Hicap program does and what this update means from the California Department of ageing. Briefly, our Hicap Program, it stands for. [ inaudible ] its a medicare focus program, providing community education, one to one counseling and advocacy to Medicare Beneficiaries as well as people soon to be Medicare Beneficiaries. Services within that are explanation of medicare benefits, explanation of Health Care Insurance terminology, a review of insurances available to consumers such as medigap pals and medicare pals, health with claims and procedures, as well as counseling around longterm care insurance. I want to note that the work that the counselors does is just above and beyond education. Its also helping people make educated decisions about their services. They will work people around what their decisions are and help them make the best decisions related to medicare benefits. We subcontract or funds to selfhelp for the elderly who administers hicap. They then serve the community through the use of 27 counselors, 21 of whom are volunteers. The counselors go through extensive training, originally 31 training hours and seven counseloring hours before they reach that status. Then once they reach that status, theyre asked to have 12 hours of continuing education right now. Right now they have counseloricounselors on staff with several languages. In just fiscal year 1617, we saw this program serve over 2,000 clients with one to one counseling services. They also do a series of advocacy on behalf of clients, which results in financial savings, as as medical bills are reduced or medicare agrees to pay for medical services for clients. So that brings us to our hicap contract. A majority of the funding for this Program Comes through the California Department of ageing. Within that chunk of money, two thirds is from the state, onethird is from the federal government. The administration of Community Living is a federal agency who provides that funding to the state, which is then passed on. They have announced that they are reducing funding available over the next three years. This is something that has been in the works for a little while. The new news that executive director mc135den had about questioning the entire federal existence of this program is still kind of up in the air, so were not sure of what we have, just the facts in fron of us. Were looking at a cut right now of about 13,000 for this fiscal year. Daas was able to find funding to cover that, so there will be no impact on services this year. The services next year, its interesting. The budget kind of actually increases, but then has a cut in it, so the impact, were still looking at. The big impact is going to be in fiscal year 1819, when those cumulative cuts really hit. So thats the bad news. The good news is that we have a little bit of time to try to see what may happen between between now and then. This is certainly a program that is very important to daas. Its something were going to keep an eye on, and well do our best to try to maintain services for folks in San Francisco. With that, this item will this contract will come before the commission again in a couple of months as we renew it with our subcontractor. Ill provide an updatas that point as well as other update at that point, as well as any other things that come up on down the line. Thank you. Commissioners, any questions . Commissioner, thank you speak into the mic. Yeah, theres some hipaa, hicap adjacent programs, so theyll kind of work together. Ill talk about that during that presentation, but hence the reason i wanted to give a more robust review of this item. Thank you. Any other comments or questions . Commissioner wallenberg . You essentially answered all of my questions in the sense of looking to potentially backfill what the projects might cost us the next few years. I guess id then put emphasis on 1819. Im sure the diligent staff and you are looking at it were working on it. What the best priorities would be. California department of ageing immediately reduced their operations budget, which pays for training and other things for that Hicap Program in order to move those dollars into what goes into the local aaas to try to reduce the impact of the federal cut, so theyre a partner in this, as well. Thank you. Thank you. Any other comments or questions from the commission . Any comments or questions from the public . Thank you. Hearing none, thank you so much, michael. Excuse me, but i neglected to ask for the coordinating care longterm council report. Thank you. Hi. My name is bern adid hadette. Hi, can you use that mic . Sure. I am a member of the longterm coordinating council representing behavioral health, and as part of our the longterm Care Planning council met last thursday . And we have basically talked about updates from the dignity fund, the study thats happening in terms of the Needs Assessment to make sure that the levels are representation and the needs will be discussed. We also talked about which is part of the biggest discussion, is the creation of employment policy, specifically for seniors who still want to work but no have ability to come back, the level of workplaces that will be hiring, and so we are looking at what policy can we recommend so that people who are willing to work and want to work will able to find work. So thats basically the highlights of our meeting last last week. Thank you very much. Any comments or questions . Any comments or questions from the public . Hearing none, thank you very much. Okay. Item d, review and approval of daas, fiscal year 1819 and fiscal year 1920 budget. Welcome, dan kaplan. Thank you, commissioners. Im here to give an overview of the Budget Proposal as it stands today, and as you remember, we go through a process of working internally then making a proposal to the Mayors Office, which we are set to do on february 21st, and then, well go into a period of time where the Mayors Office will be asking us questions, and we will be answering and discussing various other people will be talking to the Mayors Office, as well, and ultimately, that that will all result in the mayor proposing a budget, which will happen on june 1st of this year, and then, the budget process will move to the legislative phase, and the budget and legislative analysts will prepare reported and analysises related to the mayors proposal, and that will be discussed with the board and hearings will be held and well ultimately get to the place where the board makes some changes possibly but then ultimately votes on and approves the budget for the city, and that will happen right at the beginning of july. So were at the phase where were still in the agency process. We havent yet gotten to the mayoral process, and what we need to do at this point is to present to the mayor a Budget Proposal. So as i said, we will do that next week. So what im describing today is a bit of a comparison between the 1718, the current fiscal year, and the 1819, the budget year budget at a very high level. Youve received notebooks which have a bit more detail in them, and we will be seeking your approval to make this submission next week. So i guess just in a general sort of way, id like to say that this is a very stable budget. As shireen mentioned [ inaudible ] we are still in the revenue situation within the city is relatively strong there we go. And we are a little bit out of balance in total, so agencies have been asked to make very small reductions in general funds. And we have, on the state level, a revenue picture, which is also fairly stable, and so it its a kind of kind of a stable environment i guess is what i would say. So theres really several major items in here, and well talk about them in a little bit. One is the ism moe, and well talk about that, and because of that, the citys ihss maintenance of effort payment goes up substantially in the budget year. There is scheduled growth in the dignity fund, and as shireen mentioned, theres a whole process of allocating the dignity fund money, so weve only reflected that in this Budget Proposal, not tied it to particular uses. And then, there is a proposal for a Residential Care for the elderly Pilot Program which is sort of an early foray in that area. I had mentioned earlier to the commissioners separately that there is also a correction that i want to make to this document. There is a particular category of expenditure which is labelled in the presentation documents as ihss consortium, and that number on that slide needs to go up by about 4. 5 million to about 27. 2 million, and what happens is we inadvertently included our projection of what spending would be in the current fiscal year. There have been a number of programatic changes, and shireen actually mentioned these, as well, because they relate to the tiered wage project in the ihss consortium or home bridge, and we have anticipated in making that change that we will be able to deliver considerably more hours of service in that program, which is what the cost increase is associated with. So im going to move forward and go through this presentation quickly with you and certainly take any questions that you may have along the way. The first slide relates to a question that commissioner loo raised it raised at the earlier budget hearing, and the question related to how do we look at the daas budget and the asa budget in the context of the whole city budget. So what you see on this side of the chart is a representation of the city budget, and its broken up into slices of a pie that represent the major areas of expenditure, and then, on the right side is the hsa budget, of which you can see daas represents roughly a third. I should tell you that when we talk about the city budget, we tend to talk about a number of 10. 2 million. The other thing, though, that happens whenever we look at an Agency Budget is we include, sometimes in many agencies, a lot of money, sometimes smaller amounts that are called interagency transfers. So, for example, in the daas budget, we receive from the department of Public Health about 19 million which goes into providing Health Benefits for ihss workers, just as an example. And so the 10. 2 million does not include transfers of that sort, so if you added up all of the dollar amounts on the left side of this chart, you would actually get to a number of about 12. 1 million, so the individual slices include the interagency transfers, the total number of 10. 2 billion does not include the interagency transfers, and if you think about that, that does make sense, because if the city is just moving ony from one Agency Budget to the other,s from the perspective of the total amount spent, its not additional money. So we also had a question about citywide revenue projections this was commissioner loos question, and you know, basically, the city went through a process that assumed that city revenues would continue to grow, that business and property tax returns would continue to be strong, that the economy would remain healthy throughout the budget year, that unemployment would be very tight and that the Housing Market would be very tight, and that would actually restrict growth over what it might otherwise would have been because there arent more people to come into the workforce. Thats a huge factor in an economy growing rapidly, and of course in San Francisco its very difficult for people to find housing here if they get jobs here and that dampens employment, as well. So this process, then, was used for what was making the revenue projections. On the expense side, there was an analysis that really looked at labor contracts and applied some standard inflation factors and then called out particular departmental costs that might be growing at a rate different from inflation. I think i had mepgsntioned in last meeting that we had was one of the very significant ones is the growth in the ihss Program Costs due to changes in the state law, which i will mention again later. There is a website that is attached to this slide, and that is the slide for the details Financial Report that led to this. So as you know, we look at the budget in terms of sources or revenues, in terms of expenses in types of expenses, expenses of programs and expenses by character, which are types of expenses. You can see on this sheet, the daas budget is meant to grow by about 23 million, as i said before. We will add about 4. 5 million in the final budget submission for the ihss consortium item, so it will be about 27. 5 million of growth. The big area, you can see on the sources chart is what weve labeled as general fund aid. General fund aid is money that supports, to a large extent, the ihss program or the ih ihss moe, so thats a very substantial area of growth. With the dignity fund slice, which is 48 million on the 2018 chart, and 46 million on the proposed budget chart, a word of explanation is needed. I think as everyone knows, the dignity fund started off at 38 million. It grew in the first year by 6 million, to 44 million, and then in this second year, it should grow again by 3 million, which should get it to 47, and so we have higher numbers there. So what happens is that in addition to the items within the dignity fund itself, there were there were add backs in the legislative process last year, many of which were things that would fit into the categories of expenditures in the dignity fund. So for purposes, what weve done is weve added these expenditures in. So instead of 44 million in 1718, we have 44. 83 million. Some of that money was onetime only money, some of it was ongoing. The one time money doesnt move forward into the next fiscal year, so the difference between 1718 and 1819 is plus 3 million and 1. 7 million. Theres a little bit of comparing peaches and pears here because we are comparing the approved budget which has gone through the legislative process and the add back process for 1718 with the proposed budget for 1819 which doesnt include any future add backs. We dont know if there is going to be any necessarily, but if this year is like past years, there may be, so that would increase the number that is here reported at 49. 6 million, but 49. 6 should be the base number. Would you like questions now or just a general longterm trend question . It is clear from the information you provided that the gap between growth in revenues that the city is projecting and growth in expenses is widening. The expenses are growing much faster than revenue, and i understand very well how ihss is an Entitlement Program and must be funded, and those increases that changes in a way that the state is compensating counties ihss, were funding much more out of the general fund for ihss, and how long can we continue to do that without other departments in the city being adversely affected . So i you know, i think what happens in a budget making process is that we make reductions. Money moves around. The city seeks additional revenues, and then, theres also Political Action thats happened, so with regard to the changes in the ihss program, this was a very complicated dance that occurred at the state level, and what came out of the state legislative process last year was a compromise between counties and the state and labor unions representing ihss workers that was meant to do a number of things. It was meant to shift cost to counties. It was meant to increase wages for workers. And it was meant you know, and i say this with a little bit of cynicism, but it was meant to get us to the next administration. If you look at the legislation itself, senate bill 90, it actually mentions a reopener after the second year of the implement indication of the new ihss moe law. The ihss moe has some revenue that comes with it in addition to the additional costs, and those revenues hold together in most counties and in San Francisco for the first two years, and then, they start to break apart. And when i get to the ihss moe slide, ill speak a little bit more about that, but there will be a great political effort on the part of counties koostarti next year to rework a lot of the funding around that program. [ please stand by ]. So those have increased significantly, and thats really due to the to the ihss moe going up. The the Health Benefits piece is fairly oh, excuse me, ive jumped to the wrong one. Pardon me. So if we look at this one, what well see is weve got a large growth of the maintenance of effort, there we go, from 94. 6 to 117. 8, and then, we have a small increase in the office of ageing. This is due to additional dignity fund. We have a fairly stable ihss Public Authority payment. This is the Health Benefits payment, which has stayed fairly steady. And then, the other areas of the budget are really pretty much staying roughly where they are, just kind of basic inflation that adds little bits here and there. Commissioner loo . Commissioner loo i have a question. The question is the ihss consortium, the program in 1819 compared with 1718 is reduced by 25 . Yes, and so this is the item that was the error that i mentioned, so we would add 4. 5 million to the 1819 number. And just to say it again, and what happens when we put this together, was we projected we included the 1718 projection. Now whats going to happen between now and 1819 is we will be implementing the tiered wage concept within home bridge, and that will increase the wage for the home care workers. Whats happened within contract mode and shireen spoke to this before in her opening remarks, was that as we as the gap between the home bridge wage and the minimum wage went to zero, it became harder and harder for home bridge to attract and retain workers, and the number of workers started to decline on the home bridge staff, and therefore, the no number of hours of home bridge needed to provide began to decline. I dont mean to oversimplify it because it involves training, it involves other things to professionalalize t profession