Commissioner gets on there. Good afternoon. Welcome everybody. That was great conversation though. I'm sorry to break it up because [laughter] sometimes we don't ever get time just to converse in the hallways, right, and do things like that. So, I'm so glad everybody's here. Um, welcome to the administration's libraries and budget committee. Um, would the staff please roll the tape? Good afternoon everyone. Welcome to the administration's libraries and budget committee. Um this is the human services and healthline of businesses today. Today is Thursday, October 23rd. Um today we'll open with the recorded public comments of the resident services and operation lines of business. However, I was told there are no callins. So we will move on. The county administrator submitted her budget to the county board on September 16th. The proposed budget totals $3.09 billion and was based upon a property tax levy increase of 7.79%. The board adopted the maximum property levy increase of 7.79 on September 25th. Today we will be holding hearings on the proposed 2026 budget with presentations from the human services and the health lines of business. These hearings are intended to allow board members to understand what is included within the proposed budget. Additionally, these hearings will provide a forum to gather public input on the proposed budget. The line of business budget proposals and the complete 2026 proposed budget and the schedule for these hearings are available on the county's internet website at www.henipin. us/budgets. And at the end of today's budget hearing, we will provide a call-in number and other specifics on how members of the public will be able to submit comments to on the budget hearings. Um, I'm now going to go around and do introductions. I will let colleagues know that we have two very meaty subjects. So, please be as concise as you can on questions and we will take a break halfway through as well. So, I'm uh Henipin County Commissioner Debbie Goel, >> I mean Fernando, District 2, >> Angela Connley, District 4, other district, >> Kevin Anderson, District 7, >> Marian Green, District 3. >> Joe Matthews, chief financial officer. >> Jody Wentland, county administrator. >> Karine Murphy, deputy county administrator. Etsy David, human services assistant county administrator and director of finance. >> Kate Nelson, district 5, district 7, district 3, district 4, district 6. >> Welcome. And um as as people step up, we'll ask you to introduce yourself if you're called upon for questioning. So I appreciate that. And now I'll hand it back over to you, Administrator Wetland. >> Thank you, Chair Gotautell. Commissioners, thank you for joining us here today for this budget hearing for the human services and health lines of businesses. During the first half of our time together, we will focus on human services line of business. After our presentation and a discussion, we will pivot to health. Today, we continue the conversation around budgets and the ways we connect our diverse work to our organizational priorities of disparity elimination and climate action. We know we have challenge a challenging year ahead, but we've been preparing for budget shifts for several years by maximizing revenues, weighing programmatic priorities, and engaging in meticulous and prudent staffing management. A lot of hard work has been done in the budget presentations that you will be hearing about today. And I want to express my appreciation to Deputy County Administrator Murphy and to Betsy David, assistant county administrator and to the human services and public health teams that have worked to bring this forward forward today. With that, I'm going to turn over to Kareem Murphy. >> Good afternoon, Madam Chair, commissioners. Thank you for the opportunity to present the 2026 proposed budget for human services. As we have done in previous budget briefings, we will walk through some of the ways we are serving our residents. Then we will shift to the details of the 2026 proposed budget. We will share the ways we are managing priorities, challenges, and opportunities and then close to allow for a robust discussion. interim county interim assistant county administrator Betsy David and I will start today's conversation and we will be joined today by the human services directors who lead all this vital work. They will participate in your discussion in ways that will allow uh and and facilitate the discussion and presentation. I want to thank them all and for welcoming me into this work. Thank you all and for their leadership and commitment to eliminating disparities and strengthening the people and communities we serve. I want to thank uh the leaders and their teams for also the strategic thinking, the flexibility and hard work that went into crafting this budget during a particularly challenging budget season. There's a lot more than you saw yesterday. The work of the human services line of business is diverse, complex, and vital to the well-being of all of our communities. In 2024, our program served 528,000 people or roughly one, excuse me, four in 10 county residents. We're working to eliminate disparities across domains as we provide services and supports to help residents achieve safety, stability, self-sufficiency, and well-being. Here are just a few examples of that work. We've continued to address the crisis and family homelessness by creating a multi-layered system to bring families inside and to help them quickly transition into housing. We're proud of our promise that in Henipin County, no child sleeps outside. We're also continuing our work to remove barriers to mental health care for young people by partnering with school districts to provide on-site mental health care for students. We know that food security will be an even bigger issue in 2026. You'll hear more about that in our recent work to streamline customer service and support residents. But it's worth noting that even as we've engaged in robust, continuous improvement, we've continued to help thousands of residents put food on their table for their families. This is important resourced work. Miss David will walk you through the details of our proposed budget. >> Thank you. Thank you, commissioners, for letting us walk through our 2026 proposed budget. The human services 2026 proposed operations budget is 846.1 million. This is a 0.5% or 4.6 million reduction from the 2025 adjusted operating budget. The 2025 adopted budget was 840 million. The difference between the adopted and the adjusted are the bars that have come through and as of August 2025. As you can see, there are there are service areas within the human services budget that have decreased their budget. Public health decreased their operating budget due to a reduction in staffing and federal funding for significant federal grants. Our safe communities has a $4.5% increase due to an increase in community contracts. internal supports. The drivers for this $5 million increase is our IT services which we purchased through Henipin County and opioid which has a 52% decrease is due to it being a non-lapsing budget and prior budget authority expense will be utilized in 2026. Next slide please. This slide represents our property tax for human services. It is 1.8% increase or 5.8 million from the 2025 to the 2026 proposed budget. The Office of Budget and Finance instructions for the 2026 budget was a 2% increase. Property tax increases or decreases outside of this annual county request represents the transfer of work between service areas that utilize property tax or from departments outside of the human services department. Next slide. This slide represents our full-time equivalence ask. Our 2026 proposed budget is 3,718 which is an overall decrease of 6% or 238 FTE. [snorts] This reduction from our 2025 FTE will be accomplished utilizing attrition and reviewing work allocation. Our most recent payroll is 3,826 with an attrition of 15 FTE on average per pay period. This reduction of 75 FTE before the end of 2025 will help us attain this 3,718 goal uh budget for 2026. We will continue to utilize attrition and look to not hire for the next year. Next slide, please. This slide represents a recap of the previous financial slides, but adds on [cough] our fund balance use request for both the 2025 and 2026 budgets. The 2026 proposed budget is requesting a fund balance use of 60.2 million, which is 10 million less than the 2025 adjusted budget fund balance use of 70 million. We will review the fund balance information in a separate slide. Next slide please. This slide which uh we have presented in a number of our our budget presentations in the past. The left side is our operating expenses for the human services department since 2019 through the 2026 budget. The red line shows our average FTE by year. The dark blue column segment is our personnel expenses and the lighter blue represents our public aid and other expenses. Personnel costs are the primary driver of expense growth in the human services department. FTEEs increased from 17 by 17% from 3,180 as of December 2019 to 2026 budget request of 3718, a 538 FTE increase. Personnel costs on a per FTE basis increased over this same period by 31%. These two factors drive the increase in our human services department expenses. Public aid expense, which is is represented in that light blue column, includes shelter, food supports, and other community organization supports. In 2019, the public aid was 213 million and has grown to 268 million in the 2026 budget or a 26% increase equaling 55 million. >> This increase, >> I'm not seeing that number. >> Yep. It's it's a calculation that I would have to walk through with you. Yep. It's part of that light blue column and in future we can separate it out as a separate color if you'd like. Yep. This increase reflects resident demands we serve including our co response initiatives adopting services from Henipin Healthcare such as family home visiting teen hope pathways and services transferred from departments like docr safe communities as a service area. One expense initiative for 2026 is working with our community providers to utilize state Medicaid where possible for reimbursement instead of bailing Henipin County human services operating revenue consists. So on the right hand side is our operating graph operating revenue graph. Our operating revenue consists of administrative revenue, a state funding that supports the cost of direct county provided services at an average of 33% of our costs. This does not include public aid reimbursement. It's only all other expenses. our federal, state and local grants that supports programs fee for service which are changes charges for services for behavioral health, medical, case management and social workers. A fee for service is a focus of our department leadership and revenue teams to optimize and support the financial stability of our department. Operating revenue has increased 143 million or 44% from 2019 to the 2026 budget. Property tax increased 35 million or 12%. Our grants, administrative revenues, and fee for service has grown has grown at a much higher rate than property tax due to the focus on those areas from our department leadership. The other sources of revenue include our opioid distributions, any kind of tax um increments that we're receiving for housing. These are the other financial sources and has grown as well. We manage revenues as optimally as possible, reviewing operations alongside a revenue lens that allows our leadership to understand where the strongest revenue options are. This is a continued strategy in 2026. The operational revenue framework for human services department rarely allows us to cover costs at 100%. Which means we look for property tax and other supports to assist with managing a strategically healthy fund balance for Henipin County and our AAA bond rating. This last financial slide represents our fund balance from 2016 through our 2026 proposed budget. The red line represents the actual or projected human services department fund balance from 2016 through the 2026 proposed budget. The columns represent the actual operations in green and the budget in blue. As of 20 as of the end of 2024, the human services department fund balance is 18.4% of the Henipin County fund balance. A focus on keeping a healthy operating framework to support resident services along with balancing support for Henipin County's ongoing bond rating is of key importance. As noted on this slide, we operated using fund balance between 2016 and 2018 and reduced our fund balance down to 105 million. In 2019, with significant work from the leadership in human services, we outperformed the budget and added to the fund balance by 4 million with a transfer in of 14 million. From 2020 through 2022, we added to the fund balance primarily through funding sources that reimbursed our services at a dollar fordoll with COVID response. In 2023, we again outperformed our budget and we supported our community healthcare for [clears throat] 24 million, which meant that our adjusted budget for 2023, we used 78, we had a budget of 78 million of fund balance. We were able to close out 2023 only using 7 million. The significant resident demand from COVID epidemic and the EP economic impact on our communities has required our service areas to increase staffing and support our community providers. This demand along with the loss of COVID response funding has increased our fund balance use. The long range forecast for human services department shows continued fund balance use through 2028 under current operations. The human services department leadership is focused on the levers around our expense reduction and optimizing revenue to reverse this trajectory of our fund balance use over the next three years and to get to a sustainable financial operating framework. Thank you, >> Madam Chair. Commissioners, in human services, we're working to support residents and communities. The work we do touches every disparity domain, and every day we work to eliminate disparities by increasing access, removing barriers, and by offering a hand to support residents who need help. Today, we will focus on three timely priorities with within the broad work that we do. increasing food security, supporting youth and their families, and helping per helping people experiencing homelessness to transition into permanent housing. We know that many residents will face new challenges putting food on the table in the coming months. I should say in the coming weeks. >> Yeah. In response to several years of spiking demand for federal food assistance, SNAP, supp supplemental nutrition assistance program, leaders and staff and economic supports have been laser focused on the ways they can make the progress of applying for, getting, and renewing SNAP and cash faster and easier for eligible residents. This work has put us in a better position as we prepare to support residents through federal changes that will reduce access for some with the biggest impacts of the 2025 federal budget year starting next year. You'll hear more about the work in public health that public health is doing during the health presentation later this afternoon. It's been clear for several years that we need to do more to help young people [clears throat] who are struggling with unmet mental health needs and to support their families on their journeys to healing. From childhood mental health assessments to school-based mental health care and family response and stabilization, we're working across the spectrum to detect mental health issues early and to increase access to therapeutic supports to help young people to stay with their families and in their schools and in their communities. as they work toward recovery. Stable housing solves homelessness. We're taking a person- centered approach to help people to transition from homelessness into housing, whether they're living in shelters, encampments, or other settings. We are maximizing partnerships, maximizing funding, and meeting people where they're located. We continue to work with our partners in housing and economic development to continue increase to the quantity, quality, and variety of housing options to meet people's diverse needs. We believe our strategies are succeeding. Housing exits last year represented a 60% increase, a 60% increase from 2020. As of October 1st of this year, we have already helped to house just under 2,500 people in this year alone. That's >> amazing. >> And yet, one person homelessness or one person who is experiencing homelessness is one too many. The work remains opportunities and challenges. Like our colleagues in other lines of business, we face distinct challenges in in the year to come. Our hope is that the expertise and planning will help us meet those challenges and minimize the impacts for our residents. As part of several changes to federal food assistance, a new cost sharing requirement will be tied to a state's payment rate error. We're doing our part to reduce error rates by ensuring that our staff are highly trained and accountable by sharing and expecting timely data and using data to predict which complex cases might most likely which most likely will be subject to errors. We're taking a leadership role in the work with partners across the state to reform the waiver system to allow counties to support residents with disabilities in ways that are both sustainable and person- centered. An example is our participation in the long-term services and supports advisory council. We're concerned about the ways that changes to federally funded economic benefits will increase stress on families, increase risk risk for maltreatment, and increase the time untimely and out of home placement. We continue to work upstream to reduce trauma for families by leveraging state prevention grants to reduce risk and strengthen protective orders. We're phasing in new legislation aimed at preventing out of home out of place out of home placement and preserving families that are disproportionately represented in the child welfare system. Madam chair, commissioners, this concludes our prepared remarks. Thank you for your time and consideration today. We look forward to hearing your questions and sharing more with more with you about the work that we're doing. I'll turn it back to County Administrator Wentland to help start today's discussion. >> Madam Chair, commissioners, again, thank you Kareem. Thank you to the human services team. As you can see, a lot of hard work has been occurring um over the um this past year and significant headwinds that this team is preparing for moving forward in the current landscape for human services. And with that, Madam Chair, I'll hand it back to you. Yeah, kind of scary times right now. Commissioner Green, are you prepared to >> Yeah. Yeah, I can. >> I'll let you start us off. >> Um, um, just first of all, thank you so much. Um, there is so much amazing work summarized in these slides. It's it's, you know, this is the tip of the tip of the tip of the iceberg. So, I just want to thank everybody who's a part of this incredibly important work that is under duress. Um, I had two questions that I wanted to ask about. The first one was on slide 11. So, a narrative that I certainly have in my head is that state support is also dropping and or or like every year just getting less and less. Um, and it sounds like we're doing an amazing job of maximizing reimbursements, for example, and so on. And so that's great. Does is that making up for this sort of erosion in state support? >> Thank you, Commissioner Green. What [clears throat] I would say is that there's program costs that are increasing from the state and their support is decreasing. M >> what we are looking at is optimizing revenue that is not being impacted. So for instance our Medicaid um and utilizing forms of Medicaid that will increase our fee for service. So, so that answer that does answer my question, which is basically yes, the same money is is shrinking and we're doing what we can to control the parts that aren't shrinking, but yeah. Yes, Madam Chair, please. Commissioner Green, and as as Miss David identified, I think um what this budget is also preparing for is future state reduction in funding. it is not it is not solving for that yet. So the efforts that are being done in the Medicaid revenue growth where possible um will be challenging to offset the future state and federal cost shifts that include SNAP that you will hear more about. Um and it also includes the current work um around our reference in the disability council at the state level. There is still language and work there in regards to the funding gap and in that legislation. If they're not able to solve for the funding gap, the current language would reflect that shift back to counties and those are substantive dollar amounts. >> I think that maybe gets at the heart of some of my concerns. This budget looks great and I support it. Um, I don't I still feel like I don't have an understanding and I know people do of the cuts that we're seeing on the horizon and how we're anticipating them a little more specifically and and I'm not sure how that could be digested for me, but I would like a better understanding of that. Um [snorts] the other question that I had was >> Madam Chair, >> please go ahead if you want. >> Chair, Commissioner Green, I'll just say one thing uh we struggle with and I hate to use maybe a problematic term, but it feels appropriate. There are known unknowns. >> Um there are ways in which uh federal legislation impacts how state operate, how our states operate our safety net programs. It is going to be up to the the state government, the legislature and our state agencies to decide how they comply with those cuts and that impacts us. So we know changes are coming. We know requirements are coming. The specificity of them and our role in implementing them is what is the unknown. >> Yeah. >> So that's this budget does its best to approximate what we assume the impacts will be. But until the state acts uh the legislative branch and the executive branch, we won't have a we won't know the the specifics. >> It has to be a bit vague. Um I think my my second question is actually not a question. It's more sort of more of the same theme. So I was looking at slide nine or page nine slide 17 and just thinking like how much is [snorts] summarized in these challenges. Um, and I think I um I think all commissioners have been hearing from um food support agencies in the last couple days with enormous urgency and and I think of that as one body of the county's work. And I [clears throat] I I just I guess I'm not walking away from day feeling like I I know I I know our instincts are good. I know people are working hard on this. I don't feel like I am walking away knowing more than I did yesterday about like so what exactly are we doing where exactly are we sort of shoring up on known unknowns etc etc or unknown you know known unknowns and unknown unknowns um so I want to both ask for that information but also name it because the other thing is um as a commissioner there are few opportunities where I get to talk into a microphone unless I just do it sort of riffing on the deis where I just talk about the the fear and concern from the community the fear and concern I have on behalf of the community and this is one of them. So, thank you, >> Madam Chair. >> Please, >> Madam Chair, Commissioner Green, u just to provide a little context and maybe just um an overall response. There's I don't think any answer is going to be acceptable. The issue is unacceptable. >> Um we have uh approximately 440,000 motans receive SNAP benefits in Henipin County. There are 110,000 people individuals uh who receive SNAP benefits. there's a cascading impact of the federal shutdown on the way uh food security is addressed with funding. So there's SNAP which we [clears throat] have been struggling with the impact of the federal shutdown operationalizing what was about a 3 or 4 day period of confusion where we were told that applications were going to be shut off at 10 p.m. for two separate days and it wasn't thankfully. So, our staff was able to marshall and thanks to uh the leadership in human services and I want to call out uh Reggie Wagner and Sarah Holly in particular uh directors of economic supports and public health for helping marshall that. We had an operational response. I I'll just kind of categorize two buckets of response. We have there's an operational response and then there's a strategy based response. And operations um we've got SNAP that is getting cut off effectively November 1st. The women, infants, and children uh food supports program is next up. Um if increases don't um escalate aggressively, the state likely has about a month worth of funding left. So we might get through November. If demand increases, it will run out. So we're looking at roughly about Thanksgiving for WIC. And then the MIP uh cash portion will last roughly through the end of the year. And so we have this cascade of safety net funding s federal safety net funding programs that are ending in succession uh in the last two months of the year. Um operationally we've uh director Harley may get upset when I say this but we've stood up a mini version of incident command um and we've had almost daily meetings uh of our staff. So when we when it came to rallying staff to get to those 10 p.m. deadlines, um we were calling staff from various parts of human services and across economic supports to process applications to get into that 10 p.m. deadline. We had to do that for a succession of days. Um with WIC we are looking at where staff can be reallocated from other parts of human services to address what we expect are going to be an increased number of demand for those services uh for those applications uh processing. Uh WIC has very specific uh requirements in the application process. So we can't just do that over the phone. Those they're required to be in person and there needs to be discretion and privacy. So, we couldn't just have everybody just show up on the PSL and get an application filed. So, uh public health is working with facilities to identify appropriate venues and county owned facilities across the county to in anticipation of increased demand. Um, and we're reallocating staff uh based upon uh uh availability of staff to address the application need there. um MIP, goodness gracious, if if the federal government reopens, we likely wouldn't have that crisis at the end of the year, but that is right on the end. Um and so I that's the operational response. I also want to highlight that we've had I believe it's at least two, I believe it might be three separate um I call them emergency calls. These are ones at like 8:00 at night. um uh Department of Children, Youth and Families Commissioner, Tikki Brown has convened those along with um Aaron Bailey who's the assistant commissioner for the children's cabinet. Um they've invited staff from DHS, DCYF, u I believe NBH has been on in Minute. We've been real time processing some of the challenges we're facing. Um we have we're the only state with a specific waiver that allows us to co-mingle the SNAP cash benefit with MIP. We needed to detect there's an IT system. It is Maxis. Those of you who seen the black screen, the DOS, I think it's it's either cobalt or for train. And um some of you might be >> old enough to remember when that was brand new, but I was um that needed to be we needed an IT solution. the state needed an IT solution in order to uh detangle those so that we can maintain the MIP cash benefit assuming the federal government doesn't reopen and we're at November 1st so that there can at least be a benefit uh provided to beneficiaries uh for MIT cash. So those are the operational pieces on the strategy. We have been meeting almost I said we've been meeting almost daily. We have uh thank you um interim assistant county administrator um David is is here um she's been providing some light on uh I said incident command our financial structure um I mentioned that cascading impact of snapwick and mphib um with for uh just repeating myself on the operations side um on strategy we are trying to leverage those partnerships uh with the state government with the government with uh DCF with human services and with the governor's office. Um there's some discretion we hope that they might be able to um exert around addressing unmet need. Um thank you commissioner Eden for sharing with us information >> fiercely that yes >> she shared information from California. Governor Nuome has called up the National Guard and allocated $80 million. It's 80 million in California. So I just want to be mindful that's like >> [laughter] >> $5 here >> um uh for emergency food assistance. So we are prepared to make these requests. What I want to emphasize to you is what we don't want to do is go back with a series of one-off requests to the state. It's taken us some time to understand exactly what the impact on Minnesota that SNAP, WIC, and MIP are going to have so that we have a comprehensive request and rather than going back with a hey, we need a fix on SNAP now. Oh, we can you do wick now and please tell me you're worried about MIP. Um, so we expect to have an aggressive policy response. I want to call out our partners, I believe, in the room from intergovernmental relations. They're going to be guiding us about what specific ask we need to make and what type of ecosystem of support we'll need from the legislative branch on that as well. Um, and then finally on funding, we are addressing what capacity we may have to meet some immediate needs right now. Um, when I mention the known unknowns, um, we want to be mindful as we advise you on what financial opportunities or financial um, [clears throat] discretion we may have to address immediate needs, but be mindful of cuts and cost shifts that we truly believe are going to be happening in calendar 2026. So, we want to be mindful as we advise you as you make policy that you're aware of trying to solve for right now when we know that there's going to be a title wave just coming in a few a few months. So, I wanted to give you just a flavor of the operational response, the level of strategy that's um uh weaving into this and um to let you know we we we hear you very clearly. We have been also been hearing from uh food security providers um and safety net providers and community directly and we're we're assessing what is possible, what's appropriate and where we need the state to pick up. Um and if you might indulge me just one more moment and just kind of putting on my old hat. Um, I was coached very early on in my time here at Henipin is when we solve for someone else's problem, we teach them that they can dump the problem on us when the pro when it the responsibility is primarily on one of our other governmental partners. So, we want to be mindful as we as you all direct us to meet immediate needs that we're just mindful of how we may be training our partners. >> Thank you so much. That was really informative and I think it really spoke to the information I was looking for um in terms of just a deeper understanding and how we're responding and and what isn't known. And I appreciate that in the same way that you outlined how we don't want to go to the to to the state specifically with one-off requests, you're also sort of doing that environmental understanding for us as well so that it's also not a bunch of one-offs. Um, and maybe I'll leave it at that for now, but I'm just really grateful for this additional conversation. >> We have a lot of commissioners to get through. >> Commissioner Fernando. >> Oh, thank you, Madam Chair. [sighs] Um, I really appreciated the slides uh 11 and 12 for the kind of multi-year picture. I am just I'm very very proud of the work that human services and public health does. the the outcomes, the diligence, the methods, the partnership. O particularly over the last handful of years, we have really [clears throat] driven and set a vision for community response that is multifaceted, moral, uh compliant. I I'm I'm so so so proud. Um and I appreciate how diplomatic you can speak today. I'm quite sad and angry at uh the context we find ourselves in. So, um these two slides were very helpful 11 and 12 to So, I just have a few things I'll I'll bring up. Um I remember when you all kept performing better than budget. I know that there were some infusions and whatnot, but I just I the the diligence there. Uh thank you. And we need to clearly keep that up to to clarify where the 90 million come is shown in the in the orange bar then in the admin bar where does where does fund balance show for slide 11. >> So [clears throat] for slide 11 it is the red I'm sorry it's not on slide 11. >> It's on 12. I'm sorry. >> Right. But where does it show? Right. Because fund bal use of fund balance is considered a revenue or is it not? That's what I'm trying to get at. Yeah. So fund balance is that red line. So you can see that our proposed budget for 2026 leaves us at 90 million. Yes. And >> the use of 60 million shows up where on the on the bar chart >> right underneath that >> Betsy. Oh, I'm sorry. Is it the 60 million is that included in the light blue and this one as property when when >> Yeah. Is it property tax or is it >> when you're this one that shows what the revenues is to the budget? Yeah. Where does the 60 million sit in that color? >> I mean the 60 million fund balances use is in your expenses. So it's in your overall expenses. Your fund balance is not shown in the revenue. This is just pure what the revenue is going to be. It's not that your fund balance use is not showing up there. >> Interesting. I'll have to >> take out my tea accounts next to these eight tracks and maxes. Okay. I'm back. I'm back. You like that tea account joke? Wow. That's really >> getting me somewhere. Okay. [laughter] >> Yeah. Okay. >> Focusing 78. >> So, you could theoretically the 319 or 300 Yeah. 19 million of property tax that's in that light blue if you add in the fund balance use. >> Uhhuh. >> That would be total use of property tax, so to speak. that that's what I was I'm I'm trying to get the source and you'll hear where I'm getting at cuz on the budget book front on on page 17 I was kind of with I'm sure all of us looked at the amount changes from federal state and and local right so I'm interested in in in this elongated view around the revenues with federal and state and then like I said yesterday with our local jurisdiction CIP or the other day um I'm I'm I'm nervous for all of human services I mean We all know that human services across the state if we are feeling like like this if I am feeling like this then I can't quite imagine what is occurring in the other 86 counties and specifically our rural partners and I say this because of uh from a legislative advocacy perspective um we shouldn't uh solve other people's authorities too quickly. I've been provided that feedback as well and I just can't quite um stand good outcomes that we've achieved that you all have achieved being for any reason not funded in future years or for any reason not being expanded to other counties as those county boards and those county administrators um deem fit. So, I'm I'm interested in the the ma the the overall arc and then the math now because maybe there is a way in 2026 for all counties to come together um and at least attempt to establish a revenue source to fund these important essential mandated notf funded services. Uh and this isn't for me this isn't like a a blame situation. It's just we have to find the math. what is the true math and if for some reason like I don't believe that the state um re reimbures us for that tower for example um all the time maybe there are other ways by which we can tea account with the state because there is money being exchanged between our organizations and we are all better off when we center the most marginalized and seek to ensure that the services that are proven to work um remain funded and operating. Uh so it's mine is about the highlevel math and really making sure we are compelling and succinct with what we are requesting for by way of partnership. Um second thing that I'll say is um two more things. one just on page 19. 430B. It says 403B on top. No worries. Um, but is it 430B or is it 403B? >> It's 340B. >> 340B. Oh my gosh. Well, there's a bunch of numbers. Okay. Is it 340? So, it's 340B >> for the pharmacy. >> Mhm. >> Yeah. >> Okay. So, page 19, there's um just a couple typos on them then. But I'm I'm I'm interested in a deeper dive on this portion too. um who utilizes this particular statutory authority in what ways? If this is this um this is also an area um in our hospital system and North Point and any like this is a swing. This is one of those numbers colleagues that it'll hit us two or three times >> because pharmaceuticals are generally an area of high revenue for any clinician clinical setting. And so if there's rate like this is just this is one of those measures that is not just the number there is a there's a potential multiplying effect. So I don't need answers on that now but I wanted to flag that. And then um with respect to food and healthy food this is slide 14. Of course, we've all we're all hearing from everybody with respect to the current context and it's the decimation of public good is just completely disgusting and aberant what's happening right now. Um so with respect to food and I'm usually try to be you know upbeat [laughter] or encouraging and it really is not a reflection of of everyone's performance here. I'm very very proud of the work that you do and the and the work that we do. It is just so heartbreaking. Um so with food we have been creative with and and and have sought to embed dignity with North Point with funding providers funding providers even when the state and others told us to not fund food providers. Um and so I will just try to get even more creative. Uh we I authored that North Minneapolis food desert because we had no grocery. Um, I said this before. I know that uh folks on the deis don't all think this is a good idea necessarily. I don't think we need to own a municipal grocery store. Okay, I know that's not what I'm saying. I'm not saying that. But we we do need to increase creativity here. If SNAP economic assistance for the purpose of food, right? If that is taken away, one aspect is funding and one aspect is how are what grocery stores are we partnering with? what what discount rate, what card, what I mean, what what are we instituting? Now, I'm of course a bit biased because we know that all the grocery stores departed North Minneapolis and District 1 pretty close to one another, but you know, North Market, for example, like we um what would it look like for if we made our food shelf a little bit more groceryike? How can we make grocery stores slightly more affordable in this particular moment where government assistance has disappeared and free market with respect to grocery stores in areas of high concentrations of poverty do not enter? And I think that's all I can muster. Thanks, Madam Chair. >> Any comments? >> Madam Chair, Commissioner Fernando, I uh thank you very much for those comments. I will tell you um uh our incident command like structure uh met just this morning. They met yesterday. These are the exact type of ideas that we are assessing right now, their viability, how quickly they might be turned on. Um and if with your permission, I would like to invite Director Holly up if you care to just give a quick report out about where we are on some of the specifics here. >> Good morning everyone. Madam Chair, commissioners. So, oh yes, Sarah Holly, public health director here for the last [clears throat] 16 months. Whoa. Already? >> Yes. Been that long? [laughter] >> Thank you. Thank you for the opportunity. Um, so this past July, public health and human services stood up a federal impact response planning team due to Congress passing sweeping Medicaid and SNAP funding changes to mitigate the impacts on Henipin County and its residents and to respond through central coordination and to streamline efforts and share information. We have representatives from public health, human services, economic supports, North Point, HHS, Henipin Health, IGR, finance, data and evaluation, and communications. And I would also say the county attorney's office when we need them, right? >> Yes. Kind of does, but um Deputy County Administrator Murphy um is the sponsor of this effort with Bobby Jackson, Reggie Wagner, and myself co-leading this effort. um and project managers um who are supporting this. Lang Yang from public health and Maddie Johnson from internal services. Because we are mobilized to respond long term, we have been able to pivot to recent federal shutdown um initiatives that are happening here at the state and federal level. Um and very recently the impacts of SNAP, MIB, and WICK. So, we're utilizing this response and mitigation structure to best meet the needs of our residents during a very challenging time. not necessarily calling it ICS. >> Thank you. >> Thank you, Madam Chair. Commissioner Fernando, thank you. And I I know um Director Holly sat down. The other thing, you know, not only is there this right now an immediate response, and I think that's part of the challenge is we have an immediate crisis that our team is working on. There is also some actually phenomenal long-term work under the health disparity domain around exactly what you're talking about. What if how do food shelves look more groceryike? How do we create grocery and and access to food across the county? And so I think we can follow more with the work that's been happening that sits across lines of business. So it includes partners in housing and economic development. It includes our public health and human services and with the changing in our landscape, this work and the urgency um that you're indicating I think is even greater. >> Thank you. Thank you, [clears throat] Commissioner Conley. >> Certainly. Thank you, Madam Chair, and thanks to to everyone who had a hand in putting together this budget. This is uh I always look forward to this one, but all of them. Uh this one I'm most worried about. As you've heard, we're just we're all very much worried about this. I am a big fan of I'll call it the mitigation squad. [laughter] Um you know, >> so nice. >> We need to keep that even with the known unknowns and the unknowns since that's the word of the day, right? we need to keep this group of folks together meeting regularly until we know what those unknowns are right now in 2026. Um, one of the things that really stood out to me uh as solid as I think this budget is given w given with what we don't know is the FTEEs and the staff. Uh, I was going to ask about what a healthy fund balance looks like. I know when we came in in 2019, there was a lot of concern about fund balance use. Then we mitigated that. It continued to rise and now we're at a level that's not sustainable and it's for the next I think I heard 2028. Uh so I will ask about what healthy might look like. In the interim though, um I want I'm I stopped on page 15 of the budget booklet, which is uh human services has implemented an FTE strategy that allows for utilizing attrition using data to review service area staffing needs against service demand at the department level um with a with a reduction of FTEES. But that to me, help me not make that because to me that sounds like a contradiction because of additional SNAP requirements, additional Medicaid, additional reporting requirements, work requirements, things that the federal government decided vulnerable people, vulnerable people need to do, poor people need to do, right? Um things that we know aren't necessary. Um, so because of this attack on our residents from the federal government, um, I don't know that holding FTEES and not filling them is something that I need that to settle better with me. So, please help me understand better. >> Madam, please, Commissioner Con. Thank you. I'm going to start and I'm going to look to um, our CFO um, Joe Matthews. So, I think and just a credit to the work. So, one of the things and I'll look to Betsy as well if I am so feel free to assist. So, one of the things that human services um and public health have done really well is actually position we call it position management. It's actually being modeled countywide in it. And so in looking as Betsy indicated, one of the strategies to slow down our budget growth or manage because that's the crisis is if we would have not have done that, this budget would have been in a really challenging situation with a lot of unknowns of what's coming. So how do we prepare? However, within that by doing it with through attrition really trying to protect where volume needs were. So a lot of tools and thoughtful allocation and so when there have been needs even within this budget allocations of staff are provided. So for an example SNAP and some of those pressure points it is not when I say that I mean this is still a significant reduction in FTEES. So, it is not a perfect answer, but amazing work in watching where resident needs are and adjusting this work, and I'll let Joe talk about it, is expanding countywide. And so, as a county, we need to be more nimble around capability about where we're allocating workforce, where we see the pressure points coming. So, would you take that? >> Yeah. Um, thank you for that. U Madam Chair and Commissioner Connley, I think um a theme of this budget overall and I think you've all experienced it through the prior budget hearings has really been a balance of uh our mission, vision, and values and the resources that we have available and how do we line those up without compromising the core of our services. So overall, the 2026 budget has a reduction of about 250 positions. If you were to put a dollar figure on that, that's about $25 million. that would have been additional property tax levy to fund that. Betsy's team and the whole team and human services have been leaders as um as administrator wetland called out. They have done a phenomenal job not just this year, not just last year, but this has been a multi-year effort to really become nimble and frankly uh very diligent at just making sure every time we hire a position, we're trying to bring it in where it's most needed. We are bringing that same spirit countywide. Um there's a similar I think conversation that's playing out within every department on a different scale. Keep in mind human services is 40% of our workforce. So it's a huge number. They have more flexibility um just through that attrition to try to move positions around. But there are limitations to that. And so I think the other piece that this ties into around the fund balance um sometimes you'll hear local governments refer to those as their rainy day fund. It is certainly raining and um you know I also want to highlight something on that chart that shows the revenues. You'll notice um when we go through the years with the green lines, the pandemic funds, this board um and your predecessors uh really did a good job of helping us position to ride through that pandemic. And you'll notice that we don't fall off the cliff. I just want to celebrate that one last time. Um, this is about transitioning into sustainability. The headwinds when we adopted the 2025 budget, we did not expect this level of disruption regardless of election outcomes. This was not anticipated. And so, um, it is a regular conversation with myself, with Betsy, and with her team, as well as administrator Wentland and the deputies. We are trying to make sure that we're being very thoughtful on how we spend our fund balance, and we can't go back over and over to that. Well, and so I hope that wasn't a roundabout answer to your question, but we really have tried to prioritize how much property tax do we think we can responsibly recommend? How much fund balance can we use? What can we support? And then on the FTE side, we I think started this budget process and I'll look for a head nod from both Betsy and Jod. We did not want a budget that we thought would compromise our ability to deliver core services. So this is not easy I think for the public and for taxpayers to understand even with this levy. There are a lot of reductions that departments are making or efficiencies are trying to gain and uh we're doing that in a way that we believe will sustain services but of course it does add risk as there state or federal reductions. >> Madam chair commissioner thank [clears throat] you Joe. I think one of the additional things I'd like to add around this budget in here is this budget is kind of two parts. This budget is staffing which is a significant proportion and then the other portion is our contracts. It's through our public aid. When human services looked knowing the headwinds that are coming and those were better looking headwinds than we have today on it, we human services looked at both sides and what we saw with the public aid was two parts. Majority of the public aid funds are funding for our community partners to do the work that if they didn't do it, we would do mandated by statute to do it. So that is a good majority of the funding. So when you remove that, the funding that was at risk would be funding that provides food that we did not cut and critically needs especially in times of what's happening right now. it is providing the prevent it's actually housing and homelessness. None of that is mandatory services and yet we know that is the right thing to do. So this budget reflects protection of what um Joe's indicated. It is the core safety net for our community as best as they can in it and kept all of those programming and funding stable. So the two levers that this team is working so hard to do is increase revenue where they can as hard as possible, manage staffing growth as best as they can and allocate staffing and they have phenomenal tools to do that where the pressure points are. This is not a um I always call it fun fun budget green but this is not this is a challenging budget. It has been heartbreaking work that this group has done with the core. It is about the residents every moment. So they're giving you the best they can and yes it is a reduction in a significant workforce for us to deliver what we think we can today in the current con context. So, Madame Chair, let me be very clear that I understand and appreciate that and thank all the staff that worked on this and the staff who do the work on the ground every single day, right? And um are and who who are being flexible to move around to where we may need them to go. Like that's the big right. So, that is not lost on me. In fact, in the back of this booklet, looking through all of the contracts that we kept whole, >> I put exclamation points and highlighted those. So, thank you for that. I I that this is not lost on me that because our federal government chose to attack our people, we have been made to make really tough decisions. So, that that piece isn't lost on me at all. And I know, Madam Chair, we've got other commissioners to get to, but let me finish up with page 18. Um I just want clarity around the other financing sources. Talks about the housing emergency rental assistance 247 shelter and family overflow shelter ending in 2027. I'm going to assume that's ending from this budget but not ending entirely. So just clarifi clarifying that for me would be >> please. >> Oh thanks madam chair. Um, so under the other financing, what you're seeing is an itemization of uh funding that we used out of our local affordable housing aid in 2026. Okay. >> The family shelter overflow, the reason why that is saying ends 2027 is that the anticipated need from this particular revenue source >> is not going to be ongoing. >> So the program is not ending. I want to be very clear. Um, but we saw a higher need in 2026 than what we're projecting for 2027. And so we're just trying to be transparent with you and the public that the LAA funding for that particular need we plan to allocate in 26. We don't currently have plans to extend that into 27 because we're not seeing that need. That could obviously be revisited next year when we do the 27 budget, but that's our current >> intention. >> Thank you. Thank you. >> Okay, Commissioner Anderson. >> Thank you, Madam Chair. I you know I'm going to express similar um frustration around seeing reductions in the human services you know through attrition and the whole bit. I understand the need and also express the gratitude that of the hard work that it took to get us here. Um, you know, we had a budget hearing yesterday, um, where we heard about libraries and the other pieces of what we do that were largely held, um, and to see cuts in this hurts. And so I just want to acknowledge the pain that that that brings, right? Um, on slide nine, you know, that's the whole the staff reduction piece of it. I'm curious if it would be possible to get information of in which areas were uh targeting those holds and to what extent those positions are providing mandated services or if they are providing um like our value ad service because I I mean everything that we do is valuable um And but I would like to get a better handle of how much we are targeting these reductions in things that are optional from a like a statutory standpoint. Um versus what are mandated services for us. Um and I think that kind of goes across our budget books. I would love to see um like where it is that we're holding positions. How like are these positions deemed mandated through statute or not? Um we know about the November uh [snorts] deadline on SNAP. Um you mentioned wick and mip kind of cascading. Do you have an idea of the numbers of impact, the numbers of people impacted in those uh like how many more people are going to be impacted at in Thanksgiving and then how many more people are going to be impacted at the end of the year? Um, do you have that information now? And if not, happy to receive that later. But >> please, >> commissioner, I invite Reggie Wagner up, our director of economic supports to respond to that. >> Welcome Rachel. [clears throat] >> Yes, please. >> And if I could add on while you're looking at that, the dollar amounts that that are attached >> uh with that. >> Um, sure. Thank you, Madam Chair, Commissioner. Uh, Reggie Wagner, director for economic supports. So the um uh immediate what we call our our SNAP standalone food assistance is about 92,000 uh current active uh individuals. Uh it's also an area where we've had a lot of growth week over week in applications in the last three years that has not subsided at all. So that's active open cases and that's who we are most concerned being impacted by the um interruption possibly uh of the SNAP uh benefits. Just want to clarify that the um SNAP benefits are paid out uh kind of in a staggered over November 4th to the 13th. Every state has a slightly different payment distribution. So while we're concerned about November, it would hit on a staggered family basis from 9 to 14. That's how the the SNAP payments are um kind of provided through that EBT transfer. So, just to clarify a little bit what November 1 means versus November 4 to 13 as we hope that there's a resolution. Then the other uh area is our um and that's 100% federally funded. Changes down the road maybe uh with the recent changes from that HR1 federal legislation, but right now all of those SNAP benefits to families are federally funded with the Minnesota Family Investment Program. That's a um our main tanniff, temporary needy assistance uh fund. That's a block grant that comes to the states. So the way in which we get the funding uh can also mean that uh recipients are impacted in different ways. So SNAP is sort of every month. It's through that EBT transfer. It's very immediate. That's one reason why we're talking mostly about SNAP right now. with the Minnesota Family Investment Program for here in Henipin County. We have about uh 6,900 current families that are on that and that's about um I believe 19,000 individuals, right? When we count all the household members, they receive as uh our deputy administrator uh Mr. Murphy said the um kind of combined MIP cashing uh food portion. So if the year there is an interruption of the November SNAP, then those um 11,000 MIP families will not get the food support amount. The cash and we're so grateful that our state was able to come up with a systems fix to it. The cash right now will not be impacted and that generally gets paid to a family on the last day of the month or the first day. So right now we expect all of the families to get their M5 cash. The impact as the year goes on with the TANF program can be um uh uh a little bit um even less certain because we have a braided state uh funding stream with that TANF block grant. Okay. A state has what's called a maintenance of effort. State also has a TANF reserve, a fund balance. I don't know the exact number of it, but they generally have that. And so there um may be levers in which our state, if this shutdown were to persist, uh may be able to um look at what funding they were pre-authorized as part of that block grant and then also what flexibilities they may have because of fund balance or state use. So there's just a few more levers perhaps if this really were to persist to late in the year. Um, and again, SNAP does not have that sort of braided funding stream in those potential levers. Um, and then for WIC, I don't know if that's director Holly would have more of uh of those numbers. Thanks, Director Wiser. Madam Chair, commissioners, sorry for that echo. Um, [clears throat] so currently our case load for Henipin County Wick is around 13,000 individuals. um as many as 10,600 children 0 to 5 are SNAP enrolles eligible for WIC but are not currently enrolled. So if that gives you kind of a number of the individual families that could be eligible that are eligible that are SNAP recipients that could be eligible for WIC. Um this is a very high estimate as we do not have data on WIC participants who receive WIC through Bloomington, Edina and Richfield because they have their own local public health departments. um even with this high estimate capacity for Henipin County Wick would be would reach very rapidly. So we'd reach kind of our capacity very quickly based on those numbers. Um MDH Wick has stated that they anticipate WIC benefits through mid November as of um October 20th, 2025. Um I want to mention that um while there is not been mention of a cap in funding for WIC benefits um if we have see an increase in WIC participants the redemption period could increase the level or could decrease the level of funding that's available to participants here in Hen County and throughout the state. I also want to briefly mention that you know our annual WIC grant which is funded through the USDA via um MDH we receive annually about 4.4 4 million from MDH and an average of 372,000 a month for operating costs. So that includes WIC staff salaries, um supplies, equipment, communication, interpretation for our residents, travel, and other expenses. Um, just to give you kind of a um, taste for what um, the redemption looked like in September of this year, we had about 15,738 participants who redeemed around 1.1 million in food benefits total for that month. On average, um, we're looking at about $87 for the month, but around $91.50 50 cents average for that month if we exclude those that did not redeem any benefits even though they were issued. >> So, sorry, it looks like >> I'm sorry, Madam Chair. Commissioner Anderson, just a little bit on the on the average payment size uh for some of our SNAP and MIP. So on average, it's about $18 million per month that would go to our Henipin residents. That's based on all we paid out in 2024. The average household payment is about $287 across our SNAP. And so that's families as well as up to our seniors. Um so it can vary for lots of reasons. That's the average payment um for the uh uh MIB cash grant that families uh rely on. Um, again, it can vary based upon household size, but the average SNAP grant is $585 a month. So, um, so that puts just a little bit of what the what the impact is. Uh, nationally, the way they talk about the the WIC versus the SNAP on the national numbers for the federal budget, it's about 300 million for the WIC program and it's 8 billion for the SNAP program as an annual budget. So, um, so again, wick is is vital and knowing that there are so many children on SNAP that are just not on MIP and that that gap in and funding. I mean, these are both critical. They serve different needs in different populations. But, um, I think that's why we know we're most concerned about about SNAP and the impact across our communities. >> Thank you. So, I mean, kind of assuming, I don't want to say assuming, but absent levers being pulled, uh, per family that is receiving benefits, they're looking at losing, uh, $580 a month at kind of a a high end if they were receiving uh, the full MFIT or kind of an the average MIB kind of full braided funding for that MIB SNAP braided together. Um, and then there's $87 a month that would be per WIC family uh or family receiving assistance through the WIC grant. I mean, a these are for families who need it. They are lifech changing and I would dare say they are still insufficient in today's market. You know we have increasing food costs, we have increasing housing costs, we have everything is more difficult [clears throat] and everything about this is punishing those people who are at the bottom end of the spectrum who are least able to afford it. Um, and I'm gonna try to not be ad. Um, >> yeah, thanks. Um, but it it strikes me like I would I would really love to see I mean before [clears throat] these changes have gone into effect. I know I have gone out to the food shelf in Rogers, Minnesota that is on the border of you know Wright and Sherburn counties and serve kind of shared rural populations and the line of people waiting to get in at that location stretches around the corner. There are no parking spots open for people in need lining up. At the end of this month, that line is going to get longer. At the end of next month, it is going to get longer. At the end of the year, it is going to get longer. And I know it is not the county's individual responsibility to solve this problem. And by the numbers, I mean, we would have to shutter every library um to try to do this. Um like I don't think that's an acceptable solution for us. Um but I, you know, sorry. All right, I've expressed myself. Thanks. I think >> we're all frustrated. Great job. Um, and then just to resident services, my apologies. Yesterday I was a little on fire about this, so I couldn't even ask a question. Um, so thank you for all you did yesterday as well. Um, on this uh, a few things. Um, human services is why I ran for office. It's what you know my mom is a person that lives with a disability. She all of the things that kind of intertwined between my life um you know becoming a guardian child protection all of those things trying to keep family food shelves are actually much better than they were when I was growing up let me tell you. Um so and we have made them more like grocery stores thank goodness because they were terrible before. But I want to talk about SNAP and then actually Raina can you pass away? I um I have every uh Henipin County uh food shelf has already written a letter and I wouldn't be passing it out. I just want to make sure that everybody has a copy of it. They were supposed to be sending it this morning. Um so I just would say it's unfortunate that this is happening right now because I think it's taking from the important work that human services is doing which is is is never valued like it should be. um whether it's waivers and waiverss reimagined and the idea of that is really good but people might not get as much uh funding but SNAP benefits right now um I just emailed Patrick Tannis which is the governor's chief of staff with you uh Jod and Cream because right now it's in my mind if you know we're in the business of the people the whole reason we do a county operates in my mind is to help people that have the least and how do we make sure that we're fighting for them and right now I feel like we have to armor up and uh to Liz I see you in the back like we need to push the state because if we're not going to stop I like if they're not going to give money then I'm sorry like I propose that we stop playground grants or something. So unfortunately um you there's if kids are hungry they're not wanting to play on a playground. So, I just think that we honestly uh it's very unfortunate we have the federal government. We do. And I think the crisis moment that we're in is by design. I mean, the reality is is what I think this overarching theme is is let's push people back to relying on religious institutions to get their food. We have we have made it more we put more integrity in that. I mean, the reality is as a county, we have to figure out what what do we stand for in these moments and we have to fight. And I would say honestly, like every one of us should be emailing our lawmakers right after this meeting and saying, Commissioner Brown, Governor, what are you going to do? $80 million might not be anything, but Colorado is also injecting some money. We need to hear something from the governor, and we need to hear it this week. and hopefully it will be resolved, but I talked to my friend, Congresswoman Morrison, and she has no indication on when it will end. And I get why they're fighting for it because people will lose their healthcare. So, the idea of where we're in in this moment um is really challenging and I I think it throws all of us off because we're trying to fight fires everywhere. And um and I would I would just say I I would also uh Reggie Wagner, it's really good to meet you. I want to see us invest in in how we can um help emergency um your area uh and making sure that we have some technology because if we don't have people and if we're going to take people away then how can we tech I like honestly want to see a workg group that can help with the services that people are coming here for and I would love to see an investment. I want to see that in capital investments. Um commissioner you asked if I have any amendments. That's one of the amendments that I would like to see um that that we figure out how we can do better at economic supports and figuring out if there's AI or whatever it is to inject to help because it is growing. And then I want to know on work requirements right now those are actually starting to take place is my understanding. If you could just give us an update because while we're responding to the emergency need of of what the government shutdown is we're not even talking about the work requirements by the way work requirements are going to kick more people to a food shelf as well. And then we actually are cutting I mean it's not much it's just 26,000 but I saw in the back here in our food insecurity there was 26,000 negative reduction. It's at the back. I just want to make sure and kind curious as to what that is and why. But if you want to talk about the SNAP requirements and then if we could talk about the 26,000 and then I'll be done. >> Please chair. >> Yeah. What page were you referring to? >> I'm going to find it right now. Oh, I saw it at the back here. It's uh page 25. It said 2025 adjusted budget 2026 proposed budget 4 million. Before it was 4,26,000. So if we Reggie, if you just want to um give me an idea of how work requirements are going and what we project, if we have any projections in terms of how many people will be impacted by that, that would be great. >> Yes. U Thank you, uh Madame Chair, Commissioner. Um, so yes. So what you're referring to now is part of that reconciliation bill that passed over the summer that um, uh, made a range of changes to the SNAP program in particular. So a couple of things. One, just to be clear, SNAP always had a work requirement to it >> and and had exemptions uh, from the work requirement for different populations. And so, uh, what they've done now through the changes in this, uh, federal federal HR1, the bill is, um, expanded to certain new populations that they now have to meet the work requirements. Um, so the populations that, um, are sort of the the key ones in the final bill were uh, families with a child uh, with a child over 14. So, 14 to 17. So, different versions of the bill had even younger kids. So the I guess the good news is is it's older older children. So that narrows the the number. We think that in um our uh case load maybe about,00 families that might be impacted. So not necessarily each you know each month as we review their um their SNAP eligibility but throughout the year uh that's our best estimate right now uh of what we have. The other big group that uh is impacted is um they've changed the uh work requirement age from uh capping at 54. So it's now from 55 to 64. >> Was it 65, isn't it? >> Uh well, I think once you turn 65, then you're no longer. So it's under 65. And and Yep. So that is uh a group. We're still reading a little bit of the federal um guidelines, but the point is is that uh the federal government futition service has made clear uh USDA that oversees this program that these requirements are in effect as of November 1st. Okay. So, uh I think a lot of states thought there would be more consistent um uh implementation guidance and timelines and technical assistance as has happened in the past when large policy changes were made. And quite honestly, I think they they just weren't and the feds are very clear that it's November 1st. So, um we uh we have SNAP is one of our largest applications that comes in on a weekly basis, probably um I think about 5,000 a month minimum uh that we seem to get for applications. So, on November 1, we will begin reviewing for anybody that fits that family and that older uh eligibility uh as part of the initial SNAP eligibility requirement. if uh they're not meeting the work requirements. And that can be uh up to 80 hours of work in a month. It could be a certain dollar amount. So perhaps depending on the job, you might not have to do the 80 hours if you're at, you know, $20 an hour, let's say, versus minimum wage, right? Um and so, uh and it could be through, uh some type of education. It's a little bit harder for the typical college student to qualify, but there's some ability. Um and it could be through volunteering or a combination. So, if somebody's meeting it already, great. they'll be on SNAP and they as long as they're meeting it at the time of renewal, their months won't count. If they're not meeting it, then they will be limited to three months of SNAP in a 36-month period. That's what we call our time limited recipient. Nationally, it's called that funky Abod adult bodies without a able adult without children. Sorry, we don't use that anymore and that's why. All right, it's time limited. So, um I know I can't even say it now. It's terrible. So the so the bottom line is we have to roll those out. We'll be doing it um as families come up for renewal. Uh we've been partnering really closely with our uh workforce development team that oversees our SNAP employment and training providers to be prepared for this to make referrals to our community-based providers so that if somebody is not meeting them and uh wants to participate in career advancement training, there are going to be many um opportunities. So we have a lot that we've been doing to get ready for that. But it will uh impact we think the group that is um uh in that older population is about 5,000 um households. >> Please go ahead. >> Madam Chair, Commissioner, um I'll invite Blaine up to respond to your IT question. And while he's making his way up, I just wanted to comment the difference of the 26,000 that was a one-time allocation that was designed uh to ensure that some targeted food shelves could function and look more like a regular grocery store. So that was a onetime >> okay >> um operational cost. So that wasn't a there's no reduction in any of the FTEs. That was a competitive process. So the four million remains of four million. >> Thank you. >> In the post budget. >> Good to know. That's great. >> Madame Chair, Commissioner Edson, my name is Blaine Robertson. I'm the business information officer for Health and Human Services. You were talking about what are we doing in IT? Well, when I got back to our department because I was here for a long time, then I went to central IT. When I got back, I was in same conversations I was in before I left. Oops. Sorry about that. So, I asked if I could start doing proof of concepts. So, that's what we're doing. We're working with the state of Minnesota, but we're working on applications that nobody else is doing. And one of the big ones because Commissioner Connley mentioned Maxis, we're actually putting a web front end on top of Maxis and creating creating screens where would which includes multiple Maxis screens together. >> So we we're we we just we just implemented it. Um not I should say we put it into test production to to see if we can get it working. So that's that's where we are right now. But we also did proof of concept with the direct care and treatment. We also did proof of concepts with um uh uh the data and data warehouse. Um our I Henipin County views that we've had for multiple years are now being rolled out to the rest of the state of Minnesota and now they're calling them I county views instead of I Henipin views. So these are things that we are working on because we were we just weren't getting anywhere. So that's why we started doing that. Madam Chair, just one quick followup. So I think that's great. I mean, Maxis is Yeah, I I was at the state we're I mean, the reality is and with what the state is facing right now, we're not going to wish our way out of it, right? It's they are facing economic uncertainty as well. So I what you're talking about is what's internal and I think that's helpful, but what about what like what people are seeing and then also people right now are still Reggie, you know this, people are still waiting on lines. They're getting calls that are dropped. We're getting calls from um people that were providers um saying that they're still struggling to get through. There has to be more innovation in this space. I want to see us invest something that will actually really be transformative and and I just What are you thinking about in terms of that? >> So, Madam Chair, Commissioner Ason, um there are multiple projects going on right now trying to alleviate some of those weights. Um but we have looked at different technology especially in the phones and the um um online application stuff. What happens what happens when people fill out a min benefits application? It takes them like 10 minutes to finish it to fill it out which is great for the resident. It's great but that is replacing an application process when somebody came into the office that took them two hours to fill out. So they knew right away if they were going to be able to be approved or denied. That those are things that um it's great for the resident. I understand. I would I would love to fill out a 10-minute application, but if they were disqualified, it was a waste of 10 minutes. >> Well, but that's it, Madam Chair. That's it. So, they're they're applying for things. They don't know what they actually qualify for first. So, then our rejection rate looks high and and and so it's not working for residents. It's also not working for and it's not your fault. I want to be very clear and it's not any of the staff's fault. It's not working when somebody's sitting on the call for two hours either. So, it's not working for residents. We've got to figure out a ways to be innovative here. And that's where policy work, this is where our our policy work comes in. The system is is is working the way it was designed to work. It has flaws and complications, but technology and innovation can potentially help us, right? I was just in California was taking a way car which is like a self-driving car and I'm like oh my gosh it was amazing honestly it was amazing and it could be really helpful for seniors getting places. It even had a ability to take a person uh with a disability. How great is that? Because Metro Mobility here is like two-hour waits, right? And then sometimes that person has to stay in the car. Technology can help us. And I just I want us I I it was I was disappointed to hear that in our capital investment budget that we didn't have an ask. And so I would like to see us think really creatively because really strong innovation can actually be in that budget and I'd like to see it in the future. So um >> administrator wland would like to speak to this. >> Go ahead >> madam chair commissioner listen thank you. I think so a couple pieces in regards to the budget when it comes to the technology and the work that Blaine and his team have done and the investments it's reflected in the human services and public health operating budget ITRM. So, it's one of the unique things that we've done. Um, and Betsy talks about how we maximize the reimbursement. It allows us to pull down the federal reimbursement. And so, those funds are invested and we have continued to invest funding in our IT ITRM area to help continue building that out. The other component is that many of these systems that um, Blaine is um, touching on our state systems. Men benefits is a state application. We our team has been building strong relationships. They're allowing us to work with them. >> Yep. And work with them to help build out. So what what is being built new to Maxis is actually a really cool and the goal is when we build this out, it is going to be available for other counties across because we have to do it with the state. We cannot build without the state because these are state systems. Min benefits we have shared with them. Reggie has provided a list to the state around what are the components that we think would be helpful because residents it would help be helpful for a resident to when they're filling out min benefits to know what they may or may not be eligible for or to clearly check or provides some additional information. It's right now coming as a PDF document for men benefits for us to then put into maxis. And so we are advocating with the state around that. The state did receive, I believe, in the last legislative session, um, system modernization funding. We are working with counties at the table with the state with some very clear aligned priorities that we think are important and are even more important with what's happening right now at the federal level. >> Yeah. As much innovation as we can. >> Yeah. Thank you, Commissioner. I I do want to follow up with you because I sit on um for AMC and for Henipin County. I'm the chair of the performance council and SNAP has been one of the biggest headaches we've talked about there too and in fact we had the SNAP folks come on and they talked about some of the changes that they are making. It's slower than I would like it to be but they have to test everything before it launches but you're right. So I tried to um qual I tried to go into the app and do it and you couldn't even find what you need to bring to the table to put things in. And so it is a broken app and in fact um before I went on that call um before you were when administrator you gave me a list of asks and I got those lists over there. I can tell you that it's been a strain for us to get them to work with us. We have offered many many times while I have been here as commissioner and finally finally they're going to work with us. Um, I'm grateful for that because their rollouts have not been what I would call substantially successful and so I think there's an opportunity here and I'm really glad that we will step up to do some of this work together. But yeah, it's been painful since then and it it is it is a problem. It is. So I just I want to validate your your frustration. Um uh just a you know for me I'm I'm just looking at this fund balance page because I always look at the dollars and everything like this and I'm looking at the um page uh on I guess it's slide 12 and I'm looking at the fund balance that we're using and it's it's alarming. It's alarming to me because I I was here been here just almost 10 years and you've only got a couple of years on me and we saw us dig out of that and I'm just wondering how long could we last um and especially with in lie of what's coming down the pipeline uh the wave of cuts we hear what is it is that tens of millions is its millions what's the wave madam madam chair commissioners I'm going to look to assistant commissioner Betsy David to provide what we are what we're seeing as headwinds potentially right now, please. So, what we know is for our 2026 budget, we have incorporated what we knew. Oh, thank you. Um, into the budget and so the last quarter of 2026 is where we'll see that decrease in SNAP admin. [snorts] >> Okay. >> And we also incorporated any of the state cuts. what will be impacting us from what we know will be in 2027 and it's 80 million is my understanding from our um waiver impacts and then uh the additional SNAP cuts >> is that that the error rate the snap cuts are the error rate the waiver is our you know as we work with uh seniors are cutting the state support for that program is being cut now we have staff on a state committee that is working on that within Donita's um add department. But you know that's >> what's what's the error rate? What's the error rate cut? >> The error rate I would ask uh is it okay if I ask Reggie to come up? >> Sorry, Reggie. We just I don't know why you sit down. [laughter] >> That's okay. Um uh Madam Chair and Commissioner, so the payment error rate is a formula. Uh there's always been a 6% kind of threshold of acceptable errors that states can have. And so there's tiers. Um, at least for right now, the statewide uh error rate from the last federal fiscal year would put the state uh at 10%. So that's for a statewide uh would be um $80 million. We don't know how that cost will be allocated if it will. We don't know as Kareem said there's going to be legislative session coming up but uh if that gets even 10% to us let's say because our error rate was similar to the states um so if you look at the state's error rate 10% 80 million based on our SNAP benefits issued in 2024 which was 200 million and SNAP benefits 10% of that if it got a portion to us would be 20 million just for the payment error rate. So, >> yep. So, there could be uh there could be if we can get it lower in the states is lower that it could be down, you know, to a to a 5% which would be 10%, you know, $10 million. So, again, we're working hard. Uh we have I I will say that we are a little bit ahead of state right now with the data that we get. So, we are and and in some ways because we're at least 30% of the SNAP uh case load. when we do better than the state's average, that means we're helping, right, because of the volume to help that error rate down. So, I will say that we're trying to be more proactive uh case reviews, quality assurance, lots of training going on with our staff, right, Commissioner Connley, to your point, like they are just so critical the work they do every day. So, we've been training much more and trying to we know where the common errors are. So, that kind of predictive analytics, we think that there's more that we can do from that kind of data. >> Are we limited by state? Are we limited by state programming or state systems issues? >> I wouldn't say that that's a systems issue, but there is a significant role that the state plays in the quality control and the review of our cases and how they send that on to the uh feds. So, this is a very federally regulated um program with a lot of oversight and reporting. >> Yeah. Okay. >> All right. So going back to just the fund balance. Are we going to manage through these next three years? How where's the fund balance going to be in three years? >> Right. So we have and it is through working with our three pime primary levers which is what I have tried to incorporate into our director's minds. They have they I asked them repeatedly in meetings. Our three levers are our operating revenue and you can see in the slide 11 I think it is where you are seeing us optimize that right with our admin revenue increase we do not count fund balance use as revenue [laughter] >> I mean money in I don't know I just wanted to know where it went um and in fact I don't encourage us to think of it as revenue right >> um >> but as we work through that it will require us to look at staffing because that's our second primary lever. That is the lever that we are looking at is and every single week director Bobby Jackson and I meet we look at our safety stability and our our framework for how we make sure that we are meeting residents safety and stability first. That is how we are approving and pushing hires to Kareem and to uh leadership to approve. So making sure that we are trying to as much as possible reduce our FTE. That is our strongest lever we have on not utilizing fund balance. So no and I appreciate that. But I also know that in past times we've transferred fund balances from other departments. Can you speak to that? >> Yeah, Madam Chair. Um Oh, >> Madam Chair. um we we have to maintain a reasonable cushion to make sure that we can kind of absorb the shocks. And as I mentioned earlier, you know, if you call it a rainy day fund, it's certainly raining. Um I'd be happy to put together um a followup that kind of gives more context for the human services fund and general fund. So we did our rating calls last week. We actually have an updated list ready that we can share. Um, I think what's important to remember is when you look at the county overall and we move money between funds, we have a limited capability to do that. So, as you had the conversation earlier around where the county might u potentially step in to try and mitigate some of the impacts on the federal government level, you know, a dollar that we put in one fund is unavailable to address an issue in the other fund. And so, we do look at it holistically. It is a very coordinated approach. Um, I just want to reiterate again, you know, Betsy and I spend a lot of time together all year round, not just during the budget process, really trying to mitigate and work with her team about where we uh put resources. I think how we used our pandemic funds was a great example of that cooperation. We moved resources into the areas that were most critical. We've also, as a county, always committed to when we see ongoing needs, we have to find ongoing revenues to fund those. And so the the hard lever is always, you know, I think sometimes people assume the easy lever is the property tax. It's actually one of the hardest levers. These changes as we go forward are going to have property tax impacts. I think that the balance that um the administrator and all of you face as you put together proposed budgets with support from all of us in this room are really balancing you know how how far are we willing to go on trying to reduce costs because again at a certain point we we can't we can't fail to deliver the service and so uh that's where that balance comes in we certainly have um I think valued our relationship with the state sometimes it's good sometimes it's challenged um I would remind people again in 2023 the Minnesota legislature uh and the federal government were both providing increased revenues, increased funding for a number of programs and now we're seeing a very dramatic reversal of that um as the federal cuts uh take effect and as the legislature deals with their own financial situation. And so fund balance will not solve our issues. we need to think about and I think Betsy did a nice job of highlighting um you know they're looking ahead to 2028 that's consistent with our narrative um in the general fund we're also going to be talking about tapering down budgeted use of fund balance but I will say on a positive note the county has always for decades had a history of underspending our budgeted expenses and overcolcting or overoptimizing or however you want to say it in a positive way our revenues and so that is something that every finance team across the county needs to be focused on every director, every manager. Um, you know, we do need to try to be mindful of our expenses and the taxpayers resources and that allows us to hopefully minimize this. And I would just highlight again that chart. Um, you know, Betsy's team has underspent their budgeted use of fund balance. It's a topic of conversation every month. >> Um, and that'll have to continue until we get to a point where we're slowly growing those back up. >> Well, my my many thanks because we're in a really challenging and crisis mode. This is probably the most impactful budget, one of the most impactful budgets we'll do in the next this year and the next couple of years coming. So, it's certainly something I never thought I would have to see. I I managed through the downturn of the economy and the great recession and this is much worse. This seems much worse. So, I just want to thank my colleagues. I want to thank everybody for all the great work that you're doing and everything. I know there's going to be more conversations around this as we have to move rather quickly on things and I think we're going to take a break. I'm going to call it 1:40. I'll give you 10 minutes. So at 1:50 we need to get back and for the next portion of this budget. Thank you everyone. Can people come to the table? Can we restart? Can we restart? Can I get people to the table, please? >> I'm using the teacher voice now. >> And you're seeing how I eat my I know. I know. I heard [laughter] about that. >> Sorry. >> Everyone, I need I need quiet. I need quiet in here to start the meeting again. We have a lot to do. Oh, you're doing the clap thing. Yeah. >> Something. I don't know. >> Okay. Thank you everyone. I I know there's a lot of conversation because there's a lot of things going on here and it's really great conversation. Um we'll have time after this next budget uh briefing to go over that. Um we're going to start around the room because there's a whole lot of new people at the front of the table again. Debbie Gotel, Henipin County Commissioner Irene Fernando, District 2. >> Angela Connley, District 4. Heather Edson, District 7. >> Kevin Anderson, District 7. >> Marian Green, District 3. >> Joe Matthews, financial officer. >> Jody Wentland, county administrator. >> Kareem Murphy, he his pronouns, deputy county administrator. >> Kimberly Spite, CEO at North Point Health and Wellness Center. Good afternoon. Good afternoon. >> Andrew Baker, medical examiner. Sarah, public health director, district. >> Okay. So, we will reconvene and we have another hefty uh budget briefing. Uh administrator wetland, please. >> Thank you, Chair Gotel. Commissioners, we are here today with the Healthline of Business Leadership team to share the work across the health line as it relates to their 2026 proposed budget. I will turn over to Deputy County Administrator Kareem Murphy to get us going. Thank you. >> Thank you, Madam Administrator. Um here next uh for today's briefing, we'll provide some introductory remarks. Our county chief financial officer, Joe Matthews, will provide a high level budget overview and then we'll hear from our healthline leadership about its uh respective priorities. Here is the Healthline leadership team. Due to time [clears throat] constraints, today you will be hearing from the medical examiner's office, North Point Health and Wellness Center, and public health. The healthline leaders from Henipin Health, Safe Communities, and System Design are here and available for questions during the discussion portion of the briefing. The Health Line of Business serves residents in a variety of ways. The intent of this slide is to highlight a few examples. More than 3,300 or 33,000 members of Henipin Health. More than 5,000 patients treated annually at North Point Health and Wellness Center. If you like my nice my my nice white teeth, I get my dental care [laughter] as well as my primary care and more than 99% of onseen responses in under one hour from the medical examiner's office. These services are all part of the work this line of business does to keep residents safe, healthy, and thriving. I'll now turn it over to Joe Matthews, Henipin Countyy's chief financial officer to provide an overview of the health line of business budget. >> Uh thank you. Uh and I'll go through this fairly quickly. I know we have a short time. Uh on the operating budget, I just want to highlight that overall we have a $611 million budget for this line of business. It's a 33% increase. I just want to call out a couple specific items. The main driver is really Henipin Health and that is due to increased enrollment and we can talk more about that as we go through. That's a positive. Um they are stepping in and meeting the need for those uh those clients as as other areas uh other providers may be stepping back. Henipin Health is our insurance provider by the way not to be confused with Henipin Healthcare Systems. Health administration [clears throat] also has a large percentage that's really reflecting five positions being moved from other departments and organized under health administration. So that's ultimately a net even for the county. [clears throat] Uh but it looks like a large number there. Um SARS, I just want you to be aware that that is where we pay for uh the evaluation of various medical uh exam kits. The state of Minnesota had been providing an appropriation for that. It continues, but that appropriation is not keeping pace with expenses. And so we are adding funding back. This is substantially less than we used to budget for this area. So, I just want to acknowledge that the state is still providing meaningful financial support, but we're also stepping in. And then the last item I want to highlight in here is the Henipin Community Healthcare. That is where we are financing the uncompensated care at HCMC. That is the county's budgeted contribution and that is remaining flat at 38 million uh which it was increased to 38 million from 28 million in 2025. Property tax. If we could jump to the next slide again. Um you'll see here the percentage increase for health admin. It's not a it looks like a larger percentage because we're moving we've we've more than doubled the number of positions budgeted there um uh from restructuring. I want to highlight that Henipin Health does not receive any property tax funding. They are primarily funded through federal revenues and through Medicaid uh and through the state. There's an interaction there. And then also again you see a large percentage increase for for SARS for North Point. Um that is really driven by just increased personnel costs and other costs associated with uh operating that clinic. And then uh the total property tax there is $63.9 million uh up about 51% over the prior year. We go to the next one. And then here's the staffing. Uh there is a overall 2% reduction in staff within the line of business. I want to highlight um the two most significant areas are really the medical examiner which is reducing two vacant positions and North Point Health and Wellness uh which is also reducing some vacant positions. Just as a theme in the entire county budget, we worked with all departments. If there were positions that were vacant that they expected they could operate without or did not anticipate to fill, then we chose not to budget for those where possible. And with that, I will pass it all along uh back to Dr. Baker. Welcome. Can turn your turn the mic on somebody. >> Thank you. >> Thank you. Uh Madame Chair, commissioners, it's a pleasure to be here this afternoon. Um I'd like to briefly share some data and some trends and some accomplishments from the medical examiner's office. Um overall, reportable and accepted cases are relatively stable with expected annual fluctuations considering the total number of deaths in our jurisdiction. Incremental declines in non-natural deaths are not statistically significant. However, decreases in homicides, drugrelated deaths, and motor vehicle fatalities are encouraging and contributed to fewer scene visits and autopsies in 2024. Um, more about those drugrelated deaths in a moment. If I could have the next slide. Thank you. The number of autopsies in 2024 declined to prepandemic levels under our modified autopsy guidelines that we implemented to accommodate the spike in drugrelated deaths during the CO9 pandemic. With the onboarding of another pathologist this year in 2025, we have resumed performing more autopsies on apparent natural cases, collecting valuable public health data. These changes will have an unexpected increase, excuse me, an expected increase in total scene visits and death investigations as well as bodies transported to the morg, which we are fully prepared for. In 2023, drugrelated deaths peaked, but since then have been on a downward trend both in Henipin County and nationally. Still, drugrelated fatalities in Henipin County are 80% higher than nine years ago when the rise in synthetic opioid overdoses, and by that we really mean fentanyl, began. With rare exception, investigation and certification of these deaths require a complete death investigation, full autopsy, and comprehensive toxicological testing. Drugrelated deaths still account for more than one of every three autopsies performed at the medical examiner's office. Our final slide highlights some of the accomplishments of the medical examiner's office. Due to our time constraints, I'm just going to highlight two of these. Just weeks ago, the medical examiner launched a new public data search tool on our website. This tool makes public data on deedants more accessible than ever before to residents, researchers, families, and the media with just a few keystrokes. It eliminates the need to submit a request for public data. It's entirely automated and it reduces the amount of staff time needed to fulfill public data requests. Finally, by leveraging our growing anthropology services, we have enhanced partnerships with the Minnesota Missing and Murdered Indigenous Relatives Office and Missing and Murdered African-American Women Task Force using federal grant funds to apply for new forensic techniques to long-term unidentified cases. We are planning Minnesota's first annual missing person's day for the summer of 2026 to bring attention to these cases and assist families of the missing and unidentified. >> I don't know the exact date, but it will be in 2026. >> Great. Wonderful. >> Great. Um, good afternoon, Madam Chair, commissioners. Um, I'm Kimberly Spates from North Point Health and Wellness Center and I'm thank you for the opportunity to present North Point's proposed 2026 budget. As healthc care coverage tightens and economic uncertainty grows, more residents are turning to North Point for care. That's not a crisis for us. It's really our purpose. So, North Point is an anchor in community- based healthcare. We sit where health and human services meet. making sure that every person, regardless of income or circumstance, has access to care that is comprehensive, culturally responsive, and connected. When systems struggle to reach people, North Point meets them where they are with both compassion and results. So, let me share what your investment has delivered this year. Next slide, please. and health initiatives. Our culturally responsive, healthy pregnancy program achieved 100% healthy births among 35 black women. >> This is significant when black women are three to four times more likely to die from pregnancy related causes regardless of income or education. Uh the women's health initiative, heart health initiative supported by public health and commissioner Connley brought together two cohorts of African-American, black, and indigenous women who have experienced heart attacks or strokes. These women are learning heart health strategies, connecting with local experts and supporting one another. We look to expand this initiative next year. Our flavors of health program, a partnership with Henipin Health, um uses our new teaching kitchen to combine clinical care with nutritional education. Patients managing congestive heart failure, diabetes, or pregnancy or pregnancy receive eight weeks of groceries and cooking classes tailored to their health needs. Through the Health Resources and Services Administration, North Point received two national awards for making care better and easier to reach and to meet all of our operational site visit requirements. We're not only providing excellent care, we're opening doors so people can benefit. In terms of our financial and operational performance, we're seeing real progress. Um, clinical revenues have increased by 11% over the last year. Patient revenue has surpassed targets by 12%. We've reduced total expenses by 2.2% even with the inflationary pressures while managing the same 7.7 increase in staffing costes costs that have been experienced across the county. Through enhanced enrollment and payer adjustments, uninsured patients decreased from 33% to 26%. Um a 7% increase in patients with insurance coverage. The organization is breaking even um for the first time uh this month and is on track to reduce reliance on property tax dollars in the months to come. So as we look into 2026, our four priorities are focused on workforce stability. So despite ongoing workforce challenges across healthcare, we continue to make strategic progress. We anticipate ending 2025 with a 6% vacancy rate, a significant improvement. We've trained and hired new providers and support staff and continue partnerships with the University of Minnesota Dental School, Minscu, St. Kates, and Auxburg College to build a diverse pipeline of healthcare professionals. Our $5.7 million operating budget for 2026 represents a three and a half% increase over last year. And our proposed budget also includes 15.9 million in property tax that will support 280 FTEES. Rising non-personnel costs, pharmaceuticals, lab services, and interpretation are outpacing our ability to grow revenue through productivity alone. Patient service revenue is projected to increase by 14% at the by the end of this year, but that growth alone cannot offset structural cost pressures. To strengthen our position, we've implemented several strategies. a 5% reduction in non-operating expenses, expansion of payer contracts to diversify revenue, and improvements in revenue cycle management, specifically targeting denials, registration, and coding accuracy. We're aligning operations with clear productivity benchmarks to m maximize resources while maintaining high quality care. Our community board is leading our strategic planning process, ensuring communitydriven direction and accountability. The plan builds on a recent community needs assessment and incorporates the changing realities facing those we serve. As you all have mentioned previously, including shifts in Medicaid and SNAP that impact access to healthcare and well-being. We're also leaning into operational efficiency. We've launched two major initiatives, dramatic performance improvement in partnership with FQAC's across the US and excellence and equity through quality improvement. our internal framework to align data, systems, and people. In 2026, we'll focus on measurable improvements in patient outcomes, particularly chronic disease and behavioral health. Our electronic health record enhancements include full integration of dental into Epic, ensuring better coordination of care and seamless experience for patients across all service lines. Next slide, please. Challenges and opportunities. We are realistic about the landscape ahead. Very realistic. National policy changes will increase the number of uninsured patients. Pharmacy margins are narrowing due to federal drug prices mandates for medications like insulin and epipens. And we've experienced reductions in prevention and youth development funding that directly affect the social drivers of health. But those challenges only clarify our purpose. Through our dramatic improvement, performance improvement, we are reducing weight times, improving access, and increasing appointment availability. We're strengthening community partnerships that address social drivers of health and increase our capacity to serve the community. We are also investing in care coordination and front-end revenue systems to ensure patients receive the right care at the right time. North Point is not waiting for the system to evolve. We are building the model of what equitable community centered healthc care can and should look like. Our mission has always been clear, partnering to create a healthier community. And right now, that mission has never been more critical. Consider what this means. 24,000 residents served last year. 12,500 immunizations protecting our community. Over 10,000 diagnostic text tests catching problems early. And through our sliding fee program, thousands of people managing chronic conditions are able to uh do that with medications that are affordable. But here's what really sets North Point apart, our integrated care. When someone walks through our doors, they're not shuffled between systems. Medical, dental, behavioral health, pharmacy, and human services all work together. All focused on the whole person. That's how we turn your investment into something transformative. Healthier residents, stronger families, and a more equitable Henipin County. So together, we can continue to deliver health, equity, and hope for our communities. And we're excited about the opportunity to do that in 2026 and beyond. So, thank you. >> Thank you, Chair Gatel. Commissioners, thank you for having me. Sarah Holly, director of Henipin County Public Health. I just want to continue the positivity that's been placed in this space after a very, I think, challenging morning or early afternoon. And so again, um, for public health, the following accomplishments and priorities are an important part of the county's goals of achieving disparity elimination through the seven domains. We've done this through resiliency and action, responsive prevention, and person- centered care, and building collective power together in public health. Resiliency and action demonstrates public health's ability to prevent, mitigate, and respond to unmet needs in community that boldly advocates for an equitable and transformative public health system. We do this in public health by building alignment and continuity across public health services. That means our programs, staffing, optimization, um maintaining a prepared workforce ready to respond to emerging needs and infectious diseases. I want to pause for a moment and just thank the incredible team of public health, the 404 um staff that we have in the department and the work that we're doing to really mitigate the impacts of federal changes and the existing shutdown. Also strengthening our data collection and evaluation through our community health improvement plan, which I'm really excited about. Our community health assessment, also known as CHIP, um is launching a new plan in January of 2026 to improve mental health access and access to basic needs built through months of communitydriven planning and cross- sector collaboration. And for our climate action efforts, we are conducting research on health impacts of air pollution, which I think is really important, and are updating the cooling options map to support community access during cooling sites um and during heat events. Next slide. Responsive prevention and person- centered care are central to how we eliminate disparities in Henipin County. Public health continues to maximize our core public health services and programs through services service areas within the department to prevent the spread of disease, protect against environmental hazards, prevent injuries and violence, promote and encourage healthy behaviors, plan and respond to health emergencies, and ensure quality and accessible health services. We have increased access to preventative services and whole person care. This includes providing a positive experience for our customers and our clients and our partners. Also launching the Red Door Services Community Outreach and HIV prevention and status neutral team, which provides whole person care to young black men ages 15 to 34 years old and communities at high risk of acquiring HIV through our public health nurses and home visiting team serving more than 10,000 people and 2,000 families in 2024. It also includes wick reaching an average of 14,983 participants during calendar year 2024. As mentioned earlier, we expect to see a 5% increase in average participation in 2025 and are monitoring and planning for an increase in application and redemption of benefits due to the fed federal shutdown and impacts on SNAP benefits. and through our public health clinic taking care of more than 10,000 people and more than 22,000 visits in 2024. In addition, a core part of our work is to invest in health communications, community engagement, and outreach. This year, we engaged over 550 community members and 50 community organizations participating in department strategic planning process, which we hope to share with you soon. Next slide. Thank you. Building collective power together is really the only way we should do this work. This includes optimizing partnerships for improved health outcomes and disparity elimination. We have done this in so many ways, including birth justice, heart health, healthy aging, our HIV prevention work, and our continued investment of $70 million with over 70 partners. Fostering innovation and trans transformation to address unmet health needs in Henipin County is also essential to disparity elimination. This includes deepening our investment in culturally specific services and supporting community-led solutions. Due to time today, I'm going to make one note of how we're doing that through our heart health initiative. Your the your heart beats for generations campaign reached over 108 million impressions, 90,000 ad clicks. Hopefully I'm making comms proud with that. Um, with Facebook and Instagram engagement well above average. Since the launch, 2 million has supported the ad campaign, clinics, community orgs with care coordination, home monitoring, physical activity access, and culturally specific support. Over 5,000 people have been reached through events and clinics building trust this year. Next slide, please. Commissioners, an HIV outbreak in people who inject drugs and were living in encampments was declared in Henipin County and Ramsey counties in 2020. In response, the Healthcare for the Homeless Street Medicine Program expanded to deliver highquality and extremely low barrier medical care to those impacted. This slide underscores healthcare for the homelesses efforts to reduce HIV, particularly in people experiencing homelessness and ongoing commitment by public health to ensure we are meeting the unmet needs of our residents. They have greatly increased their efforts in HIV prevention, early detection and screening and treatment with rapid access anti-retroviral therapy. HCH also recognizes housing as healthcare. This is for this population and have housed 49% of participants parti participating in the Ryan White program. HCH had significant increases in pre-exposure prophylaxis or prep prescriptions to prevent HIV from 2021 to 2024 and they are prescribing more anti-retroviral or ART medications to treat HIV than ever before. HCH's mobile medical team delivers medications and care where the patient is at in community, including those staying outside. Amazingly, 83% of their panel of HIV plus patients has achieved an undetectable and therefore untransmittable viral load. HCH does not do this work without robust partnerships with community partners including Knack Clear Housing, AID, CDC, Southside Harm Reduction, Henipin Healthc Care's infectious disease clinic and the HCH board and many more. Next slide, please. I just want to take a few more minutes to briefly cover some of the challenges and opportunities ahead of us. Some have been mentioned earlier, so I'll skip over that information. Um, you know, just earlier we talked a lot about the challenges of SNAP and the increased need of community food supports. Um, while federal funding is decreasing or stopped unfortunately at this point due to federal the federal shutdown. Um, and we know we have an opportunity here to invest in community programs that provide healthy foods that are accessible and culturally appropriate. We are currently doing this through a $4 million investment from this board of public aid to 35 food shelves and communities, helping deliver over 500,000 interactions per quarter and distributing thousands of pounds of culturally appropriate food. Amid funding challenges, county support helps stabilize services in community. A new food security plan shaped by input from 50 plus partners and staff is near completion. Next slide, please. We are also preparing for an increased need for state and local government to provide previous CDC activities such as disease surveillance, population health data, and health recommendations. With changes in federal priorities, functions states and local public health agencies have counted on now now no longer are being supported at the federal level. That doesn't mean that the need goes away. However, functions such as disease surveillance, population health data, and evidence-based health recommendations are more vital than ever to keep our residents safe and healthy. These typically are out of scope for local public health agencies. However, but at this time, we have an opportunity to part partner directly with community to instill the trust in public health and I can't stress that enough. We need to continue that journey of making sure that our communities trust in your public health department. and specifically Henipin County Public Health. We are working with community to understand their concerns around critical public health tools such as vaccines so that we can meet their health information needs, welcome their questions and help them make decisions that protect themselves, their children and communities. Other challenges we anticipate include the unexpected and further federal state budget reductions with grants or direct payment at a critical juncture where we need where we have a growing need for services. At the same time, these challenges present opportunities. We are directing our existing resources on critical and core public health services with the focus on disparity elimination and prevention. We're working to optimize our capacity for core public health services and programs and community support and advocating where possible um to policy changes that serve our clients and our patients. I want to thank you for your time today and for your ongoing commitment and support of Henipin County Public Health and our vision to improve the health of all county residents. Thank you, >> Chel and commissioners. That concludes the health line of business presentation. >> Thank you, Commissioner Anderson. Are you prepared? We'll see. >> Uh, thank you, Madam Chair. Thank you for the um the information. I'm going to try to be really brief. You're welcome. Um, the um I'm going to focus I think mostly on the the public health portion of it. Not that I don't care about the other work, but I really appreciate the presentation. So, um, thank you. Um, now with everything that's happening at the federal level, uh, around public health and, uh, disincentivizing vaccination, disease detection, I mean, the work at the CDC and research and everything that's happening there. What is like can you speak a little bit more to the deficit of services that are being prov like that we're going to be missing and in what way or how much are we able to compensate that with that through internal talent? Um, [clears throat] and what might well like what are we looking at in terms of kind of not necessarily decrease in funding per se, but like they eliminated entire departments and like we can't I've heard of people not being able to talk to somebody at CDC anymore. Um can you speak a little bit more to that kind of impact and how we are responding and how we're able to um kind of not take over but what we're doing >> chair gel commissioner um so just and I may have deputy director able come up and talk about the vaccine strategy that we're building so disease surveillance as I mentioned because CDC is so impacted by the changeover of leadership departments like you know with just within HHS, SAMA, right, which impacts not just public health, but health and human services. And so really relying on our local data is going to be key here and really working strategically with the commissioner of health and MDH to better understand even how we manage, monitor, and do surveillance around infectious disease. Last year, I think on my first day here at Henipin County that we declared an outbreak for measles. We're continuing to respond to measles here in Henipin County. And so we're working to optimize our capacity within public health, not just with our amazing epidemiologists if you're out there listening, but to really stretch um our capacity. And so we are as the largest local public health department in the state relied on for expertise, for capacity um for contact tracing. And so I'll have um Deputy Director Abel come up and talk about our vaccine strategy. And I just want to say a couple things. We are in um going into 2026, we are going to be implementing the shape survey. We have our community health assessment. We have state level data that we're relying on the state to really continue to monitor, produce, and that's why I also mentioned the importance of data collection at the local level. So, the reliance um Commissioner Anderson on federal data even for food security. I think there was a headline around that data not being available at the federal level. So, we're really going to be relying on local partners, local information and and the relationships there. So, I'll turn to Deputy Director Abel to talk about our vaccine strategy because that's another concern that we have both locally and statewide. >> Sure. Chair Gatell, commissioners. Um, probably the most recent example was what happened at the federal level with COVID vaccine recommendations. So we very quickly mobilized our excellent EPI team and our vaccine team and our clinical staff and we were preparing to figure out what we would do for our recommendations at our clinics and we were very very lucky and fortunate that MDH the state stepped in and they're the ones that filled that gap to say here's based on all the clinical information that's available here's who we think should have COVID vaccine. So we're following that guidance now and then whatever would happen at the federal level, whatever decisions would be made, we would rely on our experts and our MDH partners to go forward. So regarding our vaccine strategy, what we've been doing now, I think since COVID, so it's been a while, is we're partnering with community. So instead of having these max vaccine events, we have these smaller events. We just had one last night. I think 45 kids were immunized. So, we're going into schools, into community areas, and doing vaccines that way. And we're partnering with a community agency to give those vaccines, multilingual, multicultural. And we really think the strategy of these smaller events and partnering with schools too in the school nurses is really helping raise our vaccine rates. >> Is there opportunities to share our expertise with like throughout the state? And is that like I know that doesn't happen for free. Uh but is there opportunities for us to like build out relationships either joint power agreements or something along those lines being that we have the infrastructure that may not exist in other smaller local public health uh agencies? Yeah, I think that Commissioner Anderson, I I do think that that's possible. I think that that would really take a statewide coordination and that kind of goes to um Mr. Murphy's point is I am always wondering where we step in and where we step back. I do think we have a a lot of um of course with Henipin Healthcare with our partners in Henipin Healthcare and the clinic and hospital system. We have a lot of again great expertise there that we could pull on that we could impact more of the community because Henipin Healthcare of course has a wider reach than just Henipin County. So I think there's a lot of opportunities in that way. Um, Chair Gel, Commissioner Anderson, Commissioners, I'll just add that I think our amazing federally qualified health centers in the community, our community clinics. Um, that's spaces where we want to make sure that our residents are connecting in with for vaccines, for heart health, for wick, right? We have, I think, an incredible opportunity there to do more work. We have a mutual aid agreement between in the metro area and across the state around if in fact you know incident command is declared if in fact a public health emergency happens al along with emergency preparedness that we can always leverage and so I just want to reassure you that I'm in constant contact with our Henipin County local public health agencies. We're building more relationship with our cities also that do not have local public health um agencies to make sure that we're getting information out in real time and that we have these opportunities to connect with community about these core public health services. >> I think commissioners just another thing to add is um we did build into our budget money for vaccine. So so right now vaccines that are approved nationally get paid for locally through different funding structures. So because that was so unsure, we did build some extra money for that. >> Um, Commissioner, [sighs] >> let's see. >> Sorry, I'm still really working on trying to figure out who I can bug at the state level. That's >> I really am like a worker be over here. You hear me pounding? I promise you I'm sending emails to people. [laughter] I'm very fired up. >> Yeah. Um, okay. So, you're doing all doing great work. Uh, by the way, I found out about what the um I asked a question. You weren't here about the capital. It was like the mold that you were doing. 3D mold. >> 3D. >> Very cool. Very cool. Um, uh, all doing great. North Point is just awesome. Doing great work. Um, there was one thing I had a question on and I totally passed it. Um, oh, Henipin Health. Uh, okay. So, at the rate that it's growing, um, where was that sheet? It's a lot. It's a lot. And we have Medicaid changes coming. Uh, unless something drastically changes, which I really hope it does. Um, right before that. Uh, so, um, it's the rate was like 30 42%. Yikes. So, um, can we tell me about projections because I think, um, I was just looking up too as I I try to find try to remember how this works. Um, I want to know if we've done a financial projection. I want to know if we are have rate adjustments that we've worked with DHS on. Um, because that sustainability of that, we have to have some hard conversations at some point if we otherwise we're going to be passing a ton of this like we need the state to help us. um if more uh people are not more insurers are not going to insure people um it can't just be um county being like yes we will help everybody on this one specific issue so I curious what your thoughts are as you're thinking about this >> madam chair commissioner Edison Mike Kersing is here your chief executives officer of Henipin health and I think he can provide an overview of what the growth is and the work that you're doing around that >> sure let me make sure these Mics are on. Uh, Madam Chair, Commissioner, a good question. Now, the 42% on there, I want to make sure that that is that's related to growth of our cost. So, our revenue, which has gone up as a result of our membership, and then the claims expenses as a result of that increased membership. What we've seen so far this year is about a 16% increase in the number of members we've got. So right now we're taking on around 5 to 600 new members a month which has been pretty steady for the last few months. Right now we're projecting that to continue into next year. There are some things that could impact that that we're trying to get clarification from the state on and that is whether the plans that have left the Henipin County market will come back into the market. That would adjust that number perhaps down as much as 50%. Um, now what we know is coming in 2027 are federal changes that we talked about related to work requirements and we're trying to ascertain what impact that will have to our membership and the overall Medicaid membership in the state. What we don't right know right now is what um what allowances the state is going to look for that will make people um not have to meet those work requirements. We may not know that until the legislative session happens in the spring. So, we are keeping a close eye on this. What we do know is we've worked with them on our rates. Uh we feel like our rates for 2026 are going to be adequate to allow us to continue with the current growth trend that we're seeing and they will leave us in a good position for 2026. >> That's helpful. So, there's a lot of of things that are happening um really weekly that we're trying to just make sure we're tracking with DHS around some of this growth and what's happening in the market. >> Anything else? >> No, I'm good. Okay. Commissioner Connley, >> thank you, Madam Chair, and thanks everyone for the presentations. Um really good. I'll go in order. Um I think that um I have one question but mostly just some appreciation for the work. I have been waiting on on page 12. I don't know what slide this is. Slide 12. >> Um I have been waiting for the numbers to go down on the drug related deaths since 2020. Um so to see where we're at. I appreciate though Dr. Baker the um caveat that you gave to this to this number right like there is still a heavy presence that's happening but we have just skyrocketed last year 532 so this dip is uh incredible and like let's get back down to pre205 levels I'm hoping that work that that we have been hearing about through the budgeting process is work that will help us get there um and I appreciate you in including this trend trend um when you produce when you produce your budget cuz it's very telling um and uh seeing that number go down just gives me a lot more hope than I had seeing the number last year. So, thank you. I also want to shout out on slide 13 uh leveraging talent acquisition initiatives to increase diversity in the ME workforce. I'm just grateful that you're still um committed to that work and um I know that you're holding two vacant FTEEs, but I know that the um the um this type of work is something that that you value that we value and you're uh receiving awards for it. So, uh thank you for that. For North Point, I can't say enough about uh the incredible uh things that we are happening and I appreciate the way that you framed what what's coming down from the federal government and what your charge is, right? I really appreciate that framing because it it can be heavy. Um, but it's it's what you're called to do. I will tell you that we kicked off the third cohort of the heart health uh initiative and I appreciate that you're continuing that work because that is one of the core pieces I think is bringing um women together who have experienced these things to uh every single week in sisterhood, right? to learn how to cook better, to just share our experiences with each other. Every time I kick off a cohort or go there, like there is such there's just this vibe. I don't have another word for it. Uh that is the energy is palpable and it is I will see you all next week immediately because like we've been waiting for this. So, thank you for continuing for continuing that work. Um, and for public health, I'll just say that um, I know that there is a bigger need for food than we can meet, but I very much appreciate that we are keeping it steady, right? That we are saying for what you receive this year, you will receive next year. And hopefully um, there will be more opportunity after the year turns. And I and I appreciate that that this is something that we don't cut. I've said it before, food, housing, these are untouchable things to me. These are things that keep people alive and thriving. And so those aren't areas that we can take from um especially when um bigger levels of government are taking from it. Uh I'll leave it at that. So thank you for I think prioritizing um some really good work. The only question that I had is I wanted to get a clear picture of the public health budget and I think it's in the human services book. It would be nice if it was in the health book, right? So I it took me a while to find it, but I think on page n 16 of the human services and public health budget book >> is the public health budget. >> So it's got the 2026 proposed budget a drop of 10%. >> FTEES it looks like 76. So I just can somebody walk me through that? What what am I missing with the dollar amount and FTE drop? Is that are those vacant positions just like we've been talking about for for this afternoon? And then the dollars, it looks like we had an adjusted budget for public health of 86 million. That's dropping to 77 million for 2026. That's a almost 10% change. So, I'd love to know what's driving that because I don't see what's different about the public health budget is I don't see the significant differences box that would kind of explain that out for me. So, >> Madam Chair, Commissioner Conley, I'd invite Betsy, uh, interim assistant county administrator Betsy David up to respond to that. And as she makes her way, I just want to explain one thing. Um what we tried to do in organizing the human services briefing and this briefing is around the funds out of which we largely >> operating. So this is >> fun 20. >> Yeah. >> Okay. >> An hour ago was a fund 20 presentation. This is a fund 19. >> Fund 10. >> Fund 10. I'm still new here. Thank [laughter] >> David. [snorts] Fund 20. Fund 10. >> Thank you, Commissioner Connley. And uh thank you for the question. Um we've reviewed the FTE decreases. The primary decrease is due to an actual program within Ryan White which is the largest >> uh decrease in FTE. The other decrease is net of our vacancy uh which we have budgeted is not you know the entire amount here. We've actually reduced the amount of vacancy within the public health budget. So the total is not that FTE difference. Um if possible, can I get back and answer kind of where the FTE decrease within public health is? >> Sure. >> Does that seem reasonable? Okay. >> Yeah. And and Madam Chair, I think that that would explain then the almost 10 million difference in budget. Yep. >> Is that okay? So, which Ryan White program ended? >> I would have to ask I don't know director Howard. >> Thank you. I'll um Madam Chair, commissioners, I invite Stephanie to come up direct deputy director Ael to talk about Brian White. That is under her purview right now. Stephanie Ael, deputy director with public health. Um thank you for the question. Um there there was a small reduction um related to some state funding change. So we have two funding streams for Ryan White. One is direct fun federal and then one is state pass through. And then it was the state funding cut that cut a small amount. Um the majority actually all except a small percent for administration of our Ryan White funding goes right out to community providers. So, we were able to do some different adjustments with our federal funding to make sure that those community providers could continue to have flat funding. >> Good. Mr. Matthews, go ahead. >> Madam Chair, I just also point out there's not a huge blur, but on page 19 there is a short summary and the a big highlight public health has a reduction of 7.7 million in federal and state revenues in their area. And so, >> oh, I had a question there. Yep. >> Yes. >> So, [laughter] well, I guess I teed it up. I'll hand it back to you. Um, so yeah, I highlighted that. Thank you. There there's a little bit and I guess um the only question I had is about the the costs. It says the division reduced services and contracts partially due to the federal and state revenues, right? But it also says there's other costs that were prioritized and managed with resources available um which um increase the use of fund balance. So I just wrote what other costs. Yeah, Madam Chair, I think in response to Bets's followup on the positions, we'll just give you all more detail on what's in that budget. I what I would say is again, this is an example where um when we've had to make staffing reductions or prioritize. So, the increase in fund balance is basically a recognition that we can't cut dollar for dollar with law, state, and federal revenue. There's services that are critical. And so, we'll just give you a more detailed, you know, summary of both the expense side and the revenue side as far as what's happening. And then staffing. that helpful. Thank you. Just because of the um the really important work that goes into public health, it's our first line of defense against we just heard CDC cuts and like what's not being tracked and what is and we are doing that. Um even for places within our county that can't do it themselves. We we are that arm. And so um it'd be helpful to to see that level of detail. Thank you, Madam Chair. >> Thank you, Commissioner Fernander. >> Yes. Thank you, Madam Chair. We're so close to completing briefings. Thank you >> to you, Madam Chair. Congrats to Jod and her deputies. You know, >> you weren't coming. Just kidding. Okay, I'm going to go in order. This is a really cool set of of um presentations together because of the journeying over the last handful of years. And so, um when I joined the county board, we did not have a new medical examiner facility yet. The current facility, um Dr. Baker, your commitment to staffing. Really heartened to hear about the event you're um discussing next year. So, I uh it's not that I don't have questions or demands now. It's just, you know, I predistributed them to you and others in previous years. And so, I I want to commend you for that and I thank you. Uh you always came with very particular sets of needs. It's here to hear that the additional pathologist has come on. So, I you've been specific and this is the type of data that um we have been waiting. these are the types of outcomes I should say you've always provided the data um I am still um intrigued around uh what analysis data analysis we can provide for when you know not everyone comes to when there's a uh when there's an event people will be at the hospital or sometimes people end up at the medical examiners and so I'm I'm curious around how our broader system can um what insights might be possible from a data perspective so these are all just comments I know we're nearing the end here and I wanted Thank you for your uh commitment to receiving feedback and responsiveness specifically with feedback that I've offered. Um [snorts] North Point also where I get care when I get care. Thanks. I know I'm going to make an appointment. So down the street um everyone you already know North Point is the spot. I mean uh also a new facility last year. you know, whenever a new facility is made, it is always one wondering, will it kind of meet the needs? And um if you welcome, you're welcome to come to North Point. It is a it is a community center. It's a living room. It's somebody's grandma's kitchen, so you better watch out. And so really thinking about that type of embeddedness in terms of integrated care is really inspiring for me. Um that's also true with health healthcare for the homeless by um particularly by way of its uh of its staff and how staff stay so connected but of course the physical home that has been able to be provided to North Point. So immense gratitude to the community board. You know the community board is tough. I mean I am not the one asking the hardest questions. You can for sure uh ask ba back there who's the finance director. I am not the most um activated board member. So that's cool. Uh, and I just can't thank uh you and um the workforce enough for the integral role you play in the broader community, but really districts one and two on the north side. Um, and then from a public health perspective, you know, it was March of 2020 or May of 2020 when Commissioner Connley and I were privileged to declare racism as a public health crisis. and and that's really when I came to understand differently the expertise and lens and really the visionary way by which public health approaches uh approaches its practice and I've been heartened to see that embedded from a data perspective and from a outcomes perspective across the county and so I just want to amplify what you said on that very last slide. Um the very first uh briefing I open with this data charge that we need to be tracking our own data because I am really really nervous at the time especially but now it's been validated >> that we're just not going to have data. It's really it's it's unnerving to me and then um you know I had yeah I mean no one thought the first pandemic could happen and usually in community when I say we need to be prepared for you know future health events future pandemics and the most common response I get from residents is well we won't be informed of one because the CDC is not here >> and that's a really you know it's a really stark comment to receive over and not as a joke, resident after resident, town hall after town hall. And so I just I really appreciate the the charge or the call out to that and that is something that um is is is quite heavy on anyone who cares about data and outcomes. Um and so I I I appreciate what uh Commissioner Anderson was saying about the rest of the state. If I may be so direct, a place we should begin is Minneapolis public health. um we've not been able to be successful. Um the measles response is an example where the county sought to um ensure that our efforts were aligned and effective with respect to measles. Um and both the city and the state were not receptive at that time to that type of concept. And so just it's not just a conceptual sharing like how how are we really linking up the public health authorities charges with the other public health authorities in ways that are meaningful and streamlined to residents. One could call that kind of under the consolidation charge that myself and others have stated, but it's not about consolidation when it's been taken away from the feds. This is these are this is work that should have been done elsewhere. Not unlike census in 2019 and 2020. Um we locally invested in census and thank goodness by 26 people kept our delegation. Um and so that that's what I'm um hearing now. But immense appreciation for everyone here. Um congrats to your first uh full full budget. Not quite yet done but still administrator. Thank you madam chair. [snorts] >> Thank you. Um, thank you all so much. Really, um, exciting and super important work. Clearly, um, probably my biggest comment is similar and if any of you were in the room for my comment around, uh, the human services budget, which is just really wanting to understand the pain points that you're all experiencing. Um, and I appreciate that there was um, a talk of positivity. It's um tough to find these days, but um I do want to understand better the challenges that you're facing so that we can be honest advocates with the public and with our elected partners. I also wanted to name um Henipin Health um it's gone through you know sort of ups and downs with enrollment etc. uh and I I don't have a question about it but more just want to express my interest in keeping an eye on it. I think it's um continues to be uh you know hotbed of innovation and a place that um new and different things can be tried and are tried. has that history and I want to um make sure that we're able to continue doing that and things are looking good and I also appreciate that it was mentioned will the programs that have bailed in this space they're essentially their competitors come back um so just wanting to keep an eye on that uh and then um I think my final note was just to express broad support for this great work so thank you >> thanks thanks I guess back to me here and I'm I gota try to keep us on time if I can. Um first of all I to North Point Health and Wellness I've been able to visit many times. All of us have to the great groundbreakings the the the last administration secretary of health was here. We know how impactful this is to the community. We know this is the model that we need to carry through and even with the cuts in grants and Medicaid that are coming, you're still holding the ship steady. So that's an accomplishment you should be extremely proud of. And so I just wanted to say that thank you very much for that work. Um on the board of health first of all I just want to say that some of the board of health child well-being work together has been just incredible. We have been working with um the board of health at the child well-being level to get into homes to get into the prevention mode. they there's lots of times you can get in as a board of health nurse to get to that mom or those families and talk to them, find out what their needs are and circumvent child protection because they don't want to talk to us. Let's face it, we still have the the big bad X on us. But the board of health has been able to do that and that really matters to us. Just kudos to that. I want to say that you continue that work and it's it's making a difference and it matters. Um, the one thing I wanted to talk about, I'm really impressed with the HIV impact and what you're doing and the number of prescriptions we're getting out. I wondered if there were any concerns about these HIV drugs and the costs and the availability. Are we going to see anything happen? Are you hearing anything on the front about some of that? >> Cherel, commissioners have an amazing leadership team and I'd ask deputy director Ael to come up and talk about that or area manager Don Petroscus, but I think Stephanie's beat her to the mic. Chair Gatel, thank you for that question. Again, Stephanie Ael, deputy director with public health. Um, this this can blend over into uh more information we can provide you about the 340B program, but healthc care for the homeless, any federally qualified health care center, all patients of that healthc care center are eligible for that medications, those medication costs. So it's basically a reduced cost that we receive to be able to provide medications for people. >> Okay, that's really good to hear because that's really important. We made such strides in that. And so then in general, I want to talk about the human services as a as a whole now because there's been a lot of concern about the lack of data at the federal level. Um that's going to come down. The CDC is pretty much demised. I mean, what are we going to do? And Henipin County is one of the big players here. We're collecting data. We have lots of data. Is there an initiative at the state level to bring some of this data together so we have good data? Is there anything any talk about that kind of a triage? Anybody? >> Madam Chair, commissioners, I want to mention HTAC. I don't want to keep calling Stephanie up to >> She's really good at it though. [laughter] >> But um and I think we have some HHS partners in the in the in the crowd too, but Dr. Wkelman and his team um Henipin Health Research Institute. I got that acronym right. That's an incredible um resource for us. So, it's the health um trends across communities information that we collect and we're partnering with health systems. This has been a um data >> throughout the state >> throughout the throughout the state and we're working with health systems. Okay. That team at HHS in partnership with public health because we do have staff within public health that um help with that process. Um but this the funding for that um is critical. >> Yes. >> Um and that funding has come typically from the Minnesota Department of Health something called the infrastructure grant. >> And so we're looking to work with MDH to help sustain that incredible data source that Henipin County is leading on in partnership with health systems. And so, um, I think I've talked with Commissioner Connley a little bit about this the charge here, but really making sure we can sustain that data source that we are that this data source is looked at as not only a Henipin County resource, but a statewide resource. So, that's just one really important example of the data that we have here in Henipin County, but that we work in partnership statewide. >> And I'm I'm heartened to hear about the medical examiners that you're able to do more autopsies on natural deaths because that adds to the information that we have and that's that's impactful, too. So I just I'm really excited about the fact that we could keep some of this data flowing even if it's just at our state level and maybe you know that's something to be talking about about and no about what we're doing so that they could replicate this data because we're all going to feel the miss of this data right so I just wanted to I wanted to end it I just wanted to say the incredible work we're doing here it was kind of nice to end on a little bit more of a positive note that was a pretty heavy briefing before and I really appreciate every one of you so thank you very much we're going to move On to the agenda. Item 2A is approval of the minutes of October 22nd's budget briefing. Do I have a motion? >> Approval. >> Second. >> Is there any changes, corrections? All those in favor signify by I. I. >> Motion carries. >> So, seeing no further comments on this, um I would take a um item 4A's old business, which is a layover motion. this item until 12 noon on Wednesday, November 10th when we combine convene with the budget hearing of the 2026 proposed budget to consider the administrator amendments. >> Oh, that's next. That's after 4. >> Oh my gosh. Okay, I'll move it. [laughter] Sorry. >> Second. >> Sorry. Sorry. Sorry. >> It's okay. It's been a long day. Sorry. All those in favor signify by I. >> I. >> Item five. Sorry. >> I wouldn't forget it yet. Um is open forum. Members of the public watching this budget hearing can call and leave a recorded comment that will be played for the board at the next budget hearing. If there is not enough time to play all comments, then recordings will be sent to commissioners. Uh your comments should be related to the specific budget hearing. Recorded messages will also need to meet all the following standards which are the same standards for personal comments. Callers will need to state their first and last name for the record. Callers will need to adhere to the rules of decorum outlined in the posted guidance addressing for addressing the board. Comments must be kept to two minutes. Comments that are go beyond that time will not be heard. Um the recorded comment um call line is 6126883545. The line will remain open 4 hours and I'm going to call it at 3. It's so close. So it'll be until 7:00 tonight. um will have this. And so again, the number is 612-688-3545. If you want to send an email or a letter to your commissioner, you can do that as well. To speak in person at the board meeting, please attend the annual truth and taxation meeting on dis December 2nd at 6 p.m. And yes, you'd be surprised or quite a few people show up. Um the 2026 proposed budget information and hearing is available at www.henipin henipin um usbudgets. Thank you, Miss Wetland. Thank you, staff. The committee is now in recess. Thank you.