Board of Supervisors — 2022-10-04

CEO Report

• CEO Miyasato announced awards for the Public Works Department’s Flood Control Division and recognized John Fry as Professional of the Year.
• Chris Sherwin was introduced as the new Chief Information Officer, who is currently assessing the county’s IT landscape.

Clerk’s Announcements

• The Clerk noted an agenda amendment adding a closed session conference with labor negotiators for the Sheriff’s Association and SEIU Local 620.
• Updated methods for public participation were reviewed, including virtual options and the removal of mandatory indoor face coverings.

First Amendment to Mental Wellness Center Agreement (FY 2021–2024)

• Supervisor Nielsen raised concerns about the trend of contractors returning for budget increases after initial awards.
• Staff explained the increase was necessary to retain staff for geriatric care at Polly’s House, the only provider with appropriate ADA access.
• The item was approved as part of the balance of the administrative agenda.

Regional Climate Collaborative Grant Application

• Public comment expressed skepticism regarding the grant's goals, specifically air monitoring stations and potential impacts on agriculture.
• Supervisor Nielsen stated she was not comfortable voting for the item at this time and would abstain.
• The Board voted to proceed with the staff recommendation.

Extension of Exclusive Negotiation Agreements for No Place Like Home Project

• Supervisor Hart expressed concern that the project bypassed the full development review process due to state permit streamlining laws.
• The item was approved as part of the balance of the administrative agenda without a separate vote.

Third Amendment to Stacey Miller Public Affairs Agreement (COVID-19 Response)

• Supervisor Nielsen opposed the extension, arguing the County should reduce reliance on external contractors for internal services.
• Staff explained the extension was needed because the internal staff member responsible for the work was leaving.
• The Board voted to approve the staff recommendation.

Balance of Administrative Agenda

• Supervisor Nielsen moved to approve the remaining administrative items, excluding those already voted on.
• The motion to approve the balance of the agenda passed.

Resolution of Commendation for Sergeant Kenneth Rushing Jr.

• The Board adopted a resolution honoring Sergeant Rushing for over 27 years of service to the Sheriff’s Office.
• Sheriff’s representatives and Sergeant Rushing spoke regarding his career, awards, and dedication to service.

Resolution Proclaiming October 2022 as Domestic Violence Awareness Month

• The Board adopted a resolution proclaiming October 2022 as Domestic Violence Awareness Month.
• Representatives from Domestic Violence Solutions for Santa Barbara County spoke about awareness and resources.

Resolution Proclaiming National 4-H Week

• The Board adopted a resolution proclaiming October 3–8, 2022, as National 4-H Week.
• Two 4-H members spoke about their experiences and the leadership skills developed through the program.

Resolution Proclaiming National Cybersecurity Awareness Month

• The Board adopted a resolution proclaiming October 2022 as National Cybersecurity Awareness Month.
• County officials spoke about the county’s cybersecurity program, recent policies, and staff training.

Resolution of Commendation for Employees of the Month

• The Board adopted a resolution honoring Gus Mayo and Shawn Jensen as Employees of the Month for October 2022.
• Department representatives and the honorees spoke about their contributions and work ethic.

Appeal of Planning Commission Approval for 5980 Casitas Pass Mixed Light Cannabis Cultivation Project

• The applicant appealed a Planning Commission condition requiring the installation of carbon scrubbers within 12 months.
• Public commenters cited health concerns and odor issues, urging the Board to uphold the carbon scrubber requirement.
• The Board discussed the implementability of the condition, the tiered response plan, and the health safety of the current odor abatement system.
• The Board voted to grant the appeal and approve the project subject to the conditions in Attachment Two.

Building Electrification Ordinance

• Staff recommended Policy Option 4, which prohibits natural gas infrastructure in new construction to address health and climate goals.
• Public commenters expressed support for electrification while raising concerns about costs, agricultural exemptions, and grid reliability.
• The Board discussed the source of electricity, cost implications for low-income households, and the cultural importance of gas for cooking.
• The Board voted to direct staff to pursue Option Four.

CalAIM Initiative

• Staff and SenCal Health presented an overview of the CalAIM initiative to transform Medi-Cal into a more equitable and coordinated system.
• The discussion covered the integration of behavioral and physical health services, workforce challenges, and rate setting.
• The Board received and filed the report, determining the activity is not a project subject to CEQA.

Closed Session

• The Board considered existing and anticipated litigation and conferred with labor negotiators for the Sheriff’s Association and SEIU Local 620.
• County Counsel reported that the Board took no reportable action in closed session.

Meeting Start and Roll Call

• The October 4, 2022, meeting of the Santa Barbara County Board of Supervisors was called to order by Chair Hartmann. The Clerk of the Board called the roll, and all supervisors were present. The Board recited the Pledge of Allegiance.

Approval of Minutes

• Item: Approval of the September 20, 2022, meeting minutes.
• Discussion: None.
• Motion: Supervisor Owen moved to approve the minutes; seconded by Supervisor Owen.
• Decision: The minutes were adopted.

CEO Report

• Announcements: CEO Miyasato announced awards for the Public Works Department’s Flood Control Division, including recognition for the Lower Mission Creek Reach 2B and 3 project and the Randall Road Debris Basin. Former Flood Control Engineer Manager John Fry was recognized as Professional of the Year.
• New Hire: CEO Miyasato introduced Chris Sherwin, the new Chief Information Officer. Sherwin stated he has over 30 years of experience in the technology sector and is currently assessing the county’s IT landscape to lead the transition to a standalone IT department.

Clerk’s Announcements

• Agenda Amendment: The Clerk noted an addendum posted on September 30, 2022, amending the closed session agenda to include a conference with labor negotiators for the Santa Barbara County Deputy Sheriff’s Association and Service Employees International Union Local 620.
• Public Participation: The Clerk reviewed updated methods for public participation, including in-person attendance in Santa Barbara and Santa Maria hearing rooms, virtual participation via Zoom, and the three-minute time limit for comments. Face coverings are no longer required indoors but are encouraged by the Public Health Department.

Administrative Agenda Items

A1: First Amendment to Mental Wellness Center Agreement (FY 2021–2024)

• Discussion: Supervisor Nielsen raised concerns regarding a trend of contractors returning to the Board for budget increases after initial RFP awards, suggesting the County bears too much risk. CEO Miyasato noted that vendor selection considers qualifications and service capability, not just cost. The Behavioral Wellness Director explained that the increase was necessary to retain staff for geriatric care at Polly’s House, the only provider in Santa Barbara with appropriate ADA access for complex medical needs, due to high turnover and competition from other CBOs. The Director noted the department is recruiting contract monitors to improve oversight.
• Decision: The item was approved as part of the balance of the administrative agenda.

A4: Regional Climate Collaborative Grant Application

• Discussion: Public comment from Andy Caldwell (CoLab) expressed skepticism about the grant's goals, specifically regarding air monitoring stations in Guadalupe and potential impacts on agriculture. Supervisor Nielsen asked about prioritization if the grant amount is reduced. Staff responded that budget scenarios involve a percentage decrease across the board. Supervisor Nielsen stated she was not comfortable voting for the item at this time and would abstain. Chair Hartmann expressed support for the grant, noting its importance for building capacity in economically disadvantaged communities.
• Motion: Chair Hartmann moved to go with the staff recommendation.
• Vote Outcome: Passed (4-1).

A10: Extension of Exclusive Negotiation Agreements for No Place Like Home Project

• Discussion: Supervisor Hart stated she had no objection to the administrative process but expressed concern that the project bypassed the full development review process (Planning Commission and Board of Architectural Review) due to state permit streamlining laws and delays. She stated she had previously committed to neighbors that the project would go through the full review process and maintained that this was the better course of action.
• Decision: No separate vote was requested. The item was approved as part of the balance of the administrative agenda.

A14: Third Amendment to Stacey Miller Public Affairs Agreement (COVID-19 Response)

• Discussion: Supervisor Nielsen opposed the extension, arguing the County should move to a sustainable post-pandemic environment and reduce reliance on external contractors for services that can be handled internally. The Public Health Director explained the extension was needed because the internal staff member responsible for the work was leaving, and the contract covers web support for the COVID-19 website. Supervisor Lavagnino asked for clarification on the work involved; staff explained it is primarily web support, with 23,000 unique visitors in the past 90 days. Supervisor Lavagnino stated he would support the item given the continued public interest in COVID-19 information. Supervisor Nielsen maintained her opposition, citing the symbolic importance of winding down pandemic-related contracts.
• Motion: Supervisor Lavagnino moved to approve the staff recommendation; seconded by Supervisor Williams.
• Vote Outcome: Passed (4-1).

Balance of Administrative Agenda

• Motion: Supervisor Nielsen moved to approve the balance of the agenda (excluding A4 and A14, which had already been voted on).
• Vote Outcome: Passed.

A27: Resolution of Commendation for Sergeant Kenneth Rushing Jr.

• Discussion: The Board adopted a resolution honoring Sergeant Kenneth Rushing Jr. for over 27 years of service to the Santa Barbara County Sheriff’s Office. Sheriff’s representatives and Sergeant Rushing spoke, highlighting his career, awards (including Medal of Valor), and dedication to service.
• Decision: Resolution adopted.

A28: Resolution Proclaiming October 2022 as Domestic Violence Awareness Month

• Discussion: The Board adopted a resolution proclaiming October 2022 as Domestic Violence Awareness Month. Representatives from Domestic Violence Solutions for Santa Barbara County spoke about the importance of awareness, resources, and volunteer opportunities.
• Decision: Resolution adopted.

A29: Resolution Proclaiming National 4-H Week

• Discussion: The Board adopted a resolution proclaiming October 3–8, 2022, as National 4-H Week. Two 4-H members, Kira Sheck and Ella Bishop, spoke about their experiences and the leadership skills developed through the program.
• Decision: Resolution adopted.

A30: Resolution Proclaiming National Cybersecurity Awareness Month

• Discussion: The Board adopted a resolution proclaiming October 2022 as National Cybersecurity Awareness Month. County officials, including the Chief Information Security Officer and Risk Manager, spoke about the county’s cybersecurity program, recent policies, and the importance of annual staff training.
• Decision: Resolution adopted.

A31: Resolution of Commendation for Employees of the Month

• Discussion: The Board adopted a resolution honoring Gus Mayo (IT Specialist) and Shawn Jensen (Agricultural Biologist) of the Agricultural Weights and Measures Department as Employees of the Month for October 2022. Department representatives and the honorees spoke about their contributions and work ethic.
• Decision: Resolution adopted.

General Public Comment

• Comment: Laura Dewey spoke regarding traffic safety on El Colegio Road near UCSB. She cited a fatal accident involving three young people and argued that the speed limit should be 25 mph in the designated senior zone, per Vehicle Code mandates, rather than the current 35 mph. She noted that a Roads Department traffic engineer had determined no change was needed. Supervisor Hart acknowledged the concerns and stated that District 2 staff were working with the commenter and the Roads Department on the issue, noting state laws govern speed limit setting.

Departmental Agenda Item 1

D1: Appeal of Planning Commission Approval for 5980 Casitas Pass Mixed Light Cannabis Cultivation Project

• Late Documents: Two documents received after the deadline were admitted into the record by motion and second.
• Ex Parte Communications: Supervisors Hart, Nielsen, Lavagnino, and Williams disclosed meetings or communications with project representatives, staff, or neighbors regarding the project, odor abatement, and carbon scrubbers.
• Staff Presentation: Director Plowman introduced the appeal. Ben Singer (applicant’s representative) presented the case. The applicant, Valley Crest LLC, appeals a Planning Commission condition requiring the installation of carbon scrubbers within 12 months and the reduction of vapor phase technology. The applicant argues their existing odor abatement plan meets all requirements of the Coastal Zoning Ordinance without this additional condition. Staff noted the applicant’s plan includes a tiered response that would require carbon scrubbers if odor violations occur in residential zones.
• Questions and Clarifications:
• Supervisor Lavagnino asked how staff would determine if the odor plan is failing and triggering the next tier. Staff explained they monitor for violations (odor detected in residential zones) and are hiring a consultant with advanced technology to help identify sources.
• Supervisor Nielsen asked about the progression to carbon scrubbers if intermediate steps fail. Staff confirmed this is the tiered response.
• Chair Hartmann asked how staff would identify the source of odor in a residential zone given multiple nearby sources. Staff acknowledged the difficulty but noted they would use weather data and complaint timing to investigate.
• Chair Hartmann asked if Kate’s School (in an agricultural zone with a conditional use permit) experiencing odor would trigger the condition. Staff confirmed that only odor detected in a residential zone triggers the violation; Kate’s School is not in a residential zone.
• Staff clarified the nearest residential zone is the City of Carpinteria, approximately 2,800 feet away.
• Staff clarified that the determination to move to a higher tier of odor abatement is a departmental decision based on permit compliance and is not subject to an appeal process.
• Staff clarified that carbon scrubbers are already included in the odor abatement plan for the processing building.
• Staff noted that the Air Pollution Control District (APCD) has reviewed the proprietary formula for the Fogco-Benzico system and determined that no ingredients are on the list of toxic air contaminants.
• Applicant Presentation: Representatives for the applicant, Valley Crest Farms/Headwaters, presented the project details, including a 7.75-acre cannabis cultivation site with a greenhouse and processing building. They highlighted the site’s distance from sensitive receptors and the prevailing wind direction. The applicant described their odor control system, which utilizes a "Benzico-Fogco" vapor phase system and carbon scrubbers in the processing building. They argued that the Planning Commission’s condition requiring the installation of internal greenhouse odor scrubbers within 12 months was unwarranted, unimplementable due to electrical upgrade timelines with Southern California Edison (SCE), and inconsistent with the site-specific certification by a certified industrial hygienist. The applicant stated that their current system exceeds county ordinance requirements and requested the Board support staff’s recommendation to approve the project as originally envisioned.
• Public Comment: Eight members of the public spoke regarding the item:
• Ana Carrillo: Requested the Board deny the appeal and uphold the Planning Commission’s condition requiring carbon scrubbers. She cited health concerns regarding the Fogco chemical deodorizer, noting potential respiratory issues and allergies among neighbors and Cate School students. She argued that carbon scrubbing is the best industry practice and that the vapor phase system poses unknown long-term health risks.
• Dr. William Hahn: A resident located 300 feet from the facility, reported that he, his wife, and others have experienced headaches, nausea, and respiratory distress since the installation of the Fogco system. He stated that the chemical deodorizer has not been adequately tested for human inhalation safety and cited EPA assessments indicating potential toxicity to aquatic life and tissue damage. He advocated for carbon scrubbers as a superior mechanical removal method.
• Nicholas Targ: Representing neighbors and Cate School, urged the Board to deny the appeal. He noted that carbon scrubbers have been approved as the best available control technology (BACT) in at least eight other county odor abatement plans. He argued that the Planning Commission’s condition was appropriate, that the coastal zone ordinance does not differentiate between agricultural and residential zones for BACT determination, and that the current system is causing a public nuisance.
• Charlotte Brownlee: Assistant Head of School at Cate School, stated that odors are present daily in classrooms and dorms. She requested the Board deny the appeal to affirm the carbon scrubber condition, arguing that the tiered response system places the burden on neighbors rather than growers and that the Fogco system itself causes health issues.
• Danielle Delarmy: A rose farmer located 300 feet from the facility, reported that the cannabis odors and masking materials have forced her to disband educational tours, lost tenants, and caused respiratory issues for herself, her employees, and guests. She cited specific incidents of respiratory distress and vomiting in children exposed to the fumes.
• Mimi Mosher: A rancher and avocado farmer, stated that the odor is severe enough to prevent her from walking or biking in the area. She expressed frustration with the lack of response to complaints and requested the installation of carbon scrubbers.
• Tim Bliss: An avocado farmer, stated that while he supports the cannabis industry, the odor and air pollution are serious problems. He urged the Board to support the Planning Commission’s decision to encourage the adoption of carbon scrubbers and reliable measurement standards to heal community divisions.
• Peter DuGray: Representing Carp Growers, a cannabis association, asked the Board to support the appeal. He stated that his members strive for best practices and compliance, noting that the applicant has invested in odor control technology and community dialogue. He argued that the project is a crop change on an existing farm and that the industry has revitalized local agriculture.
• Applicant Rebuttal: The applicant’s representative responded to public comments, stating that their employees and visitors have not reported health issues related to the odor abatement system. He noted that the Air Pollution Control District (APCD) has cleared the odor abatement systems. He argued that the Planning Commission’s vote was not unanimous and that the applicant’s odor abatement plan includes a direct line of communication with neighbors and a requirement to respond to complaints within two hours. He reiterated that the project is a "model project" and requested Board support.
• Board Discussion:
• Implementability and Technology: Supervisor Williams expressed concern about the implementability of the 12-month carbon scrubber condition due to lengthy electrical upgrade processes with SCE. He noted that the ordinance is technology-neutral and that the Planning Commission’s condition may be on "shaky ground" if imposed ad hoc in an appeal rather than through legislative process. He suggested that the community should pursue better science and testing regarding the health effects of the Fogco system.
• Zoning and Sensitive Receptors: Supervisor Hartman asked why odor is measured at residential zones rather than property lines. Staff confirmed this is a Board decision based on the code. Supervisor Hartman noted that Cate School, being in an agricultural zone, may not have standing to make odor complaints that "stick" under the current framework.
• Health and Safety of Fogco System: Supervisor Nielsen expressed concern about the potential adverse biological effects of the Fogco material, noting that while APCD has cleared it from the toxic air contaminants list, there are anecdotal reports of health issues. She requested assurance that there is a mechanism to cease use of the Fogco system if it is later determined to have negative medical or economic impacts. Staff stated that if a public health agency determined the product had adverse health impacts, the county would follow that protocol.
• Best Available Control Technology (BACT): Supervisor Lavagnino reviewed the odor abatement plan and noted that the applicant’s system is certified by a hygienist as consistent with industry best practices. He stated that the applicant has met all requirements and that changing the rules at the last minute would be onerous.
• Tiered Response: Supervisor Owen noted that the applicant’s odor abatement plan includes a tiered response protocol that requires the installation of more effective odor control systems (such as carbon scrubbers) if the current system fails to resolve complaints. She suggested that this provision effectively incorporates the Planning Commission’s condition.
• Efficacy and Timeline: A board member noted that the longest installation of the specific scrubber technology in question has been in place for only six months, indicating the technology is still new and its long-term efficacy is not yet fully established. Another board member expressed frustration with the current ordinance, questioning whether the board should follow laws they perceive as unjust, and raised concerns about the difficulty of identifying odor sources.
• Staff Clarification on Tiers: Staff clarified the odor abatement plan (OAP) response tiers. Tier 1 and 2 responses occur within 24 hours. Tier 3 involves a more thorough review and potential installation of alternative technologies, such as regenerative carbon scrubbers, which may take up to 72 hours. Tier 4 involves re-evaluating the entire odor abatement control system. Staff confirmed that the OAP voluntarily expands coverage to any parcel with a residence within 1,000 feet, not just residentially zoned parcels. Staff also noted that quarterly inspections will be conducted for the first year, and a consultant contract is pending to assist with determinations.
• Motion: Supervisor Lavagnino moved to adopt staff recommendations A through D. The motion included granting the appeal, making required findings for approval, specifying Attachment One (including CEQA findings and determining the previously certified EIR is adequate), and granting de novo approval of the proposed project subject to the conditions in Attachment Two. The motion was seconded by Supervisor Williams.
• Vote Outcome: Passed (4-1).

Closed Session

• The board recessed to closed session to consider existing litigation (Scott v. County of Santa Barbara), anticipated litigation, and to confer with labor negotiators for the Santa Barbara County Deputy Sheriff’s Association and SEIU Local 620. Upon reconvening, County Counsel reported that the board took no reportable action in closed session.

Departmental Agenda Item 2

D2: Building Electrification Ordinance

• Staff Presentation: Staff presented options for regulating natural gas infrastructure in new buildings, additions, and alterations. Staff recommended Policy Option 4: developing a local ordinance that prohibits natural gas infrastructure in new construction, citing health and safety concerns and climate goals. Staff noted that methane is approximately 25 times more potent than carbon dioxide as a greenhouse gas over a 100-year span and that natural gas infrastructure poses risks of leaks and explosions. Staff also outlined three other options: a carbon impact fee, lowering greenhouse gas thresholds of significance, and a local energy ordinance discouraging natural gas. Staff stated that Option 4 is recommended because it is permanent, effective, and consistent with regional policies in the City of Santa Barbara and Ventura County. Staff emphasized that the ordinance would apply to new construction, additions, and alterations, and that the county would work closely with the agricultural community to avoid unintended consequences.
• Public Comment:
• Susan Petrovich: Urged the board to apply the requirement only to new construction, not remodels, citing the high cost of retrofits and potential impact on landlords and tenants.
• Andy Caldwell (CoLab): Requested exemptions for all agricultural uses and zoning, arguing that the state may mandate similar measures anyway and raising concerns about the environmental impact of solar panel manufacturing and disposal.
• Brian Troutman (EDC): Supported Option 4, citing health risks associated with natural gas combustion (respiratory disease, carbon monoxide) and climate change benefits.
• Paul Poirier (Central Coast Green Building Council/AIA): Supported the electrification ordinance, noting that all-electric buildings can be less expensive to build and operate, and that the industry is ready for the transition.
• Lee Heller: Supported Option 4, refuting claims about the high cost of remodeling by citing personal experience with electric conversions and emphasizing health benefits.
• Michael Lynch: Supported Option 4, urging the board to act quickly and to consider agricultural exemptions on a case-by-case basis rather than broadly.
• Michael Chiakas (Community Environmental Council): Supported Option 4, citing cost savings, health benefits, and grid reliability data.
• Nadia Abushanab (SBCAN): Supported Option 4, highlighting the health risks to renters who cannot easily replace gas appliances.
• Alex Bouchot (Architect): Supported the ordinance but urged the board to clarify exemptions and thresholds for additions and alterations.
• Katie Davis (Sierra Club): Supported Option 4, citing health benefits (reduction in childhood asthma) and cost savings, and listed numerous supporting organizations.
• Jonathan Allman (Sierra Club): Supported the transition to electric, citing climate change impacts and the benefits of renewable energy sources.
• Kaylee Ellis (Grower Shipper Association): Expressed concern about unintended consequences for agriculture, citing the use of natural gas for backup generators, water pumps, and frost protection, and urged the board to exempt agriculture or provide incentives rather than outright prohibitions.
• Board Discussion:
• Grid and Energy Source: The Board discussed the source of California’s electricity, with staff providing data on the state’s electric mix (approximately 33% renewable, 37.9% natural gas, 9% nuclear, etc.). Supervisor Lavagnino questioned the reliability of the grid and the source of imported electricity.
• Cost and Culture: Supervisor Nielsen raised concerns about the cost of electricity for low-income households and the cultural importance of gas for certain cooking practices, suggesting a compromise to ban gas water heaters but allow gas for other uses.
• Economics: Supervisor Williams discussed the volatility of natural gas prices versus electricity rates and the benefits of electrification for grid load shifting.
• Support and Opposition: Supervisor Owen stated support for the measure, citing the efficiency of electrical appliances and the goal of accelerating climate action. She noted that the City of Santa Barbara’s approach has local realtor support and that the board is deciding which strategy to use to advance the effort. Supervisor Nielsen expressed opposition, arguing that the measure is not well thought through and that natural gas infrastructure is already in place, making it cost-effective. She raised concerns about the impact on agriculture, noting that electrical technology cannot currently support California agriculture in the same way diesel or gas does. She requested that if the measure proceeds, it include as many exemptions as possible, specifically for ADUs, commercial, agricultural, and cultural uses. Supervisor Lavagnino stated he could not support the measure, describing it as a mandate and ban. He argued that the market should determine energy choices through affordability and education rather than government mandates. He noted that natural gas reserves are plentiful and cheap, and that energy demands continue to rise.
• Implementation and Exemptions: Supervisor Williams moved to direct staff to pursue Option Four. He argued that while a carbon tax would be preferable, local land use tools are the available mechanism for reducing climate change effects. He stated that shifting demand to electricity ensures economies of scale for the electrical system. Supervisor Hartmann asked questions regarding the education of contractors and builders on new technologies and the cultural aspects of cooking. Staff responded that resources exist through the Tri-County Regional Energy Network and other organizations to train professionals. Staff also outlined a policy development process involving advisory committee meetings, public workshops, and Chamber of Commerce meetings to gather input on exemptions. Supervisor Nielsen asked for clarification on whether the ordinance would apply to agricultural operations that do not require building permits. Staff confirmed that the ordinance applies to habitable buildings going through the building permit process and that remote structures not served by PG&E (such as those in North County) would likely use propane and be exempt.
• Motion: Supervisor Williams moved to direct staff to pursue Option Four. Supervisor Hart seconded the motion.
• Vote Outcome: Passed (3-2).

Departmental Agenda Item 3

D3: CalAIM Initiative

• Presentation: Terri Nisich, Assistant County Executive Officer, and Lindsey Walter, Principal Management Analyst, presented an overview of California’s Advancing and Innovating Medi-Cal (CalAIM) initiative. They described CalAIM as a five-year effort to transform Medi-Cal into a more equitable, coordinated, and person-centered system. Key components include a "no-wrong-door" approach, enhanced care management, and community supports (such as housing and sobering centers) to address social drivers of health. The presentation detailed the current complex delivery of Medi-Cal services, which involves managed care plans (specifically SenCal Health in Santa Barbara County), fee-for-service programs, and behavioral health carve-outs. CalAIM aims to streamline these by integrating physical, behavioral, and oral health services. Marina Owen, CEO of SenCal Health, discussed the health plan’s role in the partnership. She outlined SenCal’s priorities, including cultivating community partnerships, advancing health equity, and expanding its role in addressing social drivers of health. She highlighted specific initiatives such as medically tailored meals, recuperative care, and the Housing and Homelessness Incentive Program. She noted that SenCal serves over 210,000 members across two counties and that the CalAIM initiative involves 5 state-led, 12 county-led, and 35 health plan-led initiatives.
• Discussion:
• Geographic Division: Supervisor Hart asked for clarification on the geographic division of Medi-Cal managed care plans in California. Marina Owen explained the different types of plans, including county-organized health systems (like SenCal), two-plan counties, regional plans, and multi-plan counties.
• Integration: Supervisor Hartmann discussed the importance of integrating behavioral health and public health to address social determinants of health. She noted that a significant percentage of health issues depend on social factors.
• Optimism: Supervisor Nielsen expressed optimism about CalAIM bringing together various providers and creating a true health and human services group with a single funding strategy.
• Resources: Supervisor Hart asked about the resources and provider availability needed to fulfill CalAIM goals. Terri Nisich identified workforce availability and technology integration as primary challenges. She noted that the board had allocated $800,000 for data sharing and identifying high utilizers.
• Rate Setting: Director Navarro provided additional information on rate setting for behavioral health plans, noting that rates are being set by the Department of Health Care Services and are expected to be specific to roles and responsibilities. She indicated that rates may differ from current Santa Barbara rates due to cost-of-living adjustments and comparisons with similar counties.
• Enhanced Care Management: A representative from a Community-Based Organization (CBO) discussed the implementation of the enhanced care management benefit under the SendCal contract. The speaker noted that this benefit is already a requirement for Full Service Partnership and Assertive Community Treatment (ACT) programs. The speaker explained that the current contracting structure prohibits reimbursement for services already provided by County Behavioral Health, meaning no additional contract or benefit will be issued for clients already receiving these services. The speaker stated that the county and SendCal are currently identifying populations not yet served by enhanced care management. Additionally, the speaker highlighted that the rate structure for these services is significantly lower than the cost of provision. The speaker also noted that care coordination planning responsibilities are shifting to the managed care plan (SendCal), creating potential workforce challenges as case workers employed by B-Well may face job opportunities with SendCal.
• KPMG Report: Terri Nisich previewed the upcoming KPMG report on behavioral wellness, noting it will address utilization management, efficient service delivery, cost estimation, and Cal-AIM readiness.
• Rate Setting Clarification: Marina Owens responded to a question regarding rate setting, clarifying that the state provides funding and the framework, while SendCal has a role in program construction. Owens emphasized the workforce challenge, noting that all counties are developing Cal-AIM initiatives and that long-term strategies are needed to retain social workers and physicians within the healthcare delivery system.
• Motion: Staff requested that the Board of Supervisors receive and file the report on CalAIM from the CEO’s office and SenCal Health, provide direction as appropriate, and determine that the activity is not a project subject to CEQA. A motion was made to receive and file Items A through C. The motion was seconded.
• Decision: The board received the report and filed it. The board determined that the activity is not a project subject to CEQA.
• Vote Outcome: Passed unanimously.

Adjournment

• The meeting was adjourned until Tuesday, October 11th, in Santa Maria.