENTITIES THAT DEPEND ON CALPERS. WE NEED TO SEE THIS GOING UP AND THE FACT THAT IT IS NOT IS VERY CONCERNING, ESPECIALLY GIVEN THE MAGNITUDE OF THE OVERALL LIABILITY. WE WANTED TO HIGHLIGHT THAT FOR THAT REASON. BUT THIS IS FAR AND AWAY OUR LARGEST LIABILITY AS AN ORGANIZATION.

ALSO RELATED TO HEALTH INSURANCE COSTS, IT IS ANOTHER SIGNIFICANT COST DRIVER FOR THE ORGANIZATION. SO AS YOU CAN SEE, HEALTH INSURANCE COSTS OVER THE LAST FEW YEARS HAS CONTINUED TO GROW AND IT IS PROJECTED TO CONTINUE TO GROW FROM THE RECOMMENDED AMOUNT IN THIS YEAR'S BUDGET OF 319 MILLION TO 463.5 MILLION BY THE END OF 2031. SO THAT'S ANOTHER SIGNIFICANT COST DRIVER THAT IS GOING TO CONTINUE TO IMPACT THE BUDGET. AND WE'LL HAVE TO BE VIGILANT ON HOW TO BEST ADDRESS POTENTIAL GROWTH TO THE EXTENT THAT WE HAVE GIVEN THE COMPLEXITY OF THE HEALTH INSURANCE MARKET IN THE UNITED STATES. BUT TO THE BEST OF OUR ABILITIES TO CONTINUE TO MONITOR IT AND AFFECT IT IN ANY WAY THAT WILL HELP TO BE ABLE TO AFFORD THE COUNTY THE ABILITY TO CONTINUE TO PROVIDE SERVICES IN A MEANINGFUL WAY WITHIN THE COMMUNITY WITHOUT REDUCING SERVICES. IN ADDITION TO THAT, ANOTHER SIGNIFICANT ELEMENT OF COST FOR THE COUNTY IS ALSO THE RETIREE HEALTH INSURANCE COSTS. SIMILARLY TO THE UNFUNDED LIABILITY FOR RETIREMENT COSTS, THIS IS ANOTHER COMPONENT OF THE COSTS THAT THE COUNTY WILL HAVE TO CONTINUE TO ADDRESS AS IT LOOKS INTO THE FUTURE TO BE ABLE TO BALANCE THE BUDGET. TO SEE A SIGNIFICANT UPGRADE FROM FISCAL YEAR 25/26 TO FISCAL YEAR 26/27. ALTHOUGH IT SEEMS TO BE MORE STABLE INTO THE OUT YEARS AS WE PROJECT. AND THIS IS RELATED TO THE COUNTY'S PRACTICES THAT HAVE CHANGED BASED ON BOARD POLICY AND ACTIONS TAKEN BY THE BOARD IN PREVIOUS YEARS WHERE WE ARE FULLY CONTRIBUTING TO BE ABLE TO PAY THIS UNFUNDED LIABILITY. AND WE ANTICIPATE THAT SOME OF THE ACTIONS WE HAVE TAKEN WILL HELP STABILIZE THE OVERALL COSTS FOR THE COUNTY INTO THE FUTURE YEARS. AND YOU CAN SEE ACTUALLY THAT IS SHOWN IN THE CHART. WITH ALL OF THAT TO SUMMARIZE, WE HAVE CHALLENGES. AND WE ARE COMMITTED TO BE SUSTAINABLE INTO THE LONG-TERM AND BE ABLE TO ADDRESS THESE CHALLENGES TOGETHER. SOME OF THE STATE IMPACTS THAT WE WILL FACE, FEDERAL IMPACTS THAT WE WILL CONTINUE TO FACE, WE'LL DISCUSS SOME OF THE LABOR MARKET CONDITIONS THAT ARE AFFECTING THE LOCAL AND NATIONAL ECONOMY, WHICH ALSO SOME OF THE IMPACTS ON JOB GROWTH AND PRODUCTIVITY THROUGHOUT THE COUNTY. WE'LL HAVE TO CONTINUE TO ADDRESS ALL OF THESE ELEMENTS THAT ARE AFFECTING OUR ECONOMY AND ALSO THE COUNTY'S BUDGET. BUT WE ARE CONTINUING TO IMPACT AND DEVELOP PLANS THROUGH THE BUDGET TO ADDRESS THESE CHALLENGES THAT WE WILL FACE AS AN ORGANIZATION. WITH THAT, THAT CONCLUDES THIS PART OF THE PRESENTATION. YOU WANT TO FIND ADDITIONAL RESOURCES ABOUT THE BUDGET, THERE IS A WEBSITE THAT IS HIGHLIGHTED ON THIS SLIDE THAT YOU CAN GO ON AND FIND THE SPECIFIC COUNTY BUDGET, THE ENTIRE DOCUMENT AND OTHER RELEVANT INFORMATION FOR THE COMMUNITY TO STAY ENGAGED, HOW TO PROVIDE FEEDBACK, HOW TO IF YOU ARE THAT YOU ARE WELL INFORMED TO FAST WHAT THE BUDGET ENTAILS, THE SERVICES THAT WE ARE PROVIDING, AND THE FUNDING TO PROVIDE THOSE SERVICES.

MR. WILLIAMS: I WANT TO TO SAY THANK YOU TO EZEKIEL AND THE ENTIRE TEAM AND OUR OFFICE OF THE BUDGET ANALYSIS HAS BEEN WORKING SO HARD FOR THE LAST MANY MONTHS. IT'S NOT A STRAIGHTFORWARD OR SIMPLE JOB. THIS IS NOT LIKE YOUR HOUSEHOLD BUDGET, TO SAY THE LEAST. THANK YOU FOR FISCAL STAFF AND LEADERSHIP ACROSS EVERY COUNTY DEPARTMENT. THERE IS A LOT OF BACK AND FORTH AND INTERRELATIONSHIP THAT GOES INTO PRODUCING THE RECOMMENDED BUDGET FOR REVIEW AND CONSIDERATION BY THE BOARD. I ALSO WANTED TO SAY, YOU KNOW, EZEKIEL CLOSED BY HIGHLIGHTING ON THAT SLIDE THE CATEGORIES OF RISKS THAT FACE US. AND WE ARE IN VERY UNCERTAIN TIMES. AND EACH LAYER OF RISK, MANY OF WHICH HAVE BEEN GENERATED BY THE FEDERAL GOVERNMENT, AND DON'T JUST MEAN THE DIRECT CUTS FROM HR1, BUT THE GEOPOLITICAL INSTABILITY AND THE ENERGY VOLATILITY AND OVERALL ECONOMIC CONDITIONS, ALL OF WHICH ARE ALSO GENERATED BY THE FEDERAL GOVERNMENT IN SIGNIFICANT PART. EVERY SINGLE ONE OF THEM ADDS A NEW AND SIGNIFICANT LEVEL OF UNCERTAINTY. THEN YOU STACK ON TOP OF THAT WHAT MIGHT COME FROM THE STATE. WE TALK A LOT ABOUT THE 30% OF OUR REVENUE THAT FEDERALLY DID HE STRIVES, 40% FLOWS VIA THE STATE. AND SO YOU PUT THOSE PIECES TOGETHER. GIVEN THE COUNTIES ARE POLITICAL SUBDIVISIONS OF THE STATE AND WE IMPLEMENT STATE PROGRAMS AND THESE REVENUE STREAMS ARE COMMINGLED, AND YOU CAN QUICKLY SEE JUST HOW SIGNIFICANT A MAGNITUDE OF UNCERTAINTY WE FACE HERE AT THE LOCAL LEVEL WHERE THE RUBBER MEETS THE ROAD AND WE ARE SEEKING TO DELIVER THESE ACTUAL SERVICES. SO WE HAVE NOT MADE AGGRESSIVE ASSUMPTIONS ON THESE. WE ARE NOT MADE CONSERVATIVE ASSUMPTIONS ON THESE. FOR THE MOST PART, WE HAVE MADE A NEUTRAL ASSUMPTION. WE ARE ASSUMING NO RECESSION. YOUR GUESS IS AS GOOD AS MINE. I THINK WE WILL HAVE SIGNIFICANT HEADWINDS IN THE NEXT YEAR. THIS BUDGET DOESN'T MAKE AN ASSUMPTION ABOUT THAT. IT DOESN'T MAKE AN ASSUMPTION OR BUILD IN ANYTHING IN PARTICULAR ABOUT OTHER NEW SOURCES OF GEOPOLITICAL INSTABILITY OR WHAT OR DOESN'T ARISE AS A RESULT OF WAR IN THE MIDDLE EAST OR MANY OF THESE OTHER HUGE FACTORS. AND IT DOESN'T MAKE AN ASSUMPTION ROUND WHAT MIGHT COME WITH THE MAY REVISE. AND I WANTED TO HIGHLIGHT THAT BECAUSE WE ARE GOING TO NOW MARCH THROUGH AND TALK ABOUT WHAT IS INCLUDED HERE AND WE ARE GOING TO LOOK AT THE SPECIFIC PROPOSALS, BUT THOSE THINGS ARE ALL SITTING HERE IN THE BACKGROUND. AND THEY ARE SIGNIFICANT. THEY ARE NOT SMALL. THEY ARE BIG. AND WE HAVE TO JUST BE AWARE OF THAT. AND BE AWARE OF THE BROAD HE HAVE CONTEXT IN THE 5-YEAR FORECAST AS WE ENGAGE IN THESE CONVERSATIONS. BUT THANK YOU TO EZEKIEL AND THE OBA TEAM. AND WITH THAT, WE ARE PREPARED TO ANSWER QUESTIONS FROM THE BOARD ABOUT THE OVERVIEW.

SUPERVISOR LEE: THANK YOU VERY MUCH, JAMES AND EZEKIEL. THANKS FOR THE BIG AND BEAUTIFUL NEWS YOU JUST DELIVERED TO US. SO LET'S SEE, LET'S SEE HOW MANY SPEAKER CARDS I THINK YOU HAVE MANY SPEAKERS THAT WANTED TO TALK ABOUT THE BUDGET ALREADY. LET'S SEE IF WE CAN GET MORE OF THOSE CARDS IN RIGHT NOW.

CLERK: YES, THERE ARE 15 IN-CHAMBER SPEAKERS AND 12 ZOOM SPEAKERS. 13. WE ARE HOLDING AT. OKAY. WE ARE JUMPING UP. THAT IS A TOTAL OF 30 SPEAKERS RIGHT NOW.

SUPERVISOR LEE: OKAY, LET'S DO ONE MINUTE EACH.

CLERK: OKAY, WE ARE NOW CLOSING THE QUEUE TO INDICATE THAT YOU WISH TO SPEAK FOR ITEM NUMBER 4. I WILL CALL THE IN-CHAMBERS SPEAKERS FIRST. IF YOU CAN JUST STATE THE NAME THAT YOU HAVE WRITTEN ON THE CARD TO HELP ME KEEP UP WITH THE FLOW. I HAVE MICHAEL ELLIOTT, ANDREA CARTER, MARISSA SIMON, KATLYN BLUE, CYNTHIA CORTEZ. AND WE WILL PAUSE THERE.

SUPERVISOR LEE: LET'S TRY THE MIC AGAIN. IT'S NOT WORKING YET.

CLERK: THERE WE GO.

DO I MESS SOMETHING? NO, I DO NOT. GOOD AFTERNOON. THANK YOU FOR THE OPPORTUNITY TO SPEAK. I AM SPEAKING TODAY IN STRONG SUPPORT OF ADMINISTRATION'S RECOMMENDED ALLOCATION OF THE 2025 MEASURE-ACTUAL FUNDS. AND ENCOURAGE THE BOARD.

TO SUPPORT THAT RECOMMENDATION IN THE FINAL BUDGET.

THROUGHOUT THE CAMPAIGN TO PASS MEASURE-A, THE NUMBER ONE QUESTION I GOT IF VOTERS IS, "BUT HOW DO WE KNOW THAT THE MONEY WILL ACTUALLY GO TO THE HOSPITALS?" AND THE ANSWER TO THAT QUESTION ULTIMATELY CAME DOWN TO TRUST. TRUST THAT THIS BOARD OF SUPERVISORS' DECISIVE, FIRST IN THE NATION PUSH-BACK AGAINST THE MEDICATE CUTS IN HR1 WAS NOT JUST FOR SHOW. TRUST THAT AT THAT BOARD UNDERSTANDS THE RISK TO THE COMMUNITY OF HOSPITALS IF THEY CLOSE. AND TRUST WHEN WE MAKE A PROMISE, WE FOLLOW THROUGH.

THE PROPOSED BUDGET SENDS A CLEAR AND POWERFUL MESSAGE TO THE VOTERS OF MEASURE-ACTUAL. MOM CESC MADE, PROMISES KEPT. THANK YOU VERY MUCH.

>> CLERK: AND I AM SORRY, YOUR NAME?

>> MICHAEL ELIOT.

>> CLERK: THANK YOU VERY MUCH. NEXT SPEAKER PLEASE.

>> GOOD AFTERNOON, BOARD OF SUPERVISORS. I AM ANDREA CARTER AND I AM HERE REPRESENTING THE 16 MEDICAL UNIT CLERKS WHOSE POSITIONS ARE BEING PROPOSED FOR DELETION. WE PLAY A CRITICAL ROLE FROM BOOK TO GO RELEASE, COORDINATE SCHEDULING FOR MEDICAL APPOINTMENTS, MENTAL HEALTH TREATMENT, SURGERIES, AND DISCHARGE PLANNING. WE WORK CLOSELY WITH NURSES, DOCTORS, MENTAL HEALTH STAFF, AND THE CORRECTIONAL OFFICERS. A LOT OF OUR WORK HAPPENS BEHIND THE SCENES, BUT REMOVING OUR POSITIONS WILL DIRECTLY IMPACT PATIENT CARE. DELAYS AND MISSED APPOINTMENTS COULD AFFECT MEDICAL CASES, SURGERIES, AND CRITICAL MENTAL HEALTH SERVICES. MANY OF US HAVE YEARS OF EXPERIENCE NAVIGATING THESE SYSTEMS, AND LOSING THAT KNOWLEDGE PUTS THE COUNTY AT RISK OF FAILING, FALLING OUT OF COMPLIANCE WITH THE CONSENT DECREE. I ASK THAT YOU RECONSIDER THESE CUTS AND WORK TOWARDS A SOLUTION TO PROTECT BOTH PATIENT CARE AND THE SERVICES OUR COMMUNITY DEPENDS ON. THANK YOU.

>> GOOD AFTERNOON. MY NAME IS A MARAIS SIMON. I WORK AT THE BEHAVIORAL HEALTH CALL CENTER. WE ARE THE FIRST VOICE PEOPLE HEAR WHEN THEY ARE EXPERIENCING MENTAL HEALTH CRISIS, SUBSTANCE USE EMERGENCIES, SUICIDAL THOUGHTS, HOMELESSNESS, FEAR, AND DESPERATION. REDUCING THE SIZE OF THE CALL CENTER CREATES DANGEROUS BARRIERS FOR OUR VULNERABLE COMMUNITY. FEWER STAFF MEANS LONGER WAIT TIMES, MISSED CALLS, OVERWHELMED WORKERS, DELAYED CRISIS INTERVENTION, AND ULTIMATELY MORE PEOPLE FALLING THROUGH THE CRACKS. WHEN ACCESS TO BEHAVIORAL HEALTH SUPPORT IS REDUCED, THE IMPACT DOES NOT DISAPPEAR. IT SHIFTS INTO EMERGENCY ROOMS, LAW ENFORCEMENT, JAILS, AND GRIEVING FAMILIES. I URGE YOU TO PROTECT THESE POSITIONS, SUPPORT THE WORKERS DURING THIS CRITICAL WORK, AND WORK WITH US TO FIND ALTERNATIVE WAYS TO ADDRESS THE BUDGET CRISIS. THANK YOU.

>> GOOD AFTERNOON. I AM KATLYN BLUE, A PSYCHIATRIC SOCIAL WORKER AT THE BEHAVIORAL HEALTH SERVICES DEPARTMENT. I'VE WORKED FOR THE LAST FOUR YEARS. OUR DEPARTMENT SERVES ONE OF THE MOST VULNERABLE AND MARGINALIZED POPULATIONS, HELPING PEOPLE ACCESS TREATMENT, STABILIZE THEIR LIVES, AND BECOME PRODUCTIVE MEMBERS OF THE COMMUNITY. ONE PROPOSED BUDGET SOLUTION IS REFERRING OUR PATIENTS TO NONUNION CONTRACTED PROGRAMS. THEY EXPERIENCE HIGHER STAFF TURNOVER DUE TO LOWER WAGES, POOR BENEFITS, INCREASING THE WAIT TIMES AND DISRUPTING TREATMENT. THESE MAY APPEAR EFFECTIVE IN THE SHORT TERM, BUT CAN LEAD TO HIGHER LONG-TERM COSTS AND POOR PATIENT OUTCOMES CAUSED BY INSTABILITY OF CARE. I URGE THE COUNTY TO CONSIDER THE LONG-TERM IMPACT OF THE CUTS AND WORK WITH SCIU TO EXPLORE REASONABLE ALTERNATIVES. UNION SHOULD BE PRIORITIZED. THEY PROVIDE STABLE STAFF AND CONSISTENT QUALITY CARE FOR PATIENTS. THANK YOU.

>> I'LL CONTINUE TO CALL THE ADDITIONAL NAMES. TRACY CORNER. TYRUS ASHFORD. JENNY RAMÍREZ. CRYSTAL. AND WE'LL PAUSE THERE. NEXT SPEAKER, PLEASE.

>>> GOOD AFTERNOON. I AM CYNTHIA CORTEZ. I WORK IN THE BEHAVIORAL HEALTH CALL CENTER WHERE WE CONNECT PEOPLE IN THE COMMUNITY TO MENTAL HEALTH SERVICES AND DRUG AND ALCOHOL TREATMENT. EVERY DAY WE ANSWER CALLS FROM PEOPLE IN CRISES, PEOPLE STRUGGLING WITH DIFFERENT ISSUES, HOMELESSNESS, DEPRESSION, ANXIETY, AND SUICIDAL THOUGHTS. FOR MANY CALLERS, WE ARE THE FIRST STEP TOWARD GETTING HELP. WITH THESE CUTS, THEY'LL FACE LONGER WAIT TIMES AND FEWER PEOPLE TO ANSWER THE CALLS. WHEN SOMEBODY IS FINALLY READY TO ASK FOR HELP, BEING PUT ON HOLD IS THE DIFFERENCE BETWEEN SUPPORT AND GIVING UP. I AM DEEPLY CONCERNED ABOUT THE LOSS OF SPANISH-SPEAKING STAFF. MANY OF OUR CLIENTS SPEAK SPANISH AND ALREADY FACE BARRIERS TO CARE. REDUCING BILINGUAL STAFF MAY MEAN SOME OF THE MOST VULNERABLE MAY NOT BE ABLE TO ACCESS SERVICES IN THEIR OWN LANGUAGE WHEN THEY NEED HELP THE MOST. THESE CUTS WILL NOT JUST AFFECT EMPLOYEES. THEY WILL AFFECT PEOPLE IN CRISES, FAMILIES, AND LIVES IN OUR COMMUNITY. I ASK YOU TO RECONSIDER THESE REDUCTIONS AND PROTECT THESE ESSENTIAL SERVICES. THANK YOU.

>> GOOD AFTERNOON, BOARD. I AM TRACEY CORNER, A MENTAL HEALTH REHABILITATION COUNSELOR WITH CENTRAL WELLNESS AND BENEFIT CENTER, AND A 12-YEAR COUNTY EMPLOYEE. I AM HERE TODAY TO RESPECTFULLY ASK THAT YOU RECONSIDER THE PROPOSAL TO CLOSE THE CENTRAL WELLNESS AND BENEFITS CENTER. FOR DECADES, CWBC PROVIDED BEHAVIORAL HEALTHCARE TO SOME OF THE COUNTY'S MOST VULNERABLE ADULTS. EVERY YEAR, MORE THAN 700 PEOPLE RELY ON CENTRAL WELLNESS BENEFIT CENTER FOR PSYCHIATRY, THERAPY, MEDICATION SUPPORT, COUNSELING, AND PEER SERVICES. FOR MANY OF THEM, THIS IS THE ONLY PLACE WHERE THEY CONSISTENTLY RECEIVE CARE. MANY OF OUR CLIENTS ARE NON-ENGLISH SPEAKING, UNDOCUMENTED, UNINSURED, OR LIVING WITH MAJOR BARRIERS TO ACCESSING CARE ELSEWHERE. THERE ARE VERY FEW PROVIDERS ABLE TO MEET THE LANGUAGE, CULTURAL, AND BEHAVIORAL HEALTH NEEDS OF THIS POPULATION IN A CONSISTENT AND MEANINGFUL WAY. DISRUPTING THESE SERVICES IS -- THANK YOU.

>> SUPERVISOR LEE: IF YOU CAN FINISH YOUR COMMENT, PLEASE SUBMIT THE REST OF YOUR STATEMENT AND WE'LL ADD IT TO THE RECORD. THANK YOU.

>> HELLO, BOARD OF SUPERVISORS. MY NAME IS JENNY RAMÍREZ. I, TOO, WORK AT CENTRAL WELLNESS AND BENEFIT CENTER. I HAVE BEEN THERE SINCE 2009 WHEN THE UNINSURED CLINIC STARTED, WHICH IS CENTRAL WELLNESS AND BENEFIT CENTER. THIS CLINIC HAS STARTED WORKING WITH UNINSURED BUT EVENTUALLY EVOLVED TO CENTRAL WELLNESS AND BENEFIT CENTER, WHICH IS LIKE A CATCH-ALL CLINIC WHICH HELPS NOT ONLY UNSUPPORTED AND UNINSURED AND INSURED CLIENTS, BUT WE ALSO HELP SUPPORT OUR DEPARTMENT BY THE CARRYOVER OF REFERRALS THAT ARE NOT ACCEPTED AT BOTH COUNTY AND CONTRACTED CLINICS. AND WE SUPPORT THAT. WE HELP WITH SOCIAL PROJECTS. FOR EXAMPLE, CLOSING THE KNOW NONE FSP PROGRAM BACK IN SEPTEMBER OF 2023. THINK WE HELPED PROVIDE SERVICES TO OTHER PEOPLE. THANK YOU.

>> YES, TO THE HONORABLE BOARD OF SUPERVISORS, MY NAME IS TYRUS. THIS IS A POSITION -- THIS IS A -- TO STOP THE CLOSURE OF CENTRAL WELLNESS BENEFIT CENTER. I AM A CERTIFIED MEDI-CAL PEER SUPPORT WORKER AT CWBC AND SPEAKING ON BEHALF OF ALL PEERS. WE HAVE MENTAL HEALTH CHALLENGES AND WORKED FOR THE COUNTY OF SANTA CLARA. I HAVE WORKED AT CWBC SINCE 2009. PLEASE BRING PEERS. BRING YOU A UNIQUE PERSPECTIVE ON THE SHORTCOMINGS WHICH CLIENTS FACE AND WILL FACE IF CWBC CLOSES. IT WOULD BE DEVASTATING BECAUSE IT'S NECESSARY -- IT'S A NECESSARY BRIDGE TO SERVICES THAT ARE VITAL TO CLIENTS, WHICH NUMBER IN THE HUNDREDS THAT ARE CURRENTLY LOCATION AND EASILY ACCESSIBLE BY BUS OR CAR FOR PATIENTS IN THE SURROUNDING COMMUNITIES. WE ARE PRIVILEGED TO SERVE. ALSO THE LOCATION.

>> SUPERVISOR LEE: THANK YOU.

>> CLERK: I'LL CONTINUE WITH THE IN-CHAMBER SPEAKER CARDS. DÍAZ, MICHAEL CELSO. ANGELA LÓPEZ. MENDEZ AND GUILLERMO. NEXT SPEAKER, LOOK AGREES. HI, BOARD MEMBERS. I AM CRYSTAL ZUÑIGA, A HEALTH SERVICE REPRESENTATIVE AT THE BEHAVIORAL HEALTH CALL CENTER. AS A HEALTH SERVICES REPRESENTATIVE, WE WERE OFTEN THE FIRST POINT OF CONTACT FOR VULNERABLE MEMBERS OF OUR COMMUNITY FACING MENTAL HEALTH OR SUBSTANCE USE CHALLENGES. WE SUPPORT INDIVIDUALS AND FAMILIES DURING SOME OF THE MOST DIFFICULT MOMENTS OF THEIR LIVES BY CONNECTING THEM TO CRITICAL TREATMENT RESOURCES, SUPPORT, AND SUPPORT SERVICES. MANY CALLERS CALL WHILE EXPERIENCING FEAR, EMOTIONAL DISTRESS, HOPELESSNESS, OR CRISIS, AND AT TIMES WE MUST ALSO RESPOND TO EMERGENCIES INVOLVING IMMEDIATE SAFETY CONCERNS. REDUCING HEALTH SERVICES REPRESENTATIVES POSITIONS WOULD SEVERELY IMPACT OUR COMMUNITIES' ACCESS TO BEHAVIORAL HEALTH SERVICES. FEWER STAFF, LONGER WAIT TIMES, OVERWHELMING CALLS, DELAYED CARE, VULNERABLE INDIVIDUALS POTENTIALLY FALLING THROUGH THE CRACKS WHEN THEY NEED HELP THE MOST. I AM BLARE BATY, A MEDICAL CLERK AT CHS AND MAUGHAN JAIL. MY RESPONSIBILITY IS COORDINATING AND SCHEDULING COURT-MANDATED PSYCHIATRIC APPOINTMENTS FOR ALL OF C HAD. S WORKING CLOSELY WITH COURTS, SOCIAL WORKERS, DOCTORS, AND NURSES EVERY DAY. WE CONTROL THE DAY-TO-DAY FLOW OF PATIENTS THAT KEEP CUSTODY HEALTH FUNCTIONING. WE ARE A CRITICAL PART OF THE INCARCERATION PROCESS. FROM INTAKE THROUGH DISCHARGE. ELIMINATING THIS CLASSIFICATION WOULD BE DETRIMENTAL TO THE SYSTEMS AND THE PATIENTS THAT DEPEND ON IT. TESTIMONY WORKING IN JAIL TAKES A SPECIAL SKILL SET. DESPITE THE STRESS, WE LOVE OUR JOBS AND THE PEOPLE WE WORK ALONGSIDE, SPENDING MORE TIME OFTEN TOGETHER THAN WITH OUR OWN FAMILIES. THEY THIS HE IS PRACTICE HE PRO. THERE IS STRESS IN CUSTODY LEADERSHIP AND REBUILDING THAT REQUIRES TRANSPARENCY AND HONESTY. BEING TOLD THESE JUST PROPOSED WHILE BE ASKED TO ORIENT OUR REPLACEMENTS IS DISHEARTENING. I ASK YOU TO PROTECT THESE POSITIONS. THANK YOU.

>> I AM ANGELA, A CLIENT RECEIVING SERVICES FROM THE CALL CENTER. I JUST WANTED TO SAY WITHOUT THESE SERVICES, I WOULD NOT BE WHERE I AM AT TODAY. IT HAS HELPED ME IN SO MANY WAYS YOU CANNOT IMAGINE. I THANK THEM EVERY SINGLE DAY. I LIVE A GOOD LIFE. THEY HAVE HELPED ME WITH EVERYTHING I THOUGHT I COULDN'T GET DONE, BUT I HAVE. AND TODAY I AM LIVING HAPPY BECAUSE OF ALL OF THE PROGRAMS. ONE MORE THING, SORRY, WITHOUT THEM, THEM, I DON'T KNOW WHERE I WOULD BE. FOR THAT, THANK YOU SO MUCH. AND I AM ALSO GRATEFUL TO SAY THAT I AM A LAW-ABIDING CITIZEN TODAY. PLEASE PUT INTO CONSIDERATION ME AND OTHER INDIVIDUALS THAT STILL NEED THESE SERVICES. THANK YOU.

>> GOOD AFTERNOON, SUPERVISORS. MY NAME IS FOR LEASH AS DÍAZ. I AM A PSYCHIATRIC SOCIAL WORKER TWO AT CENTRAL WELLNESS AND BENEFIT CENTER. I AM HERE BECAUSE LOSING CWBC IS NOT JUST REMOVING A SERVICE, IT'S STABILITY AND HOPE FOR MANY. OUR OUTPATIENT REDUCES PSYCHIATRIC HOSPITALIZATIONS, HOMELESSNESS, INCARCERATION, AND EMERGENCY ROOM VISITS, WHICH COST THE COUNTY MORE IN THE LONG RUN. CWB CEELO INDICATED ON THE VMC CAMPUS PROVIDES ESSENTIAL MENTAL HEALTH SERVICES FOR INDIVIDUALS FACING BARRIERS TO CARE: DISCRIMINATION, MARGINALIZATION, AND CULTURAL CHALLENGES. LAST YEAR ALONE, WE SERVED 700 CLIENTS WHOSE STABILITY AND WELL-BEING WOULD BE THREATENED BY THIS CLOSURE. FOR MANY, CWBC PROVIDES CARE, SUPPORT, AND HUMAN CONNECTION THAT HELPS THEM REMAIN HOUSED, CARE FOR THEIR FAMILIES, AND MAINTAIN EMPLOYMENT. I ASK YOU TO CONSIDER THE LONG-TERM HUMAN AND FINANCIAL COSTS AND KEEP THIS LINK OPEN. THANK YOU.

>> I AM MICHAEL CELSO, A LICENSED CLINICAL SOCIAL WORKER AT THE CALL CENTER. THE PROPOSED DELETIONS OF SERVICES IN OUR DEPARTMENT WILL BE HARMFUL TO CLIENTS. THE REDUCTION OF HEALTH SERVICES REPRESENTATIVES AND CLINICAL STAFF WILL CAUSE SIGNIFICANT WAIT TIMES, AND BOTH CLIENTS AND PROVIDERS WILL GIVE UP AND END THE CALL BEFORE CLIENTS WOULD BE SCREENED, REFERRED TO MENTAL HEALTH AND/OR SUBSTANCE USE TREATMENT SERVICES. THIS WILL RESULT IN INCREASED HOSPITAL AND EPS ADMISSIONS BECAUSE COMPLAINTS WON'T BE CONNECTING TO THE SUPPORT THEY NEED IN THE COMMUNITY. ADDITIONALLY, THE CALL CENTER IS A REVENUE-GENERATING DEPARTMENT. OUR SERVICES ARE REIMBURSABLE BY DHCS UNDER QUALITY ASSURANCE AND UTILIZATION REVIEW. SO IT IS COUNTERPRODUCTIVE TO ELIMINATE POSITIONS THAT GENERATE REVENUE FOR THE COUNTY. I HUMBLY ASK THAT YOU PLEASE REJECT THE COUNTY'S PROPOSED BUDGET AND WORK WITH THE UNION ON ALTERNATIVES THAT BETTER SUPPORT CLIENT CARE. THANK YOU VERY MUCH.

>> GOOD AFTERNOON, SUPERVISORS. I AM AMELIA MENDEZ. I AM H S A AND WORKING FOR MEDICAL CENTER. AND THEN THIS AFTERNOON, I AM JUST HERE TO ASK YOU TO CONSIDER THE CUTS HAVE -- IN MEDICAL FIELD. SINCE OUR PATIENTS DESERVE A GOOD QUALITY OF CARE. THANK YOU.

>> CLERK: THANK YOU. WE HAVE ONE MORE NAME LEFT IN THE BATCH OF IN-CHAMBER SPEAKERS. GUILLERMO. DO YOU WISH TO SPEAK?

>> GOOD AFTERNOON. MY NAME IS GUILLERMO. I HAVE A UNIQUE, I GUESS, INSIGHT ON WHAT HAS BEEN GOING ON. I ACTUALLY WORKED FOR YOUR GRIEVANCE DEPARTMENT. I GET ALL OF THE CALLS OF WHAT'S BEEN GOING ON AS OF LATE. THE TRUTH IS, I GET CALLS, GRIEVANCES, WHETHER IT'S 988 OR SAY ALL OF OUR CONTRACTS FROM CEMA, ALL THE OTHER ONES. THEY ARE NOT VERY HAPPY. THERE HAS BEEN SO MUCH DEGRADATION IN THE KIND OF SERVICES THAT THIS COUNTY HAS WE PROVIDING OVER THE PAST DECADES. IT'S REALLY SAD TO HEAR WHAT I HEAR. IF YOU ONLY KNEW AND HEARD WHAT I HEARD. HOW HEARTBREAKING IT IS TO HEAR WHAT THESE BUDGET CUTS HAVE BEEN DOING AND DEVASTATING TO EVERY SINGLE DEPARTMENT COUNTYWIDE. IT IS HEARTBREAKING. I ASK YOU TO KINDLY RECONSIDER AND WORK WITH SCIU TO SEE HOW MANY JOBS -- WE KNOW THE TRUTH IS THERE WILL BE CUTS, JOBS LOST. PLEASE WORK WITH THE COUNTY -- OR WITH SCIU.

>> CLERK: THANK YOU. WE WILL NOW -- RIGHT THERE ON THE TABLE. THANK YOU SO MUCH. WE ARE NOW GOING TO OUR ZOOM SPEAKERS. OUR FIRST SPEAKER ON ZOOM IS CHRISTINA LÓPEZ. PLEASE ACCEPT THE UNMUTE AND YOU MAY BEGIN YOUR COMMENTS. SPEAKER BY THE NAME CHRISTINA LÓPEZ. OKAY, WELCOME BACK. CHRISTINA?

>> CAN YOU HEAR ME?

>> CLERK: YES, WE CAN HEAR YOU. YES, PLEASE BEGIN.

>> HI, GOOD AFTERNOON, BOARD OF SUPERVISORS. MY NAME IS CHRISTINA LÓPEZ. IS CUTTING SERVICES REALLY THE ONLY WAY TO SAVE MONEY? THESE CUTS WILL HAVE REAL CONSEQUENCES FOR WORKERS, FAMILIES, AND FOR PATIENT CARE FOR THE COMMUNITY THAT DEPENDS ON US. PLEASE PROTECT OUR SERVICES AND THE JOBS OUR COUNTY WORKERS DEPEND ON. PLEASE WORK WITH K S*FPLT CIU ON ALTERNATIVES THAT KEEP PATIENT CARE AND SUPPLEMENTAL HEALTH SUPPORT WITHOUT CUTTING JOBS. THANK YOU.

>> CLERK: THANK YOU. OUR NEXT SPEAKER IN THE QUEUE IS JODY. PLEASE ACCEPT THE UNMUTE AND YOU MAY BEGIN.

>> I AM JODY HOFFMAN WITH THE TECHNICAL SERVICES -- CLOSURES AND SERVICES. AS FAR AS ITEM 27, THE DELETION OF THE SYSTEM ADMIN AT THE END POINT MANAGEMENT DEPARTMENT AND TRANSFERRING OVER SHIP OF ENVIRONMENT MONITORING TO SAF. CURRENTLY, THE MONITORING MONITORING THE ENVIRONMENT IS DONE BY THE SYSTEM ADMIN CHECK AND PROVIDE REAL-TIME MONITORING OF THE DATA CENTER ENVIRONMENT. THIS IS WHEN AN.

>> MR. WILLIAMS: ED ADMINISTRATOR CONFIGURE THE ALERT THRESHOLDS AND MAINTAIN THE MONITORING SYSTEMS AND SUPPORT THE TECHNICIANS. SO FAR SEE THE SYSTEM HEALTH AND PHYSICAL CONDITION. HIS ENABLES US EARLY DETECTION OF ISSUES AND ENSURES IMMEDIATE SOLUTIONS TO OVERHEATING OR EQUIPMENT FAILURE. TRANSFERRING THE MONITORING TO FAF WILL CAUSE DELAYS IN --

>> CLERK: THANK YOU. THE NEXT SPEAKER IS MARVIN. MARVIN, PLEASE ACCEPT THE UNMUTE.

>> HELLO? CAN YOU HEAR ME?

>> CLERK: YES, PLEASE BEGIN.

>> OKAY. MEMBERS OF THE BOARD, THANK YOU FOR YOUR TIME. I WANTED TO HIGHLIGHT A CRITICAL RISK AFFECTING OUR HOSPITAL SYSTEM. THE STAFFING OF TSS I.T. SUPPORT TEAM. THESE SPECIALISTS WORK INSIDE OUR HOSPITALS EVERY DAY SO SUPPORTING ESSENTIAL CRITICAL TO ARMBAND PRINTERS FOR PATIENT IDENTIFICATION, MEDICAL SCANNERS FOR BARCODE ADMINISTRATION, AND MOBILE MEDICAL CARDS USED FOR REAL-TIME DOCUMENTATION. THESE ARE NOT JUST OFFICE DEVICES. THEY ARE CORE TO SAFE PATIENT CARE. I RESPECTFULLY ASK FOR CLARIFICATION ON THREE POINTS. WHY HAVE EIGHT FUNDED SUPPORT CODES REMAINED UNFILLED AND FOR HOW LONG? OUR HEALTH AND HOSPITAL TSS SERVICE LEVEL AGREEMENTS, INTENTIONALLY REDUCED THROUGH CUTS TO REDUCE SUPPORT STAFFING.

>> CLERK: THE NEXT SPEAKER IN THE QUEUE IS GUADALUPE. PLEASE ACCEPT THE UNMUTE.

>> GOOD AFTERNOON. I AM GUADALUPE. I AM A LICENSED MARRIAGE AND FAMILY THERAPIST. I RECOMMEND THE COUNTY TO PRESERVE MENTAL HEALTH AND BEHAVIORAL HEALTH POSITIONS. I MOVED FROM MASSACHUSETTS TO CALIFORNIA TO ATTEND SANTA CLARA UNIVERSITY BECAUSE OF THE COMMITMENT TO ADDRESSING THE SHORTAGE OF BEHAVIORAL HEALTH PROVIDERS IN THE NATION. SANTA CLARA COUNTY'S GROWING DEMAND FOR MENTAL HEALTH SERVICES REFLECTS PROGRESS IN REDUCING BARRIERS TO CARE AND SHOWS RESIDENTS THAT THEIR MENTAL HEALTH MATTERS. CALIFORNIA HAS BECOME A LEADER IN BEHAVIORAL HEALTH, HELPING MAINTAIN ONE OF THE NATION'S LOWEST SUICIDE RATES, WHILE ALSO SANTA CLARA COUNTY REMAINS AMONG THE LOWEST IN THE STATE. THE ELIMINATING BEHAVIORAL HEALTH POSITIONS IS NOT THE ANSWER. COUNTY EMPLOYEES PROVIDE STABILITY AND CONTINUITY OF CARE WHILE CONTRACTED AGENCIES FACE HIGH TURNOVER AND OVERWHELMING DEMAND. COUNTY MIGHT PRIORITIZE RETAINING EMPLOYEES AND STRENGTHENING PARTNERSHIPS TO PROTECT HIGH QUALITY.

>> CLERK: THANK YOU. THE NEXT SPOKEN IS JEN NUNO. PLEASE ACCEPT THE UNMUTE.

>> HI, I AM JEN JENNIFER NUNO, A RN AT ST. LOUIS HOSPITAL. THESE CUTS ARE NOT JUST NUMBERS ON A SPREADSHEET. THEY DIRECTLY IMPACT PATIENT SAFETY, QUALITY OF CARE, AND THE NURSES AND HEALTHCARE WORKERS WHO KEEP THE SYSTEM RUNNING EVERY DAY. FURTHER REDUCTIONS TO NURSING STAFF AND CUTS TO WAGES WILL PRACTICE COMPROMISE PATIENT CARE. NURSES ARE ALREADY STRETCHED THIN CARING FOR MORE PATIENTS WITH FEWER RESOURCES. WHEN STAFFING BECOMES UNSAFE, THE RISK OF DELAYED CARE, MISS CHANGES IN PATIENT CONDITIONS, AND COMPLICATIONS INCREASES. RESEARCH SHOWS THAT INADEQUATE NURSE STAFFING LEADS TO HIGHER RATES OF MEDICAL ERRORS AND WORSENS PATIENT OUTCOMES. THEY THREATEN WORKFORCE RETENTION AT A TIME WHEN HEALTHCARE SYSTEMS ACROSS CALIFORNIA ARE ALREADY STRUGLED WITH BURNOUT AND STAFFING SHORTAGES. REDUCING POSITIONS WILL PUSH EXPERIENCED NURSES AWAY FROM COUNTY HEALTHCARE, WEAKENING THE VERY SAFETY NET OUR COMMUNITY DEPENDS ON. I URGE YOU TO PRIORITIZE PATIENT STAFF AND PROTECT FRONTLINE STAFFING. INVESTING IN NURSES AND HEALTHCARE WORKERS IS INVESTING IN SAFE, EFFECTIVE CARE FOR EVERY MEMBER OF THIS COUNTY. THANK YOU.

>> CLERK: THANK YOU. THE NEXT SPEAKER IS ROB MEANS. PLEASE ACCEPT THE UNMUTE.

>> AS I SEE IT, THE BILLIONAIRE CLASS AND THEIR CORPORATIONS BROUGHT US THE REPUBLICAN REGIME THAT RENEGED ON FINANCIAL AGREEMENTS, THUS CREATING OUR FINANCIAL CRISIS. SO MAKE THEM PAY FOR THE SHORTFALL BY IMPOSING TAXES ON POLLUTERS, WASTE MAKERS, AND FREELOADERS. THERE IS A LONG LIST OF PRODUCTS FROM CORPORATIONS THAT CAUSE PERSONAL AND SOCIETAL HARM. A SUPER MAJORITY OF VOTERS WOULD UNDOUBTEDLY SUPPORT TAXING MANY OF THEM. FIGURE OUT WHICH ONES AND CRAFT TAXES ON THEM FOR VOTERS TO VOTE ON. FIND A STARTER LIST OF SCREW THE PUBLIC PRODUCTS ON THE BUDGET PAGE OF MEANS FOR DEMOCRACY.ORG. THAT'S MEANSFORDEMOCRACY.ORG. THANK YOU.

>> CLERK: THE NEXT SPEAKER IN THE QUEUE IS CAM NGUYEN. PLEASE ACCEPT THE UNMUTE.

>> GOOD AFTERNOON, BOARD OF SUPERVISORS. MY NAME IS KIM NGUYEN, AND I WORK AT THE BEHAVIORAL HEALTH CALL CENTER. WHEN RESIDENTS CALL US, THEY ARE OFTEN IN THE MIDST OF A PSYCHIATRIC CRISIS OR SEEKING URGENT ADDICTION TREATMENT. WE KNOW THE IMPACT OF UNDERSTAFFING BECAUSE WE HAVE SEEN IT. WAIT TIMES ONCE REACHED OVER TWO HOURS. FOR A PERSON IN CRISIS, THAT ISN'T JUST A DELAY. IT'S THE DIFFERENCE BETWEEN ENTERING TREATMENT OR GIVING UP ENTIRELY. WHEN WAIT TIMES INCREASE, THE CONSEQUENCES FOR OUR COMMUNITY ARE REAL: HIGHER RATES OF SUICIDE, OVERDOSE, AND INCREASED POLICE INTERVENTION. THESE LAYOFFS WILL BRING THOSE DANGEROUS TIMES BACK. PLEASE MAINTAIN OUR STAFFING LEVELS SO WE CAN ENSURE THAT WHEN OUR RESIDENTS CALL FOR HELP, SOMEONE IS THERE TO ANSWER.

>> CLERK: THANK YOU FOR YOUR COMMENTS. THE NEXT SPEAKER IS SARA. PLEASE ACCEPT THE UNMUTE.

>> HELLO, I AM SARA. I I WORK AT O'CONNOR HOSPITAL. I AM A PART OF RNPA AND I JUST HAVE A QUESTION. WHAT CONCESSIONS HAVE THE BOARD OF SUPERVISORS OR THE HEALTHCARE ADMINISTRATION MADE TO ADDRESS THIS BUDGET CRISIS BESIDES ASKING US NURSES TO SACRIFICE A 4% RAISE? I HAVEN'T HEARD OF ANY SACRIFICES BEING MADE FROM JAMES WILLIAMS OR JUANA OR ANY OF THE BOARD OF SUPERVISORS IN TERMS OF MAYBE DELAYING THEIR BONUSES FOR THIS YEAR OR RAISES. INSTEAD OF LOOKING AT THE CUTS FOR THE -- IN TERMS OF SERVICES, WE SHOULD LOOK TO CUT THE HIGHER UPS. THANK YOU.

>> CLERK: THE NEXT SPEAKER IS [INAUDIBLE]. PLEASE ACCEPT THE UNMUTE.

>> HI, CAN YOU HEAR ME?

>> CLERK: YES, PLEASE BEGIN.

>> I AM [INAUDIBLE], A NURSE FOR VALLEY MEDICAL CENTER IN INPATIENT. I AGREE WITH THE LAST CONVERSATION. WHAT CUTS ARE YOU GUYS DOING IN ORDER FOR YOURSELVES RATHER THAN SACRIFICING OTHERS IN THE COMMUNITY? I WORK IN A DEPARTMENT WHERE MY UNIT HAS ALREADY BEEN MERGED AND CUTS HAVE ALREADY BEEN MADE AND PATIENT SAFETY HAS BEEN INCREASED AND NURSE BURNOUT HAS INCREASED. WHEN YOU TALKED ABOUT COMMUNITY, CORE, RESPECT, HEALTH IS NUMBER ONE AND FOOD IS NUMBER TWO. HOW CAN WE PROVIDE FOOD FOR OUR CHILDREN WHEN CUTS ARE ALREADY BEING MADE? AND WHAT WE DON'T HAVE THE QUALITY OF INCOME COMING IN. PLEASE CONSIDER THAT MEASURE-ACTUAL PASSED BECAUSE WAS AS A COMMUNITY GOT THAT TO PASS, $330 MILLION HAS BEEN ALREADY IN. CAN YOU GUARANTEE THAT WILL STAY IN THE HOSPITAL? THANK YOU.

>> CLERK: THE NEXT SPEAKER IN THE QUEUE IS GUSTAVO. PLEASE ACCEPT THE UNMUTE.

>> HELLO, CAN YOU HEAR ME?

>> CLERK: YES.

>> HELLO BOARD OF SUPERVISORS. I AM GUSTAVO MADRIGAL. I HAVE BEEN A PSYCHIATRIC SOCIAL WORKER WITH THE BEHAVIORAL HEALTH CALL CENTER SINCE 2019. I AM HERE TO SHARE HOW THE BUDGET IMPACT WILL IMPACT US. OUR UNIT IS THE MAIN POINT OF CONTACT, AGAIN, THE MAIN POINT OF CONTACT, CONNECTING COMMUNITY MEMBERS TO MENTAL HEALTH AND SUBSTANCE USE TREATMENT AND SUPPORT SERVICES. DURING THE PANDEMIC, THE CALL CENTER EXPERIENCED LONG WAIT TIMES DUE TO INADEQUATE STAFFING. SINCE THEN, WE HAVE MADE SIGNIFICANT IMPROVEMENTS AND NOW CONNECT CLIENTS TO CARE MORE EFFICIENTLY AND IN A TIMELY MANNER. IF LAYOFFS AND STAFFING REDUCTIONS MOVE FORWARD, THE COUNTY'S MISSION TO PROVIDING ADEQUATE AND TIMELY ACCESS TO SERVICES WILL SIGNIFICANTLY BE IMPACTED. COMMUNITY MEMBERS WILL FACE LONGER WAIT TIMES AND RISK RETURNING TO THE SAME STAFFING CRISIS THE SERVICES -- AND SERVICES DELAYED.

>> CLERK: THE NEXT SPEAKER IN THE QUEUE IS DELORES. PLEASE ACCEPT THE UNMUTE. YOU MAY BEGIN.

>> GOOD AFTERNOON, BOARD OF SUPERVISORS. I AM DA ROAR A SCHULTZ, THE LEAD CLINICIAN AT THE BEHAVIORAL HEALTH CALL CENTER. I URGE YOU TO RECONSIDER THE PROPOSED CUTS TO OUR CLINIC WHICH WOULD ELIMINATE HALF OF OUR FRONTLINE BILINGUAL CLINICIANS. IT SERVES AS THE CONNECTION BETWEEN PROVIDERS AND THE COMMUNITY, OFFERING MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT REFERRALS TO 1.9 MILLION SANTA CLARA COUNTY RESIDENTS. THESE CUTS WOULD INCREASE WAIT TIMES AND REDUCE ACCESS TO ESSENTIAL SERVICES, PLACING MORE PEOPLE AT RISK OF CRISIS, HOMELESSNESS, OVERDOSE, AND SUICIDE. OUR CALL CENTER HELPS PEOPLE ACCESS CARE BEFORE CONDITIONS WORSEN, REDUCING THE NEED FOR MORE COSTLY EMERGENCY INTERVENTIONS. CUTTING THE STAFF WILL NOT REDUCE DEMAND FOR SERVICES. IT WILL ONLY DELAY CARE AT A GREATER HUMAN AND FINANCIAL COST. THESE CUTS WOULD UNDO YEARS OF PROGRESS MADE BY OUR EXCEPTIONAL TEAM. PLEASE PROTECT THIS VITAL SERVICE AND THE COMMUNITY MEMBERS WHO DEPEND ON IT. THANK YOU.

>> CLERK: THE NEXT SPEAKER IN THE QUEUE IS EN, KEN. PLEASE ACCEPT THE UNMUTE.

>> GOOD AFTERNOON. MY NAME IS DR. KEN HOROWITZ WITH THE HEALTH AHEAD VIEW IS ARE YOU COMMISSION. I WANTED TO RED YOU KNOW THAT I SUPPORT THE CREATION OF PRIMARY CARE SATELLITE CLINICS. MY ONLY SUGGESTION IS THAT IN THE LIST OF 29 FTE POSITIONS, YOU CONSIDER DENTISTS AND DENTAL HYGIENISTS AS PART OF THE PRIMARY CARE TEAM. DID HE WANT TIFFS HAVE THE ABILITY -- DENTISTS ARE THE HAVE THE ABILITY TO SCREEN FOR MAJOR DISEASES, ONE IS TOOTH DECAY, AND SECOND OF ALL. IN THE HIRING OF PHYSICIANS WORKING AT THE SATELLITE CLINICS, I WOULD LIKE YOU TO CONSIDER EMPLOYING PHYSICIANS TRAINED IN FUNCTIONAL AND INTEGRATIVE MEDICINE. THANK YOU FOR YOUR TIME.

>> CLERK: THANK YOU. AND THE LAST SPEAKER WHO HAD THEIR HAND RAISED AT THE CALL OF THE CUE, BEN-Z. PLEASE ACCEPT THE UNMUTE.

>> YES, THANK YOU. I WOULD LIKE TO PUT A FOCUS ON NONDISCRETIONARY SPENDING. I DON'T THINK THAT OUR COUNTY IS DOING ENOUGH OF THAT OR PUTTING AN IMPORTANT ON THAT. AND I WOULD LIKE TO GIVE YOU AN EXAMPLE. MY CHILDREN ARE BEING SEXUALLY MOLESTED. MY SON HAS CONFIRMED. MY EX-WIFE IS LETTING AN MAN RAPE HIM AND UNNECESSARY BATHING AND SEXUAL CONTACT BETWEEN TWO OF THE CHILDREN. THIS IS ALL CAUSED MY CHILDREN GREAT DISTRESS AND BECAUSE THERE IS A CONFLICT OF INTEREST IN THE ATTORNEYS INVOLVED IN ALL OF THIS, THE COUNTY IS REFUSING TO PROVIDE A SCREENING FOR MY CHILDREN. THERE HAS NEVER BEEN AN INVESTIGATION OF ANY KIND. AND MY CHILDREN DESERVE A SCREENING. YAK THIS COUNTY IS SAYING THIS IS A CHOICE. YOU DID HE HAD TO DECIDE IF A CHILD GETS A SCREENING OR NOT OR IF A SEXUALLY ABUSED CHILD GETS PROTECTED OR NOT. IT'S TERRIBLE WHAT'S GOING ON IN THE COUNTY AND WE NEED TO CHANGE IT. THANK YOU FOR YOUR TIME.

>> CLERK: WAS THAT WAS THE LAST SPEAKER WHO INDICATED THAT THEY WISHED TO SPEAK UNDER ITEM FOUR.

>> SUPERVISOR LEE: THANK YOU. FIRST, I WANT TO MENTION THAT CALIFORNIA LAW PROHIBITS THE DISCLOSURE OF INFORMATION RELATED TO ANY INVESTIGATION OF CHILD SEXUAL ABUSE. WE ARE NOT AUTHORIZED BY LAW TO SPEAK TO THE SPECIFIC OF ANY PARTICULAR CASE OR THE RESULTS OF AN INVESTIGATION. CALIFORNIA LAW ALSO REQUIRES TO THE WELFARE DEPARTMENTS FOR KIDS TO IMMEDIATELY CROSS-REPORT PHYSICAL AND SEXUAL ABUSE OF CHILDREN TO LAW ENFORCEMENT. THE PUBLIC AND CAN BE ASSURED THAT THE COUNTY TAKES ALL ALLEGATIONS SERIOUSLY, INCLUDING AND ALL ACTIONS APPROPRIATE WILL BE TAKEN. THANK YOU. THAT BEING SAID, MOVING ONTO OUR QUESTIONING. I'LL CLOSE THE PUBLIC QUESTIONING. THIS ITEM. SPEAKING ON THAT ITEM AND GO COUNSEL THE DAIS, ACTUALLY ON -- FROM MY COLLEAGUES FOR THE QUESTIONS. SUPERVISOR ELLENBERG.

>> SUPERVISOR ELLENBERG: I DON'T HAVE QUESTIONS BUT WANT TO MAKE SOME OPENING COMMENTS.

>> SUPERVISOR LEE: I WANTED TO MENTION SINCE THIS IS A BIG ITEM, LET'S DO THE FIVE-MINUTE RULE FOR THIS ONE AND SEE HOW IT GOES.

>> SUPERVISOR ELLENBERG: THAT'S FINE.

>> SUPERVISOR LEE: THANK YOU.

>> SUPERVISOR ELLENBERG: THE WHIPLASH OF THE LAST 10 MONTHS SINCE THE SIGNING OF THE SO-CALLED BIG, BEAUTIFUL BILL HAS LEFT OUR COUNTY, LONG WITH SO MANY OTHERS, SCRAMBLE TO GO MITIGATE THE RAIL THE AFTERMATH TO OUR SYSTEMS AND OUR SERVICES. OUR COUNTY'S 2 MILLION RESIDENTS RALLIED. 57% OF US CHOSE TO SELF-TAX TO PRESERVE THE HEALTHCARE SYSTEM. WE HAVE INCREASED OUR ADVOCACY TO THE STATE AND FEDERAL GOVERNMENTS. WE HAVE MADE -- WE MADE SIGNIFICANT CUTS TO OUR CURRENT BUDGET BACK IN MARCH, AND WE'LL MAKE EVEN MORE OVER THE NEXT SEVERAL WEEKS. WE ARE DOING EVERYTHING WITHIN OUR CONTROL TO MEET THIS CRISIS. BUT THE TRUTH IS, THAT MOST OF THE FUND AND POLICY DECISIONS WERE MADE BY ENTITIES OUTSIDE OF OUR CONTROL. FEDERAL AND STATE MANDATES DICTATE WHAT SERVICES WE MUST PROVIDE AND HOW WE MUST PROVIDE THEM, WHILE THE FUNDING TO SUSTAIN THOSE MANDATES CONTINUES TO SHRINK. ALL OF THIS MEANS THAT SOLUTIONS ARE NOT COMING FROM ELSEWHERE. WE HAVE TO FIND SOLUTIONS OURSELVES. AMID THE NOISE AND THE CHAOS CAUSED BY THIS WHIPLASH, I HOLD A FEW TRUTHS AS WE EMBARK ON THIS YEAR'S BUDGET BALANCING. NUMBER ONE, I TRUST THAT OUR ADMINISTRATION HAS MADE RECOMMENDATIONS BASED ON THEIR SUBJECT MATTER AND FISCAL EXPERTISE, THAT REFLECT THEIR BEST EFFORTS TO PRESERVE VITAL SERVICES FOR OUR RESIDENTS WHO RELY ON THEM, KEEP OUR WORKFORCE STABLE, AND PLAN FOR A FUTURE WHICH UNFORTUNATELY LOOKS EVEN GRIMMER IN THE NEXT COUPLE OF OUT YEARS. SECOND, I EXPECT TRANSPARENCY, AND OUR RESIDENTS DESERVE TO UNDERSTAND IN ACTUAL DETAIL HOW THEIR DOLLARS ARE BEING USED TO PROMOTE THE PUBLIC GOOD. AND ABOVE ALL, I BELIEVE THAT EVERY DECISION MUST BE MADE THROUGH THE LENS OF HOW THOSE PROPOSED CUTS, RESTRUCTURES, OR RIGHT-SIZING WILL AFFECT THE PEOPLE WHO RELY ON THOSE SERVICES EVERY SINGLE DAY. FOR EVERY CUT, EVERY RESTRUCTURE, WE MUST ASK, WHO DOES THIS AFFECT, AND IS THERE A LESS HARMFUL ALTERNATIVE? AND WE HAVE TO RECOGNIZE THAT EVEN MODEST CUTS ARE COMPOUNDED WHEN THE SAME INDIVIDUALS TOUCH MULTIPLE COUNTY SYSTEMS, AND THE CUMULATIVE EFFECT WILL BE FAR GREATER THAN ANY SINGLE REDUCTION IN FUNDING MIGHT SUGGEST. AND JUST AS IMPORTANT, WE MUST RECOGNIZE THAT EVERY SERVICE WE PROVIDE, ESPECIALLY THE DOLLARS WE INVEST IN PREVENTION OF HARM AND TRAUMA, CONTRIBUTES TO THE PUBLIC SAFETY AND COMMUNITY WELL-BEING. BEHAVIORAL HEALTH TEAMS SUPPORTING PEOPLE IN CRISIS, HEALTH AND HOSPITAL STAFF CARING FOR ILL OR INJURED PATIENTS, AND OUR JUSTICE SYSTEM PROVIDING REPRESENTATION FOR THOSE AFFECTED BY CRIME ALL PLAY AN ESSENTIAL ROLE. NONE OF THESE PILLARS CAN SUSTAIN A SAFE, HEALTHY COMMUNITY ON THEIR OWN. THEY ONLY WORK WHEN THEY ARE BALANCED TOGETHER. AS MANY OF YOU KNOW, I HAVE TRAVELED TO SACRAMENTO NUMEROUS TIMES THIS YEAR TO ADVOCATE FOR THESE PILLARS. I HAVE FLOWN FOR WASHINGTON D.C. ON MULTIPLE OCCASIONS TO SPEAK WITH FEDERAL LEGISLATORS AND EVEN MEMBERS OF THE PRESIDENT'S ADMINISTRATION. I DO THIS AGAIN BECAUSE OF -- BECAUSE SO MUCH OF WHAT WE DO HERE IS DICTATED BY PEOPLE WHO ARE FAR FROM SANTA CLARA COUNTY. THE PREVENTATIVE WORK WE KNOW TO BE EFFECTIVE IS OFTEN NOT MANDATED, NOT FUNDED, NOT PRIORITIZED BY OTHER LEVELS OF GOVERNMENT. AND IT FRUSTRATES ME BEYOND WORDS THAT THIS IS WHERE WE HAVE TO MAKE CUTS BECAUSE WE MUST FIRST FUND PROGRAMS THAT OTHER LEVELS OF GOVERNMENT MANDATE AND INSUFFICIENTLY FUND, EVEN WHEN WE KNOW THAT THERE ARE BETTER WAYS TO ACHIEVE THE COLLECTIVELY DESIRED RESULTS. I IMAGINE I AM NOT ALONE IN MY ANGER. BUT WE MUST CHANNEL THAT ANGER AND FRUSTRATION INTO ADVOCACY, CREATIVITY, AND SOLUTIONS THAT PREVENT THE SERVICES THAT WE KNOW MAKE COMMUNITIES HEALTHIER AND SAFER FROM BEING ERODED BEYOND RECOGNITION. AND IT'S IN MOMENTS OF CRISIS THAT WE ASK OURSELVES, WHAT IS OUR ROLE? AND I BELIEVE IT IS TO STRENGTHEN THE SYSTEMS WE CAN CONTROL THROUGH OUR OWN PLANNING, RESOLVE, AND RESOURCES, AND BY MAKING DIFFICULT DECISIONS NOW TO ENSURE THAT WE CAN REBUILD LATER. OUR COMMUNITY DESERVES A CLEAR PICTURE OF WHERE WE STAND, OF WHERE I STAND, AND HOW I WILL APPROACH THIS BUDGET CYCLE. AND WHILE THE FRUSTRATION CAN FEEL CONSUMING, AND THE ANGER IS REAL, WE CANNOT BREAK DOWN, ESPECIALLY NOT WHEN THE CONSEQUENCES ARE DISTANTLY MADE DECISIONS FALL SQUARELY ON US AND THE SHOULDERS OF OUR RESIDENTS. I BELIEVE THAT WE ALL UNDERSTAND THE STAKES, AS WELL AS THE IMPACT EACH CHOICE WILL HAVE ON OUR COMMUNITY. MY COMMITMENT TO PUBLIC SAFETY, TO THE HEALTH OF EVERY RESIDENT, AND TO SUPPORTING OUR YOUTH AND FAMILIES REMAINS UNWAVERING AS WE CONTINUE TO NAVIGATE THIS UNCHARTED TERRITORY. ONE THING THAT DOES BRING ME HOPE IS KNOWING THAT THIS COUNTY HAS A PROVEN TRACK RECORD OF LEADING ON THE GROUND, TOUGH CHALLENGES, AND SOMEHOW WE WILL MEET THIS MOMENT TOGETHER. I LOOK FORWARD TO ALL OF THE DEPARTMENT CONVERSATIONS WHERE I WILL HAVE LOTS OF QUESTIONS AND ADDITIONAL COMMENTS, BUT THAT IS ALL FOR NOW. THANK YOU.

>> SUPERVISOR LEE: THANK YOU. VICE PRESIDENT ARENAS.

>> SUPERVISOR ARENAS: THANK YOU. I APPRECIATE THE SERIOUSNESS AND SOMBERNESS OF THIS TOPIC. I KNOW THAT NOT ONLY ARE WE TAKING A LOOK AT OUR BUDGETS AND TRYING TO FIGURE OUT HOW WE ARE GOING TO MAKE ENDS MEET, BUT THAT IS ALSO IN PARALLEL TO HOW MANY FAMILIES ARE GOING TO CONTINUE TO TALK ABOUT THEIR OWN FINANCES AND HOW THEY ARE GOING TO MAKE ENDS MEET, NOT ONLY TO CONTINUE TO KEEP A ROOF OVER THEIR HEADS BUT ALSO TO CONTINUE TO PROVIDE THE STABILITY THAT'S NECESSARY FOR THEIR CHILDREN AND FOR OUR COMMUNITIES. AND AS YOU KNOW, WITH THE BUDGET AND FISCAL INSTABILITY COMES STRESS. AND THAT STRESS IS -- IS -- RESEARCH HAS SHOWN IT SPREADS TO NOT ONLY THE PARENTS BUT ALSO THE CHILDREN. AND STRESS DOESN'T DISTINGUISH WHETHER IT'S PEER PRESSURE OR, YOU KNOW, SCHOLARLY OR ACADEMIC STRESS OR MONEY STRESS. IT WILL IMPACT THE WAY THAT OUR CHILDREN AND OUR YOUTH ARE GOING TO THINK ABOUT AND MAKE DECISIONS FOR THEIR FUTURE, ALSO AS WELL AS THEIR PARENTS. AND SO WE MUST MAKE SURE THAT OUR SAFETY NET SERVICES ARE THERE FOR THEM DURING THESE VERY DIFFICULT TIMES. IF WE THINK THAT IT'S BEEN DIFFICULT FOR US, AND WE HAVE LOST SLEEPOVER THERE, I AM SURE THAT IT IS SIGNIFICANTLY PARALLEL AND MAYBE EVEN MORE FOR FAMILIES WHO MAY NOT BE ABLE TO, YOU KNOW, TAKE FROM THE CHILDCARE AND MOVE IT OVER TO THE CAR ON, OR THEY MAY JUST NOT BE ABLE TO PUT GAS IN THE CAR THAT WEEK AND FIGURE OUT HOW TO CARPOOL. AND SO I THINK IT IS REALLY IMPORTANT FOR US TO INTEGRATE AS -- INTO OUR REDUCTIONS. HOW ARE OUR DEPARTMENTS GOING TO IMPACT THE EVERY-DAY LIVES OF OUR FAMILIES, OF OUR CHILDREN, OF OUR OLDER CITIZENS IN A WAY THAT ISN'T DETRIMENTAL TO THEM. AND SO I KNOW ALL OF THESE REDUCTIONS ARE NOT COMING FROM US. THIS IS NOT OUR VALUES PLACED ON OUR BUDGET. THESE ARE EXTERNAL FORCES, AND I THINK SUPERVISOR ELLENBERG, YOU HAVE OUTLINED THEM QUITE WELL, AS WELL AS OUR COUNTY EXECUTIVE. AND SO I WON'T GO INTO THAT MUCH MORE EXCEPT TO SAY THAT WE NEED TO BE THOUGHTFUL AND RESPONSIBLE AND THINK AHEAD IN TERMS OF OUR SAFETY NET SERVICES. BECAUSE THIS IS ALSO ANOTHER CLIFF THAT WE ARE FACING. WE NEED TO FIGURE OUT HOW THIS CRISIS IS GOING TO IMPACT FAMILIES. AND SO WE ARE GOING TO HAVE TO BE DISCIPLINED AND DISTINGUISH BETWEEN WHAT'S IMPORTANT AND WHAT IS ESSENTIAL. AND I KNOW WE'LL DO THAT BETWEEN DISTINGUISHING BETWEEN WHAT ARE MANDATED AND NON-MANDATED SERVICES FOR US AND WITHIN OUR SYSTEM. BUT WE HAVE TO CONTINUE TO LOOK AT WHAT THE MOST VULNERABLE OF OUR RESIDENTS AND WHAT THEY NEED AND CONTINUE TO KEEP OUR PRINCIPLES AT AS NORTH STARS. AND WE HAVE ALL COMMITTED TO EQUITY. AND I SO I HOPE AS WE CONTINUE TO HAVE THESE CONVERSATIONS, WE HOLD EQUITY AT THE END CENTER OF THIS. BECAUSE WHEN WE MAKE THESE REDUCTIONS, THEY ARE NOT NUMBERS. THESE ARE POSITIONS. THESE ARE PROCESSES THAT HAVE BEEN OVER THE YEARS REFINED. THIS IS A BETTER PATH TO SERVE OUR COMMUNITIES. AND NOW WE CANNOT AFFORD TO TAKE ON AND IMPLEMENT AND CONTINUE TO PROVIDE THOSE SAME SUPPORT SERVICES WITH THE SAME THOUGHTFULNESS THAT WE HAD BEFORE. AND SO WHAT WE NEED TO DO IS REALLY WORK TOGETHER AND CONTINUE TO AFFIRM OUR VALUES BY MAKING SURE THAT WE DON'T INADVERTENTLY CREATE REDUCTIONS THAT WILL NEVER BE ABLE TO RECUPERATE FROM AND THAT WE ARE ACTUALLY DELETING ELEMENTS THAT AFFIRM OUR EQUITY-BASED APPROACH, OUR CLIENT-BASED APPROACH, OUR FAMILY AND YOUTH-CENTERED APPROACH. AND THIS IS WHAT I ASK FROM ALL OF MY COLLEAGUES AS WE ENGAGE IN THESE CONVERSATIONS, THAT WE CONTINUE TO DO THIS. AND I AM JUST FOR A POINT OF CLARIFICATION FROM MY PRESIDENT, WE ARE GOING TO MOVE INTO ITEM ? SO I DON'T HAVE VERY MUCH TO BRING OUT EXCEPT FOR IN ITEM 5L.

>> SUPERVISOR LEE: WE'LL DO THAT LATER.

>> SUPERVISOR ARENAS: OKAY. I THOUGHT YOU SAID WE WERE DID GO -- OKAY, THIS IS JUST FOR THE COMMENTS. I THOUGHT WE WERE MOVING INTO ITEM 5.

>> SUPERVISOR LEE: FINISH 41ST AND THEN GO THERE.

>> SUPERVISOR ARENAS: GOT IT. THAT'S REALLY IT. JUST THE LAST HOO-RAH FOR ME HERE IS WHEN IF WE ARE STRESSED, OUR FAMILIES ARE STRESSED. AND WE NEED TO CONTINUE TO PROVIDE SUPPORT SERVICES FOR THEM. I KNOW PREVENTION IS SOMETIMES ON THE CHOPPING BLOCK FOR MANY OF THE SERVICES THROUGHOUT OF OUR DEPARTMENTS, BUT THAT IS ONE OF THE WAYS THAT WE PREVENT FAMILIES FROM COMING DEEPER INTO OUR SAFETY NET SERVICES. AND WE ALL KNOW THAT SAYING IN TERMS OF HOW WE INVEST IN PREVENTION. AND SO YOU'LL HEAR MY COMMENTS LATER ON IN 6 AND 5 IN TERMS OF HOW I SEE THOSE PLAYING A PART IN PROTECTING A LOT OF OUR SERVICES. BUT THAT'S THE FRAMEWORK THAT I'LL BE WORKING FROM. I WANT TO MAKE SURE THAT WE DON'T IN VERY DIFFICULT TIMES CREATE INADVERTENTLY A SYSTEM THAT IS ONLY GOING TO BE THE MOST CRISIS-DEEP RELATED CLIENTS, BUT THAT WE ARE ABLE TO PREVENT AND KEEP A LOT OF OUR CHILDREN AND FAMILIES AND SENIORS ON TRACK WITH SOME OF OUR SERVICES. THAT'S IT, THANK YOU.

>> SUPERVISOR LEE: THANK YOU. LOOK AT THE LIGHTS. SUPERVISOR ABE-KOGA. DOCUMENT TO GO FIRST?

>> SUPERVISOR ABE-KOGA: THANK YOU. THANK YOU, PRESIDENT LEE. THANK YOU TO STAFF FOR THE PRESENTATION. AND LET ME START OFF BY SAYING, I KNOW WE ARE REQUIRED TO HAVE A BALANCED BUDGET. I WILL SAY THAT THIS IS PROBABLY THE MOST CHALLENGING TIME THEIR SEEN IN MY ALMOST TWO DECADES OF ELECTED SERVICE. AND SO THE FACT THAT WE HAVE A PROPOSED BALANCED BUDGET IS QUITE AN ACHIEVEMENT. AND I JUST WANT TO THANK STAFF, OUR ENTIRE ORGANIZATION FOR THE HARD WORK IN GETTING HERE. HAVING SAID THAT, I KNOW THAT IT LOOKS LIKE THAT THIS WILL BE A MULTI-YEAR PROCESS. WE HAVE CONTINUED CHALLENGES AHEAD. WE WILL CONTINUE TO PLUG AWAY. AND WE'LL HAVE TO KEEP SHARPENING OUR PENCILS TO MEET THE CHALLENGES THAT WE EXPECT TO HAVE IN THE NEXT FEW YEARS. POSITIVES I SEE AND THIS IS MY SECOND BUDGET CYCLE THAT WE HAVE HAD SOME GOOD PROGRESS. AND JUST OVERALL BUDGETARY FINANCIAL PRACTICES, I APPRECIATE THAT WE HAVE -- WE CREATED SOME RESERVE POLICIES LAST YEAR. AND I WOULD SAY THAT OUR NEXT CHALLENGE IS TO MAKE SURE THAT WE ACTUALLY FUND THOSE RESERVES. AND I SHARED THIS LAST YEAR. I'LL AIR IT AGAIN, THAT I CONTINUE TO BE CONCERNED ABOUT OUR LOW LEVEL OF RESERVES. JUST -- AND I WOULD BE INTERESTED IN SEEING LIKE WHAT OTHER COUNTIES OF COMPARABLE SIZE LIKE WHAT THEIR RESERVE POLICIES ARE. AND I AM NOT SURE THAT IF WE ARE AT THE LOWER END. I GET THE SENSE THAT WE ARE. AND SO THAT WOULD BE MY REQUEST TO SEE COMPARISONS, BECAUSE, YOU KNOW, THIS IS -- IT'S STORMING. IT'S NOT JUST RAINING, IT'S STORMING. AND HAD WE HAD A STRONGER RESERVE, WE WOULD PROBABLY BE ABLE TO WEATHER THIS STORM MUCH MORE EASILY. SO, YOU KNOW, I KNOW THAT WE HAVE TO CONFRONT THE CURRENT SITUATION, BUT WE ALSO NEED TO BE PLANNING AHEAD AND LOOKING AT THE LONG-TERM. SO THIS IS OUR OPPORTUNITY TO PREPARE FOR THAT. I WOULD ALSO SAY THAT I APPRECIATE THE WORK THAT'S BEEN DONE IN COST RECOVERY. AND THAT THERE IS BEING REVENUE GENERATION, AND THAT WE SHOULD CONTINUE TO MAINTAIN THAT COST RECOVERY ON A CONSISTENT BASIS. I THINK THE CHALLENGE THAT WE SAW WAS THAT WE HAVE NOT BEEN DOING COST RECOVERY IN A VERY LONG TIME. SO WHEN WE DID DO IT THIS YEAR, THERE WAS SOME HUGE JUMPS IN THOSE COSTS AND THE -- YOU KNOW, I'LL MENTION THAT THE CONTRACTED CITIES AND THE DISTRICT HAVE SHERIFF SERVICES ARE FRANKLY STRUGGLING WITH THAT HUGE INCREASE. AND SO I HOPE WE'LL MAINTAIN THIS PRACTICE MOVING FORWARD. IT'S A SMOOTHER PROCESS. I AM CONCERNED -- THE TRANSPARENCY. I WOULD LIKE TO, YOU KNOW, THANK STAFF FOR THEIR PROPOSALS THAT WE SAW IN COMMITTEES. THANK YOU TO OUR CO-FOR PROVIDING IS -- YOUR PROPOSAL EARLIER. FRANKLY, I THINK WE NEED A LITTLE MORE TIME AND I HAVE THOUGHTS ON HOW TO DO THAT. BUT I -- YOU KNOW, WE NEED TO MAKE OUR BUDGET PROCESS USER-FRIENDLY SO THAT OUR PUBLIC CAN UNDERSTAND OUR BUDGET. AND I LOOK FORWARD TO -- I KNOW THAT WE HAVE A NEW BUDGET SYSTEM COMING ONLINE AND I LOOK FORWARD TO FURTHER IMPROVEMENT IN THAT REALM. IN REGARDS TO ANOTHER CONCERN AREA THAT I HAVE ALONG WITH RESERVES, IS OUR UNFUNDED ACCRUED LIABILITY. I DEALT WITH THIS BACK IN THE GREAT RECESSION TIME. THE CHALLENGE IS THAT JUST PAYING THE BARE MINIMUM, IT'S LIKE PAYING YOUR CREDIT CARD BILL. PAY THE BARE MINIMUM, YOU ARE NEVER GOING TO PAY THE WHOLE BILL. IT JUST KEEPS GOING UP BECAUSE OF INTEREST RATES, RIGHT. THE PRACTICE THAT I HAVE BEEN A PART OF IS TO PREPAY WHEN WE HAVE EXTRA FUNDS. I KNOW THIS IS NOT THE TIME TO BE THINKING WE HAVE EXTRA FUNDS. BUT I THINK AS WE PLAN AHEAD, EVEN IF WE HAVE TO LOOK AT REDUCTIONS, WE SHOULD BE LOOKING AT HOW TO PUT SOME OF THAT FUNDING ASIDE OR INTO PREPAYING THIS UNFUNDED LIABILITY BECAUSE IT SHOULD BE GOING DOWN. THE FACT IT'S GOING UP IS CONCERNING TO ME. WHEN YOU SEE THIS IS IN THE BILLIONS OF DOLLARS AND WE ARE LOOKING AT A 6 BILLION-DOLLAR LIABILITY, WHICH IS ALMOST HALF OF OUR BUDGET, IT'S EXTREMELY CONCERNING TO ME. I APPRECIATE THAT WE HAVE A PLAN FOR THE RETIREE HEALTH INSURANCE LIABILITY. I WOULD LIKE TO ASK THAT STAFF WORK SO A PLAN FOR ADDRESSING THE PENSION COSTS. AND THEN JUST ANOTHER AREA OF INTEREST AS WE LOOK INTO THE FUTURE. AND I APPRECIATE THAT WE HAVE DONE SOME WORK IN TERMS OF CONDOMINIUM DEVELOPMENT WITH THE AGRO BUSINESS POSITION. I KNOW THERE IS SOME DISCUSSION ABOUT WHERE THAT IS GOING TO GO. I CONTINUE TO THINK THAT WE NEED TO BE CREATIVE AND INNOVATIVE AND FIND WAYS OF REVENUE GENERATION. AND FROM WHAT I HAVE, YOU KNOW, BEEN ABLE TO GLEAN, I REALLY BELIEVE THAT WE NEED A STRONGER ECONOMIC DEVELOPMENT PLAN. AND CITIES HAVE ECONOMIC DEVELOPMENT DIRECTORS. COUNTY HAD ONE IN THE PAST AND IT WASN'T FILLED AFTER THE LAST PERSON RETIRED. WE HAVE ASSETS AND I THINK THAT WE SAID THIS BEFORE, WE CAN LEVERAGE THOSE ASSETS BUT REALLY WE HAVE TO HAVE A PLAN AND FRANKLY BE ASSERTIVE AND YOU KNOW, LOOK AT THE OPPORTUNITIES. I FEEL LIKE WE MIGHT HAVE MISSED SOME ALREADY GIVEN WHAT'S GOING ON IN THE ECONOMY. BUT THERE IS ALWAYS OPPORTUNITY. AND SO I WOULD LIKE TO ASK THAT IN THE COMING YEAR, WE HAVE A CONVERSATION AND ASK THE CEO TO COME UP WITH A PLAN FOR ECONOMIC -- REAL ECONOMIC DEVELOPMENT. TO SUPERVISOR DU'O'NG AND I HAVE TALKED ABOUT THE FAIRGROUNDS AND OPPORTUNITY THERE. THERE IS LAND BY ELMWOOD. THE ELMWOOD JAIL, BUT I HAVE HEARD THERE IS SOME OPPORTUNITIES TO GENERATE REVENUE ON. I KNOW WE HAVE LAND AVAILABLE, AND I WOULD JUST LIKE TO LOOK AT HOW WE CAN MAXIMIZE THAT FOR REVENUE GENERATION. AND, YOU KNOW, -- AND PEOPLE MIGHT ASK, WHY? AND IT ALL TIES INTO EVENTUALLY BEING ABLE TO PROVIDE MORE SERVICES. AND WE NEED TO HAVE, YOU KNOW, THAT FINANCIAL STABILITY. AND AS SUPERVISOR ELLENBERG MENTIONED, AND I FELT THIS WAY, TOO, WE CAN LESS AND LESS COUNT ON OUTSIDE SOURCES, THE FEDS, THE STATE, FOR RESOURCES. WE HAVE TO WORK TOWARDS BEING MORE SELF-SUFFICIENT. AND THAT IS MY INTEREST AND REQUEST THAT WE TAKE THIS ECONOMIC DEVELOPMENT SERIOUSLY AND COME UP WITH A STRATEGY INTO THE FUTURE. SO WITH THAT, I APPRECIATE, AGAIN, STAFF'S WORK. AND I KNOW THIS IS TOUGH TIMES AND I JUST WANT TO THANK OUR ENTIRE ORGANIZATION. YOU KNOW, WE ALL ARE GOING TO HAVE TO SACRIFICE. AND UNFORTUNATELY, YOU KNOW, I WISH I COULD SAY NEXT YEAR WILL BE BETTER, BUT IT DOESN'T LOOK LIKE THAT. SO, YOU KNOW, I ASK EVERYONE TO, AGAIN, WORK TOGETHER TO MAKE -- TO GET THROUGH THIS TIME. AND I KNOW WE WILL. AND THINGS WILL EVENTUALLY IMPROVE. SO IT'S IMPORTANT TO PLAN AHEAD FOR THAT AS WELL. THANK YOU.

>> MR. WILLIAMS: I WOULD --

>> SUPERVISOR LEE: TH.

>> MR. WILLIAMS: WE ARE HAPPY TO FOLLOW-UP WITH INFORMATION ON SOME OF THOSE ITEMS AND WORK ON THE OTHER ITEMS OVER THE COURSE OF THE COMING YEAR.

>> SUPERVISOR LEE: SUPERVISOR DU'O'NG.

>> SUPERVISOR DU'O'NG: THANK YOU EVERYONE FOR BEING HERE AND THANK YOU FOR YOUR WORK. I HAVE NO ILLUSION THAT ANY WORDS FOR ME WILL HELP DURING THIS TIME. THE BUDGET SET BLEAK. WE HAVE HEARD PRESS TAKES. WE HAVE BEEN PRESENTED WITH THIS INFORMATION 10,000 DIFFERENT WAYS AS TO WHY THE BUDGET SET BLEAK. WE DON'T HAVE TO WAIT UNTIL NEXT YEAR TO FIND OUT MORE CHALLENGES. THE GOVERNOR'S PAY REVISION WILL DROP LATER THIS WEEK, FOLLOWED BY THE BUDGET SHORTLY THEREAFTER, WHICH WILL PROBABLY DERAIL EVERYBODY'S BEST LAID PLANS AND FORCE US TO REPIVOT AGAIN. SO I JUST WANT TO TAKE THIS TIME THEN BY RECOGNIZING THE COUNTY OF SANTA CLARA'S MOST VALUABLE RESOURCE, OUR 24,000 EMPLOYEES, WHO COME TO WORK EVERY SINGLE DAY, DOING THE MOST RISKY WORK FOR OUR MOST VULNERABLE AND STICKING IT OUT WITH US. THERE IS NO LIGHT AT THE END OF THE TUNNEL YET. BUT YOU HAVE HEARD FROM THIS BOARD AND YOU HAVE HEARD FROM THIS ADMINISTRATION, THAT THERE IS NO LACK OF WILL TO TRY TO FIND THAT LIGHT. I ALSO WANT TO THANK OUR COMMUNITY-BASED PARTNERS WHO DO THIS WORK EVERY SINGLE DAY WITH EVEN LESS RESOURCES THAN WHAT WE HAVE HERE AT THE COUNTY. AND WE ARE FACING A BUDGETARY LANDSCAPE WHERE THE WHERE WE HAVE TO BE MORE WITH LESS. HOME. I WE CAN BALANCE OUR FISCAL REALITIES WITH OUR OPERATIONAL PRIORITIES. AND AS IT WAS REPEATED AGAIN AND AGAIN AT THE STATE CAPITOL LAST WEEK WHEN WE WERE UP THERE TO LOBBY AND KNOCK ON ALL THE DOORS IS THAT GIVE US A CHANCE, GIVE A CHANCE TO LIVE ANOTHER DAY, TO FIGHT ANOTHER FIGHT AND BUILD ANOTHER BUDGET AND BUILD BACK WHAT WE OFFERED TO GIVE UP. AGAIN, I KNOW THAT MANY COUNTY EMPLOYEES ARE WATCHING THESE BUDGET WORKSHOPS AND HEARINGS WITH BAITED BREATH, WONDERING WHAT WILL BECOME OF THEIR FUTURE, OF THEIR WORK, OF THEIR CLIENTS. THAT REALITY IS NOT LOST ON US AT ALL. IT WEIGHS HEAVILY. AND I WANT TO THANK ALL OF OUR ADVOCATES, ALL OF OUR LABOR PARTNERS, ALL OF OUR COMMUNITY ORGANIZATIONS. APPROXIMATELY, TO MY COLLEAGUES, EVERY EMAIL IS VALUABLE AND EVERY COMMUNICATION HAS ADDED HAS BEEN ADDED VALUE TO MY APPROACH THINK, MY PREPARATION FOR THESE VERY HARD CONTRIBUTIONS TO COME. THANK YOU.

>> SUPERVISOR LEE: THANK YOU VERY MUCH FROM THE HARD FELT COMMENTS FROM MY COLLEAGUES HERE. THIS IS A VERY DIFFICULT BUDGET YEAR. AND I JUST WANT TO SAY, IT'S A LOT OF HARD WORK AHEAD. WITH THAT, I WANTED TO MENTION A COUPLE OF THINGS ABOUT THIS BUDGET WORKSHOP. WE ARE NOT ACTUALLY MAKING A MOTION OF ANY CHANGES. HOWEVER, WHATEVER YOU SEE IN FRONT OF YOU RIGHT NOW, ONE THING I GUARANTEE, THAT WILL NOT BE THE FINAL BUDGET. THIS IS THE TIME FOR US TO ACTUALLY DISCUSS AND SUNSHINE ALL THE DIFFERENT ISSUES THAT WE NEED TO FIX. AND THAT'S WHY IT'S IMPORTANT FOR YOU TO SUBMIT INFORMATION THAT YOU SPOKE AND CONTINUE TO GIVE US INFORMATION THROUGH EMAIL AND LETTERS SO THAT WE CAN INCORPORATE THOSE COMMENTS AND QUESTIONS TO MAKE SURE THAT THOSE ARE BEING ANSWERED PROPERLY AND WE ARE GOING TO WHAT THE RIGHT DECISIONS WHEN IT COMES TO ACTUALLY VOTE FOR THIS FINAL BUDGET IN JUNE. SECOND OF ALL, I WANT TO SAY THAT DURING THE STATE AND COUNTY, ONE OF THE THINGS THAT WE NEED TO LOOK INTO IS MORE OF THE REVENUES OUTSIDE OF THE TRADITIONAL SOURCES. AS MY COLLEAGUE SAID EARLIER, RELYING ON THE BUDGET OF THE STATE AND FEDERAL GOVERNMENT IS UNCERTAIN. WE NEED TO RELY ON OURSELVES. US HERE WE ARE FORTUNATE TO BE IN SILICON VALLEY WITH THE 15 TOWNS OF I DON'T KNOW PEOPLE A YEAR WE CAN GET THROUGH IT TOGETHER. WE WILL ASK FOLKS WHO LIVE IN THE COMMUNITY TO BE GENEROUS AND HELP US OUT SO THAT WE CAN GET THROUGH THIS TOUGH TIME. AFTER ALL, AT THE END OF THE DAY, WE NOW HAVE A MUCH LARGER HOLE IN OUR PUBLIC SAFETY NET. AND I THINK OUR RESIDENTS UNDERSTOOD THIS AND THAT'S WHY WE HAVE ABLE TO HAVE MEASURE-A PASSED. THAT'S ONLY 1/3 OF THE HOLE BEING FILLED. THAT'S WHY WE NEED EVERYBODY'S SUPPORT MOVING FORWARD TO MAKE SURE THAT THE STORIES OF WHAT GOOD WORK THIS COUNTY ACTUALLY HAS DONE, AS SPOKEN BY SO MANY OF THE VERY PASSIONATE EMPLOYEES OF OUR COUNTY NEED TO

BE TOLD TO THE WORLD. WHY IT IS SO IMPORTANT THAT THE COUNTY NEEDS THIS SUPPORT, AND THIS IS THE TIME. WE ALWAYS SAY, "LET'S SAVE MONEY FOR THE RAINY DAYS." THE MESSAGE IS, YES, IT'S NOW RAINING, AND THIS IS WHY WE NEED TO MAKE SURE THAT FOLKS ARE COMING THROUGH, OR WORK TOGETHER TO SAVE US THROUGH THIS DIFFICULT PERIOD.

ON THAT NOTE, LET'S MOVE TO THE NEXT ITEM, WHICH IS ITEM NUMBER D, BUDGET FOR DEPARTMENTS OF UNDER FINANCIAL OPERATIONS COMMITTEE. NOW, TONY, IS IT POSSIBLE THAT WE BELIEVED ACTUALLY LISTEN TO 5 AND 6 TOGETHER? YES, IT IS. YOU CAN TAKE PUBLIC COMMENT ON THE TWO TOGETHER. MAKE JUST MOVE FORWARD SO HE THAT WE TAKE PUBLIC COMMENTS FOR FIVE AND ALSO SIX. LET ME READ THE TITLE. ITEM IS THE BUDGET RECOMMENDATIONS FOR DEPARTMENTS UNDER THE HEALTH AND HOSPITAL COMMITTEE. OKAY. BEFORE OUR COLLEAGUES START REQUESTING QUESTIONS ON THAT, LET ME AND THE PUBLIC, IF YOU WOULD LIKE TO SPEAK ON ITEM FIVE OR SIX, TO PLEASE SUBMIT YOUR CARD. IF YOU HAVE ALREADY SPOKEN ON THE ISSUES EARLIER IN IT'S YANKEE ITEM 4, WE ASK YOU NOT TO SPEAK AGAIN TO ALLOW OTHER SPEAKERS ON SPEAK.

>> Supervisor Ellenberg: MAY I ASK A CLARIFYING PROCEDURAL QUESTION?

>> Supervisor Lee: YES.

>> Supervisor Ellenberg: IF WE ARE HEARING 5 AND 6 TOGETHER, WILL YOU ASK US BEFORE THE DISCUSSION BEGINS WHICH LETTER ITEMS --

>> Supervisor Lee: I WILL DO THAT AFTER THE PUBLIC COMMENT. YOU READ MY MIND, THANK YOU.

>> Supervisor Ellenberg: THANK YOU.

>> Supervisor Lee: YES, HOW MANY SPEAKER CARDS DO WE HAVE?

>> Clerk: I HAVE A TOTAL OF 21 IN-CHAMBER SPEAKER CARDS FOR 5 AND 6. PLUS I AM SHOWING THREE HANDS ON ZOOM. SO A TOTAL OF 24.

>> Supervisor Lee: OKAY. LET'S TO ONE MINUTE EACH.

>> Clerk: OKAY. WE ARE NOW CLOWING THE QUEUE TO INDICATE THAT YOU WISH TO SPEAK ON ITEM 5, AND 6. I WILL BEGIN WITH THE IN-CHAMBER SPEAKER CARDS. IFING APPROACH THE PODIUM AND STATE THE NAME YOU HAVE WRITTEN ON YOUR CART. WE HAVE JEREMY, EDGE THE GARCIA, SANDRA, SHAWN, ASHLEY, AND A SPEAKER CARD WITH THE NAME SPEAKER -- OR THE WORD SPEAKER. AND E'LL PAUSE THERE.

>> GOOD AFTERNOON, BOARD OF SUPERVISORS. JEREMY BRUCE, WITH AMIGOS GOOD LANE A CENTER. WE ARE PART OF THE RABBIT RESPONSE NETWORK. WE ARE URGING THE BOARD TO CONSIDER ALLOCATING PART OF THE 1.3 MILLION ON PAGE 57 OF THE BUDGET TOWARD C.B.O.s SO WE CAN CONTINUE TO SERVE OUR IMMIGRANT COMMUNITY WITH JUST PRESERVING WHAT WAS INVESTED WHEN THIS BOARD MADE A HISTORIC INVESTMENT BACK IN DECEMBER OF 2024. SANTA CLARA COUNTY IS AMONG THE MOST IMPACTED COMMUNITIES IN THE WHILE WE HAVE NOT EXPERIENCED LARGE-SCALE RAIDS LIKE LOS ANGELES, MIL MINNEAPOLIS AND CHICAGO. WE FACE ONE OF THE HIGHEST, IF NOT THE HIGHEST RATES OF CALIFORNIA. FORCEMENT IN- WITHOUT THESE FUNDS IT WOULD RESULT IN CUTS THAT INCLUDE A LOSS OF FOUR AYS OF STAFF DISPATCH AT THE RAPID RESPONSE HOTLINE, LOSS OF LEGAL RESPONSE TEAMS AND SUPPORT COORDINATOR. SO PLEASE CONSIDER THAT. THANK YOU.

>> GOOD AFTERNOON. I AM INGLES GARCIA, THE EXECUTIVE DIRECTORATE HUMANA AGENDA. AND THE REASON THAT I AM HERE IS TO ASK YOU TO SUSTAIN YOUR HISTORIC INVESTMENT IN PROTECTING OUR UNDOCUMENTED IMMIGRANTS, PROVIDING FUNDING FOR IMMIGRATION LEGAL SERVICES, AND SPECIFICALLY FOR THE R R.A. AS MY COLLEAGUE JUST MENTIONED, SANTA CLARA COUNTY IS AMONG THE MOST IMPACTED COMMUNITIES IN THE STATE. WE HAVE NOT EXPERIENCED THE LARGE-SCALE RAIDS SEEN IN CITIES LIKE LOS ANGELES, MINNEAPOLIS AND CHICAGO. WE HAVE THE DONE -- ONE OF THE HIGHEST, NOT NOT THE HIGHEST RATES OF TARGETED ENFORCEMENT OPERATIONS IN CALIFORNIA. AND THIS IS BASED ON OUR SHARED NETWORKS EXPERIENCE IN 2025. AND WE HAVE EXPERIENCED MORE -- THREE TIMES MORE DETENTIONS THAN ANY OTHER COUNTY IN THE BAY AREA. THERE HAVE BEEN MOMENTS WHEN ICE TOOK 11 OR MORE RESIDENTS WITHIN A SING THE 24-HOUR PERIOD. AGAIN, WE RECOGNIZE THAT THE BUDGET ENVIRONMENT IS CHALLENGING, AND ARE ASKING IS THAT YOU PRESERVE WHAT YOU ARE COMMITTED. THANK YOU. [SPEAKING SPANISH]

>> Supervisor Lee: THANK YOU. THE TRANSLATION FIRST INTO ENGLISH, ONE SECOND.

>> GOOD AFTERNOON. MY NAME IS SANDRA PINEDA AND HONORABLE BOARD, I WOULD LIKE TO ASK FOR YOUR SUPPORT FOR THESE ATTORNEY ORGANIZATION, AND THIS IS BECAUSE OF IN MY PERCENTAGE EXPERIENCE THEY HAVE HELPED ME LOT. THEY HAVE HELPED FAMILIES LIKE MINE A LOT, AND THEY ARE VERY SUPPORTIVE FOR PEOPLE LIKE US, IMMIGRANTS. SO I WOULD LIKE YOU TO PAY ATTENTION TO THEM AND ADDRESS THEM PROPERLY. THANK YOU. [SPEAKING SPANISH]

>> GOOD AFTERNOON. MY NAME IS [INAUDIBLE] AND I AM HERE BEFORE YOU, BOARD OF SUPERVISORS, SO IN ORDER TO HAVE -- OR TO GIVE SUPPORT TO THIS TYPE OF PROGRAMS THAT WE HAVE, WHICH ARE LEGAL SERVICES FOR IMMIGRANTS. THOSE SERVICES ARE RATIONAL AND ORGANIZED LIKE HUMANA AGENDA. AND I AM HERE HOPING THAT THIS IS HELPFUL FOR YOU SO YOU ARE ABLE TO SEE HOW THESE FINANCIAL AND LEGAL SERVICES ARE VERY HELPFUL. AND THOSE ARE ESSENTIALS FOR RESIDENTS LIKE ME AND ALSO FOR RESIDENTS LAKE IN SANTA CLARA. WE -- AND THAT THESE WILL BE HELPFUL FOR THEM TO BE SAFE AND PROTECTED IN THE COUNTY. HUMANA JENICA HAS BEEN VERY HELPFUL AND WE WOULD LIKE YOU TO PROVIDE FUNDS, ASSISTANCE FUNDS GENTLEMEN, AGAIN, HUMANA AGENDA. HELPING RESTLESS DENTS LIKE ME AND BECAUSE OF THEM I HAVE MY RESIDENCY AND WE WOULD LIKE THEM TO TO SUPPORT PEOPLE LIKE ME. THANK YOU.

>> Clerk: I'LL CONTINUE TO ALL MORE NAMES. VERDE. PHILLIES, MISS WILKERSON, KIM, AND WE'LL PAUSE THERE. YOU MAY BEGIN.

>> GOOD AFTERNOON. I M SEAN BACH BAKER FROM DISTRICT TWO IN SAN JOSE. I AFTERNOON A VOLUNTEER FOR RAPID RESPONSE AMONGST MANY OTHER ORGANIZES LOCALLY. I AM HAPPY WITH THE MONEY THAT YOU GUYS HAVE PUT FORWARD IN THE PAST AND I HOPE OU CONTINUE TO DO IT. THAT BEING SAID, I WOULD LIKE TO YOU CONSIDER ALLOCATING SOME OF 1.3 MILLION ON THE PAGE 57 OF THE BUDGET TOWARD COMMUNITY-BASED ORGANIZATION LIKE RAPID RESPONSE NETWORK. AND AS MANY HAVE SAID, WE HAVE BEEN AFFECTED SPECIFICALLY MAYBE THE MOST IN THE STATE. AND 11 CITIES H BEEN IMPACTED AD THE RESTLESS DENTS HAVE BY DETENTION. I WANT TO MAKE SURE THAT YOU ARE AWARE OF THIS. MANY OF US ARE SPEAKING ON THIS, IT'S VERY IMPORTANT TO OUR COMMUNITY AND I WANTED TO MAKE SURE THAT YOU TOOK IT SERIOUSLY AND I APPRECIATE IT. THANK YOU VERY MUCH.

>> GOOD AFTERNOON. MY NAME IS ASHLEY AND I AM A RAPID RESPONDER. ALSO FOURTH GENERATION RED SOX DENT OF DISTRICT 2 AND THE PROUD DAUGHTER A MEXICAN AMERICAN COMBAT VETERAN. I APPRECIATE THE 6.7 MILL MILWAUKEE I DON'T KNOW YOU ARE CALCULATING TOWARDS THE RANDY RESPONSE NETWORK BUT I THINK HERE TO CONSIDER AL GATING SOME OF 1.3 MILLION ON PAGE 57 OF BUDGET TOWARD COMMUNITY-BASED ORGANIZATIONS LIKE RAPID RESPONSE NETWORK. UP GRABS BUILT THIS COUNTY AND ARE THE BACK BONE OF OUR ECONOMY. WE OWE IT TO THEM TO STAND UP FOR THEM AND PROVIDE AS MUCH AS -- AS MUCH SUPPORT AS POSSIBLE. IF YOU WANT TO LOOK AT THIS STRICTLY FROM A BUDGE HE WANT STAINED FOYT ALLOWING OUR ANYTHINGS TO RIPPED AWAY IF FAMILIES IN ECONOMIES THEY PARTICIPATE IN WILL LEAD TO FURTHER BUDGET DEFICITS. OUR COUNTY HAS CERTAINS THREE TIMES MORE DETENTIONS THAN ANY OTHER COUNTY IN THE BAY AREA. MAY CITY, SAN JOSE IS THE MOST IMPACTED NOW. SO WHAT I AM ASKING TODAY IS FOR YOU TO CORRAL INDICATING MORE FUNDS. THANK YOU SO MUCH.

>> GOOD AFTERNOON. COUNTY BOARD F SUPERVISORS. I AM A VOLUNTEER WITH ACTION PACT TOGETHER AND AN IMMIGRANT, NATURALIZED. OUR CONGREGATION AT.

>> Supervisor Ellenberg: MARY OFFERS COMMUNITY ADVOCACY, PASTORAL CARE, RESOURCES FOR FAMILIES. WHAT I HEAR ON THE NEWS IS VERY DISHEARTENING WHEN FAMILIES ARE SEPARATED AND TRAUMATIZED. PLEASE PROTECT OUR VULNERABLE FAMILIES, CHILDREN AND SENIORS. AND SUPPORT IMMIGRATION LEGAL PROVIDERS AND RAPID RESPONSE NETWORK. MY HOME S THAT WE LEAD TOWARD A UNIVERSAL LEGAL REPRESENTATION MODEL AS A BASIC HUMAN RIGHT. THANK YOU. IN THE SPEAKING SPANISH]

>> GOOD AFTERNOON. I AM NITA A MEMBER OF PACK, AND A THINK WORKING W -- A THINK WORKING WITH -- [INAUDIBLE]. I AM WORKING JUST TO TRY TO -- JUST TO TRY TO HELP PEOPLE LIKE ME AND NOT -- BECAUSE STATEMENTS I DON'T WANT PEOPLE TO FEEL ALONE LIKE I HAVE FAILED. I HAVE HAD FAMILY MEMBERS WHICH HAVE BEEN DETAINED BECAUSE THEY ARE NOT HAVING THE PROPER ATTORNEY SERVICE FOR IMMIGRATION AND ONE OF THEM ALREADY HAS BEEN DEPORTED. THESE LEGAL HELP IS REALLY NECESSARY. WE DON'T WANT THIS LEGAL SERVICE TO STOP. THOSE ARE LEGAL SERVICES THAT ARE REALLY NECESSARY. WE HAVE THE DEPARTMENT AGAINST DEPORTATION. ALSO WE HAD RAPID TONIGHT AND HOTLINE FOR IMMIGRATION AND WE WANT TO CONTINUE MOVING FORWARD TO HAVE A LEGAL UNIVERSITY -- AND UNIVERSAL REPRESENTATION. ALL THESE FOR DIFFERENT PEOPLE NOT HAVING REPRESENTATION AND WE WOULD LAYING TO HAVE. REGARDLESS OF ECONOMIC SITUATION, THANK YOU.

>> GO AHEAD? OKAY. THANK YOU VERY MUCH BOARD OF SUPERVISORS. I AM DIANA WILKER ZONE AM A PAC MEMBER, MEMBER OF ST. JOHN, PEOPLE ACTING IN COMMUNITY TOGETHER. AND TODAY I AM HERE TO MAKE SURE THAT YOU UNDERSTAND HAT OUR COUNTY IMMIGRANT COMMUNITIES THEY DON'T FEEL ALONE. ALL T THAT IS GOING ON WITH WITH THEM. WE ARE SUPPORTING THEM. ST. JOHN IS SUPPORTING THEM CURRENTLY THROUGH HELPING ITH DETENTION NOT ONLY WITH PRAYER. WE BROUGHT FOOD WITH THEM, HELPED THEM WITH APPOINTMENTS. AND HAD VEN GONE TO THE STATE LEGISLATION. TO PUSH FOR MORE IMMIGRATION SERVICES. AND WHEN I SEE MY FELLOW IMMIGRANTS BEING SEPARATED AND HURT, THIS IS NOT JUST IMMIGRANTS, BUT UNDOCUMENTED PEOPLE. I THANK YOU FOR YOUR TIME.

>> THANK YOU.

>> Clerk: IS THERE A PHILIS OR KIM STILL HERE THAT WISHES TO SPEAK?

>> I HAD TO PAY MY METER. SO MY NAME IS KIM AND I AM IN DISTRICT 4 AND I AM A 35 YEAR RESIDENT OF THIS COUNTY. THAT I LOVE AND I AM SORRY FOR WHAT YOU GUYS ARE HAVING TO DEAL WITH. I CAN'T EVEN IMAGINE HOW STRESSFUL THAT MUST BE TO YOU. NOR CAN I UNDERSTAND OW STRESSFUL IT IS FOR OUR IMMIGRANT NEIGHBORS TO HAVE TO LIVE IN CONSTANT FEAR. EVERY TIME I THINK ABOUT IT, IT PIERCES MY HEART. AND SO I IMPLORE YOU TO FUND ALL OF THE IMMIGRANT SERVING ORGANIZATIONS N THIS COUNTY. AND PARTICULARLY THE RAPID RESPONSE NETWORK BECAUSE WE HAVE BEEN DOING VERY GOOD WORK FOR VERY MANY YEARS. AND IT IS SOMETHING THAT MAKES A HUGE DIFFERENCE IN THE COMMUNITY. AND I JUST BEG YOU TO CONTINUE TO SUPPORT.

>> Clerk: THANK YOU. I'LL CONTINUE CALLING NAMES. WE HAVE AMY. FORGIVE ME IN I AM HE IS MISPRONOUNCING THAT. DEANNA. TRISHA. ADAM COLE. LISA HAMED AND WE'LL PAUSE THERE.

>> HI, MIME THAT I IS AMY A RESTLESS DENT OF DISTRICT FOUR AND EMPLOYEE OF BEHAVIORAL HEALTH SERVICES PROGRAM. THE COURAGE BUDGET SLASHES ALL THE FULL-TIME CODES DEDICATED TO SUPPORT THE COUNTY'S WORK OF ACHIEVING EQUITY INTERNALLY AND EXTERNALLY AND OF CREATING TRAUMA INFORMED HEALING FRAMEWORK. THE WORK OF THE EQUITY TEAM IS A KEY COMPONENT OF HE DEPARTMENT'S RESPONSE TO LATINO HEALTH ASSESSMENT AND HAD DEVELOPED CLEAR PLANS TO ADDRESS MANY OF THE KEY ISSUES HIGHLIGHTED IN THE LHA. DEDICATED STAFF ARE STILL NEEDED TO MORE MOVE FORWARD AND IMPLEMENT THESE SOLUTION FIST WE HOPE TO MEET THE REQUIREMENTS OF THE LHA. GIVEN THE STANCE AGAINST THE TRUMP'S ADMINISTRATION. I AM TROUBLED BY THE PROPOSED BUDGET. THE COUNTY HAS INVESTED SIGNIFICANT RESOURCES TO ENSURING THAT THIS EQUITY WORK POINTS. WE CONTINUE ELIMINATE EQUITABLY EFFORTS AND BELIEVE THEM TO BE EX-STRING IDIOTS AND WORTHLESS. THANK YOU.

>> GOOD AFTERNOON. I AM TRISHA DUARTE, A SENIOR PARALEGAL WITH THE COUNTY COUNSEL'S OFFICE. YOU CAN MEASURE BUDGET AND DOLLARS, BUT HOW DO YOU MEASURE THE VALUE OF ONE LIFE SAVED? ONE SUICIDE PREVENTED? ONE PERSON WHO GETS TREATMENT INSTEAD OF ENDING UP HOPELESS? HOSPITALIZED. OR IN THE EMERGENCY ROOM. WHEN IT COMES TO BEHAVIORAL HEALTH, CHEAP ALWAYS COMES OUT EXPENSIVE. CUTTING SUPPORT TODAY CREATES BIGGER COST TOMORROW FOR HOSPITALS, LAW ENFORCEMENT, JAIL STAFF, FAMILIES AND OUR ENTIRE COMMUNITY. NOT TO MENTION LAWSUITS AND LITIGATION COST. THE BEFORE MOVING FORWARD WITH THE PROPOSED LAYOFFS, I ASK YOU THE BOARD TO CONSIDER NOT JUST KEEPING THE MENTAL HEALTH STAFF, BUT TO CONSIDER THE ACTUAL COST AND NBA LOSE BE ONE CHILD, ONE TEEN, OR ONE ADULT. THANK YOU FOR YOUR TIME TODAY.

>> GOOD AFTERNOON, BOARD MEMBERS. ADAM COLE WITH CEMA. HERE SPEAKING ON BEHAVIORAL HEALTH. THIS BOARD HAS HEARD A NUMBER OF TIMES IN RECENT YEARS THAT BEHAVIORAL HEALTH WILL BE INCREASING SERVICE LEVEL, REVENUE AND THEREFORE SUSTAINABILITY AND THE BOARD HAS AGREED TO DEFER CUTS TO MIXED RESULTS. HOWEVER, THERE ARE ACTUALLY LOW-HANGING FRUIT COST-SAVE AND REVENUE GENERATING OPTIONS ON THE TAIL IT JUST REQUIRES WILLPOWER, FOCUS AND POSSIBLY BOARD DIRECTION TO ACHIEVEMENT THEM. YOU ARE IN RECEIPT OF A WHITE PAPER FROM CEMA WHICH IDENTIFIES SOME OF THESE OPTIONS, ALONG WITH AREAS WHERE SOME WRIT CAN KAEFRB CESC CAN BE PRESERVED PARTICULARLY IN SUICIDE PREVENTION. OUR COUNTY CLINICS AND SUCH. PLEASE REACH OUT F ENOUGH ANY QUESTIONS. I WOULD ALSO LIKE TO THANK OUR COUNTY EXECUTIVES FOR THEIR THOUGHTFUL ENGAGEMENT OVER THE CUSTODY HEALTH BUDGET. THANK YOU.

>> Clerk: LORAINE CONGRATULATIONS. EDICT. VICTOR. I BELIEVE PETER STONE LEFT AND ASKED FOR HIS CARD TO BE REMOVED. AND PENSION LEE. YOU MAIN BEGIN YOUR COMMENTS.

>> GOOD AFTERNOON, BOARD. I AM LISA HAMID, PROGRAM MANAGER TWO AND LICENSED CLINICAL WORK -- CLINICAL SOCIAL WORK. WE ARE SANTA CLARA COUNTY. I BOTH RESIDE IN AND WORK IN DIRECT FOUR. I AM THIS ERE TO SPEAK THE IMPACT THE PROPOSED MANAGER TWO CUTS WILL HAVE ON OUR CLINICS. THIS BUDGET CUT NEARLY OWL PM2S FROM CLINIC OPERATIONS. PM2S ARE LICENSED CLINICIANS WHO PROCEED CLINICAL LEADERSHIP, SUPERVISION, OPERATIONAL OVERSIGHT AND SUPPORT FOR FRONTLINE STAFF IN THE PURELY ADMINISTRATIVE POSITIONS. AT THE SAME TIME THESE POSITIONS ARE BEING CUT CLINICS BEING CON SOL DOUBT DATED THE COUNT CLINIC SUPPOSED TO ABSORB CHAINS FROM OTHER CLINICS INCREASING FROM 800 TO MORE THAN 1200 CLIENTS. THIS MEANS HIGHER CLIENT VOLUME AND COMPLEXITY WHILE REDUCING THE LEADERSHIP NUDE NEEDED SAFETY IMAGINE CLIENT CARE. WE UNDERSTAND THE DIFFICULT BUDGET DECISIONS IN FRONT OF BOARD, HOWEVER CON SOL DATING CLINICS AND CUTTING LEADERSHIP PLACES CLIENTS AND STAFF AT RISK. WE ASK YOU TO RECONSIDER THESE REDUCTIONS AND KEEP CAN THE INSTITUTION THAT KEEPS CLIENTS SAFE. THANK YOU.

>> GOOD ARC. I AM LORENA GONZÁLEZ, RESIDENT OF DISTRICT ONE, 29-YEAR COUNTY EMPLOYEE PROGRAM MANAGER TWO AND ALSO A LICENSED CLINICAL SOCIAL WORKER. I IMAGINE AND OVERSEE FOUR DIFFERENT PROGRAMS IN THE VHSD. CHILDREN, YOUTH AND FAMILY LOCATED IN THE EAST SIDE OF SAN JOSE. INCLUDING THE SCHOOL-AGED PROGRAM. THE BIRTH-5 PROGRAM. THE FIRST EPISODE PSYCHOSIS PROGRAM AND THE TRANSITION AGE YOUTH PROGRAM. EACH SERVING A HIGH NEED STRUNG RABBLE POPULATION THAT DEMAND CONSISTENT AND INVOLVED EXPERT LEVEL CLINICAL LEADERSHIP. THE CLINIC IS INACTIVE, IM IMAGE POE MENTATION GENERATING PRACTICES THAT REQUIRE INTENSIVE HOURS OF TRAINING. THESE ARE ARENT/CHILD I WANT ACTIVE THERAPY FROM BIRTH-5 POPULATION AND THE COORDINATING SPECIALTY CARE MODEL FOR YOUTH EXPERIENCING EARLY PSYCHOSIS. BOTH INITIATIVES ARE CRITICAL STAGES. HE LAME KNITTING MY POSITION AS A PROGRAM MANAGER TWO, NOW WOULD NOT ONLY STALL THESE EFFORTS IT WOULD PLACE A RISK THAT FUTURE REVENUE.

>> GOOD AFTERNOON. I AM EDITH, A 29 YEAR COUNTY EMPLOY AND I SUBSTANCE USE SERVICES AND PROGRAM MANAGER TWO WITH SANTA CLARA COUNTY. I MANAGE THE PROGRAMS. I WANT TO HIGHLIGHT THE REALITIES OF THE PROPOSED BUDGET CHANGES. THE URRENT RECOMMENDATION AND ACCOMPANYING ORGANIZATIONAL CHARTS WILL PUT OUR CLINICIANS PROVIDING ONSITE CARE TO STUDENTS AND WILL PLACE THEM IN SUNNYVILLE AND MENTAL HEALTH CLINICS NOT [INAUDIBLE] CLINICS. THE PLAN IS THAT THEY WILL CONTINUE TREATING THEIR CLIENTS AT THE MENTAL HEALTH CLINICS. THAT IS NOT FEES I BELIEVE. WE NEED TO MEET OUR CLIENTS WHERE THEY ARE AT PARTICULARLY WHEN THEY ARE MINOR STUDENTS. THEY ARE INNING FEET TOLD CONFIDENTIAL TREATMENT BY 42 C.F.R. PART TWO. THERE IS A CRITICAL QUINN WINDOW TO ATTACH THESE CLIENTS TO TREATMENT BEFORE SERIOUS HEALTH CRISIS IMPACTS. THE PLAN TO DISSOLVE THIS IS THE SAME AS CUTTING CFC SO THE PLAN TO REDUCE SUPPORT FOR OUR STUDENTS IS THE SAME AS CUTTING SUPPORTS FOR THE STUDENTS. THANK YOU.

>> I AM HERE TO ASK YOU TO RETAIN THE COUNTY'S SUICIDE PREVENTION PROGRAM WHICH IS IN THE BEHAVIORAL HEALTH DEPARTMENT'S CUTS. I WILL REMIND ALL OF YOU HAT THIS PROGRAM WHEN IT STARTED 15 YEARS AGO, AND GOING FORWARD NOW, HAS BEEN A PRIVATE/PUBLIC PARTNERSHIP. IT HASN'T BEEN STRICTLY A GOVERNMENT-RUN PROGRAM. IT'S INVOLVED PEOPLE LIKE MYSELF AND OTHERS WHO GIVE OF THEIR TIME FREELY TO YOU. IT'S A LITTLE DIFFERENT AGO. ON THE BUDGET. I HAVE STAYED INVOLVED WITH THIS PROGRAM FOR THE SIMPLE REASON THAT MOST PEOPLE DO WHAT'S HAPPENING NOW. THEY CUT A PROGRAM, ESPECIALLY WHEN IT'S NEEDED. I DISAGREES WITH COUNTY EXECUTIVE WILLIAMS ACEH PREACH TO LIMIT THIS TO JUST A PREVENTION PROGRAM. SOME OF THE OTHER HEALTH SERVICES THAT MONEY COULD BE USED. I'LL LIFE YOU WITH THE LAST COMMENT. IF THIS PICTURE IS AS DIRE AS YOU ARE PROJECTING IT TO BE, IS THIS THE TIME TO ELIMINATE A PROGRAM THAT'S A LIFE-SAVING PROGRAM? THANK YOU.

>> HI. I AM PENSION PROPERTY SAFETY NET. WE WORK ON YOUTH MENTAL HAD HE HAD AND SUICIDE PREVENTION. THE OVERSIGHT COMMITTEE AND PREVENTION PROGRAM PROVIDES ONE OF THE MOST ROBUST INFRASTRUCTURE FOR COMPREHENSIVE INTEGRATED SUICIDE PREVENTION. MANY OF US IN THE COMMUNITIES IN NORTHERN SANTA CLARA COUNTY BUT ALSO THROUGHOUT THE REGION WE CARRY THE GRIEF OF YOUTH SUICIDES AND MANY OF US RIGHT NOW ARE ACTIVELY WORKING ON EDUCATION, RAINING, AWARENESS, SAFE COMMUNICATIONS. THIS PREVENTION WORK CANNOT BE DONE ALONE. IT'S DONE BY MANY, MANY OF OUR PARTNERS. WE LEFT HEAVILY, DEEP ARE YOU APPRECIATE THE SPOCK STAFF WHO SUPPORT US THE PAST DECADE. THIS WORK IS CRITICAL TO CONTINUE OUR INVESTMENT IN SUICIDE PREVENTION. SO THAT WE CAN SAVE MORE LIVES. THANK YOU.

>> Clerk: THANK YOU. ALL NAMES IN CHAMBERS HAVE BEEN CALLED. SO WE'LL MOVE ONTO OUR ZOOM SPEAKERS. OUR FIRST SPEAKER IS SHOWING UP FOR RACIAL JUSTICE. PLEASE ACCEPT THE UNMUTE.

>> HI, I AM LORI CATCHER. I'M WITH SURGE SANTA CLARA COUNTY AND I AM A 24-YEAR RESIDENT OF DISTRICT 2. I UNDERSTAND THE VERY DIFFICULT DECISIONS THAT ARE HAVING TO BE MADE HERE THIS YEAR WITH THE BUDGET. I AM HERE ALONG WITH FOLKS WHO SPOKE AHEAD OF ME. ASKING YOU TO CONTINUE TO ROBUSTLY FUND IMMIGRATION DEFENSE ECOSYSTEM, THE RAPID RESPONSE NETWORK. THE ATTORNEYS THAT SHOW UP FOR FAMILIES. WHEN THEY ARE SEPARATED. FAMILY ACCOMPANIMENT PROGRAMS. I THE AM A TRAINED RAPID RESPONDER AND ALSO JUST CANNOT IMAGINE HOW IT WOULD FEEL TO BE AFRAID EVERY DAY. FROM MY FAMILY, SELF, AND WE NEED EVERYONE IN OUR COMMUNITY TO FEEL SAFE. THANK YOU.

>> Clerk: THANK YOU. THE NEXT SPEAKER IS DIANA TRAN. PLEASE ACCEPT THE UNMUTE.

>> I AM WORKING ON IT.

>> Clerk: WE CAN HEAR YOU, PLEASE BEGIN.

>> SORRY. THANK YOU. LET ME PULL UP MY NOTES. I AM A PSYCHOSOCIAL WORK WE ARE THE COUNTY IN SUBSTANCE USE TREATMENT SERVICES PROGRAM. I UNDERSTAND HR1 HAS GREATLY IMPACTED OUR BUDGET AND FUNDING. ESPECIALLY WITH BEHAVE KWROEUFRL HEALTH SERVE SERVE I RESPECTFULLY URGE THE BOARD TO RECONSIDER MANY OF THOSE BUDGET REDUCTIONS AND SERVE SESSION. EVEN IF THAT MEANS TO CONTRACT TO OUTSIDE PROVIDERS FOR SUBSTANCE USE TREATMENT SPECIFICALLY. SERVICES CAN BE PROVIDED BY CERTIFIED ALCOHOL AND OTHER DRUG COUNSELORS WHICH ALLOWS IF A REDUCED SALARY THEY HAVE NOT OBTAINED A BACHELOR OR MASTER ACTION DEGREE FOR THEIR PROFESSION THEY PROCEED VIE GREAT DEAL OF WONDERFUL SERVE ACCEPTS AND OFTENTIMES CAN HAVE THEIR OWN LIVED EXPERIENCES WHICH CLIENT HAVE IMMENSELY APPRECIATED. HOWEVER, MANY OF OUT COMPLAINTS PREUPLGD WITH COMPLEX BEHAVIORAL HEALTH NEEDS THAT OFTEN TIMES ARE NOT WITHIN SCOPE FOR THESE A. OD COUNSEL HERS. THE COUNTY HAVE RECOGNIZED NEED FOR MASTER LEVEL. 65% OF MASTER'S BUT OUTSIDE CONTRACTS 27%, SO PLEASE RECONSIDER. THANK YOU.

>> Clerk: THANK YOU. THE LAST PERSON WHO HAD THEIR HAND RAISED AT THE CALL OF THE QUEUE, IS MICHELLE. MEIS ACCEPT THE UNMUTE.

>> HI. I AM MICHELLE COLEMAN, A LONG-TIME RESIDENT OF SAN JOSE AND DISTRICT FOUR. AND I AM ALSO A MEMBER OF SHOWING UP FOR RACIAL JUSTICE SANTA CLARA COUNTY. ASK YOU TO SUSTAIN THE RAPID RESPONSE NETWORK IN THE COMING BUDGET. THE RAPID RESPONSE NETWORK MASS PROVIDED CRITICAL SUPPORT TO IMMIGRANT NEIG NEIGHBOR NEIGHBON THE CROSSHAIR OF MILITARIZED FEDERAL ENFORCEMENT. REDUCING THESE FUNDS RESULT IN CUTS THAT INCLUDE THE LOSS OF FOUR AYS OF STAFF DISPATCH ON RAPID RESPONSE HOT LIT. AND THE ACCOMPANIMENT FAMILY SUPPORT COORDINATOR. SANTA CLARA COUNSEL COUNTS IS A AMONG THE MOST IMPACTED COMMUNITIES IN THE STATE. WE ACE ONE OF THE HIGHEST POSSIBLY THE HIGHEST RATE OF TARGETED ENFORCEMENT. OPERATIONS IN CALIFORNIA. ICE DETAINED AND KILLED CITIZENS AND LEGAL RESIDENTS. WE NEED BOTH THE RESPONSE.

>> Clerk: IF YOU FOR YOUR COMMENTS THAT CONCLUDES THE SPEAKING PORTIONS OF ITEMS 5 AND 6.

>> Supervisor Lee: THANK YOU. I WILL ASK THE COLLEAGUES TO IDENTIFY WHICH SECTION YOU WOULD LIKE TO ISCUSS ON ITEM 5 AND ITEM 6. ON ITEM I ITEM 5, WE HAVE 5A FOR ALPHA. OR ALL THE WAY TO O-FOR OSCAR. LET'S GEE THROUGH 51ST AND I WILL GO DOWN IN WAY TO SEE WHAT ONE ITEMS YOU WOULD LIKE DISCUSS, VASE PRESIDENT,, PLEASE.

>> Supervisor Arenas: 5C, 5L, AND 5K.

>> Supervisor Lee: 5C, L, K. GO AHEAD.

>> Supervisor Ellenberg: E AND G.

>> Supervisor Lee: E AND G. SUPERVISOR DU'O'NG.

>> Supervisor Du'o'ng: NOTHING ELSE TO ADD. ALL INCLUDED.

>> Supervisor Lee: SUPERVISOR ABE-KOGA.

>> Supervisor Abe-Koga: [INAUDIBLE]. J, PLEASE.

>> Supervisor Lee: OKAY, J.

>> Supervisor Abe-Koga: AND K.

>> Supervisor Lee: THAT WAS THAT WAS CALLED ALREADY. WE SORE TALKING ABOUT 5C, E, G, J, K, AND L. DID I MISS ANY? SO FAR, SO GOOD.

>> Mr. Williams: C, E, G, J, K, L.

>> Supervisor Lee: LET'S START WITH 5C THEN, CORRECT?

>> Mr. Williams: I AM LARGELY PREPARED TO ANSWER QUESTIONS STARTING WITH 5C. WHICH IS THE BUDGET FOR THE FIVE SUPERVISE SOAR YELL DISTRICTS. WE ARE PROPOSAL NO CHANGES TO THE BASE BUDGET.

>> Supervisor Lee: THANK YOU. WHO ASKED FOR C?

>> Supervisor Arenas: I DID.

>> Supervisor Lee: GO AHEAD, VICE PRESIDENT.

>> Supervisor Arenas: THANK YOU. THE REASON I AM BRINGING UP 5C IS SO THAT WE CAN -- AND I'LL MAKE A MOTION TO HAVE A RECOMMENDATION TO ROLLOVER OFFICE BUDGETS. THIS WILL ALLOW FOR CONTRACTS TO CONTINUE TO MOVE FORWARD ND OBVIOUSLY IMPACT PERSONNEL AS WELL.

>> SUPERVISOR, THIS IS JUST A BUDGET WORKSHOP SO THERE IS NO MOTIONS TO BE MADE. IT'S STRICTLY FOR INFORMATIONAL PURPOSES AND QUESTIONS AND ANSWERS.

>> Mr. Williams: WE HAVE HAD A PROCESS THE LAST COUPLE OF YEARS FOR ROLLOVERS AND WE CAN CERTAINLY BRING FORWARD A SIMILAR PROCESS THIS YEAR AS WELL. THAT WOULD BE PART OF THE YEAR-END CLEAN-UP PROCESS WHERE THOSE APPROPRIATIONS --

>> Supervisor Arenas: GOT IT. THANK YOU. I APPRECIATE THAT. OKAY. SO THEN I WILL MOVE FORWARD WITH 5L. THIS IS FLEET AND FACILITIES. [SPEAKING AT THE SAME TIME]

>> Supervisor Lee: WE ARE TRYING TO DO IT ALPHABETICALLY.

>> Supervisor Arenas: I'LL WAIT UNTIL "L" H C L COMES UP, BUT.

>> Supervisor Lee: NEXT IS 5E.

>> Mr. Williams: THE RECOMMENDED BUDGET PROPOSALS FOR THE OFFICE OF. COUNTY EXECUTIVE.

>> Supervisor Ellenberg: THANK YOU ZONE. I WANTED SPECIFICALLY TO ASK ABOUT O.I.R. WE HEARD A NUMBER OF SPEAKERS ON THAT SUBJECT. AND CERTAINLY IT'S VERY GRATIFYING TO SEE THE $6.7 MILLION IN FUNDING FOR IMMIGRANT LEGAL SERVICES. WHICH IS INCLUDED ON A ONE-TIME BASIS, WILL BE CARRIED OVER IN TO THE NEXT YEAR. MY UNDERSTANDING IS THAT SOME OF THAT FUNDING GOES TOWARDS GROUPS LIKE RAPID RESPONSE NETWORK. WHO COORDINATE RESPONSES BETWEEN PARTNER ORGANIZATIONS. ASIDE FROM THIS LINE ITEM, WE ALSO HEARD REFERENCED DURING PUBLIC COMMENT TO ANOTHER LINE ITEM, CONSISTING OF $1.3 MILLION. TO ENHANCE THE RESPONSE TO FEDERAL GOVERNMENT. DOES THE 8 MILLION IN THESE TWO LINE ITEMS COVER BOTH THE EXPENSES FOR THE RAPID RESPONSE NETWORK AS WELL AS PARTNER AGENCIES RESPONDING TO REFERRALS? OR IS THAT 1.3 EARMARK TODAY SOMETHING ELSE.

>> Mr. Williams: YEAH, SO THE 6.7 IS 100 PERCENT CONTINUATION OF THE LEVEL THAT WE HAVE BEEN FUNDING. FOR THE BROADER ARRAY SERVICES I SEE DAVID CAMPOS HAS COME FORWARD AS WOMEN. INCLUSIVE OF RAPID RESPONSE AS WELL AS A RANGE OF OTHER ADJACENT SERVICE PROVISION FOR IMMIGRATION RESPONSE. THE 1.3 IS AN ADDITIONAL AUGMENTATION TO THE PRIOR ONE-TAME ALLOCATIONS THAT THE BOARD HAS MADE TO HAVE ADDITIONAL FUNDING FLEXIBILITY. ASSOCIATED WITH WHATEVER MIGHT HAPPEN AT THE FEDERAL LEVEL. NOT ALLOCATED BUT BASICALLY HELD IN RESERVE TO BE ABLE TO FLEXIBLY AND HIM BLOW RESPOND FOR, FOR EXAMPLE, WE EXPERIENCED SOMETHING HERE. LIKE WHAT HAPPENED IN MINNESOTA. AND I DON'T KNOW IF DAVID THERE THEREIS ANYTHING THAT YOU WANT D TO THAT.

>> IF I MAY THROUGH THE CHAIR, SUPERVISOR ELLENBERG, DAVID CAMPOS, DEPUTY COUNTY EXECUTIVE. WE BELIEVE THAT THE 1.3 IS AN AMOUNT THAT SHOULD BE SET ASIDE IN THE EVENT THAT THERE IS AUGMENTED, ENHANCED ENFORCEMENT BY ICE WHICH CAN HAPPEN VERY QUICKLY. IF WHAT PEOPLE ARE SAYING IS THERE SHOULD BE AN ADDITIONAL ALLOCATION BETWEEN THE 6.7 THAT WOULD BE AN ADDITIONAL AMOUNT THAT IS NOT CURRENTLY ENVISIONED. AS YOU MAY REMEMBER, THE COUNTY WAS FUNDING ABOUT $6 MILLION AND THEN THAT WAS AUGMENTED BY A ONE-TIME ALLOCATION A FEW MONTHS BACK. WHAT WE HAVE DONE IN THE PROPOSED BUDGET IS THAT WE INCREASE THE ONGOING ALLOCATION BY ABOUT, YOU KNOW, A FEW HUNDRED THOUSAND, WHICH IS THE 6.7. WE STILL BELIEVE, THOUGH, THERE SHOULD BE AN AMOUNT SET ASIDE IN THE EVENT THAT THERE IS ENHANCED IMMIGRATION ENFORCE AND THAT'S BASED ON WHAT WE HAVE HEARD FROM A NUMBER OF JURISDICTIONS THAT POINT OUT THE NEED TO SPEND FUNDS IF IN ADDITION TO THAT, THE BOARD BELIEVES THAT THERE SHOULD BE MORE ALLOCATION TO C.B.O.s, WE STILL HOPE THAT THE ADDITIONAL NONALLOCATED AMOUNT REMAINS. SO THAT WE ARE READY IN T THE EVENT THAT THERE IS ENHANCED ENFORCE. AND ONE THING THAT I WOULD NOTE IS THAT AT THE FEDERAL LEVEL RIGHT NOW, THROUGH THE RECONCILIATION PROCESS, WHICH DOESN'T REQUIRE ANY DEMOCRATIC SUPPORT, THE REPUBLICAN HOUSE HAS ALLOCATED 70 BILLION MORE TO HOMELAND SECURITY. SO WE BELIEVE THAT THE -- THAT ICE IS PREPARING FOR INCREASED ACTIVITY IN THE NEAR FUTURE. AND THAT'S WHY THIS 1.3 WAS SET ASIDE.

>> Supervisor Ellenberg: I APPRECIATE THAT, DAVID. SO ONE, IT'S LIKELY THAT IF WE NEED TO SPEND ADDITIONAL MONEY, IT'S GOING TO THESE SAME ORGANIZATIONS?

>> CORRECT.

>> Supervisor Ellenberg: THEY ARE RECEIVING IT NOW. NUMBER TWO, IS THERE A SPECIFIC TRIGGER THAT WOULD CA UNITED STATES THAT MONEY TO GO OUT? IS IT HEARING THAT ICE IS COMING. IS IT INCREASED DETENTIONS IN OUR NEIGHBORHOOD? HOW WILL YOU EVALUATE THIS IS THE MOMENT TO ALLOCATE THAT 1.3?

>> I DON'T KNOW IF THERE IS SOMETHING THAT IS AS PRECISE, SUPERVISOR. I THINK WE ARE WATCHING VERY CLOSELY EVERYTHING THAT HAPPENS. AND THAT TRIGGER WOULD INCLUDE, BY THE WAY, FEEDBACK FROM THE COMMUNITY THAT SOMETHING IS HAPPENING. AND WE OFTEN VERIFY THAT AS YOU MAY RECALL IT WAS A FEW MONTHS BACK REPORT THAT THERE WAS GOING TO BE INCREASED ICE ACTIVITY. WE WORKED WITH COMMUNITY IN THAT WE WERE ABLE TO TO VERIFY I ITD THEN OF COURSE THAT CHANGED WE WANTED TO HAVE THE FLEXIBILITY AND IT WOULD BE IN CONSULTATION WITH THE COUNTY EXECUTIVE COUNTY COUNCIL AND, OF COURSE, YOU KNOW, BOARD MEMBERS, AS THESE THINGS MOVE FORWARD, ARE ALWAYS YOU KNOW, PROVIDE INFORMATION THAT IS ALSO RELEVANT TO THE ANALYSIS BUT WE WANTED TO HAVE THAT FLEXIBILITY BASED ON WHAT WE HAVE SEEN HAPPEN IN OTHER JURISDICTIONS.

>> Supervisor Ellenberg: I THINK THAT'S PRUDENT. IT WOULD BE TO ME EQUALLY VALUABLE TO ALLOCATE IT KNAWING BUT I THINK IT'S CERTAINLY REASONABLE ESPECIALLY SINCE WE ARE VERY PUBLICALLY ACKNOWLEDGING THAT THERE IS FUNDING THERE. AND SHOULD IT BE NEEDED, THESE ORGANIZATIONS ALREADY HAVE A RELATIONSHIP WITH US. AND KNOW HOW TO THOUSAND MAKE THOSE REQUESTS. A NUMBER OF THE ORGANIZATIONS WORKING TO TRY TO IDENTIFY SOME PRIVATE FILL AN PHILANTHROPIC F- I WON'T SAY TO FILL THE GAP BUT TO AUGMENT WHAT THEY ARE ABLE TO DO. THANK YOU.

>> Supervisor Lee: THANK YOU, VICE PRESIDENT. ON 5E.

>> Supervisor Arenas: ON 5E. AND THANK YOU SO MUCH SUPERVISOR ELLENBERG FOR BRINGING THIS ONE UP. I ALSO WAS CURIOUS ABOUT THAT. I WOULD LIKE TO KNOW, DAVID, IF WE COULD HAVE A BREAKDOWN OF BASED ON THE PROGRAMS AND/OR THE DIFFERENT SERVICES IF YOU WILL. AND THE AGENCIES. HOW IT'S BROKEN DOWN. IN TERMS OF WHAT HAS ALREADY BEEN GIVEN. WHAT'S BEING CURRENTLY GIVEN. AND THAT WAY WE UNDERSTAND.

>> THROUGH THE CHAIR, WE ARE HAPPY TO PROVIDE THAT SUPERVISOR. BUT I WANT TO REITERATE WHAT I THINK THE COUNTY EXECUTIVE HAS SAID THROUGHOUT THIS PROCESS, WE ARE COMMITTED TO UNDING AS MUCH OF THIS EFFORT AS WE CAN. AND THE ONGOING ALLOCATION OF 6.7 IS ACTUALLY HIGHER THAN IT'S BEEN BEFORE. AND WE WILL CONTINUE TO HAVE CONVERSATIONS WITH COMMUNITY. AND I THINK THE FACT THAT WE ARE RECOMMENDING THAT 1.3 IS SET ASIDE TELLS YOU THE LEVEL OF COMMITMENT ON THE PART OF ADMINISTRATION. TO NOT ONLY THINK AHEAD AND PREPARE BUT ALSO BE READY TO ACT QUICKLY AND HAPPY TO FOLLOW-UP WITH THAT CONVERSATION AND, OF COURSE, WE ARE GRATEFUL TO THE COMMUNITY PARTNERS THAT CONTINUE TO ENGAGE WITH US. AND WE APPRECIATE THE WORK THEY DO. AND THEY ARE A CRITICAL PART OF ANYTHING WE DO MOVING FORWARD.

>> Supervisor Arenas: I APPRECIATE THAT. AND I AM 100 PERCENT WITH YOU ON WHAT YOU JUST FINISHED SAYING. I THINK THAT WE HAVE BEEN VERY -- IT'S EVIDENT IN TERM OF THE EFFORTS ARE COMING OUT OF YOUR DEPARTMENT. THE COMMITTEES WE HAVE HAD THE CONVERSATIONS THE SHARING OF THE RESOURCES WE HAVE SEEN. CITIES WITHIN THIS COUNTY ND OUTSIDE OF OUR COUNTY, DOING AN ICE-FREE ZONE POLICY AND THAT'S ONLY BECAUSE WE ARE SHARING INFORMATION AND WE ARE SHARING RESOURCES AND SO THE INVEST THAT WE ARE MAKING NOW IS REALLY EXPONENTIAL BECAUSE WE ARE LEFT INNING THAT WITH OTHER FOLKS. WITH OTHER CITIES AND COUNTIES. AND NOT ONLY IN THAT PARTICULAR POLICY, BUT OVER ALL THE EFFORTS THAT WE ARE TAKING HOPEFULLY WE ARE ALSO LEARNING FROM THEM THE SMALLER CITIES AND SMALLER COUNTIES, BECAUSE YOU CAN BE VERY ROW CREATIVE IN TERM OF HOW YOU PARTNER UP WITH OTHER PHONES. AND FOR ME AT LEAST I IT HAS BEEN VERY IMPRESSIVE AND I ALSO WANT TO THANK SUPERVISOR DU'O'NG FOR THE WORK THAT IS BEING DONE IN THAT RESPECT. AS WE ARE OING THIS WORK TOGETHER FOR THE GATHERINGS. AND THE OUNTY NEEDS. I JUST WANT TO KNOW WHAT THAT BREAKDOWN LOOKS LIKE SO THAT I CAN UNDERSTAND AS I AM HEARING NEEDS IN THE COMMUNITY. HOW THAT IS BEING MATCHED. THAT'S ALL.

>> Mr. Williams: WE CAN ABSOLUTELY PROVIDE THAT.

>> Supervisor Arenas: THANK YOU.

>> Supervisor Lee: SUPERVISOR DU'O'NG.

>> Supervisor Du'o'ng: YEAH, THANK YOU. I GO THE SAME REQUEST FOR MORE INFORMATION IN TERMS OF HOW THE FUNDING IS BEING BROKEN DOWN AND ALLOCATED. AND BE INTERESTED IN SEEING LEARNING FROM YOUR REFLECTIONS AND ASSESSMENT AS TO HOW THOSE ALLOCATIONS CAN BE DIFFERENT THIS AREA IN IN PARTICULAR IF THERE IS OPPORTUNITIES TO AL GATE MORE IF I WANTS TOWARDS REMOVAL DEFENSE AND A UP. AND WHETHER THAT WOULD MAKE SENT AND I SAY THIS BECAUSE THIS IS NOT PLANNED. OKAY. ONE OF OUR PACK ORGANIZERS WAS DDETAINED AT ER ICE HECK IN. AND UR SYSTEM WAS NOT ABLE TO TAKE HER CASE. SO THIS IS ONE PERSON WITH DEEP COMMUNITY CONNECTIONS, ORGANIZING ON BAFFLE OF IMMIGRANT COMMUNITIES WHO HAS BEEN IN THIS CHAMBERS BEFORE, BEFORE US, WHO IS DETAINED, TAKEN TO STOCKTON FOR TWO HOURS AND THEN NOW IS AT CALIFORNIA CITY. DAVID KNOW THIS BRINGS YOU GREAT PAIN, TOO, TO HEAR THIS. AND IT'S NOT TO SAY THAT OUR SYSTEM DIDN'T WORK. BUT OUR 24 PROVIDERS, ARE ALREADY AT CAPACITY. TO THE POINT THAT THEY COULDN'T TAKE ON ONE MORE CLIENT. AND I WENT IT SEE LIZETTE AT CALIFORNIA CITY AND I COULDN'T HELP BUT THINK OF SOMEONE WHO WAS SO WELL CONNECTED AS A COMMUNITY MEMBER, ORGANIZERS, IF SHE WAS NOT ABLE TO TAP INTO OUR FUNDED SOURCES AND SERVICES WHAT HAPPENS TO THE AVERAGE NEIGHBOR WHO GOES TO WORK EVERY DAY AND IS NOT THINKING ABOUT ORGANIZING, IS NOT OUT ON THE FRONT LINES, IS NOT IN THE TRENCHES WITH US, BUT FIND THEMSELVES IN THIS SITUATION. AND I KNOW THAT WHILE SANTA CLARA COUNTY HAS NOT SEEN MASSIVE MULTI-DAY OR MULTI LOCATION RAIDS, AS WE HAVE SEEN OTHER, MET FOLLOW TAN PACES, HUNDREDS OF OUT NEIGHBORS, HUNDREDS OF D2 COMMUNITY MEMBERS HAVE -- I CAN SPEAK FOR DISTRICT TWO, THAT HAVE BEEN DETAINED AT THEIR CHECK-IN APPOINTMENTS AND COURT HEARINGS. I THINK THAT WASN'T WHAT WE WERE EXPECTING. I THINK AT THE BEGINNING OF THIS. A LOT OF OUR STRATEGY WAS WAS TO PREPARE FOR THE WORST CASE SCENARIO IN RAIDS. BUT THE REALITY IS EVEN MORE INSTEAD JUSTICE THAN THAT. ICE CHECK INS. CHECK INS THAT HAVE OCCURRED AN ARE YOU FOR DECADES. FOR A LOT OF OUR RESIDENTS WITHOUT ANY NOTICE OR PRIOR NOTE INDICATING OR NY INKLING AS THEY HAVE CHECKED IN EVERY YEAR FOR 20, 20, ALMOST 30 YEARS UPON ARRIVAL THEY ARE DETAINED AND TAKEN. IF THIS HAPPEN TO HAVE THEIR CHILDREN WITH THEM. WE ARE SCRAMBLING TO FIND OUT WHERE THE KIDS ARE. I HEAR GREAT STRAW STRATCOM STRATEGY WAS PUT IT. MEASURED AGAINST BUDGETARY RESTRAINTS IS IS THERE A WAY TO REALLOCATE THE FUNDS TO REFLECT THE CURRENT REALITY. THAT'S PLAYING OUT? BECAUSE BECAUSE WE NEED TO ALL WE CAN TO MAXIMIZE LEGAL AND SUPPORT SERVICES FOR IMMIGRANT COMMUNITIES. SPECIALIZED TRAINING FOR ATTORNEYS, ADDRESSING ATTORNEY TURNOVER AND STRENGTHENING THE PIPELINE OF IMMIGRATION ATTORNEYS IT'S NOT JUST A SINGLE COMMUNITY BEING TARGETED. WE KNOW THAT MUCH WE CAN'T DO WHAT WE HAVE ALWAYS DONE, I APPRECIATE THAT YOU ARE AT THE FRONT LINES OF THIS EVERY DAY, DAVID ON BEHALF OF OUR COUNTY. AND THE COMMUNITY WORKING WITH OUR SERVICE PROVIDERS. WITH FORESIGHT OF ALLEGATIONS SOME PORTION OF THE FUNDS AND RESERVES. FOR THE COURTS CASE SCENARIO ON OF FEDERAL -- ESCALATED FEDERAL ATTACKS WHAT CAN WE DO WITH THE RESOURCES WE HAVE NOW TO GET US CLOSER TO WHAT COULD BE A UNIVERSALLY LEGAL OR REPRESENTATION MODEL. I KNOW WE DON'T HAVE IT IN THE BUDGET TO BUILD SUCH A SYSTEM YET, BUT FOR NOW, IN THE MEANTIME, ACCOMPANY THINK, REMOVAL DEFENSE, IS THERE A WAY TO SHIFT THE RESOURCES BASED ON LESSONS LEARN? WHEN THIS NFORMATION COMES BACK I WOULD GREATLY APPRECIATE ANY ANALYSIS AND ASSESSMENT AND ANY SUGGESTIONS FOR TRACKING CAPACITY IN REAL TIME. SO THAT OUR RESIDENTS ARE NOT CALLING 24 SERVICE PROVIDERS TO SEE IF SOMEONE CAN TAKE OCCASION AFTER CALLING THE RAPID RESPONSE NETWORK AND LIZETTE NOW HAS AN ATTORNEY AFTER A CROWDSOURCING CAMPAIGN WAS CONDUCTED WHICH LEADS ME TO ANOTHER QUESTION HERE, IS THAT IN RELATION TO THE -- I THINK THE PRIVACY OFFICE WHICH ALSO HAS A RULE OF NOT ONLY PROTECTING COUNTY ASSISTANCE, BUT BROADER COMMUNITY THROUGH EDUCATION CAN AWARENESS OF THE CITIZENS TOOLS AND TRACK OUR OVER MOVE. THE PRIVACY OFFERS GETS SMALLER EVERY YEAR AND WHAT ARE THE PLANS FOR MAINTAINING OUR PRIVACY OFFICE ND ENHANCING OUR EFFORTS AGAINST UNLAWFUL SURVEILLANCE. LIZETTE, WHICH SHE -- WHEN COMMUNITY CREATED THE GO FUND ME PAGE FOR HER TO CROWDSOURCE FOR HER REMOVAL DEFENSE, GO PUNISHED ME HELD ONTO THE MONEY. SAYING THAT WAS IN VIOLATION OF FEDERAL POLICIES. TO DO WE LET THE PUBLIC KNOW WHAT SYSTEMS AND PLATFORMS AND HOW THEIR DATA IS BEING TRACKED? THANK YOU, DAVID.

>> Supervisor Lee: THANK YOU. SUPERVISOR ABE-KOGA.

>> Supervisor Abe-Koga: THANK YOU, PRESIDENT. I HOW OLD A DIFFERENT ITEM UNDER THIS AREA. GUARANTEED BASIC INCOME PROGRAM THAT IS BEING RECOMMENDED TO TRANSFER TO OSH. I AM GOING TO APPRECIATE THAT CHANGE. MY -- I WAS MOPING TO GET ANNUAL DATE IF THEY HAVE ANY DATA ON UP AND RUNNING PROGRAMS ARE DOING. MY CONCERN OBVIOUSLY IS GOING TO BE ABOUT RESOURCES TO CONTINUE THESE PROGRAMS. I KNOW THIS IS PROBABLY NOT THE TIME. BUT, YOU KNOW, MY HOPE WAS THAT WITH THESE PROGRAMS THAT WOULD LEAD TO CHANGES IN OUR FRANKLY AT THE STATE LEVEL N MATERIALS OF HOW, YOU KNOW, HOW WE SUPPORT OR ASSIST INDIVIDUALS AND FAMILIES, SO JUST LOOKING FOR -- ASKING FOR INFORMATION ON WHERE WE ARE WITH THE PROGRAMS WHAT THE DATA SAYS AND WHAT THE OUTLOOK IN EARLY IT F FUTURE RESOURCES. THANK YOU. [SPEAKING AT THE SAME TIME]

>> Mr. Williams: WE CAN ABSOLUTELY PROVIDE THAT MUCH WE REPORT ON THAT TO FGOC. AND SO WE CAN PROVIDE YOU THE MOST RECENT REPORT WHICH SHOWS THERE IS ACTUALLY SEVERAL DIFFERENT PROGRAMS WE HAVE IN PROGRESS. AND SHOWS THE CURRENT STATUS OF THOSE PROGRAMS, THEY ARE FUNDED FOR THEIR CURRENT DURATION. AND I JUST WANT TO ACKNOWLEDGE SUPERVISOR ELLENBERG IS REALLY CHAMPIONED THESE PROGRAMS. AND WE ARE SPEAKING STAND FUNDING TO EXPAND SOME OF THEM. ALTHOUGH THAT'S A CHALLENGE IN THE CURRENT FISCAL ENVIRONMENT, BUT WE WILL ABSOLUTELY PROVIDE YOUR OFFICE WITH A COPY OF THAT MOST RECENT STATUS ROOM.

>> Supervisor Abe-Koga: THANK YOU. YES, SO I KNOW IT'S PROBABLY IN THE FUTURE, BUT IT REALLY IS -- MY INTEREST WAS THAT GBI WOULD REALLY CHANGE THE WAY THE STATE, FED, YOU KNOW, THE SYSTEM AS IT IS FOR SOMETHING THAT'S TO ME MORE EFFECTIVE. BUT THANK YOU. AND THANK YOU SUPERVISOR ELLENBERG FOR YOUR LEADERSHIP ON THIS PROGRAM. THANK YOU.

>> Supervisor Lee: THANK YOU. FIRST OF ALL I WANT TO SAY I AM SO PROUD OF THIS BOARD I AM SERVING ON WITH MY COLLEAGUES HERE AS AN IMMIGRANT MYSELF AND HOW MUCH WE ACTUALLY CARE ABOUT OUR UP GET RESIDENTS IN THE COUNTY AND HOW MUCH THEY REALLY CONTRIBUTE TO OUR COMMUNITY AND THE FEAR OF BEING SHOWN BY THESE ICE RAIDS AND WHAT NOT THAT WE HAVE BEEN SEARING. IS SO UNREASON AND UP COME PATENTLY AND SAY LENT AND PEOPLE HAVE DIED, U.S. U.S. CITIZENS HAVE DIED AND I AM SO GLAD THAT WE ARE ABLE TO STILL MAKE SURE THAT THOSE VALUES ARE RESPECT ED IN THE BUDGET AND ALLOCATE THIS FUNDING AND HOME THAT WE WILL BE ABLE DESPITE THE CHALLENGES WE HAVE IN OUR BUDGET TO SUPPORT THESE SUPPORT SERVICES THAT IS IN MANY WAYS SAVING FAMILIES AND LIVES. SEPARATELY.

>> I DO WANT TO MENTION A COMPLETELY DIFFERENT ISSUE. REGARDING A REDUCTION AT THE MANAGEMENT POSITION AT THE -- FRANKLY TINY OFFICE OF STABILITY AND RESILIENCE. -- SUSTAINABILITY AND RESILIENCE. THE COMPARED TO OUR NEIGHBORING SAN MATEO COUNTY OUR OFFERS IS VERY SMALL. CURB CONCERNED ABOUT THE IMPACTS, I WOULD LIKE TO ASK JAMES, MAYBE TO PROVIDE AN EXPLANATION MAYBE NOW OR MAYBE LATER. REGARDING HOW THIS IS GOING TO AFFECT THE WORK, FOR EXAMPLE, ON THE URBAN FORESTRY MASTER PLAN. THAT'S SUPPOSED TO BE RELEASED AND THIS IS IMPORTANT FOR OUR ENVIRONMENTAL JUSTICE EFFORTS IN THE COMMUNITY AND THESE INITIATIVES.

>> Mr. Williams: WE CAN PROVIDE A MEMO ON THAT.

>> Supervisor Lee: OKAY, THANK YOU VERY MUCH. ALL RIGHT. SO THAT IS ITEMS 5E. NOW MOVING TO THE NEXT IS ITEM 5G.

>> Mr. Williams: 5G IS THE RECOMMENDED BUDGET RELATED TO THE PROCUREMENT DEPARTMENT.

>> Supervisor Lee: GO AHEAD.

>> Supervisor Ellenberg: I PULLED HAT I DON'T KNOW IN ANYONE ELSE DID. IT CALLS FOR THE DELETION OF THREE EMPLOYS IN THE OFFICE OF COUNTYWIDE CONTRACT MANAGEMENT. AND I SEE THAT THE PROCUREMENT DEPARTMENT AS A WHOLE WILL EXPERIENCE ABOUT A 15% POSITION REDUCTION. I ABSOLUTELY UNDERSTAND THE NECESSITY OF PREDICTIONS ACROSS ALL DEPARTMENTS. I WANT TO JUST PERHAPS HAVE REASSURANCE HEAR BECAUSE AIM CONCERNED ABOUT THE IMPACT N THIS AREA GIVEN PARTICULARLY GIVEN THE CHALLENGES OF ADDRESSING DEFICIENCIES IN OUR CURRENT CONTRACT MANAGEMENT. LET ME START WITH THAT PIECE. HOW ARE YOU SEEING WORK LOADS BEING IMPACTED.

>> Mr. Williams: SURE. I APPRECIATE YOU ELEVATING THIS BECAUSE IT'S NOT OFTEN THAT SOME THESE MORE ADMINISTRATIVE FUNCTIONS GET THAT ATTENTION. IMPLEMENTATION OF CONTRACT MANAGEMENT WORK THAT WILL CONTINUE. IT'S NOT AFFECTED BY THE PROPOSALS. AND THAT WORK IS FUNDED THROUGH A COMBINATION OF TSS AND PROCUREMENT RESOURCES AS WELL AS OTHERS. IN TERMS OF PROCUREMENT DEPARTMENT OVERALL, YOU KNOW, WE WE HAVE TRIED IN THIS RECOMMENDED BUDGET TO PRIORITIZE CONSISTENT WITH BOARD DIRECTION. SAFETY NET RELATED SERVICES AND YOU SEE SIGNIFICANT IMPACTS? OF THIS THESE MORE SUPPORT DEPARTMENTS. WE THINK THESE ARE MANAGEABLE. BUT THERE IS NO DOUBT THAT IT WILL HAVE IMPACTS OVERALL ON TIMELINES AND ABILITY FOR THE PROCUREMENT DEPARTMENT TO BE RESPONSIVE TO DEPARTMENTAL NEEDS. I SHOULD JUST REMIND THE BOARD THE PROCUREMENT DEPARTMENT, CENTRALLY MANAGES GOOD PROCUREMENTS AND NONPROFESSIONAL SERVICES PROCUREMENTS. PROFESSIONAL SERVICE PROCURE LITTLE ARE HANDLED BY EACH INDIVIDUAL DEPARTMENT. WE HAVE A HYBRID STRUCTURE EACH DEPARTMENT IS RESPONSIBLE ABLE TO PROFESSIONAL SERVICES BUT NONPROFESSIONAL SERVICES AND GOOD ARE HANDLED S CENTRALLY BY THE PROCUREMENT DEPARTMENT.

>> Supervisor Ellenberg: WHAT ABOUT THE THIRD PARTY WITH C.B.O.s THAT DIVE -- THIS.

>> Mr. Williams: THOSE ARE ENTIRELY MANAGED BY THE ELEVANT DEPARTMENT. BEHAVIORAL HEALTH WITH RESPECT TO OUR SIGNIFICANT AND SUBSTANTIAL BEHAVIORAL HEALTH CONTRACTS, SOCIAL SERVICES AGENCY FOR THEIRS PUBLIC HEALTH FOR THEIRS THEY ARE NOT HANDLED BY THE PROCUREMENT DEPARTMENT AND THE REASON FA THAT IS A LONGSTANDING PER PER TIFF THAT IT IS BETTER FOR THOSE DEPARTMENTS THAT DIRECTLY MANAGE THE FUNDING STREAMS AS WELL AS THE NUMEROUS FEDERAL AND STATE PROGRAMMATIC RATES TO ACTUALLY BE THE ONES TO DIRECTLY MANAGE THOSE CONTRACTS INSTEAD OF WORKING THROUGH IS A REMEMBER CENTRALIZED PROCUREMENT DEPARTMENT.

>> Supervisor Ellenberg: SURE. YOU'LL MACH A GENERAL COMMENT ABOUT THE CONTRACTS NOW RATHER THAN HAVING TO REPEAT MYSELF WITH EVERY DEPARTMENT THAT WE ARE GOING TO ADDRESS. I DO VERY MUCH APPRECIATE THE RESPONSE TO THE REFERRAL THAT SUPERVISOR ABE-KOGA AND I PUT FORWARD TO GET SOME MORE DETAIL ON OBJECT TWO. IT'S A TART. I AM STILL LOOKING FOR A LITTLE BIT MORE. THE REPORT -- THE OBJECT OF THE NEW REPORT DOES PROVIDE BRIEF EXPLANATIONS FOR A FEW DEPARTMENTS. FOR EXAMPLE, COB SHOWS THAT NEARLY ALL OF CLIENT SERVICE CONTRACTS ARE RELATED TO INVENTORY ITEMS. I GET THAT. IT LOOKED TO ME FOR THE MAJORITY OF DEPARTMENTS. PARTICULARLY THOSE WITH HIGHLY VISIBLE DELIVERY CLIENT SERVICES THAT THEY ARE STILL NOT ENOUGH CONTEXT TO EVALUATE IMPACT. WHAT PATIENTS, CLIENTS, SERVICE RECIPIENTS ARE GOING TO BE IMPACTED BY CONTRACT CHANGES IF THE CONTRACT CHANGES ARE JUST MENTIONED AT LARGE BY CATEGORIES RATHER THAN BY WHAT SERVICES THEY PRO PROVIDE, WHO THE RECIPS ARE, WHAT I AM INTERESTED IN, AND I HOPE MARGARET THAT THIS CONTINUES TO ALIGN WITH WHAT YOU ARE THINKING. IS THAT I WOULD LIKE DEPARTMENT HEADS TO CATEGORY YES CLIENT SERVICE CONTRACTS. SO WE CAN DISCUSS THE RELATIVELY IMPACT OF REDUCTIONS WITHIN EACH LINE OF SERVICE. THERE MAY BE UNCERTAINTY REGARDING SOME CONTRACTS AT THE TIME OF BUDGET APPROVAL WE HAVE BUDGET. WE HAVE CONTRACTS. ON THE BOARD AGENDAS VERY TWO WEEKS. BASER CORE SERVICES THAT ARE INCLUDED IN THE BASE BUDGET. TAKE PLACE EACH YEAR S THAT A -- I KNOW WE ARE NOT MAKING MOTION APPROXIMATES TODAY, BUT IS THAT -- LET ME LET BE BE MORE ARTICULATE, THANK YOU VERY MUCH. REQUESTING THAT ADMINISTRATION PROVIDE A CATEGORIZED BREAKDOWN FOR THE CLIENT SERVICES CONTRACTS CATEGORY. INCLUDED IN THE OBJECT TWO OFF AGENDA REPORTS FOR THE CURRENT FISCAL YEAR AS WELL AS A COMPARABLE ESTIMATE AND NARRATIVE TO PROVIDE ONTEXT AROUND LEVELS OF REDUCTION FOR THE COMING YEAR. HOW BIG OF AN ASK IS THAT AND CAN IT BE DONE BEFORE BUDGET HEARINGS?

>> Mr. Williams: WE CAN O THAT FOR ITEMS WHERE THERE IS SPECIFIC OBJECT TWO PROPOSALS INCLUDED IN THE RECOMMENDED BUDGET. WE DON'T HAVE STAFFING CAPACITY TO TRY TO DO THAT FOR THE COUNTY WRIT LARGE. WE CERTAINLY COULD DO THAT FOR AREAS WHERE THERE IS SPECIFIC PROPOSALS.

>> Supervisor Ellenberg: SO FOR THE SHORT-TERM, THAT'S ABSOLUTELY FINE. WHEN WE HAVE THE NEW CONTRACT MANAGEMENT SERVICES. WILL THAT KIND OF INFORMATION BE AVAILABLE?

>> IT WILL BE. AND, IN FACT, YOU CAN GO ONLINE AND LOOK AT ALL OF OUR ACTIVE CONTRACTS. THE CHALLENGE IS BEING ABLE TO UNDERSTAND THAT INFORMATION. IN USABLE MANNER.

>> Supervisor Ellenberg: SURE.

>> Mr. Williams: EVEN FOLKS WHO ARE RELATIVELY WELL INFORMED SEEM TO HAVE COME TO PER FLEXING CONCLUSION WHEN HIS THEY LOOK AT SOME OF THE DATA AS EVIDENCED BY PRESS CONFERENCE EARLIER TODAY. WE HAVE A ALWAYS OF ALL OF OUR CONTRACTS, THAT'S FULLY TRANSPARENT. IT'S REALLY A QUESTION OF UNDERSTANDING WHAT THOSE CONTRACTS ACTUALLY ARE AND HAT THEY DO. HOW THEY ARE FUNDED. AND, YOU KNOW, THAT REQUIRES A PROGRAMMATIC LEVEL UNDERSTANDING ACROSS WHAT IS A VERY LARGE ORGANIZATION. WITH MULTITUDE OF FUNDING STREAMS.

>> Supervisor Ellenberg: I FEEL LIKE WE STUMBLED INTO THAT LAST YEAR IN A NOT POSITIVE WAY WITH THE REENTRY CONTRACTS. I AM LOOKING TO AVOID THAT AND WANT TO UNDERSTAND WHERE THERE ARE OKAY TWO PREDICTIONS PROPOSE BAD A DEPARTMENT THAT DIRECTLY IMPACT COMPLIANT DELIVERY CONTRACTS I WANT TO KNOW WHAT THOSE ARE AND WHO THE INTENDED RECIPIENTS ARE. SO HAT WE CAN REALLY UNDERSTAND CAN WE LIVE WITH THIS?

>> Mr. Williams: THAT I THINK WE CAN DO.

>> Supervisor Ellenberg: IS BEING, ILL LIKE TO RECEIVE THAT RESPONSE POFF THE HEARINGS.

>> Supervisor Abe-Koga: I AGREE WITH YOU. WE NEED TO BETTER UNDERSTAND THE CONTRACTS. I KEEP HEARING FROM MEMBERS OF THE PUBLIC, WELL, WHY DON'T YOU JUST CUT MORE CONTRACTS. IF WE DON'T HAVE THE CONTEXT OF WHAT THE CONTRACTS ARE DOING, IT'S HARD TO RESPOND. BUT -- AND I UNDERSTAND THAT IT'S A MYRIAD F THEM. AGAIN I THINK IT'S OUR JOB TO TRY TO UNDERSTAND THAT. AND IF IT HELP TODAY PRIORITIZE, YOU KNOW, CERTAIN DEPARTMENTS, OR I THINK THAT WOULD BE FINE TO PROPOSE. BECAUSE I IMAGINE IT WILL BE A MULTI-STEP PROCESS. I HAD IMPORTANT TO TO UNDERSTAND THE RESPECT SERVICE DELIVERY OF THE CONTRACTS AND ANY CHANGES THAT WE DO WITH THEM. THANK YOU.

>> Supervisor Lee: THANK YOU. SUPERVISOR U'O'NG.

>> Supervisor Du'o'ng: YEAH, THANK YOU. I AM INTERESTED LEARNING MORE ABOUT HOW THE POSITIONS BEING DELETED WILL IMPACT OUR ABILITY TO DELIVER IN THE SMALL BUSINESS PROGRAM. BOTH THE SMALL BUSINESS PROGRAM AND ALSO THE CONTRACT ENFORCEMENT PROGRAM THAT WAS DEVELOPED THROUGH THE OFFICE OF LOS ANGELES BE OR ENFORCEMENT THAT WAS SOMETHING THAT THE OFFICE OF COUNTYWIDE CONTRACT MANAGEMENT HAD BEEN CARRYING BUT WITH THE CONSOLIDATION IN PROPOSED THERE'SES I WANT TO HOW THE WORK STREAMS AND CAPACITY WILL LOOK LIKE NOW. I RINK THAT'S THAT WE ARE HE HAD HAD GONE INTO A REALITY OF DOING MORE WITH LESS. WHAT WE ARE THINKING OF WITH LESS STAFF WHAT INNING OVATIONS CAN E UNDERTAKE TONE HELP EXPAND OUR REACH IN OUR SERVICE PROVISIONS. HOW ARE HE CLAN WE COLLABORATINH SMALL BUSINESS TO BECOME VENDORS EXPAND COOPERATIVES. WE HAVE THROUGH VARIOUS WORK CHANNELS IN THE AUNT COUNTY ORGANIZATIONS. WORKING WITH THE CO-OPS HOW ARE WE MAKING SURE OUR BUSINESS, THAT THEY ARE INCLUDED IN OUR BOOK OF BUSINESS AND WE ARE PATRONIZING THOSE BUSINESSES THINK ANY TIME I GO TO A COUNTY EVENT, I AM ALWAYS SHOCKED TO SEE A BIG BOX BRAND VENDOR EING CATERED. WHEN WE HAVE WE HAVE SMALL PRISON BIGGS OPERATIONS THAT WE COULD INDICATOR DIRECTLY FROM. THAT'S ONE SMALL EXAMPLE THOSE ARE THE INNOVATIONS WHICH IS I THINK IS IN ORDER WHEN WE ARE DOING MORE WITH LESS. THAT HE IS MY REQUEST FOR MORE INFORMATION, THANK YOU.

>> Supervisor Lee: JAMES.

>> Mr. Williams: WE'LL PROVIDE A REPORT.

Lee: WE MOVE TO ITEM 5J. WHICH IS THE TECHNOLOGY SERVICE AND SOLUTION UNIT. TSS. WHO PULLED THIS ONE? SUPERVISOR ABE-KOGA.

Supervisor Abe-Koga: THANK YOU, I WANTED TO BETTER UNDERSTAND HOW THIS ALLOCATION WOULD WORK. AND THE IMPACT ON DEPARTMENTS. WE HEARD WITH PROCUREMENT A LITTLE BIT. BUT ALSO IN TERMS OF DIRECT SERVICES TO THE COMMUNITY. WILL WE -- SO, YES. SO WOULD -- WOULD LIKE TO GET MORE INFORMATION. ESPECIALLY WITH TSS, AND TECHNOLOGY THAT'S MY INTEREST IN TRYING TO IMPLEMENT MORE TOOLS, ESPECIALLY A.I. I WOULD LIKE TO JUST BETTER UNDERSTAND HOW THESE REDUCTIONS MIGHT AFFECT OUR PROGRESS. THANK YOU.

Supervisor Lee: ALL RIGHT, THAT'S FOR 5J. NEXT WE HAVE 5K.

Mr. Williams: WE HAVE TSS HERE THEY CAN SPEAK TO THIS A LITTLE BIT. BUT SIMILAR TO PROCUREMENT AND FACILITIES, THESE ARE AREAS WHERE WE DO NEED TO CONTINUE TO MAINTAIN SIGNIFICANT INVESTMENTS. THEY ARE CORE INFRASTRUCTURE THAT ENABLE EVERY DEPARTMENT TO DO THEIR WORK, WE HAVE TO MAKE SOME PROPORTIONATE REDUCTIONS. BUT IT IS SOMETHING THAT WE ARE ACUTELY AWARE OF AND I LOOK TO OUR CHIEF INFORMATION OFFICER TO SPEAK SPECIFICALLY TO THE PROPOSED ELIMINATION OF POSITIONS.

THANK YOU. SUPERVISOR ABE-KOGA, I THINK ONE THING THAT WE ARE TRYING TO DO ESPECIALLY WHEN IT COMES TO A.I., WE ARE LOOKING FOR TECHNOLOGIES THAT WE CAN BRING IN TO HELP WITH EFFICIENCIES. AS YOU KNOW, IT'S REALLY SOMETIMES DIFFICULT TO BRING IF THE RIGHT TECHNOLOGY TO BE ABLE TO DO THAT. AND WE WANT TO MAKE SURE THAT THERE IS ALWAYS A HUMAN IN THE LOOP. SO WE ARE REALLY LOOKING FOR TECHNOLOGIES THAT NOT ONLY HELP US BE MORE EFFICIENT THAT HELPS OUR DEPARTMENT BE ABLE TO PROVIDE EFFICIENT SERVICES, BUT DOESN'T REPLACE THE DECISION MAKING THAT'S REQUIRED OF STAFF THAT WE HAVE WITHIN THOSE DEPARTMENTS. SO WE HAVE ALREADY ROLLED OUT A NUMBER A.I. INITIATIVES THAT I THINK HAS IMPROVED EFFICIENCY ACROSS THE COUNTY SPECIFICALLY AT THE HOSPITAL AND WITHIN THE SHERIFF'S OFFICE. BUT WE ARE ALSO LOOKING AT IMPLEMENTING NEW POCs SO WE CAN START TO TEST OTHER TECHNOLOGIES THAT MIGHT ALSO HELP DEPARTMENTS WHERE WE SEE A SIGNIFICANT REDUCTION AS PART OF THEIR BUDGET PROPOSALS.

Supervisor Abe-Koga: HOW WILL THIS REDUCTION AFFECT OUR SERVICE DESK, FIELD SUPPORT, GIS, EPIC. I THINK THERE IS SOME -- I HAVE HEARD SOME CONCERNS ABOUT EPIC.

YEAH, SO IN THIS BUDGET WE HAVE 26 POSITIONS THAT WE ARE REDUCING. OF THOSE POSITIONS, FIVE OF THEM ARE FILLED POSITIONS THAT WE FULLY EXPECT TO BE IN PLACE IN TO VACANT POSITIONS, THE BENEFIT THAT WE HAVE RATE NOW IS THAT WE HAVE A FAIR AMOUNT OF VACANT POSITIONS SO WE REALLY FOCUSED REDUCING VACANT POSITIONS OVER FILLED POSITIONS EXEMPT FOR IN THE CASES WHERE THERE HAS BEEN SPECIFIC REQUESTS FROM DEPARTMENTS TO REDUCE THEIR SERVICE. THE AMOUNT OF SERVICE THEY RECEIVE. PART OF WHAT WE HAVE RIGHT NOW IS THAT WE HAVE A LOT OF VACANCIES BECAUSE WE HAVE PLANNED AHEAD FOR SUPPORT THAT'S GOING TO BE NEEDED FOR THINGS THAT WE HAVE DONE OVER THE LAST COUPLE OF YEARS. THE GREATEST UPGRADE, THAT WE SEE IS THE ABILITY TO SUPPORT AT THE SAME SERVICE LEVELS THAT WE HAVE TODAY FOR SOME OF THE THINGS THAT HAVE GONE LIVE IN THE LAST YEAR AND WILL GO LIVE FIFTH IN NEXT COUPLE OF YEARS, OUR BIGGEST IMPACT IS NOT NECESSARILY IMMEDIATELY TO THE SERVICES THAT WE PROVIDE. MORE SO TO THE LEVEL OF SERVICE THAT WE'LL BE ABLE TO PROVIDE WHEN THOSE PROJECTS THAT ARE IN FLIGHT GO LIVE WITH SUPPORT.

IF I MAY ADD, SUPERVISOR, THROUGH THE CHAIR, AS YOU CAN SEE, THE PROCESS THAT TSS FOLLOWED WAS, YOU KNOW, LOOKING AT ALL OF THE RESPONSIBILITIES AND FUNCTIONS OF TSS AND REALLY TRIED TO UNDERSTAND. WHAT THE LEVEL OF IMPACT TO SERVICE DELIVERY WAS. THE POSITIONS RECOMMENDED FOR DELETION WERE THOSE WHERE WE THOUGHT THE LOWEST IMPACT AND USING THAT AS THE METRICS WHAT WE WOULD SUPPORT. WE WOULD RECOMMEND IN AN IDEAL WORLD WE WOULDN'T CUT ANY POSITIONS BUT IT'S TRYING TO UNDERSTAND HOW WE MAKE NEWS SERVICE DELIVERY AND STILL NEED THE PARK TARGETS THAT WE HAVE TO MEET.

IF I COULD ADD TO THAT. BEFORE WE RECOMMENDED RESTLESS THESE REDUCTIONS WE WORKED WITH OUR OWN DEPARTMENT HEADS TO UNDERSTAND WHAT THEIR PRIORITIES WOULD BE DURING THE NEXT FISCAL YEAR AND THE YEAR AFTER COULD PLAN AHEAD OF WHAT THE EXPECTATION WOULD BE FOR SUPPORT. WE HAVE ALSO BEEN ABLE TO LOOK AT OUR PROJECT PORTFOLIOS TO GET A BETTER FEELING WHAT HE IS GOING TO BE GOING WILL YOU HAVE AND WHAT WILL REQUIRE THAT LEVEL OF SUPPORT. LIKE DAVID MENTIONED HAD WILL BE IMPACT, WE HAVE TRIED TO PICK THE SAY DANCE POSITIONS THAT WE BELIEVE WOULD HAVE THE LEAST AMOUNT OF IMPACT ON WHAT WE BELIEVE THE PRIORITY IS FOR THE COUNTY AT THIS TIME.

Supervisor Abe-Koga: ALL RIGHT, THANK YOU.

Supervisor Lee: OKAY. ALL RIGHT. THEN WE MOVE TO 5K. WHICH IS THE COUNTY COMMUNICATIONS VICE PRESIDENT.

Supervisor Arenas: THANK YOU. I WANTED TO JUST ASK ABOUT THE COUNTY EXECUTIVE TO SEE IF HE HAD A RESPONSE FOR THE CEMA WHITE PAPER THAT WAS SUBMITTED AROUND THEIR OBJECTIVES AND ADVISORY INDICATIONS AND -- S AND RECOMMENDATIONS,.

Mr. Williams: SURE. WITH RESPECT TO COUNTY COMMUNICATIONS MOST OF THE POSITION PROPOSALS RELATE SPECIFICALLY TO OUR PLANNING RELATED TO WEST VALLEY CITIES, 33 CITIES THAT CONTRACT WITH THE SHERIFF'S OFFICE FOR LAW ENFORCEMENT SERVICES AND INCLUDED IN THE SERVICES ARE DISPATCHING SERVICES, AND SO 17 OF THE POSITIONS AT ISSUE HERE RELATE SPECIFICALLY TO THAT. IN THE EVENT THAT WE ARE ABLE TO EXTEND THOSE CONTRACTS WITH THOSE CITIES, THESE PROPOSALS WOULD BE MODIFIED, INCLUDING THE LINKED PROPOSALS IN THE OFFICE OF THE SHERIFF. HOWEVER, WE DO BELIEVE IT'S IMPORTANT THAT THERE IS FULL COST RECOVERY IN THE DELIVERY OF THESE SERVICES, THAT'S AN ONGOING AND ACTIVE CONVERSATION WITH THESE THREE CITIES, THE CITIES OF LOS ALTOS HILLS, SARATOGA AND CUPERTINO. I HAVE BEEN DIRECTLY INVOLVED IN SOME OF THESE CONVERSATIONS. THESE ARE OF COURSE SHERIFF'S OFFICE CONTRACTS. THEY ARE IN ACTIVE AND ONGOING CONVERSATIONS WITH EACH OF THOSE JURISDICTIONS WE HOPE THAT WE ARE IN A POSITION WHERE WE ARE ABLE TO CONTINUE TO OFFER THOSE SERVICES ON A COST-RECOVERY BASIS. BUT WE DO BELIEVE THAT COST RECOVERY IS A PIVOTAL. AND THE BUDGET REFLECTS PLANNING ASSOCIATED WITH THE REALITY THAT IN THE ABSENCE OF NEW AGREEMENT, THOSE SERVICES OTHERWISE END AT THE END OF THIS FISCAL YEAR.

Supervisor Arenas: I SEE. I THINK YOU SAID 15.

Mr. Williams: 17 POSITIONS.

Supervisor Arenas: POSITIONS. AND THEIR WHITE PAPER LOOKS LIKE IT'S 13 I SEE BEING TWO, FOUR, THEY COUNT 16, THOSE ARE ONE IN THE SAME?

Mr. Williams: CORRECT. ARE YOU PLANNING TO PROVIDE FURTHER RESPONSE FOR THE WHITE PAPER?

Mr. Williams: WE CAN. I THINK THE MORE RELEVANT FOR THE RESPONSE WILL BE THAT WE WILL RETURN WITH ANNUAL DATE ON THE STATUS OF THOSE NEGOTIATIONS WITH REVISED RECOMMENDATIONS. THINK WE CERTAINLY HOPE THAT THAT UPDATE WILL BE THAT WE HAVE REACHED AN AGREEMENT. BUT IF NOT, WE'LL PROVIDE ANNUAL DATE EITHER WAY. BUT I THINK THAT'S THE MOST SALIENT UPDATE WITH RESPECT TO BOTH THIS AND THE ASSOCIATED PROPOSALS IN THE OFFICE OF THE SHERIFF.

Supervisor Arenas: I SEE. IF WE DON'T HAVE THE CONTRACT IT DOESN'T MATTER HOW WE OPERATE? WE JUST WON'T HAVE THOSE -- THAT CONTRACT. OKAY. THOSE WERE MY QUESTIONS. I APPRECIATE THAT.

Supervisor Lee: THANK YOU. NEXT ITEM IS 5L. REGARDING FACILITY AND FLEET DEPARTMENT FAF. I THINK IT'S ALSO VICE PRESIDENT ARENAS.

Supervisor Arenas: YES, THANK YOU. THIS IS -- SO I HAVE A CONCERN ABOUT THE UP INVESTMENT IN -- I KNOW THIS IS IN-FLIGHT PROJECTS PROJECTS AND LEGALLY MANDATED WORK AND THAT'S HOW THIS YEAR'S CAPITAL OPPORTUNITY FUNDING IS BEING PRIORITIZED. I JUST WONDER HOW WE PRIORITIZE AGAINST -- RED ME SEE. THERE IS ONE THAT WAS -- I WAS NOT SURE IF THIS WAS MANDATED OR NOT. BUT IT WAS A CAFETERIA RENOVATIONS, COOK, CHILL, AND REHEAT MOD FOLLOW PATIENT, STAFF, AND VISITORS. IS THAT SOMETHING THAT IS MANDATED OR THAT WAS IN FLIGHT.

IT'S IN FLIGHT. AND IT'S -- IT IS THE CAFETERIA FOR VALLEY MEDICAL CENTER. IT'S AN ACTIVE IN-FLIGHT PROBLEM AND THAT'S TO COMPLETE THAT PROJECT THAT'S IN FLIGHT. WHAT WE HAVE TRIED TO DO. IT'S ACTUALLY A GREAT MOMENT FOR ME TO SPEAK MORE BROADLY ABOUT OUR CAPITAL PICTURE. I BELIEVE WE'LL HAVE A BIGGER PICTURE CONVERSATION. I THINK AT A FORTHCOMING FGOC BECAUSE WHAT YOU SEE IN THE SEPARATE CIP DOCUMENT, IS JUST HOW SIGNIFICANT OF CAPITAL NEEDS WE HAVE AN AN ORGANIZATION AND, THIS BOARD HAS HEARD ME SAY THIS BEFORE. BUT IT NEEDS TO BE SAID AGAIN, WHICH IS THAT WE HAVE SEVERAL VERY SUBSTANTIAL AND SIGNIFICANT CAPITAL NEEDS. THAT WILL REQUIRE MAJOR FUNDING AUGMENTATION. THAT INCLUDES THE HOSPITALS ESPECIALLY IN SOUTH COUNTY, BUT IT'S ALSO OUR JAIL FACILITIES. IT IS ALSO OUR CORE GOVERNMENTAL FACILITIES, INCLUDING AS YOU ALL WELL KNOW THE FACT THAT THIS BUILDING IS BEING HELD TOGETHER IN SOME CASES BY, YOU KNOW, DUCT TAPE AND STRINGS. AND WE CONTINUE TO HAVE CRITICAL, YOU KNOW, COMPONENTS OF THIS FACILITY GO DOWN, ACTUALLY WE HAD AN ISSUE JUST THE OTHER DAY. THAT MIGHT HAVE IMPACTED OUR ABILITY TO USE CHAMBERS. SO WE HAVE A VARIETY OF CRITICAL NEEDS THE LAST YEAR OF CIP ACTIVE FUNDING PROJECTS AND THIS YEAR BOTH YOU ARE FOCUSED ON TWO AREAS, ONE IS MANDATED WORK. AND THE SECOND ARE IN FLIGHT PROJECTS PARTICULARLY HOSPITAL-RELATED IN FLIGHT PROJECTS BECAUSE IF WE DON'T COMPLETE THEM. WE LOSE IS ACTIVE PERMIT. AND I'LL GOT ON A TINY SOAPBOX FOR A MOMENT AND COMPLAIN WITH H-COUKI. AGENCY RELATED TO PERMITTING ALL HOSPITAL-RELATED FACILITIES, THAT PROCESS IS EXTRAORDINARILY CUMBERSOME. EXTREMELY COSTLY. IS RESULTING IN MAJOR DELAYS ACROSS MANY, MANY, MANY PROJECTS. TO THE TUNE OF MILLIONS OF DOLLARS. AND POSES REALLY MAJOR CHALLENGES FOR US. BUT H-KI IS INVOLVED IN EVERYTHING AT A HOSPITAL FACILITY INCLUDING NINE, 10 MONTHS TO GET APPROVAL TO HANG A SIGN UP AT REGIONAL F IT'S MORE THAN 30 POPS YOU HAVE TO TO GO THROUGH THE H-KI PROCESS, IT INCLUDES THE CAFETERIA THAT YOU JUST MENTIONED. AND SO THE REASON WE ARE PRIORITIZING CLEATING THOSE ACTIVE H-KI PROJECTS IS BECAUSE WE HAVE SUNK MILLIONS OF DOLLARS INTO THE PERMITTING IF WE LET THOSE PERMITS LAPSE, WE LOSE MILLIONS OF DOLLARS. SO UNTIL SOME OF THESE CASES, WE ARE TRYING TO MAKE SURE THAT WE FINISH THOSE ACTIVE PROJECTS. SO THAT WE DON'T LOSE THAT INVESTMENT. IN CASE OF REGIONAL I WANT TO NOTE ONE OF THINGS THAT WE GOT, AND IT'S ACTUALLY OF REAL VALUE. IT'S TRULY A VALUE. ONE OF THE THINGS THAT WE BOUGHT IN ESSENCE FROM HCA,, WERE ACTIVE PERMITS FOR A COUPLE OF PROJECTS THAT WERE IN FLIGHT. AND THAT'S MILLIONS OF DOLLARS IN VALUE. AND SO WE ARE FINISHING THOSE PROJECTS SO THE PERMITS DON'T LAPSE. BASICALLY WHAT WE ARE FUNDING IS IN-FLIGHT PROJECTS THAT HAVE ACTIVE H-KI PERMITS, EYE FEW OTHER IN-FLIGHT PROJECTS AND THE REST IS CRITICAL MANDATED WORK. DO WE NEED TO DO MORE, YES? EMPHATICALLY, YES. AND I THINK EACH OF US UP HERE AND MANY FOLKS DOWN THERE, TOO. CAN POINT TO SEVERAL REALLY CRITICAL THINGS THAT NEED TO BE ADDRESSED. AND WHAT WE NEED TO FIGURE OUT IS AS AN ORGANIZATION IS HOW ARE WE GOING TO IDENTIFY THE FUNDING FOR THAT. OUR INITIAL HOPE, OUR INITIAL HOPE, WAS THAT IN NOVEMBER OF '24, THE SOCIETY EFFORTS WERE GOING TO ADOPT A CONSTITUTIONAL AMENDMENT TO LOWER THE VOTING THRESHOLD FOR GENERAL OBLIGATION BOND FOR COUNTY FACILITIES, FROM 2/3 TO 55%, WHICH IS WHAT SCHOOL DISTRICTS HAVE. AND THAT WOULD HAVE INCLUDED HOSPITAL-RELATED FACILITIES AND OTHER CRITICAL FACILITIES. WOULDN'T HAVE BEEN EVERYTHING WE DO BUT A FEW REALLY IMPORTANT CATEGORIES OF FACILITIES, UNFORTUNATELY, THAT PROPOSITION FAILED BY A SMALL MARGIN. SO WE ARE A LITTLE BIT BACK TO THE DRAWING BOARD AT THE MOMENT. BUT I -- WE DO NEED TO IDENTIFY A REALLY SIGNIFICANT SET OF CAPITAL FUNDING SOURCES BECAUSE IN THE NEXT SEVERAL YEARS, WE HAVE A LOT OF BAND-AID TYPE SOLUTIONS. WHETHER IT'S IN OUR JAIL FACILITIES, AT OUR HOSPITALS, OR OUR CORE GOVERNMENTAL FACILITIES, THAT ARE JUST NOT GOING TO CONTINUE TO WORK WITHOUT SOME INVESTMENT. SO WE ARE VERY WORRIED ABOUT IT. WE FULLY AGREE, FULLY AGREE WITH CONCERNS RELATED TO THE CAPITAL NEEDS AND WE NEED TO FIGURE OUT OVER THE COURSE OF THIS NEXT YEAR, HOW WE ARE GOING TO IDENTIFY FUNDING FOR LESS -- WE HAVE TO ACTUALLY JUST DIP FURTHER INTO OPERATING BUDGET TO DO IT. THAT CERTAINLY IS NOT WHAT WE WANT TO DO BUT MAY BE FORCED TO DO THAT SOON. THAT WILL BE A VERY PAINFUL CONVERSATION IF WE END UP IN THAT SITUATION. BUT THAT'S KIND OF THE BIGGER PICTURE WHERE WE ARE AT THAT'S THE THINKING BEHIND THE PROJECTS, IT'S NOT ANYTHING THAT GRAND. IT'S BASICALLY DEALING WITH IN-FLIGHT PROBLEMS, IN-FLIGHT H-KI PERMITS AND OTHER ESSENTIAL CURRENT MANDATES.

Supervisor Arenas: OKAY. WELL, I AM GOING TO GET ON MY SOAPBOX. I AM NOT SURE IT'S THAT SMALL. BUT ST. LOUISE HOSPITAL HAS A EXTENDED EMERGENCY ROOM. THEY HAVE A TINY, TINY EMERGENCY ROOM. AND THEIR EXPANDED EMERGENCY ROOM IS IN THE PARKING LOT AND SO IT WAS AN ATTEMPT AND THAT PERMIT HAS RUN OUT AND SO WE ARE NOW PUTTING PEOPLE IN FORT I BELIEVES, THAT'S SUPPOSED TO BE ANNUAL GREAT FOR FOLKS IN SOUTH COUNTY. IT'S BEEN A MINUTE SINCE WE HAVE HAD HAD THE PANDEMIC. I DON'T REGRET MY VOTE IN PURCHASING REGIONAL. BECAUSE I THINK IT WAS THE RIGHT THING TO DO. BUT I ALSO NEED TO HAVE THE RIGHT THING DONE ST. LOUISE HOSPITAL. FLIGHT OR NOT, IT'S IMPORTANT THAT THEY RECEIVE THE KIND OF DIGNIFIED CARE THAT THE REST OF THE COUNTY IS SERVING IS RECEIVING. SO I WOULD LIKE TO KNOW WHAT IS BEING DONE IN TERMS OF HOW ARE YOU QUALIFYING PRIORITIZING SOME OF THESE INVESTMENTS COMPARED TO OTHER FOLKS? IS IT TIME? OBVIOUSLY, YOU KNOW, IF IT'S MANDATED WORK, IT'S MANDATED WORK IT GOES TO THE FRONT LINE. I JUST DON'T KNOW HOW LONG ST. LOUISE HOSPITAL IS GOING TO WAIT. TO HAVE EXPANDED MEDICAL CARE. THEY JUST RECENT ARE YOU GOT SOME CARDIAC DIAGNOSTIC SERVICES. YOU KNOW, THEY ARE GETTING -- REALLY WITH THE BASICS AND MOST OF THE LABOR DELIVERIES ARE BEING REROUTED OVER TO VALLEY MEDICAL CENTER. SO WOMEN HAVE TO DRIVE ALL WAIT DOWN TO VALLEY MEDICAL BECAUSE IT'S A PREFERENCE OF THE DOCTORS. TO HAVE THOSE THERE. AS A WOMAN I DON'T DRIVE 30, 40 MINUTES WHEN I AM IN LABOR JUST SO THAT I CAN HAVE A NICER HOSPITAL. YOU GO TO THE ONE THAT'S NEAREST TO YOU. UNLESS YOU SCHEDULE SOMETHING. SO I LIKE TO SEE WHAT THAT -- AND MAYBE WHAT I'LL ASK IS FOR AN RFI ON THE PRIORITIZATION ON THE CAPITAL IMPROVEMENT PROJECTS THAT ARE RELATED TO THE HOSPITALS. SO THAT I KNOW WHERE IN THAT LINE OF PRIORITY IS ST. LOUISE.

Mr. Williams: SURE. WE ABSOLUTELY CAN PROVIDE THAT. AND, YOU KNOW, I THINK IT WOULD BE HELPFUL TO -- FOR US TO LIST OUT THE SERIES OF MANDATED-RELATED WORK AT OUR HOSPITAL FACILITIES ACROSS ALL OF THEM THAT'S REQUIRED BETWEEN NOW AND 2030 AS WELL UNDER STATE STATUTE. WE'LL DO BOTH OF THOSE THINGS.

Supervisor Arenas: AND I KNOW THAT I THINK IT WAS FIRST YEAR THERE WAS A PLAN TO RENOVATE ST. LOUISE.

Mr. Williams: THERE IS AN OUT YEAR -- SO INCLUDED IN OUR OUT YEAR CAPITAL PLAN, IS BASICALLY AN IDENTIFICATION OF A BUILDING OF AN ENTIRE WING OVER AT THE HOSPITAL THERE. AS ONE OF THE SIGNIFICANT PROJECTS AMONG A FEW. BUT ONE OF A HANDFUL OF REALLY SIGNIFICANT PROJECTS THAT ADMINISTRATION BELIEVES MAKES SENSE. THOSE ARE BIG PROJECTS, THOUGH. NOT SMALL ONES. THAT IS ONE OF A HALF DOZEN SIGNIFICANT ITEMS. THAT YOU'LL FIND IN THE OUT YEAR CIP. JUST AS I SAID IN FULL TRANSPARENCY, AS OF RIGHT NOW, NONE OF THOSE SIX PROJECTS HAD HAVE A CURRENT IDENTIFIED FUNDING SOURCE BEYOND A GENERAL OBLIGATION BOND. WE NEED TO AT LEAST TRY AS A COUNTY ORGANIZATION IT'S CERTAINLY WORTHWHILE AND I THINK IT'S -- WE HAVE VERY GOOD JUSTIFICATION. TO BRING THAT IN FRONT OF OUR COMMUNITY.

Supervisor Arenas: I APPRECIATE THAT. SO AS THE HOSPITAL IN EARLIER IN OUR PRESENTATION, WE HAD AN ONGOING SOLUTION IMPLEMENT THE BALANCE THE FISCAL YEAR 26/27 RECOMMENDED BUDGET AND SOME OF THEM HAD HOSPITAL SYSTEM NET COST REDUCTIONS 34 MILLION. THERE WAS I THINK ANOTHER ITEM HERE -- EARLY REVENUE SOLUTIONS NETWORK REDUCTIONS I THINK POLICED THROUGH THE MIDYEAR BUDGET PROBLEM. THAT ALREADY HAPPENED. AS THESE REDUCTIONS CONTINUE TO TAKE PLACE OR THE REVENUE SOLUTIONS ADDED THE RECOMMENDED BUDGET. BREWER HUGH IS THE GENERAL FUNDED COMMIT THINK OF 400 MILLION PLUS GETTING IMPACTED BECAUSE THAT'S HAPPENING ON YEARLY BASIS.

Mr. Williams: THIS MIGHT BE A GOOD QUESTION TO TALK THROUGH WHEN WE GET TO ITEM SIX. THOSE INVESTMENTS GOING TO BASICALLY THE ONGOING OPERATION OF SYSTEM AS OPPOSED TO THE CAPITAL. AND YOU KNOW, BASICALLY COVER THE COSTS PRIMARILY OF STAFFING BUT ALSO SOME OF OUR SUPPLIES LIKE PHARMACEUTICALS AND YOU KNOW, SURGICAL EQUIPMENT AND THINGS LIKE THAT. BUT THE BIGGEST COST, OF COURSE, IS OUR STAFFING.

Supervisor Arenas: RIGHT, BUT THE 450 MILLION COMING FROM THE GENERAL FUND ISN'T JUST FOR CAPITAL, IT'S --

Mr. Williams: THAT IS NOT CAPITAL, THOSE ARE OPERATING COSTS, YES.

Supervisor Arenas: RIGHT. SO WHEN THERE IS ANY DEDUCTIONS, OUT IS THAT BEING BALANCED. IS ANYTHING GETTING -- IT'S ALL GOING BACK INTO THE SYSTEM RATHER THAN MAYBE REDUCING ANY AMOUNT FROM THE GENERAL FUND THAT IS ALREADY COMMITTED ON A YEARLY BASIS.

Mr. Williams: FOR IN CAREER'S RECOMMENDED BUDGET, WE ARE REDUCING THE AMOUNT OF BASE GENERAL FUND GOING TO THE HOSPITAL SYSTEM AND THAT SHOWS UP IN THE RECOMMENDED BUDGET IN THE FORM OF FEWER CUTS THAN IN GENERAL FUND DEPARTMENTS. THE WORLD WILL RECALL THAT WHEN WE STARTED TO THE FISCAL YEAR IT WAS A $280 MILLION GENERAL FUND DEFICIT AT THIS TIME ON TOP OF HR1. THE RECOMMENDED BUDGET DOESN'T HAVE $280 MILLION IN GENERAL FUND REDUCTIONS OR REVENUE SOLUTIONS AND ONE REASON FOR THAT IS THE GENERAL FUND DISTRIBUTION TO THE HOSPITAL IS COMING DOWN. AND THAT HELP US AVOID REDUCTIONS IN OTHER GENERAL FUND DEPARTMENTS. THESE ARE TWO DISTRICT THINGS THAT I THINK ARE HELPFUL WHEN YOU THINK ABOUT THE GENERAL FUND CONTRIBUTION TO THE HOSPITAL. ONE IS WHAT DOES IT LOOK LIKE A PERCENTAGE BASIS. ONE IS WHEN WE TALK ABOUT THE REDUCTIONS IN MOST GENERAL FUNDED DEPARTMENTS THE REALITY IS THE APPROPRIATIONS INCREASE TYPICALLY YEAR OVER YEAR, COSTS GO UP, REVENUES GO UP WHAT WE ARE REALLY DEALING WITH IS THE GAP BETWEEN THE TWO. BY CONTRAST FOR THE HOSPITAL SYSTEM FOR THE LAST SEVERAL YEARS, WE HAVE BEEN HOLDING THE DOLLAR AMOUNT FLAT AND MOST RECENTLY IN THE LAST TWO YEARS, DECREASING IT. THAT'S REALLY SIGNIFICANT. THAT'S NOT NORMALLY WHAT WE TALK ABOUT WHEN WE TALK ABOUT BUDGET REDUCTIONS IN OTHER DEPARTMENTS, FORMALLY WE ARE TALKING ABOUT PERCENTAGES. AND NOT THE RAW DOLLAR AMOUNTS. AND SO WHEN YOU HOLD THE RAW DOLLAR AMOUNT EVERYBODY FLAT. IT'S ACTUALLY EQUIVALENT TO A CUT. BECAUSE COSTS GROW. SO IN THIS YEAR'S RECOMMENDED BUDGET THE BASE GENERAL FUNDED INVESTMENT FOR THE HOSPITAL HAS FALLEN BELOW OUR KIND OF GENERIC CONSIDERED 10% BASELINE TARGET OF THE HEALTH SYSTEMS OVERALL BUDGET. IT'S SOMETHING THAT WE ARE GOING TO KEEP TRYING TO PUSH OKAY BUT, OF COURSE, THE CHALLENGE THERE IS, HR1. AS THERE IS CONTINUED PRESSURE ON THE HEALTH SYSTEMS REVENUES. THAT LOOKS LIKE IT'S A VERY COMPLEX PICTURE. OF AND IS REALLY A QUESTION OF TO WHAT EXTENT DO WE CONCENTRATE REDUCTIONS ONLY IN THE HEALTH SYSTEM. WITH HR1 REVENUE LOSSES THINK AND I THINK THAT'S THE BIG QUESTION THAT WE WILL HAVE TO STARE DOWN NEXT YEAR. MEANING FOR FY '28. IF THE STATE DOESN'T STEP UP WITH SOMETHING. THAT WILL BE THE CORE QUESTIONS. BECAUSE MOST OF WHAT WE ARE STARING DOWN, YOU KNOW, UNLESS WE HAVE A RECESSION OR SOMETHING ELSE. BUT MOST OF THAT $500 MILLION PROJECTION FOR FY28 IS REALLY HR1 RELATED. MOST OF THAT IS RELATED TO THE HEALTH SYSTEM. AND I THINK THE MOST FUNDAMENTAL POLICY QUESTION IN FRONT OF THE BOARD FOR NEXT YEAR'S BUDGET WILL BE HOW MUCH OF THAT IS HANDLED JUST BY THE HEALTH SYSTEM WITH THE DIRECT CONSEQUENCE BEING SIGNIFICANT REDUCTIONS AND SERVICE THERE. OR SHARED ACROSS OTHER DEPARTMENTS, TOO. BUT THAT'S, AGAIN, NEXT YEAR'S CONVERSATION. AND WE'LL TACKING WHAT'S IN FRONT OF US FIRST.

Supervisor Lee: WE ARE MOVING TO THE ITEM 6 ISSUES. THE HEALTH AND HOSPITAL, WE'LL GET THERE, TOO. IF WE CAN JUST FOCUS BACK ON THE FLEET -- FACILITIES AND FLEET ON THIS ITEM NOW.

Supervisor Arenas: IFS, IF AF.

Supervisor Lee: YEAH.

Supervisor Arenas: THIS IS INCLUDED IN THAT. SO THE LAST THING I WILL SAY IS, I NEED A RECONSIDERATION OF THE LATINO HEALTH ASSESSMENT RESERVE THAT WAS ESTABLISHED FOR THAT PARTICULAR ITEM TO BE MOVED TO THE CAPITAL I THINK IT WAS THE COMMUNITY CLINICS WHICH HAS ALREADY 5 MILLION AND -- BY YOUR GUIDELINE YOU SAID THAT IT'S FOR CLINICS AND SO AN APPROXIMATELY MILLION FOR EACH OF THE CLINICS. THE ON A STORE FRONT TYPE OF SATELLITE CLINIC.

Mr. Williams: ABOUT ONE AND A QUARTER OR THEREABOUTS, YEAH.

Supervisor Arenas: SAY AGAIN.

Mr. Williams: ABOUT ONE AND QUARTER MILLION OR THEREABOUTS.

Supervisor Arenas: SO THAT'S 5 MILLION. AND SO I WOULD LIKE TO PRESERVE THAT FOR THE LATINO HEALTH ASSESSMENT WHICH WAS WHAT WE HAD. I WILL MAKE A MOTION AND ASK FOR AN RFI AS POLICY. THANK YOU.

YOU CAN JUST ASK FOR THE RFI NO MOTION NEEDS TO BE MADE IT.

Supervisor Arenas: I DIDN'T SAY THAT I WAS GOING TO ASK FOR A MOTION, BUT I'LL ASK FOR AN RFI. THAT, PLEASE.

SURE.

Supervisor Lee: SUPERVISOR ABE-KOGA, ON FACILITIES.

Supervisor Abe-Koga: YES, THANK YOU. THE QUESTION HAD TO DO WITH OUR RENEWABLE ENERGY PROGRAM. I HAVE CONCERNS RELATED TO THE COUNTY CHOOSING TO SWITCH TO THE STANDARD ELECTRICITY SERVICE FROM SBC AND S J.C.E. AND OPPOSED TO THE PREMIUM SERVICE THAT INCLUDES 100 PERCENT RENEWABLE ENERGY. THERE IS A REDUCTION IN THE PURCHASE OF RECS, BUT MY INTEREST IS THAT GIVEN THE PROGRESS THAT WE HAVE MADE. JUST IN GENERAL WE HAVE SLOWED DOWN OUR WORK IN THE SUSTAINABILITY AREA. ARE THERE WAYS TO MAINTAIN OUR 100 PERCENT RENEWABLE STANDARD.

Mr. Williams: YEAH, THE -- I WOULD JUST OFFER TWO PERSPECTIVES ON THAT. YOU KNOW, OBVIOUSLY WE CAN AND MAKE OFFSETTING CUTS SOMEWHERE ELSE. BUT THE REASON FOR THE RECOMMENDATION IS THAT WE HAVE CONTINUED TO MAKE INVESTMENTS IN EXPANDING THE COUNTY'S RENEWABLE ENERGY OPTIONS AND IN PARTICULAR, WE ARE FUNDING FOR EXAMPLE, THE REPLACEMENT OF LIGHTING WITH L.E.D.s WHICH WILL SIGNIFICANTLY MAKE A DIFFERENCE AS WELL AS THE REPLACEMENT, BECAUSE THEY ARE END OF LIFE, BUT THE REPLACEMENT OF THE CHILLERS AT VALLEY MEDICAL CENTER WE ELECTRIC INSTEAD OF GAS AND THOSE ARE EXAMPLES OF MUCH MORE HIGH-IMPACT INVESTMENTS. AND SO IF IT'S A QUESTION OF WHERE DO WE STARE OUR VERY LIMITED GENERAL FUND DOLLARS. FOR THE BIGGEST IMPACT ON SUSTAINABILITY, OUR RECOMMENDATION IS TO EVERYTHING IT TO THOSE TYPES OF PROJECTS. WHERE WE KNOW THAT THERE IS A BIG IMPACT. ON CARBON EMISSIONS. AND A BIG POSITIVE BENEFIT FOR OPERATIONS. AS OPPOSED TO IN THESE PARTICULAR AREAS. SO, YOU KNOW, IT'S OF COURSE, IT'S AT THE END OF THE DAY, IT'S OBVIOUSLY A BOARD DECISION. BUT THESE ARE -- THIS IS A WAY WE BELIEVE THAT WE CAN HELP BALANCE THE BUDGET. BUT STILL MOVE THE NEEDLE FORWARD ON SIGNIFICANT RENEWABLE ENERGY INITIATIVES AS OPPOSED TO THE SIGNIFICANT COSTS THAT JUST GO EXTERNAL TO US.

Supervisor Abe-Koga: I MAY HAVE QUESTIONS FOLLOWING UP, SO I'LL DO THAT OFFLINE. THANK YOU.

Supervisor Lee: OKAY, THANK YOU. SO I THINK WE ARE FINISHED WITH ITEM FIVE; AM I CORRECT, CLERK? I WANT TO MAKE SURE THAT WE ARE CLEAR AND WE CAN MOVE TO ITEM 6, WHERE WE TOOK THE PUBLIC QUESTIONING ON THAT EARLIER. RIGHT?

Clerk: WE TOOK PUBLIC COMMENT ON 5 AND 6 TOGETHER AT THE SAME TIME.

Supervisor Lee: LET ME ASK MY COLLEAGUE ON ITEM 6 INCOME WHICH ARE THE ITEMS THEY WOULD LIKE TO DISCUSS. VICE PRESIDENT.

Supervisor Arenas: 6E, AND B.

Supervisor Lee: E AND B.

Supervisor Arenas: B.

Supervisor Lee: B AND E. GOT IT. THANK YOU. SUPERVISOR ELLENBERG.

Supervisor Ellenberg: D.

Supervisor Lee: SUPERVISOR DU'O'NG. SORRY, ABE-KOGA, SORRY ARE SAME, D AND E.

Supervisor Lee: WE ALREADY GOT THOSE, YES. D. B, TO BOY, D FOR DOG, AND E FOR EGG.

Supervisor Du'o'ng: B, D, AND E.

Supervisor Lee: ALL RIGHT. ONE, TWO, THREE, 45. AND I THINK LET'S GO AHEAD AND START WITH ITEM 6B. ON PUBLIC HEALTH DEPARTMENT.

Mr. Williams: 6B IS THE PUBLIC HEALTH DEPARTMENT. WE ARE HAPPY TO ANSWER QUESTIONS.

Supervisor Lee: VICE PRESIDENT, GO AHEAD.

Supervisor Arenas: THANK YOU. I AM -- I KNOW THAT THERE IS A LOT OF CHANGES HAPPENING WITH OUR PUBLIC HEALTH DEPARTMENT, ONE OF WHICH IS OUT OF OUR HANDS, AND SUICIDE PREVENTION, WHICH IS A STATE REALIGNMENT OF THEIR FUNDING FOR SUICIDE PREVENTION OVER TO THE STATE PUBLIC HEALTH. LOOKS LIKE WE ARE DOING THE SAME FOR BEHAVIORAL HEALTH FOR SUICIDE PREVENTION TO PUBLIC HEALTH. I AM WONDERING IF WHAT -- WHAT KIND OF CAPACITY DOES THE PUBLIC HEALTH EXPECT TO HAVE OR NEED IN THIS TRANSITION TO TAKE ON THIS KIND OF WORK.

THANK YOU, VICE PRESIDENT ARENAS. SARA FOR THE PUBLIC HEALTH DEPARTMENT. WE APPRECIATE THAT CERTAINLY ANY CAPACITY WE WORK TO BUILD, WILL LIKELY LOOK VERY DIFFERENT THAN WHAT CURRENTLY EXISTS IN BEHAVIORAL HEALTH AND THAT AT THE STATE HAS UNFORTUNATELY REMOVED FUNDING FOR. WHAT WE CURRENTLY HAVE IS THE PLAN TO DEVOTE A PROGRAM MANAGER 3 WHO WORKS UNDER MISS WHAT McCLINTON-BROWN IN THE OFFICE OF OUR DIRECTOR TO INCUBATE THE NEW PROGRAM. WORK VERY CLOSELY WITH THE PORTIONS THAT WE MAINTAIN IN BEHAVIORAL HEALTH. SUCH AS EMERGENCY POST AND EARLY INTERVENTION CARE. THE UNDERSTANDING AT THAT.

Supervisor Ellenberg: THAT THE STATE PUBLIC HEALTH DEPARTMENT INTENDS TO OFFER SOME AMOUNT OF MONEY TO LOCAL HEALTH JURISDICTIONS. HOWEVER, THE LAST WE HEARD WAS 12 MILLION I DON'T KNOW TOTAL FOR THE ENTIRELY STATE. SO OUR ASSUMPTION IS THAT WILL BE MINIMAL TO EACH JURISDICTION POTENTIALLY ON THE ORDER OF ONE FTE. WE ARE PREPARED TO LEVERAGE IS IN ADDITION TO THE SMALL AMOUNT OF ONE-TIME FUNDING COMING FROM BEHAVIORAL HEALTH IS ALL THE EXPERTISE THAT WE HAVE THAT OVERLAPS WITH SUICIDE PREVENTION. AND INCLUDING OUR VIOLENCE PREVENTION TEAM AND THEIR EXPERTISE IN GENERAL COMMUNITY VIOLENCE PREVENTION, AND IN GUN VIOLENCE REDUCTION. WE HAVE EXPERTISE IN OUR MATERNAL CHILD HEALTH GROUP AROUND PERINATAL MENTAL HEALTH, SUICIDE A RANGE OF EXPERTISE. AND USING IT TO LEVERAGE POLICY AND COMMUNICATION UPONS TO REDUCE COMMUNITY RISK OF COURSE WE ARE PREPARED TO LEVERAGE THAT AND WORK AS CLOSELY AS WE CAN WITH OUR STATE PARTNERS WITH OUR BEHAVIORAL HEALTH DEPARTMENT PARTNERS AND THEN MAXIMIZE THE RESOURCES THEY DO WITH.

RHONDA McCLINTON BROWN, I THINK THE ONLY THING THAT I WOULD ADD RHONDA HE RECOGNIZE THAT SUICIDE PREVENTION WORK HAS LONGSTANDING PARTNERSHIPS IN THE COMMUNITY THAT I THINK WE HAVE THE ABILITY TO RECOGNIZE AND HONOR THE LONGSTANDING PARTNERSHIPS THAT PEOPLE HAVE OE HEALTH SERVICES HAS HAD IN THE COMMUNITY. WE WILL BE WORKING VERY CLOSELY WITH BEHAVIORAL HEALTH TO REALLY NOURISH AND MAINTAIN WHAT THOSE STRONG PARTNERSHIPS ARE MOVING FORWARD.

WE HAVE BEGAN SOME EARLY MEETINGS WITH THE PARTNERS TO JUST UNDERSTAND WHAT IS WORKING WELL AND WHAT WE NEED TO FIGHT TO SUSTAIN.

Mr. Williams: I WANT TO ADD TWO THINGS ON THIS ITEM. WE ARE TRYING TO GET MORE FUNDING PASSED DOWN THROUGH TO UNITED STATES. IT WAS AN UNINTENDED CONSEQUENCE ASSOCIATED WITH THE GOVERNOR'S PROPOSITION ONE. WE'LL TALK ABOUT THEM WHEN WE GET TO BEHAVIORAL HEALTH IN A FEW MINUTES ONE WAS A SHIFT IN THE FUNDING ALLOCATION AWAY FROM COUNTIES TO THE STATE. A PIECE OF THAT SHIFT WAS SPECIFIC DEDICATION OF FUNDING TO THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH RELATED TO THESE PREVENTION ACTIVITIES. AND I THINK I MENTIONED THIS I FORGET IN WHAT COMMITTEE. BUT IN FAIRNESS TO THE STATE I THINK THAT THEIR THINKING BEHIND IT IS MORE COST EFFECTIVE FOR THEM TO RUN STATEWIDE EDUCATION ADVOCACY OUTREACH CAMPAIGNS AND MAYBE THAT MAKES SOME SENSE FOR RURAL COUNTIES IN CALIFORNIA, OR MAYBE IT MAKES A LITTLE SENSE IN TERMS OF MASS BUY OR LARGER MEDIA MARKETS. BUT IT DISRUPTS THE GOOD WORK THAT WE HAVE BEEN DOING HERE LOCALLY. IT'S NOT AN APPROACH THAT MAKES SENSE TO SANTA CLARA COUNTY. WE ARE IN THE MIDST OF THAT ADVOCACY EFFORT WITH CDPH. AND BEYOND THAT, WE RECOGNIZE THAT THERE IS, YOU KNOW, SIGNIFICANT WORK THAT'S HAPPENED IN OUR BEHAVIORAL HEALTH DEPARTMENT RELATED TO THIS AND THAT'S SOMETHING THAT WE ARE LOOKING AT FURTHER. OUR MAIN ASK WOULD BE FOR CDPH TO PASS THAT MONEY BACK TO US AND, THAT WOULD MAKE A HUGE DIFFERENCE.

Supervisor Arenas: WELL, I'LL KNOCK ON WOOD, TOO. HOPEFULLY THEY CAN DO THAT. THE OTHER PIECE I WAS GOING TO ASK YOU ABOUT, AND WE HAVE TALKED ABOUT THIS. DR. RUDMAN, RHONDA AND THIS IS THE CRISIS TO THE STATE OF CALIFORNIA ESTABLISHED AROUND YOUNG MEN. AND ISOLATION AND LONELINESS. AND I WASN'T SURE IF THERE WAS -- I DON'T KNOW IF YOU HAVE DONE WORK FIGURING OUT IF THERE IS FUNDING THAT THAT MUCH TODAY TO IT THAT WE CAN LEVERAGE OR PULL DOWN THAT FROM.

UNFORTUNATELY IT DIDN'T APPEAR THAT AT THE TIME THE STATE DECLARED THAT CRISIS RELATED TO YOUNG MEN AND YOUNG MEN'S MENTAL HEALTH THAT THERE WERE ANY FUNDING STREAMS RELATED TO IT AT THE STATE LEVEL. THAT SAID WE HAVE BEGUN LOOKING INTO WHETHER THERE IS ANYTHING THAT CAN BE LEVERAGED. WE DON'T HAVE ANYTHING PARTICULARLY READY TO GO. THAT WE HAVE LEARNED ABOUT. BUT THAT SAID IT'S SOMETHING THAT WE ARE MONITORING CLOSELY AND READY TO JUMP ON IF THEY SPOT ANYTHING. MEAN WHILE, I THINK ALL OF OUR EFFORTS AROUND MENTAL HEALTH ESPECIALLY ANY PLACE IN WHICH WE ARE COORDINATING RESPONSE TO THE FINDING OF THE LATINO HEALTH ASSESSMENT THAT ECHO THAT STATE CALL FOR ATTENTION FOR YOUNG MEN ESPECIALLY LATINO YOUNG MEN IN SANTA CLARA COUNTY LOOKING FOR WAYS THAT WE TAKE THAT INTO ACCOUNT AND ALL OUR PREVENTION ACTIVITIES, VIOLENCE PREVENTION OR SUICIDE PREVENTION, SUBSTANCE USE PREVENTION AND ANYTHING. RHONDA ANYTHING?

NO.

THANK YOU.

I APPRECIATE THAT. I THINK IT'S REALLY HELPFUL. AND THE OTHER PIECE THAT I WOULD LOVE FOR YOU TO CONNECT. WE TALKED ABOUT THIS AS WELL, IS THAT YOU PARTICIPATED IN THE CHILD AND YOUTH DEATH REPORT REVIEW. THE YEAR-LONG PROCESS, YOU HAVE GLEANED SOME TRENDS AND OBSERVATIONS THERE OBVIOUSLY. WE WANT TO WORK WITHIN THE PREVENTION FIELD, BUT IF THERE IS TRENDS IF THERE IS THINGS THAT YOU NOTICE I WOULD LOVE FOR YOU TO CONTINUE TO INCORPORATE YOUR LESSON, THE LESSONS LEARNED FROM THERE. AND I WOULD LOVE FOR YOU TO REPORT BACK TO OUR CSFC. YOU KNOW, MAYBE ON A QUARTERLY BASE AS YOU ARE FIRST BEGINNING TO ESTABLISH THIS. AND UPGRADE IT INTO YOUR SYSTEM. TO SEE HOW YOU ARE DOING. I WOULD LOVE TO FIGURE OUT HOW TO SUPPORT YOU IF THERE IS ANY DRAW DOWN FUNDING FROM THAT YOUNG MAN, YOUNG MEN LONELY -- I DON'T EVEN KNOW WHAT THE ACTUAL NAME OF IT IS BUT YOU ALL KNOW THE CRISIS THAT IS ESTABLISHED BY THE STATE BUT HAD NO MONEY CONNECTED TO IT. ALTHOUGH, WE KNOW FROM THE LATINO HEALTH ASSESSMENT THAT SUICIDES HAVE BEEN INCREASING IN LATINO MEN. AND OBVIOUSLY IN GENERAL, YOU HAVE SEEN THE NUMBER OF CHILDREN AND YOUTH THAT COMMITTED -- THAT DIED THIS WAY. IT'S REALLY IMPORTANT FOR US TO, YOU KNOW, TO COUNT ON YOU TO COORDINATE WITH OUR SCHOOL COUNTY CLAN RIFF. THAT WAS REALLY HOPING TO HAVE YOU ALL INTEGRATE IN. WORK HAND IN HAND WITH SCHOOL LINK SERVICES SO THAT YOU ARE THE EXPERTS IN THIS AREA AS YOU TAKE ON THIS PARTICULARLY INITIATIVE. AND PROVIDE GUIDANCE TO OUR SCHOOL-LINKED SERVICES TO -- YOU KNOW, TO LEND SOME OF THE BEST PRACTICES OR THE -- WHATEVER IS BEST SUITED FOR OUR TEENS OR JUNIOR HIGH KIDS OR EVEN ELEMENTARY SCHOOL-AGE KIDS. ALL RIGHT. I HAVE ONE MINUTE SO I WILL BE DONE.

Supervisor Lee: THANK YOU. SUPERVISOR ABE-KOGA, YOUR LIGHT IS ON FIRST. WHOEVER WANTS TO GO FIRST. GO AHEAD.

Supervisor Abe-Koga: THANK YOU. I WASN'T SURE IF THIS WAS UNDER THIS ITEM OR ANOTHER ITEM 6E. BUT SINCE VICE PRESIDENT ARENAS BROUGHT IT UP, I, TOO, AM CONCERNED ABOUT THE REDUCTIONS IN OUR SUICIDE PREVENTION PROGRAM. THAT WE HEARD FROM A LOT OF MEMBERS OF THE PUBLIC ON THIS. IF THE PROGRAM IS WORKING OR AT AN ALL-TIME LOW. AND YET WE ALSO HAVE TO MEET THE MOMENT. AND AS WE HAVE DISCUSSED IN HHC, THERE IS A CLUSTER. HAPPENING IN NORTH COUNTY AND SO THAT'S REALLY MY CONCERN. I THINK MISS RUDMAN MENTIONED IT WILL LOOK DIFFERENT. THAT'S MY CONCERN HOW DIFFERENT WILL IT BE. AND I APPRECIATE THE COMMUNITY ENGAGEMENT AND INVOLVEMENT OVER THE MANY YEARS AND SO, I THINK -- I ALSO HEARD SOME CONCERN THAT THEY WEREN'T AWARE OF THESE CHANGES. I VERY MUCH APPRECIATE THAT ONE POSITION WAS BEING RESTORED OUT OF THE ORIGINAL FIVE. BUT MY INTEREST WOULD BE TO CONTINUE OR MAINTAIN MORE POSITIONS. AND, YOU KNOW, I UNDERSTAND WE ARE IN BUDGET CUTS, SO DEFINITELY WILLING TO CUT THE BABY OR, YOU KNOW, COMPROMISE. BUT I WOULD LIKE TO UNDERSTAND BETTER HOW THESE CHANGES AFFECT SPECIFICALLY YOUTH MENTAL HEALTH AND I ASKED FOR A REPORT ON WHAT WE ARE DOING IN THE YOUTH CATEGORY AND I HAVE NOT RECEIVED THAT INFORMATION FRANKLY YET. BUT THAT WOULD BE MY REQUEST IS TO GET A BETTER UNDERSTANDING OF HOW THIS WILL AFFECT YOUTH MENTAL HEALTH AND BEHAVIORAL HEALTH. AND IF THERE IS AFTERNOON OPPORTUNITY TO SAVE ANOTHER POSITION OR TWO, THANK YOU.

Mr. Williams: WE CAN PROVIDE THAT INFORMATION.

Supervisor Lee: THANK YOU. SUPERVISOR ELLENBERG.

Supervisor Ellenberg: THANK YOU. I REALLY APPRECIATE THE WORK AND JUST FEEL FOR HOW CHALLENGING THIS BUDGET IS DR. RUDMAN. I KNOW THAT WE HAVE BEEN VERY, VERY CAREFUL ABOUT FEDERAL GRANTS. NOT OVER STEPPING, NOT COUNTING NOT COUNTING MONEY WHERE WE KNOW THAT WE ARE NOT GOING TO COMPLY WITH THE FEDERAL GOVERNMENT'S AGREEMENTS AND HAVE NO INTEREST IN DOING SO. A VERY SMALL PORTION OF THAT 19 IDEAS THAT WAS MENTIONED EARLIER IS INCLUDED IN THAT BUDGET. ARE FOR AND WHAT OUR RELATIVE LEVEL OF CONFIDENCE IS.

Mr. Williams: I'LL TAKE A TAP AT IT. WE TOOK PROACTIVE STEPS TO PULL OUT FROM OUR BASE. OF FEDERAL GRANT FUNDING. BECAUSE WE KNEW THEY WOULD COME WITH CONDITIONS ATTACHED THAT DIDN'T CONFORM WITH THE COUNTY'S VALUES AND NOT CONDITIONS THAT WE WOULD CERTIFY ADHERENCE WITH. WE HAVE BEEN VERY FORTUNATE THAT THROUGH THE GOOD WORK OF THE COUNTY COUNSEL'S OFFICE AND COALITION WITH OTHER ENTITIES THERE IS A NUMBER OF DISTRICT COURT INJUNCTIONS THAT KEPT SOME, THOUGH NOT ALL. SOME OF THE IF YOU WANTING IN PLACE. THOSE CASES ARE JUST NOW MAKING THEIR WAY ON A DEE. WORK WITH COUNTY COUNCIL TO MAKE AN ASSESSMENT OF WHAT PIECES WE BELIEVE CAN REASONABLY BE RELIED ON BUT DOING SO ON ONE-TIME BASIS. THE FEDERAL GOVERNMENT CONTINUES TO PROPOSE ELIMINATION OF THESE ALTOGETHER. CONDITION ASIDE. THE CONTINUED AVAILABILITY OF MANY OF THOSE FUNDING STREAMS IS IN JEOPARDY. THEY ARE NOT EAGER TO CONTINUE THEM PERIOD. THAT'S THE BALANCE WE HAVE AND WOULD PROVIDE ADDITIONAL INFORMATION TO THE BOARD OF LIKE AROUND HOW WE HAVE TRIED TO STRIKE THE RIGHT BALANCE THERE. BUT I WILL SAY, FROM MY PERSPECTIVE. THERE CONTINUES TO BE EXTRAORDINARY RISK ASSOCIATED WITH THESE FEDERAL GRANTS.

Supervisor Ellenberg: RIGHT. I HEAR THAT. AND I AGREE. ONE OF THE THINGS THAT WORRIES ME IS IF WE ARE WRONG, AND WE PUT IN OUR BOOKS EVEN 4 MILLION OR 1 MILLION THOSE CASES ARE OVERTURNED WHICH THEY WILL BE AND WE HAVE TO RETURN THE MONEY HOW DOES THAT IMPACT OUR BUDGET?

Mr. Williams: WE FACE A MULTITUDE OF PHONE HAM RISKS. WE CAN ADDRESS THAT IN COMMUNICATIONS WORKING WITH THE COUNTY COUNSEL TO STRIKE THE RIGHT BALANCE THERE THIS IS ONE OF THE MANY LAYERS WE FACE AS LAYERS OF UNCERTAINTY FACING US BEYOND JUST THE STRAIGHT UP CUTS.

Supervisor Ellenberg: I WOULD APPRECIATE OFFLINE WHATEVER INFORMATION YOU CAN SHARE. AGAIN, I AM CRITICAL AND ANNOYED WITH THE SYSTEM. I WANT TO DO THE WORK. AND I WANT TO MAKE SURE THAT WE ARE PROTECTED AND DON'T END UP WITH EVEN A GREATER NEGATIVE BALANCE. I LOOK FORWARD THAT. THANK YOU, AND THANK YOU DR. RUDMAN.

Supervisor Lee: THE BUDGET ALSO TALK ABOUT THE PUBLIC HEALTH LABORATORY WHERE WE USE THE INFLUENCE OF SOME TYPING ELIMINATING THE COVID GENOME SEQUENCING. AND THIS AFFECTS THE SURVEILLANCE CAPABILITY POTENTIALLY HOW IS THAT GOING TO AFFECT US IN TERMS OF THE TO BE READY FOR THE NEXT OUTBREAK, FOR EXAMPLE?

THANK YOU, PRESIDENT LEE. THAT DECISION TO DOWNGRADE SOME OF THE WORK WE ARE DOING IN THE PUBLIC HEALTH LAB IN ORDER TO PRIORITIZE OTHER ACTIVITIES THAT FEEL EVENING MORE URGENT RIGHT NOW, IT WAS BALANCED BY A RISK ASSESSMENT THAT'S CONSTANTLY EVOLVING. FOR EXAMPLE A YEAR AGO WHEN WE WERE MAKE SURE EVERY SINGLE PERSON WHO GOT THE FLU ANYWHERE IN THE COUNTY WE COULD SAY WITH 100 PERCENT CERTAINTY IT WASN'T THE BIRD FLU. WE FEEL COME FIT DEALT WITH THE WAY THAT FLU IS SPREADING THROUGH THE COUNTRY THROUGH THE WORLD, WE CAN DO A SAMPLING OF CASES AND SAY, HERE IS WHAT WE KNOW ABOUT THE RISK. AND CONTINUE TO PROVIDE AN ACCURATE RISK ASSESSMENT FOR THE PEOPLE OF SANTA CLARA COUNTY AND SAFE, EFFECTIVE WAYS TO PREVENT GETTING SICK FROM THAT PARTICULAR PATHOGEN, JUST LIKE DISEASES ARE CHANGING OUR DECISION ABOUT WHAT DISEASES ARE THE PRIORITY EFFORT PRIORITY TO LOOK FOR USING THE PUBLIC HEALTH LAB RESOURCES IS CONSTANTLY CHANGING AND THIS PROPOSAL, WHILE IT DOES OVERALL SLIGHTLY INCREASE THE TOTAL AMOUNT OF OBJECT TO GOING TO THE LAB SO IT CAN CONTINUE TO PURCHASE SOME SUPPLIES FOR NEWER NEEDS, DOES PULL BACK ON BOTH THOSE TWO TYPES OF TESTING THAT FEEL SLIGHTLY HIGHER PRIORITY RIGHT NOW. THE INFLUENZA SUBTYPING AND THE COVID GENOME TYPING. OKAY, THANK YOU. WE HAVE TO BALANCE THE RISK AND THIS IS WHAT WE HAVE TO DO GIVEN THE RESOURCES.

Mr. Williams: I WANT TO HIGHLIGHT. VERY FEW PLACES IN THIS BUDGET. THERE ARE A FEW VERY IMPORTANT ONES, THIS IS ONE AREA WHERE WE ARE ACTUALLY PROPOSING AN INCREASED INVESTMENT. MODEST BUT PRECISELY BECAUSE OF WHAT DR. HAD YOU HAD MAN SAID AND WE DON'T FEEL LIKE WE CAN RELY ON THE C.D.C. IN THE SAME WAY. AND SO MAKING OUR LABORATORY RESOURCES AVAILABLE FOR EMERGING NEEDS IS WHAT WHAT THIS PROPOSAL IS REALLY ABOUT.

Supervisor Lee: THANK YOU, JAMES. ALL RIGHT, MOVING ONTO I HAVE 6D. I BELIEVE A LOT OF MY COLLEAGUES ARE INTERESTED IN THIS ONE, 10 MINUTES AROUND. ON THIS ONE.

Mr. Williams: 6D IS SANTA CLARA VALLEY HEALTHCARE. KNOW HE THAT THEY HAVE A PRESENTATION. HE LEAVE IT TO YOUR DISCRETION IF YOU WANT TO HEAR A PRESENTATION.

LEN: WE HAVE SEEN THE PRESENTATION TAKE WE CAN MOVE TO QUESTIONING.

Mr. Williams: WE CAN GO STRAIGHT TO QUESTIONS, ABSOLUTELY. SO I HAVE TWO COLLEAGUES THAT WANT TO SEE THE PRESENTATION, SO OKAY, PALM. THERE YOU GO. GO HEAD, LET'S DO IT.

GUYS TODAY HERE AND TALK ABOUT THE PUBLIC HEALTHCARE DID I EVER I DISSYSTEM, JOINING ME IS OUR CHIEF FISCAL OFFICER. OF COURSE OUR CUSTODY HEALTH DEPARTMENT. I WANT TO FIRST OF ALL TAKE A MOMENT TO ACKNOWLEDGE OUR STAFF. AND YOU KNOW SUPERVISORS, YOU ALL HAVE MADE MENTION OF OUR INCREDIBLE WORKFORCE HERE IN SANTA CLARA VALLEY HEALTHCARE. ONE OF THE THINGS THAT WE SPEAK OF CONSTANTLY IN HEALTHCARE, IS TWO WORDS, TRUST AND CONFIDENCE. AND YOUR HEALTHCARE TEAM AT SANTA CLARA VALLEY HEALTHCARE. SEEKS TO MAKE SURE THAT WE MAINTAIN THE TRUST OF OUR COMMUNITY. AND THE SUPPORT OF OUR COMMUNITIES THROUGH THE CONFIDENCE THAT THEY HAVE IN THE DELIVERY OF THE QUALITY OF CARE THAT WE PROVIDE. THERE ARE TWO THINGS NOT OBVIOUS IN THIS BUDGET THAT I THINK YOUR BOARD IS VERY MUCH AWARE OF. BUT IT MAY NOT BE VISIBLE TO THE PUBLIC. FIRST OF WHICH, AND JAMES WILLIAMS OUR COUNTY EXECUTIVE MENTIONED. IS THAT YEAR OVER YEAR YOUR BUDGET OF THE HEALTHCARE SYSTEM INCREASES. WE DO NOTHING AT ALL, OUR COSTS OF LABOR GOES UP. OUR COST OF SERVICES SUPPLIES GOES UP AND JUST THIS YEAR ALONE GOING FROM FISCAL YEARS IT INCREASED BY $225 MILLION. THIS IS ON TOP OF THE $400 MILLION THAT THE HEALTHCARE SYSTEM HAS PUT FORWARD BOTH IN TERMS OF $200 MILLION ADDED YEAR, AND, AGAIN, THE ADDITIONAL $200 MILLION WE ARE LOOKING AT IN THIS RECOMMENDED BUDGET. AND IT IS REALLY IMPORTANT TO UNDERSTAND THAT IT IS THE WORK OF YOUR STAFF AT THE HEALTHCARE SYSTEM THAT IS GOING TO MAKE THIS POSSIBLE. WHEN JAMES TALKS ABOUT OUR BUDGET SOLUTIONS AS A HEALTHCARE SYSTEM, THE MAJORITY OF THOSE SOLUTIONS HAVE TO DO WITH OPERATIONAL EFFICIENCY. OPPORTUNITIES TO GENERATE REVENUE WHILE ALSO MAKING SURE THAT WE PRESERVE AND MAINTAIN SERVICES FOR OUR COMMUNITY. THE OTHER AREA THAT'S NOT SO OBVIOUS, WHICH IS ACTUALLY REALLY TROUBLING ISSUE. IS THAT WHILE WE ARE FACED WITH $1 BILLION IN LOST REVENUES RELATED TO MEDICAID, AND WE KNOW WE HAVE TO HAVE SOLUTIONS TO ADDRESS IT. THE OTHER COMPOUNDING FACTOR IN THIS IS THAT THERE WILL BE A GREATER RELIANCE ON YOUR PUBLIC HEALTHCARE SYSTEM GOING FORWARD. WE KNOW THAT INDIVIDUALS THAT WERE ONCE UNDER COVERED CALIFORNIA, 25 TO 30% OF THOSE INDIVIDUALS NO LONGER HAVE COVERAGE, WE CONSISTENTLY ARE SEEING A GROWTH IN THE NUMBER OF MEDICARE PATIENTS ACCESSING YOUR HEALTHCARE SYSTEM TESTIMONY IN THIS COUNTY. WHEN I FIRST ARRIVED THE MEDICARE POPULATION SERVED BY YOUR PUBLIC SYSTEM WAS AROUND 16%. TODAY THAT IS AROUND 36, 37% OF OUR PATIENT POPULATION. SO OUR AGING POPULATION, OUR MEDICAID POPULATION THAT WE CARE FOR, THE MEDI-CAL POPULATION, INDIVIDUALS THAT FALL INTO INCOME LEVELS THAT ARE ANYWHERE FROM 400 TO 600 PERCENT OF THE FPL. RELY ON YOUR PUBLIC HEALTHCARE SYSTEM. AND THAT NUMBER IS GOING TO CONTINUE TO GROW. WHILE WE ARE LOOKING AT SOLUTIONS TO MAINTAIN THE SERVICE TO OUR COMMUNITY. AND THAT IS A COMMITMENT THAT YOUR ENTIRE WORKFORCE WITHIN THE HEALTHCARE SYSTEM. IS ENTRUSTED WITH. AND WE ARE FULLY COMMITTED TO THAT. WE KNOW YOUR PUBLIC HEALTHCARE SYSTEM HAS TO BE AROUND NOT ONLY NEXT YEAR BUT FIVE YEARS FROM NOW AND 10 YEARS FROM NOW SO ALL OF OUR DECISIONS ARE STRATEGIC RELATIVE TO PRESERVING AND MAINTAINING SERVICES FOR OUR COMMUNITY. THE NEXT SLIDE. SOMETHING THAT YOUR BOARD IS ALSO FAMILIAR WITH. IS REALLY WHERE OUR STRATEGIC PRIORITIES ARE AT. AND WHERE WE ARE FOCUSED ON ONE IS MAXIMIZING REVENUE. YOU HAVE HEARD ABOUT OUR EFFORT TO IMPROVE OUR REVENUE CYCLE PROCESS TO MAKE SURE THAT WE COLLECT EACH AND EVERY DOLLAR DUE TO US FOR THE CARE THAT WE PROVIDE. WE ARE HEAVILY FOCUSED ON PAYER STRATEGIES TO MAKE SURE THAT WE ARE GETTING PAID FROM OUR PAYERS IN A MANNER THAT IS COMMENSURATE WITH WHAT WE ARE SEEING IN THE MARKETPLACE. AND OF COURSE AS JAMES DESCRIBED WE HAVE TO LOOK TO THE STATE. MEDICAID PROGRAM IS A STATE PROGRAM. WE ARE ONE OF THE MAJOR PROVIDERS SERVING THE MEDI-CAL POPULATION PARTICULARLY HERE IN SANTA CLARA COUNTY WHERE WE SERVE 65 TO 75% OF THE MEDI-CAL POPULATION. THE STATE SHOULD LEAN IN AND FIND OPPORTUNITY TO SUPPORT PUBLIC SYSTEMS. PARTICULARLY YOUR PUBLIC SYSTEM. WE HAVE FOCUSED ON PRIMARY CARE AND OUTPATIENT SERVICES SECOND, MAKING SURE THAT WE ENSURE THAT EVERYONE HAS ACCESS TO PREVENTIVE HEALTHCARE SERVICES SO WE DO NOT HAVE DEEP EDGES COST RELATIVE TO CLINICAL CARE. WE ARE HEAVILY FOCUSED ON MAKING SURE THAT YOUR FOUR HOSPITALS ARE OPERATIONAL EFFICIENT. BUT LOOKING AT HOW WE LEVERAGE THE FOUR HOSPITALS GOING FORWARD. AS MENTIONED, WE BROUGHT FORWARD $200 MILLION IN BUDGETED TARGET INITIATIVES. THE VAST MAJORITY OF THOSE AGAIN ARE FOCUSED ON OPERATIONAL EFFICIENCIES AND COST SAVINGS AND SERVICE RESTRUCTURING AND THAT IS SO WE CAN PRESERVE SERVICES TO OUR COMMUNITY. WHILE ALSO GENERATING REVENUE. THE BUDGET FOLLOW FY26-27, ALSO LOOKS AT REVENUE IMPROVEMENTS. BUT, AGAIN, IS FOCUSED ON OPERATIONAL EFFICIENCIES AND IMPROVEMENTS RELATIVE TO SERVICES FOR OUR COMMUNITY. AND THIS ONCE AGAIN IS A REFLECTION OF THE COMMITMENT AND THE HARD WORK OF YOUR STAFF GOING FORWARD. IT'S SOMETHING THAT PRESENTS SIGNIFICANT AMOUNT OF CHALLENGE BECAUSE WE HAVE TO PERFORMANCE A SYSTEM IN ORDER TO ACHIEVEMENT THIS LEVEL OF IMPROVEMENT IN TERMS OF THE BUDGET. IT'S QUITE SIGNIFICANT. BUT I HAVE THE UTMOST CONFIDENCE IN OUR STAFF TO ACTUALLY DO THEIR VERY BEST TO MOVE TOWARD AND ACHIEVE THESE TARGETS. NOW WHETHER OR NOT WE CAN DO IT. ONLY TIME WILL TELL. BUT I HAVE TO SAY YOU KNOW YOUR STAFF THEY ARE RESILIENT AND UNDERSTAND WHAT IS AT STAKE FOR OUR COMMUNITY. SOME OF BUDGET INITIATIVES -- AND I AM NOT GOING THROUGH ALL OF THESE BECAUSE I KNOW YOU PROBABLY HAVE SPECIFIC QUESTIONS. BUT WE ARE LOOKING AT REVENUE ENHANCEMENTS OF $34.7 MILLION. AND IT'S JUST NOT AROUND THE REVENUE CYCLE. BUT IT ALSO IS AROUND SOME OF THE OPERATIONAL IMPROVEMENTS. BUT ALSO IT IS AROUND CONTRACT PAYMENT RATE IMPROVEMENTS. I CAN TELL YOU GIVE YOU A SPECIFIC NUMBER. WE ARE ALREADY PROJECTING ANOTHER $17 MILLION IMPROVEMENT IN OUR COMMERCIAL RATE PAYMENT. PROJECTS GOING INTO NEXT YEAR. THAT'S ONE OF THE MANY REVENUE CYCLE CONTRACTS REVENUE SOLUTIONS WE HAVE PUT FORWARD AND ARE WORKING ON WE LOOKING AT PROGRAM RESTRUCTURING, OUR HOSPITAL CENSUS ORIGINALLY WE WERE PROJECTING AT IMPROVING GOING FOR 171 TO 177. BUT SINCE THIS REPORT CAME OUT. IN CONVERSATIONS WITH OUR COUNTY EXECUTIVE WE ARE NOW MOVING THAT PROJECTED CENSUS YOU HAVE TO ONE I BELIEVE 187. 89. THESE ARE ALL WHEN I SPEAK OF IMPROVEMENTS, RELATED TO HOW WE CAN ACTUALLY IMPROVE ACCESS TO EFFICIENCY AND ALSO GENERATE REVENUE FOR THE SYSTEM. NEXT SLIDE. THESE ARE THE AREAS THAT I MENTIONED IF YOU RECALL THAT FLOW CHART. WE FOCUSED ON OUTPATIENT SERVICES. YOU'LL SEE HERE A NUMBER OF AREAS IN THE CLINIC PERFORMANCE IMPROVEMENTS RELATED TO PRIMARY CARE AND SPECIALTY. WHERE WE KNOW THAT WE CANNOT ONLY PROVIDE THE BASIS TO ENSURE ACCESS TO PREVENTIVE HEALTHCARE BUT GENERATE THE REVENUES TO COVER THE COST. AND ACTUALLY PROVIDE FOR OPPORTUNITIES TO IMPROVE ACCESSIBILITY FOR OUR SYSTEM RELATIVE TO OTHER PATIENTS. NOT NOT TALKING ABOUT JUST MEDI-CAL BUT MEDICARE, COMMERCIAL COVERAGE INDIVIDUALS, THAT ARE LOOKING FOR ACTION ACCESS TO QUALITY HEALTHCARE SERVICES FROM A PRIMARY CARE STANDPOINT. WE WERE HEAVILY FOCUSED ON THAT BECAUSE WE HAVE A SYSTEM TODAY, THAT GEOGRAPHICALLY COVERED THE VAST MAJORITY OF COUNTY AND WE KNOW THAT WE PROVIDE QUALITY HEALTHCARE SERVICES WITH EXCELLENT HEALTH OUTCOMES. NEXT SLIDE, PLEASE. THIS HAS BEEN SAID TIME AND FINAL AGAIN, IS THAT WE HAVE BEEN VERY FORTUNATE TO BE ABLE TO HAVE THE SUPPORT OF THE COMMUNITY. HOW THESE PARTICULAR AREAS WERE IDENTIFIED IN THE BUDGET PROPOSAL. WE LOOK AT THE ORDER OF IMPACT ON THE

GREATER COMMUNITY IN MAINTAINING ESSENTIAL HEALTHCARE SERVICES FOR ALL RESIDENTS. TRAUMA CARE, BURN, THOSE ARE THINGS NO MATTER WHAT HEALTHCARE SYSTEM YOU BELONG TO OR GO TO, YOU RELY ON OUR PUBLIC HOSPITAL TO PROVIDE THESE CRITICAL AND ESSENTIAL SERVICES. THAT'S ONE REASON WE PUT FORWARD THESE ITEMS FROM A COMMUNITY HEALTHCARE STANDPOINT.

THERE ARE CERTAIN SERVICES THAT YOUR PUBLIC HEALTHCARE SYSTEM PROVIDES THAT NO OTHER HEALTHCARE SYSTEM PROVIDES. THE CHILD ADVOCACY CENTER, HEALTHCARE FOR OUR FOSTER CHILDREN IN THIS COMMUNITY. THE PEDIATRIC DIAGNOSTIC CENTER, HELPING CHILDREN WITH THE DIAGNOSIS OF CONDITIONS THAT OTHERWISE WOULD NOT ALLOW THEM TO PROGRESS AND SUCCEED IN SCHOOL. THE TB. A TUBERCULOSIS AND REFUGEE PROGRAM THAT WE OPERATE. THESE ARE VERY UNIQUE PROGRAMS FOR WHICH BENEFITS THE ENTIRE COMMUNITY.

WE ARE ALSO LOOKING AT THESE AREAS BECAUSE WE WERE LOOKING TO MAKE SURE THAT WE MAINTAIN AND PROMOTE HEALTH EQUITY. MAKING SURE THAT EVERY RESIDENT HAS THE OPPORTUNITY IN OUR COMMUNITY TO HAVE ACCESS TO QUALITY HEALTHCARE SERVICES, IRRESPECTIVE OF YOUR BACKGROUND, SOCIAL ECONOMIC STATUS, ETCETERA. THAT IS THE CORE MISSION AND PURPOSE OF YOUR PUBLIC HEALTHCARE SYSTEM, AND THAT'S WHY MANY OF THE SERVICES LISTED ARE SERVICES THAT ARE ESSENTIAL FOR ANYONE'S HEALTH, PARTICULARLY THE MOST VULNERABLE. IT IS BASED ON COMMUNITY AND PATIENT NEED. IN TERMS OF DEMAND, PATIENT VOLUME AND CENSUS. THOSE ARE INDICATORS THAT THOSE INDIVIDUALS ARE COMING TO YOUR HEALTHCARE SYSTEM BECAUSE THEY ARE RELIANT ON YOUR HEALTHCARE SYSTEM, AND WE HAVE TO MAINTAIN THOSE SERVICES FOR OUR COMMUNITY.

THE OTHER REASON THEY ARE LISTED UNDER MEASURE-A IS THE FINANCIAL REIMBURSEMENT. THE SHORTFALLS THAT WE WERE EXPERIENCING ARE NOT KEEPING PACE WITH THE COST OF PROVIDING SERVICES FOR OUR COMMUNITY. WITH THAT BEING SAID, I AM MORE THAN HAPPY, ALONG WITH THE TEAM HERE, TO TAKE QUESTIONS.

>> SUPERVISOR LEE: SURE. THINK LET'S SEE. MY COLLEAGUES, WHO WANTS TO ASK QUESTIONS FIRST ON THIS ITEM? GO AHEAD. SUPERVISOR DU'O'NG.

>> SUPERVISOR DU'O'NG: THANK YOU SO MUCH FOR YOUR PRESENTATION, PAUL, AND FOR THE HARD WORK THAT YOU DO. AND THE LAST TWO WEEKS I HAVE HAD THE OCCASION TO VISIT THE DOWNTOWN HEALTH CLINIC, O'CONNOR AND ST. LULU EASE. I AM OKAY. MY LOVED ONES ARE OKAY, TOO. I WANTED TO SAY THAT AT EVERY LOCATION OUR STAFF WAS NOTHING SHORT OF MIRACULOUS AND WAS KIND AND CURT. AND I WANTED TO TO SAY THAT FOR THE RECORD AND MAKE SURE THAT YOU HEARD THAT TOO. YOU HAVE A COUPLE OF QUESTIONS. THE COMMUNITY CLINICS, THE CREATION OF THE COMMUNITY STYLE CLINICS, I AM EXCITED TO SEE US THINK CREATIVELY AND BALANCE OUR PARTNERSHIPS WITH THE COMMUNITY CLINICS. TELL ME MORE, OR IF YOU CAN'T TODAY, I WOULD LOVE INFORMATION FOR THE BUDGET HEARINGS TO HELP INFORM HOW THE DEVELOPMENT WE WENT ABOUT THE DEVELOP. IN PARTNERSHIP WITH THE MAUGHAN I IT, CARE PAY SLIDE I WAS IS WHAT IS THE CONSIDERATIONS BEING MADE IN TERMS OF WHERE TO PLACE THE COMMUNITY CLINICS? HAVE WE HAD LOCATIONS YET?

>> THANK YOU. AS YOU KNOW, IN THE BUDGET PROPOSAL, WE HAVE THE IDEA OF CREATING NEIGHBORHOOD CLINICS. WHAT WE DO KNOW IS THAT OUR RELATIONSHIP WITH THE COMMUNITY PARTNERSHIP CLINICS. I HAD THE OPPORTUNITY TO MEET WITH THE CEOS AND HAVE A CONVERSATION ABOUT THIS INITIATIVE. WE WILL BE BRINGING BACK PROPOSALS THAT ACTUALLY TALK TO PARTNER WITH COMMUNITY HEALTH CLINICS TO MAKE SURE THAT WE LEVERAGE THE RESOURCES THAT WE DO HAVE AS A COMMUNITY TO SERVICE MUTUALLY IN COMMON PATIENT POPULATIONS. SO WE WILL COME BACK WITH A THOROUGH ANALYSIS THAT WILL INCLUDE OUR RELATIONSHIP AND PARTNERSHIPS WITH COMMUNITY PARTNERSHIP CLINICS.

>> MR. WILLIAMS: I WILL SAY TWO BIG PICTURE THOUGHTS ON THAT. I THINK EVERYONE RECOGNIZES A LACK OF ACCESS TO PRIMARY CARE ACROSS OUR COMMUNITY. THERE IS INCREDIBLE DEMAND. AND THAT COLLECTIVELY BETWEEN THE COUNTY'S EXISTING PRIMARY CARE NETWORK AND THE COMMUNITY CLINICS THAT THE COUNTY SUPPORTS AND PARTNERS WITH, WE ARE NOT ABLE TO MEET THAT DEMAND. WE ARE LOOKING AT AT A PILOT OF OPPORTUNITY TO TRY TO PLACE SOME SMALL FOCUS SATELLITE CLINICS FOR PRIMARY CARE ACCESS IN PLACES WHERE THERE OTHERWISE ARE NOT ANY. AND WE'LL OF COURSE RETURN TO THE BOARD AS PAUL SAID WITH THAT ASSESSMENT. WE DON'T HAVE LOCATIONS IDENTIFIED. WE ARE VAGUE TO TARGET PLACES WE KNOW THERE IS NEED AND WHERE THERE WILL BE DEMAND FOR THE PRIMARY CARE SERVICES. IN THE BROAD LEVEL, IT'S EVERYWHERE IN THE COUNTY AT THIS BUT WHERE WE HAVE A LACK OF EXISTING CLINICAL ACCESS AND CAPACITY. TO BE CLEAR, THESE ARE SATELLITE CLINICS, NOT OUR FULL-FLEDGED COUNTY CLINICS WITH PHARMACY AND LAB AND, YOU KNOW, OTHER RESOURCES. THESE ARE REALLY FOCUSED ON OFFICE VISITS FOR PRIMARY CARE ACCESS.

>> SUPERVISOR DU'O'NG: I APPRECIATE THAT. LOOK FORWARD TO SEEING THE ANALYSIS AND ENGAGEMENT PLAN TO MAKE SURE THAT WE ARE WORKING WITH OUR COMMUNITY HEALTH PROVIDERS TO LEVERAGE ALL OF OUR RESOURCES TOGETHER AND DOVETAIL THEM IN A WAY THAT MAXIMIZES ACCESSIBILITY TO OUR PATIENTS. IN A PERFECT WORLD, WE WOULD HAVE MORE ACCESS THAN NEEDED, BUT MEDICAL WE GET THERE, WE CONTINUE TO BUILD THE BEST THAT WE CAN. THERE IS A LOT OF ANXIOUSNESS AND CONSTERNATION I HEAR IT LOCALLY AND AT THE STATE CAPITOL WHEN WE WENT UP THERE FOR LOBBYING DAY WITH THE URBAN COUNTY CAUCUS. S THAT JUST SOME OF THE -- THIS DIVISION AND CREATION OF A UIS POPULATION. WHEN IT COMES TO HEALTHCARE REIMBURSEMENTS. IT'S JUST I KNOW A LOT STILL REMAINS UNKNOWN. BUT WHAT IS OUR PLANNING SO FAR OR THINKING AROUND THE ALLOCATION OF UIS PATIENTS TO OUR PARTNER PROVIDERS AND WHAT -- WILL THERE BE DUAL TRACKS OF REIMBURSEMENT? DOES THE COUNTY GET ONE RATE AND COMMUNITY PROVIDER GET ANOTHER RATE? CAN YOU SHED LIGHT ON THAT?

>> A NUMBER OF THINGS HAVE HAPPENED. AND JAMES WILLIAMS HAS MENTIONED THIS. ONE, IS THAT THE FQHCs, THE COUNTY CLINICS AS WELL AS COMMUNITY PARTNERSHIP CLINICS HAVE BEEN RECEIVING WHAT THEY CALL A PPS RATE, WHICH IS A RATE COMMENSURATE WITH FQHC REIMBURSEMENT OF A MEDI-CAL PATIENT. THAT IS GOING AWAY JULY 1.

>> MR. WILLIAMS: FOR BOTH COUNTY CLINICS AND I THINK COMMUNITY.

>> TO FOR BOTH.

>> SUPERVISOR DU'O'NG: LIKE IN A MATTER OF WEEKS.

>> CORRECT.

>> SUPERVISOR DU'O'NG: GOING AWAY.

>> YES. THAT IS CORRECT. THE OTHER AREA WE ANTICIPATE A MAJOR CHANGE IN THE GOVERNANCE MAY REVISE -- THE GOVERNOR'S MAY REVISE IS THE MANAGE THE CARE TO FEE FOR SERVICE WHERE WE BILL AND EVERY OTHER CLINIC WOULD BILL ON FEE FOR SERVICE BASIS. WHICH IS AT THE MEDI-CAL RATE.

>> MR. WILLIAMS: SO THE STATE --

>> SUPERVISOR ELLENBERG: CAN YOU GIVE MORE CLARIFICATION, PAUL, ABOUT WHAT IT MEANS? I KNOW IT MEANS ABOUT A LOSS OF $200 MILLION TO OUR COUNTY ON TOP OF EVERYTHING ELSE. BUT CAN YOU EXPLAIN WHY THAT TRANSITION FROM MANAGED CARE TO FEE FOR SERVICE DOES CREATE SUCH AN ENORMOUS LOSS FOR OUR COUNTY SPECIFICALLY?

>> UNDER MANAGED CARE, YOU RECEIVE PER MEMBER PER MONTH PAYMENT WHERE YOU ARE MANAGING RISK, THE HEALTH OF THE POPULATION, LEVEL OF RISK OF AN INDIVIDUAL IN TERMS OF THAT YOU ARE UTILIZING, IF YOU DO WELL MANAGING THEIR CARE, YOU ACTUALLY ARE ABLE TO CAPTURE THOSE DOLLARS IN YOUR SYSTEM TO PAY FOR OTHER CARE THAT OTHERWISE IS NOT REIMBURSED. THAT REPRESENTS FOR YOUR HEALTHCARE SYSTEM WHEN IT MOVES FROM MANAGED CARE TO FEE FOR SERVICE, OF A LOSS OF ANOTHER $200 MILLION.

>> MR. WILLIAMS: ANOTHER WAY TO PUT IT IS RIGHT NOW, WE HAVE AN INCENTIVE TO HOLISTICALLY TAKE CARE OF THE HEALTH OF THESE INDIVIDUALS AND TO THE EXTENT THAT WE DO SO EFFECTIVELY AND WITH THE CHEAPEST, MOST COST-EFFECTIVE DELIVERY OF CARE, SUCH AS, EFFECTIVE MANAGEMENT OF CHRONIC HEALTH CONDITIONS, SUCH AS, ACCESS TO PRIMARY HEALTHCARE AND ANOTHER PREVENTIVE HEALTHCARE, THAT WE AS A SYSTEM THEN CAPTURE THE SAVINGS FROM AVOIDED HOSPITALIZATIONS.

>> SUPERVISOR ELLENBERG: THIS IS A PERVERSE INCENTIVE.

>> MR. WILLIAMS: ABSOLUTELY. WHEN YOU SHIFT TO A PURE FEE FOR SERVICE MODEL, THE INCENTIVE TURNS COMPLETELY UPSIDE DOWN. WE WILL ONLY NOW BE ABLE TO GENERATE REVENUE FROM HOSPITALIZATIONS AND LABS AND OTHER BILLINGS. TO MAKE IT WORSE, THE FEE FOR SERVICE SCHEDULE IS A STATEWIDE SCHEDULE. IT DOESN'T ACCOUNT FOR COST DIFFERENCES BETWEEN REGIONS IN CALIFORNIA. AND WE KNOW WE ARE THE MOST EXPENSIVE PART OF THE STATE FOR HEALTHCARE. AND I THINK NOT TALKING ABOUT OUR OWN COUNTY SYSTEM. SEVEN OF THE 10 MOST EXPENSIVE HOSPITALS IN THE ENTIRE STATE OF CALIFORNIA SURROUND OUR PUBLIC COUNTY HOSPITALS. SO THIS IS THE HIGHEST COST AREA IN THE STATE FOR HEALTHCARE PERIOD, AND THAT'S NOT ACCOUNTED FOR. IT'S A TRIPLE HIT WHEN YOU SWITCH. IT'S A HIT ON THEIR HEALTHCARE AND WELL-BEING. IT'S A HIT TO US IN TERMS OF, YOU KNOW, WHAT'S ACTUALLY BILLABLE AND HOW YOU ARE ABLE TO BILL. AND A HIT TO US IN TERMS OF THE RATE FOR REIMBURSEMENT NOT COMING ANYWHERE NEAR THE ACTUAL COST FOR US IN THIS PARTICULAR AREA TO DELIVER THAT CARE. SO THE OVERALL IMPACT OF THAT IS OUR ESTIMATE OF AROUND $200 MILLION A YEAR IN REVENUE LOSS. AND THIS IS OVER AND ABOVE EVERYTHING WE ARE DEALING WITH WITH HR1. THAT'S WHAT WE HAVE BEEN TOLD TO EXPECT WITH THE MAY REVISE. SOMETHING WE NEED TO FIGHT AS HARD AS WE CAN BETWEEN THEN AND THE LEGISLATURE'S ADOPTION OF THE BUDGET. BECAUSE THESE WILL BE ADDITIONAL CUTS ON TOP OF EVERYTHING ELSE THAT WE ARE DEALING WITH. AND THESE CUTS WOULD HAVE HUGE NEGATIVE IMPACT ON THE HEALTHCARE FOR THESE FAMILIES. TO TOP IT OFF, THAT'S WHAT WE ARE STARING DOWN.

>> SUPERVISOR DU'O'NG: SO WE'LL FIND OUT.

>> MR. WILLIAMS: LATER THIS WEEK.

>> SUPERVISOR DU'O'NG: LATER THIS WEEK.

>> SUPERVISOR DU'O'NG: PAUL, MY REQUEST IS FOR THE INFORMATION THAT HAS BEEN PREVIEWED TODAY FOR FULL ANALYSIS SHOULD THIS TRANSITION MATERIALIZE IN THE GOVERNOR'S MAY REVISED BUDGET.

>> MR. WILLIAMS: YOU WILL HAVE AN INITIAL ANALYSIS AT THE MAY 19TH MEETING. WE HAVE AN ITEM ON THE AGENDA RELATED TO LEGISLATIVE AND UPDATES AND BUDGET UPDATES AND OF COURSE, WE'LL FOLLOW WITH MORE DETAILED ANALYSIS BECAUSE IT WILL TAKE MORE TIME BETWEEN THE 14TH AND 19TH. BUT THE BOARD WILL GET AN INITIAL UPDATE AT THE MAY 19TH MEETING.

>> SUPERVISOR DU'O'NG: AND I REALLY WOULD LIKE TO ALSO UNDERSTAND HOW THIS IS OBVIOUSLY HOW THIS IMPACTS US AS A COUNTY ORGANIZATION. HOW THIS IS GOING TO IMPACT TO THE EXTENT POSSIBLE HOW OUR COMMUNITY HEALTH PROVIDERS, THIS WHOLE NETWORK OF CARE THAT'S IN SUCH DELICATE BALANCE AT ALL TIMES. AND I GUESS, YOU KNOW, ANOTHER ONE OF MY QUESTIONS WAS JUST FOR US, HOW ARE WE GOING TO PROVIDE VISIBILITY INTO THE UIS PATIENT POPULATION WHEN IT COMES TO REFERRING PATIENTS TO OUR COMMUNITY HEALTH PROVIDERS SO THAT THEY COULD PLAN THEIR BUDGETS AND OPERATIONS AROUND THIS.

>> WE WILL WORK VERY CLOSELY WITH THEM. AND I THINK YOUR BOARD IS AWARE THAT WE ARE LOOKING AT THE P-CAP PROGRAM, THE PRIMARY CARE ACCESS PROGRAM, TO ENSURE THAT WE CREATE A PROGRAM THAT ALLOWS INDIVIDUALS TO MAINTAIN A MEDICAL HOME SO WE CAN MANAGE THE CHRONIC CONDITIONS SO WE DO NOT HAVE DEEPENED COSTS IN OUR HEALTHCARE SYSTEM.

>> SUPERVISOR DU'O'NG: THANK YOU. I WOULD ALSO LIKE TO REQUEST INFORMATION ABOUT THE TRANSITION THE FAMILY RESIDENCY PROGRAM THAT'S MOVING TO O'CONNOR. WHAT IS THE TRANSITION PLAN? HOW DO WE -- WHAT IS -- HOW WILL THIS IMPACT THE PATIENTS CURRENTLY BEING SENT TO THE INDIAN HEALTH CENTER? AND JUST MORE INFORMATION ABOUT THAT. REALLY WANT TO MAKE SURE THAT WE HAVE A TRANSITION PLAN IN PLACE WITH A WARM HAND-OFF AND THAT THE QUALITY OF CARE AND THE LEVEL OF CARE WILL BE MAINTAINED.

>> WE ARE HAPPY TO GIVE YOU PROBABLY AN OFF-AGENDA WRITE-UP GOING INTO MUCH MORE DETAIL. BUT WHAT I CAN SHARE WITH THE BOARD IS THAT EFFECTIVE JULY 1, WE WILL BEGIN MANAGING THE PROGRAM. THE FAMILY MEDICINE PROGRAM AT O'CONNOR HOSPITAL, TAKING THAT PROGRAM OVER FROM STANFORD. WE FULLY EXPECT THAT THE NUMBER OF PATIENTS THAT WERE ONCE SERVED BY INDIAN HEALTH CENTER WILL CONTINUE TO BE SERVED BY YOUR HEALTHCARE SYSTEM. THOSE PATIENTS TODAY ARE BEING CARED FOR BY STANFORD AT OTHER CLINICS. OUR INTENTION IS TO BRING THAT PROGRAM AND THE CONTINUITY CLINIC FOR THE RESIDENTS BACK TO O'CONNOR HOSPITAL WHERE IT BELONGS.

>> SUPERVISOR DU'O'NG: THANK YOU. THE LAST REQUEST I'LL MAKE IS I AM HAVING A HARD TIME UNDERSTANDING THE OPERATIONAL IMPACTS OF THE PROPOSED DELETIONS OF OUR NURSES IN OUR HOSPITALS. AND IN -- I KNOW NURSING AND THE MEDICAL FIELD IS HIGHLY -- IT'S VERY COMPLEX AND COMPLICATED, BUT I -- WHEN WE ARE DELETING A CLINICAL NURSE TWO OR THREE, I DON'T KNOW WHICH UNITS IT'S COMING FROM, I DON'T KNOW WHAT SERVICE LINE THAT'S RELATED TO. AND I -- YOU KNOW, AS ONE OF THE VOTES ON THE BOARD, I NEED ASSURANCES THAT OUR REDUCTIONS OF STAFFING OF OUR FRONTLINE NURSES WILL NOT DETRIMENTALLY IMPACT COVERAGE, CREATE UNSAFE PATIENT ASSIGNMENTS, OR DELAYED CARE, WHICH ARE THE NORTH STARS OF OUR WHOLE SYSTEM. BUT I I NEED TO UNDERSTAND WHERE THE CUTS ARE BEING PROPOSED, WHAT IMPACTS OF SERVICE DO I ANTICIPATE SEEING.

>> THANK YOU, SUPERVISOR. I WANT TO GIVE YOU A VERY HIGH-LEVEL PERSPECTIVE IN TERMS OF WHAT WE ARE TRYING TO ACCOMPLISH HERE. AND YOU WILL NOTE IN THE BUDGET PROPOSAL, WE ARE DELETING A NUMBER OF VACANT CLINICAL NURSE THREE POSITIONS. THE FIRST THING YOUR BOARD SHOULD UNDERSTAND IS THAT WE ARE HELD TO VERY STRICT STAFFING RATIOS WHEN WE STAFF OUR HOSPITAL INPATIENT UNITS. SO THOSE ARE VERY CLEAR. WE ARE GOING TO ABIDE BY THOSE STAFFING RATIOS AND MAKE SURE THAT WE PROVIDE FOR THE STANDARD OF CARE THAT YOU WOULD OTHERWISE EXPECT. AS A HEALTHCARE SYSTEM, AND BECAUSE WE ARE A FOUR HOSPITAL SYSTEM NOW, WE ARE LOOKING AT ALL OF THE POSITIONS THAT WE HAVE ACROSS THE ENTERPRISE. AND IN OTHER WORDS, WHEN A PARTICULAR UNIT OR SERVICE REQUIRES A CLINICAL NURSE THREE, WE HAVE ENOUGH VACANCIES IN THE ENTIRE SYSTEM IN ORDER TO ACCOMMODATE AND IMMEDIATE THAT. WE ARE NO LONGER LOOKING AT EACH OF THE INDIVIDUAL HOSPITALS IN TERMS OF THE NUMBER OF NURSES THAT THEY HAVE INDIVIDUALLY, BUT RATHER LOOKING AT IT FROM A SYSTEM PERSPECTIVE. IF I TELL YOU TO HAVE TODAY WE HAVE 300 SAY I CAN'T NURSE POSITIONS AND IN LIMB 30 WE HAVE ENOUGH TO CONTINUE TO MEET THE NEEDS OF THE VARIOUS UNITS THROUGHOUT OUR HEALTHCARE SYSTEM. IT ALLOWS US TO MANAGE OUR FIXED AND VARIABLE COSTS WHEN THE CENSUS DROPS AT ONE HOSPITAL, WE ARE ABLE TO ADJUST OUR STAFFING BASED ON OUR FLEXIBLE STAFFING MODEL. AS YOU CAN IMAGINE, TO BE OVERSTAFFED BY NO FAULT OF ANYBODY'S BUT BECAUSE YOU HAVE A FLUCTUATION IN DEMAND IN NEED, AND BE ABLE TO FLEX UP AND DOWN AS NEEDED. THAT'S WHAT WE ARE TRYING TO DO ACROSS THE ENTIRE ENTERPRISE WITH OUR HOSPITALS. IT'S A BALANCING ACT. AND I AM SITTING HERE TODAY SAYING IT'S NOT AN EASY THING TO MANAGE, BUT I THINK PEOPLE ARE BEGINNING TO UNDERSTAND AND APPRECIATE THAT THIS IS WHAT WE NEED TO DO TO REMAIN FINANCIALLY VIABLE.

>> SUPERVISOR DU'O'NG: I REALLY APPRECIATE THAT CONTEXT, PAUL. AND I ALSO APPRECIATE THAT THE NURSES THAT WORK FOR OUR HOSPITAL SYSTEM ARE UNLIKE ANY NURSE YOU'LL FIND ANYWHERE ELSE. THEY HANDLE AND WORK WITH A VERY SPECIALIZED AND VERY VULNERABLE POPULATION. THEY HAVE BATTLE STORIES THAT I DON'T ANY OTHER NURSE CAN COME CLOSE TO. SO I UNDERSTAND THAT WE ADHERE STRUCTURALLY TO MANDATED RATIOS AND LAWS THAT DICTATE THAT AND THE LEVEL OF CARE THAT'S NEEDED WITHIN OUR COUNTY HEALTH SIGNIFICANT TERMS MAY SOMETIMES EXCEED SOME OF THAT BECAUSE WE DO SERVE A SPECIALIZED POPULATION. AND THE CONTEXT THAT YOU PROVIDED JUST NOW GAVE ME EXTRA -- ADDITIONAL MEASURES OF COMFORT IN APPROACHING THIS BUDGET. AND SO I APPRECIATE THAT MORE INFORMATION WILL BE COMING. BECAUSE RIGHT NOW, THE WAY THE BUDGET READS IS THAT WE ARE DELETING A WHOLE BUNCH OF CLINICAL NURSING AND ADDING LVNS AND MEDICAL ASSISTANTS, WHICH NO KNOCK TO ANYBODY, I JUST KNOW THAT THERE ARE DIFFERENT PERSONALITIES AND DIFFERENT CERTIFICATIONS AND DIFFERENT ROLES THEY PLAY. SO WITHOUT FURTHER CONTEXT, IT'S GOING TO -- IT'S HARD FOR ME TO NAVIGATE THIS BUDGET. I THANK YOU IN ADVANCE FOR THE ADDITIONAL INFORMATION.

>> WE WILL PROVIDE THAT TO YOU. YES.

>> SUPERVISOR DU'O'NG: HAD YOU.

>> SUPERVISOR LEE: SUPERVISOR ABE-KOGA.

>> SUPERVISOR ABE-KOGA: THANK YOU. SIMILAR THOUGHTS REGARDING THE CHANGES, ESPECIALLY IN NURSING. DO WE HAVE -- WHAT WILL YOU BE TRACKING IN REGARDS TO HOW THESE CHANGES MIGHT AFFECT OUR SERVICE LEVELS OR DELIVERY OF SERVICES? ONE MENTION WAS MAYBE LONGER PATIENT WAIT TIMES. BUT DO WE HAVE CERTAIN INDICATORS THAT WE ARE TRACKING AND WILL WE BE GETTING THOSE UPDATES? I WOULD LIKE TO GET THEM AT LEAST IN HHC.

>> WE HAVE A NUMBER OF OPERATIONAL METRICS THAT LOOK AT WAIT TIME, TURNAROUND TIME, TIME TO DISCHARGE, THE NUMBER OF HOURS FOR EXAMPLE, OR MINUTES A PERSON IS IN THE EMERGENCY ROOM, WAITING FOR VARIOUS STEPS IN THEIR CARE. WE DO MONITOR THAT BY HOSPITAL AND BY UNIT. THIS IS SOMETHING THAT IS BOTH SUBJECTIVE AND OBJECTIVE. AND WHAT I MEAN BY THAT IS THAT NOT ONLY DO WE HAVE THESE METRICS, BUT IT'S REALLY IMPORTANT TO UNDERSTAND THAT EVEN WHEN I MENTION TO YOU THAT WE HAVE NURSING RATIOS THAT ARE REGULATED, THAT'S THE MINIMUM STANDARD. WE HAVE TO LOOK AT THE ACUITY OF THE PATIENT, WE HAVE TO LISTEN TO OUR NURSES AND STAFF ABOUT WHERE WE HAVE TO MAKE ADJUSTMENTS TO MAINTAIN A QUALITY OF CARE THAT IS COMPETITIVE FOR WHAT YOU WOULD EXPECT FOR YOUR OWN FAMILY MEMBER. BUT WE ALSO HAVE TO LOOK AT THE PATIENT EXPERIENCE. AND AS YOU WELL KNOW, IN OUR HEALTHCARE SYSTEM, IN MANY INSTANCES OUR PATIENTS ARE MUCH MORE DIFFICULT TO MANAGE THAN WHAT YOU WOULD OTHERWISE EXPERIENCE IN OTHER HEALTHCARE SYSTEMS. WE HAVE TO PAY ATTENTION TO THE OBJECTIVE DATA BUT ALSO LISTEN TO OUR STAFF AND WORK WITH OUR LABOR PARTNERS.

>> SUPERVISOR ABE-KOGA: WITH THAT DATA, HOW NIMBLE CAN WE BE IN MAKING ADJUSTMENTS IF WE NEED TO? WILL THAT BE A YEARLY ANNUAL BUDGET ISSUE?

>> THAT'S SOMETHING THAT WE WORK ON ON A REGULAR BASIS TO ENSURE THAT WE HAVE THE ADEQUATE NUMBER OF FLEXIBLE STAFFING AVAILABLE. ONE OF THE THINGS THAT WE ARE DOING AS A HEALTHCARE SYSTEM IS GOING TO ENTERPRISE-WIDE STAFFING OFFICE AND MODEL SO WE CAN MONITOR WHERE WE HAVE STAFF AVAILABLE AT ONE HOSPITAL THAT MAY BE INTERESTED IN PICKING UP A SHIFT AT ANOTHER HOSPITAL.

>> SUPERVISOR ABE-KOGA: OKAY.

>> RIGHT? IT'S NOT A NURSING -- NO, IN NURSING WE WERE TAKING AN ENTERPRISE-WIDE APPROACH IN TERMS OF STAFFING, OR DIAGNOSTIC IMAGING, LABORATORY, RESPIRATORY, PHYSICAL THERAPY AND OCCUPATIONAL THERAPY, CASE MANAGEMENT. WHERE WE ARE TRYING TO MOVE TO AN ENTERPRISE-WIDE SYSTEM WHERE WE ARE ABLE TO UTILIZE STAFF WITHIN OUR HEALTH SYSTEM TO COVER NEEDS WITH OTHER AREAS OF OPERATION.

>> SUPERVISOR ABE-KOGA: THANK YOU. REGARDING PRIMARY CARE CLINICS, I DEFINITELY UNDERSTAND WHY WE ARE DOING IT. I WOULD REITERATE THAT ASK THAT WE INCLUDE OUR COMMUNITY PARTNERS AS WE MOVE FORWARD WITH THE PLAN AND IMPLEMENTATION OF THE EXPANSION. AND THEN LAST QUESTION AROUND CUSTODY HEALTH. THERE WERE SOME CHANGES OR I GUESS THE DEPARTMENT PROPOSAL IN THE -- THE PROPOSAL HAS SOME DIFFERENCES WHICH RESULTS OR POTENTIALLY RESULTS IN 2.78 MILLION IN ONE-TIME COSTS INTO A $2.81 MILLION-TIME SAVINGS. AND I WAS HOPING TO GET MORE CLARIFICATION ON HOW THAT'S HAPPENING. THANK YOU.

>> THANK YOU FOR THAT QUESTION, SUPERVISOR. WE HAVE ESTABLISHED QUITE A BIT OF CONTROLS THIS YEAR ON OUR BUDGET SO THAT WE CAN MAINTAIN AND BE FISCALLY RESPONSIBLE. SO WE ARE COMING IN UNDER BUDGET THIS YEAR AND WE HAVE SIGNIFICANTLY REDUCED OUR OVERTIME BY LIKE 48%. AND SO THAT HELPS EVERYBODY. AND THAT'S WHY YOU SEE THE COST SAVINGS THAT YOU SEE.

>> SUPERVISOR ABE-KOGA: THANK YOU.

>> SUPERVISOR LEE: YES, VICE PRESIDENT, QUESTIONS ON D.

>> SUPERVISOR ARENAS: YEAH. YES. SORRY. YES. THANK YOU. I KNOW THAT THE -- YOU ARE MAKING CHANGES TO THE APPOINTMENT SYSTEMS SO THAT SO WE CAN HAVE MORE -- WE CAN BE MORE EFFECTIVE AND MORE NIMBLE. HOW ARE WE -- THIS IS ONE OF THE STRATEGIES FOR YOUR COST SAVINGS STRATEGIES TO OPTIMIZE PATIENT FLOW. HOW DO WE ENSURE THAT WE HAVE THE PATIENTS AT THE CENTER OF STAFFING? HAVING REDUCTIONS, IT'S NATURAL TO THINK THAT WHEN YOU HAVE A REDUCTION IN STAFFING THAT THE WAIT IS LONGER. HOW WILL YOU ACCOUNT FOR THAT?

>> SUPERVISOR, ONE OF THE IMPORTANT THINGS THAT WE ARE TRYING TO DO IS TO DO EXACTLY WHAT YOU DESCRIBED, IS FOCUS THE NEEDS OF OUR PATIENTS AND TO PROVIDE THEM WITH THE PATIENT EXPERIENCE THAT, YOU KNOW, THEY WOULD OTHERWISE EXPECT EVEN DURING THESE DIFFICULT FINANCIAL TIMES. IN PART OF IT IS ACTUALLY MAKING SURE THAT WE ARE UTILIZING OUR STAFF AT THEIR OPTIMAL LEVEL IN TERMS OF CAPACITY. WE TALK ON NO-SHOW RATES, MAKING SURE THAT IF WE HAVE 10 APPOINTMENTS AVAILABLE FOR OUR PATIENTS THAT WE ACTUALLY FILL THOSE APPOINTMENTS UP SO THAT WE ARE PROVIDING ACCESS TO CARE.

>> SUPERVISOR ARENAS: DO YOU DOUBLE BOOK?

>> LET ME JUST UTILIZE THIS TERM. WHAT WE WANT TO DO IS MAKE SURE THAT WE ARE SCHEDULING PATIENTS AT THE OPTIMAL LEVEL. IN OTHER WORDS, IF WE HAVE A SITUATION WHERE A PARTICULAR CLINIC HAS A HIGH NO-SHOW RATE OF 20%, IT'S IMPORTANT TO WORK WITH THE STAFF AND PROVIDERS TO FIND WAYS TO MAKE SURE THE NO-SHOW RATE PERCENTAGE GOES DOWN OR WE HAVE THE ABILITY TO SCHEDULE IN OTHER PATIENTS. IT CAN BE A TELE-VISIT. IT CAN BE A PATIENT THAT WE CALL TO COME IN AT THE LAST MINUTE. OR WE HAVE PATIENTS ON WHAT WE CALL IS A BACKLOG LIST WHERE WE KNOW THAT THEY WANT TO COME IN SOONER THAN LATER FOR THEIR APPOINTMENT. WE ARE UTILIZING TECHNOLOGY WHERE WE ARE ABLE TO SEE CLINICS THAT WE KNOW WE HAVE AN OPPORTUNITY TO IMPROVE THE SHOW RATE. LOOKING AT PREDICTIVE ANALYTICS, A.I. YOU ALL KNOW WE AS A HEALTHCARE SYSTEM HAVE BEGUN TO ADOPT BECAUSE THERE ARE SOME WAYS TO GARNER INFORMATION ON PATIENT THROUGHPUT AND EFFICIENCIES.

>> SUPERVISOR ARENAS: IS THE SYSTEM SET UP SO PATIENTS CAN MAKE APPOINTMENTS THEMSELVES?

>> YES.

>> SUPERVISOR ARENAS: GOT IT. THAT CAN LEAD TO A REDUCTION OF NO-SHOWS. I AM GOING TO MOVE TO THE LATINO HEALTH ASSESSMENT. THAT WAS IN SOUTH COUNTY HAD THE SECOND HIGHEST RATE OF DEATH TO CORONARY HEART DISEASE, CLOSELY FOLLOWING THE EAST SAN JOSE. HOW HAS THIS DATA BEEN TAKEN INTO ACCOUNT IN THE DECISION TO EITHER LIMIT OR EXPAND CARDIAC SPECIALTY SERVICES IN THE SYSTEM? AND I KNOW WE JUST RECENTLY HAD SOME DIAGNOSTIC CARE OR SERVICES ADDED TO ST. LOUISE, BUT THEY WERE NOT COMPREHENSIVE, THEY WERE SOME BASIC. TO YOU DO YOU CONTINUE TO MAKE THOSE DECISIONS OR SOUTH COUNTY AND FOR EAST SAN JOSE OR THE AREAS THAT HAVE SHOWN HIGHER CORONARY DEATHS OR DISEASES?

>> THANK YOU, SUPERVISOR. LET ME TRY TO GIVE YOU INSIGHT INTO SOME MATERIALS OF OUR STRATEGY. SO BECAUSE WE ARE A CORE HOSPITAL SYSTEM, WE ARE LOOKING AT THE SPECIALTIES THAT PARTICULARLY IN THE SOUTH COUNTY WHERE PHYSICALLY WE BEGIN TO GROW OUR OWN SPECIALTY GROUP. IN OTHER WORDS, THE NUMBER OF PROVIDERS THAT WE HAVE IN UROLOGY, GI, CARDIOLOGIST IN OUR SYSTEM. AND BE VERY CLEAR WHEN WE RECRUIT PHYSICIANS, THAT THEY ARE BEING HIRED AND JOINING OUR SYSTEM TO CARE FOR OUR PATIENTS IRRESPECTIVE WHETHER OR NOT THE NEED IS IN THE YOU WANT SOUTH COUNTY, AT RENAL NATURAL MEDICAL CENTER, OR O'CONNOR. WHAT WE ARE TRYING TO DO IS BUILD A PHYSICIAN GROUP AND A PRESENCE THAT CAN SERVE ALL OF OUR PATIENTS IRRESPECTIVE OF THE SERVICE LOCATION. SOME OF THE POSITIONS THAT YOUR BOARD APPROVED AT MIDYEAR, BUT ALSO SOME ADDITIONAL POSITIONS IN THIS BUDGET, WE WERE ACTUALLY LOOKING TO BUILD OUT OUR CLINICAL CAPACITY TO MEET THE NEEDS OF ALL OF OUR PATIENTS THROUGHOUT OUR HEALTHCARE SYSTEM.

>> SUPERVISOR ARENAS: SO THAT INCLUDES HAVING APPOINTMENTS AVAILABLE, I AM GOING TO ASSUME IN SOUTH COUNTY WITH WHATEVER PATIENT PREDICTIVE MODELING THAT YOU HAVE.

>> NOT ONLY WILL THEY BE AVAILABLE FOR CONSULT FOR THE EMERGENCY ROOM, THEY WILL BE AVAILABLE TO HAVE OUTPATIENT CLINICS IN THE SOUTH COUNTY TO CARE FOR PATIENTS WHERE THEY ARE AT. WE ARE OPENING UP OUTPATIENT CLINICS ON THE ST. LOUISE CAMPUS FOR INDIVIDUALS TO RECEIVE THEIR FOLLOW-UP CARE AS WELL AS SCHEDULE APPOINTMENTS FOR SPECIALISTS.

>> SUPERVISOR ARENAS: I MEAN, LET ME TAKE A STEP BACK AND OVERALL, I WOULD LIKE TO SEE THE INTEGRATION OF WHAT THE LATINO HEALTH ASSESSMENT, THE RESULTS HAVE INDICATED WITH THE NEXT STEPS THAT YOU ARE TAKING AS YOU ARE SHAPING -- RESHAPING THE SYSTEM. AND AS YOU ARE RESHAPING THE SYSTEM, GREATER OR EFFECTIVENESS OR EFFICIENCY, I -- WE KNOW THAT WE ARE NOT GOING TO HAVE THE SAME NUMBER OF STAFF. AND GOING TO SAY IT'S FOR BOTH EFFICIENCY AND EFFECTIVENESS. BUT WE ALSO TAKE WHAT WE KNOW IN TERMS OF DATA AND WHAT IS IMPACTING THE LATINO COMMUNITY. SO HOW WILL YOU INTEGRATE THAT?

>> WE ARE HAPPY TO REPORT BACK IN TERMS OF OUR STRATEGY BY SERVICE LINE AND HOW THAT RELATES TO SERVICE TO THE -- TO THE RESIDENTS IN THE SOUTH COUNTY, INCLUDING HOW IT IMPACTS THE LATINO HEALTH ASSESSMENT IN ACCESS TO CARE.

>> SUPERVISOR ARENAS: ALL RIGHT. SO YOU'LL DO THAT WITH WHAT? AN OFF-AGENDA REPORT, A RFI. HOW WILL YOU?

>> WE CAN DO IT AS AN OFF-AGENDA REPORT BACK TO YOUR BOARD AND BACK TO YOU, SUPERVISOR.

>> SUPERVISOR ARENAS: PERFECT. I WOULD LOVE TO SEE HOW THIS IS IS ALL CONNECTED. AND I HAVE HEARD FROM CUSTODY HEALTH SERVICES WHEN THEY REALLY BROKE IT DOWN, DR. LUNA, YOU SHOWED HOW YOU HAVE MANAGED DIABETES MANAGEMENT FOR THOSE CLIENTS HAS BEEN IMPROVED. JUST IMPROVEMENTS OVERALL IN TERMS OF SOME OF THE CHRONIC CONDITIONS THAT ARE -- THAT LATINOS ARE IMPACTED WITH. IT WAS NOT JUST FOR LATINOS, BUT WE KNOW THAT DIABETES IS ONE MAIN ONES THAT LATINOS CAN CONNECT WITH. AND I JUST WANT TO MAKE SURE THAT WHEREVER SERVICE LINE IT IS, THAT WE ARE AWARE OF THOSE FOLKS, THOSE COMMUNITIES, SO THAT WE CAN HAVE EITHER PLACE-BASED APPROACHES, WHATEVER APPROACH YOU ARE -- YOU KNOW, YOU ARE TRANSFORMING THE SYSTEM INTO, TAKE INTO ACCOUNT HOW LATINOS INTEGRATE HEALTHCARE INTO THEIR LIVES, WHICH HAS BEEN VERY LIMITED. I HOPE TO SEE THAT IN YOUR OFF-AGENDA REPORT. THANK YOU FOR NOW.

>> SUPERVISOR LEE: SUPERVISOR ELLENBERG.

>> SUPERVISOR ELLENBERG: I WILL BE VERY BRIEF. IT WAS VERY INSIGHTFUL TO HEAR MY COLLEAGUES' QUESTIONS AND COMMENTS. I AM -- WHAT I KEEP TURNING AROUND IN MY HEAD, PAUL, IS THIS NOTION OF RISK. AND THE FACT THAT YOUR BUDGET I THINK IS VERY IMPRESSIVE. AND AS YOU ACKNOWLEDGED ALSO, ALSO RISKY, DEPENDING ON SOME FACTORS -- DEPENDING IN PART ON ATTRACTING MORE PATIENTS, IN PART AGREEMENTS WITH OUR LABOR PARTNERS AROUND INCREASED EFFICIENCIES, WHAT KIND OF -- AND OTHER PIECES. WHAT KIND OF STRATEGIC PLANNING ARE YOU DOING WITH REGARD TO EACH OF THE EXPECTED AREAS OF INCREASED REVENUE TO ACTUALLY GET THERE? ARE THESE VERY LIKELY? ARE THESE MOON SHOTS? AND HOW ARE YOU NAVIGATING THAT GO?

>> THAT IS A REALLY GOOD QUESTION. OUR FINANCE TEAM IS VERY FOCUSED ON TRACKING EACH AND EVERY INITIATIVE THAT WE HAVE PUT FORWARD IN TERMS OF HOW WE ARE PROJECTING OUT OUR WORK WELL RELATIVE TO MEETING THOSE TARGETS. I WILL SHARE WITH YOU, SUPERVISOR, THAT WE HAVE ALREADY SEEN MARKED IMPROVEMENT IN JUST A VERY SHORT PERIOD OF TIME. I CAN TELL YOU THAT -- I WOULD SHARE WITH YOU THAT FROM LAST MARCH TO THIS MARCH, THE NUMBER OF PRIMARY CARE VISITS IN OUR SYSTEM HAS GROWN BY 9% YEAR OVER YEAR. FOR SPECIALTY, IT'S ALREADY AROUND 7%. AND WE ARE JUST FRANKLY GETTING STARTED. AND THE ENGAGEMENT OF STAFF HAS BEEN REMARKABLE. OBVIOUSLY, THERE IS A LOT OF CONCERN RELATIVE TO THE ADDITIONAL BURDEN THAT WE ARE PLACING ON THE SYSTEM. BUT I THINK THAT PEOPLE REALIZE THAT THERE ARE SOME OPPORTUNITIES, LOW-HANGING FRUIT, JUST LITTLE TO THE SYSTEM THAT CAN IN FACT NOT ONLY IMPROVE, YOU KNOW, TIMELY ACCESS AND MEET THE GROWING -- INCREASING DEMAND, BUT ALSO ALLOW US TO GENERATE THE REVENUE TO ENSURE THAT WE PRESERVE THIS SYSTEM DURING THIS PERIOD OF TIME OF UNCERTAINTY. I THINK WE ARE ALREADY SEEING SOME OF THE PROGRESS BEING MADE. I MENTIONED A LITTLE BIT ABOUT THE REVENUE CYCLE. I WOULD KNOW THAT SHARMA CAN COMMENT ABOUT WHAT HE HAS SEEN RELATIVE --

>> SUPERVISOR ELLENBERG: HOW YOU ARE ABLE TO SPEED UP THE REVENUE CYCLE. YEAH, I WOULD LOVE TO HEAR MORE.

>> GOOD AFTERNOON.

>> SUPERVISOR ELLENBERG: GOOD AFTERNOON, DOCTOR.

>> CFO FOR THE HEALTH SYSTEM. THE REVENUE CYCLE, THERE ARE A NEW INITIATIVES GOING ON. ONE OF THEM IS REVENUE YARD GUARDIAN, WHICH BASICALLY MAKES SURE EVERY SERVICE PROVIDED WE HAVE BILLED IT AND ALSO WE ARE BILLING ACCURATELY. AND AS A RESULT, REIMPLEMENTED IT BECAUSE THAT REQUIRES A LOT OF TRAINING. WE HAVE SET UP A TEAM OF FIVE PEOPLE WORKING WITH THE TSS PROVIDING THE TRAINING TO THE DEPARTMENTS. NOW, WHAT WE DO IS WITHOUT INCLUDING THE RMC BECAUSE THIS PROGRAM STARTED BEFORE RMC CAME IN. WE LOOK AT THE BASE BUDGET, THE BASE REVENUE FOR THOSE DEPARTMENTS. AND THEN WHAT THEY ARE DOING NOW FOR THE FACILITY CHARGES, WHICH IS PRIMARILY THE IN-PATIENT TYPE OF SERVICES, THE BILLING FOR THOSE DEPARTMENTS HAS INCREASED ABOUT 50 PERCENT.

>> SUPERVISOR ELLENBERG: THAT'S TREMENDOUS. ARE WE SEEING FEWER CLAIM DENIALS? FIGHTING THEM? HOW ARE WE ADDRESSING THEM?

>> THERE IS A SEPARATE UNIT DEALING WITH CLAIMS DENIAL. IT'S ONE THING TO BILL.

>> SUPERVISOR ELLENBERG: RIGHT. AND.

>> AND THEN THE MONEY MAY NOT COME. WE ARE LOOKING AT EACH DENIAL AND GOING AFTER IT AGGRESSIVELY. NOT JUST FINANCIAL OR REVENUE, INCLUDING THE CLINICAL TEAM AND SAYS THE DOCTORS AND THE PHYSICIANS WORKING WITH US. SO THAT IS SHOWING SOME IMPROVEMENTS ALSO.

>> SUPERVISOR ELLENBERG: THANK YOU, I APPRECIATE HEARING THAT. MUCH I AM NOT SURE IF IT WAS ALREADY ASKED FOR IF IT IS, FORGIVE ME, BUT I THINK I HEARD YOU TALKING ABOUT P-CAP AND WHAT WE ARE GOING TO HAVE TO RAMP BACK UP ONCE WE HIT 2027. HOW ARE WE INCORPORATING THAT IN OUR BUDGET? WHAT ARE THE ANTICIPATED COSTS OF RESTARTING P-CAP?

>> [SPEAKING AT THE SAME TIME]

>> SUPERVISOR ELLENBERG: CERTAINLY HEARD FROM THE STATE THAT THEY ARE NOT INTERESTED IN FUNDING INDIGENT CARE AT LEAST IN THIS YEAR. THAT'S ANOTHER FIGHT. BUT WE STILL HAVE TO PROVIDE THE CARE, OF COURSE.

>> MR. WILLIAMS: AS WE INDICATED PREVIOUSLY, WE ARE WORKING ON A REDESIGN OF THAT PROGRAM THAT WE'LL BRING TO THE BOARD IN THE FALL FOR CONSIDERATION. OF COURSE, ANY AUGMENTED FUNDING FOR P-CAP HAS --

>> SUPERVISOR ELLENBERG: EXACTLY.

>> MR. WILLIAMS: IT WILL BE A CHALLENGE TO THINK THROUGH WHAT IT IS. I THINK P-CAP IS NO SUBSTITUTE FOR MEDI-CAL. IT NEVER HAS BEEN. IT NEVER WILL BE.

>> SUPERVISOR ELLENBERG: VERY BARE BONES.

>> MR. WILLIAMS: YES. VERY BARE BONES. WE ARE LOOKING AT WHAT MAKES SENSE IN THIS NEW ERA. WE WILL HAVE TO REVISIT THOSE INVESTMENTS. IT IS A GENERAL FUND. IT IS AN EXPENSE AT ITS CORE AND SOMETHING THAT WE WILL BE BRINGING RECOMMENDATIONS TO THE BOARD AROUND LATER THIS CALENDAR YEAR.

>> SUPERVISOR ELLENBERG: THANK YOU.

>> MR. WILLIAMS: BUT THERE IS NO ADJUSTMENT PROPOSED.

>> SUPERVISOR ELLENBERG: ARE YOU THINKING THE FALL BECAUSE WE ARE NOT LIKELY TO FEEL THE EFFECTS BEFORE JANUARY? CORRECT.

>> SUPERVISOR ELLENBERG: SO THE WORK RULE REQUIREMENTS, THE REQUIREMENT ARE YOU WRITING MORE VAGUE DON'T BEGIN UNTIL JANUARY OF '27.

>> SUPERVISOR ELLENBERG: BUT THAT'S THIS FISCAL YEAR.

>> NBA IT IS. BUT IN THE ABSENCE OF A REDESIGN PROGRAM, WE DON'T HAVE ANYTHING TO BASE A BUDGET ESTIMATE ON. IT'S SOMETHING THAT WE'LL BRING WITH ADJUSTMENTS DURING THE COURSE OF THE UPCOMING FISCAL YEAR.

>> SUPERVISOR ELLENBERG: THIS IS PERHAPS MORE OF A LEGAL QUESTION THAN A MEDICAL QUESTION. BUT WE HEAR ALWAYS ABOUT WHAT THE COUNTIES ARE MANDATED TO DO. IS THE STATE OF CALIFORNIA MANDATED, ASSUME BY THE FEDERAL GOVERNMENT, IF ANYONE, TO PROVIDE MONEY TO COUNTIES FOR INDIGENT CARE FOR THE UNINSURED?

>> MR. WILLIAMS: AS A GENERAL MATTER, NO. THERE IS A LOT OF INTERRELATIONSHIP FISCALLY BETWEEN THE STATE AND COUNTIES. AND PRIOR TO THE AFFORDABLE CARE ACT EXPANSION TO OFFSET COSTS --

>> [SPEAKING AT THE SAME TIME]

>> SUPERVISOR ELLENBERG: POLICY DECISION THAT WASN'T ANY KIND OF MANDATE.

>> MR. WILLIAMS: IT WASN'T A MANDATE, BUT AS A REFLECTION OF THE REALITY. COUNTIES CANNOT DELIVER THAT. JERRY BROWN BASICALLY PULLED THAT FUNDING. AND IN FAIRNESS TO HIM, HE WAS CORRECT.

>> SUPERVISOR ELLENBERG: IT HASN'T BEEN NEEDED.

>> MR. WILLIAMS: THE PERCENTAGE OF UNINSURED PLUMMETED IN SOME COUNTIES ALMOST TO FUNCTIONAL ZERO. IN OUR COUNTY, PLUMMETED TO 2 1/2% OF OUR PATIENT VOLUME FROM OVER 20%.

>> SUPERVISOR ELLENBERG: BETWEEN PEOPLE WALKING AWAY FROM COVERED CALIFORNIA AND LOSING EDI-CAL ONLY AND SOME LOSING REGULAR MEDICAID, THAT NUMBER WILL SHOOT UP AT LEAST AS HIGH, LIKELY AS IT WAS BEFORE THE ACA WAS PASSED.

>> MR. WILLIAMS: WE HOPE IT WON'T BE AS HIGH FOR A COUPLE OF REASONS. WE ARE HOPING TO KEEP AS MANY PEOPLE ON COVERAGE AS POSSIBLE. THINK THERE ARE WORK RULE REQUIREMENTS. SOME PEOPLE WILL MAINTAIN COVERAGE COMPARED TO BEFORE. BUT UNDOUBTEDLY, YOU ARE THAT PERCENTAGE WILL GO UP SUBSTANTIALLY. OUR HOPE IS THAT IT WILL NOT GET BACK TO 20%, BUT CERTAINLY NOT STAYING AT 2 1/2%. AND IT WILL PROBABLY END UP AT LEAST HALFWAY BACK TO WHERE IT WAS, IF NOT MORE. SO THAT IS OUR CONCERN. WE WILL BE CHALLENGED IN HOW WE DESIGN THAT PROGRAM AND WHAT THAT LOOK LIKE AND HOW IT'S FUNDED. AND YOU KNOW, THAT IS ONE OF MANY MAJOR PROJECTS FOR US TO KIND OF WRAP OUR HEADS AROUND OVER THE SUMMER AND TRY TO COME BACK WITH SOME THOUGHTFUL RECOMMENDATIONS FOR THE BOARD TO CONSIDER IN THE FALL. THE OTHER THING I WANT TO TAKE A MOMENT TO SAY IS THERE IS A LOT OF REVENUE-RELATED AND SERVICE LINE AND OPERATIONAL CHANGES THROUGHOUT THE HEALTH SYSTEM. AND YOU HAVE HEARD ABOUT MANY OF THEM, BUT NOT ALL OF THEM THIS EVENING. EACH OF THESE IS A SIGNIFICANT BODY OF WORK ON ITS OWN. THINK IT'S NOT LIKE OVERNIGHT PEOPLE CAN JUST CHANGE SCHEDULING PRACTICES OR CHANGE HOW WE ORGANIZE STAFFING OR CHANGE HOW WE SCRUTINIZE CODE AND BILLING OR CHANGE WHAT HAPPENS WITH OUR NEGOTIATIONS WITH COMMERCIAL PLAN PAYERS. EACH OF THOSE EFFORTS REQUIRES FOCUS, REQUIRES INTENSE COMMITMENT.

>> SUPERVISOR ELLENBERG: WE HAVE TO DO IT ALL AT ONCE.

>> MR. WILLIAMS: AND WE NEED TO DO IT ALL AT ONCE. AND I SAW THAT BECAUSE THE TRAIN ON A HANDFUL OF FOLKS, INCLUDING SEVERAL WHO ARE PRESENT HERE IN THIS ROOM FROM OUR HEALTH SYSTEM, BUT AS WELL AS SEVERAL FOLKS BEHIND THEM IN WORKING WITH THEM, IS REALLY SIGNIFICANT. AND I DON'T WANT THAT TO GO UNRECOGNIZED. WE ARE ASKING THEM TO MOVE A LOT AT THE SAME TIME. AND WE ARE MONITORING IT CLOSELY. I AM VERY NERVOUS THAT WE ARE BOOKING A LOT OF REVENUE WITH VERY HIGH EXPECTATIONS. AND IT MAKES ME NERVOUS BECAUSE IF WE DON'T ACHIEVE THOSE GOALS, WE WILL BE IN FRONT OF YOU DURING THE COURSE OF THE UPCOMING FISCAL YEAR TO REBALANCE THE BUDGET. AND IF WE DON'T ACHIEVE THOSE REVENUE TARGETS, THE REBALANCING IS IN THE FORM OF CUTS. THAT'S JUST THE MATH. AND I WANT EVERYONE TO RECOGNIZE THAT. WE ARE GOING TO WORK AS HARD AS WE CAN, BUT WE NEED PARTNERSHIP ACROSS THE ENTIRETY OF THE ORGANIZATION, INCLUDING WITH OUR LABOR PARTNERS TO QUICKLY DELIVER ON A LOT OF THESE THINGS. WE KNOW THEY ARE HARD AND DIFFERENT THAN THINGS WE HAVE DONE IN THE PAST. BUT IF WE DON'T MOVE ON THOSE AND MOVE ON THEM QUICKLY, WE RUN OUT OF OPTIONS THAT WE HAVE TO KEEP THE BUDGET IN BALANCE. AND AS IT ONE OF THE THINGS THAT I ACTUALLY SPENT A LOT OF TIME WORRYING ABOUT IT'S WITHIN OF THE THINGS THAT PAUL AND THE REST OF THE KNOWS I ASK ABOUT ALL THE TIME BECAUSE WE NEED TO SEE THOSE SIGNS AS EARLY AS POSSIBLE IF THINGS ARE NOT ON TRACK SO THAT WE CAN TAKE CORRECTIVE ACTION BEFORE WE HAVE A BIG HOLE IN OUR HANDS. SO WE CERTAINLY HOPE THAT THAT'S NOT THE CASE. WE ARE OBVIOUSLY BUDGETING AS IF THAT'S NOT THE INDICATOR, SO THAT IS ABSOLUTELY OUR EXPECTATION. BUT I WANT TO BE TRANSPARENT WITH THE BOARD AND THE PUBLIC AND THE WORKFORCE THAT WE ARE BANKING ON THE GROUND, LITERALLY BANKING ON THE EXPECTATION OF THOSE REVENUES. BANKING ON THE EXPECTATION OF THOSE COSTS BEING AVOIDED IN ORDER TO KEEP THE BUDGET IN BALANCE. THINK THOSE ARE RISKS THAT IN NORMAL TIMES WE WOULD APPROACH MUCH MORE GRADUALLY INSTEAD OF TRYING ALL OF THOSE ALL AT THE SAME TIME. WE DON'T HAVE A CHOICE HERE. TO AVOID SERVICE IMPACTS AND REDUCTIONS, WE HAVE TO BE VERY TRANSPARENT ABOUT IT. THAT'S WHY I AM CALLING IT OUT EXPLICITLY, EXPRESSING GRATITUDE AND CONFIDENCE THAT WE WILL GET THAT PARTNERSHIP FROM THE ACROSS OUR ORGANIZATION WITH YOU, BUT HAVE A VERY STRONG WORD OF CAUTION SO WE ALL KNOW AND ARE CLEAR EYED ABOUT WHAT THAT MEANS WHEN WE ARE BRINGING SO MUCH REVENUE FORWARD AS OUR BUDGET SOLUTIONS.

>> SUPERVISOR LEE: OKAY. ON THIS ITEM.

>> I DO HAVE QUESTIONS. I'M NOT SURE IF WE CAN GOING INTO THE NUMBERS. I MIGHT COME BACK WITH YOU SEPARATELY. TRYING TO LOOK AT NUMBERS ON THE VHP ON PAGE 370. IT SHOWS A VERY INTERESTING FROM A NET COST TO A NET REVENUE. I WANT TO LEARN MORE ABOUT HOW THAT HAPPENS IN TERMS OF HOW THE REVENUE WENT UP BUT THE APPROPRIATIONS HAVE GONE TO THE WE WANT TO THIS IS SHOWING A POSITIVE NUMBER. I THINK THAT'S CERTAINLY VERY EXCITING. AND THEN IF YOU WANT TO TALK ABOUT IT NOW, WE CAN TALK OFFLINE. THINK.

>> WE CAN TALK OFFLINE, BUT I WOULD SAY TO YOU THAT THERE ARE MULTIPLE NUMBERS MOVING ON YOU AT ONE TIME.

>> SUPERVISOR LEE: RIGHT.

>> THE FACT THAT REGIONAL MEDICAL CENTER CAME ONBOARD AND HAVE HAD A DRAMATIC INCREASE RELATIVE TO PATIENT VOLUME, YOU ARE GOING TO HAVE SIGNIFICANT INCREASE IN YOUR COSTS. THERE ARE NUMBERS MOVING RELATIVE TO BUDGET THAT YOU CANNOT POINT TO ONE THING AND SAY THAT'S THE CAUSE OF IT. ANOTHER THING THAT IS OCCURRING RELATIVE TO OUR BUDGET IS OUTSIDE OF VOLUME RELATED TO REGIONAL AND INCREASING EXPENDITURES AND ASSOCIATED REVENUE IS THAT YOU ARE SEEING SOME SUPPLEMENTAL REVENUE START TO SHIFT AND CHANGE, RIGHT? WHICH WE PROJECTED IN 26-27 FURTHER DECREASES IN THOSE REVENUES, IF YOU WILL.

>> SUPERVISOR LEE: OKAY.

>> SO YOU HAVE A NUMBER OF DIFFERENT NUMBERS MOVING ON YOU AT ONE TIME.

>> SUPERVISOR LEE: OKAY, THANK YOU. ON PAGE 417, YOU HAVE THIS THING ABOUT DRINKS OF THE EFFECT. UNDER THE VARIOUS PROGRAMS, OPERATIONAL EFFICIENCIES, COST SAVINGS IS THERE ANY WAY YOU CAN QUANTIFY WHAT THE NEGATIVE IMPACTS OF PATIENT CARE WOULD BE MINIMAL? YOU BELIEVE THEY WILL BE.

>> THAT IS THE CUMULATIVE NUMBER OF POSITIONS THAT WE HAVE PUT UP FOR DELETION, APPROXIMATELY TEN OF WHICH ARE FILLED. THEY RANGE FROM COMPLIANCE OFFICE ON TO CONTRACTS MANAGEMENT TO SOME CLINICAL SERVICE AREAS WHERE WE BELIEVE THAT WE CAN MAKE SOME ADJUSTMENTS AND NOT IMPACT PATIENT CARE. I WOULD SAY THIS ABOUT ALL OF THAT. YOU KNOW, WHEN YOU START TO CUT AS MANY POSITIONS AS WE HAVE CUT OVER THE PAST TWO YEARS, YOU ARE NOT GOING TO SEE AND FULLY APPRECIATE THE IMPACT UNTIL YOU HAVE SOME EXPERIENCE BEHIND THAT. THAT'S SOMETHING WE WILL HAVE TO CONTINUE TO MONITOR IN TERMS OF WHAT IMPACT IT'S HAVING ON THE SYSTEM OR ON INDIVIDUAL PROGRAMS.

>> SUPERVISOR LEE: OKAY, THANK YOU, PAUL. LAST THING, WE DISCUSSED THE ISSUE OF HAVING -- TALKING TO CEMA AND RMP ABOUT SOME OF THE PROPOSED PLAN CHANGES AND I JUST WANT TO SAY THANK YOU FOR HAVING TAKEN PLACE THOSE CONVERSATIONS AND LOOKS LIKE WE ARE FINDING SOME SOLUTIONS ON SOME OF THESE UPDATED PROPOSALS. I WANT TO SAY THANK YOU FOR MAKING IT HAPPEN. ALL RIGHT. I BELIEVE WE ARE DONE WITH 6D. WE ARE MOVING TO 6E, WHICH IS BEHAVIORAL HEALTH SERVICES DEPARTMENT.

>> SUPERVISOR ELLENBERG: JUST NOTING THE AGENDA HAS A RECESS AT 6:30 AND I WANT TO CHECK ON STAFF AND CLERKS AND DO WE NEED TO TAKE A SHORT BREAK?

>> MR. WILLIAMS: I THINK WE CAN CONTINUE IF --

>> SUPERVISOR LEE: I THINK THERE IS A CONSENSUS OF HAVING A BREAK ON THIS BOARD, THOUGH. UNFORTUNATELY. SO I THINK WE SHOULD HAVE. HOW SHORT DO YOU THINK? 20 MINUTES?

>> SUPERVISOR ELLENBERG: 20 MINUTES.

>> SUPERVISOR LEE: WOULD THAT WORK? OKAY. 6:29. LET'S SAY 6:45 TO RETURN. WE'LL BE IN RECESS. THANK YOU. BUT IN MANY OF THOSE CASES WHERE THERE ARE SHIFTS IN DELIVERY PROVISIONS, WHILE STILL KEEPING AN EYE ON MARTHA MEANS FOR OUR CLIENTS THAT WE SERVE. SHERRI, I DON'T KNOW IF THERE IS ANYTHING THAT YOU WANTED TO ADD TO THAT. I KNOW YOU HAD THINGS PREPARED IN ADVANCE BUT GIVEN THE HOUR, I THINK IT MIGHT MOVE STRAIGHT TO QUESTIONS.

>> IF I CAN JUST MAYBE TAKE A MOMENT, SURE TO YOUR DIRECTOR, BEHAVIORAL HEALTH SERVICES DEPARTMENT. I AM JOINED HERE BY KATLYN, OUR CHIEF FINANCIAL OFFICER, MEGHAN AND COURTNEY GRAY. I THINK I WANTED TO SAY, I WANT TO ACKNOWLEDGE THE MAGNITUDE OF THE ADJUSTMENTS TO THE BEHAVIORAL HEALTH SERVICES DEPARTMENT AND EMPHASIZE THAT OUR PROPOSALS WILL CONTINUE TO ENSURE ACCESS TO SERVICES, PRESERVE OUR CORE SERVICES, MAXIMIZE MEDI-CAL LEVERAGING OF AVAILABLE FUNDING SOURCES, ENSURE COMPLIANCE WITH STATE AND FEDERAL REGULATIONS THAT ARE REQUIREMENTS THAT THEY MUST MEET AS PART OF OUR CORE RESPONSIBILITY. WE TALKED ABOUT THAT IN FEBRUARY DURING OUR BUDGET STUDY SESSION AND, WHERE OUR GOAL OF MAINTAINING THE QUALITY OF CARE THAT WE PROVIDE AND REALLY FOCUS SERVING OUR MOST VULNERABLE BENEFICIARIES. MANY OF THE ADJUSTMENTS, AS JAMES MENTIONED, ARE THE RESULT OF FEDERAL ADJUSTMENTS AND STATE REQUIREMENTS THAT IMPACT COUNTY BEHAVIORAL HEALTH PLANS ACROSS THE STATE. AND I ALSO WANT TO TAKE A MOMENT TO ACKNOWLEDGE THE MANY STAFF ACROSS THE BEHAVIORAL HEALTH SERVICES DEPARTMENT AND OUR PROVIDER NETWORK THAT CHOSE THEIR CAREER PATH AND MAKE IT THEIR LIVES WORK TO SERVE OUR MOST VULNERABLE BENEFICIARIES LIVING WITH A SERIOUS MENTAL ILLNESS OR SUBSTANCE USE DISORDER. WE RECOGNIZE THESE DIFFICULT TIMES OF UNCERTAINTY, STATE-WIDE AND COUNTY-WIDE, BUT REALLY ACROSS THE BOARD WHEN WE THINK ABOUT EVERYTHING THAT'S HAPPENING. AND OUR CLINICAL TEAMS AND STAFF AND CONTINUED TO REMAIN FOCUSED ON PROVIDING EXCELLENT CLIENT CARE AND MAINTAINING PROFESSIONALISM IN SUPPORT OF THEIR CLIENTS AND TEAMS AND COLLEAGUES. AND ON BEHALF OF OUR EXECUTIVE TEAM, WE EXTEND OUR GRATITUDE FOR THEIR WORK. SO I JUST REALLY WANTED TO ACKNOWLEDGE, YOU KNOW, JUST THE IMPACT OF OUR PROPOSALS THAT WE'LL BE ANSWERING QUESTIONS ABOUT THIS EVENING. SO THANK YOU FOR YOUR TIME.

>> SUPERVISOR LEE: THANK YOU, DOCTOR. LOOKING AT THE LIGHTS ON. SUPERVISOR ELLENBERG, GO AHEAD.

>> SUPERVISOR ELLENBERG: THANK YOU, SHERRI. I FEEL LIKE I AM SAYING THIS TO EVERY DEPARTMENT, BUT I REALLY FEEL FOR YOU. I KNOW THIS IS IMPOSSIBLY HARD. AND AS JAMES SAID, WE ARE IN FACT IN THE MIDDLE OF A VERY PROFOUND TRANSFORMATION. AND THIS SHIFT FROM MHSA TO BHSA TO ME REALLY REPRESENTS A FUNDAMENTAL REDEFINITION OF WHAT THE STATE IS EXPECTING FROM COUNTY BEHAVIORAL HEALTH SYSTEMS. I SEE THIS NEW NETWORK AS PUSHING US TO SERVE AT HIGHER AND HIGHER PROPORTIONS THE HIGHEST ACUITY CLIENTS, PRIORITIZING DEEPENED CRISIS-DRIVEN CARE, FRANKLY OVER THE BROADER CONTINUUM THAT THIS COUNTY HAS HISTORICALLY SUPPORTED. I THINK ABOUT THE FACT THAT THIS PHILOSOPHICAL SHIFT IS REALLY CREATING RIPPLE EFFECTS THROUGH OUR WHOLE DEPARTMENT. AND PAIRED WITH HR1, BECAUSE IN CASE THAT'S NOT ENOUGH, THE IMPACT IS REALLY, REALLY DRAMATIC. AND BECAUSE BHSD OPERATES A BROAD CONTINUUM OF SERVICES, I THINK WE ARE EXPOSED. THEY COMPRESS AND RESTRICT FUNDING CATEGORIES AND THIS THREATENS OUR ABILITY TO SUSTAIN HIGHLY FUNDED PROGRAMS AND REDEFINES OUR OPERATIONAL ABILITY. AND I AM SURE YOU FEEL THIS MAGNITUDE GREATER THAN I DO. WE ARE BEING PENALIZED FOR DOING SO MUCH NON-MANDATED BUT VERY IMPACTFUL AND OTHERWISE SUSTAINABLE WORK. TO ME, YOU KNOW, THE MOST PAINFUL PART IS LOOKING AT THE SHARP REDUCTION IN PREVENTION AND EARLY INTERVENTION FUNDING. WE KNOW THAT THESE ARE THE VERY TOOLS THAT LET US REACH PEOPLE BEFORE THEY ARE IN DEEP CRISIS. WE TALKED EARLIER ABOUT SUICIDE PREVENTION. THIS ALSO HITS SUBSTANCE ABUSE, COMMUNITY OUTREACH, PUBLIC AWARENESS, EVERYTHING THAT I SEE AS ESSENTIAL HEALTH SERVICES. AND WE ALL KNOW ON BOTH SIDES OF THE DAIS THAT WITHOUT THESE PROGRAMS WE ARE GOING TO SEE A HIGHER DEMAND FOR HIGH ACUITY CARE, INCLUDING E.R. VISITS, CRISIS STABILIZATION, INTENSIVE TREATMENT AND VERY LIKELY LONG-TERM CARE AS WELL. THE DOWNSTREAM COSTS ARE GOING TO BE SUBSTANTIAL. AND I WANT TO REITERATE AGAIN THE APPRECIATION THAT I HAVE FOR THANK YOU, ALL YOU HAVE DONE TO BALANCE THE BUDGET. I WANT TO SAY SOMETHING POSITIVE. I AM ENCOURAGED BY INITIATIVES LIKE EXPANDING SAME-DAY ACCESS TO TREATMENT AND OUR SCHOOL-BASED BEHAVIORAL HEALTH SERVICES. IT'S HARD TO TRULY BE JOYFUL WHEN WE WERE ALSO LOOKING AT THESE DRAMATIC -- THESE DRAMATIC FUNDING SHIFTS. I THINK IT'S GOING TO BE CRITICAL FOR OUR COUNTY TO TRACK OUTCOMES AND IDENTIFY GAPS SO THAT WE CAN MAKE A STRONG EFFORT-BASED CASE FOR ADDITIONAL SUPPORT AND RESOURCES. WE KNOW WE ARE GOING TO NEED IT. WE HOPE THAT THERE IS SIGNIFICANT IN THIS NEW PHILOSOPHY. BUT WE ARE GOING TO I THINK REALLY HAVE RECEIPTS AS WELL SO THAT WHEN WE GO AND ADVOCATE IN SACRAMENTO NEXT YEAR AND THE YEAR AFTER, WE CAN SHOW WHAT THE IMPACTS ARE OF THIS CHANGE. SO WITH ALL OF THAT, THANK YOU FOR THE THOROUGH RESPONSE TO MY EARLIER REQUEST FOR INFORMATION REGARDING THE BH CLINIC CONSOLIDATION AND LOCATIONS. I REALLY APPRECIATE THE LEVEL OF DETAIL IN THE MAPS AND THE FOLLOW-UP FROM STAFF. SO THANK YOU FOR THAT. I WOULD LIKE -- YOU KNOW, I'LL ASK ABOUT THIS FIRST AND LOOKING EITHER TO SHERRI OR JAMES OR ANYBODY ELSE THAT WISHES TO HOP IN. I HAVE BEEN LOOKING AT THE BHCA PROPOSAL TO DELAY IMPLEMENTATION OF THE NEW RATE STRUCTURE UNTIL JANUARY. I UNDERSTAND THEIR CONCERNS REGARDING TIMING AND PASS-THROUGH LEVELS AND TRANSITION READINESS. I ALSO KNOW THAT IT IS CRITICAL THAT THIS HAPPENS. WHAT I WOULD BE INTERESTED IN HEARING YOUR THOUGHTS ON ARE THE POSSIBILITIES OF GIVING THEM A LITTLE BIT MORE TIME WHILE MAKING VERY CLEAR THAT THIS EXTENDED TIME IS NOT ABOUT NEGOTIATING WHETHER OR NOT TO DO THIS. WE HAVE TO -- I BELIEVE AND AGREE WITH YOUR ESTIMATION THAT WE HAVE TO DO THIS. BUT IF IT WOULD BE BENEFICIAL FOR THEM TO HAVE A LITTLE BIT MORE TIME, I WOULD REALLY LIKE TO ADVOCATE FOR THAT.

>> MR. WILLIAMS: SURE, SUPERVISOR THINK.

We would be happy to follow up on that. I think that we have some opportunity, if there is certainty, around the new structure. We do think there is significant advantage to the new rate structure that we have proposed.

>> Supervisor Ellenberg: What do you mean by certainty around new structure?

>> Mr. Williams: Exactly what you said. Which is that the time that's being sought is time to help make the transition as opposed to time to continue to negotiate. That being said, I know that the payroll department and I would look to them, I know the behavioral health department is in active conversations with providers, including around what the new incentive-based payments, performance-based payments would look like.

>> Supervisor Ellenberg: Can you say more about that?

>> Mr. Williams: Absolutely. Sherri, go ahead.

>> Sherri: Thank you for your question and comment and James, your comment. We have been working with our providers for many months on a rate proposal. We believe we have a good solution, which is to look at one of the incentive pools and provide a guarantee of funding through those pools for fiscal year '27, which would help support the rate structure that we have proposed. We have had some conversations this evening based upon some of the decisions that we have been working on together, and we believe that we'll be able to come to fruition by July.

>> Supervisor Ellenberg: I would like to request -- what are they called? Information -- RFI. To come back before the hearings to let us know if you believe that you do have that agreement from the relevant partners. And to those of you who are either in the room or listening or will listen to the recording later, I want to hear from you, too, about the conversations with behavioral health and if you feel confident, then I would recommend in the -- during the budget hearings that we extend that period until January, as they are seeking.

>> Mr. Williams: I think what Sherri was alluding to is something that's a different proposal that's being discussed, which is -- which might be mutually beneficial.

>> Supervisor Ellenberg: Sorry.

>> Mr. Williams: I think what -- I think what makes sense and sounds like even conversations have been had today. What makes sense is for us to provide an update with an RFI to make sure that we update your offers on that. I have no doubt that VHCA will do likewise and proceed accordingly. Obviously, this is the overwhelming majority of the delivery network, and we recognize that. We recognize the depth of the partnership that's necessary and the fact that we are all collectively in this together, including this new fiscal reality, together. We'll provide the update to the board.

>> Reporter: And continue to work with Tim on that, including to figure out what exact steps make most sense to ensure continuity of services.

>> Supervisor Ellenberg: I appreciate it. And having that kind of collective understanding would be very helpful as well. Thank you so much. That's all I have.

>> Supervisor Lee: Any colleagues? I don't see any lights on. I will jump into the questions as well. First, I do want to say thanks so much to the team, the doctor, and your team for looking on your own executive leadership being mentioned. It takes leadership to not just cut programs but also those closest to your staff. And I want to thank the VHSD leadership for the alcove process to preserve the program in North County and provide a lifeline for the youth and young adults dealing with mental health issues. And first question might be best for James. You can see if it makes sense. Behavioral health is a big priority for the board. And so why is it taking on such a large share of consults related to the other departments?

>> Mr. Williams: Sure. I am glad you asked that question because you reminded me of an item I meant to address in my opening comments, but this is a challenge when you are working with all of our notes in your head. That is to talk about the big picture of what's facing BHSD. As we described to the board first back in October, then in February, the department is facing over $100 million in impact. The significant HR1 impacts felt by the health system, this is the part of county organization that is seeing the most significant revenue losses across every single one of its revenue streams where it has the biggest gap between costs and revenues. Now, we have not -- this is a really important point -- we have not asked the department to solve all of that gap itself. That goes back to my comments at the beginning of the budget workshop today, which is you see you don't see what's not brought forward. You do not see over $100 million in cuts in behavioral health included in the recommended budget. That's because we recognize that this is a major board priority. It's a major community priority, and cuts at that level would have really significant impacts on service delivery for the most vulnerable in our community. And so when you look at this budget as a whole, what it means is we are cutting another department -- in other departments, including some of those that we talked about earlier today, because of the level on behavioral health. And so while it is the case you are seeing a lot of impacts in behavioral health, it is also the case that the general fund portion of this department's action budget is going up significantly in this recommended budget, which represents, in essence, the general fund stepping in to fill some of the voids, not all, because we can't. Remember, the general fund has a deficit. But it represents the general fund stepping in to fill some of that void that was left by the state. So that big picture context, I think, is really important. And so, yes, you see a lot of impacts in behavioral health, but they are far less than what you would see if we had done what we normally do with departments with respect to special funds, which is make them fully balanced to all those special funds. That's what we do most of the time, as a general matter, and not what we did here, because of how significant behavioral health services is.

>> Supervisor Lee: Thank you, James Fox, for that big picture explanation. Now, the gross appropriation friends, increased from $873 to a million, to $1.1 billion, despite these major budget reductions. Can you explain why?

>> Mr. Williams: Most of that adjustment happened midyear. There's a recognition of the shifts in revenue and expenditure budget associated with -- primarily, most of this was attributable to shifts in the revenue expenditure budgets associated with Medi-Cal billing and accounting and change in how that occurred. So this better shows the actual accounted-related activity for the department services, particularly for Medi-Cal. I am sure Kaitlyn would love to elaborate if you are interested. But most of this appropriation adjustment happened midyear to better display that.

>> Supervisor Lee: It's not like we suddenly increased expenditures, it's just reflecting what we have been spending all along.

>> Mr. Williams: Expenditures are up, and it's related to increased activity. You know, the shift in the state's fiscal model from cost recovery for fee-for-service has increased the volume of activity. It has increased the overall appropriations. But the magnitude of the shift, in significant part, is due to that change in accounting. So there is an increase.

>> Supervisor Lee: Okay.

>> Mr. Williams: But that big jump from $872 to $1.1 billion, I would say, Kaitlyn, correct me if you think otherwise, but a majority of that is due to that accounting shift. But, of course, the overall revenue is up and expenditures are up from the prior year.

>> Kaitlyn: Thank you, James. And thank you for your question. That is actually correct. We had to create an accounting entry to increase a $150 million expenditure to a $150 million revenue to offset. So the net impact is zero. But because we actually get the revenue coming in from the state, we had to reflect that in the financial statement. But we also have a match that we have to pay back. So that's why we have to book it as revenue as well as an expense to reflect the actual.

>> Mr. Williams: And this has to do with something that happens a lot with Medi-Cal, which is the counties are forced to kind of front money and then the money comes back and forth and moves around between counties and the state as part of complicated accounting to draw down federal match. And so this is a piece of that.

>> Supervisor Lee: Thank you. Shifting to a different question, which is about the closing. There is a lot of facilities, Central Wellness and Benefit Center, Lethal Clinic, and such program, the Central Treatment and Recovery, which county contractor providers are we looking at to propose to extend these recommendations so these individuals will receive a service and communicate this with regard to this question.

>> Before we even finalize these proposals to make sure that this was a viable proposal, the main contractors we would be targeting are those in the central part of San Jose, which is most of the contractors. Many of the providers sitting here today, Gardner, CAM, Community Solutions, all have clinics in the central area that are around the same clinics that are being consolidated. It would also depend, though, on client choice. Clients can always select to go to another provider if they prefer. And also looking at the addresses, zip codes, locations, so if any are being served somewhere where a different provider or different county clinic is closer to their home, we would offer that option instead.

>> Supervisor Lee: Thank you. Let's see. A couple of items to ask this. Budget hearing. I would like to see if we could, we are able to provide the document of these providers' concerns about the rates and issues and the response to these issues and concerns. We did this a few years ago with CalAIM reform and were able to negotiate successful solutions afterwards. Having clarity to the board and the public, right? So I think this might be something good to do.

>> Mr. Williams: I think that's the same subject that Supervisor Ellenberg has requested. We'll incorporate that into that.

>> Supervisor Lee: Thank you. When we spoke with folks from NAMI, highlighting the future, not where to refer clients once the dust settles on the closures and reduction of services from providers, if we could help clarify some of that as well.

>> Thank you for the question, Supervisor Lee. We have a meeting scheduled with NAMI to walk them through all of our services and programs so there is a clear understanding about what is available to individuals who may contact NAMI for service referrals or information.

>> Supervisor Lee: Okay, great. Yeah. So if you could plan a meeting, that's exactly what I was going to ask you to do. Hopefully before, but explain the changes and make sure that they understand how to adapt to these very rapidly changing environments.

>> We'll do that.

>> Supervisor Lee: All right, thank you so much.

>> Thank you.

>> Supervisor Lee: Look at that, I did exactly 10 minutes. All right. Go ahead, Vice President.

>> Supervisor Arenas: You had four seconds left to spare. I'll take those. Okay. So I appreciate the RFI that you have already submitted, and we'll try to avoid asking you repetitive questions. Although I think there are some that might have not been answered. So I want to know with the plan to expand school-based outpatient program supports, how will you be prioritizing certain districts like ones that you currently see the most? And I know that there is a Ritz anyway. How will you do that? By the way, Meghan, you are an attorney. Are you representing the department or are you a staff member now?

>> Meghan: Thanks for your question. [ Laughter ]

>> Vice President, yes, actually, I am Deputy Director at the Behavioral Health Services Department now. I am still a licensed attorney because I did not submit my suspension form in time. So I had to pay the indemnity. But I am not here in that capacity. No.

>> Supervisor Arenas: They stole her.

>> Supervisor Arenas: And are you a therapist? What is your -- obviously you are an attorney, but there are people who have multiple degrees. Are you a therapist?

>> Meghan: I was a therapist, but I have worked in social services my entire career, including in homeless services, and spent 10 years kind of working in the behavioral health system as an advocate and an attorney.

>> Supervisor Arenas: Okay. I would just share with you that a lot of attorneys look at liabilities in terms of the services, and I get nervous when the attorneys are in the actual departments this way because of the history that we have with child welfare and clinical decisions started being a part of more of the lawyer materials of what we were going to do because it was a safer decision. I just want to have you -- anyways, this is just a question.

>> Meghan: I will keep that cautionary tale in mind.

>> Supervisor Arenas: Thank you. Okay. So how will we be expanding and prioritizing certain districts like the ones that are currently seeing most of the students?

>> Meghan: Yeah, so with the proposal, the school districts right now that currently only have the S-BAY program and don't have the S-BOP, so the outpatient services, we would add outpatient services to those schools so that there was some service activity happening on campus if referrals are received for specialty mental health services. Does that answer your question? I am happy to try again.

>> Supervisor Arenas: And I will keep going because I only have seven more minutes, so I am just going to keep going. You have answered a lot of my questions through the RFI. There were some that weren't. Here we go. Okay. So I know that FCS provides place-based services in South County. That includes Gilroy and South County Annex. Are there services expected to continue after clinic consolidation with the reduction of staff, and are substance youth services treatments expected to be provided at the same capacity?

>> Meghan: Yes, we are retaining three staff members that provide services in the South County. They will be located at different clinics than Alexi and FCS. They will go to our Children Youth Mental Health Clinics and provide services both at those sites and at the schools.

>> Supervisor Arenas: So that's a no?

>> Meghan: No, we are not expecting a reduction. Those staff would continue to provide services on campus.

>> Supervisor Arenas: At the same places I just mentioned?

>> Meghan: Yes.

>> Supervisor Arenas: Okay. And then other places, you said?

>> Meghan: They will, instead of being located at the fall clinic, it's at the Alexi Mental Health site, they would be located in our Children Youth and Family Mental Health Clinic. So one of those is in Sunnyvale, and another of those is in East San Jose, Las Palmas.

>> Supervisor Arenas: How will you accommodate the kiddos in South County that have transportation issues?

>> Meghan: My understanding and our data supports those youth are primarily seen at school during the school year when the clinicians are on campus. They are not coming up to central San Jose to have clinic visits.

>> Supervisor Arenas: Interesting. So what happens to them during the summer?

>> Reporter: We have access via telehealth. But there is -- as there is in many Children Youth and Family Services, a dip in the summers.

>> Supervisor Arenas: My son was doing telehealth, that during summer is nonexistent. So how will we continue to maintain that relationship? Because what I worry about is sometimes our kiddos are self-medicating because there is a mental health issue. And schizophrenia develops around 17 or 18. So the younger years of adulthood. So how do we keep track -- how do we make sure that we don't lose these kiddos and all the really good work being done throughout the school year so that when they come back, they have a good transition back into the -- into the school year?

>> Meghan: I would say the clinicians that work in those schools have been doing that to the extent that they are able year after year. One of the reasons that we are integrating the clinicians into mental health clinics is understanding that there are a lot of co-occurring disorders, and we expect to be able to refer more youth to substance use services who are coming in for mental health services and vice versa, having them co-located.

>> Supervisor Arenas: So could you get me data? You have an RFI currently on request, right? Supervisor Ellenberg? Could I add that to -- I would like to see what the numbers are so that in the similar way we lose some of the academic reading and other good habits, we may lose some of the therapeutic service connections. I would like to see what that looks like from the school year and then until the next following school year or during the summer would be really great to see what the fall off is.

>> Mr. Williams: We'll provide that information, probably as a separate document. It's it's guesswork teaching from the data issue, but we'll provide that as an RFI.

>> Supervisor Arenas: Okay, perfect. This is easy. Can you provide the list of community clinics as listed in the county clinic consolidation off-agenda so it's easy to read format and our offices can share it as a resource?

>> Mr. Williams: I know there was a table of the clinics provided as an attachment. What format would you find to be most useful?

>> Supervisor Arenas: Whatever the community -- you think -- any community member could look at and see these are all the different clinics that we have.

>> Meghan: We are required to have a provider directory accessible on our website, which we do, which has all of the providers in our network and can be searched by provider type, by area of the county. It provides information on whether they are accepting referrals right now or not. I would be happy to email you that link. I think that would be the best way to give community members, you know, direct visibility.

>> Meghan: I wanted to add, Supervisor Arenas, this that we did include that as part of the OAR around the clinic consolidation, and so perhaps you could just take a look and let us know if that meets your needs in terms of how we have framed the data through the provider directory.

>> Supervisor Arenas: Okay. Well, I think it was my team that I think looked at that and liked it, but thought if it was user-friendly, so maybe that is user-friendly. Already. As user-friendly as it could get. Okay. All right. I think -- all right. So I am going to -- oh, so let me ask you about the data about productivity and the changes that you will have within the clinics. There are state and professional standards to continue to ensure that the clinics will be productive amid the changes. So during this transition, how will we know that we continue to engage people? Will it be 70% of the current patient numbers that you are seeing, currently? As long as we don't lose more than, I don't know, 65% of clients as we transition over? What is that baseline? What does that look like to you? What does success mean? A successful transition.

>> Meghan: We do know from past clinic closure program transitions across the network, both county and provider, that about 70% of clients from a given program typically end up fully transferring after the closure. We are, of course, preparing to transfer everyone and offer everyone an option, and we will be tracking who engages with services and using our peers and behavioral health navigators to ensure that anyone that doesn't engage with the new provider, they are either closer or assigned to that they are followed up on to make sure that they have the opportunity to gain in services if they still want them. The metric we often look at is once the referral is made to the new provider, whether they were seen three times within 30 days and track that data even right now without closures going on to understand the engagement rates.

>> Supervisor Arenas: Okay. And the last question I am going to ask you is about the suicide prevention. I know this is going over to Public Health, but you'll continue to maintain the remainder of the continuum of care for -- for those impacted with suicide. How are you integrating some of the information about the Latino Health Assessment in your transition to -- within your realignment within the services that you are rendering within the suicide? How are you using this assessment, this health assessment to feed your changes?

>> Meghan: Thank you for the question, Supervisor Arenas. I think we will be working closely with DESJ and Public Health Department around the Latino. Our last conversation at the board, you had some ideas what you think might be helpful to include as part of our Behavioral Health Services Department. First, around the Latino Health, I think I cooperate, agree with you more about how important this issue is with respect to how we serve Latinos in our community, ensuring their health and wellness, particularly around behavioral health. Well, I would like to work more closely with DESJ, Public Health, and with our office to ensure that we are including the most critical elements that you think are important for this work.

>> Supervisor Arenas: Wonderful. The last thing is integration of -- the integration of the child and youth death report. As you participate in those and those recommendations, those patterns and trends that you see there would be wonderful.

>> Meghan: Thank you.

>> Supervisor Arenas: Thank you.

>> Supervisor Lee: I don't see any more lights on this item, and I don't have any impression minds myself at this point. So I would say we are coming near the end of the program.

>> Supervisor Arenas: Just one more. I know there is the $2 million in block grants that are getting passed on to Public Health for -- to continue primary prevention services. This is the substance use block grant that currently funds programs specifically in my district, which is a culinary academy at Rebecca's Children Services, and it's called NEEDED. And they are going to be impacted. How are you ensuring that there is a smooth transition? Because these are programs that are relationship building, right? It's not just this poster on the side of a bus or anything like this. These are folks who have relationships with the community -- with those kiddos. So how will you ensure that there is no momentum lost in that transition?

>> Meghan: We are working with Public Health to do a warm handoff. Behavioral Health will continue the contracts into the next fiscal year for the first quarter, and then they will -- to give time to transition to the Public Health Department. Certainly, those primary prevention activities are successful and key, and the intention is that they will continue on.

>> Supervisor Arenas: Yeah. I am concerned that the -- that we'll move into a suicide prevention where it's more informational and not relationship-based. But I'll take that on with the Public Health as they transition into this. Thank you.

>> Supervisor Lee: Okay, thank you. So this comes to, I believe, the end of the day. We will now recess to Tuesday, May 12th at 1:30, and we'll continue the budget workshop starting with the Children and Seniors Family Committee. And thank you to staff, security staff, and community that came to speak on this section of the budget. It's calling the meeting adjourned at 7:28. Thank you.