Senate Standing Committee on Ways and Means

Okay, calling to order the Joint Committee on Ways and Means and the Committee on Health and Human Services. So this morning we're here from the Hawaii Health Systems Corporation and they'll be presenting their biennial budget request. Good morning. Happy New Year.

Good morning. Good morning, Chair. Good morning, Vice Chair, Member of the Committee. Good morning, Chair Sanborn Ventura. Good to see you folks again. My name, for those of you that I think you all know me, but for me, if you forget, my name is Edward Chu. I'm the President and CEO of Hawaii Health Systems Corporation.

In my comments this morning, I'll be covering the HHSC region, so HTH212 and also I'll be covering Oahu region as well, so HTH215. So just, just to summarize very quickly, our, our testimony. So you know, we, we, for those of you that may not know, we are the basically the rural healthcare safety net.

We also serve disadvantaged populations and because of that we have a very important standing in the healthcare community. At this point we account for about 13% of all the acute care discharges in the state and also 19% of the emergency Department visits in the state. So it's a pretty big percentage.

And on the neighbor islands that percentage grows to the majority. As a system though, we do face several historical challenges, the first of which is we do serve a large percentage of Medicaid Quest and uninsured patients.

For government type payers, which includes Medicare, we're at about 74% or 75% in terms of our payer mix, 45% of that is Medicare, about 30% is Medicaid Quest. So we are serving those that need the care the most. The other part to mention is our labor costs are well above industry norms.

You know, the state agency we are, we follow the compensation packages and benefit packages of the state. So our fringe benefit rate as you folks know, is about 64% that we get assessed and we pay that out of our own pocket. Most private hospitals here in Hawaii pay about 30% for fringe benefit rate.

So the difference between that 30% and our 64% level equates to about $90 million in terms of what our General Fund need is every year.

So just to point that out, the other thing I wanted to just point out in our challenges is that, you know, we have a significant need for capital investment, particularly in new medical technology. We are planning to have plans to invest in an emr and that's part of a budget request which I'll summarize very shortly.

But it is starting off at East Hawaii region. They are planning to convert to the EPIC medical record system, which is a pretty significant step because then it would allow them to be on the same platform as the other major hospital systems in the State of Hawaii.

So almost all the hospital systems in the state are on epic. There are a few that are not, but I think that would be a good way to improve the patient access, patient outcomes. So we have. Part of the request is in there, and I'll go over that in a few minutes.

So just to give some context to the request, and I'm on, I think I'm on page four of our testimony. So during the pandemic period between fiscal year 2020 and fiscal year 2023, we received significant federal funds. We have provider relief funds of about over $60 million.

We have Paycheck Protection Program loans of about $20 million and received other federal funds. So if you look at all those funding levels together, that's about $100 million in federal funds that we received during the pandemic period. That helped us to kind of defray the cost of our operations during that time.

So we didn't have to ask for as much General funds as we normally would have. We realize we are stewards of state funds, so we do not want to ask for more than what we need basically, to sustain ourselves for each fiscal year.

So because of that, I think our General Fund appropriation levels going into that pandemic period and also extending into even this current fiscal year are lower than what we probably would have needed had we not had those kind of funds available. So in fiscal year 24 and 25, our General Fund appropriations were about $160 million annually.

For HTH212, we had requested about 260 million in fiscal year 26 and 190, almost 200 million fiscal year 27 in General Fund appropriations, the Governor recommended 151 million approximately each fiscal year.

So basically, just to put into context, so throughout the past fiscal years, our General Fund Appropriations represent about 22 and a half percent of our total operating and non operating expenses.

So, but, and if you look at our request, based on our projected expense and non operating expense levels going into fiscal year 26 and 27, our the percentage of General Fund appropriates that cover that is about 24% and 22%. So it's around the same level.

And that's in spite of the fact that we have significant, we expect a significant increases in costs. You know, insurance costs are going up quite a bit. Pharmaceutical costs continue to rise. Contractor labor Costs to meet some of our staffing shortages are expected to increase as well.

So because of that, that is a large reason why our General Fund appropriation looks very large. The other part of it is there's $13.2 million in fiscal year 26 and about $2.3 million in fiscal year 27 related to costs for the ER EMR implementation of EPIC in East Hawaii region.

And that pretty much is to try to build a backbone of EMR system that could support other HHSC regions in the future. There are discussions with other regions in terms of jumping onto the EPIC platform that could be supported by East Hawaii which would be a good thing I think for the statewide health system overall.

So just that kind of that 13.2 million is why that fiscal year 26 number looks a little bit bigger than the fiscal year 27 number. Just wanted to move on to Oahu region HTH215.

So for fiscal year 24 and fiscal year 25 they received 20.1 million fiscal year 2024 in General funds, fiscal year 202521.3 million in their request for fiscal year 26 and fiscal year 27 they requested $8 million in fiscal year 26, $14 million in fiscal year 2027 and the Governor recommended that amount.

So the Governor is in align with that recommendation. And the reason they're able to reduce their request to those levels is because of the acts of Legislature did back in 2022 I believe to increase the Medicaid reimbursement rate for long term care facilities.

So that increased their reimbursements for their long term care visits by about 60 over 67%. So it was a pretty significant increase for them. And then in terms of our CIP requests we have several requests that I think you know, your staff has information on. In terms of individual items.

I would just point out a few that are pretty significant. One is for the. It's under listed on the Kau Hospital but is it is for the Benioff Kau Benioff Health Center. It's a project that is being funded by that.

We requested $25 million in CIP funds for 12.5 million in fiscal year 26 and 12.5 in fiscal year 27. That is being matched by a contribution by Mark and Lynn Benioff of $25 million. So we are asking for the support for the CIP portion of that.

And I think that'd be a great benefit to a community that's growing and if you have ever been out to that area area of the Big Island. Not a lot of healthcare facilities down in that area. So. And we have an emergency. Time is, time is of the essence.

The other major request we have that's individual that was supported by the Governor is for the Kona Community Hospital ER expansion and reconfiguration. That project is going to be especially important. Their, their ER visits their capacity pretty much every day if you've ever been there.

If a patient comes into the walkways in the emergency room now everybody has to stand up and squish against the side. So, you know, you kind of have bad guys like me sit standing out there and blocking away.

So it's important that we model that so that it gives appropriate space for patients to put through the emergency room and also to be more Ada compliant as well. And the last thing is there is a request under Kauai region for some EMR capital funds and that is to there's a placeholder.

For now, we don't have exact numbers. It's 7.5 million in fiscal year 26 and 7.5 million fiscal year 2027. And those funds are for basically for Kauai region to jump onto the EPIC platform for East Hawaii to help to pay for those implementation costs of that system.

So in that sense, HHSC would pretty much for our key facilities would all be on one system. So just in summary for everything. And we also have Kahuku Medical center here and they'll be presenting on their own budget. We also have Maui Health Systems here. They're presenting on their own budget requests.

But I'm hoping that when you folks hear about us in the news or in your local community, that the sense of collaboration that we're trying to develop with other health systems and the community is evident. You've already heard about our Hilo Benioff Medical center partnership with the Benioff with a $50 million contribution there.

So we're hoping that to foster that into a long term supportive relationship there. And that also brings about collaboration with Hawaii Pacific Health and University of California San Francisco Medical center to bring specialists to bring recruitment help and also to develop and improve neurosurgery coverage for the Big Island.

So those kind of collaborations I think are important going forward. You've already seen West Hawaii, they've partnered with Queens to get onto the EPIC platform and that's been a benefit to them as well. We also had the Samiya Mahelona in Kauai, the master plan there. That's going to be a community project that will be beyond just healthcare.

It goes to housing and other social service agencies that will benefit from being to use the land being able to use the land on that campus. And OAHUI does several partnerships. One with the Adult Mental Health Division for their Polycarna program for substance abuse patients.

They also have a corp program that they're doing with the city and County of Honolulu and Queens to have a medical respite home for patients that are homeless and have other have other issues in the coming out of the emergency rooms.

And they also have a partnership with Queens to use some of the space at Malahia to house some of their long term stay patients. So that offloads some of the waitlist patients at Queen's to be able to be in a more appropriate level of care and fees up beds at Queen's Medical center that they badly need.

So that's the spirit that we bring to this Committee and to our communities every day. And we're hoping that you post will support us in that endeavor. There are tables, our budget briefing tables you have in front of you. I'll just kind of briefly go over what's in table six to point out.

So you'll see under well let me start off with HTH 212 because HTH 211 will be covered by Google Medical Center. But you'll see this the second line item under Table 6 is increase in General Fund appropriation of $67.3 million.

That is to add back for the funds that were marked as non recurring in the budget primarily to replace the ARPA funds that we had received in prior years.

That's about $41 million in ARPA funds that we had received in fiscal years 22 and 23 and also the other General Fund increase that we had received in the 24 and 25 time period. So that is one addition.

The other one that affects our program IDs are the 40 region on the 4th line down for the $8,014,000,000. I kind of talked about that General Fund request already because the amounts provided to Oahu region in the prior biennial were marked as non recurring. They had to start from a zero base.

So that's why the $8 million $14 million are there. And also the last item there in Oahu region is to restore their special Fund ceiling. That is just to be have them so that they're able to spend their cash collections on funding their operational expenditures. So that brings it up to 48.5 million and 48.4 million.

Be happy to answer any questions Members.

Any questions Quick Question. When you, when you're opening about the fringe benefit at 64%. Yes, I realize that, you know, high across the board. Well, how is it that the private sector fringes just at 30%?

It's because our State of Hawaii benefit package, because we are, we are state agency and we are, we follow the same collective bargaining and negotiations and benefit packages that state employees have. So the major difference between state and private is essentially two things. The defined benefit pension plan funding that's needed for that.

Most private companies have done away with pensions for the most part they're into like 401k or those kind of programs. So the cost of the employer is much less. The other major portion is the retiree health insurance benefit that the state provides.

Some of the private hospital do provide maybe a small amount of retiree health insurance benefit, but it is nowhere near the level that the State of Hawaii provides. So those two factors probably account for I would say pretty much all the difference between the private hospital fringe rate and the State of Hawaii fringe rate.

Well, thank you for saying that because I think the public is not necessarily aware of the differential as we are between the private sector and government and it is, we provide.

So thank you, thank you for that question. The one other thing I should mention too for HHSC that's a little different from the other state agencies is that we have been paying the fringe rate out of our own cash collections basically.

So we're trying to Fund that as much as possible out of the patient revenues that we generate. Other agencies, those costs are taken care of by State Department of Budget and Finance. So it's a little different for other agencies.

That's why, you know, sometimes they say government salaries are not as high, but the fringe benefits and the benefits that they get, especially healthcare, is huge. So that makes up some of the differences. Thank you.

Thank you. The, in your report, the Daniel K. Akaka State Veterans Home is being transferred under your jurisdiction to the Oahu region.

Yes.

Yeah. So do you, are you appropriating funds in this biennium to for operations because it will open up this year. Right. Or how does that work?

Want me to answer that or. Okay, well, I'll just give you the short answer.

So essentially the General Fund appropriation that Oahu is seeking is to the operations for Leahia Malakia, the state veterans home, when it opens, which probably will be, you know, this calendar year, sometime probably in the summer or maybe if everything goes right earlier, maybe later in the spring, that is going to be funded through, it's being run with by a management contract with a company called Ohana Pacific.

They run long term care facilities across the state. They are going to be responsible for funding a lot of the. The operations. Oahu region does have the ability to Fund some of the shortfalls in the. In the short term. But we're not asking for additional funds to out of the Legislature to.

To Fund the veterans home at this point. Okay, thank you. Sure. Thank you. Chair.

Great.

Okay, just looking at your 212 on your regions, you show a abolishment.

Which table is that?

Zero okay. Table six that he was on. It's on table six. And there's an abolishment of a position, the procurement and supply and you abolish that or it was a vacancy anyway. I guess on April 12, 2024 there is an abolishment. So is that you were just deleting the. Okay, I think it's table 11.

Yeah. Is that where you're trying to.

Yeah, that's a vacancy report, table 11. So. So with the question you're abolishing that but that has to do with the vacancy. Then can you replace the position or where are we with procurement?

This you're talking about the senior contract manager position that the one you're referring to the 1/3 line down.

Well, I'm looking at page 2021 on our table six. Yeah. So my question is table 11. zero okay. But anyway it's showing up on this page. But so are we where asking. You're abolishing positions with vacancies. So but you already have replaced or how are you accommodating procurement office?

Yeah, so this is just for the corporate office that we're talking about. So it's not a facility, it's not a regional position. We do have right now we have two contract managers at the corporate office and they feel they're able to handle the workload that we have our system wide contracts.

So we do not feel the need to keep this recruitment, this position open for recruitment any longer. So that's why we're abolishing it.

Okay, thank you.

So I have a couple of questions. One, you're talking about the partnerships you had with Queens. I thought it was also with Leahi. Leahi as well as Maluhi. Right.

The core program that is on the Leahi campus is Queens. Is one of the partners involved with that. With that program, with the medical respite. That's a malu here.

No, I thought it's both. Both. It's both. It's both, yeah. Okay. And you folks are able to. So Queen, you folks are able to offload a lot of the Queen's wait.

List or you should come forward.

Yeah, I should come forward.

So introduce myself. Good morning chairs. Vice Chairs. Happy New Year. Sean Sonata, Chief Admin Officer for the Wahoo region. To answer your question, Chair, we have programs at both Malihila and Leahi. I think what you're referring to would be bringing patients in from the Queen's wait list.

But also in our collaboration with the Department of Health and the Hawaii State Hospital, we've been able at Leahi Hospital to bring in patients into our long term care program. So it's not a special program.

Its individual contracting with the Department of Health to bring in very Low level, I guess mental health acuity, Low level, but also incapacitated individuals that could qualify for conditional release or discharge from the Hawaii State Hospital and we'll bring them into our long term care facility. That's something that's been ongoing for a long time at Leahi alone.

At Mauhia, we're looking at also admitting those types of residents where it's feasible.

But primarily we're working with a special program with Queen's where we would admit people from the waitlist who also are very incapacitated and can be released from those ER beds or those other wait listed beds and are more appropriate in the Malajia long term care setting. So we're working on that as a special project.

The reason why it's called special is because our arrangement with Queens is financial. While they might meet the requirements, the Medicaid process is very complicated where if we admit someone who doesn't have Medicaid yet, they. We get no funding. Right. And so when they get admitted, they're considered Medicaid pending and we're caring for them.

We're expending all our resources to care for the person until they get qualified and then down the line when they get approved. If they get approved, then the funding comes back retroactively. So the way we're operating with Queens is that when we admit a resident who's not qualified for Medicaid, they will front the cost.

So we're not taking this initial loss and then later on down the line then we can reimburse them when the payments come in. It's just we're not shouldering the risk of a non approval because if it's not approved then there's no funding. But if it is approved, then we're just giving them back the Money.

Department of Health 1 How many see I just finished talking to Dr. Frank a few minutes ago. My understanding was you guys were not taking any Department of Health.

That's not correct. Good. But I'm not going to dispute what is being said because it could be a different context. But from the way that I understand it to be, we have been admitting patients from the Hawaii State Hospital into our facilities. We have a record of some that's been admitted over the last several years.

Recently, he's correct. We haven't been able to do it because it has to be appropriate for our rooms if we have someone that they might think is fitting for our facility, primarily Leahy, at this point in time. But we're going to put someone like. I'll just say. I'll just give an example. I'm just making this up.

You know, a male patient from Hawaii State Hospital who may have certain adverse tendencies. And then the only space we have at our facility would be with three women. And there's one, you know, one context. Correct.

But at any point in time when we have someone that would be appropriate for our facility, we would go ahead and implement.

Okay, so I'll ask you more about that later on then. About. About how many. My other question is, you said about. And it's not necessarily with you, it's with HHSC in General. You had partnerships. Do you folks have partnerships with a cancer center?

The cancer center. Okay.

Yes. Because I remember seeing a cancer center and it was with Arthur Anderson before. I'm hoping it's here I can elaborate some of that.

Good morning and happy New Year. Chairs, introduce yourself. Dan Brakeman. I'm the East Hawaii Region CEO for hhsc. Good morning. The question about what we're doing for cancer and so forth. Actually, East Hawaii region or Hilo Benioff Medical center, has been working to become part of the Hawaii Cancer Consortium. So that's that partnership that between.

I think right now the main partners are Queen's Health Systems, White Pacific Health, I think Kaiser has a limited role in there, and of course, uh, cancer center. And they basically have a consortium together to provide access for clinical trials for. For patients.

And traditionally, neighbor island patients have not been able to get access to clinical trials because there really isn't a relationship. And there have been work through the cancer consortium to try to expand to the neighbor islands. They do more than just clinical trials, though. They do cancer prevention education.

And I think also importantly for us, it's an advantage when it comes to recruitment of oncologists because they generally get an adjunct appointment with the cancer center and the ability to do some level of research or at least have some involvement in clinical trials.

Because if you're an oncologist and you're going to go practice on a neighbor island, you're going to go, I'm going to be in the middle of nowhere. Maybe I don't have that professional support and camaraderie. And so we've always struggled to get oncologists.

And so by having this relationship we're able to basically be a more attractive place to practice because White Island, great place to live professionally though people do feel distance. So that's what we've been working on.

So when you have this relationship with a cancer center, do they get. Do that? Do they do that oncologists that they share with you folks, do they get paid by you folks or who pays them?

Center doesn't have oncologists jobs or the hospital.

Yes. So the employment, it depends on how you structure the employment relationship. So in General, we, our medical group will employ the oncologist. They will have an adjunct appointment. So they would be like an assistant Professor of hema oncology at University of Hawaii. And they have relationships and connectivity. We bear the cost for that.

Now there are other relationships where if they were actively doing, working as a researcher, the uh, would pick up that component of their cost. But generally we go out and hire people who work practice and they have more of a clinical relationship with research.

Just like Dr. When he gets an extra to do oncology work and he's also at the cancer center. But cancer center doesn't have doctors. zero, my gologist is two Japs.

That's why we wanted to combine the two, because they need to have. We'll talk. Yeah, because they've come up. One other question. Sorry. Here, just keep it going. Okay. I want to talk about the, the KL Benioff has. Have the plans changed from last time?

Because my understanding is you guys weren't going to ask us for more monies because Benioff was gonna put in the entire amount, but apparently not. What's happening? Or maybe my understanding was wrong.

I'm always careful telling Senators their memory was faulty, sir. So the initial idea to have more healthcare infrastructure KL has actually been something our board, our regional board has prioritized. So it was supposed to be in more of a phase approach. So there was phase one, phase two and potentially three. And they were smaller bites.

So the initial funding we got was for stage one. You gave us 4.0 million to do infrastructure, site and planning and design. Okay, so that was for the stage one, which was a more modest price, probably around the neighborhood of a $20 million investment infrastructure.

We had the idea, and I think it hopefully has paid off to package together both stages and to go to philanthropy and see if they would be willing to, like, do it all at once and to contribute substantially for that.

In the discussions back and forth with the Benninghops, they are very much kind of the mindset that they partner and they help. They put in the entity, the state or whoever the hospital is that they're working with also contributes, and they wanted to do a matching Fund type of arrangement.

They never, you know, said, well, you know, if you can't get it, we may be interested, but we really would prefer. Prefer to have it where the state contributes and we contribute. And I know that he had interactions with the Governor.

The Governor put this in his message with basically understanding that what the state contributed, they would match. And I think together 25 and 25 is 50. We have set aside and save some money for the project. We expected to be around a $60 million, but it does it all at once, which KL certainly needs, Puna needs.

It's just we couldn't afford to do that on our state's dime. So that's why we were staging it. But with philanthropy, they like things that have big impact. They don't do incremental. And by putting it together, I think we got a lot of interest from, you know, these major dollar donors who actually get it done.

Okay, so basically, same plan, except expedited. Yes, absolutely. Both stages are all together. So stage 1 and 2, you notice the size of the project double. It was because we took stage one and stage two, put it together and presented them, did the pit, and they were like, we can do this.

It's ambulatory and behavioral health.

Okay. All right, thank you, Ed.

I noticed on table 11 about 123 the 6th line recruitment ongoing. But that was since September 2019 for Infotech specialist 5.

Yeah, we are constantly in the process of trying to recruit people for our corporate help desk, which is a place that if you have problems with your basic IT systems, like your desktop or your laptop or anything, we write to the network that they call people call into.

And that's where the first triage level is, I guess, for IT support. So we've been constantly trying to find people to man that position. And that's why this position has been ongoing recruitment. We constantly need more people for that.

You have more than one or is this one position has just not Been filled.

Yeah. We've been able to keep the staff kind of somewhat at a constant level, but we've always had this one position that we always needed one more person for.

So despite some of the turnover that we've had, we've managed to fill some, but we still have just one position that we think would be helpful in terms of getting the whole, the IoT help that's fully staffed.

Okay, so what are you guys going to do though? Because six years.

Yeah, I mean, we've been managing so far with the volume that we've had, as you know, so far throughout the.

Years are the approach like you got to go work with either the community college. Yes. Department of Labor. I mean, gotta have different strategies. Right.

We've tried, we've tried different, different avenues of recruitment for, for that position. We are, we do reach out to community colleges, see if they have, you know, it specialists that could punish. Potentially apply for the position.

It is a specialist five though, so it's a little higher, higher grade of IT specialist than someone that comes right out of school. So it's a little bit, it's a little bit tougher. But you know, so far the, the regents have been pretty satisfied with the feedback that we've received on the help desk function.

So I think we just want to keep it on in terms of someone that can help manage the load, especially if there's any kind of absences.

Having a lower, I guess a lower specialist number is better than having none.

Right. I think. But we also have to look at the capabilities of the, of the person and what kind of work to be handled. We constantly look at these positions and what level we have. We, we've looked at recently a, one of our, one of our contract specialists in, in the corporate office.

We had it at a senior level, but we've been able to. We've had success in recruiting at lower levels and training them up. So we've taken those approaches as well and we'll be looking at those kind of position and also looking at taking a similar kind of approach.

So how many times has this position been out for recruitment? It's been up the. Out there for a while.

Vacancies. So on the vacancies you have a number of positions that the amounts, as far as budgeted amounts are blank. If those had monies before or they never had monies or how do you fill them if they're blank?

Yeah, the, the way HHC does vacancy is a little bit different than the state because you know, with most state agencies your, there's funding tied to a specific position. HHSC has position control, so it doesn't quite work the same way. When we do our budgets, we project out the amount of personnel we need to run our operations.

Now currently some of those functions are being done by, on the clinical side especially, some of those functions are being done by contract and help like contractor nurses, contracted techs, those kind of, those kind of personnel.

So when we do our budget, we look at what we need and if we're currently being filled by a contracted person, we'll, we'll flip that from a contract. We'll reduce a contract expense and add it into our personnel expense. But the total expenditures are going to be basically about the same.

So there may be a lot of areas here where you see budgeted amounts, but there's also somewhere where you don't see any budget amounts. And that, that's kind of why.

So you've literally taken the money from those positions and used it for another position. Basically.

No, we still do the function. The function still needs to be filled. So what we do is if we can't find, like right now, there's a hard time finding text. We have a hard time finding CNAs especially. So if we're able to contract for some of those positions, we contract to help fill those needs.

But the money is basically from when we budget, we have that in salaries, expense. But when we, if we can't fill that position, we are able to get the resource, then we put into contracts.

Positions that don't have money and it's vacant for so long.

If we have, if we have a position that is vacant, we don't necessarily Fund all of our vacancies in our budget request. So when you look at our numbers, we don't have all of our vacancies built into our numbers.

That's what I'm trying to get a handle on because you're not the only one. Throughout the state government, they have hundreds of vacant positions with no money. They've taken the money and used it elsewhere, but then come in and ask us for new positions with new monies.

When they actually have the positions, but they've cockroached the money and paid for something else or use it for raises.

Right. And because of the way, the way we're structured, that's not how we, that's not how. That's not the way our positions are funded. So it's, it's, it's a different type of that way.

Because if you have no money there and if we take away the position, because if you can't fill it and you're not going to fill it because you know what, the money there, you've taken the money also. Are you going to put the money back in once you get rid of the contractor?

Because here it says budget amount. It's empty. Right? Yeah. Yeah. So where can you. That's filled. How are you going to get. Where are you getting the money from?

I can. Yeah, sure. So it really is in some ways a clinical operations question. So let's say you have a position right now that says RPN3.

No, we can just talk about the real One here, Infotech Specialist 5 is that it's ongoing since 2019, but there's no budgeted amount.

I thought you were speaking of different.

Talking about it all.

Yeah, it doesn't matter. It's just a vacancy that ongoing recruitment. Some have money, some don't. Right. Like you're saying you don't Fund all your vacancies just in, I guess whatever your strategy is, but in this. I think that's what everybody's trying to understand is how do you.

We want to know what when people don't feel they move the monies around for the vacancies, we never know what they move the money around for.

Maybe this, this would help if I just gave it in the form of an example. So if you have 100 nurses that you need to operate, you may have at any given time 15% of those nurses you cannot fill. But you still have to provide the service. So you use contract labor so often.

What we'll do when we go into a budget year and we budget, we will estimate of that money for those 100 nurses, 85 of them are in the salary benefit side and 15 of them are over in the registry contract labor side.

And what will happen as we go through the year, that percentage may adjust and we'll move the money back and forth. So some of those positions, like the 15, they're there, but we know that we're going to use them as.

Use the money that in theory is there for them for contract labor because it's always moving from those positions.

That's where the money is Budgeted. In this case, there's no money budgeted. So if this is filled, where do you get the money for this one?

I think it's because you still need, in that example of the. You need the honey.

I think. Huh, what's that not? I think that we can't guess.

We want to know what the 100 nurses, you know that you're going to spend money for nursing labor. It's just, it's in some mix.

I get that. I'm talking about a vacant position that has no money. How are you going to fill it and where does the money come from? If there's, if there's no budgeted amount, well, might as well just cut the position. There's no money to it.

Yeah. So in the case of where like say this info specialist five, if, if there was a candidate that came up and was able to fill the position, we would try to find the savings or somewhere else to fill it versus versus just adding another person, take it from another position. Another position.

Or if we find some contractor savings somewhere else in the, within the organization, we can, we can try to fill it that way, at least for the short term.

So when you contract, don't you have a budget for contract contract labor?

Yes, we do.

So you have it, but yet you're still taking money from positions to put it for contracts. See, this is the problem we're having because that, that salary monies was not intended to be for contracts. If you need for contracts, then you're supposed to have, like you said, you have money for contracts, right?

Well, in General in our case, when there is a, let's say the registry nurses are a good example. So even though we may not have a salaried employee ready for the position, that function still needs to be done. We still need nurses at the bedside. The only way we can fill that position is by using contracted labor.

So we're utilizing.

They don't want to apply because they don't want to apply.

It's various reasons. It's in the variability. If we look, if we look at what we spend to deliver the nursing service, that's pretty consistent in that budgeted amount. Within that budgeted amount though, there are two buckets what we pay for salary and benefits and what we pay for contract labor.

And we can't predict that cleanly ahead of time. So sometimes part of the year you may have 30% of your money in that bucket spent for contract labor. And by the end of the year when your new grads come out and you've employed Them in whatever, you're down to 10%.

And so we have to have a bit of ability to move between those two budgeted amounts.

Okay, let's talk about non medical like you have here health unit Clerk 2 that's been vacant and has no monies at all. You know, and you have other kinds of technical regional EPR Director, no monies in life vacant. So how do you, how do you justify those?

Obviously the work's being done by somebody currently in the position in another position you've already put more work. Right. You've overlapped or whatever. So how do you justify those?

So I know what happens as we get near session. We generally do a position cleanup over the year of positions that you don't need and abolish because we have the ability to create positions. So for example, you, you create.

You, you maybe there's 10 health unit Clerk positions and you filled seven or eight of them and you've changed some of your operations and then you asset manager, you still need those positions. Are you still actively recruiting for them? And sometimes they go, yeah, we're still actively recruiting. Or go no, I don't want to go.

Well then you need to abol. So we are constantly going through a hosting as our operation change abolishment of positions because we have the ability to create, but we also abolish just before session. Over the last couple of months I probably cleaned up, you know2030 positions that for different reasons aren't being needed.

So if you, if you can create your own positions, why not just delete the ones that you don't need and just clean this up?

Because I.

And then when you need it, then recreate it. But what's the mechanism for creating it?

Because the managers often will go, well, I'm not too sure. I think I'm going to need that tech five out there.

And then sometimes, like I said, since 2019, well, that one we probably should.

Have got rid of. But in General it is a cleanup function that we run into where managers understandably want to adjust in case hold on to positions and then we have to tell them if you're really not going to.

Well, how long does it take to create a position?

We go through what they call an HRO1 process.

Who does it use? The mechanism?

Yeah. So for the corporate office, it runs through our HR Department. Generally for the regions when they need to create a position, they initiate the process and then it also runs through.

Our final say in our regions.

zero, each region we just make sure. That we, that they're in the proper classification on the, on the corporate side.

HR01 for a position. I also sign every abolishment.

Okay. Because.

Can you send us a list of all the abolishments you've did for the last few years so we can take a look?

There are actually quite a few.

But you don't ask us. You don't ask us for positions.

No, no, we don't. You notice our position count. If you look at the budget worksheets, the position count is very outdated. It hasn't been. It has been updated for many, many, many, many, many years. And the reason again is because the statute gives us position control to create anabolic positions.

Yeah, sure. So. So by seeing what you've been saying, I was listening. Yeah. Do you guys. Are you guys in a. In a process or you guys are using other employees from other departments to make up the staffing shortage? And if you guys are doing how. How is they qualified to ensure patient safety?

Because what you're telling them and maybe saying you're abolishing this, but it seems like you guys are. I don't like say, sharing. Let's say you have a custodian doing nursing work, but you guys are moving people within the Department to. To do other. Other work that you guys are shortage on. So how. How you guys.

No. Is that the case? Because it sounds earlier that if you don't have. If you have a. If the position isn't filled, you contract it. We have the ability to do that. Is it contracted like what he saying from another Department?

You guys use our employees from other departments to fill.

Well, Niki. Well, go ahead. No, in the case of the, like the registry nurses, those are nurse. Those we use outside agencies. So a private agency has nurse. Has a nurse staffing agency. We go to that staffing agency to bring in the nurses for that position. We, in terms of how we manage.

It'S like it's really an outside company.

Yeah, outside agency. Outside company.

Your agency. Agency.

Yeah, yeah, yeah. It's an outside company. Outside vendor.

That's where there's a. Yeah, yeah.

We don't, we don't have like, you know, we don't use like clerks to fill nursing positions because they're not qualified. So. Yeah, you know, I mean, like I mentioned earlier, that part of the HR01 process or the establishment process is looking at the classifications. So that's what our corporate office does to make sure the classification for the.

The employee is correct.

So do you borrow or have a partnership, I guess, besides the cancer center with other Agencies for staffing or.

No, not other state agencies. No. Okay.

So if you like what you're saying, you're just having issues with CMEs and you use an outside whatever agency or business or whatever to fill the position. You guys, how you guys market you guys pre CNA program.

So we use. We don't use contract businesses to provide a cnas. They don't exist on the neighbor island. However we do operate in run training programs who train local kids to get them certified, offer them job and get.

That's the one. Remember we went to Kona? Yeah. They started their own program because I'm not sure if the the uh was in.

Well what do you mean why I bring this up here because you guys saying you guys don't have these certain oppositions but you know you guys creating or doing you guys own but you guys only have a small amount that you guys are producing when you guys self you guys are outsourcing.

Outsourcing more than you guys are actually bringing in.

Actually for our CNAs again we don't use any contracted labor. The only contract labor we normally use are for nurses and then also for income tax. We only generally do between the transition period when for example if I have ER nurse and the ER nurse here.

You got to make sure you see.

Great table you're on the neighbor island and that ER nurse I need to replace them. Pretty much all the ER nurses are either working in r ER westwives or northwest. So we then though it takes us about four to six months to recruit a new ER nurse either from the mainland or train someone to see one.

So you still have staff that ER use contract labor to cover that piece and that's pretty much a consistent percentage of our workforce is somewhere between 10 to 15% in that transition stage and that's not maintain levels of service.

So even like you guys telework or you guys work from home, you guys have a lot that going on. The one that I concern about is that I seen that you guys have a pharmacist that is working remotely. How does a pharmacist work remotely?

We don't have any easter wise remotely. There are some functions where folks will take calls I think remotely. I don't believe we have remote points.

How much of why I think they may be that position may be someone that maybe actually was working as in our EMR as an analyst but they are technically classified as a pharmacist because they work on the pharmacy module, the emr.

Right.

So that's why it's classified as a pharmacist, but they're doing telework.

Doing telework.

Yeah.

You don't have to send me the abolishment thing. I see on here some of the positions that you have here that says.

There are some that are listed as abolished. Yes.

Chair, table Chair. Can I talk to Table 15? CIP request short renew information. Kona Hospital. What's the relationship with Queen's Hospital? Because we did have the release from Queen's, but I noticed that the $1.3 million for this year is that for plan and designs and location seeking.

Because you're going to need more money if you're going to relocate where it's going to be and plan and designs. To me, I think 1.3 is not going to make it. But I was just questioning.

But that was. Yeah, that's just for the emergency room.

Just for the emergency room. Okay. So not part of the. The new Kona Hospital, then.

Okay, so that's preliminary too. I'm not sure that's real yet.

So Kona Hospital in any funding for Kona Hospital for the new hospital is not in this budget. Correct. Okay.

This is just for our current operations address. Thank you very much. And that wouldn't be in our budget.

That's right.

Because it's not our hospital.

That's why I'm going to say where is Queen's involved with it. But now it's clarifying that these are only sort of already.

That announcement was premature. I don't think it's finalized yet. So it's not pre. It's not determined if Queens is actually going there.

And you know what, though? That announcement got people excited because they're all thinking hospital and that's why I'm raising it. But thank you for the clarification.

So in the meantime, they got to support this 1.3.

Exactly. Exactly. Yeah.

Still need the help. Need it. Yes. They definitely need the help to redesign that. I know that the health chair has one more shot.

Come back up. Sorry. Okay, one more. You know the 5.6 million and 5.1 million on your table 15. Any of those monies to upgrade Leahi so you guys can get more Department of Health?

Unfortunately, no, Chair. It's. This is funding for just some deferred maintenance projects for just bringing the facility back. You know, as you know, both Liyahi and Molly here very old. These funds are simply to maintain, maintain and bring them up normal standards. But I will say that I know that Cruz is very informed on this.

We do have a Project in place with the University of Hawaii School of Architecture. It's the community design program. We just contracted with them. We have the funds already committed and we're doing a kickoff with this team beginning next week.

And what it is, is they're doing a full assessment of these spaces that you're referring to on the Leahi campus to give us a really clear idea of how we're going to bring all of these dilapidated spaces up to form where they can be repurposed for these new programs.

So none of those monies are here.

I mean, it's already.

It's already funded. Okay, thank you.

I guess, you know, I want to go to table 13 real quick. I noticed. zero, that was your question.

zero, why don't you go ahead.

The 15% is there. Is that just Anomaly or.

Okay, because different things about.

Yeah, I mean the Hilo Medical Settle center is. And Leahi is probably the. The two higher ones, but this one was kind of high.

So the question is why is it as high as 15%? Yeah. Have you been to Hon. You've been to Honaka? So Honaka is a very, I would call it a very tight, isolated community.

The Honoka Hospital is actually the largest employer and they've always struggled to get mostly nurses and LPNs to cover and staff their staff all the way to full. And the reason being is most of the nurses either want to work in Hilo or they want to work at Waimea.

So what we end up doing is doing a lot of overtime to meet those staffing levels we even have for that facility. The CNAs that work there, we've had to put in a $5 an hour facility differential to pay them $5 more an hour than someone who works in Helo because they just.

You just can't get that staff. And so what ends up happening is people make the do a lot of overtime just to meet the safe staff staffing standards. The commuting. The commuting, absolutely.

And they can't get any nurses in that area. What's that you're saying you can't get nurses in that area?

I can't get nurses and surprisingly even eight. I think a housing is a piece of it because, you know, you have a limited amount of housing. We've run three CNA courses to try to address that overtime issue where we actually guarantee people employment.

We why they train, they get paid that going rate through their training, they get their CNA and they have a job. And honestly we've still only been barely able to keep up. So It's. It's just a realistic number. I mean, I'm glad. So how much.

If that's an issue on some of these, on some of your properties, you don't have room for housing then for.

Employees on the Honoka property, it's very much. You actually could expand some housing there. It's potential. We have a few cottages, some folks use them, but mostly the people who are transitory. The staff himself lives in Honoka, but, you know, it's. You make a CNA's wage. It's not huge. Right. And so housing is definitely a barrier.

So a lot of the younger people that we need to come into the facility, as the folks retire, you know, they're going. Well, they're not staying. So it's a challenge, especially in that.

Kind of isolated community, until DHHL completes their plans, because they are planning right above the hospital that vacant lands to build. We got the reports yesterday that they're building housing over there. That's one of their criteria.

Well, they don't go yet, but, you know, they're saying that's on their wish list. They can't say it was finalized yet.

Somebody will come and develop some housing. There's more of that.

And then table 14, I noticed with HTH215, the contract expired in 2024. And there's still some outstanding balances, that 356,000. Is that normal that the contract expires? But that balance is still.

That was HH215. Yeah, 215. So region contract.

There's a lot.

I was informed that that was the error. Okay.

Okay. And then let's see. Seven, table 20. No. What is C? What is. What does that mean? C note 1. You know where you have table for telework?

Are you?

Right there. Reason for telework. The last column now says C note.

1 on table 14.

Still not 22. Table 22. So you guys have. Yeah. So the contract manager, they tend to work five days a week.

Yeah, they work up regular. Regular work week. Yeah. There's a note on the.

So all the guys that telework are, I guess that they're not medical staff, looks like. Yeah, looks in.

No, most of them are like the back office type functions. So you're talking about IT people. You're mostly like accountants, billing clerks, those kind of. Those kind of positions.

The VP and Chief Info Officer.

Yeah, that's our Director of Information Technology at the corporate level.

For that amount, you would think they would telework less. They would telework Less. Yeah, with that. Look at the salary.

Yeah, yeah. Well, with the IT person, you know, the access to technology is easier for them than for other employees.

It's that kind of info. I thought you meant like communication specialists, like the person who. Because you would have to be there if things are going on.

No, but there's other staff on the. On the ground that take care of those. You know, the technical issues per se and if there are issues that arise.

I thought it was. I didn't think it was. Information technology.

Yeah, that's our vipression technologies.

Yes.

So what is CNO1? There's a note, I think. I don't know if it printed out on yours, but there is a note about the. Probably refers to our policy during COVID for telework. Maybe the staff can kind of. Yeah, I can send them the note. Okay.

And then I notice how are some of the registered professional nurse hybrid. There's some in there. The same table. Yeah, no, you guys can just. I'll just put it in writing and you guys can respond.

Okay. Okay, that's fine.

Okay, we're going to take a recess. We need 10 minutes and then we'll have a Department of Health come in.

Zero, I'm sorry, Chair. We also Medical centers. Right. And Maui Health System that would like to testify as well.

Okay, let them talk.

Aloha, chairs, Vice Chair, Senators, thank you for giving me this opportunity to speak in front of you folks. Excuse me. My name is Matt Mamizuka. I'm the Chief Operating Officer of Kohoku Medical Center. CEO Steve Nawahine. He sends his alloa. And his regrets. He's in the mainland for his son's wedding, so he appointed me today.

But you guys only have one request. Yeah. Is that only one. The 125,000 request? No. I thought you said the first one was Kahuku on table six. No, was I mistaken? Is that somebody else's?

Please.

I'm going to recommend. Okay, we can take a recess and you guys, you need a re. You need a minute? Yeah, I think we're good now. Okay, so.

Yeah, so we're going to be requesting for the full funding for operations NCIP that 125,000 that the Governor provided. So that's for the transportation vehicles being so rural, we find that very important. A lot of our kupuna are unable to make it to.

And that's a one. Yeah, that's a one time expense only.

Yes, yes, that is.

Okay.

And then what was the CIP one? So a little background and I'll be quick so we can take a recess. So we span our families that we serve range from Kaawa all the way to Waialua. With your folks CIP funding in the past, we have been able to increase services, dental services.

We started a brand new behavioral health program. We increased our clinic capacity from four exam rooms to 10 exam rooms. And that's all thanks to your folks CIP funding. So we really appreciate it. A lot of our CIP requests for 2627 is mostly infrastructure.

So we are an aged facility and no different than the other HHSC facilities. We share the same concerns.

And so 5.8 the first year and 5 million the second year.

That's correct. And we appreciate what the Governor recommended and we stand by that 5.8 and $5 million. And it's going to great causes, great projects. As far as operations, we requested about $4 million for 26 and 27. Governor recommended about $2 million. And we humbly request that we get fully funded.

I don't see that that's in 56 too.

No, that's not in table six. So this, he's. What he's going over is what he actually requested to the Governor. But you know, the Governor did not necessarily make the recommendation.

Okay, okay, okay. You might want to have your current legislators at least introduce a Bill for the things that didn't make it in. I see. I'll go ahead and do that.

Thank you.

Only one question. Yes. You guys have. Is it up and running already?

So we do not have a dialysis program up and running yet. We have been reached out to different companies. So right now. So all of the decisions, of course is data driven. It's very, very expensive to run a program. So there's a couple different options that we have.

We have home dialysis or we have in house facility option. But again, the capital cost to start a program is very, very expensive. You're talking between seven and $10 million. We do have the patient population to start a program. It's just the initial capital.

And so I always say our, our motto is friends and family taking care of friends and family. So the way we're looking at things is instead of meetings or dialysis program.

Yeah.

What our goal is to. Our goal is to educate our community from taking to kupuna about different habits. So two generations down the line, we won't have a need for a dialysis program. So that's how we look at that. But as far as our needs for today, we could definitely use a month. But funding is always the.

The closest facilities were like. Correct. So there's one in Kahulu and one up in Wahiawa. So you don't have to drive. I mean, they take their whole day. They're spending their whole day driving through different factories. And it's taxing. It's very taxing. I know there was a concern. Thank you. Yes, thank you.

Okay, we're gonna take 10 minutes so that we can have Department of Health set up. Thank you. Zero, you had a question? Zero, you have a question.

Okay.

That's right. The finance chair must be thinking, zero, man, he's sending me a message.

Thanks, Lynn. Aloha. I'm Lynn Fulton, the CEO at Maui Health. Appreciate the time, and I can be quick with this. I celebrated one year at Maui Health earlier this month. And so I've spent a lot of time the last 12 months getting a good handle on where we are financially as well as how we are operational.

If you remember, last year, we had presented a plan that we have to get to zero subsidy. And we are following right along with that plan successfully. Last year we had requested 7.5 million. This year, you'll see in the Governor's Budget, we have decreased that to 12 million.

And then our plan for next year will be 6 million and then zero. So I respectfully submit that. But happy to answer any questions.

Any questions. Thank you. Okay. Recession.

Going to--reconvening the Joint Committee. So now we'll hear from Department of Health who will present their biennium budget request. Yes. Good afternoon. Happy New Year.

Aloha, Chair. Aloha, Chair Dela Cruz, Vice Chair Moriwaki, WAM, committee members, Chair San Buenaventura, and Vice Chair Aquino. I'm Kenny Fink with the Department of Health. With me at the table are Deputies Marian Tsuji, Kathy Ho, Val Kato, and Debbie Morikawa, and we're also accompanied by other subject matter experts from the Department of Health if there's other questions that we need to ask and help with.

Okay, so thanks for meeting with us today and I will jump in. I made these slides before knowing the 15-minute time constraint, so either I have a couple more minutes or I'll go real fast. We can fizz back. Okay. Department of Health.

Our mission is to protect and promote the physical, behavioral, and environmental health of the people of Hawaii, and we do this following the CDC's ten public health services essentials through assessment, policy development, assurance. Our vision is that all Hawaii residents have a fair and just opportunity to achieve their optimal health and well-being.

That is our why, and our--this is our how. This is kind of a new strategic framework. We have our values on the left hand column there, and within that framework, the foundation is to optimize operations, and those are some of the key things that we've been working on: administrative efficiency, leverage technology, and increase filled positions.

And then those three areas that can be within programs of the--really the concepts of trust, trust with the public, capability--both our capability to produce information the public can understand and the public's capability to understand it--and ensuring that what we're doing is effective. We need to make sure what we're doing works.

And at the top level are really the cross-departmental areas for the next couple of years, and they're interrelated. So we've been incubating those with your support and resources within various divisions, and, you know, my vision is essentially would have like an office of offices with those cross-departmental functions that are interrelated.

This is just an org chart. We have over 70 boxes and all of the programs really are going to be responsible for the what. So if they understand the why and the how, my expectation is that they, as the subject matter experts of their areas will develop the what and make recommendations on the what.

The who--so I just want to pause for a moment, express my gratitude for the work of all of the DOH staff. I'm grateful for all that they do with a 30% vacancy rate. Everybody is doing a lot and I want to recognize that and appreciate that. So for our civil service rate, it's 28%, but overall we have a 30% vacancy rate. When I dug a little deeper to see what's vacant, there's a pattern of lower level positions have a higher vacancy rate.

And if that's our pipeline, then that is a concern that we need to make sure we're getting folks in at the lower level so we can, again, develop them and have them move into the higher levels. So this is one red flag. And then the next couple of slides are going to be the data OWR survey.

So these next series of slides I'm going to compare DOH's results with all the executive branches' results. So I was quite concerned to see that for DOH, 43% of our respondents said that they are very or somewhat likely to look for another job in the next 12 months compared to 36%. So I looked at this and said, what am I doing wrong? Is a question I need to ask myself.

There's a lot of people here that's willing to answer that.

Thank you. Thank you. I don't think there's enough time. Not enough time. So when I looked at this, I said, well, but actually compared to all departments, our staff are more likely to feel their work serves a greater purpose to find their work meaningful, to feel their job is secure, and to feel they have more freedom to decide how to do their work.

Where it's worse is they are more likely to say they don't have enough time to get everything done. Okay, what about just the work environment? Well, actually, while it's I think unfortunately low across the state, our staff are more likely to feel supported by the coworkers and supervisors. So, I don't know that that would explain why they're looking.

Greatest source of stress is work. They just have a lot of work. And I think when they feel meaning and purpose, they care a lot about what they do. And the challenge is when they feel they can't do what they think is needed to serve their community and that's taking a toll on their mental health.

So compared to all departments, our folks were more likely to have poor mental health, worst mental health days in the past 14 days. So that is a concern, and when asked what the potential solutions are, by far more staffing and resources.

So I want to say that these folks actually reported a higher satisfaction with life, yet worse mental health, which is interesting. One theory that was suggested by staff is that because they care about their work and can't do the excellent job they want to do, that is impacting their mental health at work, but the meaning and purpose is why they're satisfied with their work.

So again, I truly appreciate all that everyone has done. We've had COVID, Red Hill, Maui wildfires, we're facing bird flu, and this is all on top of everything they're supposed to do with a 30% vacancy rate. So my gratitude to them. Okay, so what are we trying to do? So I need to try something. So we implemented a pilot--this is our higher pilot--and we did it from August to December 2024 and we did it with their unique classifications to DOH for which we had delegation.

We use those, and all we did was not verify minimum qualifications upon application for all applicants. We took all applications, we sent them to the program, and when they selected their one, we verified minimum qualifications before extending an offer. It was all that we did differently. So we had our 23 recruitments. That was kind of our sample size.

Nine are still open. Through three of them that were were selected, three were selected and they went all the way up and found that they weren't qualified. So people said, well didn't you waste all that time? Well if someone's not qualified, they could just extend it to the second choice.

And for these particular cases, in one case there was only one applicant, weren't qualified, that was it. Another case, they weren't qualified at the four level so they're just going to repost it at the three level. And the third case was someone who's an 89-day hire who is just short of the required experience.

So we expect again that that will help. But what we really found was we shortened the period--when people apply for a job, they need the job when they apply. So from closure of the recruitment to getting application, saying to the program, the program, doing the interviews, then vetting the minimum qualification for the selectee to extending an offer 60 days, we were able to do that. And you can see the times there. So we could do it sooner and we'll get faster with more experience.

And the efficiency was the avoidance of 56 minimum qualification verifications that were avoided, so the recruitment staff could again do other work instead. So this was, this was a success. It was small, but we hope to see how we can learn from this and expand it. Okay, this is our topline budget ask.

You guys have this in your books. For current fiscal year, we're 1.2 billion. For 26, goes up about 9% across the board to the 1.33 billion, and mostly we're going to focus on the A funds that go up about $40M or 13% in the first year. From an FTE perspective, we do a lot of conversions from temporary to permanent.

The total net increase is about 32 or just a 1% increase in FTEs and then it's pretty static from 26 to 27. That's just high level. As we go through our budget priorities, these are themes in our ask.

We started with those that are just necessary to maintain current obligations and level of service facing this new federal Administration, understanding what our federal funding might be at risk, and then we went to--as I mentioned, we're not not going to have the workforce we want to have. So we have to--they're already doing more with less.

We also have to do less with less. We have to find what can we stop doing. Mental health, substance abuse, environmental monitoring, and I'll talk about infectious diseases. So I'll go through those in a little more detail. So, necessary to continue services: we have to maintain the Hawaii State Hospital, and while we're looking to place patients in the most appropriate setting, we have to keep it open and serve the patients we have.

So there's funding ask in there for our locum tenens providers and also for overtime. Again, emergency medical services. We have to resource the collective bargaining agreements. There's a second ambulance that was appropriate for Molokai.

The funding wasn't recurring, so we need to continue to find that second ambulance at Molokai. We did a rate study. This is now the rate adjustment for people who provide services to individuals with intellectual and developmental disabilities.

There are certain key positions that we can go into more detail that are either on the books but don't have recurring funding such as a Kalapapa because we just know the timeline, so those are temporary positions, so funding for those positions.

The EMS Medical Director, we just need to expand the point FTE for that. It's 0.33 and we just need to--we're going to make it like a 0.75. And then the Clinical Laboratory Director is a critical one to keep the lab open. To continue the lab in anticipation of what may occur, we need to separate out kind of the administrative operation and the clinical expertise to ensure we have that ability to provide everything that the state does. And then long-term care programs, we need additional funding to be able to continue to license them.

So those are some of our necessary to continue services. From a federal funding perspective, of all awards which are multiple years that are current, the total dollar amount of all of our federal awards where we're somewhere in the award period is just under $1.5B.

We have encumbered over a billion of it, and it's at 436 million that is potentially at risk over the multiple years remaining in the contract periods or the grant periods. So these are just the examples of the grants that are over $1M.

The one that's missing is the tuberculosis grant was just renewed and we did get the first year's funding; that's about $1M annually. So this is just a qualitative, the average award amount per year of the award, so you can get a feel for how much money, if these were not funded, might be at risk.

So we're just doing this exercise to understand our exposure. Okay? And you can look at that more detail. So of that federal funding, it's about 12% of our budget and 438 positions. We are aware of some positions that have been communicated about positions on immigrants and immunization, so we're concerned about those programs in particular.

So we did ask for conversion of our immunization staff to ensure that we're able to continue that work and also a tuberculosis x-ray technician. We want to ensure we're able to continue those critical services. The WIC positions, there are 16. These are entirely federally funded. These are particularly at risk if there's a government shutdown.

If these positions are funded and from the state, and the government continues to fund them, that money can be redirected into benefits. So those are the positions we've identified as being most critical in the event of a loss of federal funding. Okay, moving on.

There's a big effort to basically improve our data and analytics processes and modernize all of that. We're investing in cybersecurity and data standards, the warehouse, and trying to have more information to inform our decision-making as well as inform the public and stakeholders, including yourselves. These are a couple of key projects that are in flight.

The Electronic Disease Surveillance, Immunization Information System, and Case Management System, these are 100% federally funded right now. But again, the concern would be if that funding goes away mid-flight, you know, we may be asking for funding to continue those projects. Okay. Efficiency improvements: some things that we have done.

I've used the term, you know, death by a thousand cuts, and I say it's, you know, healing by a thousand band aids, every little bit, if we can remove one paper, one thing that has to be routed, it will add up. So all these little things that we're trying to do will add up.

So by themselves, they may not seem like much, but eliminating the notarization page, that was one more thing to chase, going to electronic signature so paper doesn't have to get routed, not requiring an ET05 when it's not required by ETS, having--pushing decision making down. So for inter-island travel approvals, you know, the branch chiefs can do that.

I don't need to, you know, they don't need to come to me. Simplifying the reorganization packages--and we're creating an HR portal. So these are just some of the things that we're really trying to look at and see what can we streamline internally. Kinau Hale, we are grateful to the Legislature for appropriating funds to pursue an opportunity.

Truly grateful as we have exhausted that process and found limitations to the deed restriction. We understand that there remains an opportunity for the state and we support DLNR's, you know, pursuit of that. We are working with DAGS, you know, to locate alternative space and then also on a redevelopment plan.

Okay, so somebody asking the budget regarding to efficiency improvement and the numbers you see in parentheses are the department priority. I'm sorry I didn't clarify that. So these you can see. A vital record system replacement, staff have worked really hard, really hard to improve the processes and the timeliness of turning around vital records, but they're just limitations to the system.

It has a lot of manual processing. So we feel that it'll be far more efficient to invest in a new vital record system. Kronos integration with HIP, HIP works fine if you're not a 24/7 operation. We learned from HHSC that they have actually created this first, so we're trying to look to expand that to our state hospital.

That will help with, you know, scheduling, timekeeping, reducing overpayments. A lot of benefit to that. Grants and contracts fiscal management module: we are coordinating with DAGS and understanding that they are looking for a new kind of fiscal management system.

This is a module that would work with that, and we're in communication with other departments, including DLNR and maybe DHS to see if multiple departments could share this that have a high volume of grants and contracts to manage. Early intervention data system: that's another one.

And then also as a force multiplier, are really investing in our human resources. If we can get more positions, we can increase our recruitment efforts so all of these things become force multipliers and helping offset some of our vacancies. Moving on to behavioral health.

So on Maui, again, we're very active supporting the survivors and those impacted by the Maui wildfires. SAMHSA was a huge partner in support. So services that have been available over this past year, you can see the talk story, case management, traditional healing practices--oh, sorry for the typo--and then that gives you a feel of the services that were delivered.

So these are contracted services to try and use local organizations as much as possible, and they have done an extensive amount of servicing trying to meet the needs. We started the behavioral crisis center in Iwilei in this past year.

The turn on the left, I think what I'd like you to see--and this is only complete through November when I pull this--you can see the columns are increasing. So each month there's a trend for increased utilization of people coming and being serviced at the Iwilei Resource Center, and we just saw the December data this morning, but I couldn't update the slide and it's even higher. So continue to see increased utilization of the Iwilei Resource Center.

On the right is a disposition, and what I want you to take away from that is that 60% of the people who are seen there are connected with services, which is actually what we would consider very successful. So they're plugged into services. A lot of it becomes some residential-based or housing-based services.

So I'm pleased to say that these data would indicate that the Center is doing what we hoped it would do. Okay, moving to the State Hospital. On the left is the census by month. That horizontal line is what it is licensed at. So it is licensed at 292.

And you can see over--since it starts with January 2023, we have significantly exceeded that. We've had to get waivers to do that and be in compliance. As we got into the late summer, it approached nearly 400. So that's a 30% increase. Some of what has been included in there was a closure of Kahi Mohala and those 48 beds.

So those effectively need to get absorbed in the State Hospital. So that was the census. Below that shows you the kinds of patients we're seeing and a high volume and basically churn of the petty misdemeanor patients.

To the right, we've really dug in and try to understand who's there and why are they there so we can develop the appropriate responses interventions. So in doing that analysis, they're--what they found was they're only about 13% truly need that level of security and intensity that the State Hospital can provide. Thirteen percent.

Seven percent are there waiting discharge, and that is finding appropriate placement in the community, and then about 80% have some outstanding forensic issue which is prolonging hospitalization. This helps inform us for where we need to go next in developing appropriate interventions.

Okay, so our request for behavioral health, we are doing an ongoing rate study and we expect in the supplemental will come in for an additional ask for a provider rate increase. Again, we appreciate the appropriation of ten psychologist positions and just, we're requesting to fully fund them and make that recurring funding. Another ask is that alternative care site.

So for the low-level folks who may not need that level of care, looking to find an alternative, lower-cost level of care. Moving from the State Hospital to just the community needs, we focus on those with a serious mental illness, but there's a broad population that needs mental health needs and has difficulty accessing mental health services, including for things such as depression, anxiety.

So the Certified Community Behavioral Health Centers are model for all comers to just be a resource to service anybody in the community. So we're asking for resources to advance that concept. We have a pilot on Maui and we're looking to build that out and expand that to other neighbor islands. Not in the budget, we have a bill for intensive mobile outreach project.

So this is for really the most severe folks who are primarily homeless to see if really with an intensive intervention we can get either better stabilization or potentially pursue ACT, but we know that there's concern about the homeless issue, particularly on Oahu.

So whereas the CCBHC focus would be primarily on neighbor islands, this pilot, we would start with on Oahu as proposed. And then for the State Hospital, sort of that other bill, when patients at the State Hospital need to get medical care, we need to get either a procurement exemption, right, get a contract, negotiate a fee schedule, and then basically process an invoice.

And we were in arrears as much as two years. So we've cleaned up that backlog, but we're looking to streamline that process by getting a procurement exemption if state hospitals need to go to a medical hospital for care.

And also if we can align it with the Medicaid fee schedule--and if these patients weren't in the State Hospital, they'd likely be Medicaid beneficiaries--then we can partner with Med-QUEST to do the claims processing. Be way more efficient, okay? So those are just a couple related bills. Moving on to environmental health. The image here, right, the red dots are where new monitoring wells have been created.

So we continue to be very active overseeing Red Hill, and with these new monitoring wells, there's ongoing groundwater testing. Staff are reviewing the Closure Plan for Red Hill. The Tank Cleaning Plan, Air Monitoring Plan, and Tank Cleaning Verification Plan have all been approved on those dates.

We provided comments on the Pipeline Removal plan. The Site Assessment, Investigation, and Remediation Plan was disapproved and that needs further work. So again, we're still continuing to expend a lot of resources working on Red Hill. PFAS: so basically beginning December 31st that HRS 321-602 became effective for packaging, so we did communications about that.

The EPA had issued a rule and there'll be new maximum contaminant levels for six PFAS that will require public water systems to begin monitoring, informing the public of the results, and complying with those levels in 2029.

So there's still a number of years out, which is a lot more to come about PFAS and planning for that. The graphic to your right are all the locations where PFAS has been detected, so it is widespread. Testing is not required, so it is likely more prevalent.

It's just these are just the places where they have tested and have found it. Staff did a study on PFAS that's available on our website finding that there were low levels in wastewater, which was reassuring, and much lower than compared to some areas on the mainland. As expected, there are high levels in landfill leachate, but if that gets properly treated, it remains controlled.

And then they also sampled AFFF release sites, known sites, and of course those are high levels as expected. So we can refer folks to that report. Cesspools: all cesspools shall be upgraded or converted by 2050 per that law. The Legislature appropriated $5M last year for cesspool conversion grants.

We awarded 243 grants for $4.8M. Of the nearly 14,000 Priority One cesspools that were identified in the report in 2022, the grants converted 243 of them. Half of--slightly less than half of the conversions--I think there are about 530 or 540 total conversions--about half were funded by those grants.

So the grants are really helpful in getting the conversions to occur. For the individual wastewater system applications, this is our backlog. We recognize that there are other permits that are awaiting review by us, building permits, and we'll talk about that. But these are just the cesspool conversion permits.

Okay, so Environmental Health is requesting a couple positions for pretreatment wastewater testing. This is regarding the underground injection well decision that's required to be regulated, so testing for that. There's an ask for $5M additionally for other grants for successful conversions and staff to manage that.

There's been a lot of interest in nearshore water testing, again, particularly on the neighbor islands, so these positions to help with that. And again, we've, you know, we hear the landfill issues coming up. We need to continue to work on sustainable solid waste management, so position for that. Okay. All right. Shifting gears.

Public health success is typically the absence of something. What have we prevented, which is difficult, whereas a lot of other things, you're looking at how effective, how much did you accomplish, how many of these things did you do? For public health, it's how much did we avoid?

Every condition up there was something that was reported to the Department of Health that we investigated. These are all the things that hopefully you haven't heard of because we are doing our job. So lots of things. Vaccinations: vaccinations are very important for preventing some most infectious diseases you saw in the previous slide.

On the left is just--you can look at the trend over the past about five years and it is a downward trend over overall vaccination rate. That horizontal line is at 95% and we're looking at measles. Ninety-five percent is considered herd immunity. We are below 95% and seem to be staying there, and there's concern with statements made by the Secretary of the Department of Health and Human Services nominee that there's concern that this trend will go further down, and we are at risk for a measles outbreak. And the concern is that this trend will go downward.

On the right is the trend in exemptions. The bottom line is medical exemptions and then the top lines are non-medical exemptions. And you can see the trend in non-medical exemptions, right, is kind of reflecting the mirror of the vaccination rate decline. Avian influenza, it's getting a lot of our attention now. There's collaboration among state and federal partners and counties.

There have been no confirmed human cases in Hawaii. There have been 66 confirmed cases as of the date of the slide on the mainland, largely those who are in industry, working on farms, poultry farms, dairy cow farms. There's one case of a backyard flock exposure and two that are unknown.

The cases have typically been mild, but there's concern about that patient in Louisiana who just passed. Patient was older, had comorbidities, but still, the virus appears to have mutated within the individual and it's raising a lot of attention. Of all these cases, there's been no detected human-to-human transmission.

The CDC still at this time considers the risk to the public low, but everybody's very carefully monitoring this. So in Hawaii, to the top right there is wastewater testing, and our state lab has done a terrific job and they were the first ones to detect the H5 in the Wahiawa wastewater. Subsequent testing, it's been negative.

They also detected it in Hilo wastewater and that has continued to be positive. So they're looking into that. The bottom is just a graphic to show--sorry, the bump in the middle are Covid cases. That just shows a decline in Covid and then the bottom line that comes up steep on the right, influenza cases.

So Avian flu is in a family of Influenza A. It's just, right now, it doesn't really infect humans, but there is Influenza A that does infect humans. So we have to, once we find it's positive for Influenza A, you have to do further testing to see if it's this H5N1 specifically.

So we work with the clinical labs and they send us their positive results so we can do further testing for surveillance to see if any of those Influenza A cases were in fact bird flu. So that's a monitoring that we're doing. Other monitoring that we're doing, we continue that wastewater, and I think today we started our raw milk sampling for that one dairy on the Big Island.

So these are some of the surveillance activities to see we, we can find. Some of our requests specific to kind of emerging infectious threats with climate change and anticipating where threats might be over the next couple of years, asking for a vector control outreach, a public health veterinarian, and this public health program manager largely to allow our state epidemiologists to focus on really their role as state epidemiology and not just administering a division.

We have two bills regarding this. One is for a vaccine purchasing program. The state can purchase vaccines at a less expensive unit cost. It can be self-sustaining if the state could then build insurance for that, but it reduces providers having either to front that money and pay for storage. There's a lot of benefit to providers to help it make it less expensive and easier to administer vaccines.

Looking at the exemption rates, we also are proposing a bill to look at non-medical exemptions for the school entry requirements. Okay, CIP requests, you have these--really the themes here. The State Hospital has a few ask, Kalaupapa, a few recurring ask, and then our revolving funds which again are kind of annual ask.

Some operational challenges, larger result of our vacancies, you know, morale. It's tough, folks are tired, they're working hard, and you know, you can look at this, but you know, we're treading water and we're getting by; taking a lot of effort to do that.

But the real limitation is to just have that heads up time and say, what can we do better or differently or more of? And that's the capacity that's really challenging us right now. So again, I do want to reassure you and the public that we are able to do what we're being asked and expected to do.

But as we're looking that we need to work differently and better and innovatively, that's the challenge, right? That's the opportunity that the vacancy shortage, I think, mostly impacts. When we look at our staff and their well-being, it impacts them too, and it's just not sustainable to expect them to keep up this pace.

So I'm speaking to a couple folks and I said, what are my priorities? I really am concerned about the declining vaccination rate. There have been measles outbreaks on the mainland, and I'm really concerned that we are at risk of having one here. And then my second concern is really the staff and, you know, what they're experiencing now.

And looking at the pipeline, the 43% looking for another job in the next year, I have a sense of urgency to address this so we can continue to fulfill our mission in protecting and promoting the health of the public. For communications, information is an incredibly important part of what we do in public health.

We've issued 158 releases over the calendar year, we've restarted Community Bulletin, and we're trying to expand our social media presence. If you are not following us, we encourage all of you to please follow us on social media, and we're available for your questions.

So did you cover everything in Table Six or were there other things in Table Six that you have to highlight?

I believe there are other things in Table Six.

Do you want to go over those that are not mentioned?

Okay. Let's see. I'll go through in order here.

You can skip the ones you already--

Will do.

And if you want to group them by program ID so you can summarize, that's fine too.

Okay. Let's see, we'll do this. I'll do this. I'll take it. Okay. All right. So looking at program ID, HH100, I think for--well, so priority-wide Hansen's disease--oh, you're going to do this one. Let's talk about Hansen's disease.

Okay, so--is that working? So for the first one, it's our six Kalaupapa positions, and again, while they were issued to us--the funds were appropriated in 22 and 23--they still needed to be established. So it's taken us--and they were only given, I guess, temporary funding. So we do need those six positions.

We do have one filled. We have a janitor in recruitment and the other four need to be established. For our Community Hansen's Disease Program, a lot of people forget that Hansen's disease still exists in our community and we do track and monitor and provide treatment for it.

And so the funding from the Feds has been level for many, many, many years and we have not been able to fill a number of as a result of that, so we are asking for an RN4 and an OE3 to be able to make sure that we are providing that tracking and treatment for the community-based Hansen's disease patients. For our TB program, we are looking for converting federally-funded position to general funds for an x-ray tech.

Again, the x-ray techs were taken away from us and so we've had to recreate the positions again and that takes time, but we do have a trade-off for that. We're training our epidemiologist specialist III and converting it from temp to perm and then re-describing it to be an x-ray tech.

Again, this is really critical because we do know that Hawaii has one of the higher rates of TB because of the immigrants that we get from the Philippines, and so one of the things that we need to be able to do, and in the schools as well, is screen for tuberculosis.

TB's x-rays are--x-rays for TB screening is one of the quicker ways to determine whether or not somebody has potentially a case of TB. For the Public Health Nursing Program, we have been experiencing a shortfall over the years.

It's one of the most critical programs to make sure that we can address people in the community that can't get to, let's say a clinic or a healthcare facility, and one of the things that we're facing is that we're not able to pay our utility bills.

So if we aren't able to get additional funding to pay for our utility bills, we may have to shut down some sites. So again, we're just, we're asking for 350,000 for--to cover the shortfall that we've been covering with other sources of funding, but it's been very challenging.

For the Public Health Nursing Program also, right now we have an admin specialist for that we have been funding with. We have grant funding until 05/26, and so we are asking for additional funding to be able to, to continue funding this position beyond the grant funds. And the next one--

I have a question, Chair. That 350,000 that you're short for electrical, is that an ongoing cost or is that--you just getting up to whatever you have budgeted?

It would be a recurring--

350 a year?

Yes.

Well, I believe 177,000 is for the utilities, and then there are other things like vehicles or their vehicle expenses because they are traveling, but we've been kind of band-aiding it by pulling funds from other sources and it's just becoming more and more challenging.

For electrical?

Can you follow-up? Just to follow-up, can you tell us where your shortage for utilities are located or is it buildings or offices or--

Hi. Diana Felton of Communicable Disease Public Health Nursing Division. So the offices, the public health nurses are in offices all across the state in different communities. We have 18 offices and that's the main place where the utility shortage is occurring, everywhere from Lanai to Waianae to East Hawaii, West Hawaii, Waimea, all across the state.

But these are buildings that we--it's under you folks. We own those buildings.

Most of the buildings we own, yes.

Do we have solar systems on all of those buildings?

I'm not aware of solar systems.

Probably not.

I don't think so.

Okay, because it could help if you start--if it's our buildings, you should start considering solar so that you can drop--have the utility rates dropped as well. Just an idea. Thank you.

Okay, let's go to 131.

Okay, so for 131, the first ask is for our immunization branch, which we are again concerned because of the new Administration. It is, I believe, 93--no, 96% federally funded and we have a program manager and a secretary that we're asking to be funded with general funds to ensure the stability of that program.

Should funds be cut, those are the two positions that we would just like to make sure that we have present and that they feel comfortable that they're going to be--continue to be paid should there be federal cuts. The second is for an epidemiologist. Three, basically we have an ELC grant that's covering it up to 73126.

This is a cross-cutting epidemiologist, which is critical for helping with new outbreaks, events, or monitoring disease trends and to reduce the risk of widespread outbreaks. The next one is a public health veterinarian.

We used to have a veterinarian, and with all of these zoonotic diseases that are occurring, we really believe that it would be helpful for the Department of Health to have a veterinarian that deals with human diseases as opposed to a veterinarian that's dealing with animal diseases. So that, we think, is important given, especially, the Avian flu situation.

Which other states do that?

Excuse me?

Which other states do that?

That's for human diseases.

You have to speak in the mic. You can state your name.

Sarah Kemble, Disease Outbreak Control Division Chief and State Epidemiologist. So there are a number of other states that have a state veterinarian, dedicated state veterinarian. I would say the majority, but I can get the exact numbers for you and follow up.

Okay, thank you.

And then the next one is for our public health administrator, which is Sarah's current position. However, Sarah is also the state epidemiologist and it really is challenging to be the state epidemiologist who's dealing with all of these new outbreaks and making sure that they are able to provide support to all of the other Department of Health epidemiologists.

So we're asking for a public health manager who basically can run the Disease Outbreak and Control Division. As you know, with the state, there is a lot of bureaucracy, a lot of administrative work, and we really need somebody that's just doing that work as opposed to--it would be a non-physician position.

We do have a deputy that is a physician, so they would be kind of dual roles. We'd still have a physician in the position, but we would have a non-physician program administrator. Then for Family Health Services Division--

I'll just--I'll do 420. I think they want to go in order.

Oh, okay. Oh, yeah. Sorry. Go ahead.

Okay. Next up is 420.

We're focused on the neighbor islands, but also eventually would like to convert over for Oahu as well. This will expand the group of folks that we're providing services for, and it won't just be for the severely mentally ill population; it'll be for other folks as Dr. Fink previously talked about.

We're asking for a total of 68 positions to be converted from temporary to permanent. And, let's see--and that's pretty much it for 420. We would like--we are also asking for funds for contracted inpatient services for neighbor islands.

This is a contract that we have right now with HHSC so that folks that are found mentally ill don't need to be flown over to the State hospital. They can stay on their home island. So this, this way they can stay within the community, they can stay connected, and it's not taking the resources to fly them back and forth since they'll always need escorts with that. For the hospital, again, continuing to look for efficiencies as well as making sure that we've got folks in the right beds.

Two things that were not talked about were a building manager position and two investigators for the hospital: building manager to oversee a lot of the construction and maintenance issues that are coming up with our Hale Hoaloha Building. It's taking a lot of staff time to manage that and kind of coordinate with DAGS and the vendor to make corrections.

And the investigators are to ensure that we do timely investigations when patient abuse or any other types of--I'm not going to say criminal--but administrative breaches occur. We want to make sure that we address those in a timely fashion. In 440, we're asking for funds to--for our Overdose Data to Action Program and to increase the federal fund ceiling for ADAD.

And for 460, which is CAMHD, we're looking for position and funds for one office assistant and transferring a human services professional from one program ID to another. And then lastly for our 501, which is DDD, we're looking to add position and funds for our federal initiatives Operations Coordinator position. That's it on BHA.

Okay, you want to speak to our physician for modern disability--

Yes. Afternoon, everybody. My name is Bryan Mick. I am the Program and Policy Development Staff Coordinator that we have. Apologies that our Executive Director, Kirby Shaw, could not be here. DCAB is asking for one new position. This is with an eye towards the new regulations that were issued by the Department of Justice: non-discrimination on the basis of disability, accessibility of web information, and services of state and local government entities.

They will be requiring that websites, electronic documents, and mobile apps comply with these regulations by--in our case, for the State of Hawaii--the effective date is April 24, 2026. So we're hoping to get a position that will be able to assist all the state agencies in complying with this and helping them as we move forward. Thank you.

Thank you.

Okay, back to our family health services. So we came to you last year regarding a birth defects program that was funded with--it's a special fund that was funded with the marriage license certificates. It was determined it's really not an appropriate source of funding for this particular program.

So this year we're asking for, and it's kind of complex, I'm not going to go into the details but essentially taking it out of that special fund, but just general funds.

So that's what this particular ask is for, is to just remove that source from this marriage certificate special fund and use general funds for it. Tor the next one, it is to convert 16 WIC positions from federal funds to general funds. And the reason for this is just, you know, we recently had a potential federal shutdown.

When that occurs, if we have offices that only have federal positions, those offices literally have to shut down. Families who need food supplies or to apply for food to determine eligibility, they can't get these food services. They won't be able to access it during a federal shutdown.

And so the purpose of having 16, which is just not the whole program, it's just 16 to be able to allow all of the offices to remain open. Right now 14 of those positions are filled. We have two vacancies.

If there is no shutdown, then essentially those positions, the funding for that can then be transferred to provide additional food. So the savings for that can provide an additional $842,000 which can allow for 3,000 additional eligible WIC recipients from above the current average of 26,000 per month. The next one is for the reestablishment of our oral health program.

It had been a program in Hawaii for a long time. Include how long we haven't had it. But Hawaii has one of the worst levels of tooth decay. Hawaii has one of the worst levels of tooth decay in the nation. Second only to Native American children. People don't recognize the importance of dental health.

It has a lot of impacts on not just the health components, people's self esteem, as well as potential cardiac problems as people get older. So we do really strongly are advocating for this. What funding is going for is two full time positions as well as to being able to provide dental sealants in school based programs.

So we would do screenings as well as providing dental sealants which makes it a lot easier for these kids to have preventive work.

So this is statewide.

Statewide.

All, all schools?

Public schools.

I mean every public. So every elementary or every middle school?

I'm Matt Shim, I'm the chief of the Family Health Services Division. Our current, we're currently working with Hawaii Keiki nurses nurses. But the idea behind this is to work with complex area superintendents each year working on a different complex and then creating a community based school based sealant program with the community health centers working with the schools.

So not everybody, not every student in public school is going to get covered the first year.

Correct, Correct.

What's the ramp up? How long for every school?

Well, if we--it would probably take about 15 years.

15 years?

$500,000 a year. Obviously, we're not asking for. We are not asking for services for...

So which ones? Because I think some legislators might ask.

So right now what we're doing is Hawaii Keiki nurses I think are in over 60 schools.

So how do we know which schools?

I have, I have a list. I can. Okay.

If you can send them to the Committee.

Yes, I can.

Do you have the ramp up plan? Do you know which?

I don't have a ramp up plan because we don't have a, we don't have a public grant yet.

They need the money.

So what are the two positions going to do? You have two positions.

The two positions will be managing the program and creating or restarting it.

Restarting it and coordinating it.

And going after federal grants.

But if--did you have an estimate of what it costs statewide?

For a total school for every single child? No.

Well, the 155,000 in public schools.

No, I don't. I do. I don't have that. I can...

Okay, so this doesn't include charter. This is only for complex area superintendents.

As a small, as a small beginning. Yes.

What is the plan? What is the overall plan? And when you, when you...

I don't think they, they have, they have a white paper. Sounds like not a plan.

Yeah, well, we don't. We, we haven't had an oral health program since 2009. So we don't have staff to do.

No, I know. I guess what we're asking is, okay, what are we going to get for this 567? So if you can just write that up.

Yes, I do have that. That was actually presented in the Form A. So I have that.

With the schools?

I have a budget that was prepared for the Form A.

So the 567 is going to be which complexes? You don't know that yet?

No, we would have to work with DOE.

Yeah, I think that's the kind of detail we're looking at. We want to know where is...

Either where the Keiki Nurses are or are not.

Oh, it's also are not.

Yeah. We actually are in all areas with Hawaii Keiki nurses.

But, but not every school is going to get covered. So if it's a 15 year ramp up, this is just a couple of schools every year.

Correct. It would be a comp. We, we'd be working to get a complex area.

And this is at the elementary school level. Yeah, yeah. I mean I remember it. You probably don't remember it. Doesn't remember it.

We had it in our schools.

So this is a small ask to begin the program and to ramp up and to create a full service oral health program for the state, statewide. So we're asking, we're asking for two billion.

Because I want to see what that looks like. I mean I think all of us would want to see which, how this would be rolled out and if there was, if legislators made this their priority, how would that affect their district.

So right now I can tell you we would still continue to work with Hawaii Keiki nurses and funding them to remain doing dental sealants at all their schools and expand the Hawaii Keiki nurses.

15 years is like a big gap.

But that's, that's, that's if we only have $500,000 a year. So that complex area and create...

We want you to be more aggressive.

Well, we can, we can, we can follow up. We can follow up. Okay.

Just to add, and thank you anyway. We're all happy that this is proceeding. However, one issue that you're going to find working with the schools is that is it going to be a place where they need a room and just to add. Because we've added more positions for preschools in the existing complexes and schools.

They're all trying to find a place. So just to let you know that there might be some problems putting a full time person and where they're going to be located.

No, but this is not full time. Right. Because. Well, at least I don't. What I recall was when you had one couple of days out of the year where all the students of a certain grade would get this service.