down. Heat. Heat. Heat. Heat. Heat. Heat. Heat. Good morning. Good morning. Welcome to the New York City Council hearing on the committees on health joined with mental health and substance use and disabilities. At this time, please silence all electronics and do not approach the deis. Again, please refrain from approaching the deis. If you're testifying today or have any other questions or concerns, please contact the sergeant-at-arms. Thank you for your cooperation. Chairs, you may begin. >> Good morning, everyone. I am council member Lynn Schulman, chair of the New York City Council's Committee on Health. Thank you all for joining us at the fiscal 2027 preliminary budget hearing for the office of the chief medical examiner OCME. I would like to thank chief medical examiner Jason Graham, his staff and everyone who is with us today. I want to acknowledge council members are Kaban Epstein Felder and Narcissis is virtual. OCM's fiscal 2027 preliminary budget is $121.6 6 million, which includes close to $91 million for personal services and $30.7 million for other than personal services. OCE's budget has increased by roughly $916,000 compared to last year's fiscal 2026 adopted budget. While there has been an increase in overall funding, several areas within the AY's operations raise important questions about whether current resources are sufficient to maintain timely service delivery and support OCME's core mission. One area of concern is the absence of federal funding in the fiscal 2027 preliminary plan. OCE has had federal grants in the past, but none are currently reflected in this financial plan. Historically, these grants have supported activities such as forensic research and work related to the city's response to the opioid crisis. Although federal funding is often a often added during the fiscal year once grants are awarded, the absence of these funds in the preliminary plan creates uncertainty. We want to ensure that OCME has a contingency plan in case the loss of federal grants becomes permanent. Performance trends reported in the preliminary mayor's management report also indicate that several key operational metrics have worsened. The medium median time to complete autopsy reports has increased to 122.5 days, exceeding the AY's 90-day target. The median time for medical legal in investigators to arrive at a scene has risen to 2 hours and 36 minutes in the first four months of fiscal year 2026. In addition, the forensic biology laboratory has experienced longer turnaround times for DNA case work with median completion times rising from 51 days to 79 days compared to the same per period in fiscal 2025. Staffing shortages appear to be a key factor behind these trends. OCM currently has a vacancy rate of 15.1% with 734 of 865 budgeted positions staffed. The loss of experienced medical examiners due to retirements, recruitment by other jurisdictions, and a nationwide s shortage of qualified forensic professionals has placed additional strain on the agency's workforce and may contribute to delays in case processing and report completion. In 2024, I wrote to OCE to increase medical examiner salaries to help address the professionals. These concerns remain relevant today as the agency continues to face challenges filling highly specialized roles. OCE does excellent work for the city and as chair of the health committee. I want to ensure that OCM has the resources it needs to operate at the highest level. Before we begin, I would like to thank the finance staff Lazaro Rodriguez, Florentine Kabor, Anisha Wright for their work on this hearing and committee staff Chris Pepe, Elizabeth Arts and Joshua Newman for their support. Finally, I would also like to thank my staff, Jonathan Buché, Kevin Mleia, and Sammy New. I will now turn it over to the committee council to administer the oath to members of the administration. >> Thank you, chair. Good morning. If you could all please raise your right hand. Do you swear to tell the truth, the whole truth, and nothing but the truth before this committee and to respond honestly to council member questions? >> I do. >> Thank you. You may proceed. I'm free to proceed. Good morning. Good morning everyone. Good morning uh Chair Schulman, Chair Kaban, Chair Hennef, and members of the Committee on Health and the Committee on Mental Health and Substance Use and Committee on Disabilities. On behalf of the Office of Chief Medical Examiner or OCME, thank you for your ongoing support and partnership across our 247 mission to serve the communities of New York City in the times of most profound need. I'm Dr. Jason Graham, the chief medical examiner for the city of New York. With me today from OCME, our first deputy commissioner, Nicholas Schulz, and Deputy Commissioner for Administration and Finance, Ivonne Williams. We appreciate this opportunity to provide an update on our budget and important current activities and look forward to answering your questions. When we testified uh last year, I introduced OCE cares which was our then newly adopted set of core values. These abiding principles of commitment, accountability resilience excellence and service inform every aspect of our work and guide our interactions with all stakeholders. This year, the agency's particularly focused on the core value of excellence, striving day in and day out to achieve the highest quality in all aspects of our work at the intersection of public health and justice. Excellence raises the bar for what a medical examiner's office can achieve for the communities who rely on us during the most challenging moments. Our vision is to deliver innovative solutions to the most pressing problems in public health and forensic science provided by caring professionals and readily available for all New Yorkers in need. I'd like to take this time today to share more about our planning and progress toward this vision of excellence accessible to all. OCME is home to worldclass fully accredited laboratories that support our mission to deliver timely and accurate answers for stakeholders. Our molecular genetics laboratory is the only facility of its kind in the country in a medical examiner's office which was a trailblazing envision trailblazing vision established in 2013 2003. The molecular genetics laboratory examines the DNA of deedants who often very young and otherwise healthy die suddenly and without apparent explanation to determine whether there might be a genetic reason for their deaths. Until recently, our lab could only deliver the news of a genetic cause of death and urge family members to seek testing for themselves. But with our focus on accessible excellence, we recognize that we can and need to do more for New Yorkers we serve. Now, with the launch of our genetic intervention family testing services program known as gifts, OCME can screen living at risk blood relatives at no cost, provide appropriate clinical genetic counseling, and connect them to potentially life-saving care, closing a critical gap in services, and we expect to begin testing our first family members very soon. Working to prevent deaths may sound novel for a medical examiner's office, but for OCME, helping New Yorkers live longer and healthier lives is already part of our mission. OCME contributes to public health by providing impartial data from our forensic investigation that informs policy and through many of our own ongoing innovations, specifically in the effort to reduce deaths from drug accidental drug overdose. Our drug intelligence and intervention group, known as DIG, works with surviving loved ones and close contacts in the days and weeks following an overdose death, offering them support, resources, and often simply an ear to listen. Staffed by social workers, epidemiologists, and program specialists, DIG leverages the unique relationship of trust between our office and the communities we serve, reaching more than 4,000 close contacts to date, nearly threearters of whom have accepted direct services and referrals to potentially life-saving interventions. As we move forward and deaths from overdose hopefully continue to trend downward, DIG offers a pioneering and proven model for how OCE can utilize datadriven insights to help additional populations in New York City affected by a whole range of public health challenges known to have a social component. We aim to make this excellence in service with its life-saving potential cutting across all walks of life available to all. The success of our mission depends on strong relationships with the community. And as we progress in excellence, our journey is expanding the trust necessary to advance our advance our work. Well over a year ago, we began to implement post-mortem CT scanning to elevate standards in diagnostic service. And I'm pleased to report that this technology has now been fully integrated into the practice of forensic medicine on the part of our medical examiners at OCME and is in daily use in our pathology centers where it's making a difference in our partnerships with the community. CT scanning is one of the many steps that we've taken to improve the working experience for our medical examiners, the highly trained forensic pathologists who directly deliver answers to families in the wake of a tragedy. As you know, OCME has been grappling for several years with a serious shortage of medical examiners, a problem that's rooted in a multifaceted national crisis that will not be fully resolved in the immediate future. However, we're pleased to report that our renowned forensic pathology fellowship training program remains a beacon for training and recruitment, attracting talented and caring physicians who want to pursue their specialty here at the most comprehensive and complex medical examiner's office in the country. OCM has filled all six of our coveted fellowship seats for the academic year 2026 2027, and we continue to hire medical examiners to serve New Yorkers from the ranks of our graduates each year. Our planning for the science park and research campus or spark kips bay project is also actively underway. This firstofits-kind health and science campus will become the new home of our Manhattan forensic pathology center and supporting facilities serving as a training hub for the next generation of leaders in forensic science and medicine. OCME has been part of the p of the bustling public health corridor in Kips Bay neighborhood for more than a century and we're excited to be partners in this transformative next step in life sciences innovation and workforce development for our city while raising the bar for forensic science and medicine. OCM also stays grounded in our foundational purpose to provide answers for communities facing the most challenging times no matter how long the mission takes. Few instances show the depth of this commitment more than our ongoing efforts to solve the coldest cases of missing and unidentified persons and return them to their loved ones. Since 2017, our cross departmental cold case team at OCM has newly identified more than 130 individuals, many from decades old cases missing from as far back as the early 1980s across all burrows of the city, including 20 victims of homicide. leveraging our in-house expertise in identification investigations forensic anthropology, and DNA science while tapping into partnerships with law enforcement, and other agencies. We're bringing long-sought peace to families and justice to those affected by crime. Our commitment to families is not limited to the office and the laboratory. We're also reaching into neighborhoods to bring assistance to those in need at no cost. For more than a decade, our annual New York City Missing Persons Day event has made expert resources and support services available in person to families and friends seeking long-term missing loved ones. Credited with dozens of identifications since its start, we brought New York City Missing Persons Day to Queens for the first time last October. This event connected more than a dozen families with confidential help, bridging a gap for those still in need of closure. The cold case and missing person's work of today extends directly from the lessons of our experience with the World Trade Center disaster of 2001. In the aftermath of the attacks, the pressing urgency to identify the 2753 victims pushed the frontiers of DNA science and continues through the present moment. An enduring testimony to excellence. The scientific legacy of the unprecedented World Trade Center identification effort informs current active forensic casework as well as our cold case efforts. While we also continue to identify those killed on September 11th. Over the past year, OCM made three new identifications of victims from the attacks on the World Trade Center in 2001 and linked dozens of remains to previously identified individuals. The new identifications representing the 1,651st, 52nd, and 53rd persons identified resulted from renewed family outreach and advanced DNA analysis of recovered remains. The remains of 1,100 victims of the disaster have yet to be identified. But as we approach the 25th anniversary of this day that changed our city and the world forever, we continue to make attempts reaching out to new generations of family members undeterred and undaunted by the passage of time. We honor their memory with our work to remember, reflect, and renew. Thank you for the opportunity to testify today, and we look forward to your questions. Thank you. Thank you very much. Um, we've been joined by uh, council members Joseph, Marte, and Lee and our public advocate, Jamani Williams. Uh, public advocate, you want to make a statement. >> Uh, thank you, Madam Chair. As mentioned, my name is Jamani Williams, public gather of the city of New York. Want to thank uh Chair Scholman Kabana Hanife as well as the members of the committees on health, mental health, and disabilities uh for holding this hearing today and allowing me opportunity to testify. As New York City faces new challenges in navigating public health emergencies without data and resources from the federal government, it is imperative that we invest in our public health systems. The FY27 expense budget for the Department of Health and Mental Hygiene and DOH sees a 13 point, excuse me, 59% decrease in funding from FY26 with proposed funding totaling 2.5 billion down from 2.7 billion. While the administration's preliminary budget does baseline critical funding for child care, food assistance programs, and the newly launched 2K initiative, this budget fall also fails to fund many programs that saw one-year investments in FY26, including but not limited to the maternal health campaign, crisis respit centers, and the NYC 988 crisis intervention and suicide prevention hotline. While we understand that the FA city faces a budget crisis, we must grapple with the reality of what these new cuts entail, especially after three years of sustained pegs under the previous administration. The state's expanded funding for mental health is heartening to see, especially for the commitment of 750 million in FY27 and 500 million annually thereafter for the healthcare stability stability fund HSF. While this help will help to mitigate some of the losses expected from the big ugly bill, projections remain worrying. Hundreds of thousands of New Yorkers will be left uninsured in an expected loss of generated in economic activity to the tune of 14.4 billion with direct cuts to hospitals and health systems totaling 8 billion and more than 65,000 jobs lost in hospital and other community health centers. In addition to HFS, the governor's budget also proposes integrating care for mental health and substance use disorders, increasing resources for sub supportive housing, and supportive nonprofits that serve New Yorkers by ensuring reimbursements are consistent and timely. These changes will not only help serve New Yorkers experiencing psychiatric illness, but also those suffering from substance abuse, two groups that face many barriers to care, including lack of access to stable housing. I look forward to hearing from DOH on what the agency is doing to prepare for the impact of these federal cuts and furthermore how the city can work with our state partners to ensure that we meet we're meeting the needs of New Yorkers. Before I move on, I do want to raise the issue of the new health care plan ratified by the municipal label committee back in September. Since implementation of the city of New York health benefits program, I've heard countless issues raised by city workers as well as medical professionals frustrated with navigating this new system. covering 750,000 city workers. This plan promised to cut the cost of the city's primary healthcare plan by more than 10% while expanding coverage and benefits. But coverage and benefits have been negatively impacted for many. And I'm believe the city must keep a close eye on how this program affects our bottom line and the people supposed to serve. Lastly, I'd like to briefly highlight that we should be moving away from. Last week, the federal government announced a new plan to allow the Department of Veteran Affairs, VA, to initiate guardianship proceedings in state courts for veterans who have no family and are unable to make their own healthcare decisions. Last year, as part of FY26 state budget, Governor Hokll insisted on expanding the criteria to involuntarily commit someone for psychiatric treatment. And in 2022, Mayor Adams announced a new policy to hospitalize homeless people deemed to be quote unquote in psychiatric crisis. Each of these attempts fails to recognize the harmful effects of involuntary treatment. Research shows that involuntary commitment can negatively affect a person's earnings which leads to poor outcomes. It can also show distrust towards health care which is problematic when a person needs continued care outside of the hospital. In some cases, involuntary treatment can be a life-saving tool. But every person with their mental health condition is different. There is no perfect solution. I look forward to working with the administration to ensure that those in need of care are met with compassion, dignity, and that we really increase uh the the structure both uh actual structure and funding so we can really push on the continuum of care that's needed and take away the cycles of hospitalization and Rikers and get folks the care they needed the long term. Thank you for giving me the opportunity to speak. Thank you. >> Thank you, public advocate. And we're we're first doing um office of the chief medical examiner. will make sure that we um if you're not here when do comes that we'll give your remarks to him. >> Thank you and chief medical examiner. Thank you for listening. >> Okay. Thank thank you public advocate. Appreciate it. So, um now we'll get to questions in the fiscal 2027. Oh, and by the way, I just want to clarify that when I announced that we were joined by Council Member Lee, she's actually our finance chair. So, I want to make that distinction. Um thank you for joining us. Um, in the fiscal 2020 >> finance chair, what? Oh. Oh. In the fiscal 2027 preliminary plan, OCME has a budgeted headcount of 865 positions. As of January, the actual headcount was 734, reflecting a vacancy rate of 15.1% and 131 vacant positions. Can your office provide the committee with a breakdown of the 131 vacant positions? Yes, we have um vacancies in various areas uh that are largely a result of new positions that have been added to our headcount that we're actively attempting to fill. We in uh those new resources have a concentration of positions in our forensic operational areas. Um, and we will be able to uh follow up and provide you with a specific breakdown of our current vacancy mortuary to investigations to um other operational areas. So, we will follow up and provide you with a specific breakdown. >> Please, that would be very helpful to us as we move forward in the budget process. Um, on average, how long do these positions remain vacant? >> It's um it varies depending on the position. Many of our positions um at OCME um require very specialized skill sets uh across forensic science, medicine um investigations and so uh the recruitment and of people with the these specialized skills sometimes takes time. Uh and so there wouldn't be a uh a one-sizefits-all answer to that. I think that it varies and we work as quickly as we can uh once we've identified suitable candidates and have offers that have been accepted to get them on board, get them acclimated and trained and in service as soon as we can. >> How are these vacancies affecting operations? >> Well, again, there there's minimal impact to operations at the moment because these are largely new positions that we're still recruiting and hiring for. So, the operational impact at this point is minimal. How is OCE advertising their job up openings? We have um not only through the routine uh posting of our jobs and city sites but we also um directly uh out reach out to areas to forensic organizations such as National Association of Medical Examiners Association American Association Forensic Sciences uh the specific forensic organizations uh and colleges who are graduating students in the sciences that may be uh suitable to uh to fill some of the roles in our laboratories and and across our agency. So, we have a multi-pronged approach through uh our human resources team to reach out to uh an entire variety of potential sources of OCM staff. >> How many positions are temporary and what is the rationale for hiring temporary positions versus full-time employees? >> We have a uh relatively small number of uh pdium or temporary positions. I can get back to you with a specific number >> if you could. >> Uh many or at least a fraction of those uh positions were um came on board in that uh in that temporary role during COVID. >> Um and so that was uh during the pandemic uh in many instances, but we'll get back to you with the specific number. >> Okay. No, that I appreciate that. Um the I I actually have a question. It's not on here, but does the HB1 um for immigrants affect because I know it affects the medical industry as a whole, the waiver. Does that affect your operation? >> We've um have a very few uh members of our professional staff who have um H1 visas. >> Okay. We um have had medical examiners and others on visas in the past and u to the extent we can support that we do but um it it can in certain instances present a challenge for us. >> Okay, that's something that um the health committee I think is going to look into and try to be helpful. Um so we can talk offline about that. The current fiscal 2026 budget added 25 positions including including two public health epidemiologists and 23 criminalists. What is the status of hiring for these roles and have they all been filled? >> Yes, there's uh these these positions are um grant-f funded uh positions and 23 of the 25 um have been selected. So, we're very close to having all 25 of those positions. >> With the two for one hiring policy lifted in the preliminary plan, do you anticipate vacancy rates declining in the near term or will Mayor Mandani's instruction to cut vacancies by 50% impact OCME? >> Well, we're with our uh chief savings officer. We're we're continuing to develop a very strategic approach to uh addressing any vacancies uh or headcount reduction. We're working closely with OM uh and that's all in an effort to make sure that our critical functions, the critical most positions in our agency are um are maintained and our services are uh to the city are not compromised in any way uh or reduced. Um we also feel that the uh removal of the two 2:1 uh hiring uh uh policy is is going to positively impact uh our vacancy rate. We believe that we can identify those critical roles and now with greater flexibility hire them. Um but we're going to be focusing on uh making sure that our services are not uh compromised or reduced in any way in in terms of our critical uh role in the city. >> Okay, great. Um, OCME's current fiscal 2026 budget reflects $4.2 million in federal funding to support various grants. However, the fiscal 2027 preliminary plan does not reflect that funding. Of the $4.2 million, excuse me, how much of this funding supports postconviction DNA testing, opioid abuse, and forensic research? >> Well, that uh $4.2 $2 million represents um the budget uh provided by 16 federal grants. So we have 16 federal grants um and that uh um is a combination of different uh types of grants supporting the work that you mentioned but uh that is uh our current um funding uh for from the federal government in in the form of grants. So we have 16 grants. We are anticipating that four grants previously that reached their the end of their term. Uh we've asked for renewal and uh been granted those who are anticipating that we're going to have additional grant federal grant funding beyond that. >> If can you provide us not here but can you separately provide us with what that $4.2 million pays for at OCE? That would be very helpful to us. >> Certainly. >> Thank you. Um because we can also be advocates as well. Um, does OCME anticipate receiving any federal grants for fiscal year 2027? You kind of answered that. >> Yes. >> Great. Again, we can also be helpful there. Um, when do you anticipate the grants to come through? You have any sense or >> the allocations from the grant will come through? At the beginning of the fiscal year. So they what's not reflected at the moment when the fiscal year uh renews that funding will be allocated from those grants based on what will be uh needed for that year. >> Okay. And also let us know if there's any changes because I know the federal budget fluctuates on a day-to-day basis. So um does OCE have a do you have a contingency plan if the federal government withholds funding? >> Well, we've we've not seen any any indication of that uh at this point. In that event, we would want we would certainly work very closely with OM and potentially the law department to mitigate any of those um reductions. Um I think that we um again are going to wait for any we're going to monitor closely for any indication of that and then we would immediately be in conversations with OM uh to strategize to again uh prioritize our critical positions and make sure that our services are not reduced. >> Do you have do you also have state grants categorical? >> We do. We have we have three uh state grants uh which account for 1.2 roughly $1.2 million in our uh FY27 budget >> and you don't expect any issues there, right? >> No, we do not anticipate any issues with the state. >> Yeah, if you can give us a list of not just the federal but the state. So, just so we have a sense, I appreciate that. >> Certainly. >> All right. Code blue deaths. Clo code blue weather emergency notice is issued when the temperature drops to 32 degrees Fahrenheit or less between 4 p.m. and 8 a.m. which we've had a lot of unfortunately. Um no one experiencing homelessness who seeks shelter during a code blue in New York City can be denied. On February 12th, 2026, Mayor Mamani announced that 19 people died to the extreme cold weather that began in late January. Were OCE seen arrival times affected by the snow? We um our our our scene arrival times um were not affected by uh the snow. We were able to respond um to death scenes. Um we activated our continuity of operations plan and we were able to to to continue to meet uh the need in the field. We uh dispatched our death investigation teams uh as routine and they were able to successfully um conduct scene investigations. Um and so the and and much of the traffic that is often seen in the city was reduced during that time. So our our our transit to the death scenes were not impacted and so our response times were not meaningfully um impacted uh due to the snow. We did triage cases and make decisions about uh the u priority that certain cases take uh over others as we do in routine work and um so we we were able to fully respond and we continue to perform autopsies in our forensic pathology centers as routine uh again through activation of our coupe plan. >> Thank you. Have all individuals who passed away been identified yet? Well, we're talking about the uh you're referring to the um individuals that were uh discussed in the previous hearing. Yes. And those were individuals who died who were outdoors and >> un uh >> either unhoused or certainly not in a residential setting. >> Yes. >> Yes. And so there those it we were during that period we investigated a number of those cases. At this point there have been 16 individuals who have been confirmed to have died of um hypothermia uh under those conditions and all 16 of those people have been identified. >> Okay. And and the others were was separate. What was the the other three? >> Those uh were turned out that they were not hypothermia related. So we investigated many cases and we've confirmed that 16 of those outdoor non-residential deaths were due to hyper. The other three, even though they weren't due to that, um, were they identified? >> Um, I would have to get back to you on that, but I I we're quite successful in getting in getting uh people identified, so I would I would say likely, but I will have to confirm that. >> Did OCM observe any trends in the locations or circumstances of these deaths? Well, there were uh there were little differences in terms of the um locations across at least uh four of the five burrows. Staten Island was relatively spared, but across Manhattan, Brooklyn, uh Bronx, and Queens, uh there were there was a relatively even distribution. There was also a relatively even distribution across um racial categories in the city. One thing that we did see was that among that group, among that 16, all but one of them were men. Um, and so that was something that was uh that was noted. And we also um out of the 16 uh there were 11 of those individuals that uh alcohol andor drugs or a combination uh were involved. And so those are I think some of the meaningful uh trends that we observe. >> Okay. Um during the hearing on code blue on wait let's see. All right. I'm going to talk to you about an issue that's come up before about um emergency vehicles and response time. So, OCME vehicles are currently not eligible to be designated as emergency vehicles with sirens and lights, which can delay both arrival at scenes and return to headquarters. What criteria must OCE vehicles meet to be designated as emergency vehicles? Do you know? This would require that the state the New York state vehicle traffic law uh include medical examiner designate medical examiner vehicles to be uh response vehicles. And if that designation uh occurs by a change in the state law, um we would have the authorization then to have to to to be equipped have our vehicles equipped to be emergency response vehicles. Um, and that is something we're certainly interested in pursuing. It would help with our response times to scenes. Um, and aside from that, we would be uh prepared to go forward. >> Is the mayor's office um have you had conversations with them about that or >> we have we have had conversations around the fact that this is on the legislative agenda? >> Okay. >> And uh certainly any support would be appreciated in that regard. >> Sure. Absolutely. We can talk about that offline, but definitely um how much would it cost to equip every OCM vehicle with an alarm? Do you do you have that? >> Um I can get back to you with that. We've at different points looked looked at that uh cost estimate so we can follow up. >> And does OCE have oversight or coordination responsibilities related to EMS response times? We um I would have to defer to FDNY or or EMS on on EMS response times. >> Okay. Okay. Um are there any steps you've taken to support EMS? Yes. I think we we work very carefully and closely with EMS in the field and I think to the extent that we can uh improve our response times, it helps EMS uh in in being able for for their teams to get back in service and uh help others. >> Okay. Um how do delayed response times impact OCM operations and case processing? Well, really uh with respect to EMS response times, it that that doesn't directly impact our uh our response. A death occurs, pronounced uh death by EMS and then cases are reported to us generally by the police and then we respond in a coordinated way after that. So they have minimal impact on us. >> Are there staffing or fleet shortages contributing to delays? >> Again, I I would have to defer to EMS about that. >> Okay. What is the total number of OCME's fleet and does its motor pool have enough vehicles? >> We have uh we have 48 vehicles in our fleet and that is adequate to keep uh transportation vehicles investigations vehicles going 24/7 365 at this point. >> Okay. So OCM's motorpool has a budgeted headcount of 26 but its actual headcount as of January is nine. So this brings the vacancy rate to 65.4%. 4%. What are OCE's efforts to lower the vacancy rates and what job openings are currently posted? >> Well, we have various roles uh at OCME uh with respect to who is uh operating our our vehicles. And so that could range from members of our mortuary teams to motor vehicle operators. And as I mentioned earlier, we've got a a number of vacancies across our forensic operations areas uh that we're in the process of recruiting and hiring for. And so uh the hope is that uh that vacancy uh those vacancies along with the others we've already discussed will be uh will be filling. >> Okay. I also want to state we've been joined by uh council member Oay. Um, in the fiscal 2027 preliminary budget, OCME has 23 contracts totaling $3.1 million for general maintenance and repairs. Additionally, the plan also includes $210,000 in capital funding for vehicle replacements. What services are covered under the maintenance and repair contracts? Those uh general maintenance and repair contracts are um really centered around uh our facilities. Uh so three primary areas facilities and the uh maintenance and repair of our facilities, IT uh infrastructure uh and uh improvements and laboratory equipment. So those three major areas account for that uh general maintenance and repair uh budget, IT, IT infrastructure, uh facilities and um laboratory equipment. >> What uh do any of these contracts include maintenance or repair of OCM vehicles? >> No, we um work with Dcasts uh with respect to the maintenance uh and repair for our fleet of vehicles. Uh, so do you, the question I'm trying to get at I think is do you need more vehicles? Um, and and the question then becomes instead of doing the maintenance on these vehicles, would newer vehicles cut down that cost and be more efficient, more effective? >> Well, I think that we um, again, we work really closely on keeping our vehicles maintained. We have a a fleet of vehicles that has is a r has a range of ages. Some of those vehicles uh used more or less frequently. Uh disaster response vehicles for example um that may not necessarily be in circulation every day thankfully. Um and so I at the moment we're u fully um capable of responding to scenes on a routine basis in the field as well as um in an in a disaster situation. And at the moment I I I I see no uh challenge with respect to having our vehicles maintained and repaired and keeping a fully functional fleet of vehicles in circulation. We're just trying to see because sometimes it's less it's more effective to have a new vehicle and as opposed to putting all of the maintenance into something that >> Well, we've also had new vehicles added to our fleet in recent times. Yes. >> Okay. All right. Thank you. Um I'm going to go uh to the mayor's preliminary management report. Um the median time for scene arrivals by meta collegal investigators was 2 hours and 36 minutes in the first four months of fiscal 2026. while it took 2 hours and 25 minutes during the same time period in fiscal 2025. In addition, the median time for fiscal 2024 as a whole was 2 hours and 13 minutes, which in fiscal 2023 it was 1 hour and 37 minutes. So, what factors resulted in OCM's longest scene arrival time? >> Well, our uh scene arrival time is very variable based on several factors. Um in in many instances our scene response is a coordinated effort with um the police. Uh in certainly in suspicious cases or cases that are criminal there may be a uh a need for crime scene to attend a scene and do their work before we respond. Um so there are there are coordinated efforts that need to go into our response time. I think uh that's one factor. Another factor is what we've already alluded to in terms of our ability to traverse the entirety of the city, all five burrows, dispatching our medical legal investigators from a single location in Manhattan. And the ability to navigate depending on the time of day, navigating traffic to get to death scenes um across the city um is uh has been a factor. staffing with respect to the number of death investigators that we have that has uh improved and so I'm expecting that there is uh and as we continue to hire those positions in forensic operations and expecting our response times to to reflect that as well. >> Great. We'll look forward to that. Are there specific neighborhoods that take longer for an investigator to arrive? Well, I think, you know, again, being dispatched centrally from uh Manhattan, there are, you know, the far reaches of the city that we have to we have to attend death scenes. And depending on the time of day, that can uh that can be a challenge, but um we we get to the scenes as quickly as possible once we're notified of the death. Again, in that coordinated effort with the other stakeholders. >> Okay. Currently, the PMMR does not track whether scene arrival times differ when responding to calls at morgs versus private locations. Is this something that you track internally? >> Calls uh in response to >> to a body in a morg. >> Yeah. >> Versus a private the what I'm getting at is that it's emotionally like difficult when somebody's in a private residence or or or a public location as opposed to you're picking up a body at a morg. That's >> absolutely and that is our we have a a set of triage priorities. for cases that are reported to us, deaths that are in hospitals or nursing homes or other settings that have uh storage. Those are they the cases that are in public view or in in people's homes are are top priority to res for >> but do you track do you track the response times for each of those? Do you separate them out? >> We do. >> Can you can you get us some of that um information? That would be great. Um, was there a specific event in fiscal 2025 or fiscal 2026 that resulted in longer wait times or again it's back to what you were saying earlier? >> It's it's the same uh factors that I was mentioning before and I think there are also occasionally events that require multiple resources being uh utilized at a single time that can reflect some of those numbers. uh for example, response to the Midtown shooting incident, which was a complex sort of protracted death scene and certain instances that require multiple resources can also um have a have an effect statistically on some of those figures, but primarily what we were referring to before, >> the PMMR indicates that the medium time to complete autopsy reports increased by 46% in the f first months of fiscal 2026 compared to the same period in fiscal 2025. 5 reaching 122.5 days. According to the report, this delay is primarily attributed to the loss of approximately one-third of medical examiner staff due to retirements, recruitment by other jurisdictions, and a nationwide shortage of qualified medical examiners. Um, you hired I think you hired several MES last year. Is that correct? >> We did. Um, we uh >> Does the PMMR accurately reflect that you experienced a 33% decline with that position? >> We we've we've lost over the course of two years um essentially a third of the medical examiner staff. We have reconstituted that staff by a number of positions, but we're still, as I've testified here before uh many times now, the in in the midst of a crisis nationally, and that's that's a crisis that we're not spared of locally. Um we are doing many things to mitigate that. Um and I'm pleased with the negotiation that took place on the part of the uh doctor's council with the city to provide better uh salaries for our medical examiners uh increasing our ability to recruit and retain. >> We've also added locom tenants uh pathologists who are trusted doctors that many most of whom we've trained who are coming on to support the doctors we have on staff. And we've also um reorganized in many ways our operations to provide better support to our onstaff doctors uh to make them more easily able to focus on the work of being a medical examiner and reduce their administrative workload in order to uh produce uh a reduction in these turnaround times >> and we we we got the OCM salaries increased that time. Are they competitive now or we still need have work to do? they're far more competitive. I think that this is an ultra competitive environment uh when it comes to uh forensic pathologists. And so I'm uh the contract is going to end in 2026. And so I'm hoping additional negotiations will take place around the um around the salary issue in the next uh contract negotiation. >> What's the starting salary for OCE medical examiners? Well, the we hiring out of uh fellowship. I'll have to get you that that detail, but the um the high end of the salary range for a boardcertified forensic pathologist is at uh 277. >> Okay. Do you do you know what the average is around the country? >> That has been fluctuating and rising over over the past few years as you might imagine. We'll uh we can provide data. >> Okay. just so we have a comparison so we can maybe help be helpful there. Um, what is the current size of the autopsy report backlog? >> Well, the the definition of backlog for me would be those autopsy reports that are not complete um after our target turnaround time of 90 days. >> Okay. >> And so we have there are a number of those cases, but we're moving in the right direction. I will get back to you on the on the current number. >> Okay. Great. All right. I'm going to talk about the drug intelligence and intervention group um which you mentioned in your opening remarks. Um the mayor's management report and preliminary mayor's management report tracks agency performance and service delivery across the city since its launch in late 2022. through OCM's drug intelligence and intervention group has played a key role in the city's overdose response by connecting surviving family members and close contacts of individuals who died from overdoses to grief counseling, social services, and treatment referrals. Um during the first four months of fiscal 2026, DIG reached 474 individuals, a 35% decrease compared to the same period in fiscal 2025. The PMMR attributes this decline to an over overall reduction in citywide overdose deaths and a 50% staffing reduction. Is DIG supported by opioid settlement funds still? >> Yes, it is. >> How much is allocated to the program? And is the funding time limited or is it ongoing? >> I'm I'm very pleased to say that we've had $4 million of opioid settlement funding uh added to our baseline budget and that will go nowhere. We will have that uh every year going forward and that incorporates the dig which um accounts for 11 headcount uh at our agency um as well as um other areas across the agency that support overdose related work and um so uh we're we're pleased that that has been baseline into our budget. And >> are all are all 11 positions filled or some vacant? We we have seven uh positions filled. Um and you alluded to a uh a staffing shortage, a 50 up to a 50% staffing shortage earlier, and that was on some levels uh related to a shortage of social workers. One of our our family services team um who is responsible for outreach to families composed of social workers and other support services. And so the shortage of social workers I think impacted uh those uh those vacancies. So we had seven full-time um uh people who are on board now. Four vacancies and I'm pleased to also report that those four uh vacancies we've had we have identified individuals to fill those and are in the process of filling. >> Great. Um by the way I just want to acknowledge we've been joined by council member Janeiro virtually. Um do you have the job titles of the vacant position? So can you get us those? Uh there are two social workers and two uh data team members. The specific titles for the data team members will get back to you. >> Okay, great. Um beyond the t the decline in overdose overdose deaths and the reported staffing reduction, were there any other factors that contributed to the decrease in individuals reached? >> I think that those are the two u primary factors. I think we also um generally speaking have sometimes challenges in reaching families. We um our dig team comes in after we've done a death investigation at the scene and we have contact for families. Some families wish to talk with us and and others may not. And so there are uh inherent challenges in doing that outreach work that could affect uh the number of people we're able to reach. >> Okay. Um, HealthyNYC sets a goal of reducing opioid overdose deaths by 25% by 2030. How has DIG contributed to progress toward that goal? >> Well, um, I feel that the work that the DIG uh, team is doing and particularly on both the data uh, side, sharing data with partners uh, uh, stakeholders to be able to use that data to then implement programs and policies in in various public health and p public safety agencies. uh has been directly contributo. I think even more uh directly uh impactful uh with respect to the uh increase of the life expectancy of New Yorkers and saving lives is the work the outreach work that our family services teams are doing to families who are bereaveved following the loss of someone uh to a drug overdose. The this is a unique population uh that has a range of needs across the spectrum of right social service needs from uh suicidal uh uh tendencies to substance use uh uh issues that need attention and the work of our social workers and the ability of social workers to contact those folks and refer them to care uh is I think active prevention life-saving work. And so I think that on those levels uh we have uh we've contributed on the part of the dig team and the dig team has also now uh an even higher level of engagement with families. Now over 80% of the of the families that we reach 80% over 80% are now accepting services of some sort. uh be that even grief and bereavement support ranging up to you know referral to health care for mental health services or substance use uh uh treatment. >> What trends is DIG currently observing in overdose deaths including changes in substances involved or demographic patterns? Anything? Well, um while we're very pleased that we've seen a reduction in the number of overdose deaths in the city um over the past couple of years, that trend is certainly moving in the right direction, >> right? >> However, the overdose crisis is not over. Uh the opioid crisis is not over. We are still seeing uh over 2,000 deaths in the city uh due to unintentional drug overdose. Um there has been and I and I would defer to the health department for the official uh statistics. Um but it's been seen uh clearly that areas of the city that are uh impoverished have disproportionately been impacted. Um older black men have been disproportionately impacted. And while this crisis is still being driven by fentinil, >> right? Um, we are also continuing to have to monitor what drugs are on the street, what drug combinations are uh with fentinil causing these fatalities, right? >> And the appearance of new drugs uh in uh on the illicit drug landscape are are of consistent concern. and the novel benzo benzoazipines, the synthetic opioids, um novel psychoactive substances. We're continuously monitoring for those and um sharing that data with our partners so so people can be aware of what's going on um on the street and what combinations of drugs are killing people. >> Okay. No, thank you. Um Council Member Oay, you have questions. >> Thank you so much, Chair, and good morning. Thank you so much for your testimony. Uh my constituents are concerned about the closure of the Crown Heights Clinic. I know that this happened last year, but there are still persistent concerns around its closure. This clinic provided a variety of key healthc care services uh that my >> council member, this is Office of Chief Medical Examiner, not DOM. >> Oh, DOMH is not my apologies. I saw the confusion on your face. Um I will forward my questions. >> I can ask them for you. >> Thank you very much. I appreciate that. >> No, no worries. >> Thank you. >> Okay. Um, any other uh council members have questions? >> No. >> Thank you very much. Very thoughtful responses. We really appreciate all the work that you do and um I still, you know, I know that you've asked us to come out. We will come out to um to take a tour so at some point. So, thank you >> anytime. Thank you very much, chair. Thank you all. We're we're going to be taking a fivem minute break and then we're going to be doing um Department of Health and Mental Hygiene. Thank you. Please keep your noise down. Keep the noise down, please. We still have a hearing rolling. Please keep it down. Now, I would like to welcome the Department of Health and Mental Hygiene and its commissioner, Dr. Alistister Martin. DOH's fiscal 2027 preliminary budget totals $2.51 billion, which represents approximately 1.9% of the city's budget. Funding for public health services totals $1.54 billion. A net increase of 57 million compared to last year's adopted budget. Of this amount, $53.2 million is for personal services and just over $1 billion for other than personal services. However, to echo our concerns with OCE's budget, the potential impact of federal funding cuts remains significant. The plan, as presented, reflects a $32.8 million reduction in federal funding compared to the fiscal 2026 adopted budget. We understand that DOH typically receives federal grant allocations closer to the middle of the fiscal year, which is why these funds are not yet reflected in the fiscal 2027 preliminary budget. However, because federal funding supports a wide range of the city's public health activities, including de disease surveillance, public health infrastructure, and prevention programs, we remain concerned about the possibility that some of these funds may not materialize by adoption. Giving given the ongoing uncertainty surrounding federal public health funding, it is important that the city carefully assess potential funding gaps and consider how reductions could affect programs that New Yorkers rely on every day. Several of the most concerning reductions appear in the disease prevention and treatment program area, which includes funding for communicable diseases HIV immunization sexually transferred infections, and tuberculosis programs. The preliminary plan reflects a net reduction of $36.7 million compared to fiscal 2026 adoption. These reductions come at a time when the city is seeing increases in certain communicable D diseases. According to the preliminary mayor's management report, PMMR, tuberculosis cases rose by 24% from 679 cases in calendar year 2023 to 839 cases in 2024. While new HIV diagnosis increased for the second consecutive year from 1700 in calendar year 2023 to 1791 in 2024. The rise in new HIV diagnosis is particularly concerning in light of recent reductions in access to sexual and reproductive health services. In 2025, sexual and reproductive health centers in Manhattan and Brooklyn closed, potentially limiting access to routine HIV testing and prevention services. Additionally, in late 2024, nonprofit organizations reported shortages of condoms and other safe sex products through the city's condom availability program. Reduced access to both prevention services and protective resources could weaken the city's HIV prevention efforts in a time when diagnosis are already increasing. That is why maintaining a strong capacity for disease surveillance, testing, and case management remains essential to protecting our public health. We are also concerned about reductions to programs focused on preventing chronic disease. In the preliminary plan, funding for chronic disease prevention within the Center for Health Equity and Community Wellness declined, including a $6.4 million reduction in city funding compared to the fiscal 2026 adopted budget and approximately $1 million less in federal funds. Chronic disease remains one of the leading drivers of premature mortality in New York City, and sustained investment is critical to improving health outcomes and addressing persistent health inequities across neighborhoods. Vaccination efforts are another area where continued investment will be essential. Vaccination coverage among young children remains below the city's 70% target. According to the PMMR, 63.5% of children ages 24 to 35 months were up to date on immunizations in the first quarter of fiscal 2026. This represents a slight decline from the same period in fiscal 2025. Ensuring that the city has sufficient resources for outreach, education, and vaccination access will be imperative to improving immunization rates. I want to commend you, Commissioner, for the newly launched media campaign to address vaccine hesitancy. Given the rapid developments at the federal level, it is important that DOH prepare for a range of potential scenarios. Careful planning will help ensure that the healthy NYC initiative to expand life expectancy can continue to move forward and that the city's public health infrastructure remains strong. Once again, I would like to thank the committee staff and my own staff for this work on this hearing. I also want to acknowledge that we've been joined by just >> All right, let I'm gonna start over. Okay, we've been joined by um Council Member Finance Chair Lee, Council Member Areola, Council Member Felder, Council Member Oay, Council Member Alder, Council Member Kaban, these are on Council Member >> Council Member Hanks, um Janeiro virtual, Norcis virtual. Okay. Um I will now turn it over to the committee council to administer the oath to members of the administration. >> Thank you, chair. Good morning. >> Please raise your right hands. Do you swear to tell the truth, the whole truth, and nothing but the truth before this committee and to respond honestly to council member questions? >> Yes. >> Yes. You may proceed with your testimony. >> Thank you very much. And good morning, Chair Schulman and good morning, Chair Kaban and Chair Lee. Uh, and to all the members of the committee. I'm Dr. Alistister Martin, Commissioner of Health at the New York City Health Department, and I'm joined today by our chief financial officer, Aaron Anderson, and members of my lead, senior leadership team. Thank you for the opportunity to testify today on our preliminary budget as it relates to public health. I'm proud to represent the Mdani administration, which puts puts forward a vision of a New York City we can all afford. That agenda is not secondary to public health. It is central to it. In our city, one in four New Yorkers are living in poverty. We know that that has a devastating impact on health. On average, New Yorkers in the poorest parts of our city die nearly seven years earlier than those in wealthy in our wealthiest neighborhoods. That is seven fewer years to spend with those they love. As we work to design a budget that supports a prosperous New York City, we do that we do uh all this work with that in mind. We have our work cut out for us. The data makes it clear that the problems of health and wealth inequity are intimately related. And the good news is that the solutions are too. Mayor Mdani's affordability agenda and our health agenda are aligned. We are focused on buying New Yorkers more time, more health, and more joy in a city we call home. At the New York City Health Department, that work is not new. For decades, we have been working at the hyperlocal level to meet New Yorkers where they are. Every single day, we are making systemic changes by building individual connections. In order to change the material conditions of people's lives at scale, we have to move one conversation at a time. Many of our programs are built on that foundational understanding. For example, the city recently put $20 million towards the strong foundations initiative, which will grow perinatal and early childhood mental health services and expand the nurse family partnership program. I personally have seen firsthand just how meaningful that program in particular is. My mother worked as an NFP nurse for nearly 15 years. I know the impact of that program not by the statistics, but by the children's books and toys that would pile up in the back of my mom's old gold Chevy and the story she told me about mentoring new moms who were considering going back to school or changing careers like she did. A few weeks ago, I got to be part of making that announcement about the expansion of services in New York City with my mom in the front row. Public health happens in a million small ways and it is grounded in the relationships we build across our city. All that work taken together contributed to New York City reaching its highest life expectancy in recorded history. That did not happen by accident. Our most recent data shows that in 2024 the citywide life expectancy was 83.2 years. That's higher than prepandemic numbers and it's a testament to a whole of government response to the CO 19 pandemic, yearslong efforts on overdose prevention and long-standing community work to move the needle on chronic disease. The increase in lifespan did not happen by accident and it represents a monumental success. That said, we are far from finished. We are still uh there are still devastating inequities in life expectancy by race, by neighborhood, and by income. We are working to improve health outcomes for New Yorkers harmed by the consequences of historic disinvestment. We know too that we have to interpret these numbers in context. Today's landscape is entirely different than it was back in 2024. Our latest data show none of the impact of the federal administration's efforts to seow distrust, revoke life-saving benefits, and send healthcare costs soaring. Public health and public services are being dismantled. Yet, we are working hard to maintain our progress in the health and longevity of New Yorkers. We stand as a bull work against misinformation spewing out of Washington DC. We have done so since the inauguration of this administration and we will continue to do so in the months and years ahead. For decades, the New York City Health Department was closely tethered to national and international public health infrastructure. But in the past year, the United States has adopted an increasingly isolationist approach to international work and a fractured public health strategy. Domestically, we are left to fill in gaps as much as possible here in this city. Earlier this year, the United States withdrew from the World Health Organization. In the wake of that decision, we became the first municipal health department in the country to join the WHO global out outbreak alert and response network or GORN. Following an unprecedented overhaul of the federally recommended childhood vaccination schedule, we continue to distribute more than 2.5 million doses of pediatric vaccines to healthcare providers across our city and to offer clear guidance where the federal government creates confusion. On Monday, a federal court temporarily blocked the CDC's attempt to change the long-standing childhood vaccination schedule. That is a public health win, but also speaks to the gravity of the federal misinformation we are currently up against. Without reliable leadership at the CDC, we are creating new avenues for collaboration and new avenues for information. We continue to work with our regional partners as part of the recently formed Northeast Public Health Collaborative. We're living in a time of heightened risk and our team is working around the clock to protect the health of New Yorkers and everyone who travels through our great city. That takes sustained investment from all levels of government and the private sector. I'm now going to turn to the funding that makes all of this work possible. The New York City Health Department has approximately 7,000 employees, all of whom serve more than 8.5 million New Yorkers, 24 hours a day, 7 days a week. 2025 marked the third consecutive year in which hiring outpaced staff departures. We are successfully rebuilding our team to full capacity and recovering from staffing shortages caused by pandemic burnout. We have an operating budget of $2 billion for fiscal year 2027. About 1 billion of that is in city tax levy. The remaining billion dollars are sourced from federal, from state, and private funding. At the city level, we're grateful to see a continued commitment to public health as we discuss the 2027 preliminary budget. In particular, we are encouraged to see resources dedicated to child care site inspections and funding which was also added for outreach and education for early intervention services at 2K sites. In response to the outbreak of Legionella in Harlem last summer, additional resources have been appropriated to support more cooling tower inspections, disease surveillance and testing, and community outreach and education. We appreciate the new funding to avert uh future legionella legionnaire's disease community clusters as much as possible. Additionally, we are happy to provide funding for community based organizations that serve LGBTQ New Yorkers, especially as federal attacks on queer communities continue. And lastly, as a kid from Queens, I'm particularly excited to see startup funding for a Jamaica neighborhood health action center to invest in the health of this community. Our brick-and-mortar presence in priority neighborhoods is a critical part of our work, and I'm encouraged by the resources to expand that model to Queens. At the state level, the governor's fiscal year 2027 executive budget for New York uh state provides crucial support for public health. I want to personally thank Governor Kathy Hokll and Commissioner Dr. James McDonald for restoring the article 6 matching funds of 36% to New York City. This reverses several years of cuts where New York City was the only jurisdiction in the state receiving lower state reimbursement for core public health services despite the fact that we are home to the most individuals with low incomes and the majority of Medicaid recipients in this state. This year, New York State will finally restore par between New York City and the rest of the state. And I'm deeply grateful for the governor's actions on that. I also want to thank Senator Rivera, Assembly Member Gonzalez Rojas for championing this issue in Albany, and we're pleased to see the Assembly and Senate include this in their budgets. Finally, thank you to Speaker Menon, to you, Chair Schulman, and the entire council for your continued advocacy on this issue. The health department also supports Governor Hokll's proposed plan for un universal child care, taxes on tobacco products, and a continued commitment to reproductive healthcare. Finally, I'll speak to the federal budget. About 20% of our budget is federally funded. That amounts to approximately $500 million. The majority of that funding goes towards emergency preparedness and infectious disease control. We expect the federal government to honor its commitment and maintain that funding. But if history is any indication, we cannot rely on federal resources. Last spring, the Trump administration unlawfully rescended 11.4 billion in public health funding. Within that massive cut, approximately hundred million was earmarked for critical disease control and outbreak prevention structure infrastructure right here at the New York City Health Department. Thankfully, our funding was retained due to a successful lawsuit led by New York New York State Attorney General Leticia James. That said, we must brace for possible future cuts. We are enduring coordinated and large-scale attacks on public health and we do not foresee them letting up anytime soon. And so we have a dual responsibility to care for New Yorkers and to serve as a national leader and a universal trusted source in public health. We remain committed to do just that. I'm very grateful for the support at the state and city levels as we continue to defend public health every single day. I'm confident that even amidst all of these challenges, a healthier, more affordable New York City is on the horizon. Thank you for your attention and we're happy to take uh your questions. >> Okay, before I ask questions, I'm going to ask Finance Chair Lee um for her questions. >> Thank you. Good morning. I was going to say afternoon. Sorry. >> Um and it's great to see you, Commissioner. Uh and to see you in person versus just a picture. Uh so thank you so much for joining us today. >> Um so I'm just going to go right into the chief savings officer plans, which I know that we've been asking every agency um and the mayor's executive order to undertake uh a chief savings officer and place one at each agency. So um what was it first? Have you identified someone who is the person that you've identified and what was the process to conduct the required review of spending and operations within the 45day time frame? >> Thank you for that question uh chair. Yeah, we are committed to uh doing everything we can to comply with this executive order and to follow through on the mayor's vision for the chief savings officer uh role. Our chief savings officer at this agency is Amiko who's our uh chief operating officer. uh to share a little bit more about the specifics on what we're doing on the chief savings officer. I'm going to hand it over to Aaron Anderson. >> Yeah, good morning and thanks Chair Lee for the question. Um right, so CSOS and I've been working very closely with CSO Miko um have been tasked with identifying recurring savings through efficiencies, program consolidations, insourcing and eliminating or sunsetting programs. Um, we've been tasked as a city with achieving 1.5% in savings for the current year and two and a half percent in the outy years starting in 27. Um, and the mayor has been pretty clear that vital services will not be cut. Um, so we've continued to go through that. Um, it's been a a long and uh detailed process over the past month and a half or so. Um, and we're we're just finalizing our work on that and preparing for submission um, tomorrow. In fact, >> yes, due tomorrow. Um, and if you could go into which unit of appropriations and program areas within the fiscal year 27 prelim budget are expected to be reviewed, which I know you sort of touched upon. Um, and how will the agency determine which services deliver the strongest public health outcomes for New Yorkers? And with that question, I just want to emphasize that obviously in our conversations about savings and efficiencies on the council side, we definitely want to make sure that that is not going to sacrifice on the services that New Yorkers are receiving because what you guys are doing is super critical work. So, um, I just wanted to preface it by saying that as well. >> Yeah, thank you for that. And I I I think we certainly share that that sense of ensuring that we're preserving critical services while while looking for, you know, realistic and achievable efficiencies and savings. Um, I mean, we've looked across the entire agency, right? We're a big complicated agency that has lots of lines of work, um, from animal care control to disease detection to school health and and lots of other things. So, um, you know, we're still finalizing what our what our proposals are and looking looking at all those areas, but it's we're really looking across the entire agency, um, at large from insourcing potential, you know, contracts, we're looking at IT contracts, um, other contracts, um, just across the board. So, it's it's hard to say at this particular moment exactly what the final proposal will be, but we look forward to, um, having further conversations once it's >> great. No, thank you. And as you mentioned, yes, DOH is definitely a big uh agency. Um so it'd be great to see where those savings can be, especially things internally, operationally, contracts that can maybe be um shared, like resources that can be shared as well would be great to look at. Um do you anticipate any consolidation or restructuring of programs as part of the review or I mean I know you're looking into it, reports are due tomorrow, but just if you could speak to any of that. >> Yeah, I mean I think Everything's on the table. We're casting a very wide net and looking across all all of our programming. Um, and also at administr the administrative side of the work that we do. >> And how have you been evaluating those programs that you're looking at? >> I mean, I think each program is different. Each program has different metrics and KPIs and measures of success. Um, and so I think it's a different it's a different evaluation for each program. And they're they're so diverse it's hard to apply a one-sizefits-all model. But we're we're certainly casting a wide net and looking carefully at everything. >> No, and I appreciate that because um as you mentioned, the programs that you all have under your portfolio are very different. So, it's great that you're looking at different metrics and outcomes to see what makes sense um in each of those program areas. So, I appreciate that. Um and how moving forward in the out years because I know it's two and a half% in the out years. So, once you guys identify those savings, what are some of the uh systems I guess that you'll have in place to um sort of follow that? I mean, I I I think it's it it depends on how it all plays out. I mean, we're this is a, you know, city hall, specifically first deputy mayor le initiative. So, we're in in regular and close contact with both the city hall teams and the OM teams about what what this will actually look like. But this is the first phase and the first step of that, which is just casting a wide net, looking at options, and then evaluating what might be actually be feasible. >> Okay. And we look forward to looking at the report. So, thank you. I know it's not easy work, so appreciate it. Um and then just moving on to medical debt because this is a topic that we had talked about briefly at the health and hospitals um hearing as well um and having worked under the head of a social worker at a previous um you know at a hospital private hospital I know that the way that they approach the medical debt relief is different depending on the hospital depending on who's in charge. Um, some are more patient oriented, some are not as much patient oriented. So, um, but DOH has partnered with Undo Medical Debt, formerly known as RIP medical debt, to clear New Yorkers of $2 billion in medical debt. And the program was first announced in January 2024, and was first funded in fiscal year 25 executive plan for 18 million, dispersed between fiscal years 25 through 27. So just wanted to check is the city on track to relieve the full promised number of people and amount of medical debt by the beginning of next year. >> Thank you for that question uh chair. This is a an incredibly important uh subject um that you can't um uh remove from the conversation around affordability, >> right? >> Um you know, as we know, medical debt is the biggest driver of personal bankruptcy in the city for New Yorkers. And um the work that we've done has been um a tremendous start. We've been able to erase about $135 million in medical debt so far. Um just over half of the individuals who have received uh those um envelopes in the mail um relieving them of their debt are in tree neighborhoods. Um and so you know we we see this as an incredibly important tool in our toolkit when it comes to addressing healthcare affordability. Um w with regard to um the future of the program, yeah, we're working very closely with Undo Medical Debt to um identify um how we can um leverage that $18 million and really make sure that we make a dent um on the um on that issue. And so, you know, um the conversations are ongoing and this is a personal uh a place of um personal interest of mine. >> Thank you. Um and just out of curiosity, how how are communities and individuals identified for inclusion in the program as a as a you know first step and then are there geographic or income based targeting criteria? And then the second part of my question which is not in here which is something close to me is how are those people being reached out to because I know you said male um but in different languages because as we know we're a very diverse city and some folks may look at it if it's in English they might just discard it and not realize. So just wondering what the outreach efforts are as well once those folks are identified. >> Yeah, it's a really good question. So first of all, we are working to cancel um debt citywide. Um now uh the individuals who do receive um the interventions typically end up being from communities that have um rates of uh legacies of of historic disinvestment. Um as I mentioned uh over 50% of u those who have received the intervention um are in those tree neighborhoods. And so there is targeting uh to make sure that we are um helping uh folks who are uh low-income, communities of color, individuals who are underinsured, uninsured. Um and we're building that sort of broader monitoring infrastructure to make sure that we can really target this intervention. >> Great. And then um I guess roughly in your estimates, how much support would that amount to dollar-wise as well? It's a great question. You know, we we um chair are are taking advantage of um the ability to buy debt cheaply here. And so that um $18 million um you know, if we add that up um you know, as we think about how we can go on the um on the market and buy that debt from participating hospitals, we can get into the billions. You know, the the numbers, >> you know, range between 1.5 and um two billion. Um and so, you know, we're we're aiming to hit um those targets. And I I'll say one other piece and that is that the issue of medical debt um can be addressed in different ways. >> And so we are looking at all the different levers that are possible and this um partnership with undo is essential part of that plan. >> Okay, great. And um how much of that 18 million investment is reflected in the budget for DOH? >> Uh that's a good question. Let me hand it over to Aaron Anderson to show a little more on that. >> Yeah. So, it's uh $6 million per year. So, there's $6 million included in FY27. >> Okay, perfect. And um I think I know the answer to this, but is the allocation sufficient to meet the $2 billion relief goal? >> Um you know, so the goal of this work is to really work closely with undue medical debt to make sure that that funding that we have can be used um as effectively and as efficiently as possible. Um and so we're working closely with them to try and identify how to do that, how to maximize the money that we have. >> Okay. Thank you so much. And that's why I just want to reiterate um definitely an issue in terms of communities of color uh for sure where it negatively impacts them um a great deal. And this is why prevention is so important because we need to make sure that we're keeping people healthy uh which saves the city and state dollars in the long run. So thank you so much for your work and that's it. Thank you, chair. >> Thank you, chair. Um, so I also want to um be I'm going to ask somebody one of my colleagues to ask questions so that they can um move on to their next hearing. But I also want to mention in terms of undue medical debt that um the CEO of undue medical debt is a friend and constituent of mine. Um so and she's um her program is being done across the country and she's met with the governors of almost every state. So, I'm very glad that we're doing work with her and that we can relieve people of their medical debt, which I think the president just said that they're not going to let people take that off of their credit reports anymore. So, that so that so it's even more needed. Um, I'm going to ask uh Council Member Oay to ask some questions and then I'll get to mine. Thank you so much, chair, and uh congratulations and welcome to the new commissioner. Uh my constituents are concerned about the closure of the Crown Heights Clinic. This clinic provided a variety of key healthc care services to my constituents um that they truly depended on, including rapid COVID, flu, RSV, rapid testing, um as well as STI testing. Uh constituents are concerned that with the closure of this clinic, many will lose access to accessible rapid testing, especially those with chronic illnesses who need to know their COVID status sooner rather than later to ensure they can get Paxoid uh Paxid or other COVID prevention treatment on time. Uh my first question is why did the Department of Health decide to close down this clinic? And I know that this took place prior to uh you being in this position. Um but many are are requesting this question from my office. >> Yeah. First of all, thank you for your leadership on this issue, council member. Um as you know, we offer um a range of of clinics which are um lowcost to nocost clinics. Uh we have six um sexual health clinics, three TB uh chest centers, and then one immunization clinic. And what we see coming through these clinics is because we're we're providing low barrier of care um uh services for folks, we see that about 87% of the individuals that are coming in are um historically disenfranchised. With regard to the the clinics that have been closed um uh three of those clinics were were closed during COVID. Um and so um we have um you know priority around trying to reopen the Washington Heights uh TB clinic and the Crown Heights uh uh clinic which you you mentioned and so um that is absolutely a priority of ours. Um at present moment we we don't have the uh ability to do that but we are absolutely um intending to move in that direction. >> So you said that I really do appreciate that there is a plan to reopen those clinics. uh what are the obstacles in in in getting to the reopening of of this specific clinic? >> Yeah, let let me let me clarify. We we we certainly are interested in in doing so and and um uh the ability to do so is going to be contingent on the funding and resources to be able to do that. Um, and so we're in constant conversations with our colleagues at OM and across city hall to um to do this and we look forward to working with you and continuing the conversation around what the future holds. >> Do you have any idea in terms of how much it would cost to open one of these clinics? Like if I were to advocate for the reopening of this specific Crown Heights clinic, how much should I be advocating to the mayor uh to include within the budget? >> Yeah, good question. Let me hand it over to Eric. >> Thanks for the question. Um, we're we're actively working on estimates and and potential projections and continuing those conversations with OMB. So there's not a specific number at this time, but >> Okay, I appreciate hearing that. Another Let me ask one more question. Uh, my constit constituents are also concerned about the lack of gender affirming care in the city. Uh we're also aware of NYU Langon's decision to close its transgender youth health program as the federal administration continues to threaten health care facilities and roll back funding from LGBTQ plus organ health organizations. As I'm sure you know, health care that is accessible and safe for queer and trans New Yorkers is now a pressing issue for our city. How can the Department of Health ensure that gender affirming care services and other health resources uh for LGBTQ plus New Yorkers continue to remain available in H&H clinics and other DHM sites. >> Thank you again for for your leadership on this issue, counselor. Um we um we are very much invested in the um care for uh individuals um in the trans community uh and nonbinary community and and uh think it's a priority of ours to make sure that we can provide the services that this community needs. Uh we recently met with the commissioner on gender equity uh to begin really thinking through how we can do a better job of prioritizing the needs um of this community. Um but um this is something that we'll uh continue pressing on and we look forward to um you know working with you and your team on making sure this is reality. >> Sure. Um would love to hear from both of you especially when it comes to uh budgetary costs of how much both of these issues would would cost. Right. I think it would would help on our side of things being able be able to advocate uh for this funding. Um, so whenever you do have those numbers, I I would love to to hear back from your office. Thank you, chair. We can follow up. >> Thank you. I just want to acknowledge we've been joined by Council Member Nurse. So, now we'll have I have a bunch of questions for you, Commissioner. In the preliminary plan, DOH's federal funding decreased by $32.8 million in fiscal 2027 compared to the fiscal 2026 adopted budget. The city primarily receives federal funding for the disease prevention and treatment program area in which communicable diseases had the highest decrease in funding followed by sexually transmitted infections and tuberculosis. We remain concerned that the city might lose part or even all its federal dollars for health services. Is the reduction of $ 32.8 million due to the federal government's new policies or is it due to external factors? >> Yeah, thank you for that question, Chair. Um, you know, we share your concern with what we're seeing at the federal government and, uh, the way they've threatened public health funding, uh, the way that they're communicating with regard to public health messaging. Um, you know, we are, um, in an unprecedented era here. And also, uh, we are not going to wait for the federal government to come in and swoop in and save us here in this city. Uh, we are leading, we are stepping in, and we are making sure that New Yorkers have what they need, uh, to be safe and healthy. With regard to the 32.8 million that you discussed, um that reduction is actually um not due to um the federal government clawing back funding. Um that's uh due to the fact that these federal grants have not fully been loaded yet in the preliminary budget. Um and so we think that once those are loaded, um the expected um federal funds will be about 20% um of our total budget or around $500 million um a year. And that's that's um sort of the standard budget timing. And that these are not confirmed cuts. >> Okay. Um, >> and Chair Schulman, I'm sorry, just just to add to that, it's it's true a lot of our funding, as you acknowledged in the in the opening, is loaded over time >> with one exception. So, it's not a cut, but there there is the expiration of federal COVID funding, supplemental funding that's ending this July. And so, actually, when we sat here, this hearing last year, exactly one year ago, and and said that hund00 million was what we had left, the day after that hearing, it was rescended and replaced. But we're we're we're basically in the final stages of spending that last amount down through this. >> So that'll be so that'll be how much less for next fiscal year. >> So the the final annual amount currently of that supplemental funding is about 30 to $35 million. So that's >> okay. >> One of the reasons that's contributing here, >> right? Um what are the ma what are the major federal grants that doh received for healthcare in fiscal year 2026? >> Yep. Uh thank you for that question uh chair. In FY 2026, we received $453 million in federal funding. Um, more than half of that supports disease control. Um, we're talking about surveillance, labs, HIV support, childhood vaccinations. Um, just double clicking on the HIV and STI funding, which is about $225 million. Um, 87% of that budget comes from uh federal funding sources. I'll hand it over to Aaron to share uh anything else he's got. Yeah, thanks for the question. Um, so some of the major federal grants that we receive include Ryan White, which is probably the biggest, um, epidemiology and laboratory capacity, housing opportunity for people's AIDS, which we split with Department of Social Services, um, the public health emergency preparedness, and then we have our core cooperative awards for TP control immunization. Those are sort of the biggest ticket pieces of our federal portfolio. >> Yeah. has um have you for fiscal 2026 has DOH received reimbursement for all its programs as anticipated? Sounds like >> yeah we we have not experienced any significant changes this year and we remain >> and do you expect any of the federal grants to be reduced or eliminated? I mean, I know it goes back and forth, but >> I mean, based on our best reading of the tea leaves and the budget that the feds passed, the continuing resolution, it it appears to be okay at the moment, but we've certainly experienced whiplash over the past year, but we're in an okay place right now. >> Excluding any CO 19 related funding, which you just mentioned, how much funding do you anticipate the DOMH will receive from the federal government by adoption? >> So, we expect the total to be around 500 million, around 20% of our budget. It's hard to know exactly until then. All right. Does DOH have a contingency plan if the federal government withholds funding? >> Yeah, thank thank you for that. Uh, Chair Schulman, we are closely monitoring uh the situation. We're trying to um really, as Aaron said, read the tea leaves and um uh predict uh what might be coming down the path. Uh but we are currently in active discussions with OM with the law department um and the mayor's office to um come up with plans. Um if there are cuts to specific activities, uh we will assess and make um uh decisions around uh what will protect New Yorkers uh health and safety the best in those um in those moments. >> Okay. Okay. The New York State fiscal 2027 executive budget proposes total spending of $260 billion compared to 252 billion in fiscal 2026. Within the city's budget, DOH's fiscal 2027 preliminary budget includes $311.5 million in state funding for health services, an increase of nearly $65 million compared to last year's adopted budget. How much funding do you anticipate DOH will receive from the New York State fiscal 2027 enacted enacted budget for public health programs? >> Thank you for that question, chair. Um, as you know, you know, the funding that comes into this department is really broken up in three different sections. City tax levy, the feds, and uh the state. >> And so we work very closely with our state colleagues. Um, and we're encouraged by what we we're seeing in the governor's uh commitment to restoring critical public health fun. We're going to talk about article six in a bit, but um you know what we're seeing in the FY27 state funds uh is that um the funding that we'll get from the state is about $722 million u which represents approximately 30% of our uh total budget. Let me hand it over to um Aaron to share more. >> Yeah, thanks Fisher. Um right, so that's the total state amount for the entire department. On the public health side alone, we're expecting probably around the order of 400 million. >> Okay. And a big piece of that is of course the the article six restoration which we are delighted to have. >> Um which DOH programs are expected to receive the largest share share of state funding. >> Take that. I'm gonna hand it to Aaron. >> Thanks. Um the single largest program on the state side is early intervention. >> Okay, that's great. The state's Medicaid program serves 6.8 8 million New Yorkers and the executive budget include includes changes to the essential plan and Medicaid eligibility due to federal policy changes and funding reductions under HR1. How will the proposed transition from the section 1332 waiver back to the basic health program under section 1331 impact New York City residents, particularly the more than 460,000 essential plan enrolles expected to lose coverage when the income eligibility threshold is reduced from 250 to 200% of the federal poverty level. >> Yeah, thank you for for that question. We share your concern, chair. Um the transition from section 1332 to 1331 is um put simply going to mean that um more people will um uh lose their health coverage. Um and as we know uh 460,000 um of those folks who will uh likely be affected by this change, the majority of those people um are here in the city, >> right? Um and so um the ultimate estimates around what do um at the state is um is thinking about is about 713,000 New Yorkers will potentially lose um their coverage uh through a combination of all of these different federal uh policy changes. And so we have not remained uh stagnant on this. We are not sitting back. We've submitted um you know public uh comment to limit the essential impact essential plan impact. Uh we're planning public education, provider outreach, advocacy, uh to try to meet the moment and help keep people covered. >> Yeah. I mean, it's interesting because none of this was in any of the one state and the assembly or senate their um budgets that they put out. So, which was odd to me, but okay. Um so, we have to keep advocating for that. Um, federal changes will eliminate eligibility for certain noncitizen populations and end federal Medicaid support for some legally present immigrants beginning in October of 2026. How many New York City residents could be affected and what steps are being taken to ensure they maintain access to coverage? >> Yeah, thank you for that question, Chair. You know, we are um again alarmed and we share your concern with what the federal administration is doing. In effect, they are um abusing immigration law uh in ways that are dangerous to residents health, to their well-being. Um and this is quite frankly going to mean that um not only will there be a chilling effect across um you know individuals uh coming to our um sites but also healthcare sites throughout the city. Um and then on top of that you add the fact that um coverage will also be threatened for for the for these communities. And so um what we are doing uh we launched the every New Yorker without exception uh campaign and uh adopted policies restrictoring restricting cooperation with um ICE on DOH property. Uh but we know the fight is uh is not over. We know we have to continue to push and to advocate and to make sure that we uh protect uh folks in the city. >> But how many New York City residents do you think could be affected by those changes? Yeah. So the state estimates that we have from New York State is um in total about 713,000 uh New York. >> That's for the state, right? >> For the state. Yeah. >> What about the city? >> We can get we can get back to you in terms of you know sort of the the slice of that that are city and the slice that are >> would like to have that. Aaron, you don't have those figures. >> Okay. All right. The executive budget notes that federal policy changes will significantly reduce federal funding for the essential plan other health services. What fiscal and coverage impact could these changes have on New York City residents and the providers and the providers that serve them? >> Yeah. Um I mean the overall impact here uh chair is that we're going to likely see an increase in um uncompensated care. you know, folks are not going to be covered uh because not only did uh not only will we see the changes which will hit in July to the essential and basic plan, but uh we're also going to see these new changes uh which will hit in January of7 around Medicaid specifically. Um but we also have to acknowledge what happened in December of 2025 with um Congress's failure to um uh sustain the ACA subsidies which has meant that um premiums have increased by quite a bit 38%. So we have a number of different things that are happening here which are leading to individuals uh not being covered. So, we think that ultimately we're going to have um more individuals um who are um going to likely need uncompensated care going to places like H&H, our partners at U across the city, and other safety net providers. Um and we are helping New Yorkers explore alternative coverage and affordable care options. >> What coordination is occurring between the state and city to prepare providers and enrolles for these policy changes? Um so you know I can speak you know from from the perspective of the health department. Um we are committed to um using every single lever we have to help individuals stay covered >> to know that they have to um uh do these uh work requirements which now have to happen every single month. Uh um helping them do their renewals which now will have to happen twice a year. Um, and so we're committed to trying to find every single intervention that we can to to do that work. >> In New York State, total Medicaid and essential plan spending is projected to reach 122.9 billion in fiscal 2027, including 65 billion in federal funding and 48.5 billion in state funding. In fiscal 2027, the state will also assume nearly 9.2 billion in costs that could otherwise have been incurred by localities. How much Medicaid funding does DOH currently receive and how might that change under the fiscal 2027 executive state budget? >> Yeah, thank you for that uh question, chair. You know, Medicaid is a critical funding source for so much of um the core programs that um allow uh New Yorkers in this uh city to get the care they need. Mhm. >> Um and so we have a number of Medicaid dependent programs, um our early intervention program, our mental hygiene contracted services like supportive housing, the ACT team, IMT teams, and our public health clinics. And so we're working with um our colleagues at OM to really assess the full exposure and and what um what might be coming down the pike here. So let me hand it over to Aaron to see if he has anything else to add. >> Sure. Just to add to that, so we receive approximately $68 million in Medicaid funding. >> Um, and that's a combination. It's really two parts. There's the the direct services we get reimbured for, and then there's Medicaid admin. So depending on the program, it's one of those two things. But we do expect a similar amount for the next year. >> Which DOH programs rely most heavily on that Medicaid funding? >> Yeah, I can um share and then have um Erin um add on. So, as I mentioned, a couple of the programs that um >> rely very heavily are early intervention um and so uh that is um very much uh part of uh Medicaid is very much part of the uh revenue that uh we rely on for patients to uh get the care or New Yorkers to get the care uh they need through the early intervention program, our sexual health clinics, uh TV chess centers, our schoolbased health centers, and uh the meal hygiene contracted services. So, um, all of these different programs serve Medicaid enrolled, um, individuals. Let me hand it over to >> Can you get us what, you may not have it now, what percentage of those program budgets are supported by Medicaid? The breakdown. All right. If you can get it to that to us, that would be great because like I said, we want to advocate, so we want to figure this out. Um, the state budget provides an additional $75 million for the medical indemnity fund in addition to its $52 million base. How many New York City children are currently supported through the indemnity fund? >> Yeah, thank you for that. We're committed to ensuring that children uh with birthrelated neurological um injuries receive all the support that that they um that they need. Um as you know uh the medical indemnity fund is a state administered uh program >> and so we're working to um support that support the state in their efforts. Uh but we don't directly manage uh enrollment or um distribute those um those funds. >> Okay. >> Um let me hand it over to Aaron to see if there's anything else to add. >> Yeah, just to add that as with so many of these state initiatives, we're we're closely monitoring what's going on with the state budget and you know, we'll see what's agreed to in the executive budget and in an active budget in April and and and take it from there. >> With what's been stated as potential additional funding, will that expand coverage for New York City children? >> We don't know yet. which additional funding >> the state budget it is giving $75 million more for the fund >> we don't know okay article six which um I took on as soon as I uh took office in 2022 and we've been advocating ever since and then um was joined last year by um Assembly Member Gonzalez Rojos and state senator Gustavo Rivera and um we were finally able to get that done. So, I'm very appreciative of that and we've been pushing um it's been on the agenda, the uh council's agenda with the state for all those years and I um had the privilege this past weekend to meet with the governor and thank her personally for that. So, um I'm very happy that we have that. Um, so with that additional restoration of $60 million for fiscal 2027, um, what programs and services are going to be um, are we going to be able to restore funding to or what programs and services will be supported with that 60 million? >> Yeah. F first before I answer that, um, just to say thank you for your leadership and for your advocacy on that issue. Uh this is a hugely important equity issue as you know >> uh you know that um the disproportionate share of individuals who uh uh are on Medicaid are here in this city >> and so we need every single dollar in this city to be able to carry out the core public health mission of uh the work. >> Um I'm going to hand it over to Aaron to talk a little bit about the specifics of um how the money is flowing. >> Did we get did we get that yet or we didn't? we're gonna get it when the budget passes and is that the way >> we're we're optimistic and confident that it will appear in the final budget. It's in the it's in the initial budget so it's it's >> well if it doesn't you tell like we'll figure it out but >> yeah and just echoing the commissioner's thank you and the rest of the council. Um right so this this um sort of reverses a major cost shift from the state to the city that occurred under prior admins dating back to 2019. Um the biggest change now is that we will no longer need to cover with city funds the difference between the 20% reimbursement rate which is what it was and now it's 36%. So it's really this is about core public health services, it's family health, it's communicable disease control, it's chronic disease prevention, >> it's environmental health emergency response and it goes on and on. So this is this is a huge change and it's really uh reversing this cost shift um that had been in place for so many years. We should when we get that money maybe we should do something publicly around what we're going to be funding and >> so that they so the state can see what the governor can see firsthand like what we did maybe inviter or something um if article let's see n do you anticipate that a full restoration of article six funding would allow the city to reinvest local dollars into other public health priorities you know, chair, we we think that a full restoration uh would certainly free free up additional city resources. Um and so with those extra resources, you know, I think the um you know core public health functions of of this department um and all of the contracted CBOS that we work with uh will be made more effective and u reach more people. >> Okay. The by the way I want to acknowledge we've been joined by majority leader Sha Breu. Um the the mayor's preliminary man mayor's management report metrics um indicates that 1,791 people were newly diagnosed with HIV in calendar year 2024 up from 1,700 in 2023 and 1591 in 2022. This marks the second consecutive annual increase following a decade of steady declines prior to 2020. The PMMR also notes persistent inequities with the majority of new diagnoses among black and Latino New Yorkers, men and people ages 20 to 39. At the same time, 90% of people with HIV are in care have achieved viral suppression. What factors may be contributing to the recent increase in new HIV diagnosis? Thank you for that uh question chair. So we use a multi-pronged approach to improving access to testing to treatment um and to prevention. Um this is a complicated question in terms of what's driving um these rates but um some of the factors include uh things like increased testing engagement, population changes, um possible increased uh transmission uh but also some of the structural more difficult uh social uh determinance of health issues. poverty, um, housing instability, um, lack of insurance, and unmet, uh, service needs. And so, uh, we know that this is an area that we, um, need to watch closely to make sure that these trends don't continue. Uh, and we're committed to, um, investing every single resource we can to uh, reversing that trend. >> What outreach and testing strategies is DOH using to reach communities most affected by HIV, particularly black and Latino New Yorkers? >> Thank you. I'll say a few words um and then I would love to have uh Dr. Sarah Bronstein uh join me. Uh but we have a number of um sexual health clinics uh that we uh currently um operate six sexual health clinics um a telealth hotline uh the Playshore network uh 2.0 one-stop model um our considerable resources around Ryan White um and so we have a number of um tools at our disposal to really uh tackle this problem head on. Let me hand it over to Dr. Bronin. >> We have to swear you in first. >> Please raise your right hand. Do you swear to tell the truth, the whole truth, and nothing but the truth before this committee and to respond honestly to council member questions? Can we proceed? >> Thank you, chair, uh, and thank you, commissioner, uh, for the opportunity to speak about, uh, what is a persistent concern about the persistent inequities we see in the, um, impact of HIV on New Yorkers. As you noted, uh there's been u in fact it's the fourth consecutive year that we've seen an uptick in new HIV diagnoses in the city and um we are very concerned. Uh we do though uh use the very robust information we capture in our HIV surveillance system to design an array of programs that are responsive to the epidemiologic trends and the um our knowledge of you know communities needs uh related to HIV and many of these are really aimed at supporting uh communities most affected. We know that we have to tailor our resources accordingly. So uh the commissioner mentioned our playore network 2.0 know uh wherein we fund um nearly 20 clinical and nonclinical agencies to provide an array of sexual health services including related to HIV really in a one-stop shop model in a whole person- centered approach um to give people all the services they need when they um have that touch point with the health care system and playore providers um are required to focus their efforts on serving communities most affected including black um and Latinx communities. Another good example of of this this programming is our be into health program which is designed to support people living with HIV and uh really ensure that specifically members of these populations and communities we know are most disproportionately affected by HIV um are achieving the HIV outcomes that the tools and technologies exist to achieve so that they are achieving viral suppression that they are firmly engaged in highquality HIV care um so that their own health is protected and the public's health is protected. Uh we certainly also have our sexual health clinics uh which provide really critical um HIV and sexual health services again to communities we know um aren't able to or aren't willing to access services elsewhere. >> And I appreciate that. And by the way, just mentioning the sexual health clinics, my office also gets complaints about the one in Crown Heights that's not there. So it's particularly there was a need that was being filled there. So we should really take a look at that. Um, why does DOH report new HIV diagnoses rather than estimated new infections as a PMMR metric? >> Dr. Brosy. >> Sure, thank you for that question. Uh, it's a it's a complex one actually. Um but we uh I mentioned our our robust HIV surveillance system which we are we are very proud of um the how robust that that system is and in that system we're able to capture new HIV diagnoses which are based on laboratory and provider reports um of positive HIV tests and and new new positive HIV tests. Um the the the metric that you mentioned Chair Schulman the estimated HIV incidents um is really an estimate. It is based on a a pretty complex model that CDC develops and that all health department jurisdictions use um to to estimate incident or new HIV infections. Um and and so data on new HIV diagnoses which we can actually count and and measure in our surveillance system are more reliable, more robust uh for for tracking the the uh the epidemic here in New York City. So that's why we report on new diagnoses in the PMMR, but we certainly do report on estimated incidents in our annual surveillance reports. >> Okay. Given that the Trump administration has cut funding for HIV prevention programs, including access to prep, how is the OMH planning to sustain HIV prevention and treatment services? >> Yeah, thank thank you for that, Chair. We we are closely monitoring um the situation with regard to bless you, I'm your leader. um uh uh closely monitoring our exposure. Um as you know um $225 million um in our budget goes to HIV and STI um uh funding and 87% of that funding is exposed. And so we're in con constant conversations with OM with the law department um and with the mayor's office to uh shore up um our defenses and make sure that we have a contingency plan in place. Uh but I'll hand it over to Aaron to see if he has more to add. >> Yeah, just to add that over the last year, we've watched that we've had this whiplash with the federal administration, right, around what's going to happen. There was a a House proposal, there was a Senate proposal, there was the president's budget. Each of them differed in their in the risk associated with what was going to happen with HIV funding. Um ultimately, as it stands today, knock on wood, we're in an okay place. >> Um but obviously we remain vigilant always. Um, access to sexual health prevention resources remains a critical component of the city's HIV prevention strategy. As new HIV diagnoses have increased in recent years, nonprofit organizations reported in late 2024 that New York City's condom availability program, which distributes free condoms through community partners, was experiencing supply shortages. At the same time, recent clinic closures, including the Planned Parenthood of Greater New York Manhattan Health Center and two Brooklyn Sexual and Reproductive Health Centers, operated by Public Health Solutions in Fort Green and Brownsville, raise concerns about access to testing, prevention resources, and sexual health services. Together, these developments raise questions about whether New Yorkers have sufficient access to the prevention tools needed to reduce HIV transmission. What is the current status of the reported condom shortage? Thank you for that question chair. So uh the NICAP program or the the condom access u program is or condom availability program is one of the largest uh free safer sex programs um in the country >> and we take any disruptions in that supply uh seriously. >> Uh we did experience a temporary supply uh shortage in 2024. >> Okay. Uh we worked quickly with our vendors uh with our distribution partners to make sure that we restored the inventory levels um across our community partner network and we have um monitoring systems in place um to make sure that uh we're tracking distribution uh volume. Uh we're we're confident that our current supply can meet the the demand. >> Okay, that that's great. um given that the PE MMR shows new HIV diagnoses have increased in the past two years, you know, it's does DMA do DOH believe that that um limited access to condoms or other prevention resources may have contributed to the trend? >> Yeah, thank thank you for that. No, we don't think that um that limited uh shortage uh caused uh that that increase in in HIV rates. We think it's a much more complicated picture than just that. And you have monitoring systems, I assume, to figure out the condom distribution and all of that. >> That's right. Okay. That's right. >> Um, how has the loss of sexual and reproductive health clinics in Manhattan and Brooklyn affected the availability of sexual health services, including HIV testing, STI screening, and condom distribution in these neighborhoods? Similar to what council member Oay was asking about. >> Yeah, thank you. Um, you know, I'm going to say a few words and then invite um Dr. Ronin back up. Um, you know, we think that the sexual health clinics um are a critical part of our infrastructure when it comes to uh protecting New Yorkers and providing this low to no cost um uh uh alternative for New Yorkers. And we also understand that for for many New Yorkers, it's it's better for them to come into one of our clinics than to go to see their doctor. there's a um a level of um uh it's just it's just a a better environment for them uh to do so. And so for those New Yorkers uh we u really want to make sure that we are providing this this resource. Let me hand it over to Dr. Bronin to share a little bit more. >> Thank you commissioner and chair. Um we are really proud of our sexual health clinics. Um, we are really a leader in the types of services, the breadth of services, and the culturally responsiveness of the services that we offer in these clinics. And we know they reach the communities that need them most. Um, so the six sexual health clinics that are operating now, you know, offer a huge range of services, right? We we are offering um sexual health services, HIV testing, um STI testing including also um linkage to or provision of post-exposure prophylaxis for HIV, preexposure prophylaxis for HIV, reproductive health services including medication abortion, vaccination services for STI, um and then increasingly as we develop um more and more partnerships with community organizations in the areas that our clinics are located in, referrals for additional services that community members ers might need. >> So, how are you um maintaining or expanding access to sexual health services and prevention resources in the areas where the clinics were closed? >> We do uh we do have in addition to the sexual health clinics, we do have um our funded community partners both clinical and nonclinical who are located throughout the burrows um and again in high needs areas including some of the ones that where our clinic closures have occurred. So between the sexual health clinics, our programming, our condom distribution that happens um again in high priority areas, we are confident that we are covering um the needs of communities with our with our sexual health services. Okay. DOH administers several I'm done with HIV. Um, DOH administers several maternal health programs aimed at improving pregnancy outcomes and reducing infant mortality, including morta maternity, infant reproduction, newborn home visiting, nurse family partnership, and universal home visiting programs. The fiscal 2027 preliminary plan includes $49.9 million for these programs. At the same time, pregnancy associated mortality continues to show significant racial disparities, particularly among black women and birthing people. In the preliminary plan, the maternal infant reproduction program was allocated $7.3 million and 9% reduction from $ 8.1 million in the fiscal 2026 adopted plan. What specific services will be reduced as a result of this cut? >> Thank you for that question, chair. You know, this is u an incredibly important issue that we must uh remain focused on addressing and trying to close uh the racial and ethnic uh gap. What we know from our data is that for black birthing people, 75% of maternal deaths are preventable. >> Um and many of those happen in the post- discharge uh period, which makes the work of community-based um and clinical support after birth very very very critical. We also know that black women are four times more likely to die from pregnancy associated death and six times uh more likely to uh die from pregnancy related deaths versus their white counterparts. Um and so we have a number of different initiatives to try and meaningfully address this. Um, one of the, um, uh, programs that, um, I'm most proud of and and take pride in is the citywide duel initiative, >> um, which we, we will talk, uh, more about, uh, but also, you know, interventions like the stress-free zone, um, in Brownsville, um, and, um, the nation's largest nurse family partnership program, which does home visiting services to, uh, new parents. And so, um, this is an issue that we remain committed to addressing. uh we have a number of tools in our toolkit um and we will uh not let up until we u make an impact on this issue. >> You gonna address the cut? >> Yeah. And just just to add to that, Chair Schman, um so there there has been no cut or reduction in the maternal health world. Um I think what you may be referring to is that the city council funds are not baseline. So the amount that you're seeing perhaps in the current year is is a little bit higher than the funding that's going to be in FY27. >> Okay. So, what portion of the $49.9 million in maternal and child health funding is dedicated specifically to addressing racial disparities and pregnancy associated mortality. >> Uh, thank you for that question. Um, and hand it over to Aaron to share more there. >> Um, so I mean I I I would say that all of our maternal work is driven by that by that goal. Um, you know, one of the Healthy NYC goals, we we aim to reduce the rate of pregnancy associated death among black, non-Hispanic women by 10% by 2030. It's a central goal for the agency. Um, there's no specific dedicated funding stream because the agency is oriented as a whole >> to addressing racial disparities in our work, and that is public health. >> What metrics are being used to evaluate the impact >> um for of the $49.9 million to address racial disparities? Yeah, thank you uh for that question. So, uh the metrics that we're using are pregnancy associated um um events, adverse events, uh pre-term uh labor, uh emergency C-sections, um and of course um mortality after um after birth. Um we have um other important metrics that we can share more, but those are some of the most important indicators that we look at. How do DOH and H&H collaborate in improving maternal health efforts and how do the services differ between the two? >> Yeah, thank you. Uh we we work very closely with our partners at H&H to make sure that we are um offering a synergistic approach um in making sure that we do the best we can um to provide comprehensive maternal mental health um maternal uh health services. U we are developing the maternal home collaborative which is a delivery and payment model um which helps to reduce uh mortality by supporting birthing people in both clinical and uh in community settings. Um and we're exploring and moving forward with the um 11:15 Medicaid waiver to fund that work. Um we also have a number of other programs including the home visiting programs um which provide this sort of community to clinical continuum and um H&H really um is able to um intervene in the healthc care setting in in the hospital and health center um setting and so um it's really this sort of combined approach there in the traditional kind of brickandmortar and we are in the community doing the work. Um but um both of our both of our um um uh teams have a role to play in making sure that we address this issue. >> A current funding level sufficient to meet the city's maternal health goals. >> Uh thank you for that question. I'm going to hand it to uh Erin to talk a little bit about the budget there. >> Uh one thing I would say is actually the number that you cited earlier, the 49 million is actually one piece. It's the largest piece, but actually when you think about the maternal health work that happens across the agency, which happens in at least three different divisions. Okay. um it's actually $69 million, so it's a substantially higher amount. Um I mean, we're always we're always thinking about resource levels and what we need to achieve goals, but I think we're um we're we're continuing those conversations. >> Okay. I mean, we haven't been able, at least since I've been in the in the council, to break this pattern. So, I'm hoping that you with all of your different expertise and background can help to break through here because it it's difficult. And I worked Yeah. I worked at Wood Hole where they had a large number of maternal deaths. Um, so it's it's an issue. So, whatever we can do to be helpful and and I don't know I don't know the you know I don't have the resolution but so yeah. Well, we're committed to to making an impact on this issue and we're committed to working >> and I don't you know, some of it is the training of the doc. Some of it is, you know, it's all different ways that we and the way that we interact with p the way docs interact with patients and, you know, it's all different kinds of things, but hopefully you'll be able to break through that. I I have confidence in you. >> Um, following changes to one second. Um, do you have Do you want to ask because I have a number of questions you want? All right. So, I'm gonna I'm gonna break for a second. Um I'm going to ask Majority Leader Abrau to ask his questions and then we'll come back. >> Great. >> Thank you, Chair, and and congratulations, Commissioner, to to your appointment. I'm confident you're going to do a great job for for New York City. >> I have a set of questions on the sleep apnea pilot program that we passed last year. In April 2025, the council passed local law 52 requiring DOH to establish a sleep apnea pilot program and public education outreach campaign. The local law established a three-year pilot program to provide access to sleep apnea screenings at no cost as well as access to home sleep apnea test. This law required DOH to conduct a public education and outreach campaign on sleep apnea. For me, this is a very important uh personal bill. I suffer from sleep apnnea. Know a lot of New Yorkers who suffer from it. Doh communicated to the council that the pilot program started on October 13 of last year. However, we have been told as of as recently as December 12 that the public education and outreach component was still in development, quote unquote. This morning, I visited the sleep disorder labs web page on DOH's website, which provides information on sleep apnea. However, there was no mention of the free sleep apnea screening pilot program. How are New Yorkers supposed to access a free program that has received zero public outreach? >> Yeah, thank you for your leadership on this issue. majority leader. Um we um are working closely with H&H to get information on this uh uh this program and we hope to be able to provide specifics um after we convene with them and and get back to you with um how things are going um with the program. >> How fast are what's the turnaround you're thinking here? because obviously we're already beyond the deadline when this program when this public outreach post was supposed to begin and can you speak to the mediums of public communication that your agency is looking into? >> Yeah, thank you very much. Uh we hope to have this posted in the next few weeks. Um and we're looking at every single option that we can to get outreach uh out to community members. um we take this uh issue very seriously and I think that uh there's a lot that we can do to um join you and your leadership in moving this issue forward and making sure that we um work with community members on this. >> Thank you. And just last lastly, the law requires DH to conduct an outreach campaign through social media, the internet, digital kiosks, and other appropriate mediums in citywide designated languages. Uh DOH is required to inform the public on health risks associated with sleep apnea. common signs and symptoms of sleep apnnea and how to access health care for sleep apnnea including the screening pilot program. Um it would be great for you know all of these uh criterias within the law to be uh satisfied uh and not just one of these requirements. And so I hope that when you look into, you know, posting this and and conducting this campaign, we're able to do the wide array of mediums um that are available to you, including getting the mayor to do a social media. You know, he's very he has a big following. It'll be great to to see some kind of work there. >> Thank you very much, majority leader. We we uh are committed to making sure that this information gets out to individuals who have sleep apnea, and we're looking at all the options. We're looking forward to working with you on this issue to identify what the best media are for getting that out. >> Thank you so much, Mr. Commissioner, and congratulations again. I'm sure you're going to do a fantastic job. Thank you, chair. >> Thank you. >> You're welcome. And I want to echo um uh Council Member Breu's um questions and say if you can get back to us with a specific timeline of when this will be implemented, that would be um I was a co-sponsor of the legislation. that's very important for particularly for people who are affected and there's so much that's been coming out since the legislation was passed about this issue and the interventions that are available and all of that. So just give us just come back to us with a specific timeline that you know so we can know. >> You got it. >> Thank you. >> Um okay healthy NYC I'm going to ask like a few more questions. Um so in calendar so healthy NYC um it's uh it's a five-year health agenda main increasing life expectancy 83 years which we've met but there are uh inequities still around that >> um what is healthy NYC's current operating budget and how are funds allocated across the seven priority areas? Yeah, thank you first of all for your leadership on this issue on healthy NYC and we are um you know elated that we have reached the goal of 83.2 years um of 83 years and passing it by hitting 83.2 two years. We also know the work is not done. >> Um, and so we rem remain committed to uh making an impact not just on this life expectancy goal, but also to uh continue to push forward on our work on each of these seven uh key drivers. So the dedicated budget is $1.7 million um which supports staff. It also supports um the Institute for Healthcare Improvement who we have on contract really helping to move um the work that we're doing on each of these key drivers on many of these key drivers um even more deeply into the work that we do. But I I will say that um this is really an all of agency approach. This is not just >> right the people who who report to me in in my office. um every single um uh staff member uh in in our agency is working towards uh in some way hitting one of these drivers and so we're all rowing um in the same direction. Let me hand it over to um Aaron to see if there's anything else to add on this. >> Yeah, not much to add. Just to say that I mean arguably our our whole budget could be considered, you know, uh an effort to advance the goals of Healthy NYC. No, because that Yeah, we I mean I think that there are ways that I wanted to see do you believe that we can meet all the indicators by 2030 the 2030 targets? >> Yeah, thank you for that. Um we are continuing to drive meaningful progress on each of these seven um drivers and um you know these drivers are not are not going to change. Chair Shman um in terms of we're not moving the goalpost um >> uh and so we we are committed to continuing to try and hit each one of those. We've had a considerable amount of success on a couple of these, as you know, with COVID deaths being down about 93%, overdose deaths down about 28%. But there's so much more work to do on the other drivers. And so, um, I'm committed to mobilizing our agency to to go after >> and I would encourage, you and I have spoken about this, of getting your champion partners behind this as well because they have a stake in it. >> Um, because it affects their their entities as well. So, and then we can talk offline about some other ideas around that too. So, >> that's great. >> Um, the PMMR reports that 832 patients were diagnosed with tuberculosis in calendar year 2024, a 23% increase from 679 cases in 2023. The report notes that staffing shortages and limited funding have affected the department's ability to carry out key tuberculosis control activities, including contact investigations and case management. Um the city's TB response also relies heavily on federal funding which you had mentioned earlier which may be subject to reductions. So what factors are driving the increase in tuberculosis cases and my second question to that is there is there any correlation with an increase in homelessness? >> Yeah, thank you for that. Um first of all to say um you know we have one of the strongest TB programs um in the country. >> Um and uh we know that TB is preventable. It's a treatable disease, >> right? >> Um there are a number of factors uh chair um you know we can start locally you know with um the federal government's posture towards immigration activities um and the chilling effect that that's causing here locally individuals not going to get care not coming into our clinics not going to health and hospitals not going to the other hospitals and health centers throughout the city. We can also think about it, you know, uh, nationally, you know, we have we're living in an era where the federal government is, uh, strangling people's access to health coverage and so people are, um, uninsured, underinsured at higher rates. And then we can think about it globally as well. You know, we think about, um, the federal government's defunding of USAD. And so um and that's one of the defensive um tools that we use to um internationally and globally um you know provide the treatment that that stems u tuberculosis cases. Um we know that 90% of the people who um we have seen uh as new um newly diagnosed with TB are non- USbor >> and um and so yeah there there's a number of different factors that we think are contributing. what what strategies are we implementing to prevent further increases in TB cases particularly in high-risisk communities? >> Yeah, thank you. Um I'm going to go ahead and um ask uh Dr. Bronstein to come up, but as she's doing so um we have um uh recently received um new um uh support uh with regard to staffing to be able to uh do the work of prevention, do the work of treatment. Um, but let me hand it over to Dr. Rossi. >> Thank you, Commissioner. Um, and we, as as you've cited, we've been very concerned about recent trends in in tuberculosis numbers. Um, just incredible upticks. I will share though, um, our 2025 uh, TB report, annual TV report that's coming out in a few days uh, is actually going to site an 11% decrease in TB cases last year, which is really incredible news. Um and we are very hopeful that this decline will be sustained but um absolutely though remain vigilant and concerned uh to make sure that it is uh that it it continues beyond beyond just 2025. Um yeah as the commissioner cited there are really a combination of factors that have led to what we've seen recently in terms of trends. Um and I just want to speak to the point about homelessness that has long been a factor of course in the >> but there's been a substantial increase. Absolutely. >> Um but I will just cite that um as you might be aware since 2022 the health department um has collaborated with various city and state agencies to really enhance TB screening and services in shelters in the Herks and other temporary housing sites. And um uh these numbers are pretty incredible in terms of the reach we've been able to make. So between 2022 and 2025 um over 30,000 individuals received on-site TV related services through this individual uh this initiative um including things like TV testing, chest X-ray services, directly observed therapy. So really um really impactful and I will um also note that you'll see in our upcoming report that the number of people with TB who experience homelessness um fell by 56% in 2025 compared to 2024. So hopeful that we're really making a dent here um due to our really >> great >> uh incredible TV program, but certainly something we'll remain vigilant around. >> Thank you. >> And chair, I mentioned the the new staff that we got. I want to hand it over to Aaron to unpack that a little bit. >> Yeah, just to add, I mean, you mentioned federal dollars always being at risk, including in this area. I mean, one of the optimistic things that happened recently is last year we got new funding for uh 79 new staff >> and over $7 million. Um, and so that brings our total TV budget to just over $20 million and like 250 heads. So, I mean, I think while federal funding is always uh, you know, a concern, the fact that the city's made this historic investment really decreases our reliance on on federal funding and and paves the path to towards stability. So, >> so now I'm going to ask um my last questions. Uh so uh on December, this has to do with the health care price comparison tool. Um on December 23rd, 2025, DOH launched New York City's health care price comparison tool, which allows individuals to search and compare prices for 33 common health care services across the city, regardless of whether they have health insurance. The tool was developed pursuant to the Healthcare Accountability and Consumer Protection Act, local law 78, legislation introduced by Speaker Menon, and is intended to increase transparency around health care costs and help New Yorkers make more informed decisions about where to seek care. Since the launch of the healthcare price comparison tool in December 2025, how many users have accessed the platform, and what trends has the department observed in how residents are using the tool? Thank you for that question and thank you to Speaker Menan for her um leadership and advocacy on this issue. You know, we think that you can't have a conversation about um affordability without having conversation about um accountable pricing and right >> just the lack of transparency that um New Yorkers are suffering um when it comes to deciding where to get their healthcare. Um, with regard to the price comparison tool, um, we are tracking usage and and working to expand the number of, uh, services and, uh, making sure that we increase public awareness. Um, >> we can get back to you with regard to the specifics and the metrics. Um, okay. And follow up with you on, um, what the use has been. >> No, that that's fine. And, um, you know, we have I see that your social media has really done an uptick since you've joined us. Um but if we can do some >> if we could do some around that because it's important. >> Um how does the department and it goes to the mayor's also agenda as well. So we have a mutual agenda there. How does the department collect and verify the pricing data included in the tool to ensure the information is accurate and regularly updated? >> Yeah. So we have pricing that is sourced through um our partner at Turquoise Health. Um, and so they're aggregating price transparency data. Um, and we're awaiting updated uh contractor reports uh on this, including pricing data and city claims as well. Um, and so um working with our partners at Turquoise um as well as OLr and uh Milleman for that. >> Yeah. Okay. Um and we talked about this already the so we want to expand when you come back with the metrics we want to see we really want to expand that out. So once we have that then we should come up with a plan of how to we're going to expand that out so that pe people are using it because I don't think a lot of people know about it. I mean we know about it because it was passed by the council but >> um >> Exactly. >> Give me one second. I'm now going to hand it over to um my um colleague, Council Member Kaban. She has some questions. >> Thank you. Good to see you. Congrats. Um really excited to be working together. I'm going to ask you a few questions specifically on early intervention. uh early intervention offers special needs educational services for children with developmental delays and the preliminary plan includes 367 million in FY27 and that's a a 34% increase from the 277 million uh in the adopted plan from FY26. So can you just start by talking us through this the services that are provided for early intervention spec spec specifically the healthcare services provided for early intervention? >> Yeah, thank you. And I'm going to um start us off and then ask Deputy Commissioner Lydia Ledak to share more. Uh but um this this program is a marvel. Um it's a program that's incredibly effective. Um we uh in a recent uh journal of the American Medical Association uh study found that uh for children um who are receiving these services um they have higher test scores in um reading and in math by third grade. Um and so um we have a number of uh different um intervention points and services uh that we use to carry out this program. And I'm going to hand it over to Deputy Commissioner Leak to share more. >> Yeah. And and in talking about those different intervention points, I think we're also specifically interested in sort of like what is uniquely uh DOH's role in that intervention as oo, you know, as it differs to ACS, DOE. If you could please raise your right hand, do you swear to tell the truth, the whole truth, and nothing but the truth before this committee and to respond honestly to council member questions? >> Yes, >> you may proceed. >> Okay. Thank you for your question. So, early intervention services and the program is a federal entitlement program for children birth to three with developmental delays and disabilities. So early intervention services are provided without regard to race, ethnicity, income or immigration status. Um early intervention services broadly are available to eligible children. Um and the most typical services delivered by early intervention are service coordination which is case management uh evaluation, physical therapy, occupational therapy, speech language pathology. Um those are sort of the most common services. We serve 30,000 children a year. Early intervention as a program is fully administered and coordinated by the New York City Health Department. It is a separate program from any service that is offered by the New York City public schools or ACS, but New York City public schools and ACS are important referral partners to the early intervention program. >> And also I I guess in in terms of the referral relationship, um what happens with kind of the cross records? How were how are they sort of negotiated or like how is the information taken together and then it sort of a plan made? I'm >> going to pass it over to Deputy Commissioner Lydia Leak on that. >> Sure. So, thank you for your question. Early intervention is a completely confidential program. So, we will only share information with system with a system like the New York City public schools when we have written parental consent. So >> like a h a HIPPA release >> kind of like that. We we are bound by both HIPPA and furpa. So which makes us >> unique in that way for early intervention. But when we do have consent to share information, we will share information with New York City public schools, particularly when a child is preparing to leave early intervention, right around the time that they turn three and are beginning to enter um you know, New York City public school services, particularly the committees on preschool special education. >> Okay. So, you're you're working with a family and a child. um you do a a screening um and you know you're in the process of doing this referral to the appropriate care workers right to support the child. Can you just break down sort of the steps um for children that have been identified to have disabilities and also how long that process takes and then from there um do you all have enough staff to do that or like do you need more? Thank you for your question and also thank you for your interest in early intervention. So when a child is identified as having say a concern about their development and again early intervention is a type of system where there's no wrong door meaning that anybody can make a referral to EI when there's a concern about a child's development. So once we once a concern is identified they're referred to us at the New York City Health Department. We will um take the referral um and assign a case manager. Every family that is referred to early intervention gets assigned a service coordinator which makes it very unique. >> What's the ratio by the way? Case like what is the case load for a case manager? >> There is no established state requirement for a ratio for a case manager, but it's about 65 uh children to a case manager. We have um in early intervention and I have this number uh we have over uh 1,200 service coordinators. They they are not all employed by the New York City Health Department. They are all early intervention services are delivered by a network of over 168 service provider agencies. I would would you be able to testify anything about sort of what best practice might be in terms of uh case loads and I like I don't know what that is. You know nurses will know what safe staffing is. I was a defender and I was like holy you know my case load of 100 is way too many. Um so I just am curious of like understanding we're always asked to do a lot with a little. the need always outpaces sort of what we have. But can you tell me kind of what would be best practice in terms of a ratio? >> I think that you know let us let us come back to you with with that figure. Um >> okay thanks sorry I interrupted you and finish. Yeah >> we have >> so I just wanted to sort of finish the process for you. Right. So >> once a child is identified we assign a service coordinator. Then that service coordinator helps the child receive an evaluation to determine whether the child is eligible for services meaning whether there is a a developmental delay or a disability. If a child is eligible and around 68% of children are eligible who are referred, right? We have an individualized service planning meeting where we authorize a plan of care in partnership with the evaluator, the case manager and the family. So that's sort of the whole process and that that process ideally between uh from referral to the time that we have a plan is approximately 45 days. You said I ideally um but how long is it typically taking? >> So I have that number >> and go ahead >> chair while um uh deputy commissioner let finding that I want to turn over to Aaron to share a little bit more about the staffing that we have because part of your question is are we staffed up to do this work right so let let me hand it over. Yeah, I mean from a funding perspective I would say one of the most important things that's happened in a number of years happened in the prelim budget and that is that we uh this administration addressed a long-standing fiscal cliff for the early intervention program. So we now have baseline funding of $79 million this year growing to $144 million five years from now um for the first time in a number of years which is a huge huge win. So >> that in itself stabilizes the city's commitment to this program >> and for for that um increase that we're seeing in the FY27 budget. I mean in terms of staff lines for example, what what do you anticipate that it might be possible in terms of growth? >> I mean the funding that was added here was really to just a recognition of the true costs of the program that had been sort of underbudgeted for >> Yeah, that happens way too often. Okay, got it. >> Turn it back over. >> Sure. So 81% of initial IFSP meetings are held within 45 days of referral. >> Sorry, what was the percentage? >> 81%. >> Okay. Thank you. Um >> yeah, you don't want to ask this. Okay. All right. I'll hand it back to the chair. >> So I have um so I'm going to ask um a few more questions. Uh some of the questions are from um a uh colleague and member of the committee who is not here but because she's virtual but because we don't have quorum I have to ask them on her behalf. So this is from council member Noris. Um we've seen spikes in measles and other preventable diseases nationally. What is New York City's current risk level and our vaccination rates where they need to be? Thank you um for that question uh chair and thank you council member uh um we um we think it's incredibly important that um our children's our city's children have access to uh uh effective vaccines and through the vaccine for children's program >> uh we are uh currently able to work with over 1200 providers we're vaccinating 2.5 million children every single year um and uh you know we do this work every single day to make sure that we are keeping our our children uh safe. Uh with regard to measles um there is at this moment um no uh heightened cause for alarm. Uh we are aware that because of the federal uh policy shifts around vaccinations and some of the messaging that's coming out from the federal government uh we are aware that you know families are getting different you know pieces of information and and it is causing confusion. sewing doubt, eroding public trust. >> Um, and so last week we um launched a brand new campaign, paid media campaign >> aimed directly at this issue with regard to childhood vaccinations. >> Um, and the goal of that campaign is to really get uh families to talk to the most trusted messengers in their lives and these are the pediatricians, >> right? >> Um, and so uh that that's some of the work that we're doing and as it relates to the measles work. >> Okay. and how are we measuring whether interventions are actually lower lowering rates of diabetes, hypertension and heart disease? >> Uh thank you very much. I'm going to um ask um Dr. Zahnat to join me. Uh but um you know this is part of our um part of our routine work that we um are focused on through delivering through the healthy NYC right >> framework. As you know, cardio metabolic um uh risk factors is a driver that we're continuing to uh address. We have a number of different interventions that we are uh focused on. I'm going to hand it over to Dr. McNat to share more. If >> you please raise your right hand. Do you swear to tell the truth, the whole truth, and nothing but the truth before this committee and to respond honestly to council member questions? >> You may proceed. >> Thank you so much for the question. um appreciate the opportunity to highlight some of the work around diabetes prevention and self-management um in the city. The diabetes prevention efforts are very focused on um food and physical activity across the five burrows. And so we do a great deal of work around food um security and food affordability. Um, namely we have three citywide programs in this regard that help to um work on food affordability and food security as a as a method of prevention and diabetes and other chronic diseases. Those include uh get the good stuff, groceries to go and health bucks and would be happy to elaborate on them. Um we also focus on diabetes self-management. So once someone is diagnosed with diabetes or another chronic disease, we have um numerous um evidence-based programs that are aimed at supporting residents once they're diagnosed through that journey. Um those programs are anywhere from five weeks to six weeks and some are even one year long. Um and they offer robust services that help folks with behavior change. They also are support groups. So they spend a lot of time together with other people with the same diagnosis. Um and then also are these um workshops and classes are taught by community health workers or registered dietitians and other actors. And so it's also an opportunity to receive a great deal of education about how to speak to your health care provider um and what types of questions might help you learn more about your disease state. Um this evidence-based intervention is actually taking place nationwide um and has really great outcomes in relationship to diabetes self-management and the prevention of um loss of eyesight um amputation, kidney disease and other um potential outcomes. So lots of work in prevention and self-management on diabetes. >> Where are we with diabetes? Because I passed the diabetes reduction act a couple years ago. So where what's the status of where we are just in general? >> Sure. Thank you so much. Um so diabetes prevalence has increased over the past 10 years. Um as a and um as a result we have a lot of efforts including the diabetes reduction plan. Um and as of 2023 diabetes remains a pressing public health challenge in New York City affecting about 850,000 adults um which is about one in eight in the adult population. And um as you know, Chair Schulman, diabetes disproportionately impacts folks living in the lowest income environments um and black and latinx communities. And so in part that's why our prevention and self-management efforts are really focused on tree neighborhoods, but then very specifically on the South Bronx, East Harlem, and central Brooklyn. >> Are we seeing a lowering of the incidents at any point or >> So we are um you know, we we are seeing some early signs that the work is is impactful, but we are still um you know dealing with a major challenge. >> Okay, we'll we'll talk more about that. Um >> thank you so much. >> Thank you very much. Um the CDC has faced challenges with employee turnover including firings and reinstatements particularly under the current administration. Have federally funded CDC positions been backfilled in the city? >> Yeah, thank you um for that question. We we are um certainly alarmed by what we're seeing um at the CDC, not just with regard to the um confusing u public health messaging that uh we're hearing, but also uh the way that uh the uh conversation has really devolved and eroded public trust around public health. Um I'm going to hand it over to >> Yeah, I'm talking about the CDC positions at DOH. >> Yeah, I'm gonna hand it over to Aaron to talk about >> Yeah. Thank you, Chair Schulman. So we have uh 14 CDC staff that are assigned to the health department. Um fortunately none of them were rifted the reduction in force which is the term for the government feds laying them off >> and none of them are currently furled. So it's a >> okay >> good stable right now. >> Didn't we have somebody that was sent to Arizona? The wasn't that a CDC employee? >> Our our former deputy commissioner of disease control is back from Arizona. >> Oh we are. >> Okay. Great. >> Happy to report. >> Okay. Um, now my my very last questions are about Legionnaire's disease. At the September 19th, 2025 oversight hearing on Legionnaire's disease, the administration testified that additional inspectors were needed to strengthen oversight and enforcement. Last year's Legionnaire's disease outbreaks highlighted the importance of inspection capacity, timely compliance, and strong enforcement of cooling tower regulations. The November plan included a baseline of $14 million in city funds and 93 new positions. The preliminary plan reflects 3.5 million in city and state funding in fiscal 2026 and 3.2 million in fiscal 2027 and the outy years legionella legionella response efforts. Why was funding reduced by $250,000 in fiscal 2027 and the outy years? >> Thank you uh for that question. Uh, Chair Schulman, you know, f first of all, we learned um quite a bit from last summer's uh outbreak in 2025 in Harlem. Um, and as you know, uh, the Legionnell sampling window has been uh shortened and reduced from 90 days to to 30 days. Uh, we also have um new staffing that uh we're going to be leveraging to uh really attack this issue headon and make sure that we keep New Yorkers safe. Um I'm going to hand it over to Aaron to talk a little bit about the budget pieces um of the conversation. >> Yeah, thank thanks Chair Schulman. So yes, we're very excited to get this uh baseline new funding. Very important. What you're what you guys are seeing as the the 3.5 and 3.2 is just a technical adjustment that's about us drawing down state funds. So that's not actually production. >> Great. Um and how how is the Legionnaire's disease funding allocated? What portion supports cooling tower inspections versus community outreach, disease surveillance, and laboratory testing? >> Yeah. So, there's Right. So, there's the three buckets. So, in disease control, so it's really surveillance and testing, we have uh $9 million and 50 headcount um starting in FY27. Um in the environmental health world, which is the cooling tower inspections, we have $2.5 million and 28 staff FY27. and in uh Center for Health Equity and Community Wellness, which is really where the community outreach and education work lives. Uh it's $1.1 million and 15 staff. >> Very good. Why does the fiscal 2027 preliminary plan reflect no additional positions compared to the November plan? >> Uh sorry, I'm not sure I follow the question. I'm trying to ask you, >> oh, have all, let me ask the followup. Have all 93 positions been hired? What is the current headcount and vacancy rate? >> Uh, we're working to hire up as quickly as possible. Um, I can speak right now for the environmental health piece at least, which is, um, you know, 14 folks have been named of the 28. >> Okay. >> Um, and we're we're in the process of ramping up across the board in all three areas. >> Right. you'll keep us posted because I we passed legisla I passed legislation around that and making inspections more frequent and all that. >> Does DOH have sufficient inspection capacity to oversee all registered cooling towers? >> Thank you for that. I'm going to ask um Deputy Commissioner Karin Schiff to join us at the table. >> Okay. So, I'm going to ask so that's one question. The next question because and then when I get through this I'll be done and we'll go on to the next thing. What is the current inspected to cooling tower ratio? Could >> you please raise your right hand? Do you swear to tell the truth, the whole truth, and nothing but the truth before this committee and to respond honestly to council member questions? >> Yes. >> May proceed. Uh, chair, as you know, the city council has established really the most rigorous and protective laws for operators of of cooling towers um in the country and and perhaps in the world. And in your legislation uh that was enacted this fall, you strengthened further strengthened those requirements so that cooling tower operators will need to conduct Legionella sampling not 90 days but every 30 days. And we think that will go a long way to giving owners more information about what's happening in their cooling tower um to be able to control that legionella um bacteria. The staffing, the additional staffing that we got will enable us to conduct the annual inspection and and any followup that's needed um of every cooling tower in the city, which as you know has been our uh goal. So, we're very pleased about that and as you heard um from uh Mr. Anderson, we are working very quickly to hire and I've I've met many of our new staff. They're a great bunch. Um and so we've got a really good team. >> And what is the current inspected to cooling tower ratio? Do you have that or you >> So we there are about 6,000 cooling towers in the city and once we are fully staffed we'll have uh 50 about 56 I think the number is um scientist water ecologists out inspecting doing the work to um uh related to inspections. Um you know the question about ratio I would say I would think of it in a more nuanced way. Some of the buildings have multiple cooling towers. the compliance um uh profile can be different. So really we asked for what we needed to be able to do those annual inspections and I'm very pleased that we got that. >> Do you need additional resources to prevent future outbreaks or you think you're good now for the moment? >> So the the the program is to promote compliance with the rigorous requirements that New York City has and as we discussed uh in the fall um that is designed as a prevention measure. We we we can't commit that that nothing bad will ever happen again. Um we do a lot of education and a lot of um outreach and also these inspections that are designed as a prevention measure. >> Okay. Thank you. And um uh Council Member Kaban has a follow-up to the 2K. >> Yes. Thank you. I I know we talked about the early intervention, but I just wanted to ask about 2K inspections briefly. Uh, I know that the the prelim shows um 96 positions to to be hired. I I just want to know how many of those hires would be specifically for background checks and clearances. >> Yeah, it's incredibly important that we get this right and that we don't have huge backlogs of folks who are waiting to get um cleared. Um and so uh let me hand it over to Erin to talk about the the staffing piece. >> Yeah, thanks Chair. Come on. Just to just to clarify, I think there are two pieces um related to this in the in the in the prelimin budget. So, one is actually fixing a prior cliff. There's this $5.4 million and that's related to 3K. This 3K roll out that happened that was funded with temporary federal dollars some years ago. So, that fixes that long-standing cliff and that's around inspections and and the regulatory side and the environmental health world for 3K. There's another piece that was added which is great for 2K and that's really um 10 headcount that grow to 23 headcount and a couple million dollars around uh the 2K roll out. So I'll defer to Yeah. >> Deputy. So and and then also what would the overall numbers be then um for for staff dedicated to the those in those background checks. So, let me let me get back to you with exactly the numbers of staff we will add for background clearances, but I'll just say that um you know, as the city moves towards universal child care, I think the mayor has made it very clear that um meeting health and safety standards is going to be a key part of that and that is our role in that in that system. Um including to conduct those background clearances. So, we were pleased to get those additional staff even as this expansion is just starting to roll out. >> Great. So it's for 2K at least it's 10 to 23. Um and then you'll follow up with any additional numbers >> and that and that includes some piece of that is specifically for the background clearance work. Part of our health and safety work includes conducting those background clearances, doing those inspections. >> And that's what that is what I'm particularly interested in is breaking that up and being like, okay, what's the number of staffs that's dedicated to specifically the the background checks, the staff background checks. >> Got it. >> Thank you. >> We'll follow up. >> Okay. So, that is um that's the end of this portion of the hearing. We're gonna take a five minute break and then um Chair Kaban and I are gonna trade place. >> 10 minute break. Okay. She wants 10 minutes. That sounds good to me. >> 10-minute break. >> And um then she and I are going to trade places and then we'll do the mental health and substance use part of the hearing. Thank you to everybody. >> Three weeks. Before we before we end, I want to acknowledge we were joined by council member Althia Stevens. Do you need to restart anything or am I good? >> Yeah. All right. >> Good afternoon, everyone. I'm council member Tiffany Kaban, chair of the New York City Committee on Mental Health and Substance Use. Thank you for attending today's hearing on the city's fiscal 2027 preliminary budget for the mental hygiene portion of the Department of Health and Mental Hygiene or DOH. I'd like to thank my I'd like to thank nobody. I'd like to thank the wonderful staff who were here. There we go. I would also like to thank Dr. Martin and his team for staying to testify today. They're they're going to be here. They're downstairs for that very exciting announcement that's taking place. Uh in the fiscal 2027 prelim budget, DOH mental hygiene's proposed operating budget is 855.4 million of which 60.8 million is spent on personnel uh on personal services covering 591 budgeted positions. The budget also includes 794.6 6 million and other than personnel services, most of which cover 388 mental uh mental hygiene contracts. The changes to the agency's mental hygiene budget and the prelim plan are mainly driven by about 82 million in additional baseline funding starting in fiscal year 2026 to support our supportive housing units. DOH's uh mental hygiene's OTPS budget of 794.6 6 million covers key mental health programs and services including assertive community treatment, intensive mobile treatment, New York City 988, assisted outpatient treatment, justice involved supportive housing, and many more. And I'm eager to discuss these programs and their budgets today. As I mentioned at our oversight hearing on March 4th, connecting New Yorkers to mental health services is not just a public safety issue. It is a matter of dignity. The city is in the midst of a mental health crisis and we want to ensure that these programs are adequately funded to allow DOH to connect people dealing with mental health issues to the services they need. So before we begin, I'd like to thank the finance staff Aman Mahadon Mahade Devon gota got to put respect on the name. uh Florentine Kabor, uh Aisha Wright for their work on this hearing and the committee staff Sarah Suter and Justin Campos for their support. I'd also like to thank my staff, uh the legislative director, Jonah Burch. And I'm going to turn it over to the committee council to administer the oath to the members of the administration. >> Thank you. Um will you please raise your right hand and respond verbally? Do you affirm to tell the truth, nothing but the truth um before these committees and to respond honestly to council member questions? >> Yes, we do. >> Yes. >> Thank you. You may begin your testimony when ready. >> Good afternoon, Chair Kavan. Good afternoon, staff and uh forthcoming members of the committee. I'm Dr. Alish Martin, uh commissioner of health at the New York City Department of Health and Mental Hygiene. I'm joined today by our chief financial officer, Aaron Anderson, executive deputy commissioner, Dr. Gene Wright, Assistant Commissioner, Dr. Rebecca Lyn Walton, and Assistant Commissioner Jamie Nichols. Thank you for the It is It is uh Thank you for the opportunity to testify today on our preliminary budget as it relates to mental health. This is my first time testifying before the committee on mental health and substance use. And so I would like to briefly introduce myself. I found public health by working in the emergency department. It soon became clear to me that many of my patients were in the ER not because of an acute health emergency, but because every other system had failed them. The ER was the last place for them to turn. I learned how much upstream systems matter by watching them fail again and again. There's one particular story I'd like to share with you. On the sixth day of my emergency medicine training as an intern, a woman came into the ER at 2:30 a.m. She was wheeling a suitcase behind her. My patient sat before me with smudged mascara, shoulders curved inwards, and hands knotted in the sleeves of her sweatshirt. She told me her story. After surgery to fix a shattered ankle, she came home with a row of neat white pills. Her oxy When her Oxy prescription ran out, she turned to her husband's old bottles in the bathroom cabinet. When that too ran dry, she found herself accepting pills through a halfopened car window behind a CVS. The night she came into the ER, she showed up because she wanted her life back. She asked me for help. And I naively thought that I could help her. But when I asked my attending, the supervising doctor about next steps, he told me something simple. Discharge her. There was nothing we could do to help. In his words, it was just not what we do here. I did what I was told. I sent her away. I would like to think she got the help she needed, but the truth is I don't know what happened to that woman. What I knew was that I didn't want that to happen again to her or to anyone else. Driven by that experience with my patient, I founded Get Wavered to help ER clinicians obtain the waiverss they need to treat substance use disorder on the spot. That program grew into a national movement, helping thousands of providers reinvision the emergency department as the front door for addiction treatment. Above all else, this patient showed me that there are so many larger systems we need to invest in to change the circumstances that bring people to the ER in the first place. That is the kind of upstream work happening at the New York City Health Department each and every day. Our mental health programming spans substance use, serious mental illness, support for justice involved populations, youth mental health, supportive housing, and so much more. All of it is making a meaningful difference in the lives of New Yorkers every day. What I share with you today are just a few of the highlights. One of our most encouraging metrics of success is that in 2024, overdose deaths in New York City fell by 28%. And that's the first decline that we've seen, significant decline that we've seen in nearly a decade. That did not happen by accident. It happened because sustained public health investments and programs that meet New Yorkers where they are worked without judgment and with resources that save lives. It happened because of community health workers like Ava and Miriam on our response and engagement teams. They walk the streets every single day and engage with New Yorkers one-on-one. I was out with them near Penn Station a few weekends ago and Ava told me the story of a shift as she worked last summer. She and Miriam were working in the South Bronx when she came upon an unconscious man surrounded by bystanders. She administered Narcan and she revived this man. She called EMS and he made it to the hospital. Were it not for ABA, that man would not be here today. And again, that 28% decline is not passive. It is the result of years of deliberate investment in nlloxxone distribution in harm reduction. And in programs like relay, relay is our hospital-based peer-led overdose prevention program. Peer wellness advocates are sent into emergency departments to meet patients who wake up from a non-fatal overdose. As these patients recover, they are met with compassion, with connection, with care. Relay uh reached nearly 1,600 patients in 2025 alone. 95% of them accepted services in the ER. Relay is a monumental success. We recently expanded to Wyoff Heights Medical Center in Brooklyn, which is now the 16th hospital that is included in this program. Again, that 28% decline is not an accident and is not caused by any one program. It is only because of a broader network of harm reduction, resources, and community based care. It is the result of the Nlloxxone we helped to put in the hands of some 300,000 New Yorkers just last year. It is a result of the response and engagement team members like Ava and Miriam who do the quiet unsung work of representing this agency every single day connecting New Yorkers to care and sometimes reviving them in the field. It is also the result of coordinated engagement with you all at city council with community organizations and with peers all rowing in the same direction. What we are seeing is an impact not just in citywide data, but in alleviating the racial inequities, too. For the first time since 2018, we saw overdose deaths decline among black and Latino New Yorkers as well. That is what public health funding does. It saves lives. And the progress is continuing. early 2025 data show that the lowest show the lowest quarterly death count since 2020. Of course, none of these challenges happen in a vacuum. For so many of our neighbors, medical issues are not the underlying drivers of their mental health struggles and substance use disorders. It's structural. Often, what New Yorkers need most is solid ground to stand on. They need a safe place to come home to. Everything else can follow from there. The most tangible way we can provide that is through supportive housing. We remain committed to the goal of the 15 over 15 program to develop 15,000 units of supportive housing which provide affordable, independent, and permanent homes to New Yorkers who are unhoused and either have or are at risk of a serious mental illness or substance use disorder. This year we surpassed 13,000 units in total of both the 1515 units and the state city partnership program units. We are well on our way to meeting or exceeding our goal, especially in one of the most expensive cities in the world. These units are a lifeline for thousands of our neighbors. We also continue to invest in our crisis hotline through 98. We provide confidential support services at all hours of the day and night and 90% of these calls are answered within 30 seconds and we offer services in English and Spanish with interpret interpretation services available in over 200 languages. Our callers are trained to refer New Yorkers to the appropriate services and make sure that whatever their concerns are, they know they don't have to face them alone. We want every person in our city to know that help is available. So earlier this week when we launched a we launched a social and digital 988 campaign in English, Spanish, and Chinese. That campaign is reaching New Yorkers right now and will continue through April. Now I'll turn to the funding that makes all this work possible. At the New New York City Health Department, mental hygiene care is critical to our overarching vision to achieve longer, healthier lives for all New Yorkers. Our division of mental hygiene leads that work and employs about 600 people with an operating budget of $850 million for fiscal year 2027 as of the prelim budget. We are grateful for that continued funding and are particularly encouraged to see a sustained city investment in our supportive housing portfolio and our outreach and and syringe litter teams. At the state level, we're grateful for several investments in critical mental health programming, including 17.5 million to expand teen mental health first aid for all 10th graders statewide. Finally, at the federal level, we are watching the administration's actions very closely and have been gravely concerned to see national mental health infrastructure devalued over the last year. At the New York City Health Department, our federal funding is concentrated in our disease control and emergency prepares preparedness divisions and our division of mental hygiene is not heavily reliant on federal funding, but every part of our agency is impacted by the rapidly changing public health landscape. Here in New York City, we will continue to meet the mental health challenges of New Yorkers with compassion rather than criminalization. And I'm proud to lead this agency in a way that puts that into practice every single day. I'm grateful for the support at the state and city levels that allow us to do this life-saving work. Thank you for your attention and we're happy to take your questions. >> Thank you. Uh and we have also been joined by council member Narcissis on Zoom. She wanted to make sure that we knew. Great. >> Thank you. >> Okay. Great. Um, I would love to start with the ACT and IMT teams and do just a line of questioning there. So, we know the ACT teams a treatment program for folks with serious mental illness who have high service needs that are not being met in traditional settings. Uh the ACT program provides essential team-based high-intensity treatment and wraparound support services for individuals with SMI um challenges, substance use disorders, frequent contact with the criminal legal system, experience with homelessness, etc., etc. What are the current fiscal 2026 and fiscal 2027 projected budgets for ACT and how much of the the current funding is contracted out? Yeah, thank you for that question and thank you for your leadership on this issue. Chair Kavan. Um, you know, we see the ACT uh program as a critical part of our spectrum of services that we can provide for folks who are dealing with mental health crisis. Um, and so this is um an incredibly important tool in our toolkit providing highly specialized long-term care uh for New Yorkers who are um who are struggling with mental health issues. I'm going to hand it over to um Erin Anderson to talk a little bit about the budget to answer that question directly. >> Sure. Thanks for the question, Chair. >> Yeah. And if you could hit headcount also when you talk about the budget too. >> Sure. Sure. >> So for ACT and fact together, the FY26 budget for the current year is 27.8 million >> and the FY27 budget is 23.3 million. >> But is there a reason why you you lump the amounts together for act and fact? Can you separate it out? Uh, sure. I can get you the separate numbers for that. Yeah. But, uh, aside from that, so all of the teams are contracted out to mental health service provider. So there's no headcount, department headcount. >> Well, I mean, even contracted headcount, I guess, is what I'm say just because it helps us think about what the the need is in relationship to um the the referral lists and all those kinds of things. >> I I'll just add here that an act team has a staffing pattern that's established by state lensure. So, it's really um there's excruciating detail on the New York State Office of Mental Health website. Uh the the staffing pattern ranges from about nine to 11 or 12 FTEEs uh with the fact team having extra staffing to address the forensic issues >> and ACT teams in particular they are operating in all five burrows. >> Yes. >> Okay. What are the days and hours of operation for those teams? pass it to this is commissioner Jamie Nicholas. >> Yeah. So, ACT teams uh are required to be available to their clients 247. Every client upon enrollment is given the emergency um contact number and and they there's always on call and available. They're seeing clients typically, you know, during regular hours, but are expected to be available during other hours as needed. >> Got it. And can you just list the providers that are contracted with for ACT teams? >> Sure. I think we provided that in writing. I I don't have I can pull it up. There's about 20 or so different provider organizations. So it's a long list of >> Great. Thank you. Um and so that's been submitted. >> Thank you. >> How many people are currently on the referral list for ACT? And then from the that list, how are they prioritized? >> Can I ask a follow? And I know again I know we talked about this at the last hearing that sometimes folks will qualify for act NIMT and you know figuring out those things but cur curious how they are prioritized. >> Are you asking about the the weight list or the referral list which >> the weight list? >> The weight list. Yeah. Okay. Um well f first of all we know that um you know having a weight list is is not the ideal scenario for what we'd like to >> I know. I want you to have more money. >> That's right. uh and and uh ultimately um folks who are on the wait list um have the ability to be um engaged by a care coordinator while they're waiting and so people have that um right as soon as they they jump on that weight list. There's a pretty large um variation in terms of the numbers of the weight list. I'll hand it over to this is commissioner Jamie Nichols to talk a little about each one of those programs. >> Thank you. Uh weight lists are it's an important issue. So I'm glad you're you know shining light on it. We've got uh 312 people on the the waiting list and referral list. We use those terms interchangeably sometimes >> um at this point in time. And and as the commissioner said, everybody is offered a care coordinator um while waiting for a higher level of care. Some people are in other treatment programs while they're waiting to be stepped up to an act team. >> Yeah. I I mean, I'd be curious if there's a breakdown on sort of like who's engaged in programming while they're waiting, what what kinds of services people are getting. um how many of those folks on a a wait list maybe aren't uh getting any any services? Um and yeah, this is really important because in my mind, the way that I see it is if there's somebody on a wait list or referral list, uh their options then become an emergency room or Riker's Island. Uh and and I think that like that's what's at stake. Um how how long does an applicant wait in each stage of the process from application to approval and then from approval to placement? >> Jamie to share more there. >> Yeah. So applications to our single point of access are um submitted by uh a treatment provider typically most commonly as a part of a hospital u discharge plan also from you know community based treatment providers on behalf of the person. uh they the person themselves may may not always fully realize that there an application has been submitted on their behalf. Just want to point that out. Um and so they may or may not >> How do they find out? How do they find out when somebody else refers them? >> Wait, is it just by the contact or >> So when when we receive the application and and find a person eligible, we'll connect them with an ACT team and that ACT team goes out and finds the person. Okay. And sometimes that's how the individual finds out. Uh and it sometimes that's a surprise to them the the time at which they were referred. They may not have been um you know they may have been in a difficult position and not you know paying attention or fully you know absorbing or remembering everything that was going on. Totally understandable. So the ACT teams are are in it's a difficult position right to show up at somebody's door and to say hi you know I know a lot about you. Would you I'd like to you know help you. Sometimes that's um uh troubling to anybody, right, to have somebody knock on your door. So it takes time for them to engage folks in care, >> but could you give a timeline? >> Timeline. So So yeah, so the the referral, sorry, that was your original question. Application comes in just I got lost in the the human story. So the application comes in uh gets reviewed within a couple of business days. Depending on uh a number of factors uh may influence the the timeline to assignment to care. the most um uh the first priority goes to people who are mandated to mental health treatment through assisted outpatient treatment. So we're required by you know New York state law to prioritize access for those folks. And so they may get connected to a treatment team you know within a few days. Other folks u may wait longer may wait I think it's up to about three months is the average time from referral to uh enrollment in the program when that when that acting shows up at their door. And if you so I understand you you prioritize the mandated folks, but for that other grouping of people, what is the prioritization look like? Like sort of what are the things that you're looking for? I'm just going to throw out an example. Is it like do you see if they have they live with family or do you like what are the things that you look at to figure out prioritization? >> Sure. So one of the things you mentioned earlier, you were wondering about you know what's going on with those folks on the referral list. Are they in treatment? So if they're in treatment um and it's not optimal but they're somewhat connected, we would see that as less prioritized than somebody who's not connected to any care without a mandate. So it'll be a factor like that. Uh risk factors as as well. Um if there's, you know, more frequent um um hospitalizations, if we see a risk of of um of harmful behavior towards self or others, that could also elevate the clinician's decision. >> Thank you. and act is is eligible for Medicaid. >> Yes. >> Do you have any concerns on the outlook uh in terms of Medicaid reimbursement and the the like are you concerned about that right now? >> I I can Yeah, >> I just want it on the record. I mean, obviously it's an obvious answer, but we want it on the record. Yeah, we we are we are very concerned as an agency uh at large. Um uh the federal administration's posture towards uh health coverage for individuals uh who are who have a history of uh being marginalized or disenfranchised is is uh dangerous. It's um unfounded and it's something that um you know we are fighting uh back on here uh in this agency and certainly relates to um the work that we do in mental hygiene but it's across the entire agency. >> Totally. Can you talk briefly about um specifically how ACT teams support the LGBTQIA plus community? >> Yeah, I can I can start us off and then hand it over to assistant commissioner um Neckl. Um you know, through the ACT teams, we provide um individualized assessments and person centered um interventions for folks. Um and we really make sure that we meet the unique needs of each and every participant who comes um uh on onto our list. Um and that includes um individuals in the LGBTQI plus community. Um let me hand it over to this is commissioner Jamie Neckl see if she has more. >> I think that covered it well. Right. The the criteria are adults with serious mental illness but everybody all of us have sort of um intersecting identities and so certainly a person's uh sexual orientation or gender identity um may be one of those and that needs to be supported by the team in their person- centered service planning. And what I'll say is we are 100% open to partnership and um taking advice and guidance um you know on this. So looking forward to continue those conversations. >> Thank you. And I know that obviously the span of um health care support, mental health care support for um specifically queer, trans, and gender expansive communities is it's a hard environment especially with private hospitals deciding that they aren't going to deliver care. And so, yeah, I'm wondering what the, you know, we've talked a lot about like is H&H prepared to take on more clients, but I also wonder if there's room for gaps to be filled in in this way. Um, so I'm just curious about that, but I'm going to move more directly to funding again. Uh, really happy about the 4.5 million that was added to FY26, the adopted budget for for the expansion of the ACT teams to kind of start clearing out some of that weight. How much funding needs to be added and baselined to expand act specifically also to just like to clear the weight list? >> Yeah. Let me start and then I'd love to hand it to Aaron. >> I really want a number. >> Yeah. Um first of all, we we share your commitment on trying to make sure that we lean in as much as possible for this program. It's a program that works. It's a program that is effective and meets people where they are, literally. Um and so we you know want to do everything we can to try and um bring as many resources in to expand the program. Let me hand it to Aaron uh to share more. >> Uh thanks commissioner and thanks J. And first just to state on the record the breakdown from earlier for act and fact. So fact is $4 million per year. >> Okay. >> The budget and act the current budget is 23.8 million. >> Okay. For >> Yeah. Um yeah. So for the four and a half million. No. Thank thank you for the advocacy. Um, uh, I don't know that there's a specific number in terms of the baselineing conversation, but I I I can say that we continue to work with the council finance team with OMB and city hall on the best way to expand these services. >> Yeah, I mean, we're eager to hear what what you need so that we can like champion that that cry like it just it is really really important effective work and y'all are doing an incredible job with it. Um according to the PMMR, the number of individuals who receive services from long-term mobile community based treatment providers increased quite a bit, right? Um from close to 5,300 in the the first four month of fiscal 2025 to approximately 5,500 in the first um fourmonth fiscal of 2026. So just curious what you think are the factors that are contributing to the increased number. >> Can I ask just to follow? Are you referring to AOT? This is outpatient treatment or which which program in particular >> for I mean yeah I think we can >> well can you break it down? >> Yeah. >> Yeah. >> I'm gonna hand it to Jamie Neck will share more of that. >> I think what you're referencing are the folks who are enrolled in ACT and and and fact and IMT teams the mobile treatment services accessible through our single point of access. I'm I'm glad to see it's increased. The the cause of that is the expanded capacity. So New York State Office of Mental Health um awarded a number of new treatment teams um that flow through our single point of access including Flex Act which is a step down model for ACT to expand those case loads. So there's four new of those new teams in New York City that funding flows through us and the access comes through our single point of access. Additionally, New York City office of mental health established a new forensic act team. Uh it's operating in Brooklyn and those spots come through us and we're able to make all those people coming in. we're able to connect more people to care with those new resources. >> Well, thank you. I'm going to move specifically to the IMT teams. Um, and I said this again at the last hearing that especially appreciative of them because of the flexibility. I mean, given that obviously that they aren't relying on the the Medicaid funding, it allows um the teams to just be more nimble uh and really meet people's needs. Uh can you tell me the projected budgets for the current budget FY26 projected for FY27 just for IMT and then the headcount associated with it? >> Yeah, >> including contracted positions. >> Yeah, completely agree with um where you land on this as well. This is hugely important uh tool that we have in our toolkit to provide an extra uh level of support for individuals who um are dealing with serious behavioral health concerns and in in complex life situations. Um and so in FY26 the budget's $53 million and in FY27 it's $12 million. Let me hand it over to Aaron to share more about the headcount. Uh, actually, if we're talking about contracted headcount, I think I'll hand it over to >> Okay, >> squish your nipples. All of this is contracted up. >> Got it. >> Me. Uh, there's a There we go. It is eight and a half FTEEs per IMT team. So, that works out to a 3:1 client to staff ratio. >> Okay. And but what's the total number? Sorry, I have >> 8.5 time 36. over. Okay. You got the capital, >> whatever that number is. >> Yeah. >> Uh I went to law school, math school. >> Uh IMT's operating in all five bureaus. >> Yes. >> And they they're those teams are 10 to eight, right? Is that is that correct? The the hours of operation? >> No, their hours are um flexible. So they are responsive. We require them to be available to their clients 24 hours a day. all staff, not just, you know, that includes the psychiatrist. They don't get to sleep at night. Y um and uh their hours, their business hours are flexible. We require them to offer services and to be proactive in their outreach and non-traditional hours. And you sent us a list of those providers also. >> Great. >> Um how many people are currently on the wait list for IMT? >> Um thank you for for that question, uh chair. So um what we have um on the wait list as of um the end of February 27, so February 2027 is 575 individuals who were um on the wait list. >> Okay. >> What what do you need? How how much money do you need? I mean again you had the one time in um 11 million that was added to to expand IMT. So same question is like what additional resources are needed to expand yeah this program. >> First of all thank you for asking the question. Thank you for your advocacy and helping us to make sure that we can provide this service. As you know this this service unlike uh some of our other programs is not um billable by Medicaid. And so we're constantly looking for alternative ways to to fund this very important work. Um I I'll hand it over to uh Erin to talk a little bit more about the uh funding piece. >> Yeah, thanks. Thanks. I mean, I think the conversation on this is similar to the conversation around ACT and and the money that was added last last adopt. So, I mean, I those conversations are continuing with with council finance team and our partners in city hall. >> Great. Um, my last question on the IMT teams is I think and I I am going to ask you with a caveat again. And I I mentioned this at the the last hearing, but what steps has DOH taken to address the issues um with IMT identified in former controll Anders 2024 audit of the program with the caveat that actually I do not agree with all of the the the criticisms because I think that when you have something that is driven by so much need doesn't have these different requirements in terms of Medicaid reimbursement those are things maybe that can't be quantified as as easily when you're putting out those reports. So like with that said, were there issues in there that you s said, "Well, these are these are valid. They're concerns. We should build on them." And what what are those? >> Yeah, we agree with your position uh on this. And look, we welcome oversight. We welcome accountability. Uh we welcome opportunities to continue to improve our process. Um and we are taking those steps to uh make sure we're not just sherking off the um recommendations and and the pieces that were useful for us. Um and so we're continuing to move forward with the process improvements to the item. >> Could you name what some of those are? Were there particular recommendations that you've taken under adisement and plan on doing some work on? >> Yep. Yep. So let me hand it over to assist commissioner Jamie Nichols on that. >> Sure. Um the the controllers's audit and the auditor is really focused on client contact with the psychiatrist or the prescriber. nurse practitioners sometimes as well um and and the the client's adherence to prescribed medications um rather than the sort of full breath of their contact with the multid-disciplinary team um of course contact with the prescribers is important uh but there's a lot more to the IMT treatment than that and and so time spent searching for clients engaging collateral contacts indirect communications all these variations in the intensity and duration of the service and sometimes periods of of not finding the person but keeping at it all that demonstration of commitment and persistence um is a part of the treatment, right? That shows um that the team cares and builds trust for folks who have been really traumatized. And so I don't think that was really appreciated by the auditors who were doing their their best. And I think they made some really um important points about the data collection and reporting out. So we've um refined that process, right? The program has grown and matured substantially since that audit. We looked at a period of time during the the pandemic. Right now we're we're we're well beyond that. And so we we have three main performance measures that we're um looking at for IMT. Uh including um retention in care, right? These are folks who have been really poorly engaged by everything else. Um housing stability and um reduction in jail time. And so we're seeing and tracking that, reporting out on it, seeing good outcomes, sharing that with the providers. Um and and that's a big lesson learned from that audit. >> Well, thank you. I appreciate that. I'm going to move over to co-response non-coresponse teams. Uh, but I want to take a second to sort of clarify what we're talking about because I think a lot of people conflate the two. Um, a non-coll response team does not mean that the NYPD is not a part of or involved in the response. It just means that they are not the the first point of contact with another person as part of that initial um initial team. I think it's important because I know you guys know the difference, but I think generally there's a lot of the public that sometimes will conflate them. Um, can you talk a little bit about what DOH's current FY26 and and projected FY27 budgets are for co-response teams? >> Yeah. Um, let me start with just a couple of words at the top on on this. We think that co-response teams absolutely have a role to play. Um, they're another tool in our toolkit. are not the tool for, you know, all situations, but they're certainly a part of the puzzle. Um, in terms of our FY2, >> that's probably where we disagree, but that's okay. >> Okay. All right. Well, hey, look, we welcome the conversation, you know, and the continued uh, you know, collaboration to to figure this out together. >> Um, our FY26 budget is um, $3.1 million and FY27 budget is 3.2, right? And do you have data uh on >> Yeah. So um we do track um uh data across things like demographics, referral sources, uh services provided. Um we um are going to have to um follow up with you, get you the exact information um with regard to co-response versus not. Um but let me hand it over to Dr. Wright to see if he has >> Yeah, I I mean I would love it like at the very least a listing of what the data that's kept and what kinds of comparisons that are are are made especially since we I know we said I think we sent them yesterday so give you a little bit of grace there but we did send it ahead. Yeah, thank you for your question, chair, and thank you, commissioner. In terms of the comparison, we'll have to get back to you on that. But um since um 2025, we the CRT served about 500 individuals. And as the commissioner stated before, as one tool in our toolkit, I think it's important to really focus on the the partnership between um police officers and the mental health uh professionals in terms of what they do and how they go together. they do trainings together. Um they don't just do CIT trainings together, but they also do deescalation trainings and all those things. And so getting you the number in terms of the comparison would be great. But I think it's important to really understand the sensitivity and thoughtfulness that goes into those partnerships and the fact that you know even when they and the fact that you know even when they or something like that they follow individuals from 45 to 60 days afterwards just to make sure that they get connected to their first appointment that they're able to uh really follow through on the recommended treatment. So I think that's important to add in to that partnership. >> Thank you. Thank you. I mean, I'd love to keep talking about it. I know I mean, the there's Be Hard would be a discreet example, and while it's a program that I I love, we're seeing that uh police are being called in to respond at far far higher rates than in other cities around the country. And that is not because people that have SMIs or experience acute crisis are fundamentally different in New York City than they are elsewhere. Um, and I think that there's a lot of broad overall data around sort of the efficacy of um, non non co-response versus co-response. It's like eager to to to have that conversation more in the future. Um, can you talk to me a little bit about the intake process um, for started with a little bit of that detail, but if you could with a little bit of that detail, but if you could dive a little deeper into that, that would be great >> because there was because you said that like there was a new my understanding there was like a new intake process in May 2025 and then onboarding of new staff in July of 2025. >> That's that's exactly right. Um there there have been some improvements to the process um mostly with regard to streamlining the intake process. And so um in the past, you know, we had um intake staff that were essentially um not located within uh the CRT uh teams. And so what we do now is we do have um an embedded model where the intake staff are with the um the co-response teams. And so I think that part of what we're seeing in terms of the intake uh numbers uh and individuals contacted is part partly us streamlining the approach. >> Great. Thank you. Um we have been joined by council member Heneife and again by council members Nurse and Stevens. Do any of you all have questions? >> Yeah. What's up? Okay. Cman nurse. Wait, are you ready? I won't have to. >> Okay. Sorry, my station over here is >> chaotic. We were not ready. Um I um I just had some questions around clubouses and syringe programs. Um and maybe the mental health continuum as well. One of the things that we've we've been really fighting for as a council is to get the all of the um the smaller club houses that were operational in a lot of neighborhoods to be you know continue to have operational funding from the city and support for serving um those communities. Um, in 2023, you all did the RFP for 30 million. Um, and seven smaller clubouses lost funding. In June 2024, the council began funding five of those club houses under our own initiative. What is the uh what's the plan this year for funding these clubouses? Yeah, let me say a few words about the program overall and then hand it over to Assistant Commissioner Jamie Nichols. So, yeah, we think this is an incredibly important uh tool that we have uh for individuals to uh get the care that they need in in settings that are not the traditional hospitalized or sterile environments. Um and so, uh this um offers us an an opportunity to help individuals in a different way. Um and so, let me hand it over to uh Commissioner Dam Necklace to talk a little bit more about Yeah, I appreciate your interest in clubouses. They're they're uh an essential part of our of our public health approach to supporting people with serious mental illness, right? You need treatment, need housing, you need a community, a place to belong um and support one another and make and um participate in in meaningful activities, right, for your own health and wellness, part of your recovery. Um we uh reprocured them, as you know, a couple years ago. At this point, we we don't have another reprocurement planned, so we're a few years into that contract. Um and the programs are, you know, expanding u with new membership um every day and uh we're sticking with those with the procurement that we launched two years ago. >> And are you all in touch with some of the smaller ones that lost funding? >> So I think that those seven unless I'm unless I'm wrong, it was seven that lost >> five. Okay. Five. Do you all are you all in touch with them? Do you stay in contact with them? >> Sure. So those the city council funding flows through our agency. So we have some um modest amount of of contact with them in that capacity. >> Okay. I mean I had I have a small one on um Holly and Broadway. I I visit every year. Um I I can't remember if they got included or not. Um feel free to correct me if I'm wrong, but you know it's we're aware of what the programs do. That's why we picked up the tab in the past and and we want to continue to see even the smaller ones receive some level of support. Um, you know, these places are also an opportunity for um families to to to have support as well and a place for folks to go and and have things to do and also to allow families to to to take a break for a little bit. Um, and so I I don't know. I really hope that we can come to a better solution for how to pick up these small ones. Um, and then I'm going to move on to the syringe uh redemption pilot uh local law 124 of 2022 uh which was uh sponsored by our former deputy speaker Diana Ayala involves the collection of syringes. The program offers participants up to $10 a day to collect use syringes to there was 3 million added at fiscal year 20. There was 3 million our priorities last year. It was also a huge priority for the progressive caucus. Does this 3 million represent the total budget for the program? And if not, what is the the budget moving forward? >> Yeah, let me say a few words. This is um absolutely uh this absolutely has been a successful pilot. Um you know over a million uh syringes have been redeemed. Um you know as you know uh the funding that um individuals can get um you know typically goes towards them taking care of themselves in in buying things like food. Uh this also offers an opportunity for uh individuals to be engaged in a harm reduction uh way. And so this program um wins on on a number of different dimensions. I'm gonna hand it over to Aaron to share a little bit more around the budget. >> Yeah, thank you so much, council member. So, the the current budget is $3 million. That's the total budget for the program. Um there is not a budget at this time in FY27. Um but we're in constant conversation with with our partners at OM about our about our needs. >> Yeah. I mean, if this is a successful pro pilot, I think we should put money in there to continue it going. I'd love to hear more in the followup if we could get more information. How many how many you said $10 million has been has been >> a million syringes. >> A million syringes. I mean, that's something we should be communicating to New Yorkers, right? Especially in neighborhoods where there's a lot of complaints about syringe uh garbage and things like that. We should be um doubling down on things where we have high success rates. So, it would be great to, you know, find out how many part how many does that million syringes represent? Is it a hundred individuals? like how many people are are utilizing this program and coming back and let's put some money in it for this year. If it's it's successful, let's not break it if it's working. Thank you, chair. >> Yeah, I just want to double down on that. I I think especially since it's such a material thing that people feel and see when they walk um in their neighborhoods. I I'm before passing it to council member Heneife, I just wanted to relay a comment by council member Bina Sanchez who is with us on Zoom. Um she's worried about the lack of new lines at DOH to process new street vending licenses. She wanted me to >> is that like mobile vending? Is that right? Food mobile vending. >> Yeah. Yeah. >> Um so uh thank you for that question. Uh we are uh certainly aware of the increased um you know uh engagement that we're going to need to be doing um with regard to licensing and inspecting um pursuant to local law which was passed uh recently. And um we are working with our colleagues at um OM to make sure that we have everything that we need uh to be able to staff that um that that uh team up and make sure that we are uh ready to um provide that service. >> Thank you. I'm gonna pass it over to Council Member Hanife. >> Thank you, Chair, and hi, good afternoon, and welcome, Commissioner Dr. Martin. >> Thank you, Chair. >> I uh would like to dig in about uh de developmental disabilities programming. The fiscal 2027 preliminary budget for the AY's de developmental disabilities program area is 9.6 6 million of which personal services spending is 924,000 for 10 positions and OTPS spending is 8.6 million mostly for 68 contracts. Of those 10 budgeted positions in FY27, only five are active as of January, which brings the vacancy rate to 50%. What are the roles and responsibilities associated with those positions? >> Thank you very much for for that question. Um, first let let's uh start with where the funding comes from. The majority of that funding uh comes from the state through Medicaid. Um we absolutely supplement and we um serve as a back stop and gap filler um and make sure that um >> you think that the 9.6 six million. >> Well, I'm I'm speaking about the the program. Um overall, um we are there to provide the service for individuals who are um who are not covered by by the state. Um in terms of the the budget, I'm going to hand it over to um Aaron to share a little bit more there. >> Yeah, thank you, Council Member Bane. So, the right the budget is is split roughly half and half between city and state funding. In terms of the positions, um, you know, this the developmental disability related services are are contracted out. >> So, you know, the staff lines represent dedicated oversight positions, sort of program consultants, uh, specialists for the contracted services. Um, >> and are you able to share who provides those contracted services? Like who are the vendors? >> Yeah, we we can follow up with you to get you a list of the contracted service providers. >> And what are the 68 contracts related to? Um so you know what we do with this program is we see oversee the um uh local uh programming and working with those those vendors. Um but in general what those uh contractors do is uh provide services across a number of different domains. So >> could you provide an example? >> Yep. Yep. So like recreational and socialization um article 16 clinical services, vocational services, homemaker and classroom education. And so across a full range of um different um intervention points and it's about 1,200 um New Yorkers who are served annually through um these various um uh venues. >> Got it. And then the contractors are they New York City based? >> That is a very good question. Um I'm going to pass it to Dr. Wright um to share more on that and if we don't have more we can get back to you. But >> thank you. as the commissioner stated that um the city uh vendors fill the gap between what's going on with the state and so those individuals that we have in the city uh yes work with uh those individuals that fall into those categories uh and so yes my understanding and and blessing >> and yeah we'd like to also call up um uh assistant commissioner Marty David off to share a little bit more on this >> yeah I'd just like to get a a brief summary on how you all are supporting people with developmental disabilities and from start to end how this program works. >> Yep. >> Okay. Before you begin, I just need to swear you in. Um, one second while I pull it up. Um, do you promise to tell the truth, the whole truth in front of this committee and council members? >> I do. >> Thank you. May begin. >> Hi, good afternoon. My name is Marne David Off and I serve as the assistant commissioner for the Bureau of Children, Youth and Families and Developmental Disabilities at the Health Department. So, the programs that we contract for um roughly fall into three categories. We fund services at licensed article 16 clinics. So there's clinical services for individuals with developmental disabilities. It's one category. Um another category is we fund recreational and socialization programs. And the third is that we offer um contracts for vocational services for people with developmental disabilities. >> Got it. And are those contractors New York City based? >> Yes, those are New York City based contractors. >> Got it. And are you able to give us an example of one and sort of provide what they do and how they're reaching their >> clients? Sure. Yeah. So um our for example um the recreational and socialization programs offer um services to residents who are between the ages of three and 21. So it it goes up to young adulthood. And um those are focused on um individuals with autism spectrum disorders. and they do a wide range of activities um and services with these individuals. So they may have um field trips, they may do creative arts, cooking, sports, um social skills, um homework assistance obviously depending on the on the age. Um and um also recreational programs and educational programs with families as well. So that's one example. Um and we have about uh we have well we have recreational socialization programs throughout all five bureaus. And how are New Yorkers learning about uh these programs? >> Yeah, I mean I think there's a variety of ways. There's not one central point of entry into the DD programs. Um I think that um referrals can be made through you know educational programs for example, right? Especially if there's a recreational afterchool program that could be of benefit. Um, also if individuals um have applied for OP state OPWD services and don't qualify for those, they can be referred to our services as well. Got it. And then you mentioned that for one of the programs as your as an example that's um New Yorkers 3 to 21 years of age. Are they are the various programs um agebound or could you share if there's >> uh what what other ages you all are reaching? >> Right. So some what maybe what we can do is um send you a a followup. >> There's different No, not a problem. There's different age breakdowns for each of the categories. So we'd be happy to send you, you know, a follow-up with the exact ages um for for the various programs. >> Okay, that'd be great. I'm going to pass it back to the chair and then come back for round two. >> Yeah, we'll come back because me and you, we gonna be here a while. Um Council Member Stevens, >> hello. Um, good afternoon. Um, I just have a couple of questions. I'm going to ask some of the schoolbased questions, but I I just had a question because last year um, we passed um, intro 997A where um, where the, um, Department of Mental Health would create a training um, program for peerbased um, mental health. And I just wanted to know um, have we already started to like distribute that information and wanted to update to see how that was going. Um, I know there has been a number of young people who have reached out to myself and my office to get more information about this and so I just wanted to just have a quick check-in to see where we were with that program. >> Yeah, and thank you for your uh leadership on this um council member. This is an incredibly important um resource. You know, many of our youngest New Yorkers can't make it to see u a psychiatrist or a social worker or a licensed mental health clinician. So having their peer uh in the high school um in that seat next to them is an incredibly important uh resource. Um so I'm going to hand it over to um Commissioner Jamie Nichols to share a little bit more um about this work. Oh sorry. >> Hi. I'd be happy to speak to that. So, um, for the local law, we are really working very closely with our partners at the Office of School Health, um, and then by extension with New York City public schools in active planning for, um, the implementation. Um, as far as I am aware, we haven't begun implementation yet, but we are, is in active conversations with them about it. >> So, do you know when it will be implemented? Like, how far are we out? Do you have a timeline? Um, because again, like I'm the chair of children services young people. this is one of the things they are constantly talking about around mental health services and this is one of the ones that they actually came in and advocated for for themselves. So it is important to me to have like a clear timeline because I know even with the legislation it was supposed to be implemented right after we passed it. So I would love to just get a timeline and update. >> Yeah. What we can do is collaborate um sorry communicate with our partners at New York City public schools and follow up with you to be to give you some precise timelines for roll out. >> Definitely. I will be monitoring this closely and I look forward to following up um about this. I'm going to ask a couple of questions around um schoolbased um health centers. The Palmer plan included a one-time city funded 1.1 million in fiscal 2026 transferred to DOE to support two school-based health centers with high populations of students in shelter and um the hiring of a vision program manager, one district implementation supervisor and five mental health implementation specialists. What are the locations of those two schoolbased health centers covered by this funding and what is the breakdown for this funding between the two schoolbased centers? >> Thank you um council member for that. The two uh schoolbased health centers are John F. Kennedy High School and um the George Winggate campus. Um >> sorry. What was the other one? >> Uh it's John F. Kennedy High School um and George Windgate. >> Oh, Wingate. >> Yep. Thank you. >> And um and in terms of the I think you asked another question around the the budget. Yeah. What was the breakdown of funding between the two schoolbased centers? >> Yep. Yep. Um I'll hand it over to Aaron to see if we have u more on that to share. >> Yeah. Happy to get back to you on the specific breakdown between the two, but yes, this is this is 1.1 that comes from DOE, New York City Public Schools to to the health department. >> I'm I'm sorry. Could you say I'm sorry, I can't hear. Could you say that again? >> My apologies. Yeah. So, it's we'll we'll get back to you on the specific breakdown of that 1.1 how it's distributed between the two sites. >> It's not split evenly. >> Uh I'll have to get back to you on the specifics. Okay. I just want to say especially when we're coming to hearings, please have the specifics because I know myself. I know I'm new to this committee, but I like details. So I or if you can ask someone to get this information to you because we'll be here for a bit, but I think that it's important that you have like kind of details because I'm always in the weeds of things. So just and I'm on this committee. Um how many total schoolbased heist um health centers are in operation? >> Um in terms of uh total schoolbased health centers, uh council member, we have um 139 uh schoolbased health centers and this um allows us to serve over 140,000 uh New Yorkers across uh students across 323 different uh public schools. >> What is the OH total budget in fiscal 2026 and fiscal 2027 for school-based um health centers? >> Yep. I'm going to turn it over to Aaron to share more there. >> Sure. The uh current budget is $ 8.7 million and it's the same for fiscal year 27 and that supports 22 school those are the 22 schoolbased health centers that we support financially directly as a city. >> Do you happen to have a list of dom funded staff and schoolbased centers? Do you have a list that you could share with the committee? >> Uh we can get back to you on the specifics. What is what is the average amount of staff in schoolbased um amount of staff in schoolbased centers? >> Um can you repeat that question? I'm sorry. Council, >> what is the average amount of staff in schoolbased health centers? Like how many staff is typically on? >> Great. Um let me um call up uh Commissioner Lydia Leak to share a little bit more uh on the details of the program. How is the LGBTQ a QIA plus students specifically supported by school-based health centers? >> Before you answer, I just need to swear you in. >> Um, would you please raise your right hand and respond verbally? Do you affirm to tell the truth, the whole truth, and nothing but the truth before these committees and to respond honestly to council member questions? >> Yes. >> Okay, you may begin. So to your LGBTQ plus question with regard to schoolbased health centers. So schoolbased health centers provide care to all students regardless of gender gender identity. The um health department provides specific training to school based school-based health center providers on working with this population and specifically in addition school-based health centers also provide referrals to gender affirming care. >> Thank you. I'll look forward to the followup for the questions that I asked that you didn't have information for. Thank you. >> Thank you so much. Um I want to ask a few questions about Jes. The past few budget cycles, the council advocated to protect the existing units of JIS and expand to meet the commitments outlined in the points of agreement for closing Rikers. So, could you just tell me how many just units are there currently? How much does it cost annually to operate a JIS unit? And how much does it cost to bring a new JIS unit online? >> Yeah, thank thank you for that uh for that question, chair. Um currently we have 120 uh units uh of just units which are um spread across a number of contracted uh providers. Uh that's KMA uh the Fortune Society and Urban Pathways. Um we have recently reprocured um or up released an updated RFP um to increase the number of DIS units and we're doing so um >> that's from the money from last fiscal year, right? the added money. >> Want to I want to make sure I'm answering that question correctly. Is that >> Yes, the 4.8 million is for the new >> revised RFP. >> And then so you know that that is really because we we want to put those just units out there at a market rate that's um going to move the units. And so we have um a plan to get to 190 new JIS units. Um let me share let me ask uh assistant commissioner Jamie Nichols to see if she has more to share on this. Yeah, I want to know the cost annually to operate a an existing unit, the cost to bring on a new one, and then as to because since you brought up the the RFP, I'm also curious because you released that that amendment to the 2019 uh Jish RFP and that the original one covered a 30 380 units. The amendment only covers 190. And so I'm also curious like why doesn't it cover the the full 380? Yeah, let me hand it to uh Aaron to talk a little about the budget there. >> Yeah, sorry. Thanks for the question, chair. Um, right. So, the the the 4.8 million is is the amount that we are able to one up to 190 is what we're able to support with that >> with the 4 >> with the 4.8. >> I see. Okay. Exactly. >> So, it's the RFP to bring the new units on line. Imagine >> with the enhanced rates that are similar to the rates that match what council enhanced through its contribution. Can but can you give the cost of per per unit to bring a new one online and to to operate an existing unit per year per unit? >> I think roughly it's around 25 $26,000 a year for the service component to bring it online. The capital financing is separate issue. >> Yeah. The amended RFP did two things. It raised the rates to to be um reflective of current market prices, right? and it added a congregate option. So the the rate are detailed in the RFP. Uh there's a rate for congregate and then also scattered and then the scattered site rates are dependent upon the size of the unit. Is it a studio, onebedroom, twobedroom? So it matches FMR. So I don't have a simple answer to that question, but it's all detailed in the RFP. >> Sure. The last question on this that I want to ask about is just what what's your What's your target for just units like DreamWorld? You're like this is how many we want and need. Will you be able to reach that target and how much more funding would you need to meet that target? >> Uh yeah, I can um maybe share a little bit about that. Currently, as I as we mentioned, um we have these 190 uh units that we're targeting. Um but we we do have a plan to uh get to 350 uh uh total units. But let me hand it over to um Jamie to share more. Sure. So, we've had 120 scattered site units since 2015. I I want to get to 121, 122, right? We need to add more. It's a really valuable service. So, I think it's it'll be 120 plus 190. Um, and um if that's going well I >> And then you want to get to that 380. Did you say 3? >> Yeah, the the 350 really. I mean, that's, you know, there's the units that we're doing and then there's also the the just home units that were announced. >> Very excited about the just home units, but how much how much money do you guys need? >> I think the how much money question is, as Jamie said, I mean, we're >> Yeah, >> there were I mean, how long is that RFP out there? It was for years, right? And there was zero response, so I think seven years. >> Okay. So, I think we're really looking forward to seeing what comes of this recently re-released one and just continuing the conversations with both council and the and the administration. >> So, I I want to just shift and ask about supportive housing. Um, the prelim plan includes baseline city funding for 81.9 million in fiscal year 2026 with inflationary increases in the out years as a funding reestimate to support existing units. um approximately 61 for the 1515 supportive housing units and the remaining 21 to support the pre-1515 program units. I I just how many total units of the 1515 supportive housing are there in New York City? >> Yeah. So, >> and how many are vacant and what's the timeline to fill those vacancies? >> Yeah. Um so, I can start start things off and then kick it over to Commissioner Jamie Neckl. So, we currently contract for over 13 uh,000 uh units. Our current vacancy rate um is about 7%. So we have a fill rate of about 93%. Um and so >> what's the number? 7% is how many units? How many homes? >> 7% of 13,300. >> Y'all keep asking me to do math like you bring your calculator next time. >> Assistant commissioner Nicholls on that. >> Yeah, I'll bring my calculator, right? So thank you. We have a great report uh with that precise number. It's 876 out of um 13,000 units. Uh but uh 417 of those have been linked to a person, right? So that person is is found met the gone to the program, seen it, said yes, I want to sign a lease and is in the process of moving into that unit. >> Okay. How long does that take? >> Uh so that um can take it depends on a number of factors, right? When the person wants to move, when um the building is um safe for human occupancy, right? we have to have a temporary certificate of occupancy to make sure it's safe um and and make sure that their vouchers are in place. It can take a a couple months. >> So, in in putting aside the folks that are like have had applications per um approved, they've looked at apartments, those other vacancies, what's the timeline to fill those other vacancies? So there are it's about I'm doing quick math 76 other vacancies where there's >> where there's just not yet a person. This is happening every day, right? The the um uh HA is making um referrals and placing people daily. >> No, but totally. But I just a matter of time until the person finds >> No, totally. But I want to know what that matter of time is. If there's an estimate around like when we can expect expect expect that >> we can get we can get back to you on that chair. >> Okay, that'd be helpful. And then I mean this is a similar question looking out further, but is the city on track to build 15,000 of of those 1515 units by 2030? >> Yeah. So I think um I can start off and then hand it over to um this is Commissioner Jamie Neckl. um we we we uh were on track to uh um hit that on the congregate housing side. Uh but things get a little bit more tricky when we think about scattered site housing. And so um as you might imagine, the idea of our staff members having to travel across the city and spending half the day on the subway. So it it makes it um more challenging. Um so that's why we um are pursuing the congregate housing option. But we'll hand it over to Jamie. >> Sure. So uh the original 1515 RFP was uh split evenly between congregate and scattered site 7 is it 7500 congregate 7500 scattered. Uh it was uh initial success with the scattered site procurement. Um we got a number of awards in the beginning but that plateaued as the housing market um you know prices went up and so last year we reallocated money that was uh originally intended as scattered site towards more congregate. So, we added more um opportunity for providers to submit proposals for more congregate buildings to build. Last year, we've got a ton of proposals. Those are all being um reviewed. And as we see how these awards shake out, right? What are the awards? What are the size of any one development and the construction timeline, we'll be in a better position to talk about when those units actually come uh to fruition. Okay. I'm going to move over to crisis respit centers. Um these centers they provide alternatives to hospital stays for people experiencing an emotional crisis. The centers offer stays in an homelike setting and have an open door policy for folks who to be able to continue their daily activities. So can you just say you know the current budget and projected for FY2027 for these centers and how many of the crisis respit centers are funded by DOH? Yeah, thank thank you uh for that uh question. We you know we think that um the cris crisis uh respit centers offer um an important um uh extra intervention to provide individuals who um who need care and so this is an important part of our spectrum of of tools to provide. Um with regard to the budget, let me um hand it over to Aaron. >> Thanks commissioner. So the FY26 current year budget is 5.3 million and the FY27 budget is 2.8 million. >> It's a big difference. I I mean I just obviously we want to see not not just stay the same but increase especially considering the the climate in the city. Um how many of the crisis respit centers are funded by DOMH? Um, >> and do you fund crisis respit centers in all five bureaus? >> Yeah. Um, so we currently have um uh four uh are we talking about the crisis residences or crisis respit centers? >> Respbit centers specifically. Okay. >> Yeah. Yeah. So, so let me let me comment on on that. So, uh, we currently have four contracts for four, um, crisis residences and, um, these allow for individuals to stay up to one week in an open door setting where where folks can, um, be, uh, cared for in that way. Um, and so we are always looking for ways to expand. Um, >> but sorry, I just just, you know, I want to be able to pass it over to my chair soon. I just want to know >> um, how many is this? So, it's the four. >> Yep. >> Okay. I'm just gonna not trying to be rude. I just want to be mindful there of the the public and the chair over here. Um, and you've sent us a list of the contracted vendors for those crisis respit centers. If you haven't, please do. >> I can tell you right now. I don't think we sent the list. It's Community Access. Okay. Um, Mosaic Mental Health, SUS services for the underserved and um transitional services for New York. >> Great. Thank you. And then my my last question on this is that there was an additional 2.5 million added at um FY26 adoption to support crisis respit centers. And this was one of the council's budget response requests last year. So, how specifically will that 2.5 million support the crisis respit centers? >> Yeah, you know, we are committed to um uh continuing to do this work of um exploring all options with regard to advancing the crisis resp. We're having conversations with OM and our colleagues across city hall to explore what's possible to expand. >> I'm going to move over to capital. funding for a second. DOH has a capital budget of 553.5 million in the FY26 to 2030 capital commitment plan, but it doesn't provide a clear picture of how much the city is investing in public health capital projects versus mental hygiene projects. C. Can you divide it? Like is there a way to divide it in into future plans? And what are the main mental health related capital projects and what are their total budgets? >> Yeah. Yeah, we we do have um uh an exciting uh few months coming up here with regard to Capitol um uh announcements. We have a brand new um public health lab, 240,000 square feet, 10 story building that's going to be open up in in Harlem. Um in order to >> It's a price tag. Um >> it's a good question. We're going to have to get back to you. >> It's about 650 between 650 and 700 billion. >> Got it. Thank you. And then in terms of breakdown between public health and mental health, I think we're going to probably have to get back to you on that. >> I mean, the one thing we can say now is, you know, the majority of our agency's capital funds are really about facilities, which is health centers, offices, which are located throughout the city and and the other piece is really it infrastructure. >> Um, so that's that's the vast majority. I mean, we're happy to get back to your specifics, but the bulk of it is in those two areas. >> Thank you. Department of Well, I shouldn't say department, office of community safety. Um, the mayor has just announced the the creation of the office. It we know that it's going to house programs and services at the intersection of mental health and public safety. Is DOH involved in the planning for the office? >> Yeah, look, chair, we um have been doing this work of community mental health for decades, and we are committed to continuing to do that work. Um, we're also excited to have conversations with folks across uh city hall at at city council advocates, anyone who's interested in addressing the issue of community mental health. Uh, we're part, as of now, have you identified any mental hygiene programs that are going to be transferred into that office. Yeah, we're still in conversations with um city hall and OMB about what the future will look like and I'm eager to talk to and and build a relationship with the new deputy mayor uh for >> so under the assumption that we don't have the answers to this yet. I'm going to put these questions out there and would love followup. Um in addition to what programs might be transferred, I'd love to know how much of the DOH mental health mental hygiene budget and headcount would be transferred to the office. Uh and then just like here's a general question of like do you believe the creation of this office will improve mental health and public safety outcomes in New York City? >> Yeah. Well, first let let me speak to the broader question and that is to say that um we are eager to work with our counterparts um at the office of um uh community safety and and we see them as partners in doing this work. uh we're going to have to get back to you on the specifics of the programming and the budgets and all of these are are conversations that we're currently having um across the agencies. >> Great. And I'm just going to ask a couple questions on behalf of Finance Chair Lee, then I'm going to hand it over to my colleague who's going to run the show from here on out. Um on on 988, there's a a total budget of 46.8 million including city funding of 34.3, council discretionary funding of 5 million, state funds of 7.5 million. a lot of people are invested in 988. Um, talk to me about what the projected funding for fiscal year 2027 is. And then also, you know, do you have data on the total call volume, including calls not answered, the current headcount that you have? Uh, and then just could you tell me if that staffing level is sufficient to meet the demand for services uh, and improve uh, weight times? I I the caveat on this is obviously We're not seeing as much call volume as we volume as we would like to. And a big part of the work is getting the word out about 988 and like preparing for there to be larger >> call out volumes. >> Super important program and one of the most important uh resources that we have to offer uh care to individuals that are in need. You know, this is a 247 hotline, you know, 365 days a year. Um, we're currently staffed to uh reach about 420 something thousand individual calls uh throughout the year. So that's where we are now. In terms of your question of our FY27 budget, um we're at $30.8 million. Um and so that's what we're looking at moving forward in terms of the the budget. >> There were other questions baked in there. Did I answer all? >> Oh, just the data on the call volume and the current headcount. Uh, I think based on what you're telling me, I think it's fair to say that the the staffing and the funding isn't sufficient and we need more because you have plans. Sorry, I just want to finish the the I mean, we also heard at the last hearing that you have plans to do PR campaigns and which we are this year. Yeah. >> So, that's like in addition to the work that you're already funding for 988. It's an added layer of of cost that's obviously very necessary. >> Yeah. So, let let me speak to a couple of those points and I'd love to hand it over to uh assist commissioner Jamie Neckl. So, um you're right, we we do have plans to popularize and and to make sure folks are aware of 98. We actually just recently launched a paid media campaign on that subject. Um in terms of the headcount, it's a little tricky because this is a contracted uh provider. So, these are not individuals that we staff or that you know work for us. Um this is a contracted provider who is doing the work. Um but let me hand it to uh Jamie Nichols to see if she has more to share. >> Yeah, the the most um important metric we we look at to understand if uh we're staffed adequately is the average speed of answer. How quickly are 988 counselors picking up the phone, responding to a text or a a chat. And they're they're doing that 90% of contacts are answered in 20 seconds or less. So that's really fast. Um, and that shows us that their staffing pattern is responsive to the demand. >> Yeah. I I mean, again, my point will continue to be that not nearly enough people know about 988. It's a critical resource and if y'all do your job, the call volume is going to rise exponentially and like we want to be prepared for that so that people continue to only wait 20 seconds for that. So, just, you know, you have partners in us advocating for for more money being put into that space. >> Well, I'll tell you this, uh, chair. I was just at Queensbridge uh houses just this this past weekend and um was doing some work with our community health workers in the community and you know an individual who was part of the housing complex came up to me and said you know the real issue that I have is that you know I have folks in in my on my floor in my family who need help and I said do you know about 988 you can call you can have your you know family your friends call this is a service that is here for you and so we do need more people to know about this and we share your uh concern and your interest around how to get this right. >> Yeah. And it's life- saving too. We've seen what happens when you know unfortunately the wrong responder shows up and it can be deadly. Um so thank you and I'm going to pass it over to Chair Haneife. >> Thank you. I just have a few more questions. Um do you have dedicated staff specializing in uh developmental disabilities? >> Yeah, thank you for for that question. And um I'm gonna have assistant commissioner Davis come back uh to share >> and then if you could also share what the funding or budgeted allocation is for uh dedicated staff. >> Hi yes we do have staff dedicated to developmental disabilities work. Um and just to clarify if we didn't say this earlier that the staff our staff are not providing direct services. So all of our services are provided via contracts with community based organizations. Um staff are there to really provide support um oversight and support for those contracted programs and providers. >> So then in terms of oversight, what uh is DOH collecting or assessing? Yeah, we do collect data um monthly from all the contracted providers on um individuals served and um you know other facets of their of their programs operations. It sort of depends on the the type of program but yeah. >> And then outside of the uh contractors does dome provide anything else uh as services are being provided or are you all just a conduit to the contractors? for direct services. We are doing that through the contracts. Exactly. >> Okay. And then I'd like to know what other disability disabilities related services do DOH provides directly. >> I would have to turn that back to >> Oh, and I also had I also wanted to know uh with the 68 contracts, how many New Yorkers are being served right now? and is there a wait time or um people unable to get into the program? What are the obstacles? >> So, so chair, yeah, we're we're able to serve about 1,200 uh New Yorkers um every single year. And that um you know is across the spectrum of the different um venues that we've discussed in the past the the clinical services the recreational um and vocational um and yeah in terms of the question around disability um yes this is part yes we we do have uh contracted providers who do this work of um helping individuals uh with intellectual and developmental disabilities but this is baked into our our culture and baked into the work that we do across the entire uh agency and and something that uh we take pride in. >> Could you share a little bit more about what you mean by that? >> Yeah. So, um you know, we are u making sure that we offer individualized person- centered care and you know across every single agency and that includes people with intellectual and developmental disabilities. >> And you mentioned every year 1,200 New Yorkers. Um is what's the budget line for this? And is there um any plan to expand the reach to more than 1,200? >> Yeah. So um I can share briefly what the FY27 um budget line is. That's 2 point uh sorry that's $9.6 million uh for um for this work. But let me um hand it over to >> And is that more than last fiscal year? Uh let me hand it to Aaron to talk a little bit about the um specifics of the budget, but but that's what we're looking at in terms of the coming year. >> Yeah, thanks for the question. So that that 9.6 is the is the budget for the developmental disabilities area specifically. Um I think if we think a little bit broader, I mean there's early intervention which is one of the single largest programs in our entire agency's portfolio and that's 300 something million dollars. So I think that's that's another place to think about this this type of work. And in the early intervention work, are you all providing direct services or is it also a contracts driven model? >> Uh I mean it's it's it's a combination. I think I'll call up uh you know deputy commissioner Leiaak EI expert. >> Hi. So thank you for your question. Um it's a combination of both. So we provide direct services from the perspective of receiving referrals, uh convening meetings with families to authorize plans of care. And then the actual services, the therapeutic interventions, the evaluations, and the case management are delivered by a network of 168 provider agencies who employ or subcontract with over 8,000 uh therapists and teachers uh who are actually delivering the care. >> Understood. And in the early intervention uh programming, how many New Yorkers are being served? >> We serve 30,000 children a year. >> And does has that number increased, decreased? >> It it tends to be pretty stable year-over-year. >> Um however, in terms of the number of children served, we saw we've been seeing a slight decline because the number of birth to three the birth to three population has declined a bit. However, uptake in EI um has not declined as much because we're very successful at establishing partnerships and ensuring uh that we are appropriately capturing uh the children. In addition, we're really excited about the two care expansion because it's going to facilitate, right, additional identification of children for early intervention. >> And uh among the 30,000, could you break it down uh by demographic? Who are which communities are you seeing um the most in need of support? >> So um the prevalence of disability in this population is about 10%. it. Um and so it does not vary right based on uh you know race, ethnicity. Um if you want we can definitely follow up with you on the specific uh breakdowns by burrow and and race ethnicity group after >> that would be great. I know my colleague, Council Member uh Riley, is very interested in uh autism in the black community and I think we would love to just learn more about what DOH is doing. And then uh how many people with disabilities did DOH work with in the calendar year of 2025? Um we we can um you know tell you that from the perspective of uh the work that we do to supplement the state um we we helped about 1,200 individuals in the last uh year. Uh but that's that's really just in the sort of narrow framing of uh the work that we do um with regard to that bureau. But it's it's hard to put the number broader in terms of all of the agency touch points with individuals with um intellectual and developmental disabilities, but we can try and figure that out for >> Yeah, I'd definitely like to um go into a deeper dive on just how many uh people with disabilities I mean I think between DOH and MOPD it's I'm still sort of teasing out uh how exactly our city is providing uh services or is allowing people with disabilities to reach us >> for resources. Um, so this is good to know and and certainly that 12 1,200 number seems like it could be much bigger and I and I think uh uh the funding uh for that is critical. Um the budget for disabilities is significantly lower than the budgets for mental health services, addiction services and administration. Why is the budget for disabilities so low comparatively? >> Yeah, thank you for for that question, chair. So, um, as you know, when we think about the services that are provided to individuals who have intellectual and developmental disabilities, uh, uh, the large majority of that funding comes from the state through OPWD. Um, and so the state is providing um, much of that support. Now, we do have a role to play for individuals that are not covered u by the state. Um and so we see ourselves as supplemental um as sort of helping to butress the state u budget. >> So you're saying that the state provides the funding for people with developmental disabilities or intellectual disabilities >> through through the through the Medicaid program >> through the Medicaid program. And then you all are there any initiatives or um program areas where you are directly reaching uh people with intellectual and developmental and of course other disabilities. >> Yeah, thank you for that. And um you know the answer there is that there there are individuals who are either waiting for um Medicaid or who don't don't qualify. Um and for those individuals, we are helping to sort of um be the safety net of the safety net um for those folks. >> Got it. And then what's your relationship with uh MOPD? >> Um I'm going to um call up um this is Commissioner My uh to share more on that. So we are very excited that um one of our colleagues Nisha Agaral was um just um appointed to lead um MOPD and um we'll definitely be working closely with her to continue to plan services. Um I'll I'll allow her to speak directly to what MOPD offers. Um but I know that um they do a lot of great work and we're excited about the opportunity to collaborate as we move forward. >> And what what kind of collaborations have already happened in the past? Um we have engaged with them um about really to just really understand the landscape of where their vocational services in particular like they do they also offer some vocational services and to really engage with them about you know what those look like what ours look like and um to think about how we can work more closely together going forward. So that's a conversation that's that has started but um is is underway. That's good to know because I would love to have um some reps from DHMH at our next disabilities and accessibility hearing. Having both agencies would be really really wonderful. >> You got it. >> Um so just to wrap up, I we're going to reach back out to you to receive the names of the 68 vendors and the ages per program that are being served and reached. And I think that's about it for now or all that I remember. Thank you all so much. And I also just want to briefly note for all of the public that are here. Thank for thanks for your patience. We are running very behind and public testimony was supposed to begin at 2:30, but we are going to take a few minutes break and then go to disabilities with MOPD and then we will have public testimony. Thank you. >> Thank you guys. >> Thank you very much, chair. >> Thank you, chair. Thank you. If you're here to testify, you must fill out a witness slip with one of the star at arms. Even if you signed up already online, please do not block the front entrance doors. Thank you. Please find your seats. We will start shortly. Find your seats. Thank you. >> Good afternoon everyone. Welcome back. I'm council member Shahana Hanife, chair of the city council committee on disabilities. Thank you for attending today's hearing on the city's fiscal 2027 preliminary budget for the mayor's office for people with disabilities or MOPD. I would like to note that assisted listening devices and an induction hearing loop are available in council chambers. If you would like a device, please see the sergeant at arms. Additionally, committee materials are available digitally via a QR code posted on a board outside of chambers. American Sign Language, live captioning, language interpretation services, and materials in alternative formats, including large print, are available with advanced notice. for future hearings. To request these or any other accommodations, please contact the council's EE office at EO officer@counsel.nyc.gov. We'll make sure that you have that or 2127886936 or email translation service.nyc.gov for language services at least three business days in advance. I would like to thank Commissioner Nisha Agarwal and Chief of Staff Sarah Roshinara from MOPD for coming in today to testify in the first budget hearing for this committee. MOPED's fiscal 2027 preliminary budget is $678,657, mainly for personnel services, covering six budgeted positions, of which three are vacant. This budget has not changed since last year's adopted budget. For too long, the needs of disabled New Yorkers have been sidelined. The creation of this committee is long overdue and I'm looking forward to working with moped to ensure that the disabled community is served adequately. At today's hearing, we will seek details on moped's programs that support the disabled community and we'll hear about its partnerships with city agencies on disability issues in all areas of urban life. I would like to recognize that we've been joined by Council Member Lee, our finance chair. I will now administer the oath to members of the administration. Will you please raise your right hand and respond verbally? Do you affirm to tell the truth, the whole truth, and nothing but the truth before these committees and to respond honestly to council member questions? Thank you. You may begin your testimony when ready. Okay. Can you hear me? All right. Okay. Great. Um, good afternoon ch uh chair Hanife and members of the committee. Um, thank you for the first ever opportunity to testify uh today at the uh fiscal uh year budget for the mayor's office of people with disabilities. Um, my name is Nisha Agarwal and I have short black hair and brown skin. I'm uh wearing a black top and black trousers and a multicolor necklace. Um, I have a fasia and I have my handy cane at my side. I am honored to um serve as the commissioner of the mayor's office for people with disabil as the commissioner of the mayor's office for people with disabilities also known as moped also known as MOPD. Um first I will share about the role of MOPD. Moped's mission is to ensure that New Yorkers is New York City is accessible and inclusive for the more than 1 million New Yorkers with disabilities who live and work in our city. We believe that accessibility is not um uh limited to one program or one agency. It is a citywide um responsibility. Um, mopeds uh work closely works closely with um partners across government and um external stakeholders to ensure that policies um uh services and programs consider the needs of New Yorkers with disabilities from the start. I want to I want to be uh I I would I I would like to share the vision for um MOPD under the leadership of Mayor Mandani. Um but to understand the importance of this work um it is helpful to look at some of the challenges faced by uh based on uh New Yorkers with disabilities in employment. For example, just 40% of New Yorkers with disabilities of working age are employed compared to 73% of the city's overall working age population. And for those who are in the labor force, um the unemployment rate is nearly double, 13% of people with disabilities compared with 7% citywide. In education, um almost 30% of adult New Yorkers with disabilities receive less than a high school um education compared to 16% of the city's overall population. And the opposite is true as well. Um while over four 41 um percent of cities overall population received a bachelor's degree or higher um only 23% of people with disabilities had the same. These um inequities persist not because of lack of skill or motivation but because of structural barriers um inaccessible practices and limited awareness of available support. So recognizing these challenges um moped moped's vision is to strengthen um partner and um expand our services and policies for people with disabilities. I'll start with the strengths. Um the key priorities from the mayor, affordable housing, access to health and mental health, uh accessible uh transportation, education equity, and employment opportunities are critical to pe people with disabilities and to most New Yorkers. Given that, um part of our strategy is to strengthen some of the existing work we already have. For example, um NYC at work uh uh program does a continuing of um individual um services to both job seekers and um employers. For job seekers, we uh offer career advice, um uh resume and um individual preparedness, um guidance on disclosure and um uh reasonable accommodations, um retention services and uh support for those who apply for city government. On the um employment side, we uh work with um uh employers on recruitment um support um pre-screening uh candidate referrals and um personalizing hiring um events um among other things. This has been very successful, but MOPED wants to um strengthen and expand NYC at work by um doing digital uh literacy training or mental health supports as um people with disabilities rebuild confidence and re-enter the workforce. There are also um administrative hurdles and uh legal lengthy um approvals for uh uh getting a city job that can uh discourage both um job seekers and the hiring managers. To accomplish this, we need to work with um external uh stakeholders and internal stakeholders, our other city agencies to do it. and to do it well. We also want to grow and strengthen the systemic change side of this uh equation using policy research and communications strategically. We can um uh start to influence the decision makers at the city, state and and federal level and have an impact on people with disabilities systemically. to expand our existing um programs or to work on new priorities. Building and expanding our partnerships is key. So, first I'll talk I'll talk about the uh disability communities. Disability advocates are trusted community messengers, have deep community ties, and the ability to focus on specific issues in depth. MOPed um covers the range of disability services and accessibility, has convening power, and also um has access to city hall and other city agencies. Moped should be uh in constant um partnership with disability advocates working together on our shared um priorities and when we have a disagreement have an open discussion and next steps for resolution. I will also add that um moped should also en ensure that lesser known disabilities for example language learning and mental health disabilities um should be incorporated into these discussions. Next are city agencies. Historically people of disability were brought into uh at the end of any project not at the start. This was frustrating for people with disabilities and it was a disservice to those agencies that were uh involved in that in that project because in the end we chose the faster design instead of the best design in the new administration. However, the heads of agencies that were chosen, including me, are um into collaboration and problem solving, and that is really exciting. Moped is nimble and knowledgeable on uh accessibility and inclusion for people with disabilities. The agencies have deep expertise in their issues and can incorporate in accessibility and inclusion into their projects with moped um assisting. It's a win-win. It ensures that the city government is efficient and has a whole approach model and New York New Yorkers um people with disabilities and the broader public will recognize that this city works for them. Um, next would be broader social movements. In the 1960s and 1970s, um, disability advocates were in conversation with the civil rights movement, um, women's rights, um, LGBT rights um immigrant uh rights and the anti-war movement. Now, in 2026, it feels more fragmented and, um, siloed. It is it it is um important to pollinate um those seeds again um and using um uh mopeds um convening power to cultivate the interconnectedness um we all have that we all do. And finally elected officials um everyone including people in elected office have people in disabilities in their lives. It may be themselves, their family members, their friends, their neighbors, or their constituencies. Moped wants to work with electeds, all of you, um to share resources and information and over time build our um relationship and partnerships with all of you. Moped's vision is bold but doable. Um like New York City, we um don't want to do the bare minimum. We want to be the best in the country um creating innovative ideas that will have a ripple effect on other cities and states. We don't want to create um programs and policies that impact some and exclude others. The goal for us is if it is helpful if if it helps us, it can help others. So, we appreciate the council's com commitment um to uh uh accessibility and inclusion and its focus on the needs of New Yorkers with disabilities. We look forward to working to working um with the council, community members, and city agencies to strengthen accessibility across the government. Thank you all for the opportunity to testify today and I'm uh I would love to have more uh to answer uh questions from you. Thank you. >> Thank you, Commissioner and congratulations again. I'm super excited and excited really to hear your testimony and your vision about moped. Um, and given this is the first inaugural disabilities committee, I think we we are going to be a power team. >> I agree. >> Okay. So, you went into this a little bit in around the city agency's uh partnerships. I want to understand if you believe New York City is currently meeting its legal obligations under the American with Americans with Disabilities Act across agencies and if not where are we falling short and what specific investments are needed to come into compliance? Yeah. So, um, Moped provides um oversight um guidance and technical expertise, and we work closely with agencies to ensure, um, compliance with ADA and local laws. Um while MOPED does not um directly uh doesn't have the direct um enforcement authority um as a we're not a regulatory authority but um we play a central role in identifying issues um elevating concerns um setting accessible standards and ensuring that agencies will follow through. And how are you all assessing whether or not agencies are complying and what uh mechanisms do you have to work with the agencies? Yeah. So, um we have um disability uh service facilitators or DSF um are um agency representatives who are um committed to making their city the city uh agencies more inclusive. Um DSF's um coordinate city agency's efforts to comply with and carry out um uh laws related to ADA and other federal, state and local laws and regulation and regulations. Um, and they um are uh they work with um other agencies and services but with people with disabilities. >> And are you able to share maybe an example of how moped has in the past uh supported a city agency? Yeah, I mean so many examples. Um but uh a good example would be the work that we did um with um uh the mayor's office of um entertainment or mo uh media and entertainment. Um and so let me give me a second to find that um because we have that. Um so um in um uh so hold on give me a second. Okay. Um so um movie theaters in New York City um must provide um open captions um in some um of the movie movie movie showings um due to a law and MOPAD collaborated with the department of consumer and uh uh worker protections and um the mayor's office of media and entertainment on this issue. Um uh the consumer and um worker protections um is the enforcer and uh moped and m um are um worked to inform um of the the issues and um moped mo um provided the website. So that's like uh working with agencies to create um a law that passed. >> Got it. So there isn't a sort of blanket policy across all agencies around ADA accessibility, but rather or could you describe what that what what's standardized? And of course what you described is very important and it's it's unique and uh we're grateful. >> Yeah. So um the so there's the DSM DSFS um in every agency and then the DF DSFs can also be um being be the same as the agency ADA coordinator. Um so they have an ADA coordinator who manages the um accessibility for um the ADA laws. >> And the DSF is someone who is a a full-time uh employee or do they have other roles and in addition to their other role they are DSF? >> Yeah. So um most DSF is in u are in are people who are in DSF and that is on top of their primary job responsibilities. Um, but another thing I wanted to mention is that um, we also do the five-year um, accessibility plan and we ask all agencies to do that on ways that we can um, everything from their building to other um, uh, uh, disability and inclusion um, activities. So we do that for all um, of the agencies as well. >> You give them feedback. No, they we as have we asked them to create um a five-year accessibility plan. So, every agency has that plan. >> Got it. And who looks that over? And >> we do. Okay. Um and also, and I was working in the health department, they have um staff who also um review it and and do that. So, I think it's important that not just moped receives that and um uh comment comments on that but the um agency leadership and um I also do that. >> Understood. So each agency has a deal DSF. >> Yep. >> Are there any specific trainings that moped provides and what are they? >> Yeah. So um there are um we meet with them monthly um and um also um moped staff are do um bi-weekly office hours for the DSF people if they have questions, concerns, etc. So, we tried to keep an open dialogue. >> And does it seem like this uh piece of support could use more funding? I mean, you mentioned that DSF's have other jobs that they're doing and this is an addition to their portfolio. >> Yeah. So, um I'm in communication with city hall administrative office and OM um and I have a plan to restructure um moped as I shared in my um out in my testimony and so uh I don't have the details at at at the moment but I'm three years three um three um uh week weeks um starting so >> no totally Well, I I look forward to learning more about the restructuring. And how is uh a DSF appointed by the agency? What qualifications do they need? Yeah. So, um the uh the um all the all of the um agencies pick a designated um employee to be uh DSF uh uh DSF individual. Um and um they uh have uh assistance on um the ADA laws and um background on that um so that they are they are um well equipped for ADA and other laws that happen. >> So essentially this is a staff person who through training uh becomes a DSF. >> Yes. but they don't need any other qualifications or there aren't other eligibility requirements. >> It's just um it the DSF it's important for them to have um knowledgeable um about ADA and other laws and regulations um uh for people with disabilities. >> And how much is uh Moped spending on its efforts to coordinate DSFs? >> Um I don't know, but I can find out. That would be great. And then would it be beneficial for every city agency to have a disability specific budget? >> Yeah, so this is a good question and there's our our pros and cons. Um the benefits might be um dedicated funding for accessible um upgrades, etc. um more consistent um compliance um strong support for DSF's um many positives but there are also posit potential uh negatives um in inconsistent um agency size and needs um oversight um uh administrative oversight um and risk of siloing um uh rather than integrating uh accessible plans. So we both have to be really thought about it and I think that's important to to for me and our our team to to uh discuss it. >> Absolutely. So it's not a one-sizefits-all model. >> Definitely not. >> But uh I agree with you that the positives are also so critically important. >> Yes. >> And then um how do you think the city can improve its disability information resources across all agencies? >> Yeah. So, I I think there's a a lot of um priorities that can be done. Um standardizing um accessibility pages, um plain language and accessible forms, um uh citywide uh accessible dashboard would be great. But again, um I'm reviewing all of these um great um suggestions that moped staff shared um and others have shared and I', uh once I do that, I would love to talk to staff and others on that. >> Wonderful. I would like to turn it over to finance chair council member Lee. >> Thank you so much, Chair, and it's so great to see you, uh Commissioner Argo. I know. Um, going back to when you were commissioner of Moya and I was at my nonprofit before. It is so great to see you and thank you for always being a champion for us. >> Um, uh, my name is Linda Lee. I have dark brown hair. I'm wearing a black jacket, blue blouse. I have really dark circles under my eyes right now because it's budget season. Uh, so yes, and I'm Korean-American, so uh, for folks. And I've always argued that um we should be giving you guys more funding when I was chair. Um and by the way, I just want to acknowledge the fact that I think um it's great that we have a completely separate um disabilities committee and we have an amazing chair who is going to be helping to champion this. But as we know, a lot of our um issues in the disabilities community impact every aspect of our city government. And so I'm super super excited that um this committee was able to be separated out and get its due uh recognition and attention to be quite honest. Um so just wanted to ask a little bit about the preliminary budget. I'll be quick. Um in the FY27 preliminary plan, MOPAD has a fiscal 2027 budgeted headcount of six positions. Um and so how are you first of all? Um, and I'd like to talk about where you think the needs need to grow because I I always felt like the budget for moped was extremely low considering the number of people that you have to service in the city. Um, and so out of the six budgeted positions, I believe three are vacant or is it? >> So, um, it actually is four headcount and two, um, positions are unfunded. Um >> where is it funded from then? How is it? >> Uh I'll explain. Okay. So um for the four titles are commissioner um executive assistant chief of staff and um uh uh um uh assistant commissioner. Um the two unfunded um positions were pegged um in fiscal year 25, the November plan. And um however um we we have um a staff of um 20 people. Uh the four are um uh positions for from the office of the mayor. Um the remaining staff um lines um are core disability a uh experts who are working on um agency uh uh partner agencies but work indirectly with the coordination of um moped. So I'll give you an example. I just talked about um At work um at work has six employees uh and the partner agency is SPS. So the this cross agency model um actually um allows disability experts to be embedded in um moped and it is a model that expands our impact um without duplicating costs. So, it's actually pretty uh a good model. >> I was going to say um so does that mean that there's shared costs not just in staffing but also in the other operational administrative costs as well? >> Yes. >> Okay, good to know and thank you for that clarification. Um, and I'm assuming that you've received the same letter of instructions asking agencies to look at different efficiencies. And is it for for you all at moped? Is it the same percentage that you guys have to abide by with the 1.5? No, it's not. Right. Okay. I just wanted to make sure. >> Um, and actually the other questions I'll forego just because you answered it with the staffing part. So, thank you. And just um I know that the chair is going to be asking more questions, but it would be great if you could inform us on you know and I see through your testimony inform us on some of your new needs and areas where you want to see growth. So thank you. Thank you chair. >> Thank you. >> Okay. All right. Wonderful. So, uh, in fiscal 2026 November plan, $25,000 in other categorical funding was added to MOPD's budget for handicapped parking education in only with an additional budgeted headcount of one. Could you explain specifically what this funding is going to be used for and why it's added as a one-time funding? And what's the title of the additional position associated? And has this position been hired yet? >> Yeah, so um the one-time funding um comes from revenue collected through summons um in uh issues uh to individuals who um wrongfully parked in the the spaces designated for people with disabilities. Um and this um funding is OTPS. So, uh there is no um additional funding um ask. It's just um uh onetime uh uh uh uh uh $25,000 $25,000. Um and I am planning for this um this funding for my new mission and vision. And so I'm I'm thinking through that as well. >> Got it. And did this exist in the past as well? >> It has. Um so we um We frequently receive this money when people decide to put their cars in uh other in the uh spaces that are designated for people with disabilities. So, it fluctuates. >> Got it. And is a fiscal 26 uh budget higher than the previous fiscal year? >> I don't know. Do you know? >> And I know it's contingent on Yeah. >> Somebody getting ticketed. >> Right. Right. So, the revenues come from the summons issued by NYPD and then the funds are transferred from DOF to mayor's office. And this fiscal year year's revenue was $25,000. It's actually lower than before only because we've been effective at ad campaigns for stopping people from parking in spaces that are designated for people with disabilities. So, there's less summons which means less revenue. >> Got it. And then this program, this education program, is this a a a signature uh workshop that you all provide? What is it? And can it if you have zero dollars, let's say nobody's received a summons, this program can exist without that? >> Um well, if people if that is zero, that would be fantastic. Um and we do trainings and education material on various topics including um the this so um that would be um consistent on our work. >> And could you just describe what the handicapped parking education looks like? >> Um the it's not an education thing. It's just called handicap parking um education. Got it. The funding that comes from the summons. >> Oh, yeah. Okay. Uh, hold on. Why don't you share? >> I'm talking as if that funding is used being used for Yes. this program, but you can clarify if I'm not >> Yeah, just to clarify, I think Commissioner Agarwal had mentioned that this is a one-time OTPS funding that comes through MOPD on an annual basis. um only because it's contingent on the number of re summones issued. Um it's it's historically was used the funding that came was used to then advertise to the community about not parking in spaces designated for people with disabilities. >> Got it. So this funding is specifically related still to the parking issue. Okay. >> And my apologies. >> Understood. No, no worries. And has this position been hired? There's no >> there's no position. So, this is just a oneshot deal for uh parking education. Okay. So, the preliminary plan lists one contract in moped's budget for roughly $16,000 in FY27. Could you share the details of this contract? Yeah. So, um the this is money is designated to ASL interpreters. Um and um that's the primary um and then we have um that's about 16 uh,000 and then we have another the 7,000 um OTPS >> that's within the 16K or in addition to Okay. And is the contractor uh a provider from New York City or is it in-house? >> Yeah, the contractor is um Z Nexus. >> Do you mind spelling that? >> And do you provide does or do they provide tactile interpretation as well? >> Um I assume they do, but we can double check. Um and the it's s sign Nexus N XUS. >> And is this a vendor that the city has been using consistently? >> Yes. >> And do you all evaluate them or do you hear feedback from New Yorkers? >> Um so um advocates and um members of the um moped um actually uh like working with Stein Nexus. So we haven't received any complaints about them. What percentage of MOPD and DOH contracts go to disability-led organizations? >> Um, we don't provide like contracting services. >> So, you don't serve as a a conduit or as a a granter. >> Yeah, exactly. And then are MWBE and disability owned businesses prioritized in city procurement? >> Yes. And we um work with um the uh city of uh the mayor's office to procure that. And are you able to share how many uh vendors that are disabilityowned are providing services to New York City? >> We can't now, but we will we will find out and share it with you later. >> Yeah, I'd really love to know. I mean, this is it's critical that we're not only just talking about access, but we're also empowering people with disabilities to >> and I think um >> the entrepreneurs. >> Yeah. And like one of the um highlights that I mentioned in the um in the testimony is our work on at work um and that um impacts um people with disabilities to get employment um and that's been very successful in the past and something that I hope it will be able to grow. Moving on to other budget needs. Following the conclusion of the FY27 hearings, the council will release its preliminary budget response where we will outline budget priority items which should be included in future financial plans. What are MOPD's most pressing budget needs? >> Um, again, we will uh talk to um city hall and OM um in this um discussion. >> You're not able to say what might be the priorities you have to >> I mean uh we're I'm restructuring the and so we don't have ideas at the moment but um working with um uh uh city hall and OM that's the goal is to create um a new structure >> got it and then at the moment how many more budget positions does MOPD need >> um for Now, we don't have that um uh request. Um but we'll let you know if that changes. >> So, there are no other staff lines that are >> one line that's vacant and I'm interviewing those people. >> Okay, got it. Coming back to the workforce, as a disabled city worker who has required accommodations in my own workplace, I want to turn to questions about disabled city workers. >> Um, what percentage of the city workforce identifies as having a disability? >> Um, that so um I can't say the uh work people in the workforce. Um, I'd have to figure that out. Um let me see the headcount we had shared that um there are hold on give me one second um in the uh we have um 40% of uh New Yorkers with disabilities um of working age are employed. So, um, figuring that that math out really rapidly, um, it would be, uh, say a million, um, 40% of the million. That makes sense. >> Well, I'm not good at math. >> I know. I'm really bad at math, too. We can tell you it. We can tell you later. And if that helps. And does moped provide uh additional um support for those who want to get a city job? >> Absolutely. And that's the reason um at work um uh uh New York City at work is um helps individually um people who are um want are seeking jobs and people who are um employers and they connect that um in in place. And so uh I find that the work done of um New York City at work is successfully is successful and it could grow as well and it has been done so well. Um and then um yeah, >> I would still love to get them get the math of the uh amount of city workers who identify as having a disability. And you know, I I I want to make sure that New Yorkers feel empowered, that >> they don't just have to apply for positions that relate to addressing disability in New York City, >> for sure. >> And so, how are we recruiting and retaining? And are there plans for promotions and advancements in their roles? And um I'm um going to meet with the commissioner of DASS because she um runs or they run um 55A program that um helps people with disabilities to get jobs without having to go through the examination process. Um and currently we have about half um it's like 70 uh 7 thou 700 um job uh by people with disabilities but only half are filled. And so we want to talk to the commissioner of ways that we can um address that or um and ensure that more people with disabilities get jobs. >> Could you just repeat that one more time? 700 people. >> There's 700 uh people the uh job slots and only half are filled by people with disabilities. >> Got it. What accommodations exist for city employees and how quickly are they provided? >> Yeah. So, um, broadly, um, every agency has ADA requirements, um, EEO, um, uh, uh, staff involved. And so, um, using that, like when I was in the health department, I knew that if I had any, um, problems related to my disability, I could talk to people in EEO. We also had um DSF people um engaged on that topic. Um and so we have the people in staff. Um it's how do we um create jobs that transition um that new jobs or existing jobs to um people with disabilities to have to ensure that the job that they're most um excited for they can get access to that. And then, you know, during COVID or the thick of COVID, there was a campaign by city workers to be able to work remote or have a uh remote um accommodation that is written into our policy. >> Yeah. and the administration did not support that and that really created harm for many many families who had been either taking care of a loved one with long COVID or were still getting sick not uh did not want to come into the office as a result of that um and other issues. Do you believe that we should have a remote remote work option that's not just um negotiated between the uh the director and the staff person? I mean I it's um I can't speak in general but I think it's like for moped we have a hybrid work environment so people that when they'll come come to the office we have a list of that and when they're going to stay home and I think that works fine um also um I think that um based on the agency based on the company it It varies um in in case to case. So I can't say in full that I uh I like um remote because I just don't know about every um job that's happening. Again during COVID uh moped partnered with Dcast and H&H to distribute 10,000 at home test kits designed specifically for people who are vision impaired for recent emergencies like snowstorms and hurricanes. What other work has MOPED done to help the disability community receive necessary services or supplies? >> Yeah, so um MOPAD works closely with NISAM um the mayor's the NYC um emergency management to ensure disabled New Yorkers are uh integral um on um emergency planning. So we do accessible alerts and communications um planning for um accessibility um evacuation centers and shelters uh centers and shelters. Um we uh uh participate in emergency um work uh activity meetings and um ensure ASL um captions and plain language are um available on emergency alerts among others. >> Could you talk a little bit more about the accessible evaluation centers I think you mentioned? >> Yeah. So, um there's I have not been to one yet, but I think they regularly um are involved in many agencies getting together about for example a snow snow uh removal. Um and that is um an area that Moped is also engaged in that um topic and uh we share um what the impact that that that may have with people with disabilities. Now, do you all lean on NISM for the supplies and resources or are you informing what supplies and resources they should be procuring? >> Yeah, so it's um it's really a coordination effort. So if we think about um COVID and the um accessible uh test um kits, we worked with um Mo uh and Moped um H&H and DASS um to create um these kits and MOPED um were um identifying um organizations across the city including independent living centers um uh uh uh providers uh with um blind or low vision priorities etc. Um DASS did the logistics and um provided um support on that. um when um Moped um coordinated the other um uh uh organizations to use um the kits and to um deliver it to um people who are blind and um low vision um uh New Yorkers. So um the idea is coordination with other um city agencies um moving that forward. >> Got it. So, as I'm understanding it, uh, MOPED is bringing together the disability, uh, led organizations, uh, assisted living centers, etc., and getting them the resources. >> And is there an evaluation process or or do you hear from these groups about what more >> uh they could use or uh how has the response been during emergencies? >> Yeah. And so, First of all, I wasn't involved in um moped at the time, but the numbers are um outstanding. So, um we they um secured um 175,000 masks and 170 gloves to 64 disability serving organizations. um and uh directly to uh six uh 6,500 individuals. Um we also facilitated a donation of 25,000 masks for um D73. Um, and so all of the stuff we do, I think that um, what I've learned for the last three um, uh, weeks is that um, MOPAD does a lot and they don't get enough credit and they're so engaged and and and um, able to do these things. And so I think that's um, very important to note. >> And then with the disability groups, are you all meeting with them regularly? what is the relationship beyond providing? >> Yeah, so um in the past they did um quarterly um community calls um and I can go into the details on that but from my perspective we should meet constantly um and not just quarterly. And so, um, we are, um, having a a meeting, um, in the next week or two of a group of, um, community members and, um, partnering with them, um, is actually key to me on how we can um, uh, work with Moped and, um, the communities that are affected. And is the budget that you all have enough for expanding the engagement with the organizations you work with. So the money that you already have allotted is going to be used for that. Yes. Work >> even though you are going to expand >> engagement with them. >> Yes. Exactly. >> Coming back to at work. Uh how many New Yorkers have been New Yorkers with disabilities have been connected to jobs or internships? >> Yes. >> Through at work. So between um July 2023 and June 2025 um the program um provided um services to um almost 130 um people with disabilities and helped 99 individuals obtain um uh uh employment. Um and then uh the program also hosted 62 workshops for job seekers and um uh uh community members. Um participated in 200 uh two 20 uh my my number is like aphasia. Um 200 um mock interviews um and hosted um seven job trainings. And then citywide um New York City talent um uh did 300 373 um individuals uh uh with um uh disability uh connection um in 24 24 to 25 and I apologize it's my aphasia so if I uh have I can share the numbers that are accurate if you if that's helpful. Absolutely. Thank you. >> Are those numbers were they goals? Did you all have a plan in terms of like here's how many people we want to reach and reach them and delivered? >> Yeah. So in the last administration I think the goal was um that to 250 2500 um and we surpassed that by a much more and so that's been really >> that's to provide >> um >> trainings or receive jobs. >> Yeah. And receive jobs, right? Yeah. >> So 2500 people with disabilities were employed. >> Um yes. As in the last administration, the goal was to connect 200 PE job seekers with disabilities connected to jobs. And um as of this year, the three-year anniversary of that program is this July, but we've so far surpassed that goal, we're at 3,737 individuals that have been connected to jobs, but this number is in partnership with MOPD and SPS and NYC Talent and Dcast. >> Got it. And uh do you all know if that number still remains. Are folks still in their positions? >> Um we can get that information to you. There is a team that um analyzes the retention services of the individuals who have been connected. So um after this hearing we can get get you the numbers of how many people have still are in those positions. Yeah, it would be good to know about the retention um around this program and um could you also just uh share what the budget for NYC at work is uh this cycle and the last fiscal cycle? Um so in um 2024 and 2025 it was um f it was $543 or uh000 and then um 2026 and 2027 is um $584,000 approximately dollars. >> Okay. A little bit of a bump. Yeah, a little bit of a bump. >> And for the retention uh piece, does Moped then provide support to those who may not be able to uh continue working or are having challenges? >> Yeah. So um the staff um has a a year for retention services if people want to find a new job etc. And um I think that's um fantastic because um retention is important and having that time line um is really helpful. >> And have retention services uh been used? >> Yes, used all the time by employ uh employees. >> Got it. And the budget for uh this projected uh fiscal cycle is that enough? it. Uh yeah, I think that um the if we wanted to expand then we may the way this began um at work was for private funding and then it was so successful that we got um city tax levy and so if we need to we can go to private funders um and um explore expanding that money. And then is there funding specifically within that bucket for uh community outreach and engagement? I'd love to know just the demographic breakdown of who you all are serving. >> Yeah. Um we can get more in the in those um that information, but um the work that the six people do um is um immense and they do trainings, outreach, so many stuff. And so I'll I'll share the details um afterwards. >> Got it. And has there been specific outreach plans made to ensure that the pool of New Yorkers is diverse? >> I think so. Yes. >> Okay. >> Can you share a little bit more? Um we have so on an annual basis we deep we anonymize the data of job seekers with disabilities and sort of analyze um the demographics of the job seekers that have been connected through NYC at work. So after this hearing we're happy to share that data with you. Yeah, I wish you were prepared to share that right now because it it is um I think very important to understand who within the disability community is being served and not being served and why they're not and how we can reach them and make sure that they're not left out. So we will wait for those details. Coming to education now. Local law 18 passed in 2023 mandated that the city create an electronic system for New York City public schools to share documentation to help special needs students secure their necessary accommodations when they move on to higher education. New York City public schools created this system in collaboration with MOPD. Could you describe MOPD's uh role in developing the system? >> Yeah, so um the New York public schools um already had the technical infrastructure in place to implement the electronic um systems um required to the law. Um and because of that um mayor's office of people with disabilities deferred to um uh public schools on the design, build out and day-to-day implementation of the platform. Our role um was focused on um providing guidance to um ensure that the systems align with people with disabilities principles and comply with all of our relevant um federal, state, um city um requirements. So the funding associated in developing this system was all New York City public schools. >> Yes. But our and we also um provided a dedicated um a digital resource page on our website um titled um resource for dis uh students with disabilities um transitioning to um high school or um higher education. Um, and this um page um provided students and families with clear information about their resources, the um the um the documents that they may need and how to navigate the accommodations um process when they um move on to um postsecary uh education. And so for supporting education work and students across elementary, middle, high school, college, does moped have any additional funding for that work or are you all relying on CUNI public schools? Yeah, I mean I think again um we work with um other agencies or CUNI um to do uh impact that um coordinating with each other helps a lot. So um uh the public schools had the logistical um uh avenues, we had the um resources and training. So working with um agencies um moves the ball forward more forward than um with us just doing it alone. >> Got it. But specifically on education, there isn't any separate allocation to support that work. >> No. >> Got it. And that's why you all don't get credit. >> That's why you all don't get credit. Uh it seems to me like you all should play even a a much more influential role in partnerships with the public schools and CUNI um and not just be giving some feedback and uh be hidden in the background. Um, and so I'd be I'd be really interested to know how you take on uh this work moving forward and then um what other collaborations are taking place with the DOE? >> Yeah. So um >> NSA >> NSA so um CUNI we do um internship um opportunities for students um uh promote hiring um opportunities for CUTUNI and their alums. Um for DOE we work with um D75 transition services to explore collaboration to get from transition um students connected to opportunities through at work um New York City at work. Um and um those are some of the ways that we are working with other agencies. And then for the school construction authority, is there anything specific that you all are guiding them through when capital projects around accessibility? >> Yeah, I don't um well, it's through the five-year accessibility plans. Um the physical what we have every agency fill out their commitment to making sure that all of their agency programs and services are accessible. So, one work stream is through the five-year accessibility plan, but also on a case-by case basis, if we get any information about schools that are not accessible, then we work with the relevant agencies to like remediate those issues, including SCA. >> But the work has to start with SCA before it comes to MOPD. >> Correct. >> Yes. because so many of our schools are inaccessible and getting them to become accessible has been a huge challenge for many of the locations. I know that my colleagues and I have been funding uh accessible playgrounds and playards and they're very very costly and similarly with adding ramps uh to schools and an elevator. elevator costs millions of dollars and it is really um it it it puts us behind. I think New York City must lead in disability justice and if our schools are inaccessible and moped doesn't play the influential role of uh really pushing for that policy um I think that's it's a disservice. I would like to see Moped play a a much more um energetic role in pushing for uh accessible schools. >> Yeah. And um I agree. And um also um information concerning um accessible school buildings is um contained in a divisionwide um built accessible profile or BAP list on the DOE website. Um and so I would um I would encourage you to um read that out. Um but my one of my goals is to um meet with the chancellor and explore ideas that we can do together um to expand um children. >> Wonderful. >> You all work with uh HPD as well to ensure that folks with disabilities are able to use housing connect and the housing lottery. The report uh from 2025 Accessible NYC um states that MOPED worked with HBD to ensure that the housing connect 2.0 platform is compatible for screen reader users. Could you talk about MOPED's housing connect compatibility efforts and is there funding associated with that work or are you relying again on HPD's funding to uh move this forward? Yeah. So, um our wonderful um moped and digital uh accessibility coordinator worked with um HPD to um identify uh digital accessibility issues and provided um recommendation uh solutions to HPD from um the launch of the um uh housing connect 2.0 until about um fall of 2023. Um and the labor costs for this for um MOPD is just um one individual who worked on that um and um with um so I'll just end there. Got it. So, one uh staff person from Moped has this in their portfolio, but I'm assuming that this person also has other relationships with agencies in their portfolio and uh that staff person's but uh uh salary, does that take into account the work that's happening with HPD or how is that determined? I guess um uh moped works with all agencies and we our role is coordinating um agencies to do this work accessibility and inclusion and so that's our our um our core area is coordinating um providing our expertise which is on accessibility and um inclusion. um we don't want um the all of the uh uh agencies to um do that that work. We want agencies to do that work. And I have found that with this administration, people are really excited to work with us and figure out a way to move it forward for the housing connect 2.0. What's the budget dedicated to that effort? Um, I'm not sure about the exact budget. Do you know? We can find out. Thank you. But none of that funding uh would be coming from open. I just want to make >> make it make very clear >> uh I understand the role that MOPD has. And then what additional housing support does MOPD provide? Yeah. So when um constituents um contact MOPED um regarding housing related matters, we refer to community- based organizations um DSS um PEU, um uh HPD, DO, all of the um uh city services and nonprofits that are relevant um for that uh individual. We um we have um housing resources on our website including resources we um have uh worked with other agencies on developing that um and some um of these um pamphlets etc. Um we I plan to review and update them as needed. And are you all uh keeping data on uh the folks who keep who get in touch with you all around housing issues to make sure that they remain housed or are able to find permanent housing? >> We do. But if it's um somebody um with um supportive housing, we connect them to um health department. Um but many times they call um moped first and then we direct where to go um if they are needed. Got it. So in this instance as well, moped is providing guidance on or giving a referral, giving them a referral to reach out to HPD or yes, the uh agency that would be tasked with completing their specific issue. Um, and so I think I'm just trying to understand like, you know, you all have a very tiny budget and you're doing a lot of connecting. You're doing a lot of connecting and uh and it seems like the other agencies are uh following ADA guidelines. However, um it's not as though you all are the ones kind of identifying the problem or saying all of our schools should have elevators or like a sort of uh accessibility policies or advocacy. Am I am I right to say that? >> Um I wouldn't. Um so in my um vision um we do a lot of programs but also impact. So, um using laws, using um uh relationships and using um communications to um message our thoughts out um that we we do a little but we want to do a lot more. And that's the goal of my vision is having moped um moped's um ideas and vision um available to agencies but also to the broader public um so that they can um uh refer to us um but I do not want um our um our office to be another agency. Yeah. because that means all that will be um put into um disabilities and I think that we should have we should work with agencies to ensure that they take their job. They don't do it like bare minimum. They do it the best of the class and in style. >> Understood. Um, what steps has MOPD taken to ensure that city agency websites and mobile applications are compliant with ADA digital accessibility standards ahead of the April 2026 federal rulemaking? And does MOPED have a plan to enforce compliance across agencies that are currently out of compliance? >> Yeah. Um, so I um we are um we do the compliance um in the five-year um accessibility plan. Um but I'll go I'll um find out anything more um after this call, after this meeting, sorry. >> And are you all able to provide an assessment of which uh city agency websites are currently compliant? Um we can I think we will tell you after this meeting. >> Got it. And so that is something that you all are keeping track of. >> And then um what is the timeline for the agencies that are not compliant bringing them to compliance? >> Um not sure >> I can answer that. So um one of our staff resources is responsible for liazing with a lot of um the IT departments of various agencies and making sure their agency's websites and digital portals that are used to interact with the public are made accessible to the WCAG standards. >> Um and every two years MOPD has a responsibility to publish um the work that we do in that regard. >> Um >> so in that report >> in that report we we don't out the agencies, but we list out the work that has been remediated. And it's a little technical, but we can get you the list of agencies we work with in remediating a lot of the digital assets that agencies have that interact with the public. >> Got it. And for agencies that are not compliant, what are the obstacles? >> Sometimes it's technical, sometimes it's financial. So to um to reference Commissioner Agarwal when she mentioned that if we don't get started on an agency's project from the get-go as like adviserss then a lot of the agencies may roll out with um a tool that after it's put out to the public the community comes and evaluates it and provides feedback um and we take that feedback mechanism in ter and take that and then work with our partners to remediate those issues. >> Got it. And you mentioned financial Um, a lot of the times when uh either a good or a service is procured that's interacting with the public and it's not accessible, it's costly to retrofit them to make them accessible later. So that's the financial burdens that come into play once we get involved. >> Got it. And are financial burdens going to prevent any of the agencies to uh not be in compliance? >> It's hard to say. Um, it would depend on the agency and the product or tool that we're talking about. Does each agency have their own funds towards uh accessible communications? >> Uh not not to not to our knowledge. >> Would you know if for the website specifically or or the apps that they use if there are separate budgets for that? >> Um I'm not I don't know. We don't know, but we'll find out. Um I think it's important also that um uh this administration and the uh agencies that lead um are uh want to work with mayor's office of people with disabilities. And so maybe in three months um we'll see some changes that will impact people with disabilities and um the broader public because the reality is um elevators impact me in a positive way but impact people with kids, impact older adults. It's it helps everyone and that's the goal that we want to see for New York City. >> Absolutely. And I would love to know um which vendor is uh is being used for the website if there is one because all the I'm I'm assuming all of the city agency websites are one contractor or are they different? >> Uh they're probably different. >> Okay. So yeah, I think you know it's it would be interesting for me to just better understand given you all are providing this sort of oversight and compliance. Yeah. >> Um that all of these agencies have a responsibility to ensure accessible website and that they're following the guidelines. Um and uh if there is a financial burden, what is that financial burden? And uh how can we remediate that so that we're not uh ex we're not saying that funds are the the reason why we can't make something accessible for a city agency. You mentioned elevators. I want to talk about accessoride. Um what is your relationship with MTA? >> Um well um we are um in constant um uh uh consultation with MTA to improve accessoride um including on services um reliant um uh to people with disabilities. So we advocate for the expansion of accessoride ondemand pilot um so riders have more flexibility and independence. Um we provide we um uh direct um rider feedback to the MTA um through advisory meetings and general escalation. And um we uh advise on um accessibility improvements um to um accessorize vehicles and the digital tool um uh called a AAR app. Got it. So that's pretty good chunk of work that you all are doing with uh MTA. Um, are you hearing from New Yorkers or organizations that you all work with about uh obstacles they're experiencing with MTA and accessoride? >> Yeah. So, um some um uh problems or issues are um unreliable um accessoride pickups um uh and long unpredictable um travel routes. um uh limited um subway accessibility um including um elevators etc. um and gaps in accessibil accessible um pedestrian infrastructure including um uh the lack of curb cuts and insufficient um uh crossing times. So all of that is like broader than accessoride but that impacts people Is there other transportation related work that moped is involved in? >> Yeah, so we work with um DOT um and we provide um we partner with DOT on um monitoring issues related to accessible um uh pedestrian signals um curb cuts and accessible street uh design. Um we also work with TLC on expanding um wheelchair accessible um taxi um services and we work um in inter agency groups on transportation equity and um pedestrian um safety and um we review accessible um in the uh mobile um technology and um uh pilot um infrastructure. And all that work also does not have a specific budget allocation. >> Yes. >> Got it. What um additional transportation support uh do you hear about that New Yorkers need which MOPD could provide with some more funding? Um well uh you know again um for moped itself um I'll talk to um uh OM and um city hall but we would like to collaborate with um uh MTA on driver trainings for the um paratransit system to ensure drivers with mobility um sensory or uh cognitive um uh disabilities are better served. Um we also expand um outreach um and driver education including um uh disability specific navigation tools and we support um for um research and pilots in um accessible new um mobile um technologies. So, those are some of the things >> that's very helpful. Yeah. And that seems like it's all um really what we need to uh be um uh up to date with uh these requirements. Could you share how many city employees are employed under 55A and under how many agencies? >> Um yeah. Um, as Commissioner Agarwal mentioned previously, there's about 700 slots dedicated to the 55A program and about half of them are filled currently. >> And then what are you all um doing to uh help the city reach the 700 goal? >> Yeah. So, um I'm meeting with the commissioner of Dcast um and she and I both want to work um on um uh the impact with disabilities and having more people do 50 55A programs um than half. We want to increase that. >> And is there a timeline for >> um I'm meeting with her two weeks from now, so I'll I'll let you know. >> Got it. Okay. I'm going to do one last review of my questions and see if I have anything else, but we might be at the end. Oh. Okay, I have maybe one final set of questions. In July 2023, former mayor Adams released a plan to support career advancement for people with disabilities. $6 million was allocated for the issuance of an RFP called co-designing and delivering inclusive employment programs with and for people with disabilities. This RFP provides funding for awardees to design and implement new training and programs to help employers make their workplaces more accessible for employees with disabilities. They have to do this work in collaboration with New Yorkers with disabilities. The RFP was released in March 2025 by the Workforce Development Corporation in collaboration with Moped and SPS. Uh awardes were scheduled to be chosen by the end of 2025. Could you share who the vendors are and uh details about the proposals? >> So um the city can't um publicly disclose the winners yet. Um but however, we will um be announcing that soon. But >> Got it. So would you say that you all are a little delayed? >> Uh no, it's just that they're um finalizing the winners and that will be released soon. >> And what's the timeline of the RFP? Is it a two-year, threeyear? >> Yeah. So it's actually four years. Um the about the first year um for the co-design process um three years on the implementation. >> Got it. And then are vendors part of the disability community? >> Yeah. So, um specifically, um we prioritized um this type of experience and um relationships in the scoring of the selection process. um and the selection process. Um who demonstrates um strong um uh uh access to um and work with people with disabilities um with a clear um plan to recruit members of the community um to serve as a co-design process. >> Got it. And do you think RFPs are an effective tool to incentivize innovation in the disability space? >> I mean, for this at least, I feel like um it's very effective in the sense that um so you uh are involved in like the codeesign process is bottom up. um and values the lived experience of the those people closer to the ground um compared to other um models which are top down um and uh prescriptive and so I think that has been successful at least for this one example >> and then are there other municipalities or state governments which have issued similar RFPs? >> Um not that we know of. >> Got it. And are there um other policies or programs that uh other municipalities are providing or have launched that we are looking at to replicate? >> Yeah. So um we have um uh countrywide um mopeds um and we're meet I'm meeting them for the first time to next week. Um, and it's exciting because we can talk about these issues and if they do something that we can steal, um, and we we do something that they can steal, um, we'll make the country better. >> Amazing. That's great. All right. Well, that was my final set of questions. Thank you, Commissioner Agarwal and Sara, for being here and being prepared. >> Super appreciate it and I'm looking forward. >> I'm Thank you very much. Thank you. break. Okay. We're taking a 5m minute break. We'll be back and begin public testimony. Ladies and gentlemen, would you kindly find your seats? We are going to start the hearing momentarily. >> Please find your seats, guys. Find your seats. We're going to begin shortly. Please find your seats. Settle down. Settle down. Find your seats. I now open the hearing for public testimony. I remind members of the public that this is a government proceeding and that the quorum shall be observed at all times. As such, members of the public shall remain silent at all times. The witness table is reserved for people who wish to testify. No video recording or photography is allowed from the witness table. Further, members of the public may not present audio or video recordings as testimony, but may submit transcripts of such recordings to the Sergeant-at-Arms for inclusion in the hearing record. If you wish to speak at today's hearing, please fill out an appearance card with the Sergeant-at-Arms and wait to be recognized. When recognized, you will have two minutes to speak on today's topic of the fiscal 2026 preliminary budget for DOH and OCME. I just want to say something. There's over a hundred people signed up today. So, in order for us to get to everyone, um, because we have to be out of the chambers at a certain point in time, I'm going to really ask people to please keep to the two minutes. If you have longer testimony, you can submit it to us and then we'll make sure it gets into the record. If you have written statement or additional written testimony you wish to submit for the record, please provide a copy of that testimony to the Sergeant-at-Arms. You may also email written testimony to testimony@counsel.nyc.gov within 72 hours of this hearing. Audio and video recordings will not be accepted. Okay. Was okay. The first panel is Trina Prior Prior. I'm sorry. It I've been here since 8:30 this morning. So, I'm lucky I know my name. There you go. >> Me. Yeah. Megan Peterson. Megan Peterson. Okie dokie. And Ryan. I'm gonna not do this the right way. Manganelli. Close enough. Okay. All right. Um settled. >> Okay, we ready? >> Trina, you want to go? >> Great. >> You got to >> put your mic on. >> Put the mic on. >> Okay, great. Good afternoon, everyone. Yeah, >> my name is Trina Prior and first let me address uh Chairman Lynn Schulman. >> Yep. >> Chairwoman Tiffany Kaban and distinguished members of the committee. I'm Trina Prior, Secretary Treasurer of Local 372, New York City Board of Education employees of District Council 37 ASME. It is an honor of Local 372 to present this testimony on behalf of the 24,000 members we represent, including 256 SAPIS, which is an acronym for substance abuse prevention and intervention specialists. Under the leadership of our president, Sean D. France the first local 372. We respectfully request the city of New York to fund the SAP program through a dollar fordoll match with the state legislature. Since 1971, SAPIS workers have provided a range of mental health and intervention services to the largest school system in the nation through teaching social emotional strategies and providing behavioral support. SAP workers ensure that the students in New York City public schools are ready to learn in in a group or individual setting. SAPIS use evidence-based programs approved by Office of Addiction Services and Supports, also known as Oasis, as positive alternatives for New York City public school students in need. SAP is service grades K through 12 throughout all of New York City's 32 school districts, including special education. Okay. Um, let me go quickly here. Um, >> just going to ask you to summarize the rest of it and then submit it. Okay. >> Yeah, that's what I'm trying to do. Um, here. Okay. Local 372's goal is to partner with you and your colleagues in the city council along with the mayor >> in making a smart investment towards the quality of life for New York City students, their families and communities at large. It remains our shared responsibility to ensure that our children meet and exceed their potential. Without SAPIS, we are robbing students, struggling students, of their opportunity to quality, competitive education and untimely changing the trajectory of their futures. This is why local 372 again requests that the city of New York assist our efforts in pushing for a dollar fordoll match with the state legislature in this year's budget. >> Right now, our budget We have to >> bing. Okay. >> Sorry. >> It's okay. >> Um, yeah. No, we we got the gist of it. And please make sure you submit the rest of what you have. >> Yes. It it was going to be emailed. >> Okay. Great. All right. Thank you very much. Okay. Um, Megan. >> Hi. Thank you for having me. My name is Megan Peterson. I am a health department research scientist and I am also the president of local 3005 as part of DC37. We represent scientific and technical workers at the health department and medical examiner's office. I'm concerned that when we need to make budgetary cuts, as we're being asked to do now through the chief savings officer, we always cut staff lines and vacancies. But if we're going to serve the public, we need to have staff. And I would urge the city to look holistically at our contract portfolios. Uh one example that comes up for us in the union is that we have really struggled to hire nurses and administrative public health nurses which we represent in good union jobs but we spend a lot of money on contracts to costly temp agencies for nursing staff. So that's one example. Um, I also wanted to bring up the water ecologists who are also represented by our local and sort of the struggles and staffing. And I just want to make the point that we can increase the number of positions and the number of staff lines that we have. But so long as those positions are being paid the wages that they are right now, we are going to continue to suffer from high turnover, difficulty hiring, and by extension, a lack of public services. Um, that is all I had. Thank you. >> Thank you very much. Go ahead. >> Good afternoon. Thank you, chairs Scholman, Kaban, and Hanife and committee members for the opportunity to testify. My name is Ryan Manganelli. I'm a senior manager of policy at the 32BJ Health Fund. Our fund provides healthc care benefits to more than 200,000 32BJ members and their families through contributions from over 5,000 employers. For years, we've seen rising hospital prices in New York City drive up the cost of health benefits and squeeze wages. I'm here today to urge the council to prioritize healthcare affordability in the city's budget by fully funding and staffing the office of healthcare accountability and by working with the administration to address the ongoing impact of rising hospital prices in New York City. As the city faces a budget deficit and rising health care costs, it's important more than ever to lean on the Office of Healthcare Accountability, which is tasked with providing the council with recommendations on the the portion of health care costs spent on hospital care and convening key stakeholders to examine the cost of healthcare services in the city. Last year, the office published its first report on health care cost drivers, affirming that the city plan also faces health care cost growth driven by high and rising hospital prices. Similar to other commercial payers, from 2022 to 2024, the city employees PO health plan paid New York City area hospitals more than two and a half times the price of Medicare on average. Hospital prices varied widely by system from under two times Medicare at Mount Syinai compared to three times Medicare at Montafir Health System. We urged the council to act by asking the largest hospital systems to explain these prices and their impact on employers and wages. Uh the city and all New Yorkers need relief from unaffordable hospital prices at our leading hospitals and the relief cannot wait any longer. Thank you. Yeah, Ryan, I have a question for you. So, I don't know if you saw the testimony earlier, but I asked a question about the transparency portal on the website. So, if at another point in time, if you could call my office and get back to me about what you see there, um, we want to follow up on that. >> Absolutely. We'd love to follow up on the comparison tool. >> Great. All right. Thank you very much. This panel is excused. Thank you. All right. Next panel is Robert Asavvidito, Elizabeth Valdez, Mike Schweinsburg. Dr. Robert. Oh, I'm sorry. Robert >> Robin, I'm sorry. I can't read the writing. Recant. Dr. Robin Recant. Yes. No. I guess Michael Kush or Macall Kush. Okay. Um Jordan >> Rosenthal. >> Sure. >> Juan Peninszone. There's one here. Yes, he is. Okay. Okay. Robert Esavito, why don't you go first? Okay. Uh my my name is Robert Aavedo and I'm a member of uh disabled deduction of Metropolitan New York >> here. Um a little description, I use a wheelchair and I'm wearing a red shirt with brown pants. Um the mayor's office uh for people with disabilities has long been chronically underfunded limiting its ability to serve as an effective lison between uh New Yorkers with disabilities and city agencies. As a result, city services programs, activities, and newly built facilities like the Hunter Point Library in Queens had too often been planned and delivered without uh sufficient accessibility producing uh federally non-compliant out outcomes and exposing the city to costly litig. ation. Boo. Um, an increase in the funding today would enable the office to intervene at the earliest stages of program and facility uh planning, ensuring accessibility is built in from the outset and preventing uh litigation higher longterm costs. Other major cities invest significantly more in their disability offices. It is time for New York City to m make a comparable commitment. We respectfully request a significant and sustained increase in the funding for the mayor's office for people with disabilities so the city can fulfill its legal obligations and ensure full inclusion for all residents. Thank you. >> Thank you very much, Elizabeth. >> Good afternoon. My name is Elizabeth Valdez and I'm the systems advocate at the Brooklyn Center for Independence of the Disabled. I'm here today to urge the council to make a significantly stronger commitment in the city budget to the mayor's office for people with disabilities. For far too long, this office has been underfunded since its inception in 1968. And through its various forms over the years, it has never been given the level of investment needed to truly meet the needs of New Yorkers with disabilities. Today we have an opportunity to change that with new council leadership, the creation of a disabilities committee, a new administration, and a new commissioner at MO MOPD. This is the moment to reverse decades of neglect. People with disabilities interact with city government every single day. Whether it's living independently, accessing transportation, securing and maintaining accessible um housing, or simply participate participating fully in our communities. We rely on city systems to function effectively and equitably. But when those systems fail us, when there are communication breakdowns, accessibility barriers, or a lack of understanding about a disability services, the consequences are severe. Too often, individuals are pushed into nursing homes, shelters, or substandard congregate housing. These outcomes are not only devastating for individuals and families, they're also far more costly than for the city and state. Despite the growing needs of our community, MOPD's budget has not kept pace with the city's overall budget. In fact, in the proposed 2026 2027 budget, MOPD would see no increase from the $678,657 it received last year. Unless the council takes an action, increased funding for MOPD is not just necessary. It is also an investment in equity, efficiency, and dignity. Thank you very much, Mike Schweinsburg. >> Kindly, um, my name is Mike Schwinsburg. I'm the president of the 504 Democratic Club. I am an old man with graying brown hair and glasses and a checked rust colored suit and a blue shirt. Um, okay. We are the largest minority by far. Yet today I've heard 10% of the population, a million of us don't go by the dennial census, which deliberately underounts us. Check out the CDC website that did an extensive survey every year. And the last year they were allowed to publish their findings was 24 and they pegged us at 28.7% of the population. Excuse me. 28.7% of adults. >> Okay. >> So, they're not counting our kids. Count our kids. We're over 30% of the population. Uh we are totally intersectional and found in every single segment of society. We are the most marginalized of every marginalized group and 60% of our population come from communities of color. We maintain when you lift up the disability community, you are rising all marginalized communities from the bottom up. You need to understand that because here comes our budget ask with regards to the budget for moped. When we came up with a figure of $10 million $10 million for the first year for moped, it of course seemed quite reasonable to us. $5 ahead. Those who have seen Moped's offices know there are great many unused cubicles and spaces that could be utilized by masses of interns and incubator projects to develop concepts and solutions in the crisis areas of employment, housing, education, health care, transportation, mental health, disability culture, and voting. Um, >> just round it up. I'm just going to round up and say nothing about us without us. Our clarion call and uh next year I'm coming back. We're going to ask for 15 million the year after that 20 the year after that 25. But moped has to forcefully act on behalf of the largest minority, not depend on every other agency in the city to do it. Thank you. Thank you, Jordan. >> Hi. Um, my name is Jordan Rosenthal. I'm a social worker. I am the director of advocacy at Community Access, a supportive housing nonprofit. I'm a peer, a person with lived mental health experience, and I am the lead organizer for correct crisis intervention today, which is about a coalition trying to have non-p police mental health crisis response systems. I just want to say uh thank you so much to all of the chairs for staying here and listening to all the testimony. Um power to you guys. I couldn't do it. And I just the things that I want to highlight that are in my testimony that are bolded are the most important uh or the most important things are last year um with help of the progressive caucus we were able to get a 4.5 million investment in peer behavioral health workforce. I want that up to six million and I want the eligibility strengthened to only be things that are in the crisis continuum whether it's post or pre or post or during right um specifically community access where I work is asking for 540,000 of that 6 million and that's to create interdisciplinary teams that we can have internally to our housing sites. Um, and the other ask of this that's really relevant is as the mayor announced the office of community safety today, I really urge the council to hold a joint oversight hearing between mental health and workforce development about peer behavioral workforce development because we need more peers and more community health workers to actually make OCS have teeth. Um, with that you can look at my testimony. Thank you. >> Thank you, Dr. Recant. All right. >> Go ahead. >> Um I'm here actually on behalf of myself and other people who have suffered from being on ex um accelerated outpatient treatment teams which I believe are illegal according to Supreme Court decisions and federal law forced psychiatric commitment whether inpatient or outpatient is illegal. and the and the the um the the the outpatient treatment teams are funded partly by the state and partly by the New York City Department of Health and Mental Hygiene. And if you're going to give money to a now there are some people who may be dangerous, but it's but Kathy Hokll just strengthened the law and made it very clear you don't have to be dangerous. You anyone can commit you and it has to be the but by law it has to be the least restrictive alternative. you're given no alternatives. And they kept me on there for 14 years. I called the um person who wrote the law in Albany. And he told me, "All you have to do is tell them you don't want it." No, it didn't happen that way. And they keep you in your home. They don't tell you when they're coming. They abuse you when they come. They bang, they try to bang your door down and saying, "If you don't come right away, we're calling the police." They have called the police. And they if if you don't take medicine and force medication, according to a Supreme Court decision from a long time ago, Rivers vats is just not allowed unless it's the only way to control very very seriously violent behavior. They give it to everyone and they have the hearings every six months in in in the city um in in the New York State Supreme in what's called the exparte room which means that you can't be there but the law says that the person receiving the treatment has to be part of the decision. And what's wrong is that this is funded partly by the New York City Department of Health and Mental Hygiene. They're going to fund such a program. Um it it really needs to be changed >> and there the New York City um oh okay >> no round you just summarize it. Go ahead. >> Um New York City lawyers for the public health public interest >> and the NYCLU and legal aid they all oppose this law in many many ways. >> I thank you. Um Juan, >> hi Juan. How are you? >> Hi how are you? Thank you so much for the opportunity for uh to testify. I'm Juan Pinson. I'm the senior director of women relations at the Community Service Society. >> Uh in my written testimony, I lay out three things that uh New York City can do to protect access to health coverage as federal changes under the HR1 bill put thousands of New Yorkers at risk of losing care. So I'm just going to like I'm going want to highlight one of those things which is investing in trusted community- based programs like the managed care consumer assistance program and access health NYC programs like macab and access health are lifelines that connect New Yorkers to coverage uh help them resolve insurance problems ensure that they understand their rights. The this support is especially critical for immigrant communities at this time when fear and language barriers often prevent people from seeking help through government channels. The impact of MAP is clear. Since 2020, the program has handled more than 21,000 cases, secure over 1 million in savings for consumers, and achieve a 90% success rate. The program is also reaching those most in needs. Seven in 10 clients are people of color and most be most speak a language or than English at home. Thanks to the council investment last year, MAP expanded from 12 to 20 community based organizations and that expansion is already working. We have seen nearly a 40% increase in cases in just the past few months, showing both the growing need and the program's effectiveness. So at this time when federal changes are creating confusion, fear and new barriers to coverage, this is exactly the kind of infrastructure that we need to protect. This is why we urge the council to maintain MAC's 2 million allocation in FY27 and to invest 4.5 million in access health NYC to support outreach and public education. Thank you. >> Thank you. Before you go, uh there are questions by uh the other members. So, Chair Haneife, >> thank you, Chair, and thank you all for your testimony. I have questions for Robert, Elizabeth, and Mike. I'd love to know what your relationship has been with Moped, the interface, and uh or organizationally, personally or organizationally, and what you would like to see Moped provide that they're not providing right now, or what more do you want them to see? Okay. So, my interaction with moped goes back to when I organized New York City's first disability pride parade with Victor Kalis, that then commissioner, making it such an easy and wonderful uh event. It turned out very, very well thanks to him. And he was succeeded by someone who I never uh had communication with except out in public. Um, and I'm really delighted with the new commissioner who had an early meeting with me. Um, however, I believe that moped has always been underfunded and that funding's just gone down and down and down and uh, so now I believe it requires a dramatic I've always thought it required a dramatic increase to deal with the myriad problems that face our community. um you know we are as I said totally intersectional but that means we have lots of pro from mental health issues to mobility problems to breathing problems you know I mean we can't have that interspersed through a bunch of different agencies dealt with by non-disabled people who just don't get us it really has to come under uh the opaces of one office which I'd rather have be a department really but okay all things in good time really would love to see uh moped better funded it'll be fully funded as I said after four years at 25 million um but compare that with all the other agencies that's not even comparable so we're not asking for a lot we're asking for a big increase but it's not a lot of money in terms of what what should be. So I think it can be >> uh a great agency and um I look forward to your supporting our $10 million ask. Thank you. >> Of course. Appreciate it. I'd like to hear from Robert and Elizabeth if you have any comments. Well, um, one of my my earliest, uh, interactions with with Moped, um, was watching, uh, their them give these their videos, uh, to teach me how, uh, to build an accessible website. And that's that really Yeah, that that that was a great thing. And I think they could extend those kind of videos to younger uh students in in the schools. That would be a great thing. But remember, they need money. They need money. So yeah, but that's >> Thank you. >> Yeah. My interaction with uh moped has been ever since I became an advocate and not for people with disabilities and um we need money just like we're all here saying and saying that everything is underfunded for people with disabilities. You know we're the largest minority but we are the least funded. >> Thank you. >> Chair Kaban has some questions also. Thank you. I just want to uh thank Dr. Rant for your testimony. Um agree that there are a ton of problems with the laws around uh involuntary commitment and com and compulsive treatment. Um especially about how we define >> behavior. I mean, there's a a large disconnect between, I think, what mental health professionals, peers, doctors will define as dangerous and what others who are asked to go out into the community and enforce that law would define as as dangerous. So, thank you for bringing light to that. Um, Jordan, I love that you brought up the workforce um question. I I know that I have reached out or we have reached out to the committee on economic development because I do want to hold a joint hearing on exactly that issue. Not just a pipeline for peers, but also a pipeline for street workers. I think we've talked about this before, but not every professional is got the thing to do street work. You could be you could be a social worker and say, I want to do forensic social work. I want to do clinical social work, or I want to do work in in our streets. And that's those are entirely different things. Um so I want to thank you for that. I know we had the announcement on the office of community safety today and from your perspective just wanted to hear briefly what you think is going to be really key um for being included in sort of like the organizational structure there. Great question. Thank you so much Council Member Kaman or Chairwoman Kaban. Um I would say the number one thing for me when I'm thinking about be heard in terms of changes is not only structure of the teams of who is responding but upping the ratio of teams. I think if you look at the expansion of be heard and the number of teams as it's gone over like um expanded to precincts it hasn't kept up pace. So basically, because there are so many eligible calls and not enough teams, even if we were to make it citywide or 247, we'd still come up against the same problems because that ratio is so off. And with the fact of um circling back to hiring practices, uh there has been lots of discussion about the difficulty of hiring social workers for the Be Herd teams. And my pitch to council and um Reita Prince if she hears me is peers should replace the social worker on be heard teams. You can have someone who is like me who holds both identities. I am a social worker and a peer. And I'm gonna just say um as Jordan Rosenthal, private citizen, I can say that my MSW education would not have primed me to do that street work of being a beheard responder. I think that you know learning and peer work would and a specific um training that would need to be developed through H&H or now the uh office of community safety would have to be developed to make this workforce. But being just a social worker doesn't give you the check to have those skills. >> Thank you so much and thank you chair. >> Thank thank you very much. This panel is dismissed. Thank you so much for being here and for testifying. Okay. So the next um panel will be Anna Krill, Laura Jean Hawkins, Rosa I'm gonna >> Okay, I'm gonna butcher it, but anyway. James Bristo. >> Anna, you want to go first? >> Good afternoon. >> Oh, you're gonna go first. Okay. My name is Laura Jeene Hawkins and I am the advisory board chair of Atoria Queen Sharing and Caring, DBA Sharing and Caring. I am also a member of Elmherst Hospital's community advisory board and chair the patient care committee. I am here today as a woman who has been an advocate and ally of the cancer community for over 20 years. I am also a woman who has had her own health journey with thyroid disease and endometrial hyperlasia undergoing years of biopsies and ultrasounds. Fortunately, all of my tests through the years have come back negative. That is not the case for many. However, there is currently a cancer epidemic in our state, our country, and our city. Cancer is occurring in younger and younger adults. These are called early onset cancers which are diagnosed in adults between the ages of 18 and 49. A very public example of this is the recent death of actor James Vanderbeek who died of stage three colon cancer in February just one month before his 49th birthday. No one knows why this is happening. But what I can tell you is that more and more people in our community are being diagnosed with cancer and they are turning to us for help. help that is getting harder and harder to do with our limited funds. Since 2020, we have experienced a 25% increase in the demand for our services. Funding under the council's cancer services initiative has stayed flat since the initiative was created. The time for increased funding is now. On behalf of my board, I thank you for the council's many years of support and for your funding. You've been very generous. But now is the time that we ask you to please increase funding for the cancer services initiative and support our request of $250,000. Every dollar increased is a life benefited and possibly saved. Thank you. >> Thank you, Rosa. >> Good afternoon. My name is Rosa Sarmento and I am one of the sharing and caring bilingual Spanish navigators. I'm also the wife of a cancer survivor, a a former community advisor board member of Amharst Hospital. As a patient navigator, I have focus on increasing sharing and caring community outreach efforts in my community is the Spanish speaking community through Queens, educating them about cancer awareness and the importance of yearly and timely cancer screening. As an immigrant myself, I understand the fears the new arrivals to our city may experience. As sharing and caring, we had to strive to build trust, reduce fear, and eliminate cultural and financial barriers in order to promote earlier detection and treatment, as well as to improve access to lifesaving services. Over the past two years, I have assisted many Spanish speaking survivors, helping them to apply to for public benefits, secure access, right, and other transportation services. And I have authorized emerging needs assistant for medical bills, rent, utilities, and food. My team and I have also gone out into the community educating vulnerable at risk population and encourage cancer screening. And the more that we do, the more that is the need. Since 2020, the demand for our services have increased 25%. Our funding from the council, however, has stayed flat. On behalf of the Queen's Cancer community survivors across the city, I urge you to support our request for increased funding. Thank you. >> Thank you, Anna. >> Good. >> Good afternoon. My name is Anna Krill. I am a two-time breast cancer survivor and founder and president of Sharing and Caring. It brings to mind 33 years ago when I was initially diagnosed with breast cancer. I prayed to God to grant me life because I wanted to raise my two little girls. With that prayer also came my commitment that I would give back every single day. From that point on, that is how sharing and caring was created. We address the disparities in Queens County. We provide support services for those who are newly diagnosed and in treatment. We help people in every single aspect of their road with cancer. We are the face of hope. We're the face of survivorship and we are their life link. So with that I have to say in 2020 again I was diagnosed with breast cancer and during my treatment process I also realized a very alarming fact. Younger and younger people are being diagnosed. Their needs are greater and greater and we need your help in order to be able to help them survive. Uh on behalf of the cancer community, I truly urge you, please support our funding request of $250,000. It will mean everything to those who are struggling with this horrific disease. Thank you for your time and your support. >> Thank you, James. >> Good afternoon, Chair Schulman, Chair Kaban, Chair Hane, and members of the committees. I am James Bristo, vice president of public policy and government affairs for Vibrant Emotional Health. Thank you for the opportunity to testify today. Vibrant is widely recognized as a national leader in crisis response. As the administrator of the 988 suicide and crisis lifeline, we oversee and strengthen a nationwide network providing life-saving support 24 hours a day, 7 days a week. At the same time, we operate NYC 988 locally, giving us both macro and microlevel insight into suicide prevention operations. Beyond crisis response, Vibrate Emotional Health has spent decades building deep trust in communities across the five buraus. From pioneering New York City's first family support program in 1989 to managing one of the city's most robust youth and family peer support networks, we have consistently led with innovation, compassion, and cultural humility. Our program served New Yorkers from all walks of life, including youth and young adults, families navigating complex systems, older adults seeking to remain in community, and individuals living with co-occurring challenges. Turning to the fiscal year 27 preliminary budget is encouraging to see an attempt to be made attempt being made to address structural programmatic deficits particularly as it pertains to rights sizing the outyear budgets for supportive housing early intervention. It is also positive to see investment in the new public health lab as well as the muchneeded cost of living adjustment. Additionally, private emotional health greatly appreciates the council administration's current support for NYC8 operations through the provision of an additional $5 million in fiscal year 26 which was added in the adopted budget and implemented via council discretionary dollars. This additional funding facilitates increased capacity for NYC 988. The criticality of this funding has only risen over the past year as contact volume has continued to go up year-over-year and the additional support allowed us to reduce weight times for all New York City contacts, ensuring quicker access to a trained C crisis counselor for help seekers. We are confident in the council and the administration's ability to see the continuation of this vital funding stream into fiscal year 27. Furthermore, we are optimistic about the administration and council's commitment to mental health and want to point out additional areas that are right for enhanced investment. For example, youth peer services are an important tool in reducing barriers of mental health care. >> Yeah. >> Summarize. >> Yeah. Uh young people today face unprecedented mental health challenges. Research consistently demonstrates that youth are more likely to open up to peers who share similar life experience and speak their language. Targeting investment towards robust robust youth peer services such as a helpline is a way to see instant benefit. Thank you. >> Okay. So, wait before you go. Uh, Chair Kaban has a question and chair Hanife. So, Chair Kaban, >> great for you. Oh, >> um, should we expect an increase in the cost of administering the 988 system in future years? >> Uh, well, the the the contact volume continues to go up year-over-year. So, I would say there is going to be eventually there's going to be a need for additional funding to maintain pace and to be able to um ensure we have the appropriate capacity to to address all help seekers that contact us. And um in April 2025, Gothamus reported discrepancies between how Vibrant Emotional Health and the city sorry and the city thank you calculate 988 call and contact volume. And these are discrepancies that appear