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Final Stanislaus County budget sees increase in spending
Stanislaus County

The Stanislaus County Chief Executive Office released the 2019-2020 Recommended Final Budget last week, which will serve as the final spending plan for County operations during the second half of the recently-adopted two-year budget cycle.

With the release of the Recommended Final Budget, the operational plan for year two of the spending cycle is fully set, utilizing a model that is meant to streamline processes and promote performance reflection while maintaining transparent fiscal responsibility. When the Chief Executive Office released details of the County’s first-ever two-year spending plan in September 2018, the financial model went beyond the typical 12-month budget to promote long-range planning and create more time for County departments to manage their financial resources.

Since then, the process of transitioning from an annual budget to a biennial one hasn’t come without missteps along the way, Stanislaus County Chief Executive Officer Jody Hayes said in his 2019-2020 budget message, including unintended confusion, “aha” moments that were too little, too late and the need to determine ways to fine-tune the process along the way.

Embracing vulnerability is all a part of the process, Hayes added, which in turn provides trust and courage to forge ahead towards success.

“In other words, the process hasn’t been perfect and I’m okay with that,” Hayes said. “I am proud of what we have accomplished so far and look forward to realizing some of the benefits of our hard work.”

The final budget proposal totals $1.4 billion in appropriations, with an increase of approximately three percent for all funds compared to last year’s adopted budget and a $17.9 million, or 1.3 percent, increase above the Adopted Proposed Budget for 2019-2020 that was approved by the Board of Supervisors in June.

The majority of that 1.3 percent increase over the earlier draft of the budget, $11.6 million, is attributed to the Performance Visioning Carryover Savings program transfers, which was implemented as part of the two-year budget model and allows General Fund departments to transfer savings realized in year one to their year-two budget at Final Budget.

The remaining $6.3 million in increases is primarily provided in support of public services, including $3.4 million in support to programs and services in the Chief Executive Office, like Countywide initiatives and local agencies, shelter and Census 2020 projects in Focus on Prevention and application and annual licensing activities provided through the Cannabis Program, to name a few. Just over $1.2 million will go towards information technology development, and $1.1 million reflects increased insurance premiums and loss expense costs from the Risk Management Division. An addition $175,000 will go towards Countywide programs and a new Cannabis Manager in the Chief Executive Office.

Budget Year 2019-2020 is balanced with $1.3 billion in estimated revenue and the use of $64.6 million in fund balance/retained earnings, a $3.9 million reduction in the dependence on County reserves when compared to last year’s reliance on one-time savings. The $1.3 billion in estimated revenue included in the Final Budget is an increase of 3.4 percent from the amount projected in the 2018-2019 Adopted Final Budget, and 0.4 percent over the 2019-2020 Adopted Proposed Budget.

The General Fund totals $377.6 million in the 2019-2020 Recommended Final Budget, representing an increase of $21 million or 5.9% over the total from the 2018-2019 Adopted Final Budget. Discretionary Revenue assumes 7% growth in property tax revenue, and stable sales tax revenue. The General Fund is balanced with the use of $20.3 million in fund balance for a total Net County Cost of $276.3 million.

The Final Budget also represents an increase of 20 positions from 2018-2019, but a decrease of 42 positions from the 2019-2020 Adopted Proposed Budget. A majority of the reductions are tied to the Health Services Agency Clinic Consolidation Plan, with other minor adjustments attributed to right-sizing in various departments and agencies.

The County also received a boost from Gov. Gavin Newsom’s May Revise, with the Governor committing to dedicate surplus funds to reserves and one-time spending with targeted investments in priority areas like homelessness, In-Home Support Services and additional resources for disaster response, recovery and prevention. Statewide, Counties are allocated $275 million in funding dedicated to homeless shelters, navigation centers and supportive housing.

Looking ahead, Hayes stated the two-year model is a “leap of faith,” but one that has dedicated more time to long-term planning for success.

“We will continue to move forward with purpose, building upon the strong foundational plan we have laid, and make time to reflect on what works well, identifying areas that could use a little fine-tuning. We will make positive strides and grow from our successes,” Hayes said. “We will also embrace our vulnerability, seeking continuous improvement through the inevitable missteps along the way. We will work to celebrate imperfection, recognizing its ability to serve as a catalyst for learning and creative solutions. I wouldn’t have it any other way.”

The Board of Supervisors adopted the 2019-2020 Recommended Final Budget for Budget Period 2018-2019/2019-2020 – Year 2 with a 5-0 vote on Tuesday. 

Costa, Gray propose congressional bill to address critical physician shortage in rural areas
Costa and Gray
San Joaquin Valley congressional members Rep. Jim Costa, D-Fresno, left, and Rep. Adam Gray, D-Merced, are shown discussing their bill H.R. 2106 in a virtual press conference on Tuesday.

BY TIM SHEEHAN

CV Journalism Collaborative

Two San Joaquin Valley congressional representatives have introduced a bill that could help address the vast shortage of doctors in the region, particularly in underserved areas. 

Rep. Jim Costa, D-Fresno, and Rep. Adam Gray, D-Merced, say the Medical Education Act would, if passed, establish a program of grants to support expanded medical education programs in underserved areas of the nation.

The Valley could be one of the key areas that would benefit from the legislation. California has about 90 primary care doctors per 100,000 residents statewide, the federal Health Resources & Services Administration reported in November 2024. 

That’s more than the ratio in some states, and less than some others. The nationwide ratio is about 84 doctors per 100,000 residents.

But in the San Joaquin Valley, home to about 4.3 million people, doctors are much more scarce – about 47 primary care physicians per 100,000 residents, according to Dr. Tom Utecht, chief medical officer at the Fresno-based Community Health System.

That number is “a little over half of what is necessary to take care of a population,” Utecht said Tuesday in a video press conference. “We have the lowest physicians-per-capita rate in all of California, in the San Joaquin Valley.”

Introduced last month, the Medical Education Act is something of a placeholder for the time being until the Congressional Research Service can weigh in with financial estimates of what is needed in different parts of the country, Costa said. 

A companion version was introduced in March in the U.S. Senate by Sen. Tim Kaine, D-West Virginia, and Sen. Alex Padilla, D-Los Angeles.

At this point, the legislation does not specify how much money will ultimately be sought or how grants would be structured.

Costa said the shortage of doctors in the region “is combined with language barriers, cultural barriers and distances … and that would really go for rural parts of our country regardless where folks live.”

“If you live in rural areas, it’s just more difficult to have access to good quality health care,” he added.

Costa said the legislation, if it can survive a Republican-controlled House and Senate and a Republican president, “would be transformative because it would invest expanded resources to minority-serving institutions and colleges located in rural and underserved areas to establish schools of medicine and osteopathic medicine.”

The bill would also create an avenue for more historically Black colleges and universities, as well as Hispanic-serving institutions, to establish medical education programs, Costa said.

Gray noted that when he was in the state Legislature, he and colleagues “worked to get hundreds of millions of dollars in funding to expand the UC Merced campus, to ultimately secure the funding to put the first medical education building up on campus.”

Gray added that the UC San Francisco’s medical education program in Fresno “is an important part of creating the (medical) workforce of the future for the valley, but more importantly, solving this access to care issue that plagues Valley communities.”

At UC Merced, director of medical education Dr. Margo Vener said there has been a surge of interest in the university’s program that funnels students through an undergraduate program for their bachelor of science degree through a medical school degree in collaboration with UC San Francisco.

“All the students that we are enrolling are from the Valley and for the Valley, because they want to really make a difference in promoting health in their communities,” Vener said. That, she added, is likely to eventually translate to those would-be doctors to stay in the Valley to practice medicine.

“The data suggests that two factors really strongly influence where physicians stay to practice,” Vener said. “One of them is where they’re from, which, of course, is why we’re recruiting students from the Valley for the Valley just to stay (and) be doctors for their community. And the other factor is where you went to residency. Those are the two biggest drivers.”

That’s something that was underscored by Dr. Kenny Banh, assistant dean of undergraduate education at UCSF Fresno. “Regional campuses such as UC Merced and UCSF Fresno not only grow doctors, but they take those doctors, physicians and medical students from their communities in the region, and train them in those regions to go back to be physicians in those areas,” he said.

While the costs of the Costa-Gray legislation are yet to be determined, Banh said there are also costs associated with doing nothing to expand medical education.

“There’s health care costs, regardless of how we work it, if we don’t invest in having an adequate supply of physicians,” Banh said. “There’s a cost on the human that can’t access care” and doesn’t get to a doctor until a condition is not treatable “or with significantly worse morbidity and mortality outcomes.”

“And that cost is borne by health systems taxpayers, one way or the other,” Banh added.

But even if the Costa-Gray bill were to pass in this congressional session, the payoff of home-grown medical schools producing a bumper crop of physicians in the Valley or other deprived parts of the country would be years down the road.

“I think it’s really important to understand why we need to invest now for our future, because it takes so darn long” for a student to go from being a college freshman to a practicing doctor, surgeon or specialist, UC Merced’s Vener said. 

After a four-year bachelor’s degree, a student must then complete four years of medical school, which in turn is followed by a residency of three to five years.

“Then often people will do a fellowship to become, for example, a cardiologist or a gastroenterologist or something like that,” she added.

“If you start investing in just one student now, it’s going to take such a long time before they really are there to take care of you at that moment when you need them to be your gastroenterologist, your cardiologist, your emergency physician, or, dare I say, your family doctor,” Vener said.

That, she said, is why it’s also necessary to expand residency programs that can attract would-be physicians into the region in hopes that they will remain once they complete their training. “We need those doctors now, and that’s why this effort is important,” Vener said, “because this is what will both inspire people to stay, but also inspire people to really come and embrace the communities and serve them.”

In a related development, state Assemblymember Esmeralda Soria, D-Fresno, recently introduced a bill for the University of California system to develop a comprehensive funding plan for expanding the current SJV Prime+ BS-to-MD partnership between UC San Francisco and UC Merced, with the goal of transitioning the program to a fully independent medical school operated by UC Merced.

“We have seen firsthand the impacts of medical workforce shortages throughout the Central Valley,” Soria said in a prepared statement. “AB 58 would help ensure the Legislature is equipped with the information needed to secure appropriate funding for the medical education provided for our community at UC Merced.”

— Tim Sheehan is the Health Care Reporting Fellow at the nonprofit Central Valley Journalism Collaborative. The fellowship is supported by a grant from the Fresno State Institute for Media and Public Trust. Contact Sheehan at tim@cvlocaljournalism.org.