[00:09] Speaker 1: Good afternoon, everyone. I'd like to call to order the special meeting of Tuesday. No, Tuesday, June 23rd, 1:30. This is a special meeting of the Board of Supervisors for Alameda County. I'd like to ask the clerk to call roll and establish our quorum.
[00:29] Speaker 2: Supervisor Marquez.
[00:30] Speaker 3: Excuse.
[00:30] Speaker 2: Supervisor. Town.
[00:32] Speaker 4: Present.
[00:34] Speaker 2: Supervisor Miley. Supervisor for Toronto. Bass. President Halbert.
[00:40] Speaker 1: Present.
[00:40] Speaker 2: We have a quorum.
[00:42] Speaker 1: Thank you very much. I appreciate those members of the public participating in our meeting in person and online. If you're here to comment on any items before us today, either closed session or open session, we ask that you would fill out a speaker slip. And to participate online, we have some special instructions which the Clerk will now provide.
[01:12] Speaker 2: Detailed instructions are provided in the teleconferencing guidelines. A link to the document is included in today's agenda. To view an automated translated transcript or listen to an automated translated audio of the meeting from English into multiple other languages, please utilize the Wortly link in today's agenda or the QR codes posted throughout the room and select your preferred language from the dropdown menu. If you are joining the meeting using a computer, use the button at the bottom of your screen to raise your hand to request a speak. When called to. To speak, please unmute your microphone and state your name. If you're calling in, dial star 9 to raise your hand to speak when you are called. To Hope when you are called, the speak will enable you to speak. If you decide not to speak, notify the clerk when your call is unmuted, or you may simply hang up and dial back into the meeting. When called, you will have two minutes to speak. Please limit your remarks to the time allocated. Public comment will generally alternate between in person online speakers as determined by the President of the Board and subject to open overall time limits. In the event that technical difficulties disrupt the Zoom webinar, the meeting may be recessed and reconvened via Microsoft Teams. Detailed instructions are provided in the teleconferencing guidelines. Thank you.
[02:29] Speaker 1: Thank you. I note that we have Supervisor TAM participating remotely under the just Cause provisions of State Senate Bill 2449. Supervisor Tam, would you care to make your required declaration?
[02:43] Speaker 5: Thank you, President Halbert. I am participating remotely under Government Code Section 54953 8.3, Parent C and PARIN 3 under the Just cause provision. Because of medical recovery, there are no adults 18 or over present in the room.
[03:00] Speaker 1: Thank you, and we wish you a full and speedy recovery. I note that we also are joined by Supervisor Marquez, so we have a full 100% participation today. Our next item is to provide public comment on closed session items. There is a list of specific items under closed session. We will take public comment only on those items. At this point. There will be public.
[03:27] Speaker 6: Well,
[03:30] Speaker 1: actually, we don't have public comment on open session items. That's right. So if anybody would like to make a comment on closed session items, now would be the time to do that. Do we have any speakers on closed session items in the room first and online after that.
[03:48] Speaker 2: First speaker is Kathy Reeves.
[03:53] Speaker 1: Welcome. And just let us know which item you're speaking on. The first rank. First one.
[04:06] Speaker 2: Thank you.
[04:06] Speaker 6: Good afternoon. My name is Kathy Reeves. I have been a legal secretary in the public defender's office for 26 years and I'm a shop steward with SEIU. 10 to 1. I spoke to this board earlier regarding how the more than 4,000 plus employees of Alameda county who are members of SEIU 1021 are being treated. I reminded this board and the county administrator that we are the wheels that make this county run. I said we are being treated like indentured servants, scraping by from paycheck to paycheck. And the fact that many employees travel for up to two hours just to come to work every day because they cannot afford to live in Alameda County. Those in leadership are well compensated, while we, the frontline workers who keep this county functioning, are given crumbs. You want us to pay for our benefits, but you don't want to give us enough money to pay for housing, food and gas, which are the basic necessities of life. Previously I said we deserve respect and fair wages. Now I'm saying we demand respect and fair wages. Stop treating us as though we should simply be grateful. We are the backbone. Without us, this county would shut down. I said that. We are getting tired Now. I'm saying to you, we are past tired. We are done with being treated like peons. We work hard every day. We are not afraid. You are about to meet in closed session with the labor negotiators. I hope that you carefully consider the points that I have made today. Thank you.
[05:56] Speaker 7: Thank you.
[06:00] Speaker 2: Next up is Gene Moses. Jean, please unmute.
[06:14] Speaker 8: Jing.
[06:28] Speaker 2: Hello? Okay, go ahead.
[06:32] Speaker 8: Yes.
[06:33] Speaker 2: Can you hear me?
[06:35] Speaker 6: Yes.
[06:37] Speaker 2: Is this the correct time to make a comment on the budget? Thank you. I wanted to say, first of all, this is only for closed session items.
[06:50] Speaker 8: Got it.
[06:51] Speaker 6: Thank you.
[06:52] Speaker 2: Sorry to interrupt. There are no more speakers.
[06:57] Speaker 1: Thank you very much. Just another reminder to the public. We meeting tonight today does not include public comment on the budget. We have closed public comment which was concluded after two days of meetings last Thursday and yesterday. And so there's no more time for public comment on the budget. I did welcome and I do welcome seiu's comments on our labor negotiations. So thank you for sticking to that as agendized. And so we are finished with closed session on public comment on closed session items. And we are now going to recess into closed session and we will return when we're done with our discussions in closed session with that, we are now in recess. Good afternoon. It's 3:35. I'm re asking that we readjourn to open session. Will the clerk please call the roll to establish our quorum?
[08:11] Speaker 2: Supervisor Marquez.
[08:12] Speaker 3: Present.
[08:13] Speaker 2: Supervisor Tam.
[08:14] Speaker 5: Present.
[08:16] Speaker 2: Supervisor Miley. Supervisor for Donald Bass. President Albert.
[08:22] Speaker 1: Present.
[08:22] Speaker 2: We have a quorum.
[08:24] Speaker 1: Thank you very much. I'll ask our County Council, as we are reconvening from closed session, is there any reportable action from closed session?
[08:33] Speaker 7: Thank you.
[08:33] Speaker 1: President Hubbard, your board took no reportable actions in closed session today. Thank you. I note that we have Supervisor Tam also joining us remotely under just cause provisions. So we are in full attendance. The next item before us is listed as item number one on today's agenda. Fiscal year 2026, 2027 recommended proposed budget deliberations. This is a meeting continued from yesterday June 22nd. I'll ask our county administrator. The floor is now yours.
[09:15] Speaker 2: Thank you.
[09:15] Speaker 9: President Halbert. Members of the board, we report you today for your board's deliberations on the fiscal year 202627 proposed budget that was submitted to your board on May 28th. We just distributed a letter that I will read into the record with two attachments as well. We will have a brief presentation to provide some additional information to frame your discussions today. Today you will deliberate on the fiscal year 2627 proposed budget which was presented to your board on May 28 and has been available to your board and the public since that time for viewing. Your board held public hearings on June 22 and following extended extensive public comment, close both the hearing and public comment period on next year's budget. The budget before you provides a balanced $6.7 billion spending plan across all funds supporting county programs and services throughout the county and a workforce of more than 10,400 employees. The budget closes a $185 million funding gap while maintaining critical investments in county priorities without major funding reductions or layoffs. The recommended general fund budget totals 4.3 billion and includes over 1.2 billion of investments for services delivered through community based providers prior to the close of Budget hearings Yesterday, your board received a letter from my office recommending final budget adjustments for inclusion in the final budget. These adjustments reflect board approved actions and technical corrections and do not increase county costs. In addition, prior to the close of hearings yesterday, a letter was submitted by Supervisors Fortnotto, Bass and Miley for discussion. In summary, to approve a one time allocation of up to 19.3 million for the Alameda Health System to help mitigate the proposed reductions in force Conduct a performance audit of AHS. Extend the PHP IOP program through October 31st of 2026. Direct staff to convene a planning group for the PHP IOP program that you extend the board's AHS ad hoc committee and also direct the County Administrator in collaboration with the Auditor, Controller and AC Health Director to identify one time funding options. Today your board will deliberate on the proposed budget as well as the final budget adjustments and the letter submitted by Supervisors Miley and Fortnado Bass. Following your discussions and deliberations today, you will provide directions to the County Administrator to prepare a final budget that will incorporate your direction as well as the final adjustments and bring that back to your board for formal adoption this Thursday at a special meeting that will convene at 4pm so what you have before you is a copy of a letter summarizing my comments as well as another copy of the final budget adjustment letter and the copy that a copy of the letter that was submitted by the Supervisors related to the Alameda Health System. We'd like to start today by providing you with yet some additional background information, a couple of updates related to the final budget adjustments to help both inform and frame your discussions and deliberations. Today we also will be distributing a separate memorandum that responds to several questions that were raised by members of your board prior to and during the hearings yesterday. So with that we're going to start with just another brief overview and again today we're at almost the final phase of your budget with deliberations and direction to the County Administrator and final adoption on Thursday. We want to just call attention again to the pressure environment that your board is operating under with stakeholder pressures, fiscal pressures, policy pressures, as well as external stakeholder input and your board initiatives. Again emphasizing that these are interrelated, definitely not independent, and are competing priorities for the same resources, staff capacity and leadership attention. The goal is to balance our immediate operational demands with long term strategic goals and our challenge is to remain fiscally responsible, policy compliant, responsive to stakeholders and aligned with your board's priorities while continuing to deliver high quality services to our residents throughout the county. With that, we're going to just quickly provide an overview of the budget that's under your consideration and provide some additional context related to Measure W as well as Alameda Health System.
[14:34] Speaker 2: The fiscal year 2627 proposed budget totals approximately 6.7 billion across all funds. The general Fund budget totals approximately 4.3 billion. And the proposed budget includes over 10,400 full time equivalent positions representing a reduction of approximately 45 full time equivalent positions compared to the prior year. Here we see community based organizations which remain an essential partner in delivering services throughout the county. The proposed budget includes approximately 1.25 billion in contracts with 271 community based organizations. These partnerships support health care, behavioral health, housing, social services, public safety programs and other community needs. Here we see the the budget of CBO contracts over time and you can see that the proportion of the value of health program contracts administered by CBOs
[15:50] Speaker 3: compared to the other program areas.
[15:59] Speaker 8: Just to recap some of the Measure W information, this is your board's approved policies that govern how Measure W revenues are managed and allocated as we went over yesterday and this represents the Home Together Fund budget in AC Health
[16:23] Speaker 3: and
[16:23] Speaker 8: here we have the total H and H budget that includes the Home Together investments and as as noted here, this also includes that $5.5 million in new Prop 1 backfill included in the final adjustments. The FY2627 Essential County Services Fund budget allocates $58.7 million total including the $20 million in estimated excess Measure W sales tax receipts which are currently unallocated and those are represented in both the total and and the basic needs category. As a reminder, your Board heard Testimony at your April 28 work session from a variety of community providers and it is captured here in the request that came from the Senior Services Coalition as well as the other community groups that came to speak before the Board. Those requests total $19 million and represent a continuation of programs that were funded in the 2526 measure w essential County Services Fund budget. In follow up to your questions yesterday about the contract specifically in Social Services, this represents those specific contracts. The first one is a $2.2 million in social services and for the information we got from social Services, those contracts are expiring at the end of this month and a new RFP is in process with the start date of July 1st. 30 out of the 77 contracts are being extended with a temporary six month extension. That second line is a new ask so it doesn't support an existing allocation in the 2526 budget. The third the $1.7 million supports those 14 contracts and they will also have a temporary six month extension through the end of the year and then the emergency prepared meals program. That contract expires on at the end of June 2027. And you can see the expiration dates of those additional contracts there, which is not June 30th of 2026. And the social services director is here if you have additional questions. This next slide represents the county's investment in Alameda Health System. As you can see the top part of the table is are the contracts that we have with the hospital system totaling $170.35 million. The bottom portion is our financial agreements with the hospital. We returned $7 million to them annually, which was initially part of a capital designation that came to the county to help with the acute tower replacement debt service, but we now provide it back to them to support the electronic health record project. We pay approximately $50 million annually on our debt service for the Highland Acute Tower replacement project. And they the hospital system has a net negative balance limit of $100 million at June 30 of the fiscal year. But within the year they have the ability to borrow up to $200 million. The agreement is that they bring it down to the $100 million by June 30 at the end of the fiscal year. So so in total we have investments of $327.35 million with the Alameda Health System.
[20:48] Speaker 9: And just to note, those are direct investments through the county. And in addition as you know AHS receives directly 75% of the Measure A receipts, probably close to $150 million annually.
[21:14] Speaker 8: And to review at the end of our hearing yesterday, County Administrator Mirinishi will review the letter that was submitted.
[21:27] Speaker 9: So attached in your packet is the letter that you received yesterday from Supervisors Miley and Fortnado Bass. And we wanted just to highlight and summarize the recommendations and the content of that letter. But essentially it was a request that your board consider investing up to an additional 19.31 time funding for Alameda Health System to eliminate the remaining 92 proposed layoffs that they have as part of their budget balancing plan. And you direct the county administrator to work with the auditor and AC Health director to identify one time funding options for the upcoming year. There was also a provision that AHS conduct an independent performance audit with an outside firm that there be an extension of the partial hospitalization Intensive Outpatient Behavioral health program through October 31st of 2026 that AHS operations be stabilized and strengthened by convening a planning group to evaluate the long term feasibility of the PHP IOP services. And and that the board oversight be continued through continuation of the AHS ad hoc committee that has been convened by Supervisors Miley and Fortnado Bass. And that finally, if the PHP IOP program is determined not to be feasible, that there be insured continuity of patient care and support of the staff who would be impacted by layoffs without the county's intervention. So those are the items that are before your board for discussion and deliberation today. As noted, your official public hearing is closed. Today is an opportunity for your board to discuss and deliberate amongst yourselves and to request additional information or questions from staff. And as you know, most of the department heads are present or available to respond to questions, as is the AHS CEO in the audience today. Thank you.
[23:36] Speaker 1: Let's bring it back for deliberations. Who would care to start? Supervisor Miley?
[23:41] Speaker 10: Sure. Thank you. President Albert yeah, thanks a lot. And as it's to be said, appreciate the county administrator, her team and the county agency and department heads for all the work on the on the budget. You know, I've had the benefit of sitting through 26 of these budgets since I've been a county supervisor and we continue to do justice, I think and provide the necessary safety net services to the county population that is so deserving as well as to support our work, our workforce, frontline workers and others and to rely on our community based organizations to help us provide the services we need to provide to the to the client population. Initially, before I talk about ahs, I just want to be reassured that the funding for the AAA contracts that funding is if the agency director, Social Services Director could approach the mic. I know I can see you out of my peripheral vision the those contracts, AAA contracts are being extended by six months and then the additional funding for the balance of the fiscal year is committed and will be available.
[25:27] Speaker 2: Can you put that slide back up again? Well, Amy brings a slide up. Andrea Ford, Agency Director for Social Services. So yes, this slide explains the funding that will be available. In addition, I have a few updates about the pending RFPs. The senior injury Prevention and Health Promotion anticipated award date will be July 10, 2026. CalFresh Outreach anticipated award date will be July 14th of this year. Telephone, reassure and visiting. July 14th is the anticipated award date. Supportive Services, Adult Daycare, Case Management. They receive a six month extension. Legal Services, Elder Abuse Prevention, Transportation anticipated award date August 7th of 2026. Senior center activities. August 7th is the anticipated award date. Nutrition Services six month extension. July 1st, 2026 is the anticipated award date. Family Caregiver Support Program six month extension. June 26th is the anticipated award date of the RFP. And so far, three RFPs have been awarded. AMSBUTsman Information and Assistance Award contract on July 14th. I mean, it'll be on your board's agenda on July 14th. Then the Health and Medicare Advocacy and Information awarded and contracted.
[27:04] Speaker 10: Okay. Hopefully that gives those CBOs the assurance that they can move ahead with their staffing, with their obligations, recognizing that not only are their contracts being extended, but there'll be funds available for them to compete for through the balance of the fiscal year.
[27:30] Speaker 2: That's. Yes.
[27:31] Speaker 10: Okay. Because I do think it's refreshing when the board is so attuned to the needs of older adults. I really like that I can just sit back and relax because a lot of the advocacy was already done and is being handled. So I think you understand how we feel about those contracts.
[27:56] Speaker 5: Yeah.
[27:57] Speaker 2: And as the agency director over adult naging services, I feel the same way.
[28:00] Speaker 10: Good. Excellent. Excellent. And I know my colleagues will probably ask a little bit more about the Food Recovery and American Services and that sort of thing. I'll leave that up to them now and then I know this isn't. Is on you, but I know with the bridge funding for. Bring the other agency director up. You can sit down now. Thank you, Andrea. Yes. So the bridge, because we haven't talked about this, because it's baked in, we're good to go. The bridge funding for the CBOs who are relying on funding for preventive mental health, that is solid and moving forward. Yes.
[28:49] Speaker 2: Supervisor, Your board approved on June 2 $37 million in bridge funding. And that covers a wide variety of prevention programs that.
[29:00] Speaker 3: Including. Well, I won't talk about the UALP
[29:03] Speaker 2: because that went as a part of
[29:04] Speaker 3: the BHSA plan, but that covers the
[29:08] Speaker 2: vast majority of the cuts that we were anticipating.
[29:11] Speaker 10: And the other entities that were concerned about their contracts, they're not being cut. Right.
[29:21] Speaker 2: The UELP providers. So we've talked about them a couple of times. Those are the cohort of providers that opted into early intervention, which their funding is not cut for this year. ACBH will hold them harmless for as they transition to early intervention, which will actually set them up for billing in the future, which we think is a more sustainable path.
[29:47] Speaker 10: Right. And we're doing this because we, as you said, we feel it's a more sustainable path. We've got to comply with Prop 1. And we're just. And we want to do the best we can to continue to support those CBOs, both their staffing and their ability to deliver services. But they've got to transition to billable, and we're going to provide them with the technical assistance.
[30:14] Speaker 3: And Behavioral Health has set up a
[30:16] Speaker 2: technical assistance team specifically to support with that transition. And then separately, as I shared yesterday, our public health department will also be convening some groups specific to prevention so that we can think about how to leverage any state resources that might be available.
[30:35] Speaker 10: Okay, thank you. Have a seat. So now for the. The big kahuna that's in the room. Like, you know, James Jackson, Alamede Health Systems, and my good friend Jeanette Dong, who used to work for the county. And I've known Jeanette since her times working at the city of Oakland, Mary Harris. And look at her smiling over there. So I just want to point out that we appreciate the work of Alameda Health Systems, both your executive team, your staff, and the work of the bargaining units at hs. And I appreciate the work that Supervisor Fortnado, Boss, has collaborated with me on the ad hoc committee and also her chief of staff, Dave Brown, and Erin Armstrong, my deputy chief of staff, to help us with all of this. It's been a herculean task, but we're here. And we do value the need of HS to be fiscally sound and to be able to deliver the services it delivers and to ensure that the frontline workers are secure in their. In their jobs. And I think that's one reason why Supervisor Bass and I are coming forward with this request to the board for. For this $19.3 million, because, you know, we're all in this together and we didn't produce the situation that caused the fact that HS has these challenges. Some of it is in external to our control with HR1, for instance, but because we're all in this together, the county hs, which is theoretically it's independent, but it's an extension of the county, particularly since we have the 17,000 obligation to provide safety net services around healthcare here in the county. And so we need to look at that very carefully and ensure that that's happening.
[32:48] Speaker 1: So.
[32:49] Speaker 10: And we want to make sure that there, I think we all value labor peace. We all value that in Alameda County. You know, we've often said Alameda county is a labor county, and we hold ourselves to that standard and that value. So in order to ensure your ability to balance your budget, to ensure labor peace, to ensure support for our frontline workers, and to ensure the continuity of services. I think Supervisor Bass and I have worked hard with you labor, our staff, the county administrator, as well as the agency director, and in some cases even the county auditor, although she likes to stay in the background, but she's there to try to come up with a package that is really sound. And it's also understanding if the board comes forward this $19.3 million, that will forestall any reduction in force for these 92 workers for an entire year. It will also provide the ability to transition the iop. It will also allow us to continue our work as the ad hoc to look at not just the present situation, but we need to be looking two and three years down the road for the next couple of fiscal years trying to adjust this. And we do recognize that this isn't just ahs. We need to look at this in the context of Alameda Health Systems, our federally qualified clinics, our CBOs deliver health services, the alliance and then labor, we need to all be looking at this comprehensively in terms of the safety net services for health services here in the county. So the ad hoc. We're taking on that burden, that responsibility, that heavy lift, because Supervisor Bass is up for the challenge and I'm up to collaborate with her around that challenge. So with all that being said, that's. I'm framing this. That's why we really feel the board needs to come up with this 19.3. I think it's also we're not telling the county administrator where to get the funding from. We're just saying we want the funding to be provided to AHS, the 19.3 million. And then AHS will deal with balancing your budget around the additional resources that you need. And then it's also understanding HS has passed their budget, but they will be coming back to their board of trustees in September to once again review and their budget and determine if there's any adjustments that need to be made. And then we'll be looking at that again at our health committee, Supervisor Tam and I, in September as well. So we've got both the ad hoc committee working on this and we've got the health committee monitoring and tracking this as well. So that provides some of the framework for this around ahs. So I'm hoping that the board supports this. And then AHS has done some efficiency reviews and since we started down this road, has come up with about $30 million in efficiencies to address some of its deficit. But I think it will continue to work on efficiencies. But that's another reason why we're putting in our proposal the idea of having a performance audit efficiency review of HS to see if there's any further efficiencies that can be ascertained. But even more importantly, to try to build confidence and support among HS management and its bargaining units, its frontline workers, that efficiencies are being looked at and being looked at from an objective perspective and from a perspective of which all can hopefully have some. Some assurance that the information provided is accurate information. And so that's another reason why we're proposing the performance audit and efficiency study. So. And the final thing I would say about ahs, AHS has stepped up. I know, being on the board and then with Supervisor Marquez joining us on the board, you know, there was a strong push to stabilize Saint Rose. I know since I've been here, Supervisor Steele carried that burden for many years. And then Supervisor Vallier and then Supervisor Marquez finally was able to get it into a position within the county family through hs. And HS stepped up, and you're doing that. So you've been a very good partner. So I think it's incumbent upon the county to do what we can to be a partner and supportive of AHS in this time of challenge. So that's some of my framework at the moment. I don't know if the. If James Sachs wants to say anything at the moment or if you want to wait until Supervisor Bass has a chance to weigh in on this, I
[38:21] Speaker 1: would recommend that we all maybe have a couple of comments and then because we all have.
[38:27] Speaker 10: Yes.
[38:27] Speaker 1: Comments.
[38:27] Speaker 10: All right. Yes, Mr. President.
[38:29] Speaker 1: If that's okay.
[38:31] Speaker 10: Mr. President elders and I always respect
[38:34] Speaker 1: my president, Supervisor Fortune on a Bass.
[38:39] Speaker 2: Thank you, President Halbert. I wanted to touch on a few topics, but I'll start with Alameda Health System and our board letters. Since Supervisor Miley kicked that off. I will just add that providing health care, especially to those who are uninsured, who are not able to have the benefit of private insurance, that's really one of our most important tasks as a safety net system. And so really investing in our public hospital system as well as the broader health ecosystem is really important. And HR1 is causing seismic shifts, which we are just starting to see. I think that this board letter and hopefully the board's approval will allow us to really set the stage for better preparing ourselves for what's to come and for having a much more collaborative process than we've been able to have, given how some of these impacts have been felt and how things rolled out. So I concur with my colleague that this is really about shoring up our safety net, looking to the future and making sure that moving forward, all of us as stakeholders, the county ahs, our labor partners, that we can all work together transparently and collaboratively to solve these problems together. And they will likely be even harder than they have been over these past few months in order to address how things are changing. Secondly, I wanted to just highlight a few things in the board letter. We have not yet had a formal report back to the board board on what this ad hoc has done over the course of four meetings. And so I'll try to do this quickly since it's already in writing. In November, the board of trustees at Alameda Health System approved a reduction of force of 372employees. And then our board, as required by law, conducted our b lenson hearing that was in February. And we also had another meeting that concluded that process in March. And so with our board direction during that here those hearings, we were able to move forward with a number of things, including the creation of the ad hoc committee as well as some additional county investments. One of them our county administrator touched upon, which is our net negative balance or our line of credit. So increasing that limit as well as allowing for a higher intra year maximum and allowing a foregoing of the 5 million in annual debt payments. So again, that credit line increased by 100 million. In addition to that, we also reduced the AHS behavioral health funding withhold from 20% to 10%, which provided approximately 8 million in additional cash flow. Now, at the ad hoc meeting, there were a lot, there was a lot of discussion about additional revenue generating strategies. I won't go into everything that we discussed, but there were a number of items that were brought forward by labor which we had discussed in terms of additional services that could be provided with new revenue. Also coming along with that, the Cath Lab in particular is one where there is additional room for for demand. We brought in the Alameda alliance and they were able to increase the reimbursement rates by an additional 1% in July of this year and 1% in January of next year, which is resulting in an estimated 3.2 million in revenue. So all of that has been factoring into this process. We've looked at billing optimization and revenue cycle improvements. That work is still ongoing. There have been a number of meetings as well as a task force that AHS has convened. There have also been performance improvement initiatives. And these initiatives have been able to generate about, well, almost $30 million to help close the deficit that AHS has. We talked about lease. We talked about cost saving strategies now, including lease consolidation. So AHS will be exploring ways to reduce future leases. Some of them don't expire until next year, as well as exploring ways that they could house more of their operations on county properties. And then we also looked at the executive bonus policy, and AHS confirmed that there were no bonuses paid this current fiscal year and there will be no bonuses paid next fiscal year. We also talked about increasing transparency around that policy, which they are considering considering. So where we are today is that as you heard from the introduction of the letter, there are currently 92 remaining reductions in force. That's FTEs, which our board action could address. We also talked about the performance of audit. And I know Supervisor Marquez had a question about that timeline. What we understand is that will take AHS approximately three months to procure that performance audit. And they can speak to this as well as what. And then for the firm, at least, there's one firm that's in consideration who could be mutually agreeable to both parties, AHS and their labor partners. It will take them about six months, months to complete. So that's the information we have. We discuss extending the IOP PHP program for four months. As I said yesterday, there's a group that has already met once and that will meet my office and my staff in particular are certainly available and willing to support Alameda Health in whatever it needs to move that process forward. So I believe that's a summary of most of the items. And I do want to clarify that because somebody asked in terms of the funds that need to be identified for the up to 19.3 million, we do not anticipate that any Measure W funds would be utilized. I want to make that clear. I certainly don't support that. I want us to be able to look at other funds because we have had many, many conversations about how to add that. So in summary, we have done a lot of work. It's been a very rigorous process. And I think that this board letter really sets us up for more collaboration and more board engagement. Engagement of all the partners in the future so that we can really weather this unprecedented storm that our health system is going through. President Halbert, I have at least one question on the Measure W slides. I have other comments, but I can hold them until everyone has a chance to speak.
[45:54] Speaker 1: Supervisor Marquez?
[45:55] Speaker 2: Oh, can I actually, can I just ask the Measure W question? So thank you to the county administrator in terms of clarifying the Measure W Essential County Services Fund and that estimated overage of 20 million being included in the budget that is in front of us for adoption. In regards to to the slide with the 19 million allocation. Thank you for sharing that. We had talked on April 28th at our work session and then again on May 19th at our work session. And the total I have on those slides is 19.5 million. So it looks like there is a AAA Senior Community Services Employment Program allocation of 500,000 that is not included.
[46:44] Speaker 8: That is not a contract our social services agency has, so that that would be a new service. Andrea has more information about maybe where that came from. Our understanding is that's a City of Oakland program, not a county program.
[47:00] Speaker 9: Okay.
[47:11] Speaker 2: Good afternoon again. Andrea Ford, Agency Director. It's an employment program that used to be run out of the AAA and it was taken over by California Department of Aging. So we no longer run that employment program in Social services. And I don't think we should be funding the City of Oakland to run their program. Thanks for that clarity.
[47:37] Speaker 1: Does that conclude your comments for now? Supervisor Marquez?
[47:42] Speaker 3: Thank you, President Hubbard. Again, thank you to everyone who's worked tirelessly this entire year on this budget. It's been an innovative process and a lot has occurred. So I'm proud of the good work and more more obviously for us to still attend to. But just want to highlight a couple things that I want to make sure I flag. We talked yesterday about the idea of updating our master fee schedule before the end of the year. I want to thank Supervisor Fortuno Bass for also flagging the assessment appeals application and re evaluating that. I believe Supervisor Miley brought up the environmental fees for Environmental Health Services and so definitely want to see us work on that in this upcoming year. And then we also talked about our operational reserves being at 5%. So I'd like to also respectfully have a plan come back to us to get that up to the 16% level, at least a plan to get as close as we can. It's really important that we have that level of resiliency and sustainability. We don't know what's going to happen in the general election in November, so just kind of have to brace ourselves for that impact. So it's really important that we get ahead of these issues as much as we can with respect to the senior coalition and their advocacy. Thank you, Wendy Peterson, for being here. Thank you to staff for clarifying where we're at with the contracts, the timeline, the extension, the $20 million being captured in the budget for the excess funds for Measure W. So I'm satisfied with that I do, however, want to flag. We know that seniors are the fastest growing population in our county and to Supervisor Miley's point, it is really difficult to see every year. I feel like that coalition is constantly advocating for really a nominal amount of money in comparison to our total budget. So I would like us to look at what are we going to do to deepen and provide more meaningful investment to our seniors and aging population. So something that we need to look closely at in the upcoming year. Also just want to put on everyone's radar. Next Tuesday, June 30th, we're going to receive a presentation and an update from our reparations commission. So just want to put that on everyone's radar to be mindful of that meaningful work. I know that it's captured under our board priorities, but we I'm excited and honored that our county is taking this seriously despite what's happening in the federal level. And obviously we aren't taking action on that today. But just want to make sure that that stays top of mind for all of us. And we will hear from the commissioners that have dedicated hours and hours of time doing that work with the listening sessions in the community. Just want to thank everybody for their engagement on that and also proud of the work that this entire body has done with respect to the Russell City Redress Fund. So wanted to flag that with respect to and then the lastly, before I get into the board letter brought forward by my colleagues, I'm also really pleased to hear the advancement for the work for the Office of Immigrant Refugee affairs. We've got the 3.3 million contract extension captured here. As I mentioned yesterday, we'll be receiving an update on the current contracts at our ACT Committee on July 16th and then a full presentation so the entire board can learn the work of the implementation study done by our consultants and supportive philanthropy that will take place on July 28th. So also exciting that that work is advancing with respect to the board letter, the 19.3 million it says up to so what are going to be like the checks and balance if we could just kind of have a sense of how much we're actually going to have to draw down. I'm really pleased to see the performance evaluation and efficiency savings. I think that's going to be critical as we see with the budget projections in the upcoming years. We're projecting a deficit for the next five years. So we are going to continue to have some hard conversations and I do think it's important that we discuss and look at every role entity in this discussion like, what are we all doing to help resolve this? Because it's going to take all of us. And I am struggling with the fact that I want to provide these services to the patients, to the community. But the asks keep on coming, the hits keep on coming. I'm even saying I'm bringing up initiatives that we don't even know exactly what the funding is. So this is just going to be a really difficult year for us. So we are going to have to show some restraint. I know that's hard to say and hard to do, but I think it's something we have to start preparing for. So just want us to be mindful of that. And then with respect to wanted clarification on the ask for the intensive outpatient services in the board letter, it's for four months, but I know many of the people that were calling and advocating were requesting for a six months. So I don't know if we have clarity around that. So that is a question I have.
[53:34] Speaker 10: Yeah, I think between Supervisor Bass and I, we can answer the question. First of all, the 19.3 million, we're not designating that so much go to these different things, but we do know 92 people need to retain their jobs, and that's going to be about 17 to 18 million right there for that entire year. And so that would leave a balance of about $2.3 million that would have to be spread out to deal with the IOP and the performance. But let me pass the baton to Supervisor Bass.
[54:16] Speaker 2: That is exactly right in terms of. Yeah, that's exactly right. In terms of the up to amount for 19.3 in terms of the PHP IOP program. You know, I have met with a number of those workers. We have heard a lot of them speak at our meetings as well. It is a very important program. Both myself and Supervisor Miley separately have also had conversations with our professional staff, our behavioral health team, as well as our AC Health director. And to be honest, it was a bit of a compromise in terms of what we think we can do and how long it would take to do a feasibility study to look very closely at what the options are for continuity, for financial viability, etc. We have been getting a lot of information around revenue generation in particular. That's one of the items we want to dig deeper into. So I personally was hoping we could keep it going longer, but we ended up having to compromise among the various parties. And certainly I will say my staff is very, very, very eager and ready, willing and able to support with that feasibility study and to work with the various stakeholders because we want. We care very deeply about that program, too.
[55:41] Speaker 3: Okay, thank you for that work. With respect to extending the ad hoc, do we know for how long?
[55:50] Speaker 10: I think we're going to probably need to extend the ad hoc for at least the next two fiscal years. I think 27, 28, 28, 29. And I think by November 2028, we'll know if there's a new administration and. But the ad hoc potentially would be able to conclude June 30th of 2029. Yeah. So I'm thinking at least the next two fiscal years.
[56:22] Speaker 3: Okay. And then do we have a list? Not today, but can we be provided a list of the 92 positions that will remain intact? Do we have that?
[56:39] Speaker 8: Welcome.
[56:40] Speaker 7: Thank you very much. Good afternoon, Supervisors. James Jackson, CEO of Alameda Health System. We can provide that list. I do not know that we have provided this specific list thus far, but that's certainly something that we can provide.
[56:54] Speaker 10: Let me just say, too, Supervisor Bassler, Mr. Jackson can chime in. The 92 covers all of the bargaining units, and then there's an additional 28 that are in the IOP that are being covered as well with the extension over the next four, you know, four months could be a little bit longer. It just depends. Yeah, so that's 123 people or 120 people.
[57:32] Speaker 3: That provides clarity. And again, I do agree, you know, we want to maintain the entire healthcare ecosystem. We've fought really, really hard. No more questions for you. Thank you, Mr. Jackson. And do appreciate Alameda Health System's support and the affiliation with St Rose Hospital. So I think these conversations are timely and it just shows you how quickly the landscape changes within the last year. So this is a moving target. So I do appreciate everyone's involvement, but I do think, you know, we're going to have to continue to have hard conversations, and at some point we're going to have to, like, dig deeper and explore other options because I'm just. I'm fearful of setting the precedent that we're always going to be the answer because I. We don't know what's coming. Right. So I just. I just want to caution us with that.
[58:31] Speaker 8: That's all.
[58:31] Speaker 3: Thank you.
[58:33] Speaker 1: Finished?
[58:33] Speaker 2: Yep.
[58:34] Speaker 1: Supervisor Tam, join us.
[58:37] Speaker 5: Thank you. President Halbert. Yes. I have served on the Finance and Budget Committee with you for the last year, the Social Service and also the Health Committee. So there's some issues that I have a deeper dive and understanding of that was presented based on yesterday's public comment. But first, off. I want to appreciate the sacrifices and the hard work that went into closing this 91.4 million budget deficit. That would have been more than twice that amount had we not done some prudent planning or the board prior boards have done some prudent planning combination with one time funding and the elimination of 45 positions, which I know comes mostly, almost half of it comes from the Alameda County Health Department. So this budget provides bridge funding from the Alameda County Health to the community based organizations that will transition from prevention to early intervention backfilling funding that would not qualify under Proposition 1. And we've incorporated most of the 23 recommendations from the Care first jail's last initiative into the three year Behavioral Health plan that was reported and presented at the health committee and the Home Together plan with Housing for Justice involved individuals. We talked about a staffing study at Santa Rita Jail and also added the standalone $36 million in the forensic plan that was presented in the public safety budget. And this budget also protects our safety net services from HR1 with Measure W. And I would support a greater connection and collaboration and nexus between the work that we're doing with the immigrant community under measure W with some of our UELP providers in the long term. And I think we protected the most vulnerable populations by funding the respite centers for the unhoused by providing compassionate care for those that have terminal illnesses or chronic conditions. We also invested in the African American Wellness Hub to the tune of almost $30 million to address health disparities with this board letter that's being presented with Supervisor Miley and Supervisor Fortunata Bass. And I really appreciate their work in convening the meetings and trying to get at solutions that we can see today. But essentially we're being asked to shift a quarter of AHS's deficit to the county, asking us to close instead of a $91.4 million budget deficit to add $19.3 million or $110 million at the county level. And so I just have some questions about that effort because you know, I agree with everyone. Healthcare for all is a priority for the county, is core to our mission and our reason for being. But we need to understand how we can sustain this. And so I'd like to understand maybe like three or four questions that I have about the board letter. It was noted that we raised the NNB by $100 million. So now AHS has access to $200 million. And how much do they intend to use in this coming year to address some of their Budget shortfalls. And then we also heard from the May revise that the State Senate and State assembly will be delaying the program cuts to medi cal to July 1st of 2027 and hopefully soften the impacts of HR1 to AHS. And more importantly, I'd like to understand the potential sources of funding for the 19.3 that we're asking both the Alameda County Health Director and the Auditor Controller to identify funding options to provide that one time supplemental allocation. Because after yesterday's presentation by the auditor on the cafr, we don't seem to have the two months of operating costs in reserves while we're also facing rising costs of risk and in insurance and we have some exorbitant legal settlements that we are having to pay out right now. And I want to also understand like the configuration of the ad hoc committee. When we formed it after the Bullenson hearing, it was primarily with Supervisor Fortunato Bass and Miley because, well, they don't serve in committees together. There wasn't going to be a Brown act issue. But going forward, if this is a standing ad hoc committee, is it going to follow the Brown act with the noticing? Is it going to be open to the public and will they offer opportunities for the public to comment as well? So those are my questions on the board letter.
[64:06] Speaker 1: There was a couple of questions in a row there. Why don't we unpack those? Do you want to ask the specific ones one by one of AHS, Dr. Jackson, or do you want to separate questions for him separate from staff? You asked a few different questions in there.
[64:26] Speaker 5: Right. So the first one was we had just raised the NNB back in March to buy $100 million. How much of that do you intend to use?
[64:42] Speaker 1: Let's take the questions for Dr. Jackson now and then let him sit back down and you can ask questions of staff after, after that, if there are any.
[64:52] Speaker 7: So very good. And then bees certainly. And Char Albert, thank you for the deference. But I, I am not a physician. I, my father was, but I am not a physician. But I, I appreciate the second time I've done that.
[65:07] Speaker 2: Isn't it?
[65:07] Speaker 7: It's okay. Yeah, I don't mind. I don't mind. But I just want to be clear.
[65:11] Speaker 1: Dr. To me.
[65:12] Speaker 7: Very good. So to your question, Supervisor Tam. Our intent is to not use any of the NNB to close our budget gap because we have operational costs which our projections show over the next couple of years we will reach and exceed without significant changes to our cost structure. The ceiling that the new debt limit imposes. And so we don't think it's fiscally prudent to close a budget gap with more debt. But our projections show that we're going to use the entirety of the additional space that was granted by virtue of the work of the county administrator in the course of the expenses that we believe we're going to accrue over the next couple of years.
[66:02] Speaker 5: So what happens to the 92 positions that we're saving now for one year going forward? And how is the NNB going to be used operationally to fund those positions? Because I want to understand if it's a sustainable model that we're working with.
[66:23] Speaker 7: So the positions. You've heard this before. I know, but 75% of our expenses are in labor. So the vast preponderance of what we spend goes right into payroll. And so we believe that to change our cost structure in a significant way, we've got to have less FTEs. And the other piece of that is that, you know, people drive ahs. By no means are we suggesting we don't need people, but our volumes are only now approaching where they were pre Covid. So our staffing has continued to accelerate the numbers, but our volumes haven't, and we're only now back to the levels. And so I want to assure the supervisors, as there was a need for more staff and the volumes warrant, that we're prepared to have more staff. What we have seen is that our staffing has grown without a commensurate requirement because of the volumes that we're seeing. And so I never want to suggest that we don't need people. People need jobs, and we need individuals to do this work. It has to be done in a way that aligns, and that's what we're doing. So to your question, we do believe that we can take this time that presuming the supervisors endorse the recommendation of the chairs of the ad hoc and use attrition voluntary separation programs such as the early retirement and the voluntary sepulchre separation to let people choose to leave the organization as opposed to having to do a reduction in force, which is what we have been contemplating for the past six plus months. And so we still intend to change our cost structure, but we intend to do it in with the Runway that this would provide to do it in a way that is, frankly, less onerous on the individuals involved.
[68:15] Speaker 10: Yeah. If I could just weigh in. Mr. Jackson is correct. Because our understanding, Supervisor Bass and I. Our understanding is, you know, labor's position is this will Allow for some conciliatory time so that potentially there can be a systematic approach to maybe negotiations at the bargaining table so that we can achieve a balanced budget in the future. But at this point, without this money, labor is not prepared to move forward with any consideration, any consideratory steps. And we can get into more detail around that, but that's the bottom line. And so our feeling is we'd rather provide that Runway. We'd rather keep labor peace, we'd rather keep people employed providing services and give the time for all sides to come together and negotiate something that is agreeable to, you know, to all of us.
[69:25] Speaker 5: I appreciate that clarification. So will the effect of the may revise in terms of the delay in the program cuts to medical and the impacts on HR1, will that also help lengthen your Runway and help you evaluate? Or is because it didn't sound like the RIFs needed to be implemented at this moment. Right. You were looking at starting potentially the next fiscal year, but this will buy you additional year with the 19. But will the slowdown in the HR1 impacts provide more, I guess, Runway time for you?
[70:19] Speaker 7: So I guess I would ask for more clarification about the slowdown in HR1, because we haven't seen a change in HR1 implementation. And so these reductions in force were originally planned to take place on March 9th of this year. The supervisors, in their wisdom, asked that we delay that for the ad hoc process to take place. And we did. And so they were projected to take place at the beginning of the new fiscal year, which was going to be July 6th. And in full transparency, that's still kind of tracking because we believe that supervisors will take the action that has been contemplated, but we have to plan for the worst and hope for the best. And so assuming that the supervisors do endorse the plan that was put forward, then the RIFs will not happen. But we have maintained the cadence because if that were not to happen, we have to begin changing our cost structure. What this action that you are considering does, is it does bias the time that Supervisor Miley alluded to for us to allow for natural attrition and other methods of changing our cost structure.
[71:31] Speaker 5: Okay, thank you.
[71:34] Speaker 7: Certainly.
[71:35] Speaker 5: So the other two questions I had were for staff is just to get a better understanding of what, what options we have with the 19.3, given that we. We had a pretty extensive presentation on our CAFR and the restrictions on our reserves, and the fact that we. We don't even have the recommended two months of operating reserves, and the fact that we're dealing with exorbitant legal settlements.
[72:14] Speaker 9: Supervisor Tam, you're correct. And we also just closed a significant funding gap. So I think we will need some time to consider options. We'll be looking at one time funding. The NNV in the line of credit that your board has extended is certainly something that we would also be looking at. And consistent with our policies, we'll also be looking at the most restrictive funds. Part of this is going to rely on our year end and the expenses extent to which there might be some unanticipated funds. But again, as you know, the county has many needs, as do county departments who have also requested supplemental funding. So it will be a challenge. But we're committed to working together and come back with options for your board to consider.
[73:05] Speaker 5: Thank you. And to Supervisor Miley, did you intend to Supervisor Fortunata Bass that the ad hoc committee becomes like an act for all committee of the board that's Brown acted, noticed and open to the public.
[73:23] Speaker 10: We might have to go down that road eventually, but at the moment we're not intending it to be. Brown acted just yet because Supervisor Bass and I need to agree on the stakeholders who need to participate. We need to get a sense of the scope as well as the facilitation and things of that nature. So ultimately we might come back to the board requesting that it become a standing committee. But at the moment we're just looking for the board to authorize the ad hoc to continue so that we can do the work necessary around heavy lift. Not just what we're doing immediately, but over the next two to three fiscal years and not just with ahs, because I know you know this, the whole health system is in Crisis because of HR1. So we want to pull all of the stakeholders together to see how we can better address that whole ecosystem going forward. So we possibly will be coming back to ask it to be a standing committee. And then the other thing around the funding, Supervisor Tamp, keep, keep in mind that if the board doesn't provide the funding and there's uncertainty and there's uncertainty around delivery of services as well as uncertainty around job continuity that, you know, that could bite us in the butt and provide even more challenges for us of which we're trying to avoid.
[74:59] Speaker 5: I appreciate that. It's just I'm trying to reconcile the fact that we have the standing committees you and I serve on the health committee. We get briefings, extensive briefings, including recommendations and adoption of the three year Mental Health Care Services act funding. We get updates from AHS on the budget. And so obviously for me, and the reason I'm on the health care committee, it's a priority. Our whole healthcare ecosystem is a priority. I have four, excuse me, three out of the four county hospitals in my district, and four out of the eight federally qualified health clinics are also in my district. And as you saw earlier, we are supporting the healthcare ecosystem with what? $327.35 million from the county to the AHS, and then we have $74 million in health PAC funding for the FQS, which provide the indigent care for those that are uninsured, whether they have no medical, they have no private insurance, they have no Medicare, they don't have anything. So I'm just trying to understand our workload and how we're making sure that the information is presented.
[76:21] Speaker 10: Oh, yes, it's my intent, and I think I've kind of talked it over, Supervisor Bass, that whatever comes out of this ad hoc, we will be bringing to the, you know, the health committee ultimately. But the ad hoc, by being ad hoc, gives us more flexibility at the moment. And definitely we don't want to create any more forums and any more committees, because even at one point in my conversations with the health director, agency director, you know, we thought about my staff using the community advisory group, community provider advisory group for this. But thinking it through, we just think the ad hoc would probably be a better forum for this. And if we have that level of flexibility and it's not subject to the Brown act initially, it just kind of gives us that luxury to create the meetings, the agendas and things of that nature. And then, like I said, ultimately, anything we come up with that is related to the health safety net will be coming to the health committee and depending on what is advanced, will ultimately come to the full board.
[77:36] Speaker 5: Okay, thank you for the responses.
[77:40] Speaker 1: I see we have our county council possibly wanting to weigh in on this. Scott. Okay. So I just wanted to point out that the. An ad hoc committee is limited in
[77:55] Speaker 2: time and limited in purpose.
[77:59] Speaker 1: And the ad hoc committee committees you've been talking about extending in this week
[78:06] Speaker 2: both look like they're not really limited in time or in subject, and that
[78:12] Speaker 1: makes them look a lot more like a standing committee, which is subject to the Brown act and has to be public, just like your other standing committees.
[78:23] Speaker 6: So
[78:25] Speaker 1: now, in the early stages, when you're trying to sort of work things out, I think you can continue to be an ad hoc committee. But if you're talking about three or four years, that's going to be a standing committee. It's going to have to be public. Was that
[78:46] Speaker 10: let us know county council when we need to become a standing committee. I'll be on because I think we've got a. Isn't the Finance Committee ad hoc? The. So we. We have a couple of ad hoc committees, but I understand we will transition when you tell us we need to transition. Because I always listen to the president of the board and County Council.
[79:12] Speaker 4: I don't know.
[79:13] Speaker 1: I'm hearing that. It's not. Stan, it's not a. It's not. It doesn't meet the definition of ad hoc today other than it's preliminary. When. When it was formed it did. If you're talking about continuing it to 2029 on whatever subjects, that looks a
[79:33] Speaker 10: lot like a standing committee.
[79:35] Speaker 1: So perhaps as long as we don't take action to define it as that long, then it isn't that long.
[79:43] Speaker 10: Would that be okay?
[79:45] Speaker 1: But I hear your point that what we are going to be discussing the topics.
[79:51] Speaker 6: So.
[79:51] Speaker 1: Yeah. You'll continue to keep us apprised.
[79:54] Speaker 10: Yes.
[79:54] Speaker 1: We don't have to decide this today.
[79:56] Speaker 2: President Halbert, perhaps we could return to the board with an update before the end of the year so that we can evaluate the status of it.
[80:06] Speaker 1: I think that's fine. Supervisor Tam pointed out that the health committee also does this. Why don't we just have a committee of three and make that be the board a quorum. Fine, I get that. But anyway, the point is pick one or the other. But if we're going to do both for a while, that's fine. But I hear her comments and points that there's a lot of overlap. But let's just continue to hear a report by the end of the year. Is that what the suggestion was, Supervisor?
[80:37] Speaker 2: That's my suggestion. I mean, I do think things are pretty sensitive at this moment. And assuming the board does have a majority to pass this, we will need to sort of monitor things. You know, there's the October 31st deadline for the feasibility study of the IOP. We do want to get the performance audit going. There are some things that I think we want to currently track. So coming back by the end of the year I think would be a good touch point.
[81:07] Speaker 1: Yeah, go ahead.
[81:10] Speaker 5: Just as a reminder, we do have a committee of three to deal with HR1. It's the joint Social Service and Health Committee, which includes Sue Pfizer, Fortunata Bass, advisor, Miley and myself. It's not really can be done.
[81:29] Speaker 1: It can be done. You're Right. We don't have to solve it today. But your point is very well taken. Supervisor Tam, were there other questions or comments? And Supervisor Fortunato Bass would like to weigh in on comments already made.
[81:49] Speaker 2: Yes, I thought it might be helpful to hear a perspective from Labor. Since the ad hoc on AHS involved the county AHS and Labor, it might be helpful to hear their perspective very briefly. And we do have Maria Bettencourt, who's the president of SEIU. 10 to 1 on Zoom. If we're able to. If she raises her hand and we can unmute her, I think she could provide a perspective so the board has a more well rounded. More well rounded information.
[82:27] Speaker 1: Maria Bettencourt, to raise her hand and then promote her to a speaker.
[82:38] Speaker 2: Maria, you can unmute.
[82:45] Speaker 4: Hi. Thank you. Supervisors, my name is Maria Betcourt. I am a specialist clerk at John George and a proud SEIU member, also the chapter president for seiu. And I'm here to request that you support the work of the ad hoc committee led by the Supervisors Bass and Maile to reduce impacts of the cuts and layoffs at ahs. After months of meeting and deliberations, we ask that you support the request to provide funds to reduce the number of impacted members and workers and to the services. While HR1 will continue to have negative impacts on our social safety net. We call on the leadership of the county to help support much needed health care services for Alameda county residents. We call on the state also to ensure that we have local resources to help keep our local public hospitals open and available to everybody. Only through our partnership at the local, state and federal level can we turn the tide on these attacks on our safety net. We ask that you help us keep as many healthcare workers services open and valuable people employed while we fight the cruelty of the HR1 cuts. I don't know if any of the supervisors have any questions for me. I am on the ad hoc committee. I'm part of it, you know, with Peter and other folks from Labor. So if you have any questions, I mean, I can answer whatever you guys ask.
[84:12] Speaker 1: Supervisor Tam, do you have any questions of.
[84:17] Speaker 5: Yeah. In your opinion, how has the ad hoc committee been working in terms of trying to get a meeting of the minds on some of the operational efficiencies and things like collection?
[84:31] Speaker 4: I think at first, the first few meetings, if I'm going to be really honest about how I felt about it, felt like they weren't going anywhere in the beginning, not until I think we were able to. To show some inefficiencies and it seemed like people were, were more willing to listen. So I think at this point it has become helpful. Yes. The first two I didn't feel like went too well. But I do feel like having the ad hoc committee is going to help us long term.
[85:03] Speaker 5: And you're optimistic.
[85:05] Speaker 4: Go ahead.
[85:07] Speaker 5: You're optimistic that you can find or the ad hoc committee collectively can find the savings that would offset the deficits that are anticipated.
[85:24] Speaker 4: I mean, that's the hope. I think what, what's really good about the ad hoc is the, the transparency that it brings. Having supervisors, HS leadership and labor present.
[85:37] Speaker 5: Would you have a problem if it was a Brown acted committee?
[85:45] Speaker 4: I mean, I don't know what, what.
[85:47] Speaker 5: Well, that means increasing the transparency. That means it gets noticed. It gets. There's opportunities of participation both virtually and in person.
[86:02] Speaker 4: I mean, I don't think I would have an objection to that.
[86:05] Speaker 5: Okay, thank you.
[86:09] Speaker 4: Of course.
[86:17] Speaker 1: Supervisor Tam, any other questions?
[86:18] Speaker 9: I.
[86:20] Speaker 5: No, I don't have any further questions on the board letter.
[86:25] Speaker 1: Okay, well, so I have questions. Well, I have a few comments to make and then I have some questions about the board letter as well. So first of all, I don't know, we have 15 or 20 professionals over here working around the clock. We started in December. We had ongoing meetings periodically in the months of February and March. This month alone we've had numerous meetings, countless hours. I don't know how many trees we used. A lot. There's a lot of work that goes into this budget. There's a lot of work that goes into this budget preparation and analysis every single year. Binders, binders, binders. A lot of work that goes into this. In addition, this year we had a lot more megabytes and bits of information downloaded to our website. So a lot of people able to, to see without having to print everything out. That's because our staff worked really hard. So thank you for doing that. I am also continually impressed that we have different ways of looking at the information. And in fact today some things just sort of popped. And I don't know if I missed them before, but they popped. Could we put up the Slide 4 from the presentation? And here we show 20, 25, 26, $6.14 billion spent. Our proposed budget, $6.7 billion. Taxpayers of Alameda county funds, federal government funds, state funds. We know how vulnerable we are to the federal cuts, but yet a 569, $570 million increase. 9.3%. I still can't get us to put the percent change, but I have a calculator 9.3% change in spending this year. Yes, we have pressures from HR1 cuts, but we're spending 9.3% more. $570 million more more. And how are we able to do that? The generosity. I'm assuming this Measure W is in these numbers. The generosity of our community that allows us to do this so that we can adequately fund the safety net services that we are mandated to provide, so that we can fund the unfunded mandates that are placed upon us. This includes discretionary funding so we're able to fund the discretionary projects that we choose to fund. Even though some people feel we shouldn't be able to do that. I would say nobody knows our community better than us. And we know better those groups that deserve discretionary funds and we work hard to make that happen. But it becomes comes from the generosity of our community. That said, I also like to turn to slide six, two more slides. And this is also very illuminating. These are just the CBO contracts and we see healthcare services. I mean back I know Covid was 2021, 2122 2223, but look at it from 500 million in 2223 to 900 million, almost double in CBO contracts in healthcare services. The others somewhat flat. But we've seen an explosion there. It's not without the generosity of our community that we are able to provide that. But indeed we have Disastrous cuts from HR1. Some would call them almost emergency levels. It's good that we have Measure W, but if we're not continually prudent with the dollars that we have and if we're not continually questioning the dollars that we have to spend, we may not get the next Measure W. And I'm concerned about that. And so I'm thankful that Supervisor Miley and Fortunato Bass did this board letter which not only preserves jobs, important jobs, jobs by people that came and spoke to us about their jobs and what they do at the Bailenson hearing that have come continually to our committees, called us, called on us individual offices, had ZOOM meetings. I see some members in the audience today that have been on Zoom with me fighting for their jobs, important to do, and bringing the board letter that provides temporary relief to maintain those jobs. But it's going to be imperative and even though we have Measure W, we should be acting as if it's an emergency that we find efficiencies across our system. Now, questions I have for our Was it the president of the SEIU, the lady and Dr. Jackson, Mr. Jackson, PHP and IOP and the crossover between behavioral health. So I'm just going to come out and say it. I absolutely support finding efficiencies at AHS. I've talked with Mr. Jackson. He's already found 28, $30 million. Can we find more? He has a great go get him attitude. Yes, we should be always looking for more. If another company is willing to help us do that, then why shouldn't we look at it? Especially if the county is going to pay for it. That's great. And it's the right thing to do optically that we are going to be looking at under every rock. If we're not in the situation that we're in today financially with cuts, what message does that send? They've already done a lot. We're going to continue to do more. But I just have to understand and believe that we're not going to scratch the surface of the cuts that we could find. Not cuts. The efficiencies we could find. If we consider php, IOP and behavioral health and synergies with our own county behavioral health. When I heard at the BALANCE meetings, workers at AHS describing what they do and its social work functions that they provide, and God bless them for doing that, because we have people in a very vulnerable situation at the hospital and they're there for medical attention, but they're getting great connections to services. That's social service work being done in our hospitals. The crossover, the interconnectedness, the linkage between our hospital system, our health team and our social services team. It's inextricably linked. And I don't know that we're going to be successful. I hope we are, but I think we would be more successful if we viewed this board letter through the lens of a more holistic approach. That does not mean necessarily taking every county, agency and department through a efficiency review, although I think that's needed. I'll separate the two. That's one thing I was pleasantly surprised to learn. We already do a lot of that by ourselves. I did not know that our account administrator is going to be providing us information that outlines some of that. But I still believe that we should be looking at across the board efficiencies. But at least as it relates to this board letter which is before us, I don't see how we should reasonably limit a study of efficiencies to just ahs without exploring the linkages to public health and social services. So that would be a question for Mr. Jackson and a question for the member of the ad hoc committee, the president of seiu. What will be what would be the benefits or not? The disadvantages or advantages, the pros and cons? Should we or shouldn't we be pushing for an efficiency review, including a linkage with the departments that I mentioned? Please, your position.
[96:58] Speaker 7: I was really gratified to have the conversation with you about the concept of the efficiency studies. And I think we would be remiss to not be open to that possibility. And that's the essence of what you and I talked about as it pertains to behavioral health. I welcome that opportunity, the challenge that we have. And I, I applaud Supervisor Fortunata Boss and others for their efforts to really make sure that we're doing everything possible to sustain the IOP PHP program. I will never disparage the work that they do. Their work is extraordinarily valuable. And you've never heard me say anything differently. And you won't because I, I understand the value of that program. I've had family members who have benefited from that program. So that's a personal note, but I just want to share that professionally, personally, I see the value. I am also the steward of scarce resources. And I can't in good conscience indefinitely endorse a program that we cannot see a way to at least having it at a break even proposition. It's something that we were able to carry in the past, but I cannot, as the CEO of the organization, endorse carrying that kind of a negative margin on an indefinite basis. And so the supervisors who are chairing the ad hoc in their wisdom have given us this additional time to look at other options, how we might be able to working in concert with Alameda Health and Behavioral Health specifically, either reimagine the program or create a handoff to other resources in the community. And that's. We, we can do both things. And that's exactly what I believe will happen over the next four months. So optimistically we come up with a way to, to keep this work going in some constitution. If we can't, we have sufficient time to try to find safe and appropriate placements for the patients who currently receive services from that program. Supervisor, I hope I've answered your question.
[99:08] Speaker 1: If we go to look for efficiencies, should we be looking for them across the agencies that provide these services, including AHS and Public Health and Social services, or what good will it do if we're not looking at the different pieces of the puzzle?
[99:24] Speaker 7: I appreciate the question, Supervisor. I'm just reticent to weigh in on areas that are outside of my scope of responsibility. And so as it pertains to AHS 100%. But I. I am reluctant to make that sort of a judgment on other agencies that I think you're referring to.
[99:42] Speaker 1: Okay. What about Melissa? Maria logged off.
[99:50] Speaker 3: Oh, okay.
[99:50] Speaker 1: All right.
[99:51] Speaker 4: No, no, I'm still on. Yeah, I'm just.
[99:56] Speaker 1: Maria, we're talking about doing an efficiency study. Have you been able to follow the dialogue so far?
[100:01] Speaker 4: Yes, I was listening. I think the efficiency study on AHS is something that. Yes, seiu. We. We also requested it. I think it makes perfect sense, and I don't disagree with you, that it would also make sense to. To look at the social services in the county. But I also don't represent those members. I represent the SEIU members out of Alameda Health System. But I don't disagree that it sounds like it makes sense.
[100:29] Speaker 10: All right.
[100:29] Speaker 1: Very good indeed. We are very compartmentalized. I see. Well, I see the broader view of efficiencies. And thank you, Maria, for that. Efficiencies, money to be saved. No better time to start than sooner than later. A question, though, I have about the board letter. Remind me again, what is the stipulated time frame for procuring? And as I understand, this would be an AHS procured service that we will then pay for. And it has to be mutually agreeable between our board and their management. Is that right?
[101:12] Speaker 2: So the board letter will allocate up to $19.3 million. Because that's what we understand will cover saving those 92 positions that are now slated as a reduction in force. Doing. Allowing time, four months time for a feasibility study of the PHP IOP program and allowing AHS to procure this performance audit. They need to procure that audit separately. I don't know if they want to answer directly the time it will take to procure the audit as well as to complete the audit. I had heard an estimate of nine months total, but it might be better for them to speak for themselves.
[101:53] Speaker 10: Yes.
[101:53] Speaker 1: The procurement process and timing and then how long it takes to do so.
[101:59] Speaker 7: We are. After we spoke last week, we have activated our procurement team to really start putting the pieces in place to allow this to happen. Presuming that again, the board letter is approved by the supervisors and the funding is made available. So I think we can expedite that process. In terms of how long the evaluation will take. I believe that the assessment period that's been identified is six months. So presuming that we can expedite consummating an agreement, which should take anywhere from, I would think, you know, at the Outside three months, and I'm hoping much sooner than that. And then the evaluation to follow at six months. So we're probably talking maximum nine months, ideally faster than that.
[102:43] Speaker 1: What would that procurement process have to look like in your world?
[102:48] Speaker 7: I am, you know, supervisor. I don't want to say things that I can't, you know, deliver on our procurement team. As of the end of last week when you and I spoke, they've begun doing the work and so they're looking at it right now exactly what it will take. As soon as I have clarity on that, I'm more than happy to come back, whether it's via email or in person and explain how that process is going to work. But I just, I don't want to say things here that I can't deliver.
[103:13] Speaker 1: So time wise. So you think not three months and then six months to do so, nine months and then this doesn't have a budget amount in here. And so the question I have for the team that wrote the board letter, unless I'm missing it, is this meant to be something that they procure and we pay for?
[103:35] Speaker 2: We are proposing to allocate up to 19.3 million, which would be used for those three bullet points, eliminating the reductions in force, procuring the performance audit and also extending the PHP IOP program performance.
[103:55] Speaker 6: Got it.
[103:55] Speaker 1: So that's 19.3 million for all of those three.
[103:58] Speaker 6: Right?
[103:59] Speaker 1: Inclusive of. Okay, got it, got it, got it. I didn't realize that. Well, all right, that's that then. You have a bucket of money and you have to do those three things with it. Okay, then I would suggest that we do get a report back to us at the major milestones. I would say that procurement would be one of them. When you get it done, let us know. Let all of us know, whether it's a letter or a report to our board would be helpful. And then with regard to the outcomes at the nine month mark, whenever they're done, that you would report back what the results were. Yes, sir. So that's fine. I would still prefer that we allow this study to somehow include a linkage to. I mean, I think it'll be a shame if we do a study like this and we don't allow AHS to explore or the group that they contract with to explore synergies and efficiencies with their team and our teams that again are working on the same thing in different places. And maybe that's why we have, I don't know, 271 non profit organizations across our county. We have to be efficient. I don't think we're going to get there until we do it across the entire organization, but that's another story. So I've said my piece. I don't know what the passion or the room for compromise is, but that's what I would like to see have happen. Supervisor Marquez, I see you itching at the microphone.
[105:41] Speaker 3: Yeah, I gotta leave in like 10 minutes. So thank you for everyone's work on this. And I hear you in terms of efficiencies, and I agree with you, but I strongly feel that is a separate conversation. If we combine it to the task at hand, it's only going to further delay what we're trying to accomplish here. So I hear you loud and clear. I would prefer that we discuss a work session when we come back from a recess. I'm not adding anything else before August 4th. No more adding on. It's something that we take up. But, but, but I mean it, like, seriously. If we add it to this, there's no way we're going to get an RFP done in three months and then study six months. It just.
[106:28] Speaker 1: That's a good point. I do have a question about that. We've talked about HR1 cuts as the existential emergency of our day. Emergencies allow for. Should allow for speed of movement. If we can't do something as if our hair is on fire. So, Supervisor Miley, if we can't do something that expeditiously, then either it's not that big of a deal, which I believe it is, or we don't have the will to move quickly. My opinion, but I. I'm the only, Only one that feels that way. Or at least I may be the only one that feels that way. And so if we take it to a work study session, then so be it. Supervisor Miley, I see recognize you.
[107:15] Speaker 10: Yes. I just would like to say I agree with Supervisor Marquez and you know, the ad hoc committee, we were focusing on ahs, and that's why we suggested the efficiency study, the performance audit directed at ahs. So that would help us with that particular piece. But clearly I support what Supervisor Marquez was saying, and I support your concern about us looking at efficiencies throughout the entire county. And you know, I've suggested on many occasions that certain county departments be. You know, we have performance audits for certain county departments on a regular, ongoing basis. We queue. We queue them up. And I just don't think we need to kind of mix the two at the moment. But I do think it's important that we maybe identify what county agencies or departments we want to have a performance or efficiency study undertaken and then pursue that post haste. But I just don't think it should be part of today's discussion. And unfortunately, we do have a lot of. A lot of priorities and demands, and it's. It's challenging to prioritize what is a priority, because when we try to prioritize what's a priority, a lot of things become a priority. Look at that. And we don't even have the sheriff's oversight, our Office of Inspector General up there. I know some of you think that's important, and I don't necessarily think it's as important presently, but, I mean, there are many priorities, you know. So I would say we should take it up, but I would try to keep it separate from what Supervisor Bass and I are requesting today.
[109:14] Speaker 1: Supervisor Bass and then Tam. Thoughts?
[109:18] Speaker 2: I don't think I need to necessarily add to this. I think a performance audit is important for our county as well. But like Supervisor Miley said, we really focused in on our ad hoc mission. I did want to speak to a couple other things that I haven't yet shared. One is, you know, just a big appreciation to everyone who's participated in our budget process because we have learned a lot from the community and we have been doing, you know, ongoing work to make sure that the needs in our communities are addressed. And I think hopefully people see that through the Measure W allocations, there's great investments in food, in seniors, in our immigrant and refugee community. So I wanted to make sure I acknowledge that I spoke yesterday about some of the work that we heard about from the Prevention Matters Coalition, the Care First Jails Coalition, the CARE Collaborative, and really appreciate all of that work. In regards to deliberating on the board letter that we will get on our budget on Thursday, I wanted to share a couple things that I would like to see in the final budget letter. One is the children's services budget that was actually mentioned in prior letters. I would like that to also be mentioned again in the letter that we end up approving. And specifically, what we heard the other day in terms of that children's services budget coming back to the board so we can really see what we're investing in terms of children and give the public an opportunity to participate. And then secondly, I really appreciate our county administrator sharing with us that she and her team are going to be doing work on updating our master fee schedule. You know, we have to look for any source of revenue, whether it's here at the county or at the state level. And again, would really appreciate if the letter that comes to us on Thursday includes a reference to that master fee schedule, as well as a prioritization of the assessment appeal fee. And I heard Supervisor Miley mention the environmental health inspection fee. Is that correct? And then lastly. Well, maybe not lastly. I understand that there are some answers in response to the board's questions. I don't think we've received those yet, so at the appropriate time, would like to get those. And then finally, I really want to appreciate our staff for continuing to improve our budget process. You know, we have our proposed budget that was two weeks earlier, which really gave me and hopefully others time to digest it. We have our budget books, the online budget. There's even great information from each of our department heads about metrics and alignment and goals with our EV 2036. So it's really great work and a mountain of work and wanted to appreciate that. And I just had two suggestions for continuing to improve our budget process. One is that if the budget book is able to be a searchable PDF document, I know some of us looking at this might find that to be a useful tool. So, you know, you can answer that question online or, you know, email me to let me know if that's at all feasible for next time. And then I think we mentioned this quite a bit, but to the extent that we can get presentations and slides in advance, it really helps. I mean, I found yesterday getting the slide the day of and trying to respond and react and ask questions, it was a lot to take in, even though it's a lot of it is already in the budget that was proposed. So I just want to really encourage us to continue to try to, you know, push for getting those documents in advance and also posted online for the public. Thank you.
[113:19] Speaker 1: Thank you, Supervisor Tam. Any other comments? Is Supervisor Tan still with us?
[113:32] Speaker 5: No, I don't have any further comments other than echoing the appreciation that's already been said. I did have a chance to go through the budget book pretty extensively online, and I don't know, I was able to search at least for the. The CBOs that are funded by the various departments. I guess there's a different feature that Supervisor Fortunatovas may be talking about. So I appreciate all that hard work and I do support the board letter that's before us for funding for ahs, but I also want to point out that it's going to come potentially at the expense of our ability to do other things like, you know, perhaps bankroll a Real estate transaction. But if I had to choose, I would choose the fund supporting AHS and patient care any day.
[114:31] Speaker 1: Very good. Do we need a motion or we're actually going to recess again until Thursday?
[114:36] Speaker 9: Well, I would like a sense motion to give the county administrator direction. And let me just repeat what I heard from the board and what we would bring back to your board as part of the final budget. So the direction that I would be seeking from your board is that we incorporate in the final budget the proposed budget presented by the county administrator's office on May 28. That we incorporate the final adjustments that have no net cost increase. That were presented as part of the letter yesterday and attached again to your memorandum today. That we also include the letter from Supervisors Miley and Fortunato Bass regarding ahs with the following amendments or clarifications. On item A, with regard to approving the allocation to mitigate reductions in force. As well as support a performance audit and extension of the PHP IOP program. There was a comment about having regular updates and reports back, particularly with regard to the performance audit, procurement and performance. Also on item C, with regard to extending your ad hoc committee's work, we won't put a date on there that was discussed. But there was a request that there be a report back by the end of the year. Or a commitment to do that regarding the status of the ad hoc committee extension and continuation beyond the end of this year. And then you have items D and E, as they stand in the letter. And then we will also address in the board letter some of the policy statements that your board made today with regard to reserve level senior services efficiencies. And we do already plan to include some information. And departments have been submitted submitting data to us on that, as well as reference to the children's budget, which we've also referenced in the memo that we just handed out to you, as well as the master fee schedule. So we'll reflect those as policy statements in the final budget letter that we bring back to you on Thursday.
[116:50] Speaker 3: And then with respect to the master fee schedule, prioritizing the assessment application, environmental health permits. And you've already addressed the reserve for the operating budget.
[117:03] Speaker 5: If you need a motion, I can move that.
[117:07] Speaker 10: Second.
[117:08] Speaker 3: Okay, it's been moved in second.
[117:10] Speaker 1: Supervisor TAM makes the motion incorporating our administrator's comments. Supervisor Miley seconds the motion. He would like to have discussion.
[117:20] Speaker 10: Well, I just want to. I neglected to thank the county administrator staff for their work in the unincorporated area. TAM and I are painfully aware of the advocacy that's taken place in the unincorporated area around budget justice, budget transparency, et cetera. I think this budget shows a lot of improvement. So thank you,
[117:46] Speaker 1: Supervisor Marquez.
[117:48] Speaker 3: Can we also just make sure that the director position for the Office of Immigrant Refugee affairs is also captured? I know specifically we called out the contracts, but want to make sure we
[117:59] Speaker 9: can reference that as well.
[118:00] Speaker 2: Thank you.
[118:02] Speaker 1: Is there anything more to add to the budget?
[118:10] Speaker 3: We're good.
[118:12] Speaker 1: Okay.
[118:12] Speaker 2: Oh, just one question. Thank you for the memo answering the questions regarding the budget I had emailed over. Will this also be posted online with the other budget documents?
[118:24] Speaker 9: Yes. Yes, it will.
[118:25] Speaker 2: Thank you.
[118:28] Speaker 1: Emotion's been made by Supervisor Tam. Seconded by Supervisor Miley. Roll call vote, please.
[118:34] Speaker 2: Supervisor Marquez, I. Supervisor Tam.
[118:38] Speaker 5: Aye.
[118:39] Speaker 2: Supervisor Miley. Supervisor for Donald Bass. Aye. President Hubbard?
[118:44] Speaker 1: I vote yes.
[118:45] Speaker 2: Motion passed.
[118:47] Speaker 6: Now,
[118:49] Speaker 1: technically, we are recessing or correct. Okay, we're going to recess our meeting today. We will take up final adoption and final budget adoption. No more deliberations. No more adoptions. Do we have public comment on Thursday? Okay, yeah. Public comment has been closed for the budget. Deliberations have been closed. We're going to read into the record what the final budget adoption is, and we're going to take a vote on it.
[119:22] Speaker 9: Correct. And that's scheduled for this Thursday at
[119:26] Speaker 1: 4pm this Thursday at 4pm which we will have a closed session before preceding, so plan accordingly. Everyone, see you at 4 o'.
[119:37] Speaker 4: Clock.
[119:37] Speaker 1: We're in recess. Thank you.