this federal waiver due to decisions at the feder government, the waiver is no longer viable, given the economic environment in california. high employment rate, we n our longer qualify to waiver those requirements. so san mateo county, santa clara county, and san francisco county now have to -- our clients now have to comply with that work requirement in order to get calfresh benefits. >> supervisor cohen: meaning that they have to have a job to get the -- >> not necessarily, supervisors. it can be work activity. it can be as little as six hours a week of work fair or it can be 20 hours a week of employment training, it could be city college, it could be sub doctors sidized employment. so what we're basically doing is expanding -- with existing funds, expanding the number of slots in our workforce development program, so they can choose a range of options. what we're dryitrying to do is

simply have this a make work program. we're trying to structuring the program so it's providing meaningful employment training and leading to jobs, rather than simply working off your food stamp grant which isn't a productive way to approach the expiration of this waiver. in our county assisce program, we received a grant from the state, adding about $2.5 million under the housing and disability advocacy program. this is a pool of funds to provide rental subsidies for homeless people. this state funding will help us increase the uptake or acceptance rate, the approval rate of those applications. the one new f.t.c. that you see in this is the state grant for

the manager to this program as well as to serve a linkage role between the hssa and department of homelessness and supportive housing. and lastly, under calworks, our welfare to work program for families is undergoing really large changes statewide and really looking to make it more of a -- a whole family system of care, not focusing just on work activities, but really focusing on the whole family needs and providing support for housing, family stablization services, which is mental health and d.v. counseling. for thest tie, we're going to have a state funded home visiting initiative for kids underage two, and we're really moving away from sort of a compliance based program that makes sure they're participating in work activities and towards a program that makes sure that the whole family is taken care of, from the child's needs to the adult, with the hope that

they move into self-sufficiency. and so to that end, we're reengineering the way we're structuring calworks and attempting to move positions that are exclusively currently focused on that sortf eligibility process piece of the program and shifting them over to focus on the eligibility but only as part of their job. the rest of their job would be focused on the employment activities, case management, and the like, and you'll see that in substitutions that are reflected in our budget in that ogra pr. -- position substitutions, excuse me. the board asked for us to address a couple of things. the first is what workforce development programs do we have for transitional age youth and homeless and formerly homeless, and so this slide provides a high level view of what we provide. all of those people can access the full range of services that we have in our agency, provided we get them eligible for either cal works if they're a family,

c.a.p. if they're a single adult, or calfresh, and then that opens the door to our services that are largely funded through state and federal dollars to move folks into work. but we also do have programs that we're funding specific to those populations in addition to our general workforce services, and that is about $2.7 milli $2.7 million for transitional age youth under a couple programs, and then for our homeless clients who are in shelter or formerly homeless living in supportive housing, $1.3 million to focus on sec tar specific training for those populations. and then, the board asked -- or the budget committee asked for what h.s.a.'s role in as creating a pipeline for specific jobs, and what our role is. we have four different areas of intervention where we try to make sure that our clients and

participants in our workforce programs are prepared for city jobs. it's important to note that city jobs is not -- is not the only outcome of these programs, it's simply one option, but through partnerships with d.h.r., department of human resources, to ensure that our placement through the public service trainee program, jobs noo quafy for -- to meet the minimum qualifications for city jobs, and we've created a career pathway certificate program within the human services agency for p.s.t.'s, public service trainees, who are in our agency. and what we've been able to do is create a pathway into our -- our administrative support positions, but also into our eligibility staff. so we have individuals who formerly were on public assistance but are now employed by us to didding the enrollment and eligibility work for families that are struggling like they were prior to efforts in our programs. and that concludes the d.h.s.

part of our presentation. i can turn it over to september or answer questions on d.h.s. if you'd like. >> supervisor cohen: we're going to go ahead and go to questions, and then we'll get the next part. >> great, supervisor. >> supervisor cohen: supervisor yee? >> supervisor yee: i have several questions, and they're sort of all over the map because the variety of services you offer. so i'm going to start with the senior or the pipeline to workforce. >> for seniors? >> supervisor yee: yeah. as you may know, i had a hearing on it, ad had some follow up discussions, and one of the things -- even though we don't have exact numberne o of the things that we -- we all kind of concluded was that there is a real gap in terms of

trying to get our seniors to are reemployed in most -- get reemployed in most cases. and let me just back up a little bit. partially, what we're seeing is that there are many seniors that are getting older, and they left the workforce possibly because they thought they could retire and live in the city with whatever income they had, the fixed income. a lot of them are on s.s.i. >> excuse me, supervisor. >> supervisor yee: yes i. >> i was wondering, maybe it might be appropriate to ask the question about senior and ageing and adult services when -- after they present? there's still more -- >> supervisor yee: are they presenting? >> yeah. sherry mcspadden will present for department of ageing and adult services. >> supervisor cohen: if we don't have any other questions about the overall budget? >> supervisor yee: yeah, i do. >> supervisor cohen: okay. ask questions about the overall

budget, and then we'll here from the hear from the daas, and then oece, and then you thl answer your questions. >> supervisor yee: there's two. igh m be a question for you and dcyf. in terms of foster kids, part of -- part of what i know is one of the best things for a foster child is to have a court assigned at r-- advocate. we'v been trying to get more mentors, they're called counselors, to help out with the kids. and i'm finding out their role is more important now that we're finding many kids are being placed out of the city, and the separation of whatever they had connected to -- in the

city is less and less. what are your -- what is your organization doing to help support that effort -- and i know we had this discussion several years ago. i have the question why dcyf didn't fund them. >> we do work very closely with casa, the court appointed special advocate for kids. our associates are working very closely with the casa volunteers in providing support for the chiren. ca volunteers, are, depending on the situation, allowed to participate in the child and family team meetings, which is also a requirement under ab 403. this is for any life changing moment in child's life while they're in foster care, we're required to have a child and family team which wraps around that child all of the support in sort of his or her world, so not only the social worker,

maybe the advocate, maybe the birth parent, the foster parent, things like that. so casa is really integral to the level of services we provide. >> supervisors, about placing kids out of county, we do have a high out of county placement rate. a lot of that is drin by there are a large number of relatives who used to live in san francisco, and it's always best to place a child with a relative rather than a stranger, even if the stranger is still in the city. that sort of artificially drives up our placement rate. we do have a number of kids who are not placed with relatives who are placed out of county, and that has a lot to do with the cost of the living in san francisco, and the difficulty of getting foster parents, and so as i mentioned a couple slides ago, we have a really robust effort to increase the number of foster parents in san francisco and have a goal that no child shall be placed with a stranger out of san francisco is our goal, and so that would

require us to get between 60 and 70 new foster parents in san francisco. >> supervisor yee: there -- there was an issue with fire victims. i know you help with the relocation piece. maybe you do this, but we have some families in some recent fires where there issues was their house burned down, they didn't have a car, and they couldn't make it to work. does your program help with that or you're not sure? >> not necessarily. the program is funded through general funds, so presumably, we would have flexibility to provide supports like that. but really, the fire victim assisted fund is exclusivelitor housing costs. it could be for move in costs, it would be for housiclothing ,

but typical situation would be family would continue to pay the rent in the unit that it burned out, and then we would go in and sub left side sidize the difference then that and the -- subsidize the different between that and the rent that they're paying now. we've got one person managing a whole lot of units, so he can't be expected to do the case management. it is something we might want to explore together is either having a formal funding to do a contract with a community organization to provide that case management and maybe the flexible funding to do things like auto repair that you suggest or hire additional case workers for us to work directly with these fire victims. so this program's kind of been evolving and growing as we've been administering it over the

past number of years. so i think given the size now, it's ripe to be up for examination. [please stand by for captioner switch]

>> if anything we would like to expand there. the adults and single adults live in the southeast part of the city and the valley and

maybe hunters point. so a bigger footprint would be helpful for us. >> i don't think that would happen. >> we know there are barriers. we are remaining there until that building ever went away. >> fair enough. i agree with you that you need to have -- continue to have a presence and i would agree that it would be more fantastic if it was a larger presence because i recognize that a lot of your portfolios support it. my constituents with supported by your services. i want to talk a little bit about expenses. expenses are fringe benefits and employee salary. >> it's about 30%. the largest 33% is our aid payments. so grants to -- cash grants to families, wages for in home supportive services providers,

child care subsidies. that would all fall under there. so really direct support for low income families, single adults and seniors. >> i think there's a request for funding for in home support service. >> it's in our budget. it's not really a request. it's more of an obligation. in the state through the budget act in 2017, that changed the funding structure from one where there was a fixed county cost irrespective of a growth in cost. in 2011 and 2012 the state went to that funding formula. it was fixed and the cost grew ignificantly in san francisco to the increase of minimum wage, of the wages of providers and due to increases of social work staff and our very large iihs case load. we didn't have to pay for any of

that under that formula. we had a fixed number. in 2017 the state, due to a number of factors, reexamined that and returned us to the funding structure that was prior to 2012 which had us roughly in a 30% share of the cost of the program. so what happened is you saw itbuilt up from 2011, '12 and '17 all of these increased costs that we weren't bearing all the sudden in 2017 we were responsible for that cost. that's why you have that huge increase in general fund. >> perhaps now that we are going through a transition in the middle of anlection fro one governor to a new governor, particularly a potentially a candidate with a strong connection to san francisco, you might be able to appeal to the winner to help go back to the pre-2017 -- i think it's -- or 2012 -- >> back to the 2012 model. >> that would be helpful.

maybe even somewhere in between. >> enter i between. this is for the incoming administration, whoever that may be. this is one of the top priorities for the california state association, county welfare director's association and us. >> yes, i'm a representative. there's been a lot of conversation around it. >> i knew it. >> we want to continue to push for that. >> of course. >> let's keep moving forward. i don't want to lose any momentum. i want to hear from all our departments and then we'll pepper you with a few more questions. i wt to bring down i think your next person. >> good afternoon, supervisors. september garrett, director of the office of care and education. i'll be brief. our mission is to help ensure all san francisco families with young children, our youngest residents have access to high quality and affordable early weit a little growth in our young children. we are pushing almost 50,000 of our youngest residents and nearly half of our parents of young children have difficulty

finding and affording high quality early learning and that's a challenge for our working parents and youngest san francisco rests get off on their stronge start to thrive. our budget proposal this year will say sort of building on a theme, we seek to draw down as much federal and state support for early education and child care as possible. unfortunately in the u.s. today we don't receive enough investment from federal and state needed in san francisco. there's an unmet need of about 25% of low income state and subsidy eligibility of pre-school age children and only 20% of parents of infants and toddlers receive assistance who are eligible. so an 80% gap. that's where san francisco's leadership really comes in. our work, we have two programs, early learning scholarship and financial assistance to access quality for all parents and

children, zero to five as well as preschool for well which is entering the 14th year. we reach a total of 7,900 of san francisco's youngest learners. our budget proposal continues that work and seeks to provide a modest cost of doing business increase for the professionals who care and educate for our children which will be useful to help make sure that their compensation, our educators are among the lowest income professionals in our city. we have some work to do there. so our budget proposal really is to try and begin to close the gap so the-- for these professionals. another highlight, a modest cost in the budget but very exciting in terms of doing better to fulfill our mission, on october 1st we'll be launching a new digital hub and three languages to help our parents know the whole array of early

education options, apply for financial assistance and get connected but know where there's realtime vacancies because unfortunately our programs are so over subscribed that we don't have the best information to make the right matches based on preference or when a space might be open for a child. we are really excited and you will hear about that more later this year from us. we do have some modest growth because of unmet need. we are able to work with other departments and we have a few new child care centers opening this year, one in mission bay that has been literally a decade flavor of love and a few others. so we'll have some modest growth and new opportunities for children and families. with that i'll conclude. i'll take any questions. >> i see your name on the roster. no? >> yes, i do. >> okay. >> yes. >> it's all yours. >> all right. thank you,

september. what in your budget -- considering that we have 2400 low income child waiting to get into quality care, and we all know that not all but many of these same familiest these children come from are living paycheck to paycheck and when you -- when i watch, you know, over the last few decades those families that were paying their rents many of them also couldn't pay the rent and they were out on the street. these are not the ones that are homeless already but they are like one paycheck away. what in your budget is really going to, like, help reduce the -- help those 2400, 2500 kids on

the waiting list. i know a proxy passed but that funding is not going to come into play until close to the next flyear. can you let me know what is being done in your office? >> so in short, supervisor, we have a big gap to close and our strategy to serve more of those children, 2400, about 1800 are parents of our youngest children, infants and toddlers. our strategy is to draw down as much state and federal dollars as possible. the budget deal in sacramento will bring california statewide 13,047 more child care subsidies. we will do everything we can to get more of those dollars into san francisco. also the federal ccdbg child care development block grant will be hitting in california in about six months and there will be an opportunity to complete for another few thousand spaces for san francisco and we will do everything in our power to make

sure we as a city and our partners complete successfully for more subsidies for children. in our budget of one -- of about 104 million you seen that slide, $89 million is different combinations of provider payments so families get access. we do a couple things, we stretch dollars as much as possible. we hope to grow services by another 450 children, which is small in the scheme of need but big in terms of what we are able to do is kind of being aggressive and layering dollars. so the answer is not enough but we hope to at least get 450 more kids off that wait list in the next year with this proposal. >> was there any increase in general funds for city help with this? >> we are fortunate with the public education enrichment fund to receive revenue growth. every dollar of revenue growth is targeted or programmed in this proposal to expand svices

to families. >> and how much was that? >> i would defer budget staff. i'll get that number back to you shortly. >> okay. and that was built in verses the question really is was there any additional general funds that was put into your budget? >> no, it was -- our budget proposal represents growth in public education that is programmed for services. no additional general funds. >> okay. >> last year when the board added back $4 million to your budget, what happened to that? >> to do -- say the question again. >> last year when the board

added $4 million back into your budget using general funds, what happened to the $4 million? >> those were a gift and resources we used to make sure that infants and toddlers on the child care wait list were served. the investment was a one time investment and we know the importance ocontinuity ing families so $2 million was invested in subsidies this year, reaching i think 117 children and families currently. those services requested to carry forward the balance will continue to serve those 417 families next year. >> i'm disappointed that we actually couldn't get more funding into the budget to reduce that -- those kids on the waiting list. >> figuring out how to meet the need is a challenge. i did want to get back to your question, the public education and enrichment fund growth this year. it was a total of $2.5 million.

we'll be using that to serve more families, provide modest cost of doing business increased to the professionals who care for the services and a few of the new programs that have opened, like fair fax last year will also be receiving city support. those new spaces that came online that weren't budgeted in the prior year. >> thank you very much. >> thank you. >> thank you for your presentation. we are going to hear from the next presenter, department of ageing and adult services. sherine mcfadden. >> good afternoon chair cohn and supervisors. i just want to start off by saying that it's world elder abuse awareness day today. as you may have seen our staff and our community providers out in your neighborhood out reaching to seniors about scams that they're particularly vulnerable to so hopefully you were able to at least help get the word out or be involved

yourselves in that. i'm going to start by talking about our department programs and then community-based services. our department programs are ones that we do with direct services staff. the first to get you a highlight of the public conservators office, we have close to 150 -- i'm sorry, 550 individuals under conservatorship within our department currently. most of them received treatment in locked site facilities because it's the most property level but thanks to our partnership with the department of public health we've been working on community-based conservatorship models as well. that frees up capacity and makes the legal requirement in the least restrictive environment. right now we have about 30 people on different types of community-based conservatorship models. in home supportive services, just wanted to say that we rolled out our home bridge tiered wage which means that workers are getting $2 more an

hour than the minimum wage and then they can also -- if they get more training then they can go up to $3. what we are hoping is that will really help with our workforce retention through home bridge, which is our contract mode of seices for peoho wan't tive manage their own worker. so, i mean, i know i presented this to you before and now we are three months into this process and we are really hoping it will help with the workforce retention. and then community-based services, dignity fund updates. this year we completed the dignity funds community needs assessment as the first step in our four-year planning cycle. it was approved by our commission after a public hearing in april and will support our work next year. i will be presenting that to you for your approval next week. i just wanted to really thank you for your par t--

participation. we had forms in every district, we conducted 29 focus groups and we administered a survey to about 10 individuals. so it really helped form the process. also we've developed an allocation plan for the $3 million for the new fiscal year that are in dignity fund legislation and i'll talk about those in a minute. i just wanted to also highlight a couple of things that wouldn't haeomut other wise just because they are not -- they don't have budget impact right now. this year we were able to get a consultant to start looking at putting together strategic planning to create a disability culture center in san francisco. we are really excited about that. that's an idea that came out of multiple disability communities, thinking really about disability as its own culture, celebrating the history of the ada and really the fight that some of -- some of the fights that started

in san francisco at our federal building, really highlighting that and celebrating the history of disability in san francisco. i'm very excited about that. there's an idea that was supported by -- very strongly by mayor lee and we are working with the institute of san francisco state, a variety of other departments such as the mayor's office on disability and then our community partners as well to get that off the ground. so we are hoping that we will launch that next fiscal year. then supported home pilot, a lot of you supported this as did mayor lee. this year we've launched supportedomend basically that's a program that helps people who are more middle income, who don't qualify for in home supportive services to access much needed home care in order to stay safely at home. it's a pilot so right now we have just the few over 100 clients enrolled and our community provider institute on ageing is working with ucsf.

ucsf will be conducting an evaluation of the model and they will provide us with an interim evaluation report soon. just to move on to the dignity fund allocation, the $3 million in growth for fiscal year '18 and 19'19, it was just complete to help inform this funding allocation process and also used our previous community -- or previous needs assessment too. so the first thing is really enhancing community services, which we to through senior centers mostly and community centers and really there was an ask for intergenerational programming, which is something that we really haven't delved into much. it will be an opportunity for us to work with some of the other departments, particularly dcyf to figure out how to best model that and it's a way for us to support organizations that are serving people throughout the

life span. the second is nutrition support for adults with disabilities. one of the things that we've been seeing -- most of our department's funding for nutrition has historically been focused on older adults and we are trying to increase some parity for younger adults with disabilities. we are also seeing an increased wait list for adults with disabilities who are under 60. we wanted to address that with this, 300,000. i also wanted to say i do have copies of the allocation plan for you if you'd like them. we can leave them with you. >> thank you. they handed it to us. >> you already have them? >> yes. >> okay. >> is this it? >> that's it. so out reach and awareness. one of the key findings in the community needs assessment kind of not surprisingly but unfortunate that people don't know how to access services for people with disabilities and older adults. so we are going to spend some resources really making sure that we do a well run

informational campaign and also use some peer ambassadors to reach out because we know one of the best ways for people to get information is from their peers. so this gives us a chance not only to have them reach out to their peers but also gives us a way to either provide some part-time work or pay for older people and people with disabilities who might need some income in addition to what they already have. then we are looking at mitigating social isolation and this funding would go to phone and web-based support, suicide prevention programs and peer visitor programs. we also -- this year we've been putting some resources into supporting caregivers, caregivers don't have any really real good means of support. there are really no good -- there's no good funding source besides our local general funds for them so we wanted to put more funds into that. that would be primarily

providing services. we really want to look at assessing our case management needs. we've had an ask from our providers to provide more behavioral health case managers. what we would -- what we are opting to do instead is really to work with our partner departments, particularly department of public health to see if that's the way to do it. if the resources are already there or if we need to beef up the resources we don't want to create a duplication. we certainly don't want to do something better at it than we are. we want to make sure that we are providing needs for a higher level of case management and access to that. we will also be providing training for our providers who are working with more and more -- people with more and more complex needs. then supervisor yee, i just wanted to say that right now this is the first full year of funding we've had in the reserve program, which is an employment program for older adults and

people with disabilities. it's 320k. we are hoping to serve 100 people with we will have some evaluation results because we are about to end the first year of full funding and so we will be able to take a look at kind of how it'sworking. you know, that's another thing that we are very excited about it's a way of getting employment for people who have been in the workforce and have a wealth of information and expertise to bring in. it really helps them get income but also helps i think -- i think really helps with the organizations that they are placed in. they have a lot of expertise. then as you know, we've been talking internally about how we might take advantage of the infrastructure on the human services side to maybe see if there's a way to create a program for older adults so we could parer together on that. >> supervisor yee, do you have a question? sure.

>> thank you, chair cohn. let me reiterate. you were part of this discussion and this is something that probably wasn't captured when you did your assessment for dignity funds. when we had the hearing on the older adults and people with disabilities, which is our employment, itcame out there seemed to be a gap for us as a city trying to help this group of residents. these would be people that probably worked in a workforce, left the workforce for a few years, realized they can't afford to live in the city, needed to go back to work. some of them have skills that are pretty easily adoptable to go back to work for a few days or so. i talked to -- i think it was

yesterday i was mentioning that to the -- which department was that? >> economic and workforce development? >> no, our hr, human resources, for them to maybe look at that piece in terms of getting jobs -- access program to expand their access program to have people go back into city department jobs. the other category that is missing in all of this are those that may not have had those professional skills and they have been out of the job market for a while and now they have to develop maybe some more current skills that are needed in the job market and that's going to cost a little more than 300,000 for those 100 people, at least the budget that i've seen. >> that will. the budget that i talked about is what we already have in the

over all budget. if we were to start focusing on a different population that would cost more than $300,000 and i think we talked about what some of those models might look like. in addition, one of the things that you wanted to have come out of the hearing was to have the departments talk with each other. so that certainly has started and we are committed to continuing to work together. so department of human resources, mayor's office on disability, the mayor's office on economic and workforce development and dos have also beennd - a human services, wee alleen talking about how we might improve that situation and think about new models to serve older adults. >> so one of the models is this model for older adults. can you talk a little bit about that in terms of how you expand that? >> one of the models? >> well, i received a proposal. >> sure. so i don't know the details as

well as somebody on the human services side would know, but basically what the model is that we would leverage the infrastructure that department of human serces has, they have a lot of experience in working in workforce development, they have a lot of relationships in the community with various employers and so we would be using local general fund dollars to develop something for older adults because the older adults generally don't fit kind of the -- they may not fit because of the incoming guidelines into those programs but we would be able to use the relationships to hopefully final employers in the community, some subsidized, some unsubsidized positions in the community. >> right. i just want to -- >> i was just going to say, one piece of that really would be focused on people who have been marginally employed and another piece would be looking at people who left the workforce and are going back into the workforce and may have been professionals or held a higher level of job.

>> right. sorry it wasn't you who actually presented it. my staff has not gotten back to me about -- somebody came into my office with the presentation and unfortunately this took place while the budget process was going on already so we couldn't capture it. i'm hoping that we could understand it better today so this is the opportunity to support this grouping of people that need to go back to work so they don't become homeless also. but the proposal was for a group of 100 people, older people that -- and it would cost $70,000 -- $700,000 i believe. >> we will stop here. we've spent an hour on this.

barbara, the department of public health. come on down. >> may i read additional items? >> yes, i'd like to read and call items 7, 8 and 9. >> item number 7 is the ordnance admitting the health code to set patient rates and rates for over services provided by the department of public health. ie ie -- item number 8, to sign the california mental health services participation agreement to facilitate the transfer of funds to cover san francisco obligation to pay for mental health treatment for san francisco foster children based out of county. and item number 9 is a resolution to authorize for the acceptance and expenditure for 2017/2018. >> barbara and team, presentati presentation five to seven minutes. when you answer keep it tight

and concise. >> you got it. >> welcome, barbara. the floor is yours. >> supervisor, chair cohn, good afternoon. i was going to pull up our -- i'm going to pull out our powerpoint. >> just introduction remarks. let me tell you about the department of public health. they have a total budget, a big one -- >> $2.4 billion. >> thank you. they are coming to is for an additional $173.4 million. 6,785 personnel and they are looking to increase their team by 18. >> that's right. just really quickly, over 70% of

our budget includes two hospitals and behavior health. so wanted to just highlight that. our revenues, we do leverage $1.6 billion from the medical and medicare and so it's really important for us to get as much medical dollars as possible to offset the general fund. our goals are financial stability, maintaining court programs and equity, implementing our electronic helicopt health records and help our vulnerable populations. we've done several areas where we supported our patients with our hospitals and we have an important program coming this next year of $6 million for tax. we are expanding services in our hope one centers and we have a $30 million capital project for expanding of our southeast

health center. we've incorporated about $9.2 million into a new drug medical drug organized system. the city just got two more organizations that just got proved by the state. there's 26 programs that are now drawing down drug medical and are certified for a variety of different programs. ment, out patient treatment, adolescent out patient treatments are examples. some of our other programs that you might have heard about already is expanding access to medication for addiction treatment through our street medicine team. we have a health out reach team that is doing lots of engagement in parts of the city. we also have focused in on syringe clean up and disposal. so we have lots of people out there picking up those needles and as you know it's so important to have clean needles to ensure the transmission of disease and transmission of disease. looking at improving services for sexual assault survivors at the hospital and also expanding

our -- i saw the public depender was here that just got again in the last couple of hours. our operations include 16 positions in terms of some of those are including ten ftes for medication addiction, the sweet and beverage funding to provide the core support and the sexual assault program. i'm done. your direction, supervisor. >> thank you. i appreciate that. so i'll talk to you a little bit about increase for salaries and benefits. talk to me about the one time investment in capital and technology projects that are kind of a recuring theme for a lot of the departments. you've got i think a request also for a new investment in

chronic deci chron chronic disease prevention. i saw that on one of the slides. maybe touch base on the over all operational increases. >> a lot of our increases are in our providing of care. that's our biggest component. as you know, having a large trauma center, that's always going to be an issue because we cannot control who comes tgh the front door. we are always catching up and for example we built a new hospital. lots more people coming to the front door. so we are always trying to make sure that that revenue is covering the positions that we are expanding for the hospital. we've also -- we are in the middle of our bond issue now in which we are renovating our old hospital building. >> how much is that bond issue -- that bond should it pass, think positively, what's that going to yield? >> i think it's $220 million. >> yes. >> so for the southeast health center, some renovations for other primary care centers as well as the building that the hospital used to be in and we are taking a lot of people out

of those buildings to ensure they are in a safe programming. >> what's going to happen? >> we are trying to figure that out right now so we've got some large costs of what out would cost to do administration, what it would cost to do clinical labs and housing. that's the cost that we've incorporated into the -- so there's a largest electronic health records. we are going to phase two. i have to tell you that we have hundreds and hundreds of staff that are working on our electronic health records. it's one of the largest, mt important things that we have going on for the medical component because we have millions and millions of dollars. i think it's $1.6 billion going through that program. so the better electronic health system to capture every visit that we have the more revenue we

produce. >> can you talk to me about your revenue streams? >> a large portion of that is medical and medicare and that's the majority of those and then we get state grants and mching grants from the state. >> what happens if -- well, you know, when trump was elected he threatened to cut services to the health department to project how they would impact and was the emergency fund. it created something. >> the rainy day fund i believe. >> last year there was also the affordable care act. >> the affordable care act. >> that is always going to be a concern for us. as you remember in the past seven or eight years we had healthy san francisco and that was almost $60 million on those matured. today the majority of those clients are being able to be --

we were able to draw down some federal government from the aca. we will be in a financial situation if those go away for the very non-disabled population because before we -- women who were pregnant and greatly disabled individuals could get medical. they were the only individuals that could. then that expanded to everyone by income status, not by health status. we are always prepared to think weaut what woul watched that federal legislation very closely. right now we are watching the e reimbursements for pharmacy. we think that's going to be $6 million. that's called 340b. we are ensuring that -- we are tracking that to make sure that if that goes away that we are prepared to lack at our internal cost and begin reducing that. we just are hoping that we can continue to get that aca dollars that has made us a very viable

organization and also one that has been able to draw down as much revenue as possible. >> all right. at this time i'm going to pivot to supervisor sheehy. >> supervisor sheehy: i want to ask about the care back draw. that seems to still be out there. it's -- not as much as it has been. >> right. that's about 300-plus thousand dollars. that came in after our budget was done so that always happens as you know, supervisor. we have three different fiscal years with the federal government and then the state government, our fiscal year and one that starts in march. so we are always watching that one and that's $300,000 deficit that we are still trying to figure out how to patch that one. >> are you able to rebalance the budget, your budget? are you able to rebalance your budget to account for the back fill or loss? >> that's one of the things we

are looking at. hopefully by the next time we come we can talk to you. >> you have it together. i think it's next week when you come. >> we'll work with the mayor's office to work with that. >> thank you. >> didn't we back fill last year out of the federal reserve? >> last year we back filled the cdc grants that came through -- midway through -- sorry. this current fiscal year in 17-18 the patient year cuts to the cdc and then that back fill in the '18-19. >> i think that supervisor cohn was referencing this, didn't we set up a federal reserve last year? >> we did for 17-18. i think it's almost fully expended, last year's -- we'll work with your department and

office over the next week to understand. >> i just have two other questions. so what's the expose to -- i did hear that you don't have a great deal of exposure to aca private insurance. there is risks with the change in the requirement that those rates may skyrocket because people don't have to buy it. >> so it's a ricochet for us in that aspect. we don't have a plan with californ california. so we won't be exposed to that. the san francisco health plan manages all the medical patients. we may see people dropping out because of costs and the mandate that has been dropped off. what we could particularly see

in the city of san francisco dignity, the chinese hospital as we did before that will try to take those clients in as charity care or under healthy san francisco. >> last year i just want to talk about exceeding the revenue goals from the hospital. i think as i've heard, one of the biggest drivers is the revenue. >> again, that's going back to -- thank you. that goes back to the aca and all our staff to make sure that everybody gets put onto medical. so we'll take some some of those kovrplyments -- compliments and give them back to the aca. thank you. >> supervisor fewer. >> thank you for getting us that extra money. so i just have a question. what are some ways that your department ensures equal access to mental health services on par with non-mental health medical

services? >> we have three insurance plans now. one is medical for chronic diseases and that does cover some mental health services. those who are not severely mentally ill. th w those with severe mental illness and we have the one for substance abuse services. so there are multiple ways for us to ensure access. an example would be somebody goes into a primary care center and they are exhibiting a higher need of mental health. those will be deferred into our mental health clinics and we have a whole process because we have staff who really need, who are very aware of the mental health system and they will refer those in. so we have every door that we have you can also access not immediately but you can be referred into or provided mental health services. >> mental health providers. >> that's right.

>> okay. and then how -- i mean, do they see nonprofit [inaudible] parity? >> we have many dozens of cbos that we provide millions of dollars to, almost $300 million. i think maybe it's $250 million. we contracted cbos to provide care. also the fact that we've tried to make it a behavior health system so that you don't have to be severely mentally ill to come into the system at all and that those exhibiting depression and stress and trauma also are served at different levels of care. so we have different levels of care. >> and then what is dph's strategic thinks on the nonprofit commune tu --

community? >> i think one of the issues they face is the cost of -- they don't own the facilities. so that entire cost we've seen some their insurancees go up, theirrkers comp issues go up. so we try the best we can to continue to expand those dollars and when we can we work with those. some of our cbos have their own unions and they have to make negotiations with those unions that sometimes don't quite meet what we fund for so we are always trying to catch up and work with them on that. so we work closely to try to suppo them. >> great. and -- how does the mental health contracted community help ensure the fulfillment of mental health parody laws? >> the parody laws make sure

that individuals have access to medical care and mental health. it goes back to that question of people coming into our service ensuring they get access and we have done the reversal. we are incorporating primary care into our services. hr360 is a great example of that and our south and market clinic where we have medical providers there. the data shows those with mental illness don't get the adequate medical care and actually have a mortality rate of 25 years younger because of the lack of medical care. we try to make sure that parody is throughout the department. >> thank you very much. >> supervisor supervise yee. >> good afternoon. i've been talking to you and

others about the level of care for seniors and people with disability. one of them -- one level is the residential homes and there was -- you know, i discovered that we have a program that's called patch. or something else. can you explain that? >> sure. one of the things that we found over the years in providing referraling into residential care facilities and these are care facilities who are licensed by the state for seniors and people with disabilities, is the fact that they do not have the mental health and addiction experience and so what we try to do is to enhance their rate t ensure they are meeting the programatic needs of the clients that we are serving. so those are the -- those are the clients that we give patches for. for those who have more -- they

have more needs. they have daily needs in terms of trying to manage the mental health and the addiction issues, some of the residential care facilities, this as new phenomena for them and we try to enhance the rates so they can get the right kind of staffing and support they need to make that over all cost work for them. >> so i understand that many of these facilities are closing down at this point. >> it's been a historical issue that's happened over the last two decades and part of that -- i've been here for some of that and i've watched that and some of them have been family that is have leased facilities that the next generation -- i've seen two or three of those, the next generation is not interested in taking up that buiness others that have not been able to keep up with the costs of rents for their facilities. it's a really important level of care for us and win of the areas that we are working on