With the growing demand for care services from child care and early childhood learning and care for people with disabilities to elder care to meet the needs of our aging population, California is poised to lead in establishing a care workforce that not only responds to the needs of families seeking such care, but also to create pathways to economic mobility for care workers. Quality affordable care for families and uplifting the wages and working conditions of care workers are essential to growing our economy and to strengthening our communities when care workers do not have to live in poverty, can experience housing security, and can have job stability. This initiative recognizes that today, the true cost of care is not acknowledged and thus pushes care workers to fall behind.

As Betty has seen traveling to the diverse regions of California, the health care workforce shortages are acute in many areas of the state. Yet there is growing interest in meeting these workforce needs by developing health care professionals from the very communities that need them. As Governor, Betty will work with our public education institutions as well as with regional and local leaders to increase education, training, and development opportunities for this targeted workforce initiative that has the potential for stable, good paying jobs, increase health care access, provide the culturally and linguistically appropriate care in demand, and harness the unique attributes of regions to expand care options, such as elevating the importance of the natural environment in the eastern Sierra,

Betty’s vision for California to sustain its climate leadership is linked to economic growth. California’s Climate Jobs Plan must be taken to the next level where local and regional economies benefit from our clean technology investments, especially in areas experiencing the most significant climate impacts. Opportunities for infrastructure development such as that for renewable energy, battery storage, and grid modernization offer living wage jobs. As well, manufacturing and small business and entrepreneurial enterprises can diversify regional economies for better resilience in areas such as water conservation and reuse technologies. This workforce-of-the-future development initiative holds promise in increasing both economic and environmental sustainability in low-income communities and communities of color.

Digital literacy is critical as the demand for it spans across all industries and at every level of work. Universal digital literacy, especially with the increasing prominence of AI, will ensure broader access to information and opportunity, and for workers, boost wages and facilitate financial security. With respect to AI in the workplace, workers should direct the deployment of AI. Digital skills education and training for adult learners should be inclusive and must be flexible to meet them where they are (working multiple jobs, caregiving responsibilities, other obligations that have kept these learners from attaining credentials or degrees).

• Funding: Immediate attention must be directed to new revenue to support the losses in federal health care funding. California will not be able to cut enough in the budget to offset these losses; it cannot tax its way out of the deficit. To stabilize health care will require California to cut, raise revenue, improve service delivery, and make investments to grow the health care workforce.
• Public and Provider Communication: The complexity and consequences of the Medi-Cal provisions compel regular public awareness communication to better prepare Medi-Cal enrollees as well as regular engagement with providers. More focused, regular communications with older adults, persons with disabilities, and non- or limited English-speaking persons may be warranted.
• Participation: The impacts of H.R. 1 will vary throughout California, and as such, the state and counties must include the participation of managed care plans, providers, and community health organizations to identify and maintain robust provider networks and safety net resources.
• Administrative Hurdles: The added workload for counties and the State necessitate support for counties, especially smaller counties, to build human resource and systems capacity and capability for more frequent eligibility redeterminations, work reporting requirements, and more.   
• Core Safety Net Providers: Funding must remain intact for public hospitals and their emergency departments, community health centers, clinics, and local public health departments to serve those who are low-income, uninsured, or underinsured, the number of whom will grow s a result of the H.R. 1 cuts. 
• Behavioral Health: Although the H.R. 1 impacts to behavioral health are not fully known, they likely will curb access for Californians needing care. 
• Funding: The Managed Care Organization (MCO) tax is assessed on health plans based on the enrollment of their members in Medicaid in order to draw down federal funds. California’s MCO tax must be reviewed for compliance with H.R. 1.
• Waivers: Federal Medicaid waivers may be attainable to give California more flexibility and opportunities for innovative service delivery, or as efficiency or cost-cutting measures such as service delivery through managed care plans.
• Serving Immigrants, Refugees, and Asylees: The loss of Medi-Cal and food assistance eligibility for immigrant families who serve as the backbone of our workforce and economy will result in more costly emergency room care and instability in the economy. Serving this vulnerable population must be a priority for any new state revenue generated as counties have limited capacity to absorb this health care responsibility.

California’s ability to keep all who are eligible for Medi-Cal enrolled depends on the success of the counties and other key stakeholders as outlined above. Emerging from the War Room may be new models of service delivery that involve cost-sharing, information and resource sharing, and more integration across providers and disciplines.

Development occurs at the local level, yet localities alone cannot dictate building patterns. The state has sought to coordinate and incite development, but the current hammer approach creates an adversarial relationship between governments that distracts from the broader goals. State and local governments should be working together to encourage development.

Potential Solutions:

• Lean in to the state’s “pro-housing” model that recognizes localities doing the right things and doing their part to solve the housing crisis. This program gives preferential scoring in a few non-housing funding programs. This should be expanded to new non-housing discretionary funding and select existing transportation/infrastructure programs.
• Incentivize business development in localities that produce housing to increase opportunities for economic mobility where housing may accommodate workforce needs and workforce may address community needs.
• Upzone to allow for more development. Currently, jurisdictions are required to zone to their Regional Housing Needs Allocation (RHNA), but there is little incentive to zone excess capacity or to speed the development process. Localities should be further rewarded in the “pro-housing” designation program if they zone beyond the minimum. 
• Target adaptive reuse, mixed-income/mixed-use projects in re-activated community redevelopment areas. Vacant buildings are prime candidates for tax increment financing. These buildings already exist, and traffic counts for new residential development will be much less than the prior commercial uses. The value of repurposing commercial buildings to ground-floor retail and upper-floor residential in downtown areas is the vital role they play in enhancing public safety. 

Affordable housing development is necessary to support low-income renters facing the brunt of the housing crisis today. Yet affordable housing development relies on a patchwork of inconsistent subsidies that are approved in one-off bonds that inevitably run out. A stable funding source eliminates wasted resources from standing up one-off programs, and facilitates development by allowing for longer-term pipeline planning. A dedicated source of state funding is needed to address the severity of the housing crisis.

Although we are seeing signs of unsheltered homelessness decreasing, there is no ongoing funding plan to prevent, alleviate, and end homelessness.  The temporary nature of state Homeless Housing, Assistance, and Prevention (HHAP) grants along with the loss of federal funds and requirements for local encampment regulations call out for ongoing state funding for counties and cities to continue making progress on alleviating homelessness.

Potential Solutions:

• Reinstate redevelopment agencies. These local government entities use tax-increment financing from the local property tax base to fund affordable housing, as determined by the locality. The dedicated source of funding that is controlled at the local level will give localities a needed tool to shape development in their communities, while providing the stability of ongoing public funds. 
• Link developer incentives to meeting supply targets so housing production and tenant relief are balanced.
• Establish funding sources for rent stabilization in the form of direct rent subsidies, while balancing increasing rental housing supply.
• Commit to ongoing HHAP funding so local strategies for reducing homelessness can be paired with funding certainty. 

One of the causes of homelessness is the insufficient supply of housing in the state.  It takes years to build new housing stock, but urgent action is needed today to prevent more Californians from becoming homeless. Once someone falls into homelessness, they face trauma and crisis that make it much harder for them to get back on their feet and into stable housing. Further, we have insufficiently addressed mental health and substance use among this population. Too many experiencing homelessness have severe unmet health needs that are not addressed by current programs; and incarceration is not a tenable solution. 

Potential Solution:

• Make preventative support available to hard-working Californians at risk of becoming homeless. A recent UCSF statewide survey found that the vast majority (82%) of people experiencing homelessness believed a one-time payment of $5,000 to $10,000 would have prevented them from becoming homeless. A state fund should be established and made available to those below a certain income threshold for periodic access when they need it. These small investments are well spent to prevent one from becoming homeless, with costs spread across a myriad of public institutions. Statistical modeling through AI can help identify trends on who is most at risk, such as those exiting institutions or have heightened health risks. This can be instrumental in serving veterans, older adults, foster youth, and others.

State government has focused on housing development in recent years, pouring unprecedented resources into affordable housing. However, the state’s administrative infrastructure was not designed for this level of production. With the current layers of complexity, the state has room for improvement to streamline administration, align requirements and timelines, and make the most of our public investments in affordable housing development. 

Potential Solution:

• Create a one-stop shop for housing functions in state government by aligning all development funding programs into a single state agency. California is the only state with housing administrative functions falling under multiple elected officials. California’s housing administration is fractured, even compared to other large states facing housing affordability challenges. The state must be willing to realign its housing programs to accelerate rather than hinder development of needed affordable housing.  

Governments have not kept pace with the speed of technological innovation. Every innovation should be on the table, but effort must be made to embrace new technologies. In the housing space, innovations are needed: data analytics to shape policy, funding models that challenge the status quo, and building methods that speed construction and lower costs. Additionally, innovation in the area of insurance can bring stability for property owners as well as for insurers.

Potential Solution:

• Encourage new building models. Investment should support new building types that can bring down cost and time to develop, such as innovation in tiny homes and modular housing. Financial backing can support factories building housing through direct investments, loan guarantees, and tax incentives. The state can look into standardized development models that can be applied with faster approvals across the state. 
• Identify in single family-adjacent neighborhoods, opportunities for less dense affordable housing — especially in commercial corridors, which taken together numerically can produce much housing in a tenth of the time it takes to approve seven-story new buildings. 
• Use data-driven models for identifying and determining whether zoned non-vacant parcels have a reasonable probability of development as required under current law, rather than relying on anecdotal determinations by individual planners. Such models also may be useful in determining the feasibility of maximizing the existing housing stock in producing additional housing units, such as in homes owned by older adults or empty-nesters; and in addressing potentially adverse impacts on strategies such as social housing. 
• Increase collaboration between the health care system and homelessness supports. Hospital systems and insurance plans benefit from keeping people housed, yet there has not been a coordinated approach to channeling their efforts. The state can coordinate major hospitals and health plans to find out how we can better coordinate investments and efforts. The CalAIM initiative allows health plans to bill for housing placement, but that is just the start. For example, respite care beds can be used to ease the burden on emergency rooms while giving support to these high-need patients. 
• Push insurance companies to adopt innovative business practices and actively participate in strategic risk management partnerships.  While much has been reported about insurers using AI and other technological innovations in their business practices such as claims management and processing, innovation should drive how risks are identified and how they should be valued. Additionally, innovation consists of insurers engaging in strategic collaboratives to address risk reduction and risk mitigation so homeowners’ insurance may be predictably and stably priced to lower the costs of losses to businesses, individuals, and government — collaboratives with first-responders, local officials, homebuilders, climate modeling experts, homeowner interests, community leaders, and more.