Senate Standing Committee on Health and Human Services

Calling to order the Joint Committee on Ways and Means and Health and Human Services. So this morning we're going to hear from Department of Health, who will present their supplemental budget requests. Good morning.

Morning. Chair, Chair Dela Cruz, Commissioner Moriwaki, Committee Members, and Chair Senior. I'm Kenny Fink of the Department of Health. I'm here today with First Deputy Val Kato, Acting Deputy Director for Behavioral Health, Dr. Courtney Matsu, Deputy Director for Environmental Health Kathy Ho, and Deputy Director for Health Resources Debbie Wari and a number of staff in the audience.

We are here to answer your questions. I'll give a brief presentation to get us started. Okay. This is from the World Policy Uncertainty Index. And you can see in the past year it has spiked. We have experienced lots of uncertainty in our interactions with the Federal Government.

During this last year, there's been a number of issues of policy uncertainty, particularly around vaccinations, but also decisions by the Fda. So in a lot of our interactions with the Federal Government, there just continues to be significant amount of uncertainty from a policy perspective that has impacted trust.

This is a Kaiser Family foundation survey that was conducted in January of this year, which is in blue and as compared to June of 2023, in green. And you can see kind of across the board trust in people's doctors, the CDC and their local health Department has declined over that period.

So that is a challenge for us as it is important that we are trusted in our information. This is just a little more detail for your reference on how it plays out and how the trust is declined. I do just want to highlight that the greatest trust that people have is in their doctor.

So the importance of access to care and the usual source of care is incredibly important for people to be able to make informed choices. Okay. In addition to the policy uncertainty, there's been resource uncertainty. There's a little bit of timeline. I just want to highlight that.

March 25, the rescission of COVID supplemental funding received notif we received notification that these supplemental grants were terminated effective immediately. We spent an inordinate amount of effort understanding the impact of those funding cuts. There was subsequently a preliminary injunction, which became a permanent injunction, and those funds were restored.

So with a tremendous amount of effort, we ended up at the same place. But what has persisted is the requirement for how additional information we need to submit and exercise to draw down federal funding. So it's still accessible, but it requires more effort.

Other notable one was October 10th, which was the federal shutdown during that time as a result of reductions in force and then people leaving the CDC Staffing had been reduced by about a third. A lot of that has been restored. But we're still working to understand the status of a lot of the programs at the cdc.

How that also impacted us was the WIC funding. So during that shutdown, there was no funding for wic. So we had to move funds around to ensure that the WIC program continued without interruption. Okay.

As we look at the House and Senate markups of the appropriations bill for this fiscal year, so the continuing resolution only goes through January, as you know, and there's uncertainty for what our budget will be for this fiscal year. For most of the upcoming state fiscal year, it was funded through the previous federal fiscal year.

So it may impact what we currently have, but it will significantly impact next state fiscal year, which is what we're talking about in our budget today. The House has about a 19% decrease compared to last year, where the Senate is relatively flat. The areas that have been identified for potential cuts are noted there on the right.

So again, this is just an area of uncertainty as we're looking at that. As we look at communication both in those markup bills, other policy statements and activities by the Federal Government. These are areas that we've identified to be at higher risk of reductions in funding.

And these are the reasons why this impact is about $80 million in 80 positions. These are not included in the budget. Ask because funding. We have not been notified funding has been cut. But there are reasons to believe that funding may be cut going forward. These are at risk.

What I did not include in this were grants that had been extended. So these were five grants that in September of 2025 received a 12 month extension. We were notified Tuesday that they've all since been cut. So four months after they received a 12 month extension, we were notified that the funding, these grants had been terminated.

I appreciate the team that has been working tirelessly for the past two days to understanding the impact of these cuts. And we were notified this morning that those determinations had all been rescinded and the grants continue.

This is another activity where we've spent a tremendous amount of effort to remain in place despite all this uncertainty and policy and activity and resources. I have been telling my staff our mission and vision remain the same. We continue to work to protect, promote the physical, behavioral, environmental health people of Hawaii.

And we remain persistent in that despite all that those changes, the most important part for us to be able to do this is our staff. We are grateful for the authority the Legislature gave us in Act 291 for this hiring pilot which has been quite successful.

We hired 38 candidates under this average of 95 days from when the physician is posted to when the person starts. And that's much more quickly than we've been able to do. It is not perfect. Sometimes because we receive and review all applications, we find some people are not qualified at the end.

So there's some waste in this program. And sometimes we just go through a pool of candidates and don't make any selections. So we continue to work to see how we can improve this process, but it's showing success. To the right is a chart that looks at our vacancy rate. We have 3,551 positions, of which 2,611 are filled.

That is our overall vacancy rate of 29.7%. And you can see that varies by Administration. And because most of our positions are civil service, that's a CS and I carved out the exempt positions separately. Okay. With those changes, for us to be effective, we really need to have trust.

So people are wondering, how are we countering misinformation, disinformation from the Federal Government? People are going to believe who they trust. So it's. While we continue to put out information that we believe is trustworthy, we need to earn that trust. Part of that is done through community engagement.

We had additional training for folks to be more knowledgeable about how to do effective community engagement. We've increased our communications through. We're doing a website cleanup and increase our social media activity. In a state of nearly 1.5 million people, we have 15,000 subscribers to our Instagram account. We're not getting as much reach as I would like.

So I respectfully request all legislators to follow us on social media, be able to amplify our messaging. We would be grateful for that. Okay. We have lots of data. Try to be transparent. These are just existing dashboards for the public to be able to access it.

We need to work on making them more easily to find on our website, but we have lots of information available to the public. Transparency is really important to build that trust in what we do. Okay, just going over, just a couple highlights. Just going to call it kind of one for Administration. This is for your reference.

The intent is to highlight the breadth of what we do as a department. So one of the key things we did for Administration was consolidating our review and tracking of travel UIP requests, converting from, you know, Sunshine Law and compliance. So it has been a priority to improve our level of compliance.

And that's been consolidated and seems to be working pretty well. Okay. For behavioral health, just going to highlight. That's a graphic of the opioid settlement funds. So again, that is available to the public. How much money we've received, how much we've distributed. The projects we've been distributed on is all publicly available.

One of them is the distribution of 40,000 naloxone kits which is used in the case of an overdose to reverse an overdose. So that's one thing to protect the public. For environmental health, just want to highlight the emphasis on food safety and security, the testing 130 food samples, going to whole Foods and testing for pesticides.

So that's an increased effort that we've been done and very successful improving and increasing our food safety and security activities. Okay. For public health, just highlight a couple things because the Legislature had supported us by giving us two positions to restore our oral health program.

So again, not having fluoridated water, these dental screenings and dental sealant program, this outreach is even more important. So there were services, dental sealant services provided at 34 elementary schools across the state.

We also have awarded that three and a half million dollars in contracts that you gave us last year to support increased access to family planning, reproductive health services throughout the state. Not a highlight, but I'd like to just note two Kalaupapa patients passed away this past year.

There are five who are still living, three who reside full time at Kalaupapa. I'm feeling that it is of increased urgency that there's an approved plan so that then there is time to make preparations based on that plan. So I just want to emphasize that.

Okay. But there still needs to be better coordination. Right. Because we have that we have not been presented a statewide plan because it's not just DOH, it's DLNR, DHHL. There's no clear state position.

So we did introduce a bill last year. We're hoping it will be reintroduced again this year which outlines sort of the jurisdictional changes for county.

Within. That's a working group.

No, I think it should be some joint Committee between Health, DLNR and Hawaiian. Yeah. To. To have a more robust discussion.

Yeah. That bill wasn't referred to me, so I don't.

Tim.

Joint community.

Yes.

So if you. Yeah, because then we.

Yeah. We probably need. We've been asking for something for like several years because we're, we're not, we're not clear as to how we have to budget our exit strategy or our long term strategy. And there's facilities that we probably should try to maintain and restore. There's probably remediation that we have to pay for DHHL.

Still not sure if they're going to do homesteading there. I'm not sure what Dylan R's overall plan is. So there's quite a bit you just, you don't want to repeat. The same thing we have done in the past with sugar and pineapple where we just let all the.

The flumes go to just disappear or you know, it just, they just fall apart. And then now you don't have water systems in place and you just don't want to. It's barely being held together now. You just hate to see it fall apart.

So we would be happy to provide information at a subsequent hearing.

So does your bill include all of the partners that actually should be looking at and overseeing and stewarding this area?

So it primarily addresses the jurisdictional issues that DoH's mission is we're there to care for patients. If there's no longer patients there. You almost have the easy part. We do, yeah. So once you're. It's the land. What's the last patient? So the.

It is how the landowners intend to use their land after their existing either lease or cooperative agreement with the National Park Service.

So is there an end date for you to oversee? That's in the.

In the bill is after the last patient passes. It would then trigger the transition of the jurisdiction. What we've heard from the community, people have different. But what does the law say connect. That is to make Maui County whole again.

Well, what I mean by that is what, what does the law infer? That as soon as the last patient moves on, you're out. Then next day, a year later, one. Year maybe your transition. To move slowly, move all your operations out.

And so you're responsible for all of the caretaking of the land until one year after the last patient exits.

Well, currently it's in partnership with the National Park Service. So the parks. We've gradually been transitioning responsibilities to the National Park Service.

Yeah, see that's what's scary, right? Is like it's three different agencies having their own MOAs with the National Park Service versus having a state position negotiating. And this is what we said several years ago. So I don't know if we have to legislate a state position, but there has to be somebody and you're.

You're not the best person to have the long term relationship with them because the law doesn't allow you a long term position. Yes.

Yeah. So it's also a separate. Excuse me, a separate county. And I've wondered about that.

That's what he's saying. So at one year, within one year after the last patient that county's gone. He's no longer.

Does it disappear under the law?

What we are. What we are proposing is a change to the law. Okay. What is the future of Kalawa County?

But I thought you said the current law says one year. No, no, no, that was in the bill. Okay. I'm asking what's the current. The current laws. It's unclear. It's open. Yeah.

So it could mean the next day you're out. It could be interpreted that way.

And it could be after the last patient because right now nobody have one patient. Right.

The law still has Colorado County. Department of Health still has jurisdiction over Colorado County. So I don't believe that would change.

So is there an end date in the current law? No, that's not. Okay. So the county is permanent as the current law stands? Yes.

Sure. So last time we visit there. Since we visit there, we understand the transition of the home train. You got to go to the different head owners. Whatever you guys are doing to preserve it. What are you guys doing to preserve it?

Because when we was there, Senator De La Cruz, Senator Lynn said all the time she was in the house too. Now she never ever heard you guys ask for any funding to keep preserving whatever is there.

So basically not just you, but previous to you that you guys may be just letting it just fall in a pot and nobody's doing anything, nobody asking for money to fix it. I understand you're going to give it to the forestry guys. But again we have houses and buildings there that that should be preserved and.

Historically preserved, except they're not the landowner.

So that's where that has to be figured out because they have really among some management role but they don't own the land. It's. It's the peninsula split between DHHL and DLNR so that when. When the last patient is no longer there, the way how I read the law is they can exit which means it's.

It's left to DLNR and DHHL. So I don't know what their plans are because they're the landowner will be funds.

There's anything that we can do to have.

Last year there was some budget requests that we funded in Nauru, the landfill that we. Yeah.

You know, requested for the packages that you're describing. Yeah. Those requests have not.

Yeah. The awkward part is it's not going to be their facility after. Yeah. So that's where it has. We don't have a better strategy to to move forward. I'm not saying we're going to exit. It's still stay that. But Department of Health would not have a. No role. Really?

Because it's under the National Park System.

No, no, no. They don't own it. They don't own it. It's a. It's a partnership. The peninsula is owned by the state.

Yeah, I understand that. Yeah. And their contract is only for the health care portion.

Well, the law is only for them.

Yeah, that's right. Yeah. He's the mayor of Colorado right now with no taxing power. But according to Senator Kanuha, that bill is still alive. You just gotta get Chris Todd to hear it.

I guess the house.

Yeah, the house. So it wasn't deferred. It's not dead.

You just gotta get Ben to hear it. So. So that bill includes other partners in that bill jurisdiction wise.

So it defines their jurisdiction. It really affects primarily our jurisdiction for the Administration of Colorado County and the status of Colorado County.

But the hard part is we should pass the bill so that there is a state MOA with U.S. Fish and Wildlife or National Park Service. Not three departments having their own MOAs.

Should also do it possible so that they will sit around.

For two years trying to figure out who has jurisdiction.

Well, that's. And what we've been asking the last, what, three years of how the three departments are going to work together. And my understanding is they have a working group, but it's not at the level where the three directors are talking to each other. It's all staff related.

No, we actually do all talk and I again, I think the, the. Okay, then you should have a plan then the. What do you talk about? So DLNR has a cooperative agreement, right. That goes into what year we have 2040. And their agreement is with whom? It is between the landowner of DLNR and the National Park Service.

Okay. Department of Fine Homelands has a lease with the national park service through 2034. So and I think if there's a break in that lease, like there are terms that are very disadvantaged to ending that lease. So those agreements are in place, right, for about 10 or 15 more years.

That's the timeline for the land owners to decide what comes after.

So the DJ contract, I mean, lease is. Is that the cemetery then?

No, it's half the peninsula. Half the peninsula is owned by DNR. Half of the peninsula is DHHL. So whatever path of the. Wherever the graveyard is, I think it's DHHL's.

That's how I thought. Because it came out as a no.

But right now DHH does no management of the peninsula. It's all Department of Health. So that's where really what the agreement should be is how does, how do we transition DOH out so that DHHL and DLNR can start managing the peninsula? Because then that's what's missing. So they're all going directly to.

They're missing that step, but they're going directly to. To National Park Service when that should have been after we've agreed internally what we're going to do.

That's kind of confusing because of the cemetery. So are you guys involved with cemetery stuff?

So for what we would consider where the Kalapalpa settlement is located today is on DHHL land. When we've gone to where it was originally located on the windward side that is dealing our land. So there, there's a cemetery.

If everybody came on the site visits, they would know that's why it's so important to come to the site visits.

Noel, the reason I asked that is if the responsibility for you to do burials and all that kind of stuff, then what happens after. But I don't know if we want to give it to any of our.

Yeah, but, but the law, the law doesn't say, the DO leaves after the last patient, but they still keep the cemetery. It just says they leave.

Good. But we still got responsibility.

Yeah, but the other landowners haven't come in to say if we want to protect the cemetery, we need X money. So that, that's what I'm saying is that it's. There's a big hookah as to who's going to do what.

That's because of the exit dates. That's because of.

That's because of us.

Yeah.

The state is not talking to each other. The three agencies have to come up with a stronger moa. But is not enough.

But your bill that you have, that's already existing. Does it cover some of that?

No, we just discussed this. It only discusses them leaving.

Yeah, yeah, yeah, yeah. Just wanna. Then you gotta. We gotta bring it up to the agencies. Another or something of discussion. Future.

Okay, I hear an echo. You can continue.

Thanks for our budget. So what I have here is what was appropriated in fiscal year 26, what was appropriated for 27 in the biennium budget and the percent increase from 2627. And then the right hand column is what we're asking for in our supplemental. That's the total dollar amount.

And then those columns are the percent increase I did from 26 to the supplemental ask. And then what was already in the base to our supplemental ask. So when we look at our budget compared to what's already in the budget. Right.

From what was passed last year for the biennium, we are asking for $16.2 million increase in A funds, 38 million increase in special funds and 110 million increase in revolving funds. You will see in our supplemental compared to 26.

Can you refer to table 6 and just kind of.

Yeah, I, I will. Yep.

No. But. So this table and that table, how are you reconciling it?

I'll go through in detail.

Okay.

Okay. I'll move on. We have four General Fund requests and this is the order. I just consolidated the two state hospitals together. So we have four General Fund requests on table six. These are the top four items. And I'll go through each of these so we can go through table six.

So the first one that is funded is our priority. Number two is for emergency medical services. We're in the budget asking. Let's see, supplemental increase was $8 million in the governor's budget. Right. That's a. Let me see. That should be priority one up there.

Yeah, it starts with. Yeah, Department wide priority is. Starts with two.

So for the $8 million that we're asking for in HTH730. As we've looked more closely on what we truly need for next fiscal year, the reason for the ask is that.

Right is that the right number or.

No, $8 million is what's being asked for. 730. That is what's in the governor's budget.

Yeah, but you said you're looking at the numbers.

So as we looked through it, we found that we converted from cost based budgeting or cost based contracting to budget contracting to be more predictable and stable in our funding. When we made that conversion, we ended up having to shift from a calendar year cycle to a September to August cycle.

We had to move it up three months. Okay. So that's the cycle we're on now within that contract. Because these contracts include services for paramedics and EMTs, and the counties have public employees, we follow the collective bargaining agreement increases mostly BU10, also BU9 and we have to add that to our contracts.

So the new amount is for the new each year.

So that amount where we have not kept up with the adjustments, we only need four and a half million dollars to behold the continued services through August of 27. We need that 4 million 4 1/2 million to be added to our base to get us whole to include the.

CBA increases of four and a half, not eight.

So. So we're decreasing our ask from eight to four and a half. Okay, but I'm going to ask for it back respectfully.

Okay.

So this is to cover those CBA increases that have occurred this past couple years. It will be recurring in our base to keep it whole going forward. We are estimating CBA increase percentages and putting in that budget to keep us more consistent prospectively. This will catch us up. Okay, Shifting to behavioral health.

This is the Behavioral Health Crisis Center at EVA. Just real quick, you can see how the utilization has increased since it's opened in March of 24. It has connected over 2,000 individuals with services, including placement in clean and sober homes, residential substance abuse treatment, homeless shelter, stabilization beds and otherwise connected with services.

There's still about a third of patients who are seen there who either refuse or aren't connected with services. But we with this patient population, basically about two thirds of them getting connected, we consider to be very successful for how this program goes.

We are looking at ways how we can address the most challenging patients that third, many of whom have frequent visits. So we're doing better. But I just want to show you that the investment in this program is working Very well.

What is the numbers though? You saying the beds and all of this, but when we went over there, and again, not being prejudiced to any foreigners, when we went over there, none of those people that was getting the medical help was from Hawaii. Every single one of them was told to me was not from Hawaii.

So again, we're investing, yes, we investing, but are we investing the dollars in the right area? Because we put in the money to help these guys get off the streets and get some of them goes there revolving over and over getting the treatment. So again, they're not transitioning to anywhere else. It's just going back to the street.

When they get sick or they get on staph infection, they end up back in your facility. But it's a revolving door. So the statistics and the numbers that I want to see is the success rates of them not reoccurring, going back over there into the facility because it's costing the taxpayers money. So where is the.

After they go there or they go to a medical facility home or they go to a daycare or a hospital, where are they going from there? Because that's, that's a lot of money we're spending for people investing that again, have no vested interest in our taxpaying brackets for Hawaii residents.

So within the chart, it is hard to see. I apologize for the small font that bottom left hand indicates where they go. So about a third of folks, yes, they do revolve and have frequent visits for about two thirds of folks do get placed and connected with services through that facility.

And that describes, you know, where, where, where they go. So as I mentioned, they'll go. We have over 500 placed in stabilization beds. You know, 250 are placed in homeless shelters. So we do connect them with placement.

I understand that. Again, what we don't have is the data on the process. Now you send them to a homeless shelter, how long do they stay there? Do they go back on the street? See what I mean? So you, you guys let go of services because you guys don't track it.

But what I'm saying is once they go to the shelter, after they wear out the time at the shelter, guess where they go. They don't go to homes, they go back to the street and this process starts all over again.

I just, I don't know if that's the right question for them because once it's in the shelter, that's really going back to dhs. So yesterday they gotta share the data to me. They gotta. Well, that's what we were saying. Yesterday they don't have data.

So that's why we want the reorganization of DHS so that we can collect data.

Ohs not all of these. Yeah, yeah, yeah.

So the homeless.

Homeless and housing.

Okay. All right. The state hospital. So there are two General Fund asks for the state hospital. So the BHCC Behavioral Health Crisis center is one of the programs. It's preferable if we can identify, respond care for patients while they're outpatients and reduce the need of them having to be admitted to the state hospital.

The BHCC is one of those ways and we are working with HPD and rather than arresting people, if they can take people to the BHCC and we keep them in that system and connect them to outpatient services. But patients, you know, do people do get arrested, they do come to the state hospital.

So we've been working very hard to decompress the state hospital. On the left are some of the activities that we have done. We have discharged patients to community hospitals to put them in psychiatric beds.

We've been working that if people are neighbor islands and would be transported or transferred to Hawaii to be admitted if we can keep them admitted on their neighbor island where there are neither supports or their family. So that is one of the things that we've been doing.

You gave us the authority to be able to discharge patients directly to a long term care facility and we've been utilizing that believe we discharged about 15 patients into a long term care facility. We want to get patients in the most appropriate setting which tend to be less expensive than keeping them in the state hospital.

That top right graphic just shows what the census has been over from for 23 through 25. 2025. We are licensed for 292 beds. I believe the peak was about 391. Through the decompression efforts we've gotten as low as 358. But we see it's just starting to come up.

That bottom right graphic is again over that same period of time, but this is a snapshot of patients admitted at that time. What's the offense that they committed.

And what we're seeing is the distribution is shifting that there's an increase in felony C of patients admitted to the hospital for felony C. When we looked more closely, we're not seeing there's an increase in admissions of people for felony C is that their length of stay is getting longer.

So that's why they're contributing to a higher proportion of the census. So we're trying to really use these data and Dig in more deeply to understand the root cause, to see how we can better address these issues going on.

So even though we've had that decompression, the census is coming back up, so more patients are coming or staying longer. And there's also a desire to create capacity for civil admissions.

So whereas we thought we would not need as much funding, such as for overtime, as the census goes up, we're still going to need that additional funding, but for contract events.

So you gave us $5.5 million last year to contract for beds, and one of our asks is to continue that $5.5 million, such as to contract with nursing facilities or these other hospitals that are caring for patients to keep them out of the same hospital. So that's the 5.5 million.

And then when the increased census, we're looking for the 2.5 million for overtime, which is what's in the budget. So this just shows what the average census was for fiscal year 2022 through 2025, and also shows what we've been paying, what we've been budgeted in our payroll and what we've spent.

And the variance as the census has gone up, we've had a negative variance because we've had to use overtime to care for the increased number of patients at the state hospital. When we got into 2025, our shortfall was about $6.5 million.

This is when you saw again a significant increase beginning in 24 of patients we are working to hire folks. So when we look at what the actual is spent, it is both for fill positions and overtime. In 2026, we're projecting this year a $10.3 million shortfall. But this includes $3.7 million of THP that we fronted.

If you account for that, we're still at about six and a half million dollars of payroll shortfall due to the need for overtime. And as we are projecting for 27, it's down a little bit, but we're still projecting over $6 million of a budget shortfall.

So, you know, when we had the informational briefing, I remember Dr. Mattson saying that the Governor had task Q forks to reduce the number of patients by half. You're telling me you folks have not been successful in that?

So we were tasked to reduce by 100 patients and we have reduced it by 47. However, patients are coming in faster than.

You folks are able to. Okay, the other question is, prior to every session, you folks know this, because that's my pet project, is to try to relieve the overcrowding of HSH I ask you folks what is the primary reason for, for the population growth and usually it's a 704.

So each year I come up with 704 bills to try to reduce, to try to lower the amount of the evaluation so you guys can process them and get them out. You folks. Now you're telling me you haven't figured out how much. I mean why we have the census.

I mean increase or I mean I'm more than willing to submit more bills but I don't know how much on the 704 we can do other than.

Is the 704 the Act 26 folks. Same thing. So there I'll start and then Dr. Mon the highest volume of admissions are the 704s still is. Is the highest volume of admissions in is the the most effort because of the frequent churn of admissions and discharging.

So they take the most transition type work because they are the greatest one because their, their length of stay is so short.

Okay. I just want to make sure that the Committee knows what 704 is. It's when. It's when they basically as soon as they get arrested and their defense attorney says they are unfit to proceed so they can't go any further.

So we are asking the state hospital originally it required like three examiners to determine whether or not they're fit to proceed. That's why you guys see me reducing bills to try to reduce it down to one because they couldn't find the three. Okay.

So now and I've also tried to task them with trying to like the, like the class, the class C make it non violent ones to get those even though they're class C felonies to get them down to one examiner.

So whenever you guys see me asking for like one examiner it's not to try to get them released because as soon as they get evaluated and they're determined fit to proceed they're supposed to go back to jail and then they proceed. Okay. And that relieves Hawaii State Hospital.

So right now, Hawaii State Hospital, according to them it's mostly we haven't figured out whether or not they're insane and we haven't quite figured out whether or not they're fit to proceed so we can put them back into the system.

That's what I mean by 704 and that's why do we have any more compression requests to try to bring those population down and they're talking about like 75% is like 704.

So this 7, it says 704. 421. So these are the folks with petty misdemeanors. And so that's why it's, it's the length of stay. It's very short. They come in because they need to have fitness evaluation.

So these are like the homeless people who like devastating the streets, who like problems and stuff like that. And we, that's also why we try to do law enforcement diversion so that the cops go, you know, hopefully start diverting them before they get into the system.

Because as soon as the, as soon as the judges see them, they automatically go to state hospital. We want the cops to be able to like send them directly to like evil A. And so whenever you start seeing those law enforcement divergence, that's the reason because I don't want them to go to state hospital.

There's no room.

Right. And we're working, we're working with others in terms of trying to find other.

Ways to, to expand service facilities, but that failed last year. So we got to come up with another plan.

Yeah. And we got to work with the prosecutors. Right. Right now because they're not in agreement. They want them to go through the system and as soon as the judge comes in, they, the law is they automatically go to state hospital for evaluation. Okay. And we don't have room.

How much long care patients you guys have that is in there? More than a year or so much of patients you guys have like that.

So I would say the, the ones who are on the short term, the act, not Act 26, but the ones on a 704421 the ones coming in with the petty misdemeanor charges, they stay for about seven to 10 days. So that's the shorter length. But they're the ones who come in frequently.

So that's why we have a high admission rate because a lot of those folks come in but they don't stay very long.

That's why on the felony Cs you see there, if you look at our population, just one day you'll see a lot of those with a felony C and that's because they're not necessarily coming in frequently, but they stay for a very long time because they're still. We're trying to get them fit to.

Proceed coming up here. Right. Asking us that's okay.

Then if you don't like report whatever, you just hopefully adjusting.

You insane, right?

Yeah. Okay.

See what you. So so basically I just wanted to let the. And Brandon knows this, as chair of psm, we're also trying to get DCR because they're asking for behavioral health beds in their facilities to hold on to some of the 704 patients. We haven't been successful in that, so.

But we're still trying to talk, and I guess now it's going to be, I need to talk to.

I think there's probably a disconnect between the city and state when it comes to 704 patients. Because a lot of the 704 patients is. We consider them the police or whoever, they don't know who they are. There's no record of them. And so I think there's steps that happen that before they get the treatment that makes them.

It's longer, it lasts longer.

Sometimes they know. It's like the repeat offenders. They know.

But I'm saying the new ones or the ones that could have been helped earlier, there's a miss, there's a disconnect, and I don't know how to.

What to do. Yeah, but this involves more than just DOE.

And I think, you know, the reason why Dr. Fink put the slide about the BHCC, the Behavioral Health Crisis Center, is that that is one way where we're trying to work closely with HPD law enforcement to bring folks to that facility so that we can do the assessment there rather than, you know, getting them into the judicial, the court One.

Pilot, the IHS triage to kind of help by that. We never expanded it.

But we got to.

To get the police and the prosecutor to agree that.

That was.

No, but what if. What if we added a position for you and change the law instead of having three, we actually have someone, a state employee that actually does do that determination?

I. Every time. I'm just gonna let you know, every time I try to get it down from three down to one, judiciary comes in and fights it, and that's where I end up losing my.

No, no, no, no. But I'm not saying why. Well, it can be one, but it could be a designated doctor within the state hospital that can determine that quickly, and then we move on.

Oh, we. We have that already. State examiner. DOH, state examiner is already one of the examiners. And so we try to.

So one.

Okay. Hire two more doctors. And then we got three.

Would be that we. When we do our assessments for, for fitness to also to include recommendations on whether or not the client would be appropriate for inpatient or outpatient and send that. Then the judge can use that information and determine where they would want to court order the person.

Before they're sent to the hospital.

Yeah.

So they would be under the custody of the Director of Health. But it doesn't necessarily mean they have to go to the State Hospital. But I would say that majority of them are sent to the State Hospital and they might need to. Right. And they probably don't need. And you know, inpatient level.

That's why they keep asking us for money.

Okay, how long are we going to.

Well, I just wanted to bring up the reason why we're having this influx. The reason why we're having the influx, is because the people. That is, again. We don't want the data, which we already harp on that. IHS. They don't. They don't share anything. And when they go examine him, they take too long to process them.

And then HPD picks them up, take them to, to jail, and they end up in the hospital. But the guys that we are hiring and contracting to go out there and do the job, they need to do their job. They're not. And that's the problem. Why are you guys getting influx?

Is a majority of the influx is houseless people. Right? They're in downtown, they're in the communities. They're going to a point that they reach a certain level. Where was the meet and greet from IHS before they reached that level? No more. And how come we don't want. Because we don't want the data.

Are we giving them big money? Millions. But they're not in it's not you guys. They're not doing their job. So that's the reason why they're going where you guys stay. Because they're not doing the job. If they do the job, we take all the grants away.

And if they don't, give us some statistics.

Okay, what is the question?

What's the question? Right. Question would be we need to have these agencies do their job so they don't end up in the.

Yeah, but these guys don't control the IHS contract. It's going to be DHS. So that's what. That's why we had the meeting yesterday. That's why we're talking about the reorg.

Yeah.

So they're related. But you need. You need the DHS reorg in that particular section of.

How can we make one Bill to exp.

Yeah. So that's what we talked about yesterday.

Yes.

The Department is now going to work with the Chair to develop a bill so we can reorg that component.

But it would help if we also have the data from HBD. How many instants they have the same people over and over, same issue.

Doesn't matter. Doesn't matter because there's no place. There's no room in the facility. So no matter. At this point, no matter how much data we have, there's no. There's no room in the hospital. So what we got to figure out are alternatives so that-

there's no referral to this hospital. So it's not. It's.

The data is one component, but that's still not going to stop the overflow of too many patients going there that they cannot accommodate. Okay. We should probably move on and then. So you guys can take care of this in subject matter, five and a.

Half million, which was again, what was appropriated last year for contracted beds. And what is currently in the budget is a two and a half million dollars for our payroll shortfall. And we're. We're asking that three and a half. We're going to give up for EMS to ask for back here.

Okay. And the hospital is fully utilized now because I know it's. At 1.0 they were sections that were not open and not you.

zero, yeah. What happened to that lawsuit? You guys getting your money back? You should ask for that.

Yeah.

Okay.

I mean.

Okay.

Yeah. Okay. All right. And then the last trial fund ask was for HH 720 is for criminal background check. Oka Office of Healthcare Assurance, responsible again for licensing healthcare facilities, but also for background checks. There's a number of requirements of Medicare and Medicaid for certain providers, particularly long term care. These are the requirements of a background check.

The cost is passed on to the employer of this requirement for background checks. The intent is to help protect vulnerable patients, to not put people in positions of employment with direct patient access who might take advantage of those patients.

There are other programs because most of these, other than that initial FBI check are state databases, ecrim, we can do electronic exchanges with some of those other databases. We cannot. There's this thing called a wrap back program which would be ideal which we could do just real time automated checks.

And in theory, as other states have done, not actually charge our healthcare providers at this time. We've been beta testing. We just need this $121,000 to finalize development of the background check system for those providers who are required to do background checks. This will help them track their folks for providers.

What about the 30 million before that?

Oh, all right, okay. Sorry. I just went through the general funds first and I'll get special funds. Sorry. It's a lot work, but last one is not in our budget. As you may have heard, we are in the process of finalizing leases for two spaces to relocate Kino Holly staff this is not currently not in the budget.

We did not. We are executing cont leases this week and we now have learned the cost is $3 million for these leases per year. And these will hold, as you can see there, about 550 style.

Yeah. Okay. Well this, you know, this is my inverse fear because if we're going to end up leasing this is going with the amount of even just a couple of years we could have just bought the new building. And that's why we tried to do the Hawaii Loa campus.

But then Castle Foundation added these restrictions which now prevent DOH from going there. And now Dillonar was like oh good. If not going to take it, we'll take it. So we got to, we really got to figure out a long term solution because this is going to cost us more in the long run.

Because even like the evil property, right, we leasing them from the city doing the rail. When the rail stuff come true, we're going to lose the lease and we spend hundreds of thousands in the renovation.

Nobody's going to help you. I'll try to. I'll try to find a building in Wahiawa or, or Milani. If nobody here is willing to help, then I'll help you. Big Island. Big island. Because how much you gotta make?

That's your CIP request building and.

Not that easy. We Try. Is that the same one about the county that we tried to fix?

DLNR?

Oh, was it DLNR?

It was a. We.

We had explored it. Yeah. It was a little bit of cost prohibitive. Yeah. Yeah. Okay. These are the remaining requests. These are all special Fund requests. These should be in the.

They're all like, I'm not driving to Ohio.

Okay. Okay. This is just. Just a little bit of vaccination data. It's for the 2425 school year. So it was in the fall of 24 before the current federal Administration took office. And while the vaccination rate increased, ticked up a little bit from the previous year, the trend is down on vaccination rate, exemption rate is up.

This kind of, coupled with the messaging coming from the Federal Government. Right. We've just seen a decrease in vaccination rates. Concurrently, we've seen an increase in vaccine preventable diseases. There was just this one case of mumps and two cases of measles. And we were frankly lucky that we did not see more community spread.

We have seen wastewater testing that's been positive for measles, but there have not been other reported cases. It could be that cases are out there and they weren't diagnosed to report it. It could be there was a traveler who really was slightly contagious, but still a shedding virus that got in the wastewater. We don't have great explanations.

I just want to highlight that it's a concern. This is just an incidence of pertussis cases, and you can see it's increased almost threefold compared to the previous year. So this continues to be a real threat.

From a finance perspective, there was one systematic review that was done that estimated the cost of investigating, let's say a measles case was over $40,000 per case of investigation. So if we have an impact, there's a real fiscal impact in addition to a health impact.

Okay, but this is defunds, right?

Yeah. So as a result of everything going on, just to mention that we joined the West Coast Health Alliance. So we've joined these other three states to provide, you know, scientifically based information, having writer information, if you're interested, but specifically to the B Fund, ask.

So Act 175, that was passed last year, established the immunization Purchasing Program and is modeled on the Vaccine for Children program to make it easier for providers to have vaccine in their office to be able to administer to their patients.

When we looked at what we spent on the Vaccine for Children program, which is federally funded, we spent about $21 million. And that program covers about half the kids in the state.

When we looked at calculating what our special Fund would be, we don't expect everybody to cross over to, you know, purchasing program right away, provided we can continue to purchase through the CDC. So we are requesting a ceiling of $30 million of special funds.

Act 175 allows us to collect the money from the health plans to cover the cost of purchasing vaccine. But we need the authority to spend that money to do the actual purchase. That this ceiling would allow us to actually purchase the vaccine. Right.

Because we can purchase it at a best available pricing which is less expensive than the plans. Than the plans actually save money. It's better for everybody. DBC, we're requesting an increase to the ceiling of $5 million. That chart shows the balance of revenue and expenditures over the past couple years. That red line is the current ceiling.

And you can see with the projected expenditure it would approach, if not exceed the ceiling. There are new activities that are desired for use of these funds, particularly to respond to the auditor's findings with increased compliance activities and potentially exploring increasing redemption sites. So requesting an increase of funding, dodge that ceiling.

Senator Ashimoto.

So what, you know, actually, so over the Christmas break I went to go recycle some cans just to see what the experience was. And that's not the only time he.

Recycled plenty right at 21, which is, you know, I don't know up when you can, but you know, I was like at the end, I was just like if you if to make people worth it wasn't worth the trouble.

So I think you have to figure out how to make it more convenient and, and you know, you had to have to go pack it all up, had to go drive. Right. And I think coupled with Administration problems, we have so much money in this Fund.

I don't know what the problem is of like, we got to think, think through a lot of this stuff of what are the new technologies that we're using. I know we had a whole hearing on it, but, but I think, you know, part of it is, I think is 5 million really enough?

You have what, 60 million I think looking in your chart over there. Yeah. So you have a lot of money. But the point is, is how do we push the redemptions up? Right?

Because I think at the end of the day people are gonna be like, okay, I'm just gonna throw it away because it's not worth my time.

Yep. Well, I hope you don't throw it away. You throw it in your blue bin or recycling. But yes, we are we recognize that there is an issue with redemption. We recognize. And also nationwide redemption rates are lower. We do recognize that there is a need to create perhaps more redemption centers.

As we spoke about in the informational briefing, a site in Kailua was unable, had to close because of the leasing issue. We're talking to the county, the counties, about increasing space for redemption.

We're also looking at perhaps approaching other agencies who may have properties that they could lease to the Department, and then we can maybe increase rates that way. So we're exploring all options.

Yeah, But, Kat, if you just use your money to buy properties.

Yeah. So one of the. One of the issues. I understand that one of the issues is, you know, everyone thinks that we have a lot of money in the.

Where you cannot leave. Like if you did a statewide plan.

Yes.

Where you don't have a state agency with land that you can use or a private. Why not just purchase something? Right.

You can lease it to the Department of Health.

We could. We could do that, but we run the risk of if the redemption rates go higher, then we have to pay everybody their nickels. That we would. Which we have this Fund that is recycled. I see that the teeth are mashing, but there is that. There is that possibility.

And that if it happens, then we would just have to come in for appropriation.

That's fine, because then if you buy a property like in urban Honolulu and you put the redemption center at the bottom, and then above the redemption center is your new Department of Health.

We'll explore that.

Thank you. But you must know how much is old money that came in that will probably never be deposited. Do you know what that number is?

I'm going to call upon Lene, who is the acting branch manager.

That's the reason we have the informational briefing. No, I listen to it. Yeah.

No, we're trying to tease this out now. Right. What is the action?

May I ask you to repeat that question, please?

No, I. I think what is the amount that you know will never be redeemed? And so it's like, then. So then you can take that money and then you can do some of these broader program improvements. Right. Because I think it's.

At certain point, the program has been around so long, like you probably got collections, I don't know, 10 years ago that hasn't been redeemed. Right. And you're going to be like, okay, is it ever going to get reading? Probably not.

So if you take a Look at our Y27 request, our anticipated expenditures, we are looking at that difference to Improve on our programs and it exceeds our revenues. So we are.

No, I'm not talking about revenues. I'm talking about over time. You should know how much you don't really need to put in reserves. Right. That's not going to be redeemed.

So prior to Covid, we were. Our redemption rate was about 60 plus percent.

That's over five years ago.

Yes. And it has decreased since then. Yeah. And so that's, that's where we're trying to recoup with the expenditures in FY27 to improve the program. Such as.

No, no, but what I'm saying is probably, okay, let's say 10 years ago, you, you got a redemption of maybe 60% of the funds. The 40%. Right. Left, you're probably not going to get redeemed. So you can carry that over and do something to pay for something. Right. To increase recycling or get innovative. Right.

So we don't have that calculation to. Reimbursing the deposits to find the nickels. We do pay a handling fee to the recyclers. That additional handling fee.

Yeah. That should be baked in though into that. You should know that actually we only.

Collect $0.06 per container that's sold in the state. We, our handling fee is much more than that penny container fee. So we have the 5%. We get that.

So, so of the, I don't know this. According to Senator San Juan Ventura, she said there's 80 million. I don't know how much is in there.

What is it? 89. Yeah.

What, what is, what is your expected redemption?

It keeps going every year. It keeps. Yeah.

Of that money. So what is the, what is, what is it that we need to have redemption plus handling that we actually need? Right. Because then the rest is just all free money for us to do other things. We don't know that number.

So expenditures have been about 600 million in the last year. Or I would say in the. Yeah.

600 million. 600,000.

60 million. Fy 25. It's about, it was about 54 million.

54 million. And then you have, you have still 89.

So you give you a little idea of at the end of last fiscal. Of the last calendar year, we have about 74 million in cash balance. 5 million of that is currently encumbered. We need additional 2 million for the rest of this fiscal year for expenditures moving into FY27. We do have that.

We require that additional balance to provide encumbrances to contract the redemption center operations into the next fiscal year. So yes, there is, there has been a carryover of funds from year to year, and that's part of which we are looking at doing improvements in FY27, which.

So. So why is the balance so high, though? Are you just not income? Are you just not spending down the encumbrance?

Well, all right, 55 million encumbrances. Majority of that is with the redemption centers. That's the nickels that are anticipated for payout.

Yeah, but then you're actually. So you're encumbering it, but you're not actually spending it.

Not all of it, but the thing, the difficulty is.

So why are you covering 100% when you know redemption is 60?

No, we're not encumbering 100%.

What are you encumbering then?

Off the top of my head, I don't know what the percentage.

Okay, well, I think. I think we just need better data. Like we. Or I think the point is you just gotta figure. Figure out what is. What is the true balance. Like, I think. I don't know if you got that. Tease that out. I don't think the last hearing, but I would imagine we need that information.

Yeah, and they also need an auditing ability to just do it. Well, that's. That's another.

Yeah, we do have an audit. We do have auditing ability, but we're. We're entering into a. As a result of the auditor's review of our program, we are entering into an audit RFP for auditing. So we're going to. That's part of the money that we're asking for so that we can. We can enter into that contract.

I recognize that there. That there seems to be a large sum that's still left in the. In the Fund. And then I also recognize that the redemption rates are lower. We will look at all options, including perhaps purchasing properties so that we can increase redemption and make it much more easier for the consumer.

You're spending the entire room up to your ceiling now?

Close to next. Next year we will be close. Yeah. So how much.

But you have much more. You have a lot more than what.

Your ceiling is from past years. Yes, we do, but we're looking at spending with the auditor's proposals or contracts.

No, what we. What we can do is in the budget, just put a line item, redemption centers, and we'll use. Instead of Geo Bond, we use special Fund. So it comes out of your special Fund. Because you have that money, you're not doing anything with it.

And I feel like unless we do something like that, you're not going to take a risk. You guys are just going to kind of keep reviewing and planning and reviewing and planning. So we got to do something and then we can just do an audit. We can just ask the state auditor to audit.

No, they don't. Yeah, they don't want to. They don't want to do the audit. I guess the audit of the Department they're willing to do. They don't like the idea of the auditor does not want to do the Department of Health's job of auditing the redemption centers, which they haven't done.

No, that's fine. But what we can do is add a position to auditor but Fund the position from their special Fund and then they contract that money to go and just do what they're supposed to have to audit your contract and see if they're not going to do it.

Okay, we're. Right now we have an RFP that is under final review from our procurement office to do just that.

Okay, so I got follow up question. So I've had the calls by any of the stores and so forth questioning the audit you guys have put on them for their recycling. Where is that at? In other words, you guys wanting to have them do an audit that running then some $10,000.

I mean the impact to these small mom and pops. What's the deal with that?

There's a state law that requires independent third party audits of the redemption centers. Of the distributors or the stores and the bars and stuff. Yes, of the distributors. And so we, we heard from the small businesses and therefore the Administration had issued a Executive order to essentially stay the enforcement of that for the. For the year.

Yeah, that was like.

That was like super impactful.

Yeah. So we are looking at long term solutions for that.

Write down, not let me. They're not being forced to have to do the auditing internally for businesses for this year. Okay, so you guys going. So after this year you guys might visit that again.

There's a Bill. Well, there's a. It's a state model. That's why. Yeah, so yeah, we're looking at long term options.

Would you guys use some of the recycling money to help offset costs if they're being forced to or do we need to write on bill to have you use the funding to help offset? I think a bill. Yeah, yeah, that's what I mean. Okay. No, thank you. Thank you. Has a bill that you got to.

Hurry up and spend it on redemption centers instead. If you. You got to figure out what your priority is because there's not. If everyone Keeps adding all these things to. To require. There's only so much money, so you better spend the money on the priority. If not, that's going to all be their General Fund request.

Since we're on that topic, have you folks created any kind of checks and balances with reportings? Because I think, yeah, the state auditor is kind of tired of auditing you folks. Because right now it just seems to be going by honor system for these distribution centers that are returning this or reporting this.

So instead of kind of continuing this cycle of insanity. Auditing, Auditing, auditing. Are you guys internally structuring anything that would have any kind of direct checks and balances?

So part of the auditor's recommendations was to conduct risk based audits of the redemption centers as well as distributors. And so the RFP that we're preparing now that to go out is for that auditing service. So that's one aspect of it.

In addition to that, we are looking at our payment procedures to see if we can do something different to help with that gap.

When are you folks looking to launch that?

The evaluation? We're doing the evaluation now.

Okay, thank you. Thank you, chair.

Okay.

Okay, next.

Okay, next. The next two are revolving funds. So this one is for the drinking water revolving loan fund. These funds are used for both public and private water systems. In the past year, distributed over $57 million for projects.

I believe you folks are very familiar with this for this one and the next one because there's additional funding through, I think the BIL and requires a lower state match. We're not requesting any state appropriation, just raising the ceiling for us to expend more federal funds through these programs.

And this is the other water pollution control revolving Fund. And about $93 million was expended last year in projects. There was a pilot of $2 million on Kauai to support cesspool conversions. Also investing in recycled water systems. So it's a. You know, our municipalities are benefiting from this federal funding that we're able to distribute. Okay.

There is one laboratory in the state that can do cannabis testing. And there's requirements of our current medical cannabis program to ensure that the product is safe and not contaminated. There's a need to have some redundancy should there be a disruption on that lab. And then also to have a reference lab for validation purposes.

Not just to ensure it's a quality assurance for patients who are participating in the medical cannabis program, but also as we're looking to increase enforcement activities of illicit distribution of intoxicating substances. A Reference lab would help be able to do that testing for enforcement purposes.

Okay. So my understanding and vice chair, maybe you could help us on this. We made this request during conference. There was a blank because we wanted Department of Health OCCR to be more diligent about getting all of those cannabis, you know, those, you know, from the retailers. Okay. And so there was a request for a lab.

And my understanding was Department of Transportation has the monies for the lab. So why can't you folks use the Department of Transportation lab? Because they need to do cannabis testing too.

I'll start. My understanding is right. So. But they're. They're testing human specimens. That's correct. Particularly for the blood alcohol and other. For human specimen for intoxicated drivers. This is a partnership with the, uh, proposed partnership with the, uh, College of Pharmacy in Hilo.

So it's also to support that capacity locally, um, within our state system and in Hilo for this, you know, cannabis reference testing. So it serves a different purpose. The Department of Transportation, as I understand, does have a contract with a private lab to do testing.

And this would be, again, not testing human specimens, but more substances that the College of Pharmacy would be able to do.

Just to follow on that, what are you doing in terms of coordinating? Because there's a number of labs involved. DOT is trying to develop the drug testing. Also, I understand that the Jabsom or the cancer center, which of the two also has a lab that they're testing and you folks are testing.

So what are you doing to coordinate so that it's not duplicating? If in fact you're doing something differently, then we should know who's doing what.

I'm not sure if there's a little bit of confusion. The lab that we're looking at is testing products specifically. I think DOT is probably more interested in testing the levels in a human specimen. And so our testing really is about product testing. That comes off under stuff Manufacturing.

The retailers to determine the amount of thc. Remember, we had problems before or from the farms directly. Right.

And so right now, the lab that currently exists does all the testing. But we need a reference lab that's going to also monitor whether their testing is accurate. So when they finish their testing, it goes to the retailer, then the retailer puts it on the shelves.

We then need to go back and make sure that the labeling that let's. For example, this is one example labeling that's on the shelf actually matches what the label originally put on there when it was originally tested, and it can be used for law Enforcement.

So if law enforcement sees this products and they want to know whether it's above the.

It's not taking blood versus the dot. One is you're taking blood or they're trying to figure out if they have the substance in their system.

So who's, who's going and pulling out the products. And for you first they need the lab. We don't have that capacity. Right.

Okay. Next.

So real quick. So. So as of today you guys still fall under federal of Wait, can you.

Keep the question toward the budget amount though?

Okay. No, no, no. But that's going to lead to the budget amount because when you look at that the registered the registry under a legal cannabis that's being sold based on your criteria of testing, there's only one legal. One that is on the books today. Literally one legal strain that is on the book.

So I kind of taken aback by you guys testing.

No. So they would test the product to see if that whatever, whatever they grab is legal or not after it's tested.

Yeah but at the federal standard level there's only one legal that has been rightfully cleared by FDA and patented. Which is what happened at the conference. So you know, while we're testing all this it still doesn't strange. Yeah, no, no, I know that but. Yeah, but we're not, this is state law. Yeah.

So basically we good with whatever is out there then based on your. No, we're not. That's the reason we need the lab. No, no, but that's what I saying. So to today there's only one legal that meets that strains of being tested that has been cleared by Fda.

Which is why I'm asking why run the test if there's only one that has passed the 10 year levels of patented. Okay.

No matter the lab determines if the product is legal or not.

Because then this testing would be void. No, no, no, no, no. I think your guy's talking apples and oranges. I think she's talking about the medical, the medical, the one that's the FDA approved one. But then we, we have a different, the dispensary. We have a different law that allows for medical. Medical cannabis.

And that's what they got to test is within state law.

So. So we're going doing separation between state and federal law. We have been.

It has been. That's what's been the case. Obviously.

No, by just looking at it. Because then if that's the case and if, if say then we'll go revise it.

Yeah. If Trump decides to declass to the regular Right.

No. No matter what. Which is saying the testing level and the safety measure.

I mean if it's a, if it's a nationally approved product, then FDA or you know, some federal agency would do the test. This is state approved law. Products that are approved by the state law that they have to test to make sure that it meets the qualifications of the state law.

So I'll give you the qualifications. And the current comes from the Department of Health. If somebody dies from it, does the state assume that liability as well?

No, for the same reason we don't assume the liability when somebody overdoses on alcohol and just checking. No, we're not doing it. I just like be sure because there's a lot of out there.

Okay. Okay. Next.

Well that's where you something want to learn.

Next again.

Okay. See this is the last, last one of special funds for vital records. This is probably the place where we interact the most with the public in the past where we received the most complaints from legislators. I'm pleased that those complaints have decreased.

There's been a significant amount of effort by the staff, reduced the backlog by five to seven months of certificate processing. But it still is a very cumbersome process with an antiquated system of multiple disjointed databases.

Okay, so you need the 469 to fix it.

So a new to modernize The SIM is $5 million. We have a million of federal funds. We really need $4 million to do this. We understand General funds are really not available.

So because there is the biostatistics improvement special Fund, we're looking to raise the ceiling to be able to use the special Fund money to implement the system in phases. It would take longer and likely cost more overall.

Which, which Department priority is this? Maybe because you can go over the. Because you're not, you're. You're going by a different list than we are.

So we're going HC90 overall. So it was Department priority three. Three.

Okay. The 1.5. No, that's. No, that's your, that's the program ID priority.

Seven 60. It's on table six.

Yeah, that's why it's HC90.

Is that the second item?

It is the Department wide priority 90.

Oh 90. Thought you said three. Okay. Yeah. So that says refunds of 469,000.

Increase the special fund ceiling from the current balance of over 500,000 to a total ceiling of a million.

Okay.

Part of that is the Legislature reallocated how we expect. Reallocated how we dole out our fees that we get in Act 148. Yeah. So previously we had got a dollar, now we get $7. And so it increased our special fund. And so we want to be able to use that special fund money to finance the new system.

Yeah. Okay, next.

Chair, sorry, I have a question with regards to. Yeah, so specifically with the special funds. Sorry, two questions actually. Number one, what do you think is driving the need for more certificates? Because you folks had increased from 2023, about 172,000 certificates to now 2025, 300,000 certificates.

So I'm just curious, what is your Department suspecting could be an increase of these requests?

We suspect it's real ID. So everyone who needed to get their star on the driver's license, they all had to come in and get birth certificate.

Okay, makes sense. And then my last question is, is this program really going to help you guys to expedite the process even faster? Is it, is it a vacancy thing? Because five to seven months of backlog, I would think it would need more hands on.

We're automating it. So right now we have five different legacy systems. For someone to fulfill an order, they have to go to multiple systems to pull information. It's a little crazy. So this is going to compile everything into one system system.

Somebody goes online, puts in an order, same system, we can pull it down and get it out.

And once, and once the program is up and running, how long from the time they order it to the time they get it?

Well, right now for birth certificates, it's almost instantaneous. We've caught up. So if you put in an online order today, you're going to get in the next couple days. oh, nice. Okay, so we're maybe two months, up to two months behind on death certificates. But. And we're, we're trying to catch up, but it's very difficult.

We have to put a lot of manpower in, in that just to keep up. Yeah, with the new system, it's going to be much better. Yeah, thank you.

I'm going to hold you to that. We still getting complaints as to how you guys are.

Okay. Just transitioning to our CIP requests. So speaking of Kalapapa, there are underground storage tanks. There are some federal regulations that by 2028 we would have to like do a double wall or other kinds of monitoring of the tanks rather than investing in that money.

Because the tanks would have to be removed by 2045 because they're within 100 yards of the coastline. Just want to remove the tanks. So this is the money to remove the Underground storage tanks at Kalapasa. Second one. We've been exploring the, you know, the need to renovate the state lab.

So this is an ask to be able to do that.

Some of this you already got, right? It's only. You're only going over fiscal year 27.

Only going over the new asset.

Yeah, yeah. If you got it. No, you already got it.

I don't think we have that.

But why is it under fiscal year 26?

Yeah, some of it you got.

This is the second year of the biennium 27.

Yes, but we. The USTs, we didn't have remote there within some sufficient funds.

Diana, this is actually.

You need to come up.

Thank you. The UST ask is for the actual construction phase of the process. Of the process.

I'm just wondering why is it in fiscal year 26 versus 27?

It should be in 27. Okay. It was not given last year.

Okay. So this ask is for the new. The supplemental year. These are all supplemental. Correct. Okay, so almost everything should be all 27 then. Because you have both fiscal years. If you look. Yeah.

Table 15. Oh, the table, I think. Is a little confusing. It starts with what was already appropriated. If you go to the bottom of it has the new ask. Okay.

Check which.

So what part of it did you do for Kalapapa? For example, we gave you funds for the synthetic cover and we gave you funds for the roof. So is that done? That's for the landfills. That's in process. Okay, so it's done. So you're asked additional amount is what different?

No, it's table 15. So if you look, I think what they're going down. It starts with number nine. Program. Program ID health 100 Department wide priority nine. So you're only asking for storage tank removal.

That's it. Not for this year. Yes.

2027.

Yeah. Question on this page. Thank you, Chair. For the ones for the Waimano Home Road campus. Is that roof replacement for where the state lab is or is that the other building?

It's the other building.

Okay. And then could you provide a breakdown. Of what your phase one renovation is for? For that, if you don't mind.

This for that.

This is for 10 and 11. Yeah, 10 and 11. Sorry, no, Department wise. 10 and 11 and you're one. Yes, 10 and 11. Priority 10. 11 on table 15.

Yeah. Right. So the Waimana Poly complex is for electrical switches. It's a concerns about the electrical system. They're cracking concrete walls with now water infiltration that risk causing further damage. So the General repair is what we're calling the health and safety improvements is that that building is where your clean.

Clean, clean air and clean water branches are or.

No, it's be. I got it below the guard shack.

Okay, but at some point you're not. None of this includes a roof replacement. For where your state lab is, Right?

The state lab would know. But Haleola is.

Yes. Okay, thank you, Chair. Okay, why don't we just go on to 12 since we discussed 10 and 11.

So the health and safety improvements for the health centers. This is to Fund planning, design to replace the roof of our health centers or health centers. Okay, and then number 13, that's the Haleola roof.

Yes, that's the clean air, clean water building.

And then 14 is.

I think it's the. The BNF ad for the $2 million. The $2 million for just the, you know, deferred maintenance statewide.

So there's 57 facilities just on Oahu that we have to maintain. So that money is to do little fixes all over the funding for the state hospital.

Is that going to be reimbursed or is this new? Is this part of the problem with the building that's under litigation or is this.

The 2 million is not gonna. They're starting at number nine. This was already given to them. So from number nine now, this was already. Powell, this is in the budget. This is 27. I know, but it's done. It's starting from them. If you look at that, what they're asking for, they confuse us by adding the whole biennial.

They were only supposed to add the supplemental requests, so no need to. You guys already gave the first half.

That year is PO27.

Okay.

These are our new supplemental requests.

Yeah. So starting from our list, number nine down, that's what's new. Everything is already appropriated. Okay. Okay. Any last questions? Because we have HHSC outside.

I just have one more question on contract costs. Table 14. Just one question. I think you might know where I'm going with this. Table 14. This is page 22 of 44, your Catholic Charities contract. This is for community based residential to sexually reactive youth services statewide. Is that the contract for the property in ial?

Yes.

Okay, and then your that contract is how I read it. Here is. That's a six year contract. Okay, thank you. Thank you, Chair.

Okay, we're going to recess for five minutes so that HHSC can set up. And then at one o' clock we have Department of Transportation. Yeah. There's one group.

Okay, reconvening. So next we're going to hear from HHSC on their supplemental budget requests. Good afternoon.

Good afternoon. Chair Dela Cruz and Vice Chair Moriwaki and Members of the Committee and as Chair Buenaventura as well, of the Senate Health Committee. You just have one request. We just have one request. Yes. So I just want to introduce myself. I'm Edward Chu.

If you didn't guys have seen me before, but I'm the President, CEO of HHSC. And with me here, representatives from all our regions. Again, our CEO from West Hawaii region, Dan Brinkman from East Hawaii region, CEO Sean Sonata from the new CEO for Oahu region.

We also have Stephen N. Medical Center, our CEO there, and Christina Sato and Kurt Akamine from Kauai region. So I'll get to the. I'll give you the Viewer's Digest version of our, of our narrative testimony. No, we read it. You read it. Let's go straight to table six. Okay, so the first request is for Kahuku Medical Center.

It is a General Fund request for about $1.4 million is what the Governor had recommended over what they had already been appropriated in the final budget. So, Stephen, do you want to come up and talk about that?

We can just. Does anybody have questions on that item?

Okay, do you have any CIP requests? Yes, there are CIP requests. I believe It's a table 15, if I'm not mistaken.

Does anybody. You have questions on.

Go ahead. I have questions for kahukum.

The 612,000.

The 612,000. But you also on, on the, on table 16, which is a lapse. You're lapsing that amount and you're asking for. I don't quite understand what your request is for the mam. Gram. And then you're, you know, on the, on the left, you get cash.

Yeah. So I guess I'll explain that one. So the, the lump sum for Google Medical center, which you see about 650,000, I believe that's what you're referring to. So that was a Fund. That was a. Funds that were appropriated back in 222022 and 2023. Yeah.

So they requested us to, if the projects weren't already at a substantial completion point, to let those funds lapse as General funds. And then the Governor would put in money as C Fund for, for the supplemental.

This where I was saying during the Senate retreat where the Governor typically had said, if they don't want to pay for CIP out of cash. Yeah. And so this was cash for that. Right. They Were asked to lapse the cash, which means now they don't have the money to build it.

So now it's in the governor's budget as Geo bond request. Right. So they never spent the cash and it got absorbed in carryover.

So, for 211, the medical center, what I see is that you had Al together for fiscal 23. You had 2 million in CIP, 3 million in. In. In cash. No, wait, which one are you talking about?

Yeah, where are you?

No, but it's. Yeah. No, no, but before, previously, in 20232024 they had appropriation. I just want to. What is the status of those projects? Because you had previous appropriations. Yeah.

Or in the previous biennial, in fiscal.

Year 23 for the medical center project, lump sum. And then you're lapsing 650. But you got 6 million and then for the lump sum. No, that's Oahu region. So for Kahuku. So what were the projects? And did you complete the projects and so the balance is 650 that you're lapsing?

No, no, no. They had previous CIPS monies. So separate that question first. Did you se. Did. Did you spend the CIP monies that you had in the last biennial? Yes. Okay. And what were they spent on?