Good morning everybody. I'd like to call to order the May 16th, 2023 meeting of the Board of Supervisors. If we could begin with a roll call, please. Supervisor Koenig. Here. Friend. Here. Cummings. Here. Hernandez. Here. And McPherson. Here. I'd like to begin with a moment of silence. Any member of the Board of Supervisors would like to dedicate the moment of silence to Supervisor Cummings? Yeah, I'd like to dedicate the moment of silence to Ed Benson Porter, Jr. who at 78 passed away peacefully on April 28th, 2023. In the 1970s and 80s, Ed owned North Bay data services on Pacific Ave in Santa Cruz. He was a beloved teacher at Santa Cruz High School and pioneered some of the first computer classes in Santa Cruz County. Ed began to serve on the Santa Cruz City Council in 2020 working on several committees and advisory commissions and was reelected to the Santa Cruz City Council in 2024. Ed participated in many local political groups including serving as the chairperson for the People's Democratic Club here in Santa Cruz. General Mass will take place on June 3rd at 1 p.m. at the Shrine of St. Joseph at 544 West Cliff Drive in Santa Cruz. Thank you. And I'd like to acknowledge this National Peace Officers Week and issues National Peace Officers Memorial Day. I'd like to acknowledge Sergeant Gutzweiler, Sergeant Baker and Sergeant Butler who passed away in the line of duty and also have them on to the moment of silence. We could have a moment of silence, please. Thank you. Please stand for the Pledge of Allegiance. I pledge allegiance to the flag of the United States of America and to the Republic for which it stands, one nation, under God, indivisible, with liberty and justice for all. Good morning, Mr. Plausius. Are there any changes to today's agenda? Yes, we have one change. This is on the Consent Agenda, item number 20. There's additional materials. There's a revised memo, packet page 164 which is replaced. The commission name should read Santa Cruz, Monterey, Merced, Managed Medical Care Commission. That concludes the changes to today's agenda. Thank you, Mr. Plausius. Any board members like to pull an item from consent to the regular agenda? Yes, Chair. I'd like to pull item number 23. Okay, we'll pull item 23 and we'll make it item 9.1. Is that okay, Madam Clerk? Yes, Chair. All right, so now we'll open it up for public comment. This is an opportunity for members of the community to address us and items that are not on today's agenda are within the purview of the Board of Supervisors, items that are on the Consent Agenda or if you're unable to say items on the Consent Agenda. Good morning, welcome. Thank you. Buenos dias, good morning. My name is Teresa Carino and I am Co-Founder and Executive Director of Salud y Carino. I'm here to speak on the Justice and Gender Report and Recommendations. I am on the commission and served as co-chair for two years. I am also a survivor of gender-based violence. I share all of this because we can't talk about justice and gender without talking about the fact that more than 80% of justice-involved women in custody are also survivors of gender-based violence. I'll say that again. More than 80% of justice-involved women in custody are also survivors of gender-based violence. In 2017, Dr. Susan Green presented a report to this board entitled, Gender Matters, a Profile of Women in Santa Cruz County Jail based on 31 interviews with women in the main jail in Blaine Street. The JAG Task Force and this commission are a result of those women's voices, nothing about us without us. The 2021-22 report submitted to you all contains many recommendations I would like to speak on too. Develop permanent supportive housing specifically for women, including women with children to reduce cycles of homelessness and incarceration. In 2021, Dr. Green and I conducted interviews with 16 women in the main jail regarding safe and affordable housing. I distinctly remember how many of the women thanked us for asking them what they thought and for simply listening. I was blown away because all I could think was thank you for trusting us and for sharing your story. What we heard is that they wanted a chance to start again. They want to be seen. They want a safe place for them and their children. They want what we all want, a good life. The second recommendation I'd like to speak on is to encourage the Sheriff's Office to establish an outside reporting mechanism separate from monarch services for the pre-related concerns. PREA stands for Prison Rape Elimination Act. What this means in simple terms is that the Sheriff's Office shouldn't be regulating itself. There should be an outside agency looking into pre-related concerns brought to light by the women in custody. Thank you. Thank you. Good morning, welcome. Thank you. Good morning, honorable boarders, supervisors. I'm Cheryl Norte. I'm a former co-chair to the Justice and Gender Commission and I'm a senior analyst with the Housing for Health Division with Santa Cruz County as well. It's been an honor to serve on the Justice and Gender Commission, which is a platform that continues to recognize the distinct needs of justice-evolved women and acknowledge the gender-specific disparities that exist within our justice system. This commission, along with great women like Dr. Green, community stakeholders, survivors and women with lived experience has over the last two years taken a comprehensive, gender responsive and culturally sensitive approach to implement initiatives that enhance their access to support services and create a systemic change. This commission serves as a catalyst for change in this community, empowering women and transforming lives. As we move forward, let us remember the words of acclaimed feminist writer, Maya Angelou, who once said, each time a woman stands up for herself, without knowing it possibly, without claiming it, she stands up for all women. The Justice and Gender Commission stands as a beacon of hope in this community, ensuring justice, empowerment and opportunity for justice-evolved women and their families. I wanna say thank you so much to this board for your support, but also to encourage you all to continue to support us and continue this vital work. Thank you. Thank you. Good morning and welcome. Good morning, everyone. My name is Salazar Gutierrez and I'm the current co-chair of the Justice and Gender Commission and have been involved since it was a task force. The commission has submitted our biannual report and there is a long road ahead of us. You will notice that most of our recommendations are interconnected and that is because we as humans are complex and require interconnected solutions. We are encouraged by the news that Blain Street will be reopened and look forward to knowing when that will be happening. With Blain Street being opened, we hope it will provide women equitable access to the educational opportunities with Cabrillo and vocational training, like the hospitality and food service certification that men at Roundtree receive as well as opportunities for therapy that many women have asked for in an environment more conducive to healing. We also hope and look forward to resuming in-person contact visitation. In-person visits have not occurred for either men or women for more than three years. Currently, children are not able to have in-person visits with their mothers or fathers in custody. Having had family members incarcerated while I was growing up, the in-person visits we had were a way to connect. Knowing that there are children in Santa Cruz County who cannot hug their moms, dads, and other family members is heartbreaking. More than half of incarcerated people in Santa Cruz County are in pretrial and haven't been found guilty except maybe being disproportionately poor and people of color.  We hope this board will recognize the importance of addressing these unique needs of women in our criminal legal system. If we want to help people succeed after they have done their times, we need to provide opportunities for healing, healthcare, housing, education, and employment. It may sound like a lot, but the costs are a fraction of incarceration. Thank you. Thank you. Morning, Dr. Green, welcome. Good morning, thank you. My name is Susan Green. I'm a research associate in psychology at UCSC and I staff this commission. I wanna thank the JAG community for your dedication and especially thank the women with lived experience who have the courage to share their pain and perspectives. We are listening. One of the core values of JAG has always been nothing about us without us. You are the experts. This year marks 30 years that I've been working with women in jail. Things are worse for women everywhere in recent years. And when looking at women in jail in Santa Cruz County, it's also worse than ever.  There are longer waits for admittance to state hospitals which can leave people restricted to their cell for 23 hours a day for weeks or even months. There are no contact visits. More women report a parent who has experienced incarceration, higher rates of recidivism, more sexual assault cases in custody in recent years, and fewer housing options for women with children than in years past in Santa Cruz County. Our investment in incarceration has risen while some alternatives to incarceration have dissolved. As this report states, many of our social problems that are not of the jail's doing become the jail's problems. To talk about the things that need to be improved at the jail does not take away from the good work being done by the people employed there. This biennial report identifies the commission's activities and accomplishments over the past two years and includes recommendations where there is need for improvements both in custody and in our community. I'm encouraged to hear that Blaine Street will be reopening to accommodate an electronics upgrade but admittedly disappointed to read that it might not stay open. We hope you will see the value of opening Blaine and make it a priority to keep it open. And we ask that you work with the sheriff's office over the year of the project to identify ways to keep Blaine open. I've always felt that the more I learn the harder it is to walk away and pretend it's not my problem. And I'm confident that in Santa Cruz working together we can do better. Thank you. Thank you, Dr. Green. Good morning, welcome. Good morning. Hi, my name is Eileen. I'm a case manager at Monarch Services Confidential Emergency Shelter. And part of my role at Monarch is to support with the safe release program which provides women being released from custody one to two nights in a safe motel. We also support with any immediate needs and connection to community resources. I've seen firsthand positive impacts of this program for some women that one to two night bridge is exactly what they need in order to connect to family or outside programming and find a safe place to stay which is the goal. However, that being said, we have face challenges. Often we see women being released late at night or on the weekends oftentimes without a phone or an ID or means for transportation. It can be really hard to even secure that safe bed night. Additionally, although our advocates are fully trained in supporting with trauma around domestic violence, sexual assault and human trafficking and much of the incarcerated population are survivors incarceration in and of itself creates a whole new set of traumas. And it can be extremely hard when women are released and they need further support with mental health or sobriety issues when those community connections take longer than the one to two night bridge that monarchs providing. So although safe release has definitely been a step in the right direction, I think we're many steps away from being able to make sure that all these women being released have a safe place to land. Yeah, thank you so much. Thank you. Good morning, welcome. Morning, my name's Sarah Schumacher. I'm a public defender here in Santa Cruz. I also serve on the JAG commission, specifically the release and reentry subcommittee. I'm also going to talk about one of the clients that one of the first clients to use the safe release program that was just spoken about. This was a young woman with no prior criminal history who was college educated who chose to leave the workforce to careful time for her young child. At the time of the offense, she was alleged to have committed domestic violence against her husband who she lived with at the time and they were in the process of divorcing. I obtained her case. She had private counsel. I obtained her case after she'd been in custody for four and a half months awaiting placement at the state hospital. Ultimately, she was deemed competent and she was released through the safe release program. She couldn't return to the family home because of a stay away order. She didn't have any friends or family in Santa Cruz and she lacked financial power since her husband had been the provider. This small step allowed her to be on home confinement on an ankle monitor in a motel which was what the judge wanted to release her. This small step allowed her to then apply for jobs and employment. She obtained jobs as a living nanny working exchange for housing. The impact of those few nights in safe release was that she was able to obtain money for supervised visitation to visit her child to hire a family law attorney to stand at a real chance in family law court. We were able to resolve her one's felony cases for misdemeanors and she was able to comply with her probation with flying colors. So that small step of just being able to get out of jail when she didn't have any place to go provide her the stability she needed to progress. Although safe release is wonderful, we need more solutions for more than just a night or two upon release from jail. We need transitional housing for women and we need more housing and treatment options for women suffering from addictions and mental illness that is keeping them trapped in the criminal justice system. Thank you. Thank you. Morning. Good morning. My name is Jesse Silva. I am a child of a previously incarcerated parent. I'm also a librarian at the Santa Cruz Public Libraries and I've been providing library services inside the county jails and juvenile halls for about eight years now. I'm here to speak and support on the commission on justice and gender and advocate for the health and wellbeing of all the women and girls who are incarcerated in Santa Cruz County. I've been involved with the commission on justice and gender since it began two years ago and I've seen firsthand how effective it has been in improving the lives of women in the criminal justice system, reducing recidivism and intergenerational trauma and crime and holding accountable people and policies for reducing and preventing harm to women. As someone who's been inside the main jail and inside Blaine, I have also seen firsthand the drastic differences between these two facilities. As a maximum security facility, the main jail is not suitable for all women and I'm pleased that Blaine will be reopened. I hope to see Blaine remain open permanently so that there is a minimum security option for women as there is for men. This would provide more equitable facilities. This would provide more equitable facilities for men and women and improve the health and wellbeing of incarcerated women and their families. Thank you to the supervisors for your time and for supporting JAG and thank you to the commission for its invaluable service to women and their families in this community. Thank you. Good morning, welcome. Good morning, thank you. My name is Rochelle. I am the first time going into jail. I went in for charges that I did not do and they were recently dropped, but I have quite a story. I'm a survivor of domestic violence.  I have experienced PTSD my entire life since this and going into jail, it has increased dramatically. Luckily I was a part of the safe release program and I was taken into the mayor pose a home which is part of the monarch services. This place is extremely important because of one of the statistics, 75% of women who were killed by their intimate partner were murdered when attempting to leave or after they have left. So what this does is this give women a place that's safe. They can work, they can get therapy, they can get help, that I've got food, I got clothing and the hotel voucher was extremely important. After my release of jail, my partner was waiting for me outside of the courthouse. So having a place to go to where I was safe was the most important thing. Ever since I've experienced this I've completely changed my life. I sobered up, I'm not smoking marijuana, I'm not bartending, I've completely changed. I've now been accepted into the Gemma house and I'm very thankful for the opportunity that it's given me. I have a binder that's full of all the work that I've put in the past month from domestic violence classes to therapy to NA meetings. And I encourage all of you to look through that and see what it looks like for a woman who was struggling to gain their life back. I have some more statistics for you. 20 people per minute will be victims of domestic violence in the United States. One in three women were victimized by domestic violence in their lifetime. It used to be one in four. 20 million women in one year will be victims of domestic violence. And the most important part of this is the most dangerous time for women is when they leave a relationship. Thank you. Thank you. Good morning, welcome. Good morning, board. Greg Benson from the EMS agency. It's an honor stand before you and I just wanted to express my appreciation for the proclamations that you included in the agenda packet of recognizing the upcoming EMS week for our responders. Santa Cruz County run about 18,000 calls a year for service in the EMS system. And we can only pick a handful to kind of recognize the cooperation and collaboration that all of our system partners put together. This year through those proclamations you recognized four events and one retirement of a critical member of our team. Sorry, critical member of our team that after a 45 year long career is gonna hopefully take it easy and slow it down a little bit. In those proclamations, the four calls we have two cardiac arrest saves and two trauma patients that were absolutely sustained life-threatening injuries and without intervention would not be here today. Again, thank you and I appreciate the proclamations and they'll be dispersed at a upcoming meeting to the other responding agencies. Thank you. Good morning, welcome back. Good morning, Emily Chung, Public Health Director for Health Services Agency. I wanna piggyback on what Greg Benson shared about EMS week. So emergency services week is next week, May 21st through 27th. So thank you again for the proclamations. The theme for this national event is where emergency care begins. And this truly is where emergency care begins as Greg mentioned in terms of how many calls for service integrated system of care offers throughout our county. I wanna really acknowledge our own team within Health Services Agency that make up our EMS administration backbone. And that includes Greg Benson as our director and we have our medical director, Dr. David Galaducci and our staff in public health, including Claudia Garza, Shelley Hudson, among many others who support our EMS work. We do, our team does work such as our certification and quality assurance for our paramedics and EMTs in our community and works with pre-hospital admissions in our hospital systems. And many other things that I won't name today. We also backbone the emergency medical care commission and to ensure the quality of the services throughout our integrated EMS system. So we wanna thank everybody that is part of that whether they are first line responders in fire or paramedics or our emergency room staff and so many other types of positions that provide first responder care. And while I'm up here, I do want to acknowledge everybody that has spoken about the justice and gender commission. I really do think that's a wonderful work that everyone is doing and support this from a public health approach. These are important issues of equity and justice to ensure that anybody who's incarcerated has the opportunity to improve their conditions. So thank you for considering their work and to everybody for that work. Thank you. Good morning and welcome back. Good morning. My name is Jen Herrera. I'm one of the assistant directors with the County Health Services Agency. I'm here to follow my colleagues to, I think the board for the proclamation for emergency medical services week. The EMS sector is truly vital and is there for a community when it provides a critical service for a community when it's most needed. I'm also here as a representative of the JAG commission as well. And I want to thank the County and all of the JAG representatives before me for being part of this collective effort to have multi-sector engagement to support women who are incarcerated. It's not just about elevating the voices of those who are incarcerated, but it's listening to them, recognizing their humanity and recognizing that those of us who are in power and have the ability to change structures have an ownership to do that. So thank you very much. Thank you. Good morning, welcome. Good morning, honorable supervisors. I'm Lynn. I'm the executive director of CASA. And I am supposed to come up here to talk to you today about why not allowing in-person visitation is difficult for children. And driving here, I realized that the prepared speech that I had, I wouldn't be unable to give. And that's because, and please excuse me, I very recently and unexpectedly lost my mother. And I went into a Verizon store, as you do to have her phone turned off. And I realized that she was my emergency contact at the age of 57 years old. I still relied on my mom to keep me safe. And now speaking, sorry, it's very recent. Speaking as the director of CASA, I would say it is one of our underlying fundamental principles that removing a child from their parent is traumatizing to that child. In fact, this is so self-evident to us that it is the underlying principle for every CASA in this country. When we remove children due to incarceration from their parents, we take away their safety net. We cause the trauma that you see in me today. And we can heal that. We can take steps to healing it with in-person visitation by allowing our parents and our children's to touch each other again. The smaller the child, the more important that is. It allows them to self-regulate. Another one of our fundamental principles is that the sooner we can return a child to their parent, the better for that child. So please, please, affordable housing and the continuation of medication when people are released from prison is so very, very important. And I'll just finish by saying if I know everyone in this room has lost someone and most of us have lost parents, well, many of us have lost parents, if you could touch or hug your parent again would that not help? That's what we're asking you to give our children. Thank you. Good morning, welcome. Good morning, Esmenal de Torres, Program Manager with Monarch Services and also a member of the Jack Commission. I've worked with female survivors of domestic violence, sexual assault and human trafficking who have been in custody both at main jail and blame facilities for the past six years. Both facilities come with their challenges, but for sure, blame is more humanizing for those individuals that are in their healing and recovery phase. For example, at Blaine Street, it is easier to program. Programming can be more fluid and readily accessible to all. They have classrooms to be able to meet with community service providers to talk about traumas, settings, more inspiring to practice healing and coping mechanisms. At main jail, there tends to be more lockdowns, less programming, less time spent outside, more indoors, more confined, oftentimes with individuals dealing with mental health crises that just exacerbate everyone else's mental health conditions. I've been with women at main jail in the gloomy rooms trying to have sessions and then can hear the other women behind the wall screaming due to their mental health. Individuals expressing how they feel off or not well because they have not been given the medication they need or given other medications in lieu of what is prescribed because the jail does not have it or simply because they have not been able to get medical attention that they need when they're in custody. And since Blaine closed, women feeling great pain dig deep down to their bones because they are not able to see or hug their children. It was very exciting news to hear about Blaine reopening and programming starting soon. Blaine needs to remain open and stay open permanently, not just for one year. Women have been overpopulated in the units, have had to wait and be cluttered in a couple of units while units for men around to remain open and available. Blaine is a space for women who try to rehabilitate and get programs they need to better themselves. It's a space to connect with the outside resources that they need for successful community reentry and a way for us to see less recidivism. Thank you for your time. Thank you. Good morning, welcome. Good morning, thank you. My name is Rebecca. As an individual having lived experience with the criminal legal system and as a survivor of the criminal legal system, I wish to express my sincerest gratitude. Thank you to Dr. Susan Green and the Justice and Gender Commission to include the appointed representatives as well as the growing body of community members who are contributing to the cause for being dedicated and committed to advocacy and action for the target population. Thank you to the Santa Cruz County Board of Supervisors for taking the actions necessary to establish the Justice and Gender Commission. And thank you to the County commissioners for thoroughly considering and taking action on the related issues as they are brought to awareness and brought to attention. Thank you for hearing and listening to the voices of experience. As in order to facilitate necessary change, acute understanding must be present with effective communication and impassioned collaboration. The incredibly important issues being addressed can continue to be approached with the urgency and focus they require. While the core issues at hand are undoubtedly challenging to face, the courage and responsibility that is exercised in the process has and will continue to provide better circumstances for the affected women, their children, their families and the community. Thank you. Thank you. Good morning and welcome back. Good morning. My name is Cassie Gazapura. I'm a former public defender. I now work at Monarch Services and I've been a part of the JAGS commission's work for the past five years. One of our areas of focus has been healthcare for system impacted women.  In fact, they've probably felt it more acutely. As it stands now, mental health needs become the JAGS problem and JAEL is not the place to address these issues. According to chief radices report to the commission last August, nearly two thirds of women in custody receive prescription medications and nearly half receive psychiatric meds. When women are released, most are not able to fill prescriptions for the meds they are taking in custody, which often leads to immediate destabilization which in turn culminates in re-arrests, perpetuating the cycle. Most JAELs are the largest mental health provider in the county and this is true in our community as well and healthcare including mental healthcare and reproductive care are inadequate to meet the needs of women. We've heard accounts of miscarriages in custody and lack of access to appropriate care including prenatal care. We understand that the sheriff's office may not be aware of miscarriages as they are often not talked about and are highly stigmatized and they are always not a medical procedure. And we believe the women who are brave enough to share their experiences with us. Our JAEL should not be our largest mental health provider and we hope this board will consider the need for increased investment in meeting physical and mental health needs rather than simply incarcerating. We can create better alternatives for our most vulnerable community members so they do not continue to cycle through our JAELs which exacerbate these problems at high cost to taxpayers and overall community wellbeing. Lastly, when the contract for the JAEL medical provider comes before you all, we ask that you recognize these issues, identify them directly and think them through during the contract review process. Thank you. Thank you. Morning, welcome. Morning, thank you. My name is Katie Mayetta and not only do I stand before you as a consultant that supports and really making social changes for criminal justice but also as a woman that is a child of incarcerated parents. And really I've been a part of this, this amazing justice and gender task force for a long time. And we wonder why are we separating out women from this ongoing problem that is affecting our entire community of justice and mental health and substance use in our legal system? And the truth is that trauma has affected women way more significantly. And you guys have heard all of those points but also this legal system has been built by men for men in a world that originally was for bad people. And we wonder what bad people really mean. And bad people is a definition that has been blurred that now we're recognizing that that really means children who have been traumatized, children who have been put in really difficult situations that because of the social ethic, I don't know color of their skin, how much money that they had, the situations that they grew up in have affected the way that they have lived. And we are now changing that. We have so many programs that are now preventative. And now we are in the system that we are now addressing those issues. And it's amazing, but now we have a lot of people that are in our legal system that we need to help them now.   But we are working within the system that we have, the facilities that we have, the damages that we've already made, and it's taking a long time. Cal Ames is one step towards that and the decisions you're making now are all of those steps towards that. So thank you so much for your consideration and thank you for the changes that you are making now for that. Thank you. Good morning, welcome. Hi, good morning. I come a little bit unprepared, but I am here in support of the Justice and Gender Commission. I am a commissioner and I am also the executive director at Walnut Avenue Family and Women's Center. I'm also a psychologist that specializes in trauma. So I'm here to reiterate all of the things that have already been said and to thank the commission for the incredible work that has been done already and thank you to the folks with lived experience who are brave enough to come forward and share their stories. And I just want to reiterate the points that trauma-informed care is a necessary service that we need to continue providing. We need to keep Blaine open and continue improving those services. And then secondly, I just want to reiterate the importance of parents being able to touch, hold and feel their children on a regular basis. Thank you. Thank you. Good morning, welcome. Good morning. My name is Sarah Kochan and I am currently a member of the JAG commission. I want to thank you for taking the time to hear our stories today and our perspectives and for supporting JAG. I was raised in Santa Cruz. I grew up here for my first five years. In 2017, I got married and my husband, my now ex-husband and I, we came here and we bought a house in Brookdale. I was a stay-at-home mother. We had our first daughter in 2017 and I was a stay-at-home mother and homemaker for four years. My daughter and I were never separated for more than an hour. I was breastfeeding her until she was almost four. And on 7, 7, 2021, my husband, my ex-husband and I, we got in a physical fight. I had cracked ribs and my husband ended up with bruises from Ibidam. After that fight, my daughter and I, I talked to our neighbors and I got a rental agreement to move in next door. And my daughter and I ended up living there until nine, two, about for two months. On 7, 25, about two weeks after our fight, I found a restraining order on my car, my car window outside. It was signed by late Judge Paul Maragonda and it was based on, it was signed without any due diligence and my husband was granted full custody of my daughter. He made up three lies in this restraining order. He said I was living in a vacant building. Obviously it was vacant when I moved in. I got a rental agreement.   CPS never contacted me. They never came to see my daughter and I. But with a stamp from a judge in one day, my daughter was ripped apart from me. We were living next door. I was completely financially dependent on my husband. I was a stay-at-home mother and homemaker. So, I didn't really have lots of funds but I started consulting attorneys and I eventually got a criminal attorney because I eventually needed one. My daughter didn't wanna go and stay with her father. He was next door. We saw him basically every day driving by but we didn't really talk and she didn't, he was also, he works full time. So, he wasn't capable of taking care of her. I was eventually and ended up getting charged with a felony. Eventually I was charged with three felonies from the Santa Cruz County DA's office. One felony for kidnapping my daughter. So, I had to hire a criminal attorney and start to fight that. On nine two, I was arrested here in Santa Cruz and I ended up bailing out the next day. When I was arrested, my daughter was handed over to my husband and my husband disappeared. He abandoned our house and there was absolutely no contact with me. Despite, in the restraining order, I was supposed to be getting supervised visitation with my daughter Monday, Wednesday and Friday and every other weekend of the month for about, for months, my husband disappeared. He didn't contact me. There was no visitation. On nine, in December, I was arrested and eventually facing three felony charges from the Santa Cruz DA's office. Ma'am, ma'am, if we could just. Anyways, it's a long story. I thank you for listening to me today and I just wanna thank you for supporting JAG. Thank you, it's an important story. Morning, welcome back. Thank you, good morning board members. I'm Randy Morris, I'm the director of the County's Human Services Department and I just wanted to thank your board for recognizing two important month of May proclamations that is in your board agenda packet. The first is the month of May is Cal Fresh Awareness Month and that is the program formerly known as Food Stamps that we administer in the County Human Services Department and it is a month where California encourages local government to increase awareness about the benefits of Cal Fresh to fight food insecurity, to dispel myths about Cal Fresh and to assist eligible local residents to apply and enroll in Cal Fresh. Pleased to report that we do really wonderful work here in Santa Cruz County and we have 39,000 residents enrolled in the Cal Fresh program and I wanna give a special recognition to our community partners at Second Harvest Food Bank with whom we have a contract under your board's approval that does amazing work in the community raising awareness and encouraging and assisting people to apply for Cal Fresh. The second proclamation that is in your packet is another month of May recognition that the federal government, the administration of community living recognizes older Americans month. The theme for this year's recognition is aging unbound and it is a effort to ask us locally to explore diverse aging experiences, discuss how communities can combat stereotypes about aging and to invite us to promote flexible thinking about aging. And finally, I wanna take a moment to recognize your board has on consent item number 37, which based on a direction from a chair friend and Supervisor McPherson back before COVID, we were directed human services in the county administrator's office to apply in partnership with our AAA Seniors Council to AARP to become a member of the age friendly community. And because of COVID and the disasters we have been delayed in doing so, we now have a governance committee working with cities, community partners, the AAA and board offices. And I want to turn it over to Alicia Morales from my department who's playing a lead role to say a bit more about the consent item. Thank you. Thank you, Director Morris. Morning, welcome back. Good morning. Good morning chair friend and county supervisors. My name is Alicia Morales and I'm the HSD director of adult and long-term care division. And in that capacity, I am here today in partnership with our CAO's office to speak on item number 37 on your consent calendar. These efforts are important because like California and much of the nation, Santa Cruz County is seeing a demographic shift with an increasing older adult population. By 2030, it is estimated that one in three county residents will be age 60 or older. To better prepare our community for this shift, the county is working closely with partners from the seniors council, the four city jurisdictions, local community-based organizations and county residents to develop a strategic plan with an emphasis on equity to implement the California master plan for aging. Our membership into the age-friendly network will help ground this important work and allow us to engage and collaborate in meaningful ways to make Santa Cruz County a place for all ages and stages regardless of ability, socioeconomic status, race, ethnicity, gender, identity, sexual orientation and all other factors that make each of us beautiful and unique in our own ways. After we are formally accepted into the age-friendly network, we plan to come back before your board to update you on our efforts under the master plan for aging and how membership into the age-friendly community complements this work. Your support today is an important step in creating a livable Santa Cruz County for all. Thank you. I'm sorry, I'm very emotional. All of these speeches were very touching. Thank you. Morning, Director Machado, welcome back. Thank you. Good morning, Chair Friend and board members. I want to thank the board this morning for declaring the week of May 21st through May 27th as Public Works Week in Santa Cruz County. This year's theme is connecting the world through Public Works. This is a national event and this year's poster illustrates how Public Works connects us all through infrastructure and service. And I'd like to comment that Public Works is a very broad topic in a broad area. It includes housing, it includes utilities, it includes solid waste, it includes flood control. I just want to thank you for that recognition for all that our staff does. So thank you. Thank you. Good morning, welcome. Good morning, it's nice to be here. My name is James Union Whitman. I'd like to make comments on number 13 on the consent agenda on quantified ordinance adopt military weapons youth AB 481. I haven't read what was on this today but over the past maybe seven or eight weeks it's come up three or four times in the city. And this is at least the second time in the last two months. What's not really being discussed is the military weapon that's in my hand and that any cell tower under 150 feet is totally unregulated. There's a free document anybody can access that in 1976, 8,500 documents were declassified by almost every three, four, five letter agency including the Russian military and our military. So my point of standing here is it seems like as an 11 year old kid doing what I was doing, the job of law enforcement is probably six times more difficult. And that's primarily more difficult because most people don't have a basic understanding of our US Constitution and our Declaration of Independence. Our first US Constitution only lasted two years the flags that I'm standing right here those are corporate pirate flags. So these supervisors may seem to be supporting the public but they're under the control of the city and county managers and that's not an elected position. So what's really going on here with justice and who you guys represent. Thank you. Thank you. Is there anybody else in chambers? Madam clerk, is there anybody online? Yes, chair. Colin user one, your microphone's now available. Thank you for the people who have been speaking just now. I always am better informed from listening to members of the public regarding item 13 military weapons. I think the militarization of the police is an assault on the public and the police and sheriff already have more than enough weapons in their arsenal, in my opinion. And we should not be having this kind of damage to the public under the guise of protecting the public regarding the justice and gender task force and women disproportionately harmed. I always am looking at what environmental and social problems and the policies that we're subjected to are negatively impacting people. And what James just said about military weapons being the wireless cell phones, cell towers, Wi-Fi, you could go on and on the satellite. This is a key factor and we know that exposure to these anti-life microwave frequencies results in depressive tendencies, fatigue, headaches, memory loss, concentration problems. The focus needs to be removing the harm and stopping the corporations that are violating our health rights from causing egregious harm. Thank you, Ms. Gara. Is there anybody else online? Evan, your microphone is now available. Hi everybody, I'm in supervisors. My name is Evan Robles. I'm the co-chair for Justice and Gender Commission. I've also been involved since the early days of the JAG task force and believe wholeheartedly in our work. I'm also the director of campus and housing at Housing Matters in both roles. I work to empower, raise the voices of and foster resilience among vulnerable women in our community. Unhoused and unaccompanied women are highly vulnerable, have high rates of incarceration and are often victimized and the impact of their struggles reaches far beyond the individual and impacts this community as a whole. Of the 31 women in jail interviewed for Dr. Susan Green's 2017 report, Gender Matters, more than three out of four women reported that they had experienced homelessness and nearly half indicated that they did not have a safe place to live upon release from jail. There is a severe lack of housing in this county. We cannot begin to address the challenges presented in our jails without expanding and developing permanent, not transitional but permanent supportive housing, specifically for women and their families. The endless cycle of homelessness and incarceration is costing this county dollars, impacting the beautiful environment, public health and so on. These issues cannot and will not be resolved until there is enough affordable housing in this county, particularly for justice-involved women. I do wanna thank all who have spoken in support of the JAG Commission. Additionally, I am encouraged by the opening of Lane Street and would like to advocate that it remain open beyond the project completion date. Thank you for your consideration and service to this community. Thank you. Clay, your microphone's now available. Good morning, Clay Kemp, Executive Director of the Seniors Council and I'm here to echo the comments of Alicia Morales and Randy Morris and all the issues they brought forward. We're really happy to be here acknowledging Older Americans Month and especially happy for multiple projects that we're working on with HSD and other county staff. Especially excited to see the age-friendly communities come back on the agenda. We were all gung-ho to do that until COVID put us all in a major stall. So nice to see things starting to revisit. A couple other things that I wanna share that we're all working on together. One is the mention of CalFresh Week. Project Scout and the Seniors Council have an independent grant to make sure older adults are also accessing CalFresh and it's kind of the perfect partnership in that when Project Scout prepares a seniors taxes and sees that somebody is low income and would probably qualify for CalFresh, that's a natural partnership to just offer that person assistance with the process which we're more than happy to do. A couple other things to highlight, you've already heard about it but you will certainly hear more is our work together on master plan for aging. We were just one of 15 agencies in the state awarded a grant to develop master plan for aging activities and plans for both Santa Cruz and San Bonito County. So we're working closely with Alicia and Randy on that. You'll certainly be hearing more about it. And then the other thing that no doubt will come back to this board is two senior needs assessment projects. One that we work with every four years with California Department of Aging to conduct and another independent survey that the county will be conducting kind of as a followup to dig a little deeper on the findings of the state survey. So lots of partnerships in the queue thanks to everyone for those efforts and just close with reminding everyone that ageism is an equity issue and looking forward to addressing that as well. Thank you. Thank you, Mr. County. We have no further speakers, Chair. All right, thank you. We'll close public comment and bring it back to the board for comments and action on consent. Supervisor Hernandez. You know, first I wanna thank County staff for moving forward with the AARP membership as well. I remember sitting in on some of the first few meetings before the pandemic and as a council member back then with a former council member, Lowell Hurst, we attended the first few meetings to discuss that. And so I'm really happy that we're moving forward with this so we can continue some discussions with having to do with isolation, health, walkability of our communities. And I think that AARP really does focus on some of these important issues. So thank you. The other thing is I wanna thank the Jag commissioners and supporters for speaking up on this report as well. I think that advocacy is always important and appreciated and especially for dealing with issues with incarcerated women. And so thank you for speaking up on these issues. And also I want to thank my new commissioner, Judy Giddelsen for the Sandwich County Regional Transportation Commission. You know, many times these commissions are contentious and a thankless job. So I really wanna thank Judy Giddelsen and all my commissioners really for the job that they do. Thank you. Thank you, Supervisor Hernandez, Supervisor Cummings. Thank you, Chair. First I'd like to start by thanking all the members of the Justice and Gender Commission for their hard work on this item and the recommendations that they brought before us and all the people who shared their stories here today. It's really critical that we're understanding how people are being treated in a criminal justice system but more importantly how women are being treated in the system and how we can improve the circumstances that people are in to make sure that they're getting the help that they need so that when they have served their time that they're prepared to go out into a world where they get support by the community. I have some questions that I wanted to ask on this and it's to follow up on some of what we've heard. In particular, it's encouraging that Blaine Street is being reopened but I'm wondering if we can have staff speak to what might be done to keep Blaine Street open permanently and what opportunities there may be. Yes, regarding Blaine Street, keeping it open permanently. Yeah, I don't know if the sheriff's representative is here to speak on that. We can certainly comment. The main issue has been staffing. We have a severe shortage of correctional staff and requires four staff members, additional staff members to staff Blaine and so we're having to use mandatory overtime to do that but I'll leave it to the sheriff and see what we can do in the CAO's office to support the sheriff in doing that. Yes, staffing has been our primary issue with keeping Blaine open. As Mr. Palacios just referenced, our staff's been on mandatory overtime for well over five to six years at least. In order to open Blaine, it's four full-time employees to maintain it 24-7 and as a result of us opening Blaine, even now it's gonna be an additional one to two mandatory overtime shifts for every staff member we have every six weeks. And that's an addition to the mandatory overtime that they're already working. And then the other question for follow-up was somebody mentioned the Well Path contract which would be coming to us soon. I'm just curious what the timing is on that and whether there are other options because it sounds like there's some concern with that as well. I believe that contract ends in 2024. So that ends my questions on that but I would like to see if we can add additional recommendations that staff provide a response to the recommendations that have been brought forward by the Justice and Gender Commission, including what it would take to keep Blaine Street open permanently and report back to the board by no later than the second meeting in August, understanding that there's a lot going on right now and we can get some responses to the recommendations that have been brought forward. It could help it so that this isn't just a report that we're gonna approve and then it goes and sits on a shelf somewhere that we're actually gonna proactively try to address some of these recommendations. Yes, we can provide a response to you within the next couple of weeks to a month. Then the next item I had a question on was item number 29 related to inmate welfare and so maybe you could just stay up here. So looking at the budget, one of the things that stood out was that about 75% of the funds for the inmate welfare fund are being used on staffing. So I'm just wondering if you could break down since there wasn't a breakdown in the report of what that staffing is. I'm just gonna run to better understand what- Yes, I have Kathy Samse here, who's our fiscal manager and I was gonna have her speak to that. Thank you. That funds three program coordinators that directly and only work on inmate programming and also a program manager. Great, well, thank you for that and I think next year's report is to be helpful to have that broken down a little bit so we can know what programs are being offered and that way it's clear for folks that this is really to support the programming and services they're being offered in the jail. And then the last comment I had, it was on item number 38, which is safe park funding for safe parking programs and just wanna thank county staff for finding, it's about, it's over $366,000 that's gonna go towards helping to support some of the safe parking programs that we have for people who are experiencing homelessness. The county has been helping with these programs for quite some time now. I just wanna thank the county for helping to find those funds and for that ongoing support. And that concludes my comments on the consent. Thank you, Supervisor Cummings, Supervisor Koenig. Thank you, Chair. I also wanna begin by thanking everyone who shared their stories with us today. Really helped deepen my understanding of the issues that face women in our community and hope to continue the work to improve the conditions for men who are involved in the correctional system so that we have better outcomes for all. I certainly share this interest in ensuring that we open and keep Blaine Street open as permanently moving forward. And in fact, I was just speaking with our personnel director about this issue of how we can ensure that we hire enough correctional officers to keep that facility open as well as fully staffed roundtree as well. I do think it's a great injustice right now that men have access to a medium security facility that's more supportive at roundtree, but women do not. So she informed me that we are taking several steps. First of all, a number of salary increases, one that's already happened and a couple more coming up, one at the end of the year and another one at the beginning of next year. We also took some time to identify where there's bottlenecks happening in the application process for new correctional officers and she committed to addressing that so that it becomes less of an issue going forward. And I think that of course we can continue to work with the sheriff's office to do outreach to the community about how important this role is and how it really can lead to better moralistic treatment for folks involved in the correctional system. I also wanted to comment on item 38, the agreement with the Association of Faith Communities in the amount of $355,000 for the Safe Spaces parking program and thank Human Services for finding this money to be able to support this program. It is incredibly important. I mean, not only the success of the program, the fact that 39% of households involved in the program do move on to find permanent housing. Thanks for the speaks to how effective it is. And not only is it effective in terms of the outcomes, but it's incredibly effective in terms of the cost of providing these services because these faith communities are bringing their own land and oftentimes their own volunteers, they're able to offer these services really for a cost per space or cost per bed for an amount far below what we see from some other providers. So really glad that we are supporting AFC in this effort and hope that our board can continue to find funding and support them beyond 2024. I think particularly as we see things like the oversized vehicle ordinance going to affect in the city of Santa Cruz, it's important that we provide sanctioned options at the same time that there is greater enforcement throughout the community. And finally on item 41, accepting the lowest bid for the Soquel Drive project, I'm just really excited to see this move forward. I think combined with the bus on shoulder, auxiliary lane project on Highway 1 that we just broke ground on, combined with the $38 million that Metro is receiving to buy, really ultimately replace almost a third of its fleet with zero emission buses. This Soquel Drive project is moving us towards a true 21st century transit system in our community and it's really great to also that we are including the fiber optic cable portion of this project that's going to bring high speed internet right here to this building, the headquarters of county government. So truly that poster, we're being worthy of the high-tech look of that poster celebrating Public Works Week next week. That's all my comments. Thank you. Thank you, Supervisor Koenig. Welcome back and Supervisor McPherson. Thank you, Mr. Chair. I too want to thank those who came from the Justice and Gender Commission for stepping forward and letting us know how you think it's working or not working and how we might be able to improve it. And I especially want to thank Ms. Green for her leadership in this. She's been really sticking with this and you have a great leader in overseeing how we can improve the system that we have. A couple of items on the consent agenda. Item number 17, the mosquito vector control request for proposal. Thank you to the CAO and the Ag Commissioner for bringing this item to the board. This is a positive step to improve health in Santa Cruz County and providing adequate resources to deal with the invasive mosquito issue. I know it sounds like a little issue, but it can be really huge and be very, very worrisome to the people of this county. And this is yet another facet of climate change that is impacting our local community and we should take a closer look at how we can properly fund this because we need to continuously fund this very, very serious health related issue in Santa Cruz County. On item 31, emergency communication system or crews aware, the lack of integration for the different communication notification systems has really been a problem in my district in Santa Rosa Valley, the Fifth District. So I appreciate the work from the OR3 to address these communication challenges quickly. And as I'm afraid, we only have a greater more serious emergencies in the future. On item number 37, which has been mentioned about the age-friendly communities. I want to echo the gratitude for our county staff and the seniors council for working collaborative on a path forward to join the list of age-friendly communities. As was mentioned by Clay Kempf of the AAA, the Area Agency on the Aging, which I'm a member of, that we are one of the 58 counties, one of 15 to get a grant. This is an important distinction that our county's efforts to address the needs of the senior community that's growing very rapidly percentage wise in this county through our master plan on aging work. And I'm glad that we're continuing this work is very, very vital for this increasing population. Thank you, Mr. Chair. Thank you, Surveys and McPherson. I'd also like to acknowledge Dr. Green in particular for your leadership in this work from the time that you were working within our offices directly to the time that you spoke out and so that there was a need to elevate these voices, not just through your research, but through your policy work. This really is without your leadership, this wouldn't have happened, this elevation. And I just want to acknowledge that. I also want to acknowledge your approach and the commission's approach to ensuring that there's first person voices that are included in the report as opposed to just a lot of times, as you know, doing academic research, things get aggregated and the personalization gets taken away, you've really elevated the individual stories in a way that really informs the policy-making process of great appreciation to the commission. I'm fully supportive of Surveys or Cummings additional direction on this item and a few additional items on the agenda. There's a collection of public works items, including what Surveys or Koenig had mentioned that the investments on Soquel Drive are important. It's actually the largest investment we've made in pedestrian and bike safety in that corridor and multimodality in its history. So it's a pretty significant increase in safety. It's a large challenge in particular for those that live in the Mid-N-South County that try and use that transport corridor. There's a lot of safety challenges around it. I'd also like to acknowledge the initial appointment. There'll be a second vote on it, but Dr. Hernandez to the Alliance Board. Hey, the Alliance Board really is the health fail safe for many in our community low income residents that require Medi-Cal coverage or maybe are currently uninsured and are looking for coverage. And so having his voice, he's a statewide leader and that will be very important. I'd like to close also with, and I'd like to acknowledge I see the Assistant Director here of Public Works is here, Mr. Wiesner. There's a whole collection of information on our storm damages. And it takes a long time to build out of these. We had 185 road sites just in the last set of storms that were damaged. Some people still don't even have access directly to their homes or on secondary access back in. So Supervisor McPherson noted about communications challenges. We have access challenges. And so you have, as we acknowledge Public Works week upcoming, you have employees that are working pretty significantly to ensure that they can restore access and actually just to acknowledge that just in the short time since that damage, I know that 28 of those 185 have already been completed. 45 are in additional already under construction, 48 are under construction sort of so appreciation for Public Works sticking to that. So now would be an appropriate time for a motion in regards to consent, recognizing that one item was pulled for the regular agenda. I'd like to move consent agenda minus item 23. Second. Is there a motion with the additional direction that? Yes, with the additional direction that Supervisor Cummings added. Thank you, Supervisor Hernandez. We have a motion from Supervisor Hernandez for a consent agenda with the additional direction on the Justice and Gender Report that Supervisor Cummings had added a second from Supervisor Cummings. So we could have a roll call vote please. Certainly Chair, Supervisor Koenig. Aye. Cummings? Aye. Hernandez? Aye. McPherson and Friend. Aye. Passes unanimously. Thank you. We will move on to the first item of the regular agenda which is to consider a report on the County's recent activities to implement the California Advancing and Innovating MediCal or CalAIM initiatives. Pro-authored by departments representing the County's CalAIM Governance Committee which is the Health Services Agency, the Human Services Department, Probation and the Sheriff's Office. And direct the County CalAIM Governance Committee departments to return on or before December 12, 2023 within an update on the County CalAIM implementation activities is outlined in the memo of the Director of Health Services and we have the Agenda Board memo. And I'll say as the current chair of the CSAC Health and Human Services Committee this is a major initiative that's been worked on. I appreciate Director Morales's leadership at a statewide level of this. Director Morales, are you kicking today's item off? Are you kicking today's item off? Okay, I'll pass it to you. Good morning, Board. For the record, Monica Morales, Health Services Agency Director. A little bit higher. How's this? Much better. Okay, thank you. Really wanna give thanks for allowing us to present to you today on CalAIM. As you are aware, as Supervisor Friend mentioned, this is a transformational moment for our MediCal population in our system. I'm joined today with Jennifer Herrera who's our Assistant Director at HSA and Amanda Guy who also works for HSD. What you'll see presented to you today really speaks volumes about the dedication of multiple departments that have aligned through a governance structure to put in place the various components of CalAIM. The California Advancing Innovative MediCal is really a long-term commitment by California which I'm very proud of that. We're taking a bold step in our state to really ensure that we're engaging with our MediCal population and we're actually coordinating care in an equitable way. Key changes for you to kind of keep in mind as we're presenting are really in around three areas. And those three areas, they have a lot of detail but we're trying our best to kind of boil it down to you today and we'll be coming to you with more details. One of the key areas is our delivery system. So what that really means is that you're gonna see changes now that allow different workforce to actually enter and provide services such as CHWs, peer navigators, doulas in our MediCal reform as part of our MediCal reform. In addition, you're gonna see pushes for us to do more data integration which is big across multiple departments and even with the state, the standardization of assessment tools. We kind of do, depending on the system, do our own thing. And so now this is actually forcing us to coordinate. The second area you're gonna see is around program changes and those really entail expansion of care or nation of community services that address determinants of health. I can't emphasize how important that is for us. Now we would be able to use some of the MediCal funding to think about housing vouchers, utility payments. We never used to be able to do that before. So that's significant for us. And last is around payment reform. We used to pay for the service. Now we're gonna pay for who provides the service. Take some time to think about what that means for us. It also means that the majority of our rates, specifically for behavioral health are changing. So the way we pay for inpatient or outpatient care that we were paying for hospitalization, that we were paying for substance use treatment, all of those rates are changing. And so it means for us looking internally as how we've done rate payment before, how we work with our contractors and now mix it all up, expanding it, but also rethinking of how the payments actually gonna impact us. Today we've received about $2.6 million in some of the transition grants from the state to start looking at making some of these changes that I've highlighted for you. Like any change, it's exciting. We know it's the right direction, but it's been quite difficult. It's been tedious. And we're still trying to figure a lot out. Today what we're hoping to do is present to you a high level of where we're at as a county in implementing this, how we're coordinating with our sister departments impacted by these changes and also our community. We won't be done in 12 months, even 24. My hunch is it's gonna take three to five years and a lot of new staffing to actually move through these changes. I wanna now recognize the commitment by our staff, also in you for actually being bold, really adopting this change and monitoring, always asking me, how's it going? How's it going? And me coming back to you and saying, we're still figuring it out. So appreciate your patience with all of this. I now wanna transition to Jennifer who will, and Amanda who will actually jump into some more of the details. Good morning. So today's presentation as Director Morales mentioned is focused on providing relevant background related to CalAIM, which is a major health initiative from the state. It's impact on our county as an organization and we'll also review some recent CalAIM projects from the county and what to expect in the next six months. So what is CalAIM? California Advancing and Innovating MediCal is a long-term commitment to transform and strengthen MediCal, offering Californians a more equitable, coordinated and person-centered approach to maximizing their health and life trajectory. This is done over a five-year timeframe from starting in 2022 through 2027 and by implementing the initiatives that Director Morales mentioned, broad-based delivery system changes program updates and payment reform. And when we think about health and what makes people health and well, even just reflecting on the comments from today's public comment from the Jack commissioners, health is more than just access to a medical provider. It's access to a home, it's transportation to groceries, it's childcare. So as a safety net health insurance program, MediCal aims to support longer, healthier and happier lives to beneficiaries. So to meet this goal, CalAIM is updating the MediCal program to expand benefits that supports the whole needs of the whole person. Health happens, doesn't just happen, the medical office, it happens in our communities. So some background on MediCal, it's complex with fragmented origins. It starts at the federal level where the Centers for Medicare and Medicaid Services set the parameters for the Medicaid and CHIP programs and the Feds provide partial funding to states for implementation. The states share in the rest of the costs for the program and are responsible for designing the plan with the federal parameters in mind while they implement the plan for its residents. So in California, the Medicaid and CHIP programs are combined as the MediCal program, which is managed by the Department of Healthcare Services. MediCal provides comprehensive health coverage to at low or no costs for 13.4 million low income individuals or one in three Californians.  So locally, our managed care plan is administered by a central California Alliance for Health. The county is responsible for administering the specialty behavioral health services for the MediCal population. And this is done through HSA's behavioral health division, managing both the payment system as well as providing direct services for these two plans. So as you can see, MediCal is complex for the fragmented design. Within the parameter, the federal parameters for the Medicaid program, the state is redesigning MediCal through the CaliM initiative to be more streamlined and person focused, which is leading to major changes for our local plans and service providers. Changes to the MediCal program affects approximately 90,000 county residents. So approximately a third of our county population have access to MediCal benefits. However, accessing this benefits from MediCal is a complex process. Just because someone is eligible doesn't mean they automatically receive benefits. First, they have to be aware of the MediCal benefit. Locally, we have a whole network of partners including county and non-county organizations who are focused, who are just solely focused on outreaching to eligible residents supporting them with MediCal screening and applications. Once an application is submitted, they have to be enrolled in MediCal. Human Services Department determines eligibility and enrolls individuals into MediCal. Once enrolled, they are typically assigned to a local managed care plan and have access to their benefits. And then they have to utilize their benefits, which is challenging given MediCal's fragmented design. Many county programs and community organizations are focused on supporting MediCal beneficiaries with navigating this program. We have entire ecosystem just around MediCal navigation. Depending on their needs, some MediCal beneficiaries access six or more separate delivery systems such as managed care, mental health, substance use, dental, in-home support services, et cetera, just to get their needs addressed. As one would expect, the need for care coordination increases with greater system fragmentation, greater clinical complexity and decreased patient capacity for coordinating their own care. And to retain access to MediCal, eligibility is redetermined on an annual basis. So in summary, MediCal is complicated to access and utilize and many of our county systems and community partners are involved with supporting outreach, screening and utilization of benefits. CalAIM strives to streamline the system, making it easier for 90,000 residents to navigate. The streamlining requires major changes to how health and social service entities collaborate. The CalAIM mandates expand just beyond health and human services. A major initiative of CalAIM includes benefits for people transitioning in and out of custody. This includes mandated MediCal screening and enrollment in the correction setting. Starting in 2024, there will be a phase in of MediCal eligible individuals who are incarcerated to be allowed access to services within the correctional settings, 90 days prior to being released. Currently, no MediCal services are allowable while someone is in custody, which further fragments care for people as they transition out, as was noted during public comment today through the job commissioners. The Sheriff's Office and probation department are now responsible for ensuring MediCal screening and support is implemented within their correctional facilities. They will also be responsible for supporting eligible individuals with accessing MediCal services while in custody. Across these departments, CalAIM also requires more robust data sharing in order to support more coordinated care for the MediCal population. In addition to the mandates, there are many opportunities, which as Dr. Morales mentioned is very exciting. There's an opportunity to actually improve how we do care coordination for individuals within the county and with our community partners. There's also an opportunity to expand Medicaid administrative activities or MAH revenue. This is a program managed by HSA but utilized by many community partners. And it provides a pathway to offset expenses related to MediCal outreach and navigation. And due to the data sharing requirements, there's an opportunity to update how our data systems. Implementing these systems and mandates, excuse me, these mandates and opportunities in the five year CalAIM timeframe is a massive undertaking. Though CalAIM sets a strategic vision for where we are headed, the role has been iterative and dynamic. Many policy and operational decisions are being developed as we go. As such, it has been difficult to analyze the short and long-term fiscal implications of this cross-cutting initiative. These mandates are requiring our county systems to collaborate and shift our operations in ways that hadn't been possible before. All counties across the state are struggling with this massive change to our work and we're all figuring it out as we go. Our county organization has developed a governance committee to support internal collaboration, tracking CalAIM updates and funding opportunities and supporting the development of our internal strategy. This five-member committee includes a representative from each of the departments with CalAIM mandates, including HSA, HSE probation and sheriff's office and one community member with experience receiving services through all of our departments. In the next few slides, we'll highlight a couple of recent CalAIM projects implemented by the county. So the first is behavioral health payment reform. CalAIM is mandating changes to the reimbursement, financing and billing mechanism of the specialty mental health plans, that's specialty mental health and the drug medical organized delivery system, DMCODS. These changes are effective July 1st, 2023. So as a reminder, these plans are administered by the health services agencies, behavioral health division and they provide medical recipients. They serve medical recipients with severe behavioral health needs. Services are provided by behavioral health and through contracted providers in the community. Currently we are reimbursed based on our costs administering the services. CalAIM is shifting reimbursement to a fee for service model based on the provider who provides services. So for example, a physician's time is likely to be reimbursed at a higher rate than a community health worker. This change has massive implications for our entire behavioral health system, requiring us to change our operations to align with the new funding model. As DHCS releases the new rates, HSA's behavioral health division is tasked with renegotiating agreements with contracted providers. This mandate has been a major lift for our community. As a state recently released the new rates and we have a tight timeframe to execute new agreements with providers all in time for the July 1st start date. With the newly released rates, HSA is analyzing the fiscal impact for our behavioral health system. However, we do anticipate potential short-term deficits with everyone adjusted to this new structure. I'll now turn it over to Amanda Guy, HSE division director of planning and evaluation to review the next project. Good morning. A target population of CalAIM, the justice involved, has been an area of focus in the county through the MediCal enrollment and screening mandates. These mandates include the pre-release MediCal application process, 90 day services pre-release being offered and in custody behavioral health linkages, coordination of enhanced care management, community supports with reentry and transition providers. This image demonstrates a multi-phased approach to enhancing outcomes for the justice-involved population and captures the complexity of the collaboration needed. In 2022, Santa Cruz County had over 5,700 unduplicated individuals incarcerated. 60% of those arrested did not have MediCal, 40% were on MediCal. As we continue to learn more, we will dive deeper into the data to better understand the needs of this population. As of January 1st, 2023, all counties need to implement pre-release application processes in jail and youth correctional facilities. The human services department, health, sheriff, probation, ISD and the public defender held a planning meeting at the end of last year to implement the pre-release MediCal application process. That's puzzle piece one on the slide before. By anchoring to the booking process and planning for community connection for those that are released quickly, we will screen everyone in custody for MediCal and offer an application alerting human services of the incarceration to manage those benefits, either to suspend them as required or to lift the suspension for the 90-day pre-release implementation. There are a series of grant opportunities provided by the state, and we have applied collectively for the justice-involved round two funding to support the mandate implementation. In the next six months, we are actively going to continue working on process improvement with the MediCal enrollment and screening in the correction setting. And another area of focus is the custody to community transition, those next four puzzle pieces. We need to really enhance what we currently have. In the jail, programming is offered to support rehabilitation, but more focus on that transition space and connection to behavioral health, enhanced care management, and community supports will require dynamic collaboration and planning. This in alignment with a focus on behavioral health payment reform and data sharing, working towards one person, one record, will be pivotal in meeting the CalA mandates and enhancing the wellness of our justice-involved community members. By focusing on strengthening our services, we will grow the enhanced care management program and use standardized screening and transition tools for behavioral health. As noted, collaboration is key for this initiative. Our governance committee executive leaders have closing comments for your consideration. I'd like to introduce for the Sheriff's Office Chief Dan Freitas. Good morning. Chief Dan Freitas with the Sheriff's Office. We're very excited for this new program to start. We believe that there's gonna be a lot of resources that will help us better serve our incarcerated population and hopefully reduce recidivism on the backend by allowing services to be provided to the inmates once they're released. We'd like to thank Probation, HSA and HSD for their support in their working on this, as well as Lieutenant Chris Shearer from our office has done a significant amount of work on this project as well. So thank you. Thank you Chief. Next for probation, we have Chief Probation Officer, Fernando Geraldo. Good morning. First of all, I do wanna thank Jennifer Herrera and Amanda for really helping us coordinate this effort and really learn how it will impact and benefit those in our community, particularly of interest for me. Well, everybody in the community, but my role is overseeing individuals in the justice system, both adult and juvenile justice system. This will impact juveniles as well. We'll be able to enroll them in medical. It's critical of that 90 days prior to release that individuals can have critical access to those behavioral health and physical health services that they need to ensure a smooth transition back into the community. And again, so we can see them succeed and not recidivate. These dollars that can potentially come to probation departments across California will help fund what are coordinators or enrollment specialists. That's what's real critical to identify those individuals immediately and be able to enroll them. Probation's role as a connector in the justice system will be able to connect these individuals to our partners to receive those critical services. So again, thank you. And we're really looking forward to how this will help our individuals in the criminal justice system who are disproportionately individuals of color coming from communities disproportionately living in poverty, so this will really help. Thank you. Thank you, Chief. Thank you. And next we have the human services director, Randy Morris. Thank you, Amanda and Jen and high board members. If you're overwhelmed, you are not alone. This is one of the most complex but most profound reform efforts in California safety net and how to fund Medicaid. So this is important work and the staff will continue to try to understand this and share it and educate ourselves and you. I just wanna share two quick touch points with you that are very specific to human services. Everything that you heard about assumes that somebody is on Medi-Cal. Wanna make sure your board is aware that over the last three years due to federal and state waivers, people who are on Medi-Cal did not have to do their annual renewal. And what that meant is throughout the United States of America, people who are on Medi-Cal and then often about 25% of people on Medi-Cal lose their coverage at the time of the early renewal, mostly the most disadvantaged. For the last three years, nobody has dropped on Medi-Cal. So our numbers have gone up from the high 60,000s to 92,000. We, those waivers have ended. So over the next year, there are 92,000 people in our community have to go through renewal process. And if they lose their Medi-Cal, they do not have the opportunity to take advantage of these services. The second and last touch point I wanna share is I will be back in front of you in August for the six month report in from the Housing for Health Division with Dr. Robert Ratner. We have been talking about the unstable funding we have in Housing for Health, one-time grants that are gonna expire. And CalAIM is a potential funding source to help people experiencing homelessness. So we are doing all we can to take advantage of this Reform Act effort to find a sustainable funding stream to support those people who are on shelter in our community. And thank you again, Jen and Amanda, you guys are the engine behind this Reform effort locally. Thank you. Monica, sorry. Didn't know if you wanted any closing statements. Thank you. I'll be off guard there, Amanda. You know, this is just summarizes our commitment across the county from the different departments. Their recommendation here for you is to accept and file this report. And obviously for us to come back at the end of the year in December to give you an update on what we're learning specifically for me is also our work with our contractors. I anticipate you're gonna be getting some emails, some phone calls on the way that CalAIM changes will impact them as well. So we're hoping to come back to you in December with more updates, specifics on what we're seeing in terms of the finances, specifics on the programming pieces and also the capacity that we have and most likely we're gonna need as this rolls out. I think it'll bring it back to the board for questions. I do have just an initial question. I mean, obviously the state's putting forward a lot of transformational initiatives at once in the greater health and behavioral health space. So oftentimes the one-time funding, this is more of a structural reform than a one-time funding situation. But maybe Director Morales, what are your biggest concerns or fears with this transition? What flag should we be concerned with as we do the transition? Two key areas, the staffing. As you know, we've been struggling every department in this county and actually all the counties are struggling with staffing. So it means more care coordination. It also means more behavioral health specialist and clinicians. That's a big concern in order for us to transition and truly embrace the opportunities of CalAIM. The second is the rate changes. As noted, we've received rate change information starting early this year. And the last information we received on one of the rates was in April 21st. So we literally have to have all this figured out by July 1st. As you know, that's not gonna happen. So I'm already apologizing ahead of time for the scope of the hiccups that we know we're gonna have to all go through together. And the third area is our contractors. I'm really concerned about the way this will impact them. It's a shift for them in terms of how they deliver service, how they're doing in terms of their performance, they have to meet thresholds in order to get paid. And we've been flexible before around that and we will no longer have that flexibility. So I do understand that for us, we need to think about the entire ecosystem and that includes our contractors. We have been meeting with them to share with them the information as we receive it to talk about the changes. And we will continue to meet with them on the rates and negotiate something that we think might work for the entire county. We have incentives in place to help them through that transition as well. But again, those would be my three kind of key areas where I'm definitely biting my nails. Thank you. I have questions from board members at Supervisor Kronik. Thank you, Chair. Thank you all staff for presenting this interesting and complicated topic today. On the one person, one record initiative, I mean, I assume that means essentially having one record for a patient no matter whether they're accessing services managed by the alliance or directly by the county, is that right? Yeah, the idea is that there's more information sharing on our clients and you don't have to actually one lose information across department or systems or have the whole comprehensive profile of where a client is. Concept is that you're able to better assess if there is a gap in services that they're actually eligible for. And also the data integration piece is going to be key for us. And I'm not sure if Jennifer or Amanda want to address any of those pieces. No, I think you've captured it. It's really looking at how our systems can work together more dynamically to provide that services. And doing that through data integration is one way of supporting that collaborative effort that's needed by the folks on the ground who are working together. But it's also a tool that can be really effective in supporting more effective service delivery. OK, I mean, I know we've all heard how much even the private sector has struggled with creating a unified patient records. It sounds like the state's providing a little bit of money to help us with this effort. Are they providing any guidance or best practices? Or is it kind of is each county so unique that you've got to figure it out from where you are? I would say both. They're providing guidance in terms of a vision. It's transformational. What that means is that the local level, the counties really have the burden of kind of figuring out the implementation steps. There is funding, as I mentioned, that we received. You've approved a lot of those through your consent agenda items, approximately at least for health. And I got some numbers from Human Services, about 2.6 million that we've received in CalAIM specific transition grants. And those vary depending on if it's ECM, if it's specific for just dental integration, if it's specifically to some of the data coronation pieces. So they're coming in different buckets. But so far, that's what we have. We anticipate more technical assistance. Ideally, there's going to be more opportunities for grants like PATH. And so again, deferring to my colleagues here if they want to add any other details to those pieces. There are other counties that have managed to do complex integration. We are currently looking at with ISD assessing our current systems to see that technical aspect of certain data fields being able to connect. So we are working on that currently. And really working on the state has provided some direction and they're looking at a data exchange framework and providing some governance. Because one of the major barriers is the legal mandates and obligations we have for privacy and security specifically with health and human and how we can ensure those are maintained, but also work within that structure to share information as needed. And there is some guidance that is coming out. And there are conversations being had for more clarification for the counties. OK, thank you. And then my other question is on this point of moving towards a fee for service model. I do share your concern a little bit about this director Morales. I mean, we've heard. Well, I'll just jump to the question, which is who sets the rates for reimbursement? I mean, is it the state federal government? Are they going to be specific to each county or different types of communities? I mean, obviously we live in one of the most expensive communities in California and the nation. And we've seen within the private sector that private health providers have struggled with reimbursement rates that are lower than the cost of service. You mentioned we could see some deficits in the short term. So we're going to be able to keep up with that and eventually overcome it. I have to speak a little bit more to that. Well, the model is designed for us to overcome it. However, I do agree with you that some of the coastal counties and here in Santa Cruz, where we know it's really expensive, we'll have to navigate that together and be fully transparent about what we're learning. The state does provide the rates, at least for behavioral health. They're posted on the DHCS website. What you'll see is that all the rates have changed how they're paid hourly, if they're paid for mobile crisis, if it's paid for psychiatric services, if it's for daily care, all of that has changed. And so for us, yes, as we get used to paying for who's providing the service versus the service, it's going to take some time. There's some rates that we do see that are higher and some, for example, for community health workers or doulas or navigators, they don't seem to be as high. Now, we know if this model is changing into helping with determinants of health, it's not going to be the clinician doing that. It's going to be the CHW, it's going to be the peer or mental health liaison. And so that's what we're trying to see. How do we think about the inequities that it's actually creating in terms of payment for the workforce? So I encourage you to monitor that. I also encourage you to advocate for that too at the state level. And we will try to bring more numbers for you that really kind of share with you what we're learning so far. We're still trying to understand the latest rates. So I don't have a lot of information in terms of how that's going to roll out to our contractors. We're going through negotiations as we speak, but in December, I should have more information for you. Okay, thank you. Thank you, Suvazer Cummings. Thanks for that presentation. I just had one question and it was related to some of the questions that came up earlier related to the Justice and Gender Commission work. And some of what was being spoken was about when people are being released from being incarcerated and having access to healthcare or medication upon release. And I'm just wondering how this, because it sounds like it might help fill that gap if people can apply when they're incarcerated. And then upon being released, they're signed up for MediCal and can carry that through with them as they're being released. And so I'm just wondering if that's the right train of thought there and if this can help with some of those issues. And so maybe just wondering if you could speak to that. Wintika Amanda. Sure. Yes, this will help with that. So those coordinating with our enhanced care management with those community supports and then this next iteration or phase we'll be focusing on for planning is that transition space of custody to community. How are folks exiting within that 90 days of starting to receive services while they're in custody and then moving out into the community with those services intact. So that's what we'll be planning on these next few months and moving forward with that initiative. Great, we're looking forward to hear how that rolls out. Any other questions? Yeah, I've got a couple of comments. And thank you to Health and Human Services Probation and the Sheriff's Department for this collaborative effort. That's absolutely necessary. It's a tall order for counties. One of the most complicated and challenging that I think we're facing in my 10 years as a county supervisor. And the state's efforts are meant to improve health outcomes and we all want that. But we really have to lay the groundwork locally of how this fits us and it could be different from other counties as was stated, but it will really be important to track whether the resources available the state resources available from to implement these updates, keep up with the actual costs. I just hope to have high hopes that we don't have to deal with what's called unfunded mandates coming down from the state because this is going to be a costly venture. It's going to be one that really deserves our attention when it serves a third of our county. I look forward to the next update and how we're doing on that. And I want to thank the team for this cross-departmental coordination. It's absolutely necessary. I think that this is one of the biggest things that we have to work with in our county to serve a third of our county, a high percentage of our population. So thank you for your efforts to date. And I hope we can get the collaborative effort from the state as we implement this. Thank you. Thank you. We'll now open it up to the community. Is there any member of the community that would like to address us on this item within chambers? Madam clerk, is there anybody online? Yes. Colin, user one, your microphone is now available. Caroline Garrett, as I listen to this convoluted system here I hear words like feeling overwhelmed, complex, different budgets, the complex medical system on and on. This program does not seem like it is in any way providing services to people who need it. And what people really need for mental health or good health outcomes is healthy diet, good food, housing, employment, an environment in which they're not poisoned by chemicals or radiation. And I think of the contrast of seeing the film, Sickle by Michael Moore some years ago, comparing our health system with countries, other countries like France and England. I don't know how it is nowadays there, but people would just walk in, get healthcare, didn't have to go through all kinds of financial proof. I mean, this is a for-profit system by the insurance corporations. And what I've heard about single payer healthcare sounds much better. And I also remember in 1966, being in the former Soviet Union with my then husband and he got sick, the healthcare people came to the hotel, all three taking care of very nice. This system does not help people. Thank you, Ms. Garrett. Is there anybody else online, Madam Clerk? We have no further speakers online, Chair. I recognize we do have some in chambers. Thanks for sticking with us. Welcome back. Hi, my name is Katie Mayetta and I actually am a consultant that implements CalAIMS across California. And I've been doing it for a little bit now. I just wanna be very clear that we're not starting from scratch in Santa Cruz County. We've actually been implementing CalAIMS in different forms for quite some time. And the probation department is part of that as well as the sheriff's department and behavioral health. So we've been trying to implement these programs through Prop 47, trying to develop these transitions from incarceration. The collaborative courts have been a huge part of that. We've had whole person care, which was the pilot that CalAIMS is stemming from that is continuing. That's now providing the enhanced care management. We've also had other programs which we've implemented drug MediCal, which is our organized delivery system, which is now CalAIMS implementation that was part of the pilot that now we're implementing. So we're not starting from nowhere, which other counties are that have not opted into those programs. We actually have all of those things established. Now we're just trying to implement all the other stuff too. So we're not starting from scratch. We have the collaborations that other counties don't have. We actually talk to each other, which is amazing. We all actually know how to work together. We know what we're doing. The problem is, is that what we're being asked to do is a really, really heavy lift. And it takes a lot and it's gonna take a long time. The implementation of CalAIMS is over a five to seven year implementation. And so the state knows that, but we have come a long way and we've been doing this already. We're just working out the kinks and it's gonna take a little bit of time, but we're getting there and because of our collaborations, I am so hopeful and I'm super excited about it because we've been talking about this change for like 20 years and it's here and it's really exciting and we can totally do it and it's gonna address all the issues in our community if we do it right. So we just need to do it right. Thanks. Thank you. Good morning. Yeah, good morning. My name is James Ewing Whitman. I think most of the services that are offered are actually excellent. It's great when the state and federal government can do things for people that are actually really helpful. I think there's many things that people that for whatever reason get incarcerated, there's just lots of good systems to help. Now, last Tuesday in the city council, a subject came up as far as things going on where let's see, I don't have the paperwork with me but these are the notes I took as far as who can give someone else a 51 and 50 in the state of California. All law enforcement can. Otherwise there's a designation at LPS individual and that can be an individual in the county that usually uses undergraduate degree and a two to three year advanced degree and then two years of direct observation. So once again, all law enforcement can make this designation as can someone with that training but with someone with that training in the county can authorize anybody to also do that. So I'm gonna repeat that law enforcement's job is about six times harder than when I was a young teenager. That's because the citizens seem to just blindly ignore like they're mesmerized or hypnotized which seems to be the case. Now, several people who spoke here today, I guess I could mention names but I'm not going to at this point. I've been hearing for years different things going on. We have so many issues with health that people aren't talking about.  You work for the state and the government. So it's really kind of deceptive what's really going on behind closed doors. So all this stuff there seems to be a lot of positive things that we're talked about. So let's try to work on that. Thank you. Thank you. Anybody else in chambers? All right, I'll bring it back to the board for a motion. I'll move the recommended actions. A motion from supervisor Koenig to step in from supervisor McPherson. I appreciate it for the work. If we get a roll call, please. Supervisor Koenig. Hi. Cummings. Hi. Hernandez. Hi. McPherson. Hi. And chair Friend. Hi. That passes unanimously. We will now take our 1045 scheduled zone five item. Director Brown, I think you are on zone five. So if you want to come on forward and we will, I'll pass it over to our zone five chair, supervisor Koenig. Thank you, chair Friend. Wait for director Brown to get seated. Good enough. I'll now call to order the regular meeting of the Flood Control and Water Conservation District zone five board of directors. It is 1048 a.m. Tuesday, May 16th, 2023. Clerk, could you please call the roll? Friend. So sorry, my microphone. Director Friend. Here. Cummings. Here. Hernandez. Here. Brown. Here. And Jaff, absent. Okay. We have a quorum. Are there any additions or deletions to the consent or regular agendas today? No additions or deletions. All right, thank you. Does anyone wish to provide oral communications to the zone five directors board? Sitting down here in chambers. Is there anyone online? No speakers online chair. All right. We'll move forward with item four, approval of the zone five meeting minutes from December 13th, 2022. Any discussion? Is there a motion or is there any comment from the public on the minutes from last December? Seeing no one here in chambers. Anyone online? No one online chair. I'll move the recommended actions. Second. All right, motion by Director Friend, second by Director Brown. To approve the minutes, say for the discussion. Seeing none, we'll call out please. Director Friend. Aye. Cummings. Aye. Hernandez. Aye. McPherson. Aye. Eric Koenig. Aye. All right, motion passes unanimously. We'll proceed with item five, action on the consent agenda. Does any director have comments on the consent agenda or questions? Seeing none, any member of the public wish to comment on the consent agenda? Seeing no one here in chambers. Is there anyone online? No one online chair. All right, we'll turn to the board for action. I'll move consent. Second. Motion by Director Friend, second by Director Cummings. To approve the discussion, Seeing none, clerk, we'll call out please. Supervisor Friend. Aye. Cummings. Aye. Hernandez. Aye. McPherson and Brown. Aye. And Koenig. Aye. Motion passes unanimously. All right, we'll move to a regular agenda. Item H, to consider approval of the proposed fiscal year 23-24, zone five, and zone five expansion construction budgets as outlined in the memorandum of the district engineer. District engineer Machado gave a report for us. Yes, thank you chair and directors. Matt Machado, your district engineer. And so the item before you today is our 23-24, zone five budget. It really contains two significant components. It includes our maintenance and operation portion of the budget and then our, we call it our expansion construction. It's really development that occurs in the zone. The key elements of each of those, so maintenance and operation is really funding crude time to do channel maintenance and pipeline maintenance in the district and then the expansion construction is really to do permit processing and plan check reviews for development that's in the zone. Combined together, the proposed budget today before you is in the amount of $3,828,861. And historically, we bring this budget to you before the county budget, which will be the end of May. So this is just an advanced look, let the recommended action be foreused to consider approval of the proposed 23-24, zone five budgets. So I'm here to answer any questions that you may have. Thank you. Questions from directors? All right, so now I do have one question, which is on the master plan for zone five. Of course, it's gained a little bit more interest since the flooding that we saw on SoCal Creek during the atmospheric river storms this January through March. There was sense of when the public engagement process for that master plan will begin. Yeah, great question. That will be this year. We're wrapping it up now and we're pretty excited about not only is it a master plan of the infrastructure, it will also include a capital improvement type program to give us a guidance of where we should go, where we should invest, how we should finance all the needs of the district. Many of the district facilities or facilities that are a little bit obscure in terms of ownership, we'd like to settle that through this master plan and CIP effort. And so our vision is to have that this summer. And so we will share timelines and schedules with your board. Great, I'm glad to hear that this master plan includes a slightly expanded scope of work and we'll look at some of those capital project opportunities. Yes. Great. All right, if there's no further questions from the board, anyone in the public wish to comment on this item? Anyone here in chambers? Is there anyone online on the phones? The speaker's online chair. I'll return it to the board for action. I'll move the budget. I'll second. Oh, go ahead. I'll second. Okay, motion by director Cummings, second by director Brown. Any further discussion? Seeing none. Very cruel call vote, please. Director Friend. Aye. Cummings. Aye. Hernandez. Aye. McPherson. Brown. Aye. And chair Koenig. Aye. That passes unanimously. All right, the 23-24 budget being approved, I will adjourn the meeting with its own five board directors.  Thank you, supervisor Koenig. We'll return back with item eight on the regular agenda, which is to consider a presentation on tobacco product waste by the health services agency to adopt a resolution recognizing tobacco waste as a public health and environmental threat, creating a tobacco waste ad hoc committee and directing the chair to take related actions and direct the health services agency to return on or before June 27, 2023 with recommendations on establishing the ad hoc committee to address tobacco waste. That one in the memo of the director of health services, we have the agenda item and the resolution. Director Morales, welcome back. Thank you, board. I'm here today with my colleagues, Emily Chung, who's our public health director and Tara Lunard, who's our tobacco manager. Very pleased to be here with you today, following for your direction. You wanted a case study on tobacco waste product and also consideration for a resolution. I'm very confident that the information that you're gonna hear today will really set the board on that trajectory that you've been on for many decades. We've seen great strides in California and in our county around the decreased use of tobacco products. There's definitely more work that can get done. As you know, we continue to see communities of color, youth in our environment disproportionately impacted by tobacco, tobacco waste. Just in the US, for example, tobacco products kill about half a million individuals and 40,000 in California alone. So our work is definitely not done. The information that you will hear today will really align with what the local cities are doing. And hopefully continue your efforts and your work as you're advocating for more responsibility, more advocacy and accountability to on tobacco waste specifically. I'll now pass it to Tara, who will kind of walk you through some of those details and what we know about the latest science on tobacco waste products and what our local cities are also doing there. Thank you. Thank you. Thank you, Supervisors. Tara Lunard, senior health educator, tobacco education and prevention. And we are here today to talk about tobacco product waste. And when we talk about tobacco product waste, there's a number of different products, but the most relevant product today is cigarette butts. Cigarette butts are the most littered item on the planet and it's estimated that as I'm sitting here speaking to you today, 4.5 trillion of them are inappropriately discarded on the surface of our planet. That figure comes from a number of other data points and one of them is the International Coastal Cleanup Data, the International Coastal Cleanup is done the third week of September every single year. And in 2019, which was the last time they did a major cleanup, you can see there that they picked over 5,700,000 cigarette butts in one day off of local or international beaches and riverways. That's more than any other item, including plastic water bottles, plastic caps, plastic bags, plastic straws. But context is everything as Director Morales just said. TPW is not just the inevitable end of life of a useful productive product. It is in fact the remnants of a deadly addictive product, which as you just heard kills half a million Americans every single year. So it adds very real insult to literal injury that three quarters of these items end up just flicked on the ground, tossed on the ground. Now you might be thinking, oh, maybe this is a problem in urban areas. Maybe this is a problem in Paris and Europe where smoking is even higher. But in fact, right here in Santa Cruz County where yes, we have a high interest in environmental protection, I can tell you I have done a number of tobacco waste cleanups from North County to South County and everywhere we go, cigarette butts are a blight on our streets, on our parks, and on our beaches. These happen to be pictures of a tobacco waste cleanup that we did at Felton Covered Bridge Park a number of years ago that park backs up onto the San Lorenzo River. And as you can see, we picked up almost 3,000 cigarette butts in one hour.   This middle picture that you see here was taken on a beach in Tampa, Florida. It's really heartbreaking. This was a series of photos of a black skimmer bird actually feeding its chick a cigarette butt. And what you see on the right there is a photo that was actually taken by our own Santa Cruz County Tobacco Education Coalition co-chair. Some of you might know her, Rachel Kippen. She took this picture right down the street at the Santa Cruz Yacht Harbor. And what you're seeing is a sea anemone trying to digest a plastic cigarette lighter. This is just absolutely heartbreaking. And these are the kind of photos that we're sharing to our youth. And many of our youth, as you can imagine, can't even imagine being 40 years old let alone being 40 with lung disease. But when you show them photos like this, they start to question this industry. And it helps us when that industry targets them with things like bubblegum flavored vape juice to maybe think about whether or not this industry that they should be believing. Why are these items so toxic? There's two reasons. One, filters are made of plastic. In fact, they're made of cellulose acetate. And it's estimated that there are 12 to 15,000 cellulose acetate strands in a single cigarette butt. That is a photo actually of Dan Haifley, the executive director of both A-Bond Doors and O'Neal C. Odyssey in the past at one of our cleanups.  We now know that microplastics never really go away. They break down into microplastics and now we're learning more about nanoplastics which bioaccumulate. And so if you're a seafood eater, it's estimated that you have probably eaten about a credit card's worth of plastic in the last year. The second reason that cigarette butts are so toxic is they leech the toxic remnants of these chemicals into the environment, including lead, arsenic, nicotine. Many of the same chemicals are in secondhand smoke. Now, as a culture in the United States, we've all agreed that we don't want these chemicals in the air that we breathe. And that's why you can no longer smoke in most shared indoor spaces and many shared outdoor spaces. And yet these same chemicals are on the ground under our feet every single day, leaching these toxins into our soil and eventually into our water. Again, context. I'm not going to go into too much detail about this slide, but the last time that I prevented to the County Commission on the environment, I was asked about whether or not we have data on whether or not cigarettes, the industry in general, can be traced to global climate change. And we now have that data. And we can talk about the fact that cigarette butts are bad for the environment from beginning to end from deforestation to grow the tobacco, to pesticides to grow that tobacco, to water use, to fossil fuel depletion. And then you can see right here the amount of emissions from one cigarette. Maybe that doesn't seem like very much until you remind yourself that there are six trillion cigarettes manufactured and sold across the nation, across the country, across the world, excuse me, across the world, six trillion of them. And as Director Morales just mentioned, it's an environmental justice issue. Tobacco waste disproportionately impacts low-income communities and communities of color. And why should that be any surprise to us? Because these are the same communities that the tobacco industry has systematically exploited through specialized products, specialized marketing. And the result is that we tend to see a higher density of tobacco retailers in these communities, a higher density of tobacco advertising in these communities, more advertising, more stores, equals more products, equals more waste. You might be thinking all this and thinking, well, okay, these are the things we have to put up with, right? We're reasonable people. We can make compromises because we wanna make sure that we're protecting smokers as much as possible from the harms of cigarettes. Guess what? Filters don't even work. And here's the real kicker. The industry knew that all along. Filters were never designed to protect smokers from the toxins of cigarettes. They were only designed as a physical barrier to keep loose tobacco from literally falling into a smoker's mouth. The sudden mythology around the magic harm reduction of filters only came into play right around the same time as the certain generals 1964 report on smoking and health. And then suddenly, oh, don't worry, the industry says, don't worry, you can use a filter. Well, there's two problems with that. The first, again, is if filters really worked, we wouldn't see half a million Americans dying every year from smoking related illnesses. But the second is that we now know because we have accessed internal smoking industry documents that as early as 1958, their own scientists recognized, and I'm gonna read this quote directly, that quote, selective filtration of harmful compounds was a thermodynamic impossibility. It's impossible. And this is really, really important because as many of you know, our own assembly member, Mark Stone, tried to, he supported a ban on the sale of single use filtered tobacco products in 2014, in 2015, in 2018. He couldn't even get it out of committee. There's several reasons for that. But one of the biggest ones was this misunderstanding of tobacco filters as a harm reduction tool. We now know and study after study is showing that that is not the case. In fact, we have new research that shows that because of the hard filter and the way it changes the way people smoke, that plastic filters have actually led to an increase in the most common form of lung cancer called adenoid carcinoma. We also know recently that we have a new source of waste, which is electronic cigarettes. There's our triple threat to the environment. They also contain the non biodegradable plastic. They also contain remnants of the tobacco e-juice and they also have a lithium-ion battery which counts as electronic waste. And no surprise, big tobacco takes no responsibility. Just like they've taken no responsibility for the health impacts of their product, they take no responsibility for their environmental impacts. And they externalize this cost onto government agencies, volunteer organizations. Take a look at these pictures. Is this really who we should have cleaning up big tobaccos waste, children? These are students from Watsonville High School that I was working with on a capstone project or the most vulnerable in our communities. This is the cleanup that we did on Main Beach and Cowles with the, thank you downtown streets team. So what do we do? Here we are.  I don't know about you, but I have seen a whole bunch of cigarette butts within 10 feet of a garbage can. I have seen people on Pacific Avenue smoking five feet from a no littering sign. We know that we cannot rely on individual behavior change to change this issue. And we know that for many years of tobacco control work. We need to start looking at upstream policy solutions. These are solutions that focus on policy, environment, systems level change, including corporate responsibility. And this should not be something new. We have many other tobacco related policies in place that do that exact same thing. There are tobacco product waste policy examples. Several California jurisdictions, including our neighbors to the south in the city of Watsonville have banned the sale of all electronic smoking devices. Many other jurisdictions in California have banned the sale of single use electronic smoking devices. These are things like puff bar and vapor lax, which literally come preloaded with a certain amount of e-juice. They are not refillable.  As you know, the cities of Santa Cruz and the city of Watsonville have passed resolutions recognizing tobacco product waste as a public health and environmental threat. And they have both resolved to bring forth policy options to address that waste. And we are working with them we're in various stages of that process with those two jurisdictional bodies. What would a tobacco product waste resolution look like? What would it do? It basically is just saying that the county recognizes TPW as a public health and environmental threat. It provides an opportunity to gauge local support. It encourages different types of data collection which might include financial analysis, community outreach to both community members and tobacco retailers. And it supports community collaboration. I appreciate that one of the things that has been suggested in this resolution is talking about cross jurisdictional communication and action. It might specify current action what you are willing and able to do right now. And it can also lay the groundwork for future action. Thank you, Tara. I wanna really commend our staff from our tobacco prevention program, Tara Leonard and Jasmine and Andrea Solano and others for this incredible study session that really summarizes the complexity of this issue but of really clear facts about what we know about tobacco product waste and potential actions we can take. So today in our recommended actions for the board to consider is this presentation from our staff. And then also to recommend adopting a resolution that is included in the board packet that recognizes tobacco product waste as a public health and environmental threat. Creating a tobacco waste ad hoc committee and directing the chair of the board of supervisors to take related actions in support of addressing the issue of plastic tobacco litter. Also, if adopted, if a resolution is adopted, also recommending to direct health services agency to come back in June with recommendations on establishing an ad hoc committee to address the tobacco waste topic. So again, thank you all for your consideration of this issue and also wanna acknowledge the Tobacco Education Coalition which Tara mentioned, which have been around since 1985 in our community working on advocacy education and training with a wide variety of stakeholders, elected and community members to address this issue. Thank you. Thank you. Are there any questions or comments from board members before we open it up to the community? Professor Koenig. Thank you, Chair. Thank you HSA staff for this presentation in particular Ms. Lettern. It's enlightening. Of course, if you've ever participated in a beach cleanup yourself or as you said, a cleanup of Felton Park or any of our parks or waterways you've seen this problem firsthand. And it's kind of like the more you start looking at and training your eyes to see the issue the more you see of it and you realize just how widespread it is. And I know as someone who's participating in those cleanups that after a number of them it just, I mean, and every time the cards come back with cigarette butts at the top of the list as far as the most picked up item on all these cleanups. And especially when you're doing these cleanups with our youth and other folks you just feel like we've got to do something about this not only because it's the right thing to do but to demonstrate to youth and everyone in our community that we're able to make laws to prevent this kind of toxic waste from entering our environment. So we are the people in Monterey Bay Sanctuary and I think we have to stand up and tell the world how this is impacting our wildlife and our environment. We're the ones seeing it firsthand. I don't think that people littering cigarette butts are doing it out of malice. I think they're just doing it out of ignorance and maybe not realizing that this is in fact toxic waste. So our role here is to help educate them and ultimately to prevent corporations from needlessly doing this harm to our environment. That's fundamentally government's role is to ensure the private sector operates in a way that is beneficial for society and not harmful. I think also our County has done a lot to be a leader as far as plastic waste goes and actually on the tobacco issue in terms of banning flavored tobacco, banning single use plastic bags, addressing the single use cup issue. And so having seen this effort failed at the state multiple times, we have no choice but to address it at the local level. So I'm very supportive of the resolution today and next steps as well. Thank you. Thank you, Steve, those are coming. I just wanna thank the staff for all their work on this. I've been engaged in this topic for many years now and helped with leading the city on their efforts to try to ban single use plastic filtered cigarettes in the city of Santa Cruz. And I'm really excited for this item coming to us today and being able to be supportive of all these efforts because we know now that these filter, I think a lot of people don't realize that these filters are made of plastics and how they accumulate within our environment and how that cascades through the different food chains and through food webs and ultimately ends up in our systems as well. And to supervisor Connick's point as stewards of the Monterey Bay Sanctuary, it's upon, it's our duty to really be mindful about how this is getting into the ecosystems and doing what we can to prevent this toxic waste from going into our Monterey Bay Sanctuary. And so I just wanna thank all of your work. And I know there's many groups out there who have also brought this information to our attention and wanna thank them for their efforts on being advocates for supporting this at the local level. I hope I know there's been some community members that have been waiting. So if you would like to step forward, we open up for the community for an opportunity to speak on this item. Hey there, my name is Taylor Lane. Thank you for working on this and we really appreciate it. I'm the creator of the cigarette surfboard and we've made 15 surfboards over the years with over 200,000 cigarette butts picked up off California beaches and many of which coming from Santa Cruz and some of the first boards we made were from here. And of these 200,000 cigarette butts that I've personally sifted through, we're seeing maybe a couple of hundred e-cigarettes and things like that. And as we've traveled the world, we've seen this issue pervasively everywhere. And so we know that Santa Cruz can be a leader in this and what we're trying to advocate for is not a ban on tobacco but instead looking at a ban on single use filtered cigarettes. We're still saying you can sell tobacco in this community but that it's in a different shape or form. And all these communities we've traveled to around the world are looking for a leader. And if it can't happen here in Santa Cruz, it really begs the question, where else? As I heard some other people talk today about the responsibility we have to be stewards of our marine sanctuary, we're in radical times and that means we need to take radical action against these corporations that continually push this issue onto our community, onto young people, onto all sorts of wildlife.  And we've gone to the state level and we've been shot down. So we're trying to seek a local policy here and we know there's a lot that's gonna happen and take some time. But really, we thank you for coming here. And it's really our duty as the next generation. We're bearing this burden on our shoulders and we hope that you guys can push forward with something in the future that'll really hold these corporations accountable for their waste because it's just con man stuff that they're doing and we don't deserve to take on that burden. So thank you for your time. Thank you. Good morning. Good morning supervisors. My name's Ali Webster. I'm chair of our local surf rider foundation chapter Santa Cruz chapter. Nice to see some new faces. And I'm really excited to be here and not talking about the local coastal program. Surf rider foundation would like to express their support for the board to adopt this resolution before you. I won't get into all these details that we've already been talking about but I do encourage anyone who hasn't already to just look around you as you walk through the parking lot this evening and see that these cigarette butts are everywhere. Once a committee is formed, we highly encourage the committee to consider focusing on the specific issue, a single use plastic cigarette filters as a start to this local path against tobacco waste. Focusing on this one issue makes the endeavor far more achievable and far less divisive. It also has the potential to force the hand of big tobacco to consider alternatives to plastic and ripple change across the country and the world in the same way that our styrofoam and straw bands have created change throughout forcing large companies to explore alternatives. Surf rider partnered with Cigarette Surfboard and other nonprofits and individuals is looking forward to working with the board and providing you with proof of public support that is needed to move this issue forward with the ultimate goal of the ban on single use cigarette filters in Santa Cruz County. Thank you for making time for this issue. Thank you, thank you for waiting for the item. Good morning, welcome. Good morning supervisors, my name is Tyler Fox and I'm a Save the Waves ambassador here as well as the founder of Santa Cruz Waves and I am here in support of this research, more research and an all out ban on cigarette filters or the butts. They are such a small issue but I'll never forget a video I saw where they dropped one in a fish bowl, little gold fish bowl and that gold fish died. So they're toxic and I think we have an opportunity to really show the rest of California coast and the world that we're not gonna stand for this and that we can really make positive change that will ripple throughout communities all over the world. So thank you so much. Thank you, anybody else in chambers? Okay, is there anybody online? Yes, chair. Colin user one, your microphone is now available. Take the comments on preventing corporations from doing harm to our environment. I see filters on cigarettes as a false image of safety. You gotta get rid of the filters, the cigarettes and some call the cell phones big tobacco too. And this is something you can't see the radiation harm but it is doing harm. I think of the book toxic sludge is good for you. Lies, stand lies in the public relations industry. The book opens with an account of how they got women to smoke in the 1920s after they had won the right to vote and how Edward Bernays, the father of propaganda working for the tobacco industry, convinced women to smoke. And there's always the propaganda that goes along with selling these toxic produc