budget. but things like that could help us readjust our priorities so that we are serving the population appropriately. >> and we're looking for every penny. so i'll bring those issues back and raise them with operations team at laguna and we'll see what we can find out for you. >> supervisor breed: thank you. >> thank you mr. wagner for your report. i think just from my perspective, i want to thank you for coming before us today. it is obviously disappointing i think to everyone that we're here, and voting on what we're voting on. and i think the message from my perspective at least, and i think from this committee, i think we're all focused on what we're going to be doing next year structurally. i think the time is now for no more band-aids and figuring this out for the long haul. i look forward to that dialogue. i know it will be intense and i look forward to working on that.

thank you. >> chair farrell: if there are to further questions for mr. wagner we'll go to our budget report. mr. rose. >> harvey rose: the bottom line of this request is $46.1 million. and this request, if you look at page 6 of our report, in table 3, it's paying for miscellaneous salaries, permanent salaries, temporary salaries, premium pay, holiday pay, and -- so it's a 46 million request while it is true that the bulk of the revenues are not coming from the general fund, they're coming from within the department, supervisors, if those funds did not -- were not needed, if there was not this deficit in salaries and overtime, then those revenues would cause the general fund to have -- to need less general fund in next year's budget. so it's -- the bottom line is

this is a deficit. and fortunately, there are revenues that can help pay for this. but if they didn't have the deficit, those revenues would fund next year's budget. on page 4 of our report we pointed out the proposed supplemental would appropriate, as has been pointed out, $12.7 million from the state revenue loss in general fund reserves and that's shown in table 1, page 3 of our report. i know the supervisors know this but there are two additional sup premental appropriations pending before the board of supervisors, the public defender's office, 751312 and the sheriff's department 3,458.970. if the board approves it the state revenue loss reserve lch no balance and the general fund reserve will have a remaining balance of 21.3 million. on page 7 of our report, as has been discussed by the committee,

fiscal year 09-10 through 12-13 the department of public health's budget for both hospitals, san francisco general and laguna honda, regarding salaries and -- and for laguna honda materials and supplies has resulted in shortfalls and the department has needed supplementals during that timeframe. the serious thing about this supplemental is that there is a very significant amount of general fund moneys going towards the supplemental namely the 12 million combined with the state revenue loss reserve fund as well as the general fund reserve. our recommendations are on page 8 of our report. we recommend that you reduce -- and this is based on a detailed review of the actual expenditures to date, as well as the projected expenditures through june 30, we recommend that you amend a proposed supplemental to reduce by

1,1222, which would reduce the general fund reserve appropriation which would be a direct general fund savings from 4.3 million to 3.92849 secondhansimilarlyto 44.857. that's the revenue side. on the expenditure side we recommend that you reduce the proposed ordinance to reduce the expenditure appropriations by 1.222, which include san francisco general hospital fringe benefits reduce that by 550,000, reduce the laguna honda salaries by 5 22,000 and reduce materials and supplies to laguna honda by 150,000 and that totals up to the 1,222,000. we recommend that you approve this ordinance and i would be happy to respond to any questions. >> chair farrell: thank you. do we have questions for the

budget analyst in seeing none, thank you ver mr. rose, mr. wagr and to ms. garcía, department of public health. i've spoken with her on a number of occasions and appreciate their intent to take care of this long-term. any members of the public that wish to comment on item 2, please step forward. >> hello. good afternoon, supervisors. is this working? my name is gus feldman with 2021, i am field representative for 1600 workers at san francisco general hospital. right now, the report's certainly feeling the crunch of the budget deficit that was discussed today. and i think it's most -- i think feeling this most vierly, in the fact that many department

directors, or division directors i should say have been directed to put a halt to all future hiring, our current hiring, and that has created a situation in which workloads have become unmanageable. it's created a situation in which patient care is being jeopardized, and which both patient and staff safety is being jeopardized. in the psychiatric unit it has been reduced to 12, the graveyard is staffed by two people, one rn and one psychiatric technician. we're concerned about this. as mr. wagner pointed out really well in his presentation, the full implementation of the affordable care act presents great opportunities for dph to bring in much-needed revenue. i think the approval of the supplemental at this time is critical. we can't allow the department to enter into 2016 without full

staffing, without the tools that it needs to really present itself to the public as a viable healthcare option, and hopefully get that and take advantage of those opportunities for revenue. thank you very much. and i hope that we have the full support of the committee for the supplemental. >> chair farrell: thank you very much. next speaker please. >> i'm brenda, i work in the medical clinic out at san francisco general. we're in the process of implementing the affordable care act right now. so i will tell you that part of it is they have these excellent standards that are going to be attached to the amount of revenue that we get. so if we don't meet these standards, and a lot of it is related to satisfactions of the patient, that means no long lines for wait, no waiting to get your phone call picked up, all these things are going to be judged. and the amount of revenue that we receive from the federal government is going to be based upon whether we meet all seven of these standards. so when i hear them talking about cutting people's salaries

at a time like this, when one of the things that you're going to need, you're going to need high performing, high productive employees, who are not miserable because, if they're miserable, because their salaries have been cut, guess what, the budget is going to be cut anyway because we're not going to meet the standards. and so all of us are trying to do that. i'm on the service excellence, where we're trying to change the tone at san francisco general, to change the way things are done at san francisco general, to make sure we do meet those standards. so if you cut people right now, that's just going to -- it's going to blow it all up. and we may not meet those standards because there's no way that two people, working on the nursing unit taking care of 10 patients is going to meet that standards. it's just not going to happen. it's humanly impossible to meet the standards that are going to be placed upon us, once this gets implemented and full -- so i give credit to the head of the

hospital. she's been working really hard, sue, barbara garcía, even people like me, everybody, we're all in this to make sure that this works. because we want public health to remain strong like it is. we want to still provide the best service that we can, like we do. but, you know, all these ltle things, you can't -- you can't undercut us. so this is not the time to be cutting public health. this is the time when public health really needs to be built up. you know, i'm almost to the point now where i feel like there needs to be some sort of bond measure or something so that public health isn't constantly short every time. the bottom line it's not getting enough funding to perform at the level that's required of it. i mean that's the structural problem we have. is that it's not getting enough money to perform at the standard that you need it to perform. so i hope you really take that into consideration. >> chair farrell: thank you

very much. next speaker please. >> good afternoon. my name is -- and i'm with 1021, a field representative for city funded nonprofits. and i want to speak in support of the supplemental. i think that since the economic downturn, we've seen year after year, just incredibly devastating cuts, and i think that this year we're blessed with a better budget, and that we need to share the wealth, and physically with our most vulnerable residents of the city. we can't see the level of cuts that we've seen, year after year. the department is completely -- there's just nowhere else to cut. and we have to take care of our vulnerable people. we do. so i hope that you vote in support of this. thank you. >> chair farrell: thank you very much. next speaker please. >> i'm rebecca, i'm an r.n. public health nurse with the city and county of

san francisco. one of the things that gus mentioned was, in the psychiatric unit, and when you start cutting staffing, it becomes a health and safety issue for our workers. and the potential for people to get injured, and assaulted, goes up. so it's so important to be adequately staffed in public health. and i'm just asking for your support on the supplemental bill. thanks. >> chair farrell: thank you very much. are there any members of the public that wish to speak on item no. 2? okay. seeing none, public comment is closed. colleagues, we have the supplement a before us. we have recommendations that the department of public health as agreed on from our public analyst. could we entertain a motion to accept the recommendations of the budget analyst and amend the appropriation? so moved. we can do that without opposition. can i entertain a motion to move this item forward as amended. we can do that without

opposition. thank you very much. mr. clerk, can you please call item 3. >> the clerk: 3. hearing to receive an update on the human services agency's budget for fy2013-2014 and fy2014-2015. >> chair farrell: thank you very much. colleagues, this is one of the opportunities we have to hear from one of our larger city agencies before the crunch of budget season to give it preview into their budget picture for next year. i also -- i know we have trent -- here, the head of our human services agency. i'd also like to recognize in the chambers with us former supervisor bevan dufty who is here. welcome back, supervisor dufty. i don't know if you or someone else wants to start the presentation. hold on one second. i think you're green lit. >> good afternoon, supervisors.

trent rohr, director of the -- agency. nice to see you again. i have a presentation. so what i want to do is give you a pretty high level view of our 730 million dollar budget, talk a little about some initiatives that will be before you in june, that we hope to have funded in our budget and then talk to you about sort of the big piece of our budget this year, and the changes have a lot to do with what's going on in sacramento. and the good news is the better revenue picture in sacramento is directly benefiting us as an agency and us as a city and of course the clients whom we ser serve. >> chair farrell: i want to recognize chief financial officer who is here as well as ann hinton from the head of our department of aging and adult services. thank you for being here. >> thank you. to start off with our reduction

plan which is small when you keep in mind that our budget overall is over $730 million. so our 3% general fund target is about -- under $1.4 million, that we can meet in 13-14 and 14-15 with increased revenue, principally from the state, and then some non-salary underspending, just scoring those savings and that's typically in the contracts area. so there's no service impact or staffing impact for meeting our reduction target. so this shows our budget in the current year, and then the budget year, in 13-14 and breaks down what the human services agency looks like. you know that the human services agency is comprised of two city departments, department of human services and department of aging and adult services. the yellow slice there represents the admin support for both departments.

so basically they support -- the department of human services and department of aging under the rubric of the human services agency. you can see roughly the breakdown, almost two-thirds of funding is for department of human services, a quarter for aging and adult services, and then under 15% for program support which is really another name for administration. so we contract support, i.t., personnel, and the like. so sort of a key thing to keep in mind about the human services agency's budget is we are largely funded by federal and state sources. roughly a third federal, a third state, and a third county general fund. it's not exact. it fluctuates from year to year but that's sort of roughly how it plays out. and then, furthers, a lot of what is funded are entitlements

or aid. so it's important to know that because those aren't funds that we have any discretion over. these are entitlements to families, single adults, to our seniors, whether it's getting support for food assistance or cash assistance through welfare programs, providers under hiss. it's hard to see on the slide but sort of upper right green section, the 16% ever operating general fund, some of that is a required match or maintenance of effort to draw down the federal and state funds. and that's about $45 million. so if you take the $45 million out of the 111, that's about what our discretionary general fund is. so roughly $750 millio0 milliont we consider general discretionary fund. in other words funding that we as an agency, the mayor, and of course the board of supervisors, have discretion over and set your priorities through that

funding. the next slide shows where we spend our dollars. and it really breaks down sort of our major program areas. adult services is lumped into one big slice but that represents a lot of programs, mostly supportive services, which is providing in-home services for seniors and disabled results to allow them to remain in their communities. you see program support, admin, the next largest is family and children services, which is child welfare, childcare, adoption, services to families whose children are at risk, or victims of abuse or neglect. the bulk of the 130 million goes toward services like adoption assistance. the next largest is everything from front end street and emergency services to our emergency shelter system for

single adults and families, through the back end which is supportive housing for families and single adults. in the middle between the shelter and permanent housing is transitional housing, services to help stabilize homeless individuals whether it's case management or employment services, and these service are principally provided through community based organizations, our community partners. as proposed for 13-14, i'll point out a few of the changes. and of course i said it's good news which means increased funding for us and primarily from the state and the feds. large increase in homeless services, you'll see from 88.9 million to 102 million. this represents a bit of a reconciliation for our federal mckinney dollars. the grant cycle and the federal fiscal year don't exactly match. they don't match at all, our local fiscal year. and so every year when we apply for these grant funds they come

in at a different time. so we're trying to get a solid and standard way of recognizing that in the local budget and avoid the fluctuations we might see year to year. it doesn't necessarily represent new money but trying to make it a little simpler to make year-to-year comparisons. some of the -- another big piece is a shift of transitional housing for our youth and/or homeless service area which is not a new program but it's budget mechanics shifting that. we have funding for expansion of housing for families and single adults. some through our federal application process. and then funding for possibly a new emergency shelter in bayview hunters point, 100 bed shelter. in our adult service area, you see about a 6 million increase. that's principally an increase in ihss for an increased case

load which is representative in wages and benefits. and i want to point out the black segment in the upper right because it represents a significant increase investment by the state into our calworks or welfare to work program. in january the governor proposed about 160 million statewide to increase our work focus in our calworks program. which translates to increased funding for our community partners to deliver employment training services as well as increased employment services staff to help our families move from welfare towards self-sufficiency. some of that will also take the form of increasing our subsidized employment program which is shown really tremendous success in moving families into self-sufficiency. >> chair farrell: mr. rohr, i want to make clear, and thank you, we've spoke in my office before this hearing. you know, in the context, so people understand the context of budget cuts and so forth, and

reduction for the mayor's budget reductions, i think the bottom line is you're able to achieve those cuts but also the overall budget increase for your budget is basically coming from the state and feds almost on a dollar-for-dollar basis so we're in a fortunate situation with your agency. >> that's right. i'll talk about some of that expansion in a couple of slides. one piece i forgot to point out which is significant is the increase in medi-cal that you see from 24 -- a little under 25 million to over 31 million. our role in medi-cal delivery is to enroll families and individuals who are eligible. we process their applications. we do outreach to get them in. we provide ongoing case management to make sure they remain eligible and continue to receive medi-cal benefits. the increase is because of the affordable care act which as you know will be implemented january of 2014. the affordable care act will provide for the first time medi-cal coverage for single

indigent adults who are age 19 to 64, as well as some expansion for our families. we anticipate a medi-cal case growth of about 30,000 single adults. put that into context right now our medi-cal case load is 47,000 right now. we're looking at an increase of about two-thirds. and with that, obviously with 30,000 new applicants and recipients, we're going to need the staff to process those applications. we're doing a lot around technology to be able to add a significant number of clients without a commensurate increase in staff. we're not increasing our staff by two-thirds. but the increased staff will allow -- we think will enable us to process those applications in a timely manner and get folks onto medi-cal. a big piece of our budget, as i said earlier, is aid payments or entitlements. i point this out again to say that this is an area that we don't have a whole lot of

control over. in fact, you know, we want to maximize enrollment in our programs for folks who are entitled to benefits. some of our programs are goals to get them off, whether it's public assistance or welfare we want to get them to self-sufficiency so they're not relying on a low level of cash assistance. on supportive services the more focuses who can avail themselves of in-home care we want to do that. it's more cost effective than institutional care and more humane and a much better strategy for folks moving forward. similarly cal fresh, which is the new name of our food stamp program, we want to get -- it's not represented in here because we don't pay for the aid but we want to get as many people onto food assistance as possible. not only does the food purchasing power go back into the community but it helps food stability and nutrition for our folks who are in need.

foster care is going down. it continues to decline. we were at about 2500 kids in foster care, as recent hi as six years ago we're down now to about 1,000. it's great news to keep kids safe with their birth parents and not strangers in foster care or other counties with relatives or foster parents. sort of the policy and program changes, and i want to touch on the most -- maybe that should have been first because all of these are what drives the numbers that i just presented to you. as i mentioned mid-cal and the affordable care act one of the most significant shifts in new initiatives for our agency in many years, it provides an opportunity to enroll tens of thousands of people into medi-cal, which of course saves the city money in terms of providing healthcare, because we're getting reimbursed from the feds and the state.

it provides an opportunity to get folks onto other benefit programs, to which they might be eligible. the affordable care act talks about what they call horizonal integration. what that is, once they're on medi-cal, medicaid nationally, medi-cal in california, we want to see what other programs, benefit programs they're eligible for. the one with the biggest overlap is cal fresh which used to be called the food stamp program. some of the technology and business processes i taked about to allow us to absorb 30,000 applicants without a commensurate increase in staff we will be training our workers. so when a client comes in he or she or the family will be able to not only got their medi-cal eligibility done but also their cal fresh or food stamps eligibility. >> chair farrell: has that been done before in the department? >> we do a little at the the front end on the screening but in terms of the complete process

being one worker, no. >> supervisor avalos: i'm looking forward to that being not a novel thing. >> in fact, -- >> supervisor avalos: you're doing that. >> yeah. it's actually just the beginning. we have embarked on a process that we're calling a no wrong door approach to benefits, which ultimately -- and this is really driven by the affordable care act because that used to be the barrier. we had single adults out there not eligible for our programs but under the affordable care act they will be. ultimately 2015 or so, we think an individual will be able to walk in our door and see one worker, or even do this on line. and be certified eligible to all the programs to which he or she is eligible and the same goes true for families. there are efficiencies which are great for the city in terms of savings. also, of course great for the client, to have one visit to our agency rather than three different applications in three different buildings and three different workers.

the consequence though of course of this affordable care act and horizonal integration is increase in the cal fresh workload which we will see. we're proposing increases in staff to manage that. again not commensurate with the growth but additional staff to allow -- to handle that growth funded by the state and feds as well. i mentioned governor brown's refocus on employment for our calworks program, and our share of his increase as proposed in january is about $3 million. that flows right into jobs now which is our local subsidized employment program. the governor was very impressed with the state -- not only our county but other county's ability to deliver subsidized employment programs under president obama's stimulus act and outcomes for families with regards to that program. he talks a lot about investing in counties and our systems to subsidize employment.

we're particularly well positioned because we have our existing jobs now program and it represents an expansion of that which of course is great news. family and children's services and realignment this is under realignment phase two which was part of the governor's revenue initiative that passed, what realignment basically does is takes funding for child welfare out of the state general fund and dedicates a tax revenue stream to it. in this case its sales tax, vehicle license fee. because those revenue streams are growing and because our share, being filed chair systems across the state, it's fixed in constitutional language as revenue grows so does our funding. we're anticipating growth of 3 million for childcare in this coming year. it could be much higher than that. what this means is increased funding for our children in foster care, our families who are at risk of being in foster

care, things like transitional housing for aging out foster youth, whatever package of services and staffing we need to help our families who are most in crisis in the city. in housing and homeless, hop la is the housing opportunities for persons with aids program. this is a program that we began administering a few weeks ago. this was formerly administered by the housing authority. it's procured through the mayor's office of housing. and we competed to be the administrator of hop la and were selected as the administrator of the program. it's a federally funded program, provides housing subsidies in form of section eight or voucher to homeless individuals with aids or hiv. it fits nicely into our stream of supportive housing for homeless individuals with our housing first program, local program, and now hop la. so it allows us to sort of, on the opi