Gregg Hart — The speaker addresses Chair Hart directly.
Dawn Addis — Thanked for her remarks on indigent care and the hearing's goals.
Will Owens — Introduced himself as being with the Legislative Analyst's Office and indicated he would present the overview.
Mark Newton — Introduced himself as being with the LAO.
Mr. Owens — Mr. Owens concludes his presentation and offers to answer questions.
Luz Rivas — Assemblymember Rivas asks for examples of county-by-county differences in discretion over scope and parameters.
Luz Rivas — The Legislature is referenced in the context of keeping county trade-offs in mind; likely part of the committee discussion led by the chair/member.
Luz Rivas — The chair and committee members are referenced as having recognized the need for more information.
Luz Rivas — A compliment is directed to the chair/member about their appearance, likely in a light exchange.
Luz Rivas — The chair is addressed as 'Mr. Chair' and thanked for allowing questions.
Luz Rivas — The response thanks 'Dr. and Assembly Member Rambula,' likely a garbled reference to the speaking member; exact identity uncertain.
Luz Rivas — The chair is referenced in the procedural call for questions.
John Harabedian — Assemblymember Harabedian is welcomed to the meeting.
James Ramos — Assemblymember Ramos is welcomed to the meeting.
Esmeralda Soria — Assemblymember Soria is welcomed to the meeting.
Esmeralda Soria — Assemblymember Soria discussed rural community access and data collection, asking whether emergency room utilization could be compared before and after HR1 or the related cuts, and continued thanking the presenters while reinforcing the same concern about evaluating impacts on rural areas.
Mark — Mark is referenced as one of the LAO representatives who should have a chance to respond.
Will — Will is referenced as one of the LAO representatives who should have a chance to respond.
Dr. Ramula Mark Newton, L.A.O. — Introduced as a Legislative Analyst's Office witness adding comments on the issue.
Darshana Patel — Assemblymember Darshana Patel discusses possible ways to collect comparable county data, expressing willingness to work with committee members on different options. The discussion also references reporting to the Legislature and how legislative direction or requests could encourage counties to provide the needed data.
Andrew Hewitt — Introduces himself as representing the Department of Finance and gives disenrollment projections tied to HR1.
Tyler Saddwith — Identifies himself as California's Medicaid Director at the Department of Health Care Services and begins testimony.
Angel Lonso-Corone — Identified himself as representing the Department of Finance and began discussing Covered California disenrollment projections.
Cecilia Aguiar-Curry — Assemblymember Addis is referenced in a brief, continuous discussion about baseline data and the broader point that the situation being discussed is a consequence of HR1. The mentions collectively reflect the same line of argument without a substantive shift in topic.
Sanal Patel, Department of Finance — Introduces himself and responds to questions about HCAI data.
Ying Jo Huang, Deputy Director, Department of Health Care Services — Introduced as the Department of Health Care Services deputy director responding to questions about tracking between Medi-Cal and Covered California.
David Alvarez — Introduced as the next speaker; likely Assemblymember David Alvarez or another Arambula reference, but the transcript says Arambula.
David Alvarez — The speaker refers to Assemblymember Arambula; this appears to be a likely misstatement of Assemblymember David Alvarez, who has history with assistance unit plus one.
Angel — Angel was referenced as having discussed the decrease of enrollees tied to the state's $300 million funding.
Tanya Heitman — Assistant County Executive Officer for Santa Barbara County; begins testimony on the county's indigent care program and need for renewed state partnership.
Elizabeth Hernandez — Elizabeth Hernandez, interim deputy chief administrative officer for the County of San Diego Health and Human Services Agency, testified about the county’s CMS program and the strain on county health services. She explained that CMS is a payer of last resort with limited benefits, relying on community health partners because the county does not operate public hospitals or primary care clinics. She noted that enrollment fell dramatically after the ACA, from nearly 11,000 enrollees in 2010 to only four last month, and said community stakeholders consistently emphasize the need for compassionate, preventive care rather than emergency-only access. Hernandez added that the Board of Supervisors is exploring reforms such as expanding eligibility and covered services with one-time funding, but that state support will be essential as medical costs rise and even a small increase in uninsured residents would strain the system. She also described a DHCS letter changing the way 1991 health realignment funds are redirected and concluded by asking for a funding framework and a modest statutory technical correction to reflect current conditions.
Jason Britt — Jason Britt, Tulare County's county administrative officer, testified about the county's indigent health care challenges before and after the Affordable Care Act. He explained that more than half of county residents are on Medi-Cal and that Tulare County has financially distressed hospitals, but county indigent care is far more limited than Medi-Cal and cannot provide the same benefits, provider access, or continuity of care. Britt described the pre-ACA system as fragmented and inefficient, with varying county eligibility standards, long waits, delayed treatment, heavy emergency room use, limited specialty care, and chronic conditions going untreated until they became more serious and costly. He said counties must quickly rebuild capacity to serve residents losing coverage, including hiring physicians, setting up eligibility and authorization processes, adding nursing support, processing claims, negotiating provider agreements, and monitoring care without dedicated funding. Britt also reviewed the funding history: realignment funding created in 1991 to support county indigent care was later reduced under AB 85 after ACA expansion, leaving Tulare County with about $7 million compared with roughly $14 million before, while he estimated indigent care needs would exceed $20 million. He urged the Legislature to provide immediate one-time bridge funding before January 1 so counties can prepare their systems and cover medical care, and stated the request is for $100 million.
Jason Britt — Identifies himself as being from Tulare County and offers recommendations.
Michelle Gibbons — Identified herself as with the County Health Executives Association of California and offered technical assistance.
Michelle Gibbons — Responded to the committee and said counties are interested in prevention.
Dr. Ramplin — Asked to explain the differences between full-scope care and indigent care, and what restricted Medi-Cal offers.
Unidentified county witness — The witness described how indigent care is often minimal, with limited primary and preventive services causing patients to delay treatment until conditions become severe, sometimes resulting in extreme outcomes like amputations. The witness also noted having previously worked as an emergency room doctor, reinforcing the perspective on how lack of outreach and early care leads to avoidable crises.
View Details — Addressed as 'Assemblymember'; exact identity unclear from transcript, so no member ID can be confirmed.
Jim Patterson — Referenced as having made an earlier point about the issue.
Ms. Heidern — A forthcoming witness is referenced as someone who can provide more detail on the profiles.
Katie Heidorn — Katie Heidorn is introduced and then identifies herself as the director of state health policy for the California Health Care Foundation, serving as the next panelist.
Ms. Gibbons — Referenced as having previously mentioned the California Health Care Foundation's historical lookback.
California Health Care Foundation — The speaker references the California Health Care Foundation as having published a historical lookback on county indigent care programs and then notes that the Foundation has also published several other works on possible models and historical approaches, using those publications to support the discussion.
consultant — A consultant called every county to compile information on indigent care programs and eligibility requirements.
Dr. Sondor Hernandez — Identified as the CEO of the speaker's foundation and cited as having testified in January in favor of a statewide solution.
Ms. Hernandez — The speaker asks Ms. Hernandez if she has anything to add to the discussion.
Ms. Heitman — The speaker asks Ms. Heitman if she has anything to add to the discussion.
AB85 — The speaker says a modest technical correction to AB 85 would significantly support local jurisdictions.
Jason — Jason is praised for clearly sharing information about the issue.
Ms. Hyman — The chair invites Ms. Hyman to add to the discussion, and the exchange remains focused on bringing her into the conversation before moving on to the next witness.