Health, Housing & Human Services Committee - Regular Meeting

Okay. It's just about 01:30. Do we have everyone we need here online and in person with us today?

Yes. We do supervisor, like, most present here in person. Okay.

Fantastic. And it sounds like we've got a good sound check. Wonderful. Yes. So we will go ahead and call our meeting to order. This is the health, housing, homelessness, and human services committee of the County Of Monterey. It is Monday, August 18 at twenty twenty five at 01:30. We are, I believe, on air. I'm not sure where we are on air, but we are recording. We are live in person at the Monterey Room of the County Board Office, 2nd Floor Of The County Government Chambers in Salinas.

We are live here in the District 4 Offices supervisor offices in Marina as well as on Zoom. So however you're joining us today, thank you for being here with us. We're happy to have you, and we will call to order. Supervisor Luis Alejo is in the Monterey Room of the Salinas Chambers, and I am here present in the Marina District 4 Office. Are there any additions or corrections to our agenda today?

There are none.

Alright. That was easy. And is there anyone who would like to make public comment today on items that are within the purview of the committee, but not otherwise on the agenda? You if you're in person, you can approach the the front of the room, or if you are on Zoom, you can raise your hand, and we'll go ahead and call on you and allow two minutes for public comment. I'm not seeing anyone walk to the front of the room, and I'm not seeing any hands raised. We'll do one more final call for public comment. Alright. Unless I'm missing anyone, I'm not seeing anything. Anyone come up, then we'll close public comment and move on to our regular agenda. We have two items on our regular agenda today.

The first is a presentation from the health department, and this is part of the request that we've made at the beginning of the year just to receive department overviews from each of our departments that fall within this committee's overview or purview. So Elsa, I'm Inez, I would thank you for being here with us and sharing a little bit about what the health department, all of the things that the health department has responsibility for. We'll pass

it Yes. Good afternoon. Thank you. As indicated, my name is Elsa Mendoza Jimenez, and I currently serve as the director of health services for the county of Monterey, and I'm happy to be able to provide a high level overview of your health department. This is our updated organizational chart. We have, seven major bureaus and then an administration bureau bureau that oversees all of our core functions. And as you know, we report to this to the board through our county administrative officer, Sonia Delavroza. Our sorry, let me minimize my screen here. Okay. Okay.

So this slide shows our budget for the current fiscal year. Our adopted budget is, almost $456,000,000, of which 404,000,000 are revenues we bring in from outside sources. On the right hand side, you could see the mix of revenues that the health department is able to bring into the county for its services commencing with patient revenue for those individuals that we serve who are on Medi Cal, Medicare, self pay, or commercial. We issue many licenses and permits that mostly funds our environmental health, animal services, and some of other units. Mental Health Service Act, is transitioning to Behavioral Health Service Act, is a major funding source for our Behavioral Health Bureau.

State grants and federal grants are also part of our bread and butter. Many of our programs in public health are funded with either state funding or federal grants. Behavioral health is also a recipient of some federal grants. Clinic services is also a recipient of a couple of federal grants. And as you know, 1991 health realignment, mental health realignment, and social services are core funding for county services that were realigned back in 1991 and then in 2011 to local county, and the health department is a recipient of four of those revenue sources.

Property taxes that fund our emergency medical services, that's community service area 74 that helps to keep our EMS system up and running. And then another funding source for EMS is the uncompensated care or MADI, which our court finds that then help to fund uncompensated care for

indigent care services provided by our local partners. Our current budget

also consists of using 23,100,000.0 of our behavioral health fund balance, which a combination of their, BHSA and other behavioral health specific revenues. Restricted fund balance is, bringing in, revenues that we have in, clinic services or some of our other bureaus for specific services and expenses that were incurred in that year. And then about $18,000,000 of our budget is funded with general fund. I I like to repeat that only about 4% of health departments funding mix is generated through local general fund contribution. And we currently have about 1,290 allocated positions.

In terms of oversight and advisory boards to the health department, we have our board appointed behavioral health commission that helps to guide our behavioral health staff in terms of strategic direction, implementation of services. Many times, items will be presented to behavioral health commission for their approval, and then those items will be brought forward to the board of supervisors for them to take action. Our our community health, center board is the, oversight body that has a a co applicant agreement with the county board of supervisors. And now I realize that this slide was updated, so I will fill in the blanks. The Community Health Center Board has a co applicant agreement with the County Of Monterey where it clearly delineates the responsibility of that community, mostly patient driven advisory board to the clinic services and what the roles of the board of supervisors.

The community health center board really provides strategic direction on scope of services, where our services are located, and the board of supervisor really handles the administrative side, the human resources, the finance, the budgeting, etcetera. The Hitchcock Road Animal Services, recently, about three years ago, became a joint powers agreement between the County Of Monterey and the City Of Salinas. And so the JPA board of directors is the governing body over our cock Road Animal Services. And then we also have a community member driven advisory committee that helps to, guide their services. EMS has several, medical care, clinical care, operations group, and, quality improvement committees that are comprised of members of our EMS system, so hospital, fire, community members, law enforcement, etcetera, that really help to kind of drive and shape the EMS Medical Services Agency scope operation and services.

In terms of our active projects, I'm gonna speak to them from a capital and then operational. So on the left of this slide, you can see, some of our current, active capital projects beginning with our mental health rehabilitation center and our behavioral health urgent care center, which are located will be located on the Constitution Parcel off of, over by Creek Bridge. Medical Recuperative Care Center, will be a project that we're building over by our SHARE Center over off of Laurel, which will help to provide a a place for individuals who are no longer able to stay in a hospital but still need ongoing care after they're released from the hospital, a place for them to be able to recoup, before they go back to their setting, which many times, these are individuals that are unsheltered. We are, in the process of finalizing a lease agreement with a developer to build a new health center in the city of Marina, so that should be coming before the board of supervisors for consideration over the course of the next couple of months. Ongoing medical I mean, laboratory upgrades that really started with the COVID pandemic and an influx of federal funding for that, and we're just wrapping up the final laboratory upgrades so that we are more efficient and effective and able to process more recent specimens safely in our lab.

We've implemented a pilot redesign of our admin building now that we are fully embracing a hybrid work schedule. We

have

a policy in place in terms of who gets a dedicated space, who doesn't, and so we're creating these pilot phases that we're now gonna roll out through the rest of the building that really gives staff an opportunity to have touchdown stations, impromptu meeting space, hoteling as they call it, etcetera. And animal shelter our animal shelter is 20 plus years old, and so it's in constant need of upgrades and, repairs. Same thing with the Alisaw Health Center. We recently finalized our our tenant tenant improvement agreement with the landlord, and we're gonna be making some significant tenant improvements at the Alisalle Health Center, again, to make it safer for our patients and our staff and increase the flow of patients in that. And then we've outgrown our space in terms of storage capacity.

So later this fall winter, we'll relaunch our project with Public Works to build a new storage facility right on next to the 1270 Medevidade Building. And then, recently, we resurfaced our parking lot at 1270 Natividad. We had the grand opening for our behavioral health access clinic on the LSL. And then in partnership with Seneca Families, we opened up a children youth crisis stabilization unit and crisis residential, program. In terms of, major programmatic, projects, in behavioral health and in concert with some of the other bureaus.

We're working on implementing, CareCourt. And, December is when we launched, CareCourt. And so around that time in December, we'll come back, with a joint presentation with other stakeholders involved on how it's going in our first year of implementation of, CARE Court. You might recall that, senate bill 43, recently passed, and, we deferred to implement it until 01/01/2026. This bill expands the definition of grave disability to include substance use disorder.

And so behavioral health and other stakeholders are working together to identify the flow, the criteria, making sure everybody understands, who will be eligible under SB 43 and all the expectations around that so that we are ready to launch come January 2026. And behavioral health staff, is working, fiercely on understanding all the transition and changes with the behavioral health service act to get ready to launch. And lastly, in behavioral health, we are celebrating our one year opening of Hope Housing in Marina later this month, and we plan to come with the full report in September, with how our first year of implementation of bridge housing is going in our county. In terms of clinic services, we, launched as a pilot last year or, the deployment and expansion of our mobile health center. We're happy to report that we've executed an agreement with the local dentist, so now we'll be able to offer dental services on our mobile clinic along with family practice.

And we have, executed agreements with several school districts, including Salinas Salinas School District and Solidad School District, and we'll be launching that, the next month or so now that school is, back in session and looking to expand to other school districts, as a need, an interest arises. We also, your board just approved an agreement with a dentist also at the Alisalle Health Center. So on the 1st Floor of the Alisalle Health Center is a dental practice that your board approved us entering into contract with the dentist there. So, hopefully, in January 2026, that clinic will now be able to provide dental services to our clinic services, federally qualified health center patients. We launched chiropractic services over a year ago in Seaside, and now we're incorporating it at our Natividad campus sites.

It's definitely a service that is well welcomed by our patients. And so we hope to be able to make room in some of our other clinic sites to be able to add chiropractic services as well. And I already mentioned about Alasat Health Center Dental. In terms of EMS, your board, recently approved a new agreement for an ambulance service provider that the staff are planning, for transition come 02/01/2026 with AMR and the other, stakeholders in the EMS system. In terms of, activities under environmental health, as you know, we're still, actively responding to, the Moss Landing, fire, and that'll we'll continue to work with, other stakeholders and the owner to make sure that everything is cleaned up and, we're able to move forward from that.

And we are entering fire season, so, hopefully, knock on wood, we don't get hit with a major fire as, our neighbor down to the south are experiencing, right now. They're working with many interested, public members to become micro home enterprise kitchen operators, which is going, really well. So this gives an opportunity to somebody who wants to cook homes, cook meals in their home, and sell them out of their home the ability to be able to do it in a manner that is safe and helps to reduce foodborne illnesses. We are expanding our healthy housing initiative with the recent implementation of an asthma remediation pilot. So we're working with clinic services who is identifying individuals who are taking their medication, have asthma plans, but yet are still not improving their systems.

And so those referrals are being made to our community health worker team in our Office of Equity and to Environmental Health. And they're conducting home visits of these patients to identify what the triggers are. And we've been about forty five days into implementation, and it's it's going really well. And we're able to help those patients identify what household, for example, plants, dust, etcetera, may be in the home that are preventing the the individual from managing their asthma. And so we hope to be able to flush out the pilot and hopefully be able to sustain it ongoing.

And then as you all are aware, you know, we're working with the DA and local law enforcement to really conduct enforcement efforts on a permitted full mobile food vendors and illegal dumping in our county. For public guardian, they're working with behavioral health, as I mentioned earlier, on on getting the county ready to be able to implement senate bill 43. And then other things that are across multiple bureaus is implementation of participatory budgeting process in the next month. Your board will get a presentation from the, TAMC and, the health department and public works regarding a participatory budget process we did in North County to give community members an opportunity to be able to identify how a million dollars should be invested and what infrastructure projects at their school. And so this is something we hope to continue with public works and our other capital safe you know, active transportation grants, but we're also looking at to see how we as a department can make some funding available, to the community to be able to identify what investments they want their, taxpayer dollars to go to.

We're working with First Five and others to recreate our building safe and thriving communities strategic plan. This is a second version of violence prevention. Before, you might remember that the board adopted a violence prevention plan that was really focused on reducing gangs and violence from gangs in our community. And so in the last year, this program has moved over to the health department, and so we're kind of reframing it more from a a public health lens to try to reduce injury and violence in our community. And then, of course, ongoing working with our partners to increase opioid awareness, prevention, and making sure we're making treatment services available in our community, particularly in South County.

Because up until now, there hasn't been much in terms of treatment services in street medicine, as we like to call it. And then in terms of contracted community based organizations, about half of the health department's funding goes out to community based organizations' providers to help us fulfill our mandated services and other funded services. This just lists, you know, type some of the services that we contract with for behavioral health and public health. And then in the agenda item was a a worksheet that, identifies all the community based organizations that the health department contracts with. Just a reminder of our current three year strategic plan goals, and really, we're here to enhance, promote, and protect the health of our county individuals, families, communities, and the environment.

And so with that, I'll take any questions you may have.

Awesome. Thank you so much, Elsa, for the presentation. And to your entire team, which is a large team, I think one of our largest if not, are you the largest department one of the largest departments we

have here

at the county?

Second largest The Tivinet's a little bit bigger than us.

Okay. Okay. So a second largest department that we have here in the county. And maybe before we go to questions, if we do we have the CBO list? If we could just throw that up on the screen just to share that briefly.

Yeah. I'll I'll give me I had it up. Let me find it real quick.

And thank you again for pulling that data together. I know it's a lot, and it's a big ask for all the departments. But we do have a lot of money that flows through the county back out into the community to contracted nonprofit organizations and community partners that help deliver significant amount of service delivery. And I think part of what we wanted to do is highlight where those non prop who those nonprofit partners are and what the source of funds are that are passing through the county and for what purpose through this through this process and the committee. And so being able to highlight which different departments and which different bureaus and which different funding sources we have we are providing and who which nonprofits are receiving those dollars so that we, I think, as a board can see, you know, where we're where we're some nonprofits are receiving, you know, multiple different contracts to provide many different services and where we may be able to do better job of coordinating efforts or where maybe we need to do a better job of providing more support for folks for some of our organizations.

So I think there were a couple pages here of different organizations that are receiving quite a bit of support through the health department. And do you have a total amount of money, Elsa, that is contracted out, or do you know what roughly what the total amount of dollars It's

about 50% of our budget. So probably about 200 to 225,000,000.

That flow through in those that list of nonprofits?

Mhmm. Well, no. Not not through just these. So we also have contract with providers, you know, like physician groups, etcetera. So there's a whole other list of contracted entities that aren't community based organizations.

Okay. Got it. So these are just the nonprofits that are listed here?

Correct. Mhmm.

Okay. Got it. Alright. Thank you. And this is all in the attached in the attachments that are on the agenda. So for anyone that wants to take a closer look, that's all listed there. Okay. Thank you. So we'll bring it back to supervisor Alejo for any comments or questions to start with.

Yeah. I appreciate the presentation from the health department. Certainly, a lot of critical services that are provided to our community. Just a few questions on some of the points you you on some of the points you raised, miss Jimenez. On the CareCourt, I need to get a report at the end the year. I know early on, think that towards the beginning of the year, think we only had two actually app applications. You know where we stand now that we're in August? How many folks are undergoing care court? It

was about a dozen.

About a dozen have been referred,

but how many of them

have actually been enrolled?

Couple. A

few. We definitely have a couple care plans, so it's the volume has not been huge. Yeah.

Alright. Well, I both were good to get one year.

Yeah. We we really didn't start to actively see referrals until probably the last several months and then actually accepted them to move them forward. Initially, some of the referrals didn't meet the criteria for CareCourt, and we you know, if if you would like, we can come back sooner than December to provide an update possibly in October.

So when do we start

December? December.

Last December. Yeah. Right. Yeah. Yeah. It would be great to get to, like, at least a one year.

Okay.

In December? Makes sense to get to twelve months of Mhmm. And I I know last time we talked about this, one of the challenges was that that if if a family member petitioned for somebody to go through care court if they didn't show up at court, then it's kind of dropped as well. I was like, one of the challenges is even some of the applicants not following through, and a lot of time and resources go into an app application only for it to be dropped later.

Yeah. I can tell you one of the largest, referring entities that we've seen has been Department of State Hospitals Mhmm. On folks who are coming back. And behavioral health is also looking at working with families, so we do have families who may be reaching out to us to provide information. And then we're looking internally to see would a petition be appropriate in this situation? And if so, behavioral health is looking to file some of those as well without without having the family have to do that. So when we do get that information, we are starting that process as well.

Well, I look forward to that. On the also, of course, you said some safety measures will be done too. What what are the safety concerns there?

So we've had issues with flooring, you know, refresh. Some of the so the flooring is kind of one of the issues that we corrected a few years back, but we have to recorrect, so to say. And then just wear and tear in the building. So, you know, we wanna make it, you know, brighter walls, refresh the entire facility so that it's easier for staff to work. The current landlord we have, we continue to have issues with the elevator, but the current landlord we have is very responsive and addresses the the needs immediately when there is an issue with the elevator or any other thing that could cause concern.

In terms of it's still safe to operate. We're still operating. But we are then wanting to make some improvements to the clinic just so that it feels like when you go to the Alisal Integrated Health Center how inviting and warm and welcoming it is. We wanna make sure that our Alisalle Health Center has that same feel when you walk into it for both our patient center staff.

Last question. You sound like food vendors because when some of the enforcement actions were taking place, they seem to all disappear, and now they're all back again. So are we gonna hear more of what's gonna happen in that in that enforcement case? Kinda been out of the news, but

Yeah.

Now that that they're all back at the places with the bright lights that we see them.

Yeah. They're yeah. They they came back. And so I what I can tell you is that environmental health is working closely with the district attorney's office and local law enforcement agencies to go out when, they're back up in operation, and I can't speak to what's happening on the court side

of I saw that case. Yeah. Unpermitted folks might have come in, but we don't see that unpermitted folks came in. They could get their permits, and that's why they're out, or are they operating as they were?

Previously. Okay. I I think I can even though they were offered the opportunity to come and comply and get a health permit, I can't say that many of them took us up on it.

That's good to know. Thank you, though, for for the working in in this area that heard from the community, people part of the county.

Yeah. We wanna commend the district attorney's office has been really a great partner to work with and partnering with our environmental health registered and environmental health specialists to be able to go out safely to address the concerns that we're seeing in the community.

Yeah. Thank you for all.

Awesome. Thank you. Any other questions?

Nope.

Okay. Awesome. Thank you. I do have a handful of questions, and I think with given how big the the health department is, it's almost at each individual bureau. We could go into sort of a ton more detail talking about all of the work that happens.

But I do wanna, you know, I think given where we're at with the federal HR one and some of the significant funding impacts, the broader question of assessing what type of losses or impacts the health department is bracing for or or might be anticipating with losses of federal dollars. Have we done an initial assessment of what that could could be and what types of impacts could be coming to both to the health department and to our partners who are partnered with the health department. Do we know what that might do we have a sense of what what scale that is going to be?

Well, when you look at our budget, it's probably not a a large scale. But I can tell you that the federal government did let us know that the nutrition nutrition and and physical physical education education component of SNAP Ed is no longer going to be funded come October 1. So that's about $700,000 that comes to the health department. We are working internally to identify you know, it's about three three FTEs. We're not concerned about not being able to find a place for those individuals.

And there might be some rollover funding, so we're continuing our contracts with a couple of small nonprofits that help to do education in the schools that we're not in. And so we'll be able to continue that into the coming fiscal year. And it really gives us an opportunity to kind of revisit what is happening in terms of nutrition, education, and physical activity in the community and where the gaps are and an opportunity for us to kind of figure out how we're going to sustain some of some of those activities. In terms of the Medi Cal side, still exploring and trying to understand exactly what the impact is gonna be in terms of number of members. I think we're gonna lean on our department of social services and our local managed care plans and our state associations to help us decipher of, you know, the 45,000 or so lives that we have assigned, how many of them are in the UIS, which is the unverified immigration status because those effects will take place with the state budget.

And then in terms of the federal, you know, work requirements, having to apply twice a year now for medical consideration. We still don't know exactly how many lives that's going to be for our county and how many of those lives are are assigned to the health department. So we're still working with our partners to try to come up with some estimates. I think internally as a county, we've been having conversations with social services and others to try to hopefully get a better idea. We have a Central California Alliance for Health board meeting later this month.

So, hopefully, we'll be able to get better insight from CCAH in terms of the impacts from the federal changes. And I'm hoping that I could partner with the other county departments in sometime in October, possibly come back to this committee with a clearer picture of what we anticipate to be the impacts.

Okay. That's helpful. And I know Santa Clara County has already put sales a tax measure on their ballot given the scope that they anticipate hitting their county budget and the need to remediate the loss. They had a special election already planned, and so the timing for them was was appropriate. But for me, it raises the question that I'm I'm not in a position we haven't been presented yet with the total impact of what we know or what we anticipate those losses will be.

So I'm looking forward to being able to answer that question, even if it is in rough form by department. And so you're thinking next month, two months?

Yeah. Probably next

month, we can come back with a preliminary estimate.

Yeah. Just so that we can begin to wrap our heads around and and talk about that in a way that is more concrete and begin planning, I think, because there are decisions that that we'll have to make collectively and as a community about what our priorities are and where we where we where where we want to choose to make decisions to backfill if there are conversations about what that looks like. So Yeah. And and

as part of that conversation, you might recall section 17,000 mandates local counties to provide services to our indigent indigent health care, you know, pre ACA. It was an obligation of the county to be able to provide care to individuals who were uninsured. And then obviously with the implementation of the ACA, we no longer had a need to provide separate funding for indigent. But as more individuals become or fall off the Medi Cal program, whether because of their documentation status or whether because of all the new federal requirements, it is something that we should begin to explore how we're going to meet that that mandate at the local level.

Yeah. And if I recall the last before ACA, I think we were up to spending close to $15,000,000 a year in that in that line item for indigent care. So that's not an an unsubstantial amount of dollars that that have to be dedicated in that in that space. So thank you, Elsa. A couple other questions.

In terms of the oversight boards, I had a chance to visit and meet and just express my appreciation and commitment to continue working with the clinic over clinic clinic community board, a great group of folks that are clearly committed to making sure that our county clinics are working well and serving the needs of the community. I did have a question. I was also online visiting the Hitchcock Animal Services Advisory Committee the other day looking at the list of advisory committee members. And I did have some questions just about how people would know how to access or apply for vacancies on those boards the clarity of knowing who appoints who, like how the appointment process works when you're on those websites. So just a a a comment or a feedback for the department or whoever manages those web pages that I'm making it clear sort of who appoint how the appointment process works.

When the constituents that were in my office asking those questions when we were on the website, it was was a little bit confusing for us to navigate with them. So I'll just share that

that

feedback. We're always encouraging people to apply and trying to get them to navigate on their own the process for making those applications. I did wanna on the capital improvement project list that you have, it's extensive and a lot of work that I know the department is managing and and and pushing forward pretty successfully. But I I know at one point, some of those projects weren't all on the county's capital improvement committee radar or on the main capital improvement list. And I just wanted to make sure, at this point, I think they all have now been added to the CIP project master list.

Is that Yes.

For for the for the county owned facilities, yes. Those are on the county's capital improvement project list.

Okay. That they all looked familiar to me from that reviewing that list. I just wanted to double check on that. And then on the clinic services, I think it was on slide number 11. The I think there's there's so much happening with clinic services, and we pay attention partly because of the Marina Clinic and the Seaside Clinic, which are both beloved providers of care for community, our members and our residents here in Seaside and Marina.

But the one of the additional services that you didn't mention there, but that I just wanted to call out is the availability of the virtual visits, which have been, I think, especially beneficial for folks who, for whatever reason, have not been comfortable visiting an in person clinic for for a variety of reasons, especially right now. And then I wanted to check-in. I know the referral is in place around language access, but I just checking in to see where we're at on the language access as a programmatic priority to to to make those investments and make that access improvement?

Yeah. Definitely. So on the first point regarding telehealth, video health visits, telephonic visits have always been part of our business. With COVID, we were able to move to video appointments, and so that is just part of our normal business operations, hence why I didn't highlight it. Particularly, if we are getting noticed that individuals may not be comfortable coming into our clinic setting, we are most definitely offering them the ability to be able to have a a virtual visit with our provider.

So it is something that we will continue to make available to our community. And in and in terms of our language access, we continue to improve our staff's ability to be able to ask the question the right way when patients are coming in. So with that, we are capturing a language preference more accurately in our in our data system. We've met with local community based organizations. And even today, staff were meeting with because they have a pretty robust language access program in terms of videos, in terms of staff that speak a different a third language embedded within their clinic system.

So we'll hope to be able to learn from them and adapt it here locally. We are looking to create some short videos that we can put up in our lobby. We're going to be bringing in a community health worker, office assistant to come into our clinic setting who does speak a third language to be able to have conversations on what else we need to be doing aside from making sure we're asking the question correctly, making sure that in our system now it's flagged so we're able to schedule interpretation services for that clinic in advance, and also, too, in terms of some of the education or notices that we should be making available in various other languages, other indigenous languages in our Alisoft Health Center and hopefully helping them infuse that across our clinic system and some of our other service lines as needed.

Got it. Great. Thank you for that update. And I know we'll be getting more updates on that over the course of that referral as it moves its way through. One of the other clinic questions I had, and I know we'd sort of exchanged some emails about this, Elsa, but as we as we look at the ongoing restrictions for reproductive health care for women.

I know access to birth control is one of the things that we want to make sure everyone has open access to and specifically long acting birth control. And so, you know, going back, I think it was maybe ten years ago or maybe a little more than that, our county health clinics weren't able to provide long acting birth control options, And they were referring folks back over to Planned Parenthood, but it was kind of a punt people back and forth. Planned Parenthood needed a woman to be cleared by the primary care doctor at the clinic before they were able to provide the long acting birth control. So you were kind of making an appointment at one location, then back at the other, then back, you know, so back and forth, back and forth, which was really challenging for people. And so what I understand now is that our county clinics are able to provide long acting birth control.

And so can you just speak to that and verify or confirm that current status for folks?

Yes, most definitely. So we have ongoing training with our providers to ensure that they're certified and being able to prescribe or implant long acting birth control. We have the family program that really focuses on STD prevention, the ability to be able to prescribe birth control to our females, but we are not able to provide abortion services because of our federal status. And so that is one of the service lines within when you think about reproduction that the county is not able to offer. Although I do understand that Planned Parenthood Marmonte is planning on keeping their two clinics in Monterrey in Monterrey County open and active, and and they offer full scope reproductive services.

So, unfortunately, the clinics in Santa Cruz County both have closed down or will be closing down soon. It looks like Planned Parenthood Marmonte will keep our Seaside and Salinas clinics active in our county to be able to provide that full scope service to our residents.

Right. Okay. And just to be clear, so the forms of long acting birth control that we have available, are those available at all of the county clinics?

Yes. We have about 15 providers in our clinic services bureau that are able to prescribe methoprostol now. And we might have a handful of others that are willing to prescribe for therapeutic abortion. So we are trying to build our own internal capacity for the prescription of mefabristone.

Okay. And sorry, going back to the first question, the long acting birth control, like IUDs?

Yes. We we have providers that are certified and ongoing certification so that they can implant the IUDs appropriately across all ages.

Okay. And then also, I'm I know there's, like, a a number of different options, and so we have a variety of options available for all of our patients assigned to county clinics. Yes. Okay. Fantastic. Thank you.

Except for abort except for abortions.

Other than okay. Right. Got that. Perfect. Thank you. Thank you for all of the work on that and to make that possible. I think it's gonna make things a lot easier for a lot of folks to have that available in one location. And then moving on, just a couple other questions for public health. And I know with the STRiVE grant and going way, way back again, for a long time we were limited because of some federal legislation that prevented us. When we talk about violence prevention, we weren't able to talk about firearms or guns as part of the violence prevention conversation through because of federal limits, those apparently have changed.

And so now when we talk about violence prevention, my understanding is that we are now freed from those limits, and we can talk specifically about the impact of firearms and guns when we talk about violence prevention. So it it are we doing specific work or is there plans to do specific work around gun violence prevention specific to safe firearm storage, education about how to talk about firearm safety in homes, things like that, sort of along the be smart for gun safety, moms demand action kind of strategies.

Our current federal grant under the STRIDE program is really focusing on healthy relationships amongst our high schoolers. So that is not what you are describing is not a program that is currently funded by the federal government. Now, I did mention in my talking points that we are working with First Five and others to build a new strategic plan that will build safe and thriving communities. What the intervention strategies are that will be identified are yet to be determined. Hopefully later this fall, early winter, we should have a draft plan that we hope to be able to bring to the board, if not by the end of the calendar year, at the beginning of the calendar year.

Okay. Got it. Thank you. And then I guess along those lines, suicide prevention and I know we, the behavioral health had train trainers available to provide mental health first aid training and use mental health first aid training to local school districts. Do we still have those trainers available?

I believe so, but I can double check.

Yeah. To some extent, we believe we do. We also know that there are agencies out there that could be contracted and, you know, the county has contracted them and various organizations to be able to do that training. Then some of our community partners have also contracted with those other agencies to be able to provide Mental Health First Aid training. So we may provide it to some extent, but there are other resources that we are able to link up with to make that training available to our community based partners for their community health workers, for example.

Great. Thank you. And then my last question is around the public guardian and Natividad Medical Center inpatient mental health unit and sort of the interaction between the public guardian and folks who are in the mental health unit and how just sort of general, I have some more specific questions, generally how that works. And maybe I guess I'll generally request a more in-depth presentation on the public guardian as it relates to the mental health unit and folks who are who come into that that unit at some point. But maybe just generally, if you could speak to that.

So Natividad is the entity that's responsible for staffing the mental health unit. They currently contract with Vituity to be able to provide the psychiatric services for patients in the mental health unit, and then they hire the rest of the staff to be able to support those services. If a psychiatrist in the unit, after we've exhausted our 5,150 or 5,270 process deem that the individual needs additional support or time to be able to get back on healthier path, then they will refer that individual to the public guardian's office for consideration for conservatorship. There are specific timelines from when that referral needs to be submitted. It gets assigned to a deputy.

The deputy does their investigation. There's a consultation with the second psychiatrist because there has to be two psychiatrists that sign off on a referral for conservatorship. And if that individual is deemed to be a good candidate and conservatorship is the last resort for that individual, then we go through the process of petitioning the court for temporary conservatorship for that individual, getting them placed in partnership then with behavioral health once they get released from the mental health unit. So really, in terms of managing that, it's natividad, vituity with the public guardian, and then behavioral health if the individual becomes conserved.

And how often does that happen? Is that a regular occurrence or not?

I wish I would have known you were gonna ask me this, so I

could have brought some

stats. It's okay.

We well, I'll I'll just how about I'll just make a general request, like, that we that we bring that back, and I can pull some more of my questions together, and I'll get them to you.

Definitely. Okay. Perfect. Volume, Thank it's not high.

Okay.

It used to be higher in the past. We're happy to come back and provide you a presentation on why we've been able to keep the individuals longer in the hospitals under 5,002 and 70. We can keep them, I think it's an additional thirty days, which then gives the psychiatrist the time and the patient to be able to ensure if their meds management is on par and therefore the individual doesn't have to go down the path of conservatorship can be discharged from the hospital. So happy to bring back a more detailed presentation in partnership with Natividad on the MHU.

Yeah. I'd be really interested in that. Okay. Let's add that for a future agenda item. Okay. With that, let's open it up. Thank you so much, Elsa, and thank you, Melanie, for chiming in as well. And we'll open it up to anyone else in the public who has questions for this item presentation general overview of county health department. Anyone in chambers? Anyone in person? Anyone online? You can raise your hand. Alright. I'm not seeing any questions.

Thank you.

Those from the supervisor, Alejo, and myself. Alright. Thank you so much. We appreciate it, Elsa, and thank you for all the work you're doing.

Thank you.

Okay. I think we have a second agenda item today, and that would be another presentation from the health department, but from the Behavioral Health Bureau Mental Health Rehabilitation Center, the MHRC project. We have Fabrizio Chambeau, our assistant bureau chief.

Yes. Good afternoon. Sorry. And members of the public, my name is Faldizio Chombo. I am the working Adeclas assistant bureau chief for the health department, behavioral health bureau.

I'm joined with our behavioral health director, Melanie Rhodes, and our health director, Elsa Jimenez, as well as members of the public works facilities team online. So, Sofia, if you could please promote Luis Ochoa and Leonard Camposano in case, there are any questions they can assist. And so, yeah, we're here to give you an update on the mental health rehabilitation center project. First off, we'd like to thank you for the opportunity to provide you this update. This is a central, project to our bureau's goal of expanding behavioral health services by creating a dedicated local facility where residents of the county and neighboring counties can receive care close to home rather than relying on out of county placements or state hospitals.

So today, we'll walk you through, how the project has evolved, where we stand today, and the steps ahead. But before I do that, I just wanna make a note that the presentation that I'm gonna share, it's a little different from what was included in the agenda. There are two additional slides that are included in my presentation today, and I'll just, mention them as as I, come across them. Okay. So a little bit of, history on this.

So this project, really began back in late twenty twenty two, but the first, action on this was in February 2023 when our bureau applied for a $20,100,000 in state funding to rehabilitate a wing of the Old County jail that's located on Natividad Road. The intent was to turn this wing into a 100 bed mental health rehabilitation center. On 06/20/2023, the state approved our application, and the board of supervisors formally accepted the funds on August 2023. Fortunately, on February 2024, the sheriff's office determined that the jail site was needed for their own use, so which meant we had to identify an alternative location for the project. And that's when we pivoted to a new site, which is an undeveloped parcel at Constitution Boulevard and Medical Center Drive across from the Southern Complex.

This is a map of that location. It's that red quadrilateral highlighted here in the map. And then so kind of moving back to our background. So moving to this new site meant that the project went from a rehabilitation project to new construction. Since our grant application had committed to 100 beds, we needed to look for ways to build a similar facility with about the same number of beds.

So the project was then redesigned as a six sixteen bed facility plus one support building. The model that we based this on was the San Mateo County Stornediros facilities, which has been successful in both design and operation. And part of the reason why we turned this into six separate 16 bed facilities instead of one large building goes back to a federal Medicaid rule called the institutions for mental mental diseases or IMD exclusion. This is a rule that goes back to 1965, that states, that was created when Medicaid was first created, and it prevents, Medicaid from paying for care in mental health facilities with more than 16 beds. So by designing six smaller facilities, we make sure that Medi Cal can reimburse for the services provided at these facilities.

This was not just a design choice. It was a financial necessity to sustain the project long term. Kind of going forward to November 2024, we brought a report to the board of supervisors. At that time, we shared that our estimated project, budget had increased from $45,000,000 to $75,000,000 mainly due to shifting from renovation to a new construction. At this point, I also want to highlight that this estimate was based on cost that we saw when we built our Alisal Integrated Health Center.

So that led the funding gap of approximately $54,000,000 between a $20,000,000 grant and the estimated project's budget of $75,000,000 To address this, we you may recall that at that same meeting, the board received a presentation from the CAO and K and N financing regarding TLPs. So the board approved four to one seeking certificates participation to finance that, that gap. This next slide here just provides you with a view of the layout of the six MHRCs and support building. And so in this design, we try to address some privacy issues raised by the board by the board of supervisors by facing all MHRCs inward. This is one of the slides that's missing from the agenda.

Here, you can see a draft layout of the MHC buildings. So please keep in mind that there will be six, so this will apply to all the the different the six MHRCs. This is very similar to the San Mateo project, but since they've been operational for a few months, we did reach out to them, to seek feedback, that they had received from their operators, and we try to incorporate, some of those changes in here. For instance, one of the things that we heard is that they needed additional staff work area and storage space. And so these those considerations were included into this floor plan.

And, essentially, you can see the green arrow, that's the main entry. The red arrow, it's staff entry. And to give you an overview of the color coding, so blue, it's client areas. Yellow is shared space. Orange is staff only, and gray is building support.

The other slide that is not part

of the

agenda, it's the draft floor plan of the support building. So this building intends to house electrical and mechanical support for all six MHRCs. It will also include an industrial kitchen to provide food preparation for all the MHRCs. There's also a conference room that is projected to be used by the MHRC operators for training purposes, And there's will also be other office space, for campus security, the dietary director, as well as dropping space for staff that are in the campus, visiting clients at the MHC. Okay.

Going back to, a project background. So as we were working on this MHC, proposition one, was approved back in March 2024. And so, part of proposition one was, the issuance of bonds. And so the state issued a request for applications for round one of the bond grant. These applications were due on December 2024, and our bureaus submitted two applications.

One was a $31,000,000 application to expand the MHRC. Essentially, the intent was to take three of the MHRCs and expand bed capacity, from 16 to 32, which would increase our project's total bed capacity from 96 to 144. The other application was an $11,000,000 application for the construction of the behavioral health urgent care. The some of the issues that we came across this was that the grant application had a quick turnaround time and did not allow for collaboration with our architectural team before the application was due. So, in May 2025, our bureau was preliminary awarded both applications.

But as the architectural team was engaged, it was determined that expanding the MHRC to house 32 clients was not a viable option due to space and utility limitations. So as a result of these findings, we requested a meeting with Advocates for Human Potential and the HCS to discuss how we could still preserve the $3,031,000,000 dollars. And, essentially, what we're looking at at is separating the project into two distinct projects while maintaining our original 96 bed count, and we met with the state in July. Our request is currently under review. We were hoping we would have some news to share today, but as of today, we have not heard back from them.

Hopefully, they they promise that by the end of the month, we'll have we'll have a response. Another challenge that we are facing is that from the last time we presented to the board, costs have continued to rise. And today, that cost, it's approximately a $172,000,000. There are several factors driving the increases. One, the site is completely undeveloped, meaning we need to bring in essential and infrastructure such as water, sewer, and electricity lines.

There's also construction inflation, including federal tariffs that have raised, the cost across the industry. And then there's also a 20% contingency that is included to ensure that the project can weather further cost pressures. Despite all these challenges, we continue to pursue every available planning stream to offset some of these costs. So kinda highlighting some of the things that we've accomplished to date. So we have completed our programming.

That was done in April 2025. We we have engaged architects and engineers and are moving forward with design work. We are currently on performing environmental review with with SQL documentation. There's also geotechnical assessments and traffic studies that are in progress. And going forward, we expect to finalize floor plans in the next couple of weeks.

That will then be followed by public outreach to the neighboring communities in 2026. We expect to complete environmental review followed by contracting process and then begin construction in early twenty twenty seven. We projected construction completion in 2029. So in summary, we've come a long way since 2022. We've had to adapt the project in significant ways, but we maintain momentum.

The emergency remains a top priority. It will be our county and neighboring counties much needed local treatment capacity and reduce our dependence on out of county placements. One of our next major milestones is bringing a presentation to the full board of supervisors with with further updates on financing, design, and timelines. And with that, that concludes my presentation. And me and the team are here to address any questions you may have.

Alright. Thank you for the presentation. A lot a lot there. I'll pass the floor to start to supervisor Lejo.

No. A lot of changes the last time we talked about this. I just wanna be clear on the full grant amount. Obviously, the the application for the project has grown, right, from its original 96 and the estimate of up to 75,000,000, now the 172. So in terms of the state grants, beyond the 20,000,000, the the behavioral health bureau was also awarded the 31 and 11.

So the 31,000,000 was to expand the image That's right. And then then 11,000,000 to build a new behavioral health care center.

So that's 62,000,000 a total of the 30. Right? Yep. Yeah. K. That's good. But then the obligation is bigger, obviously. Right? Yeah. Costs are are greater. And just with the changes happening with federal funding, well, does that also impact? Does it does it place this project at risk as far as How how you envision how how this this would bring in funds, providing these services, how we would bring in funds to be able to pay the c the COPs and the cost? Do you expect any of the recent federal changes to impact this, the planning streams?

So at this point, we don't. But, obviously, as more information, it's released and, you know, also talking about earlier about bringing a presentation next month, We will definitely make sure that we take that into consideration.

Yeah. If I may, at this point, all of the proposed changes to the Medicaid program are really geared towards who's enrolled, work requirements on the physical health side of the house. We haven't seen any proposed changes for MedicaidMedical funding for mental health services for those experiencing a severe mental illness. We have not seen any proposed changes to to that funding.

And and, obviously, it leaves a large unfunded amount, a 100 and additional 110,000,000 for the COPs. Does that does that overall number include the debt service? It has a 20% contingency, but does does that is that the total cost with the debt service over the life of the the the COPs?

No. It does not need to be interest at this point. It's just the construction policy. Yeah.

Mhmm. So it's gonna be much more significant. Much more. And and and explain the the outreach that's gonna happen because that was one of my areas of concern previously. When is that gonna happen? Yeah. So, essentially Then you would, I guess, do a similar presentation to the neighbors of the group address. Right?

That is correct. Yeah. So, essentially, what we have been waiting for, it's having those schematics finalized, right, the floor plans and and all that so that we can then show the community this is what it's gonna look like. And and so I know that the intent is to have these outreach events near the neighborhood. And so, yeah, that's our plan to share that information, provide the type of individuals that are gonna be served in this community at in this facility as well as cost and billing layouts and all that stuff. So Mhmm.

What's what's the time frame for that? Is that the end of the year or

the No. We we we think it's probably gonna start happening in September. Probably in September. Yeah. We wanna do this as soon as possible. We wanted to share this with the committee first so that the board was aware and then bring it to the board of supervisors and then start those outreach events.

So when it comes to the full board, will we get the the overall cost with the debt service?

We can

include that. Yes. Numbers. The only thing I'm saying that we were at we were in one of our other policy committees looking at some of the major products the county has. Right? The seaside, Department of Social Services, those are all big numbers as well. So it it's it's whether the county is in the region to work had the wherewithal financial wherewithal taking on debt. As we take out more debt, it does impact their credit rating as a county, which we just a few years ago, we had really approved our credit credit rating, but this will certainly have an impact on on that. So I look I look forward to again, just keeping an open mind. I'm not arguing with the the the need isn't there.

Obviously, my my concerns were just the process of informing the residents and how we roll this out to the community, which we're gonna engage in very soon. And then, obviously, my biggest concern is the the the financing, the expense of it. The state is beginning to see if an amount, but it's still I'll say it's going to be at least two times what the state has contributed when when we when we end up getting the fuel. Yeah. If I may

Rosa, the last time we presented when the project was estimated at $77,000,000, with a period of third thirty year payback period, the total cost with interest was a $145,000,000.

It's almost double. Yeah. That sounds sounds about right. Yeah. Okay. I I appreciate that. Thanks for the update on him, and and go on and look forward when we consider full board suits. Thanks.

Thank you. Any other questions, supervisor?

No. No.

No? Okay. Great. Yeah. So I guess my my questions are generally around the the cost increase and just the financial like, making it work financially.

I know when we'd when the board approved the moving forward with with the financing or approving the the the proposal to finance it. The idea was that the the even with financing the rate the the Medi Cal revenue would be sufficient to to cover the cost of the finance the the interest on the financing. Is and I just to be clear, is that still the case with this? Or where where's the where do where do we where do we cross over that line? At what point does the revenue for operations of the project or of the program become not enough to cover the the cost of building the project?

Yeah. So definitely, we're there now.

Mhmm. Yeah.

The the project would not generate enough medical revenue to pay for debt service, depreciation, and all these other things. And so that's that's where we're trying to see if there's other funding sources that that we could leverage both internally with, you know, increasing productivity or other things. But, yeah, supervisor asked you that we're definitely there now. The the way as it stands right now, there there's not enough medical revenue to cover

Can you say what the anticipated annual gap is?

I don't think

And, again, we're still working, refining these numbers. And if we're not Yeah. And we don't have maybe I think we're planning to come to budget committee

Yeah.

Later this month, so we'll have a a little bit of a better picture. But the department is committed to figuring out what else we need to do within our overall system of behavioral health services to ensure the viability of this program in terms of once the MHRC is up and running, our capacity to be able to not only bring in enough Medi Cal revenue for services that are delivered there, but across our entire system to be able to make good on our COPs and our debt services. You know that recently we've gone through a whole payment reform with behavioral health, so now we're getting paid slightly different than we were before. We're trying to improve efficiencies within our system, maximize the time that we are spending with our clients to ensure that it's all billable time. So there's a lot of like we did with clinic services to try to ensure sustainability of primary care services.

We're beginning to explore and implement new things within our behavioral health system of care. So that hopefully we can confidently say to the board and to the community, by the time that this is constructed in several years, we'll have a plan in place that's already been in motion and implemented to make good on on paying back the debt for adding this asset to the community.

Yeah. Is there I mean, and then the other question, I guess, is is there a point at which the cost becomes like, what where's the cutoff point? Like, where's the, hey. This doesn't this no longer this no longer pencils, And do we know what that point is? And then within the timeline, I'm looking at the slides again.

Within the timeline that we're operating on, if we if we hit one of those points, where are the where are the off ramps that that exist? Mhmm. You know, I know I know we're in a we're in a we're in a we're a sort of programmatic committee. We're not in a a CIP or or or budget committee, but, you know, just looking at it with the because if we if we don't think about those off ramps and if we don't think about the cost pieces, you know, there will ultimately be programmatic impacts to services and programs that we really do need and care about. So this is a critical piece of those programs and that, you know, is necessary to to fit.

I I under I'm I'm I get all of that. But given given some of the uncertainties that exist in the construction space right now, I just I wanna be thoughtful about those realities and not find ourselves on a path that we're unable to pivot if if that is in fact what becomes a necessary reality for us. So just I'm throwing that into your I know you guys are always thinking about those things.

Definitely. We wouldn't wanna put the county in a situation where we would be compromising other services within the health department or county. Luis Ochoa is our lead over at Public Works Parks and Facility, and I see he has had his hand up. So I'm hoping we can give him the floor. Perfect. We'll go to

you, Luis, and then I think Florence Cabatha Green also had her hand raised too. So we'll we'll pass it over to our experts in the that space. Mhmm. Flores, floor is yours.

Yeah. So just one extra detail that I wanted to share with with the group. The $172,000,000 budget for the project shared and to put it into everyone's perspective is a a schematic design. So as the project progresses, PWFP, in conjunction with the health department, we will be doing, recurring, estimates of the project to make sure, you know, that the project stays in check. So we'll do another estimate when the project is at 50%, and the last one will be either a 90 or a 100%.

Yet the one caveat I wanna put to the whole group is, you know, we're still working in our environmental review. And so depending on the outcome of that, there could be items of the project that may need to be redesigned or adjusted to accommodate the environmental design, the CEQA, environmental impact statement report that is gonna have to be prepared for this project, as well as any outcomes that may come out of a traffic study that we are currently underway and that is part of the CEQA. And so I just wanted to flag that, but as I said, the project will be running and keeping on top of the budget and doing professional engineering estimates to make sure we that our numbers are as accurate as they can be by relying on professional experts on the field in, today's, you know, construction environment. Yeah. Just wanted to share that with the group.

Mhmm. Yeah. Thank you. And, Florence Cabasso Green, did you also, I saw your hand was raised earlier.

Yes. Actually, Luis said exactly what I was going to say. I just wanted to put that in everybody's perspective is that, you know, we're we're we've made a lot of progress, and we have a good idea of of the scope of the the cost, but we still need to progress, you know, through the the process of getting professional engineered estimates and taking into consideration any, outcomes of the environmental review. So thanks,

Luis. Great. And then to the to the question of, public, outreach, you know, I I I I'll defer to to the the supervisor whose district this this sits in, but I know that my my my my my preference would be on any project that that's happening in my community. I would wanna make sure that we're we're we're starting early with information and often. And even if it's, you know, not not finalized, that we're we're making, you know, making the information that is available available to the public as early as possible so that people know what's what's going on and have opportunity to know about every every every every chance to to have their their their their voice heard in in the process.

So I know the health department is skilled and has the resources to to to include include the public, but I I think that if if given that the board has, you know, said yes, let's move forward on this, I would hope that we can make sure that there's a a website for this project that has information, at least what what currently is available, and that there's a stakeholder list and that anyone who wants information knows where they can sign up to get information. And that anytime we're talking about the project, there's a notice that goes out and people have the ability to to, you know, be notified. And that as as things develop, people can continue to get alerts about what's going on. So that that would be, I think, a baseline for for my expectations for how we can at least move forward with public knowing what what's going on with the project. So but I'll defer to additional coordination with district one.

So I

I think it's it's District 2.

It's D

2. The prop the property itself is in my district, but the residential it's a dividing line between my district and supervisor church's district. So the residents the neighbors will are definitely D 2.

Yeah. Okay.

And to that point, we have maintained regular communication with district two regarding any concerns or public comment that they may be receiving. Nothing to date, and, obviously, we will coordinate with them as well when we start to do our community outreach and community meetings. As Fabrizio said, we've been waiting to get a little bit more of a final design. We softly introduced it when we first were down the path of planning, but we wanna be able to show the community what this is gonna look like with trees and schematics, and more importantly, how it's gonna look from the neighbors that are are surrounding the you know, the where they share a a wall property line. We wanna make sure that any concerns that they may have about the look and feel and proximity to their properties is addressed.

And so we've been working with the team to try to get some of those schematics, probably not final final, but final enough to be able to and I see Luis nodding his head, to be able to showcase it to the community.

And just Okay.

Sorry. Just wanna highlight that no approach is off the table at this point as far as engagement with the community. I know, supervisor, the last time we presented, know, you mentioned that we should do mailings and all these things. So we're trying to get the addresses of the surrounding properties to make sure that we do that. Zoom presentations, in person hearings. So nothing's off the table, and and we'll make sure that we try to do as much as we can.

Okay. Fantastic. Well, sounds like you guys are paying paying attention to that that point too. Okay. Well, I mean, let's open it up to public comment. Is there any is there anyone from the public here who would like to comment on on this item? I'm not seeing anyone stand up in the room. We don't have anyone here in Marina. Is there anyone with us online who would like to raise your hand for public comment on this item? This is our mental health rehabilitation center MHRC project. I'm not seeing any hands raised.

Madam chair, since there's no further comment, just another suggestion, I think we should notify the Salina City Council if if we decided to move forward on this, of course, which I know they've been talking to staff, but just some of the electeds. So I'm not sure everyone is aware of the the plans for this property within the city limits. Yes. Supervisor Church and I, we included providing direction to do the door to door or mail directly rather than the the Facebook ads that were done last time and some of the postings. I don't think everybody got that that information, so that was provided as direction last time.

But I think what's different, Elsa, like, before we keep going down, I think I think we need to circle in with the board sooner rather than later because of the cost Mhmm. Changes. The number grew over doubled Yeah. When you add in the debt service. And rather than keep doing all this work, if the board and our budget team and our assistant CEOs, you have to be able to make a decision whether we can afford this right now. Right? At your last presentation, which is one of the key points, you you told the board that you believe that the reimbursements could pay for it.

Right.

And that's why what you just said right now, which is

why Which was a true statement at that point.

I was doubtful. Was skeptical that that we could. Right? It's it's not too good to be true just because every project that we've done, the last two the juvenile hall, the jail, all went over budget, and that's outside of the political context that we're now. We're talking about terrorism.

Mhmm. So now we're at a point where we do know it's not gonna pay for itself. And then that that that makes it even clearer to the board of supervisors that if we move forward on this, it's gonna take millions of dollars every year from something else when we know our budget's getting tighter each each year. At least our financial forecast shows that it's gonna get more difficult rather than easier. And and when you look at who this will serve, it's not it's it could serve some of our patients, but it was intended to perhaps serve

50.

Residents from neighboring counties. Correct. And we know that Santa Cruz recently built a similar facility. Correct? No?

They don't have a mental health rehab center.

I thought when we met, I'll say, you showed me that there was some facility, a lot of facility built in Santa Cruz. And No. Because I wasn't aware of that, and I that was the

They have a Puff, which is different than a mental they have a psychiatric unit facility, which is shorter length of stay than, like, a mental health unit, but then people are released back into the community. I I don't believe they have a mental health re rehabilitation center the way that we are programming here.

Well, this is a one on one after one of our meetings, you brought it up. I didn't even know about this facility. It would you have you have brought it to my attention that this had recently been built, and you you gave me some of the the designs to show what it look like, to what it look like.

San Mateo.

Because that's where I became aware of it.

Probably San Mateo San Mateo Mateo is the one that I was showing you that they recently built it, not Santa Cruz County. So I think San Mateo has a m a m HRC, and we would probably be the next one in this whole kind of Bay Area Central Coast Region.

I'm gonna go back because I was that that raised

I'm gonna go back too. But That

that raised concern for me because it could be a competitor. Right?

Competitor facility. So so

we're we're gonna bring in the neighborhood, but there's a there's a facility that was built two years ago in Santa Cruz County.

I'll go back too, but but they don't have an MHRC.

That raised skepticism of of whether it would bring in the types of patients that as we previously thought that could pay for itself. But here we are building a new facility, not necessary for all our residents, but it is gonna take away financially from the different core accounting services. So that's, like, a question for Deb and the rest of the our budget experts to say, can can we really afford to set right now? And before we we keep doing more work and moving forward, I think the board has to relook at this new number and the new fiscal analysis financial analysis of whether, Johnny, at the end, is gonna be able to afford this and perhaps put us in a more tough financial situation in the years ahead by taking on something that we know is not gonna pay for itself often.

Right. But we're exploring how we're gonna make it pay for itself. And then we'll work with our team at Public Works who's leading the project in terms of what some of those you know, what at what point do we kind of safely off ramp, the project, put a pin on it until there's additional, revenue. So going back to so Santa Cruz has an institutes of mental disease, an IMD called 7th Avenue, but that's we we don't have any locked facilities like that in our community, and that's the closest IMD to us before you get to the Bay Area and then the Central Valley and other parts. But please go back to your notes and circle back with me on that because this would be the only mental health resource rehabilitation center in kind of all of Central Coast, South Of San Mateo.

Alright. Thank you. That was it, madam chair.

Oh, and just for the record, I do wanna remind us that our Alisel Integrated Health Center did come under budget Yes. I think by about $3,000,000, so we can maybe top that one too. But that one was and so, hopefully, that is the the what what is foreshadowing of what's gonna happen in the future in terms of us making sure we come within budget of our projects.

Bring up that example because I think it was, what, 25,000,000 Mhmm. Almost 19,000 square feet of building. And I brought up on our our last CIP meeting because when we're talking about the new department social services building, their their cost was, like, double that. Right? And I said, we just built this facility two years ago for 25,000,000. And why is it one of comparable size costing 50,000,000? I'm still skeptical because Mhmm. The health department did was, I think, contracted with a

Yeah. We worked closely with public works. Mhmm.

Good price for building on that side.

And that was built during the COVID pandemic too. So

Mhmm. Consideration that your costs are higher. Yeah. I it was gonna be higher today, but not double just on on

on No. What Fabrice was saying is during COVID, costs were even greater. So

the others are even greater.

Yeah.

But, yeah, definitely a good example of that. Mhmm. How we could build beautiful buildings for professional services not at an exorbitant cost. Mhmm. Yeah.

Definitely a challenge to navigate these things. And I'm I'll send your team. I you know, I think just because something comes in over budget doesn't mean that we, you know, give up on it, but I I definitely think some of the questions that you're asking, I appreciate them. And I think it's along the lines of the questions that I think we all we are we're all asking then trying to figure out, you know, what the path forward is. So I appreciate you keeping us posted and apprised as we navigate forward.

And, you know, clearly, the county is headed into some more challenging times, and the general fund won't be in a position or isn't currently in a position to to backfill for for anyone. So unlike where we've been in previous previous budget cycles in the past, I think it it just leaves us it leaves us without some of those buffers that maybe we've had to be able to to step in. So you know that, we know that, and how we move forward. I think collectively, we're all just a little more cautious together as we as we make the decision. So yeah.

I think the the the thought to sort of circle back in with our budget team, CEO team, and find the right ways to keep the full board apprised, and then maybe be really clear about where those where where the where the what you're thinking in terms of the ways to the ways your options for moving forward, what the what the what the off ramps might look like, and and and then keeping in touch with the board before we, commit along the way will be important. So okay. Well, I didn't see any public comments, so we'll do one more and more final call for public comments, before we close, this item. I don't think there was anything else on our agenda today, but I'm gonna double check. It's about 03:00.

But with that, we had the one item to bring the mental health unit and public guardian conservator back. And I think do we have who do we have coming up on our next agenda? Do we have our next presentation scheduled? We've completed all of them. We've completed all of them. Oh, fantastic. Do we have okay. Well, we'll I'll touch base then on what we have scheduled for our next set of presentations. Our next meeting is scheduled for September 15 here in the Monterey Room and on Zoom. Do we know what time that next meeting is scheduled for?

Is that September I think

it's 01:30. Yes. 01:30.

Yep. So we've got September 15 at twenty twenty five at 01:30. We'll be in the Monterey Room and on Zoom, and probably, I'm assuming here in the District 4 office as well. We'll see you all then. Thank you so much for spending a portion of your day with us today. We appreciate you and all the work you do. Thank you.

Alright. Thank you. Take care.