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. i'll provide an updata's 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, there's some hipaa, hicap adjacent programs, so they'll kind of work together. i'll 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 i'd then put emphasis on 18-19. i'm sure the diligent staff and you are looking at it -- >> we're 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

aaa's to try to reduce the impact of the federal cut, so they're 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 long-term council report. thank you. >> hi. my name is bern adid hadette. >> hi, can you use that mic? >> sure. i am a member of the long-term coordinating council representing behavioral health, and as part of our -- the long-term care planning council met last thursday? and we have basically talked about updates from the dignity fund, the study that's

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 that's 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 18-19 and fiscal year 19-20 budget. welcome, dan kaplan. >> thank you, commissioners. i'm 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 mayor's office, which we are set to do on february 21st, and then, we'll go into a period of time where the mayor's office will be asking us questions, and we will be answering and discussing various other people will be talking to the mayor's 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 mayor's proposal, and that will be discussed with the board and hearings will be held and we'll 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 we're at the phase where we're still in the agency process. we haven't 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 i'm describing today is a bit of a comparison between the 17-18, the current fiscal year, and the 18-19, the budget year budget at a very high level. you've 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, i'd 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 -- it's a kind of -- kind of

a stable environment i guess is what i would say. so there's really several major items in here, and we'll talk about them in a little bit. one is the ism moe, and we'll talk about that, and because of that, the city's ihss maintenance of effort payment goes up substantially in the budget year. there is scheduled growth in the dignity fund, and as shireen mentioned, there's a whole process of allocating the dignity fund money, so we've 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 i'm 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 it's 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, it's not additional money. so we also had a question about citywide revenue projections -- this was commissioner loo's 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 aren't more people to come into the workforce. that's a huge factor in an economy growing rapidly, and of course in san francisco it's 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 we've 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 that's 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 we've done is we've added these expenditures in. so instead of 44 million in 17-18, we have $44.83 million. some of that money was one-time

only money, some of it was ongoing. the one time money doesn't move forward into the next fiscal year, so the difference between 17-18 and 18-19 is plus $3 million and $1.7 million. there's 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 17-18 with the proposed budget for 18-19 which doesn't include any future add backs. we don't 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 long-term 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, we're 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, there's also political action that's 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, i'll 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 that's really due to the -- to the ihss moe going up. the -- the health benefits piece is fairly -- oh, excuse me, i've jumped to the wrong one. pardon me. so if we look at this one, what we'll see is we've 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 18-19 compared with 17-18 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 18-19 number. and just to say it again, and

what happens when we put this together, was we projected -- we included the 17-18 projection. now what's going to happen between now and 18-19 is we will be implementing the tiered wage concept within home bridge, and that will increase the wage for the home care workers. what's 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 don't mean to oversimplify it because it involves training, it involves other things to professionalalize t professionalize the job, but it's to make it easier for home bridge to attract and retain workers. we believe it will succeed, and as it succeeds, the size of the workforce will become larger, and home bridge will come closer to deliver the number of hours that the ihss asks it to deliver. so as that happens, the costs will go up.

if the -- if the 22.7 is a good estimate of where we are this fiscal year, which we think it is, the higher number of 27.2 is our estimate of what will happen at we raise the wages of the home care workers and as we begin to have more home care workers and can deliver more hours of service. so the number in the current fiscal year, 29.2, is a number that was developed before the labor problem started really manifesting themselves, and so we are, obviously, dramatically underspending that budget in the current year. does that answer the question? >> commissioner loo: not really. i have to think about it. >> okay. i mean, i think the key is we had budgeted in 17-18 at a

level of service we had hoped to be able to buy from home bridge. because of home bridge's labor difficulties -- difficulties in the sense of not being able to attract and retain workers, we have made changes, changes in a way that we hope will significantly allow them to provide more hours, so instead of allowing them to provide this many hours of service, we're allowing them to provide $27.2 million hours of services. [ inaudible ] >> they, like most of our contractors are reimbursed for actual costs up to a not to exceed amount. you know, because you see lot ofs of you budgets for daas

contracts, between our program office, our contract office and the provider, an agreement is made on what the budget will look like, and that's what's in fact presented to you. so -- so we pay them for their costs. one of the things that's happened over the last year, which is not a good thing, as far as we're concerned, is the cost of an hour of service had gone up quite a bit, because the number of workers delivering the services has gone down in number, but, you know, most of the infrastructure of the organization has stayed in place. so one of the things that having additional workers will do is it will -- it will stablize the cost of an hour of service. >> commissioner loo: all right. thank you. >> okay.

now to the slide i started talking about wrongly before. so character is our word for a type of service, and as you can see, the aid payments character grew substantially. this is mainly as a result of the increase in the ihss moe. there are some smaller growth in contract services, which includes mainly dignity fund and -- and clf-supported services, but that's mainly what's changing here.

so in coming up with our budget submission, we actually went through revenue projections for all of the parts of the human servic services agency, including daas. there are a number of areas where it looks like revenues are going down, in our cal mesh and cal works programs, and others where it's going up. for example, our medi-cal eligiblity programs, these are entirely an artifact of what's happening in the state budget, so cal fresh program is shrinking budgetarily because budgets are shrinking stayed wide, which is the sign of a good economy. fewer people are eligible. that's true for cal works, as well, which is tied to employment and unemployment rates. the medi-cal program is one

that grew tremendously during the early years of the implementation of the affordable care act and is more stable now but at a much higher level, and the state is catching up in terms of its eligiblity budget. we had assigned by the mayor's office, a $1.3 million general fund reduction in the budget year, and twice that, a $2.6 million are you duction in the budget year plus one, or fiscal year 19-20. as you may know, the ihss grew a lot during the recovery. we're still catching up on our hiring, and we think we can cover the gap in the budget year with at least salary saving, so we are not proposing any reductions in program. and i am -- i am not thinking

that in order to meet this, i will need to put a hiring freeze in place. i'll let you know that if that turns out to be wrong, but i'm not anticipating that we will. so -- so basically, we have also been asked by the mayor's office to propose no new fte, which we have not done here. so ihss maintenance of effort, and this is ofshl tis obviousle there are several big cost increases. one is under the new law, the rate at which each county's ihss moe increases is governed by an inflation factor. under the old program, the

inflation factor was 3.5% a year. going from 17-18 to 18-19, it's going to climb by 5%, and going from 18-19 to 19-20, it's going to climb to 7%, where it's going to stay. 7% is a very rapid rate of growth, and as you can see, adds $5.6 million in the first year of the project. the minimum wage increase -- if you remember, san francisco has its own city minimum wage, and it will be going to $15 an hour on july 1st of this year. the minimum wage increase is something that triggers a change in the ihss moe because the cost of paying the wages go up, and under the state law now in effect, the county pays a share of that. so our estimate of the impact

of the 18-19 increase is $7.8 million. and then after 18-19, we will grow by inflation. our minimum wage will grow by the cpi in each year. obviously, that will depend on what the cpi is, but we're assuming it will be somewhere between 35 and 50 cents a year going forward. so another 7 million going forward in the second year. and then one of the things that's an artifact of the current state law is the state proposed a great increase in the maintenance of effort payment on counties as a whole. in total, it was about $592 million shared between all counties, but the legislation sb-90 included a large state general fund offset in the

first year, $400 million. in the second year, which is 18-19, the state offset is $330 million, so counties have to pick up an additional $70 million of cost among them. and then in the third year and going forward, the state offset will drop to $150 million, so that'll be another big increase for counties to cover, which is part of the reasons is becomes unsustainable after two years. so all those things together in the budget year increased costs by $18.7 million, and then a further $25.2 million in the second year. >> excuse me. >> yeah. >> in the druktory memo, you

mentioned infligsa mentioned. [ inaudible ] >> so in developing its proposal, the state attempted to look at the way the total fund costs of the program were changing, and so if you think about the drivers of the cost of the ihss program, you can split them out different ways, but one way to look at it is there's a major cost component, wages for ihss workers, health benefit costs for ihss workers, and sort of the dollar per hour side, and then, the number of clien clients served by the program and the average number of hours permonth a client's received. and so wages are climbing up.

health benefit costs are, in most counties, a number to medical inflation. certainly, they are in this county. the number of clients is climbing, and the number of hours perclient is climbing, although probably the slowest of all of those. so the state has argued that the total fund costs of the program are increasing at a number closer to 7% than the 3.5% that was in the previous ihss demolaw. so the 5% in the budget year is really a phase-in of that 7% inflation factor. that's how the state got to that? >> so in essence, it's primarily being driven by increased caseload and increased needs as opposed to inflation as we normally think

of it because milk has gone up at the supermarket. it's primarily more caseload and more hours that the individuals need. >> that's a very big part of the driver, yeah. and you know, this is -- this is not something that we wouldn't expect, right? we, like every other state in the nation, have an ageing population. more folks with serious disabilities are living in the community, obviously -- >> oh, no, that makes sense. i was just measuring inflation the way that general economyists measure inflation. >> oh, yes. okay. residential care for the elderly. one of the things that happens in our budget process, we fund

things in our target, and there are some things that we propose to the mayor outside of our target, and this proposal for rcf for the elderly is something that is in the latter group. it's outside of our target, so we would be asking the mayor to come up with an additional $1.1 million in the budget year and $1.2 million in the second year. and i just want to be clear about that. that's got kind of a different status from some of the other thipgs we've thin-- things we' talked about. basically, as you know, our cfe's are community-based karen at this times that provide a

staff staff, a place to live, and personal assistance care for people who need it. one of the phenomena that i think everyone is aware of is that, you know, as -- as people's needs go up, some people can continue to live successfully in the community with support like ihss; some people need a higher level of care and more of a 24-hour environment, and the goal of the proposal is to begin to move us into this area to be able to provide some emergency placements and then to provide some what we call patches to -- to support the ability of individuals -- low-income individuals to be able to continue to stay in san francisco but in an rcfe

environment as opposed to an in-home environment. you want to add? that's the basis. >> yeah. i mean the only thing i'd add is we really see a need for this with the dementia population, and we don't have a lot of resources for them, so we're hoping this helps us -- we do this through our contract, but we'd really be able to help these few individuals who would be able to utilize these beds. >> and aren't -- okay. commissioner wallenberg, please. >> just had a quick question. so the proposed enhancement is the three proposed beds and 20 long-term beds, so what is the baseline that we're starting from? >> well right now, we don't really have access -- we have some access to place in some of our programs, but we just show there's a real shortage here, so community living fund has

some. we have, like, i think two emergency beds for adult protective services, but that's just simply not enough, and we're really seeing that sometimes we can't adequately provide services for people because their living situation means that -- you know, isn't enough, and they need care -- ongoing care that they can't get at home. so i think, you know, we're just starting -- we're hoping that we're going to build this into our budget and we're hoping that the mayor will be interested in this, but we're also just trying to elevate the conversation, so i think if it doesn't happen in this budget, we're really trying to elevate the conversation. we've had a lot of conversations also about looking at waivers, going back to the state and getting -- getting more of the conversation to happen at the state level, but it's really here for the purpose of creating conversation, and if we're able to get it into the budget to be able to serve these people better who will be

the fortunate ones to access it, it'll allow us to just kind of continue that conversation and see where we get with it. >> so i mean, i think the difference here is we've had a tiny bit of emergency access in the program already. we haven't really come to terms with a program that would be more of a long-term program that would say, you know, someone is not going to just step into an rcfe for a short-term stablization thing, but that's where they would live going forward. >> the long-term trend, however is for fewer and fewer rcfe's in san francisco, and so is there -- how -- is there anything that we can -- anything that we can do about that, or are we going to be placing people outside of the city? >> so i think there -- so there's been a lot of work done on this issue, and i think most

recently, both the you cute care collaborative has done a lot of studying the beds, the loss of beds, not just in san francisco but the region in general, and will be making some recommendations to the health commission and to the hospital council about what could -- kind of what are some directions that we could go to help preserve what we have, and certainly, there has been talk at the city about how to -- about some different ways that we could incentivize people either keeping their businesses or either starting new ones, and it's still kind of a nascient conversation, but there's not a plan that says yes, the city's adopted there, but we're getting there, and eventually we will have a plan

that says this is what the city's good going to do about that. one thing i think we agree on is we don't want to have a policy of sending old people out of the city because they need something that we don't have, or even worse, sending them out of our general region, so i think there's a lot of energy in this conversation or goodwill. but it's going to take a lot of effort and some putting some new resources in or incentivizing it in some way that we don't have it yet. >> thank you. commissioner wallenberg. >> yeah, and that kind of leads me to my question, what are the current numbers in terms of needs for actual individuals and then what that looks like. and then, i guess i had kind of a more nitpicky question in terms of what any given times means the beds being -- the three emergency beds and the 20 long-term beds. >> that phrasing was meant to

me we could sustain an average of 20 folks for this amount of money. >> yeah. >> and i think your other question, we could get you that information because that research has been done, but it would mean bringing it in, maybe making a special report to you. i think it -- and we did talk about this also, is the post acute care collaborative, once they go back to the health commission, maybe we could ask that that report be also brought to this commission. might be helpful. >> yeah, we could do that. that would be fantastic. >> mr. chair, just a point of curiousity as we're discussing this. i know that the church up on laguna honda, received a part of the stipulations, and part of the residents there would be ageing seniors in transition. does that show up in our budget or is it hsa or is it

department of homelessness? >> it's not in ours. >> okay. >> we can find out. >> it just would be curious to see who would have that. >> i have a question. >> commissioner loo? >> commissioner loo: we were talking about seeking new money, and we all know that budgets are really kind of tight. what happens if we don't get the money? that means we don't -- we don't have the full grant or is the agency making efforts to find other sources. >> so if we don't get the money, we will not have the money, but we will continue the conversation, we'll continue looking for other avenues for this. like i said, i mean, one of the things that we -- a lot of the conversations that we're also happening at the state level, because this is a statewide problem, so we will be hopeful that maybe some money will materialize there or figure out a way to expand the current waiver or do a different waiver for san francisco. there are a lot of different

possibilities, but really, this is to -- to elevate the conversation here and we're very hopeful that it'll happen. >> other states have put in place more robust residential care waivers than we have in california. they probably don't face the kind of housing and infrastructure costs that we face in san francisco, so you know, there's a lot of work that needs to be done on developing this level of care. >> commissioner lang? >> commissioner lang: i actually like this notion a lot, and i have a question. there's something we can do as a commission in terms of advocating and pushing this before the mayor to have something like this included? can we sort of put together an advocacy plan in relationship to these new dollars? can we help? >> will with, thank you. the first step would be approving the budget

submission. >> yeah. >> we're going to get there, too. we're going to get there, too. >> i think that's the biggest part is really just approving it and saying you've thoroughly vetted this and you know it's important because of what you're seeing because you're the eyes and ears on the ground for older adults and people with disabilities, and then, there might be something later where if people have questions about it and the value of it for the community, that there might be an opportunity for you to voice that. >> okay. well, in relationship to sort of approving this budget and finding some dollars, i want to go back to something totally different, but it's still on.and i want to thank you and your staff for doing the charts to help us sort of follow this in a very simple way. but if i'm looking back at 2016 at the general fund operating budget, which was basically about 13% or 33 million, and then, i look at the current year, the general operating budget of 5.8 or 2%, i'm

wondering what happened to the other dollars, if you would. you following me? >> yes. >> in the dignity fund? >> yes. because part of why i was asking to see the chart, i wanted to see how dignity's funds were laid out the year before. >> and again, i'm a little bit freelancing on this. i was here, but when the dignity fund was created, in the -- in the hopes of the dignity fund at the beginning of the process, there would be a huge infusion of new money. the legislation that ultimately got passed didn't do that. it established a base that was

based on actual costs from -- i think it was from 15-16 inflated forward, but they were very close to the actual costs in 16-17. they were actually a little bit lower, and then we added some additional money. so most of that general fund operating, or much of that, actually sort of flowed into the base of the dignity fund, so that's one of the things that happened. [ please stand by ]

>> i want to get a better handle on the flow of the money from the dignity fund. i don't understand that yet. i can talk offline, but as we're looking for more money, i want to look everywhere. >> thank you. marie? >> um, so marie jobling, executive director of community living campaign, but today i'm speaking to you as a hardworking senior here in san francisco. as you know, the president has released the budget with massive cuts to medicare, medicaid and social security, in addition to all of the specific programs that may be eliminated or reduced, that executive director mentioned. san francisco can deal with this because we're a rich city. and i'm not just talking about the financial wealth of some of the people.

we represent a vast reservoir of time, talent and experience and are ready to step up to help one another, to contribute to organizations throughout the city and to advocate for a more just system in these hard times. as you move this budget forward to the mayor and board of supervisors, we ask that you make employment and mobilization of this talent a priority. we don't want to just be seen as a problem for the budget. we want to be part of the solution. over the next few months, we ask that you work with the staff and mayor's office to find ways to he and funding for paid and stipeds for others. and support individuals that want and need to work. in a way, it's one of those outside-the-target requests and not something that you can put in the budget right now, except as a statement that you say is important. these programs help us overcome ageism and ablism, that add

barriers to older adults and people with disabilities seeking employment. we know that demand for the programs far exceeds capacity already. with changes the a the a federal level, we expect the number of people that want and need to work to grow. your support formally and informally during the budget will mean a lot. thank you. and i have some information about the issue. >> thank you. any more comments or questions from the public? thank you. >> i'm charles mistner, member of senior and disability action, retired federal employees. i would certainly second what maria said there. i'm a healthy senior. i've been retired for 13. better health than i've been because of a physical exercise

program and i can work. there are many seniors like myself, who have major disabilities but otherwise capable of producing something in society. we have a political problem in this country, not an economic problem. that political problem has created a debt, federal debt, approaching $20 trillion because of the wars primarily. we have a problem in this city with the hospital industry, deciding if they want to throw out the people that are too ill to be taken care of unless it's 24-hour care and they don't want to pay for that. and this hospital industry is making millions of dollars, though they claim they're not for profit. as it was told at the last health board hearing at this issue, the -- no, this was in the supervisors' chambers.

sutter healthcare has $14 billion in the bank. 44 executives making over $1 million a year. the last i saw, kaiser had $9 billion in the bank and they have million-dollar executives. so they want to kick this problem out to the city and let us take care of it. i worked for the presidio and the army, that's where i started. and when the army gave up, i advocated it be turned into a home for seniors. we paid for this -- many generations have paid for the presidio. now it's a playground for the rich. who created that? lexus liberal pelosi. that's who created it. that's somebody you can put some pressure on, can't you? she's running for re-election. she turned it over to, what,

lucas to have his film studio there? there was a nice hospital there. it could have been the center of the senior community. and all those houses could be turned over to seniors. oh. they made market rate housing, high market rate housing. and turned it over to various corporate, what do you call them? i forget -- trusts. trusts, yes. they collect money and give money to the community, quote, unquote. so we have a political problem in this country, not an economic problem. and we should do something politically to change the situation, because we're not going to go anywhere, as it is now. >> thank you very much. any other comments or questions from the public? hearing none. any further comments or questions, commission, before we vote? >> i did have one question.

in light of marie's public comment, i wanted to see if it would be possible to get a rundown of the employment-related programs that we do fund. we're certainly aware of reserve and a few of the others that we were able to approve within the last year or so on the commission. it would be great to see them in one place. >> sure. i can get that. >> sure. all in favor of the budget as -- all in favor of the fiscal year budget presented by dan kaplan. motion to approve? >> motion. >> second? >> second. >> all in favor, aye. any opposed? none. motion carries. thank you to the staff for providing very, very good,

useful information, and bringing clarity to a process that is frequently opaque. okay. back to the rest of the agenda. item a, review and approval of the medicare improvements for patients and providers act, contract mi-171806, associated budget and subsequent amendments. welcome back, michael. >> hello, again, commissioners. the item before you today, the department of aging announced they made funding available for area agencies for the mippa program. we have to enter into a contract with california department of aging to access the fund. that contact has been added to your packets. part of the execution of that contract requires it coming before the commission for