Seattle City Council Housing, Health, Energy, and Workers Rights Committee 3/7/19

Good morning.

Thank you all for joining the Housing, Health, Energy, and Workers' Rights Committee.

Today is Thursday, March 7th, 2019. And the Housing, Health, Energy, and Workers' Rights Committee will come to order.

I'm Teresa Mosqueda, Chair of the Committee.

I'll soon be joined by Councilmember Bagshaw, and we know that Councilmember Juarez is watching from afar today.

I'm gonna go ahead and start with the public testimony since we have one person signed up to testify.

There's two items on the agenda today, Mr. Zimmerman, for your comments.

And we have first a briefing on the medical demonstration transformation waiver and a briefing from Seattle Housing Authority.

So go ahead and start your two minutes.

Yeah, good.

Sieg Heil, my sweet, lovely, sugar Fuhrer.

My name is Alexey Mironov.

I want to speak about housing.

I come to this place for the last 10 years and speak more than 2,000 times.

And housing is a goal number one, what I want to speak.

We need approximately 300,000.

You're absolutely right, Consul.

We need approximately 300,000 housing for poor people who make less than $40,000.

And for many years, for 10 years, I come to this place and every day I talk.

Fixing this problem is very easy, but you need 50% of all apartments who in the city belong to people who make less than $40,000 per year and cannot pay more than 30%.

Just make everybody equal.

How we can fix this?

There's two points what we need to do to go to this goal, what I've been talking for many years.

Number one, Seattle right now recognized from east coast to west coast like number one fascist city in America.

And fascism is very simple.

Without change this political philosophy about fascism, nothing will be changed.

It's number one.

Number two, what is absolutely critical, all council need go out because all council in this chamber, all of it, Repeat, all of it need to go out right now.

It's exactly what is supposed to be we need doing right now.

Without this, nothing will be changed.

We have a consul who violate constitution five times, like Gonzalez.

In civilized country, she supposed to be going jail for a lifetime.

Here, nothing change.

She supposed to be move out now.

Mr. Zimmerman, items on the agenda.

No, no, it's number two, what is we need doing for bring 50% all housing to this.

It's very simple business location.

So please, listen to this.

Stand up Seattle.

Stand up the 700,000 idiots.

Change rules.

Thank you very much.

Thank you.

Anybody else here to sign up for public testimony?

Okay, that will conclude our public testimony for today.

Thank you very much, Mr. Zimmerman.

Before we get started on our first items, I want to take a quick minute to say happy early International Women's Day.

Tomorrow we're going to be celebrating International Women's Day, and whether or not we're out there protesting, compounding inequalities, or celebrating the contributions of women across this world, we need to take some time to reflect and do some self-care about how we are working to change the current context of inequalities and to ensure that women truly do have equal rights.

So we see you, whether you're out there trying to disrupt business as usual or doing your daily job that maybe doesn't get recognized every day.

We see you.

It's International Women's Day, and we recognize you and thank you for all that you have done, especially to all the women in my life, if my mom is watching, and to my sister, my grandma, all of our family and friends, and especially to our all-women's office, Farideh, Sejal, Aretha, and Erin.

It's an incredible honor to work with you every day and the Women in Central staff and the Majority Council of Women.

Thank you for all the work that you do.

We also want to recognize the incredible work that this city has done and to make sure that the workers in this city, whether or not you're in Seattle City Light, who we talk to often for the silence breakers, the folks that we'll be talking about today who still have disproportionate health outcomes as women and having our healthcare access constantly threatened.

We are continuing to fight on the ground level in Seattle to stand up and fight for rights in the workplace and equal rights in terms of access to equal pay, and health care access.

We also want to make sure that we're recognizing all the laborers who are women across various sectors for your contributions to make sure that we do better in terms of not just accepting $0.78 on the dollar, but recognizing that even though we've increased penny by penny, year by year, actually since 2012, we've decreased from $0.86 on the dollar to $0.78, so we've got some room to make up for.

We're going to keep fighting.

And one of the ways that we're doing that is on the topic that we're talking about today, which is ensuring equal access to healthcare.

We know that's an economic stimulus, and it's also an economic stabilizer.

One of the big issues that I'm going to be working on is access to affordable childcare throughout the city.

We know that when we couple childcare with access to housing, it makes sure that folks not only don't have to rush home and worry about an hour and a half commute, catching multiple buses, and whether or not they're going to be overcharged, by their daycare who are predominantly women as well working in the daycare centers.

When we create greater access to child care and ensure that it's affordable, that's an economic stimulus and equalizer for women as well.

And one of the big issues that we're obviously talking about is access to housing.

And we know that women and people of color and members of the LGBTQ community are more likely to face housing discrimination.

and higher rates of eviction.

So we want to, in our committee, make sure that as we celebrate International Women's Day, we're thinking about health care, economic stability, access to housing, and access to early learning and education.

Thanks also to the women of color, specifically in Seattle, who work for our departments every day.

We also see and hear the results from the Race and Social Justice Initiative work.

I know Farideh Cuevas from our office has been participating in the interdepartmental task force to address sexual harassment and assault.

And when we saw the most recent statistics that said not only was there discrimination based on gender, but it was compounded by race and ethnicity statistics, that's unacceptable to us.

So we take a moment to celebrate and we also recognize that We have a lot of work to do to ensure that our intersectional approach to creating greater justice for all in this city really does start with us.

And I'm looking forward to celebrating all that women have brought to the success of this incredible city and recognizing we have so much more to do.

So with that, let's talk about healthcare.

And Farideh, do you mind reading into the agenda item number one?

Agenda number one, Medicaid demonstration transformation for briefing and discussion.

Welcome.

Thanks so much for being here.

So we are lucky today to have Jeff Sakuma and Susan McLaughlin to share with us a little bit about the Medicaid demonstration transformation.

I keep saying waiver, if that's the appropriate terms, and you guys can help us out here.

Very excited about this and, you know, given our work on the Board of Health and our ongoing offices continued commitment to creating a regional health plan.

We've been working very closely with King County partners, very interested in mirroring what we see in San Francisco and LA, which is a true safety net health plan for those who are priced out or excluded from health coverage options if they don't get it from their employer.

So we love health in this committee, and we also know that our options for policy levers at the City of Seattle aren't as great as they are at King County, so really relying on that partnership with all of you.

And perhaps there's ways in which we could be stepping up our efforts at the city level that we're not aware of.

So looking forward to hearing your presentation today and hearing more about how we can be helpful and also contribute more to the transformation efforts.

perfect thank you for that introduction and hopefully that we will be able to sort of sort of demonstrate sort of this alignment that we have at the city with what's going on and Boy, I loved your opening.

What came to mind very quickly was my 93-year-old mother and my three older sisters who raised a very woman-centered man in this community to really sort of understand and appreciate them to such a great level.

So thank you for that.

I love that.

You're giving me goosebumps, and I already teared up earlier, so it's going to be a good day.

Okay, so thank you again for this opportunity.

And Susan here is going to take a bulk of this.

And I really, really appreciate the fact that we have been able to hire such an amazing leader for this very, very important project.

Again, my name is Jeff Sakuma.

I am the Health Integration Strategist in the Human Services Department here at the City of Seattle.

And I also am the City of Seattle representative on the Governing Board of Healthier here.

So we are going to sort of go through a series of slides that will sort of talk very specifically about the Medicaid Transformation Waiver, and specifically what we are here to focus on, and that's Initiative 1. It's a three-part waiver, but we'll talk a little bit about that in just a sec.

Our goal here, as you will find out, and a lot of our work obviously is very focused right now on people who are on Medicaid in our community.

But really our goals, as you will see, are much broader in terms of really trying to impact the health of all the folks here in the city and in the county and in the state of Washington.

So I'll let Susan take it from here about healthier here.

Thank you, Jeff, and thank you, Councilmember Mosqueda, for inviting me.

I'm really excited to have the opportunity to talk to you today and share what we're doing at Healthier Here and our strategy, at least for 2019 and going beyond.

And I, too, echo the thanks for that introduction.

That was wonderful and empowering and appreciative of the City of Seattle's focus on women and equality, gender equality, so thank you.

So I am the Executive Director.

I'm Susan McLaughlin.

I'm the Executive Director of Healthier Here.

And I thought I would start just telling you a little bit about who we are.

So Healthier Here is a nonprofit organization, and we're dedicated to improving the health and well-being of people in King County through innovative cross-sector collaborations.

So we are working in partnership with the healthcare providers in our community, as well as community-based organizations and social service agencies.

So that we can catalyze and test new and better ways to respond to the health and social problems of our region.

And especially for those that are most vulnerable.

So you talked about the strengthening of the safety net and that is very important to us as well and making sure that people have access to care.

And as Jeff mentioned, while the Medicaid Transformation Project is really focused on the Medicaid population, the goals of Healthier Here are for people of the region and the entire region, and particularly looking at equity and reducing health disparities.

We want the system to work better for everyone, regardless of how they access their health care.

So Healthier Here has a 26-member, cross-sector, multi-stakeholder governing board.

It includes representation from medical and behavioral health providers, our hospital health systems, all of our local tribes, our community-based social service organizations, our Medicaid-managed care organizations.

We have city and county government seats represented.

and then foundations as well as advocates and consumers on our governing board.

Healthier Here has a staff of about 15 people right now that provide much of the backbone functions to ensure that we have success in the transformation goals that we have set out for the region.

And then Healthier Here is contracted to be the Accountable Community of Health, or ACH for short, for the King County region.

So what that means is our initial funding is through Healthier Washington and the Medicaid Transformation Project.

However, longer term, we expect to have more of a diverse portfolio of resources that include grants, community and provider and partner support, as well as philanthropic investments to make sure that we can continue the transformation work beyond the waiver period, which, you know, is time limited.

So there are nine ACHs in the state of Washington.

The map on this slide shows you the different regions.

Healthier here is one of only two single county ACHs.

Pierce is the other one.

So most of the ACHs represent multi-counties.

And we essentially act as change agents for the Healthier Washington Initiative.

That's the state's vision that they've set forth for transforming the entire health care delivery system.

And then the Medicaid Transformation Project, which is the go-first opportunity.

We are responsible at Healthier Here for planning, designing, the implementation, and then the oversight of the work for this region.

Healthier Here aims to have a system of care that works better for people, for providers, and for our community-based organizations.

This means that people in our region get better, more equitable care that results in an improved quality of life.

It means that our provider organizations get the supports that they need to achieve better results and also to make the transition from the current fee-for-service way of paying for care to value-based payment arrangements that really focus on outcomes and quality.

And then also to make sure that our community-based organizations have the infrastructure and the capacity they need to engage with the healthcare delivery system in an improved way so that we can more intentionally address the social determinant needs of individuals.

So Jeff mentioned that the Medicaid Transformation Project is made up of three initiatives.

Starting on the far right is the foundational community support services.

This includes new Medicaid benefits for a small subset of Medicaid eligible individuals to specifically provide supportive housing and supported employment services.

Initiative 2 in the middle is long-term services and supports, and that also includes new Medicaid benefits, again, to a subset of eligible individuals.

And it's primarily to support family caregivers that are caring for their loved ones to help people age in their homes longer.

And the City of Seattle is very actively involved in this Initiative 2 through its Aging and Disability Services and the Area Agency on Aging.

And then initiative one is the delivery system reform incentive program.

And that's the component that seeks to transform the health care delivery system through the accountable communities of health.

It's by far the largest part of the Medicaid transformation waiver.

As you can see, it's up to $1.1 billion over the five years for the state.

And that is where we're going to focus today is on the transformation through accountable communities of health.

However, if you are interested in the other two initiatives, certainly Jeff and I can arrange for others to come talk at another time in more detail about those two components.

Just real quick.

So looking at that last slide, these three buckets, do those correspond to the previous slide, which is the triangle that sort of touches on delivery of health care, supporting providers, and social determinants of health?

Do they correspond or overlap?

Yes, sort of.

So the slide with the triangle is really focused on the initiative one and the delivery system reform.

However, the goal of the whole waiver is to address these three things.

And so when you look at, for example, supportive housing and supportive employment services, that's really getting at the social determinant needs of individuals and providing new Medicaid benefits.

And similarly with the long-term services and supports.

So, they are focusing on different populations somewhat in different areas and are currently a little bit siloed in how they're moving forward.

But we are working to figure out where we can leverage them together.

So, for example, as we're doing the delivery system reforms that you'll hear about, we're How can we connect to those supportive housing services that are available to, again, it's just a small subset of the people we're touching are going to be eligible for that benefit.

But if they are, we want to make sure we can connect them into that.

So there's some connection that way.

Great.

So our friends from Seattle Housing Authority are here and they're doing a presentation right after you, which is really timely.

We wanted to tie in health and the health of individuals and the health of the housing, because you can't be healthy if you don't have stable housing.

Could you tell us a little bit more about the type of supports that the individuals or that the community is providing or that maybe the city is providing or needs to step up on in that kind of third area on the triangle related to social determinants of health?

To me, as I'm trying to think how can we be more helpful to the city, perhaps this is the area that we can lean in on.

Absolutely.

So the initiative three, the foundational community supports, is managed by a third party administrator through a request for proposal process.

The state is working with Amerigroup, which is a Medicaid managed care plan, to administer that.

It, what it does, so in the supportive housing arena, it does not provide any dollars for housing.

It is the services that support people to find and maintain housing.

So it can look like case management support to help identify affordable housing or housing that might, where they might be able to use a subsidy or a housing voucher, landlord negotiations.

And then in-home supports and services to keep people healthy so that they don't get kicked out of their housing.

So a lot of case management, checking in, linking to other types of services that might be necessary to keep an individual stable so that they can maintain their housing.

And for the employment, it's very similar kinds of things.

It doesn't provide wages or anything like that, but it provides the services and supports that help people find and maintain employment.

And Amerigroup manages that right now?

Amerigroup manages the benefits.

Do they receive any funding from the City of Seattle?

Do we contract with them in any way?

So this is entirely funded by the Medicaid Transformation Project at this time.

What Amerigroup does is it contracts with local agencies in all of the regions across the whole state.

And then there's the state has set eligibility criteria to access those benefits.

So when a service provider identifies a person who meets the eligibility criteria, then they can request a benefit from Amerigroup and then they would receive, and most of them are housing providers, they can receive the Medicaid benefit for that individual to provide supportive services for that person.

Thank you for flagging this.

This seems like an area that I'm going to need to follow up on because I want to make sure that we're acting as good partners with Amerigroup, even if they're not receiving any funds from the city of Seattle.

Anecdotally, and maybe we can talk about this at the next meeting, when I've been to shelters, for example, the women's shelter in Belltown, And I talked to one of the case managers that's been there for 10 years.

She said last year was the hardest year.

No, 2017 was the hardest year that she'd ever had because she'd had women who were getting to the end of their 12-month stay at the shelter.

They had Section 8 vouchers, but there was literally no place that she could find to put them.

in the city along transit lines that would be accessible to their work.

So I want to make sure that we're acting also in good faith to make sure that they can meet the goals of the transformation waiver.

That seems like a big area that maybe we could step up in because even if they're contracted with our local community partners, There are so few resources, and maybe you guys can shed some light on that later, but that seems like a big component of your work to create stable and healthy communities, and we just wanna make sure we're doing our part there.

Yeah, it absolutely is, and thank you for that, because I think one of the goals of Healthier Here and our role as sort of this neutral, objective entity that's not attached to anybody but supported by our whole community is to figure out how we can leverage and align resources to reduce fragmentation and have greater impact.

And so what you had just described is a really great way to do that, to take the little bit that's available through the Medicaid transformation and make it more impactful by aligning resources.

So thank you.

And we can help get you connected to the right people to get more information on that.

So moving along, one of the most important things to know and understand about the Medicaid Transformation Project, it is not grant funding.

So it's a pay for performance contract between the federal government and the state of Washington, and then also between the state healthcare authority and the ACHs, so in this case, In Healthier Here.

And what that means is that we only earn money for the region if we collectively, as a region, are successful in improving the health outcomes for individuals in the Medicaid program.

The health care authority in its negotiations with the federal government set and determined the outcome metrics.

I'm going to show them to you in a minute so you have a sense of what they are.

And they also set targets for each region and each ACH.

So we get measured semi-annually on our performance on these metrics.

to determine if we've met the milestones.

And then if we do, we are awarded a certain amount of incentive dollars that we at Healthier Here can then invest towards innovations in our region.

And to that point, I think then we really want to make sure that we're helping on the housing and economic stability front if this is how you generate revenue for future efforts.

Yes.

Welcome, Council Member Bagshaw.

I apologize.

Morning meetings went a little longer.

No problem.

We had a good conversation.

We are on slide 10 right now.

And we talked a little bit about how the transformation waiver includes access to better care, more equitable care for folks in King County, supporting providers to make sure that they have access to the most recent information, that they're integrating their care better, and that it's a values-based payment program.

And then this is where I think maybe we'll want to follow up on how we can ensure greater access to housing stability and economic stability with our partners who it sounds like our third party contractor with a mayor group.

So we'll follow up on that later.

Yeah.

Do I understand that some of this money can be used to pay for supportive housing?

Yes, so there is, well, so in the Medicaid waiver, there's three initiatives, and one of the initiatives is new Medicaid benefits specifically for supportive housing and supportive employment.

It's initiative three.

And so it's a subset of Medicaid-eligible individuals that are eligible to receive those benefits, but then it provides resources to housing providers to provide supportive services to individuals to help them both get and then maintain housing stability.

Yes.

Okay, and then this next slide just shows a little bit deeper about the pay for performance contract and a really significant part for us and our region in terms of how we earn incentives.

So as we move down the path of the Medicaid Transformation Project, the amount of money that we're eligible to earn becomes more and more at risk for meeting outcomes.

In the first two years, as you see on this slide, 2017 and 2018, 100% of our funding was earned by meeting reporting requirements.

So we had to submit a project application, an implementation plan, we submit semiannual reports, and we earn incentive dollars that way.

But beginning this year, one quarter of our funding is going to be at risk based on how we perform on the metrics.

And then it gets more and greater and greater amount.

And so what that means is exactly what you were suggesting, which is that we have to be really focused on how can we as a region meet our targets on the measures so that we can make sure we can keep the money flowing into our region and earn the maximum amount.

And then this next slide here shows you what the actual metrics are.

And again, these are metrics that were set by the healthcare authority and negotiated in their contract with the federal government.

So we as a region and actually all the regions across the state didn't have any input into what the metrics were.

And the other thing is that they are tied to the projects that we selected as a region.

Jeff's going to talk about that in just a minute.

But you can see that the metrics are very healthcare-oriented clinical measures.

And you can also see across the top our four project areas that we're going to talk about how there's a lot of overlap.

And that was really done intentionally so that we can come at improvement on these measures from a variety of different angles.

to increase our likelihood of success.

I will tell you and Jeff can say more about this as a board member, the board is very interested in looking at measures that go beyond just these healthcare clinical measures because if we would have had a say, I think we would have selected different measures for our region to incorporate things like equity and health disparities and then also to be looking at how successful we are in addressing the social determinant needs of individuals and where there are significant care gaps So we will be building those into our work going forward as well.

That was my question.

Thank you, Chair.

There's nothing that stops us from adding those metrics so we're not precluded to just this list.

That is correct.

We only get paid for this list, but we can add as many measures as we see fit to help us be successful.

You know, one of the things that we've been working on, not just in Councilmember Mosqueda's work, but in other committees, is that we see where there's real equity, where there's real value in addressing the social concerns we have, that all these other elements fall into line.

I mean, just as an example, we received a copy of a study late last week that was called system failure.

And the focus they had there was really on more of the mental health, the 100 people that were most often seen in jail or up at Harborview.

And that if we can focus on the health measurements and the outcome and the equity issues, that these other things begin to fall in line in ways that we hadn't anticipated.

One other question, sorry about my soapbox.

The next is.

Yeah, that's OK, because I couldn't agree with you more.

Right, exactly.

Across the top on your slide 11, it says opioid use 7%.

Now I'm assuming that that's what you're looking for is a reduction in opioid use or what does that 7% mean?

Yeah, thank you for that.

It's actually the state, when they set up the Medicaid transformation project, we picked from eight different project areas.

We had to pick a minimum of four and could pick up to eight projects to focus on.

At Healthier Here we selected four.

Those are the four projects at the top.

The state also assigned weight to those projects.

So those percentages are actually how much weight is assigned to the measures and the incentive dollars.

So in translation, bidirectional integration, that is 56%.

That means 56% of the dollars we could earn.

are going to be tied to the metrics that are in that column.

Whereas for the opioid use, only 7% of the dollars that we can earn are tied to those measures.

So what it does for us as an organization is helps us prioritize some of our work towards high value measures so we can bring in more money.

And then once we have the incentive dollars, once we've earned them, we can use them however we want.

And so that's the nice thing about the performance-based contracting.

On the last slide regarding performance-based contracting, so we see the makeup of the full funding.

What has been your yearly budget and have you been able to maintain the funding this year given the incentive payment has started?

Yeah.

When we get to that, when we jump ahead, I'll show you the yearly budgets.

But what I can tell you is that in 2017 and 2018, we did earn 100% of the dollars we were eligible to earn.

So you'll tell us about 2019 in a minute?

Yeah.

Yes.

Well, yes.

Because yes, what we have to do and how we will earn them.

Great.

So I'm going to turn over to Jeff now who's going to just go a little deeper into our project portfolio and how we're moving the work forward.

Yeah, so as Susan said, that we had a set of measures that we, or areas that we could focus on.

And we decided as a governing board to really narrow it down to four.

Four was the minimum that the state required.

Two of them were targets that were dictated to us.

That's not a very good term.

required and the other two are optional.

So the two that were required is starting with the very inner circle is the integrated care and that's the integration of physical and behavioral health or as I always tell people it's bringing people's body and their heads if you will, that we are serving the whole person as opposed to our system in the past which had funding that came down for physical care, had separate funding that came down for behavioral health.

So this is about tying that all together and doing so at our ACH level, but then also as we sort of bring that down to the experience for the patient as well.

The other mandate was around opioid use disorder.

And we'll get into, Susan's gonna talk about these to a little greater extent.

And obviously that was one of the mandated areas and obviously something that has been very important for us here in the county.

The two that were optional that we picked were what's called transitions, increased safe and successful transitions, specifically for those leaving jail and for those leaving the hospital.

And then the other is the expansion supports for those with chronic conditions.

So as you can see that those are all things that sort of fit very well in sort of the larger goals that we have both in the county and in the city.

Are you going to talk more about the transitions?

Yes.

So Susan's going to go into a little more depth about each of those.

The second slide here, the next slide here, is super, super important.

And that is, as Susan has been talking about, is sort of the equity framework that our board has set around all of this so that it isn't just enough that we sort of meet these targets, if you will, that we really need to be very vigilant about making sure That equity is sort of put throughout everything that we do, so that we are not just improving the health outcomes of certain segments of our population, but that we are doing this for everybody.

And particularly lifting those who have the most disparities.

So, and also that we are, the other framework is really that this becomes a very consumer-focused process as well.

So that we have these three frameworks that we work from, and that's community-based care coordination, so that things happen sort of on the ground where people are accessing care.

That we are addressing the social determinants of health in everything we do, and that we are improving equity and reducing disparities.

And I'm going to have Susan talk some specifically about the ARF, yes.

Great.

So I'm going to just break that down a little bit for you.

So starting with the physical and behavioral health integration work.

So this is really, you've probably heard a lot about this.

It's been going on statewide for a number of years now.

And the waiver work is designed to complement what the state has been doing, which is to move and integrate the finances for behavioral health, which includes both mental health and substance use disorder treatment, with the physical health care system into single integrated managed care contracts.

And that started in King County on January 1 of this year, that financial integration.

What the waiver is doing and what we have the opportunity to do through Healthier Here then is to make sure that the integration goes beyond just integrating the finances, but actually at the clinical point of care, that care is delivered in an integrated way and that providers are actually addressing whole person needs as Jeff described, the head and the body and all of the needs of an individual instead of just one piece.

Is every hospital and medical center in our region signed into this?

Yes.

So if somebody comes up for emergency treatment that they will be admitted and Medicare or Medicaid will help cover that.

So yes, everybody, all of the hospitals in the region are partnering with Healthier Here.

Because of the size and scope and the number of providers we have, we have to stage a little bit.

And so not everybody will receive resources and shift to the new model in 2019, but it will be kind of a rolling, we have sort of cohorts of providers.

But by the end of the waiver, that is one of our main goals, which is that wherever anybody receives their care in King County, their whole health needs are getting met and they have a multidisciplinary team-based care that addresses all of their needs.

A question about the integration of behavioral health and physical health.

Does this also incorporate oral health?

We know a lot of people self-medicate with prescription drugs or other types of drugs if they're in chronic pain.

And then we also know that especially for kiddos, sometimes they're perceived as acting out when really they have an oral health crisis.

Is oral health integrated into this model as well?

So thank you for asking that question.

Oral health is a very significant component to all of this and actually crosses all of the projects.

In the initial version and the way that the waiver was written, it is not.

But I can tell you that sort of the long-term vision for the state is to start with physical behavioral health and then to roll in oral health and then also some of the long-term services and supports, again, You want to get sort of the financing and the incentives and so forth all in the same place.

That said, we have had a partnership with the Acora Foundation.

We have been, which works.

the Washington Dental Association.

And...

That one makes more sense to me.

Yes, intuitively anyway.

And we have been having conversations with our providers as well, so that as, especially when we talk about making modifications to electronic health records and other ways that people are screened, which are very costly and time-consuming, that if maybe we're just going to focus on physical and behavioral health right now, but let's put the oral health question in, So we only have to like do the modification once and then put the resource behind it at a later date.

So I'm hopeful and anticipate that we will get there.

Okay.

And as you think about additional metrics that you're holding yourselves accountable to that might be outside of what we're getting reimbursed for, I think oral health is really critically important in our lens of today and tomorrow in terms of Women's health and maternal health and child health, we know that access to appropriate preventive oral health is good for those who are pregnant and those who may become pregnant and the health of their babies in the future.

And health disparities really do stem from poor oral health access in many cases for those who are trying to conceive or are having a baby soon.

I really think that it's a health equity issue as well and appreciate you bringing that forward.

Yeah, thank you.

Thank you for bringing it up.

So some of the levers for healthier here for the integration is the development of mechanisms for shared care planning across providers and provider types.

We will also be looking to enhance the screening and identification of individuals with chronic medical or behavioral health conditions, again, regardless of where they enter the system.

And so what this means is that if a person goes into, for example, a community behavioral health agency because they're depressed, the community behavioral health agency is also screening them to see if they've seen a primary care doctor and if they have any chronic conditions that might be impacting their depression, and vice versa, so that in primary care people are being screened for mental illness and substance use.

We also hope to continue to expand evidence-based and best practice approaches to care across providers.

We'll be developing interoperabilities of data systems so that data systems and electronic health records can talk to each other.

We know that one of the biggest barriers to doing whole person care is that people don't have the, they have, don't have the information they need and information is not easily flowing or being shared across providers and provider types, so we're working on solutions to that.

And then enhanced care coordination, again, to help if people are receiving services from multiple providers, which is the highest likely scenario in King County, that that care, there's mechanisms to coordinate care amongst those providers.

Last budget cycle, we put money in for a coordinated approach.

There is a group up in Northgate that answers 211. Allie Franklin is our contact.

I don't know if you're working with her, but I'd love to know.

Partly this arose out of something and I'll be on my soapbox just 30 seconds We also put money in for something that we call the low acuity approach for our first responders so that This is a little different approach, but it's not it's not new.

It's just Seattle hasn't adopted it yet, but we're working on that I want it done in 20 I was hoping by March but we're hoping by the at least the second quarter and so rather than sending out our firefighters our first responders with ladder trucks and ambulances for somebody who may just simply need a different kind of response.

But it's not a high acuity response, it's a low acuity, meaning maybe it's an overdose, maybe it's somebody who's passed out from alcohol, whatever.

But the idea is that we send people out in a in a glorified mom van, not with an ambulance and a ladder truck, but people that we may have a nurse practitioner on board, may have somebody with mental health or behavioral health training, and then maybe there is a first responder that has the basic medical response right at their fingertips.

But overall, we are picking up this model from Colorado Springs, Mesa, Arizona, S2, that it makes so much sense in a system-wide approach because people get the care that they need at the level that they need.

Big ticket is that we have to have a bed for them.

We've got to have a place where they can go 24-7.

It may not be Harborview Hospital, but it needs a place where they can get whatever care they need for that period of time.

So I'm working with every provider, anybody who will sit still long enough to talk to me.

We need more beds.

And then that, of course, means we need more housing.

And that, of course, is something that Councilmember Mosqueda and I are really deeply focused on.

But I'd love to talk to you more about how we integrate our low acuity model with the work you're doing.

So I would love to follow up and talk with you more about that too.

That is very consistent with some of the conversations that we are having.

I was actually saying to Jeff earlier, our conversation is starting with the emergency department docs and how we prevent preventable emergency department visits, which is the low acuity people that you're talking about landing there.

And so I think there's real opportunity there.

to leverage the resources and the interest to really build out something creative and innovative for our region.

Fabulous.

So before you leave today, let's make sure we exchange phone numbers.

Yes.

Because you are part of the linchpin of what we're trying to accomplish.

Yes, we would love to do that.

And then I'll just side note, we are working with Crisis Connections and Ali Franklin and are very excited with the partnership that the city and what the city is bringing to that.

I'll talk in a minute about the concept.

Ali's probably talked to you about the community information exchange.

Right.

And she got that from San Diego, right?

Yes.

through the San Diego 211. That is a high priority for our region.

It's come up in every table and design planning meeting that we have had.

And so we are going to actually Healthier Here is going to convene all interest parties around that.

It's going to take all of us to build it and get it to scale over the next couple of years.

You are the best.

And if I can ask, we'll follow up on this.

We, my office, would really like to be involved.

one individual who's my legislative aide, that Allison McClain has been deeply engaged in this for mental health and behavioral health, has good close connections with the county.

And if I can't be there, we would really like to have her there just so we're sharing the same information.

Thank you.

Yes, we would love to have you there as well.

I was just going to add that the beauty of the Healthy Hair Governing Board is that it is this 26-member, very cross-sectional group of folks.

So as issues like the low acuity piece arises in the city, it's a very quick discussion with Elise Chayette from Harborview, who's also on our governing board, with Susan.

And so we can quickly sort of prevent the silos from sort of becoming even more siloed that we sort of quickly begin sort of across discussions.

Well between you Susan and Elise I have great faith.

Well thank you yes and my mantra is like can we get it to one conversation instead of seven conversations right?

We can do more together.

So really quickly, because I want to be mindful of time, under safe and successful transitions, this includes, as Jeff mentioned, transitions from hospitals, transitions from psychiatric settings, and transitions from jails.

In 2019, Healthier Here is going to focus primarily on hospitals and psychiatric settings, and then we'll expand out to include transitions from jails.

although knowing that we're talking oftentimes about the same individuals who it's kind of a roll of the dice whether or not they land in jail or a hospital, so we're very mindful of that.

So Betty Pine is somebody that I've worked with for decades and she is in the King County Jail Health.

One of the issues that she and I have talked about before is that if we, and somebody ends up in jail, we know that it's traumatic, more traumatic, than almost anything else.

But if it's somebody who is suffering from an addiction, we need to get them on a plan before they leave the jail for ongoing, whether we can get them on buprenorphine or if it's methadone or whatever.

And I keep running into walls where people say, we can't do that because, the feds don't allow us to do that because, and it makes no sense to me.

If we can get people stabilized, provide them with a plan so they can move on rather than just that spin cycle of back on the streets, buying more drugs, So I'd love for us as part of our conversation if you can give me an update on that.

Absolutely, absolutely.

Can you talk a little bit about the metrics that you've seen so far?

Have you seen an uptick in folks accessing transitional care services?

And what do you think has been the most kind of meaningful lever there?

So we are just moving into implementation.

So we actually haven't implemented much of anything yet.

That is our entire 2019. And in fact, today we have a governing board meeting.

They are going to hopefully So, we will hopefully approve our 2019 investment strategy of about $8.7 million that will go into these four areas that we're talking about.

And so, I will have more information on that as we move further into the year and would love to come back and share some of the the things that are working and lessons that we're learning from this.

Wonderful.

And one of the things that we were able to do last year with Council Member Baggioz, the Chair of Budget, was to put some analysis into the budget of how our health services or how the jail environment is affecting individual health.

And wanted feedback while King County manages the jails, it's within our borders.

So I think we feel that there's a responsibility and a role for us to play to make sure that those who are going into jail, that we're trying to do everything we can to prevent that.

that they actually have a healthier experience in there and that they're not being exposed to mold or trauma or harassment.

And if your body is able to sort of give us any feedback, if there's themes that you're hearing in terms of asthma or conditions that people are experiencing at higher rates when they go into jail, we would love to have that health data so that we can do our part to help respond.

Great.

I will check into that and see what kind of data we have access to at the moment.

And we're continuing to build out our access to data.

Obviously, data is a huge part of this so that we can both track how we're doing and make course corrections when we need to, but also understand where the needs are.

Okay, I'm going to move us to the prevention and management of chronic conditions.

Healthier Here is, in addition to a primary focus on people experiencing mental illness and substance use, we are focusing on cardiovascular disease, diabetes, asthma, and chronic obstructive pulmonary disease or lung disease for our region.

And we'll support activities that help manage and prevent the worsening of these conditions.

So your question is really relevant in terms of who is at exposure.

It includes things like making sure that providers have the necessary knowledge and tools to manage the population.

So who, if I'm a primary care clinic, who are all the people in my clinic that have diabetes and what percentage of them have uncontrolled diabetes?

And I'm gonna really focus in on following up with them and getting them into their appointments and trying to get their diabetes under control.

That's an example of how that would work.

Also, community-based self-management support.

So whether a person is newly diagnosed, they're transitioning out of a hospital or a jail, and they have a chronic condition, who is working with them in the home to make sure they can fill their medications, they know how to take their medications appropriately.

They can do all their follow-up help with exercise, access to nutritious food, as examples.

And community health workers are a core part of that, and that is one of the things that we at Healthier Here are very interested in building capacity for those non-traditional community-based workforce that can really support people in their community, speak the same language, have common experiences, and so forth.

healthier here become something that people think of?

Let's just say I'm a nurse in a small clinic.

Do I think about what is healthier here doing?

Do I think that there might be some resources online that I could go to?

Because it strikes me that everything you're talking about about integrating the system is precisely what we've been trying to accomplish for decades and that you're now doing it.

So do people know about you?

So yes and no, some people do and some people don't and our goal is to make sure everybody knows about us and we're doing a lot to make that happen as we go through the waiver process and more and more communication.

All of the Medicaid hospital health systems, community health centers and behavioral health agencies know about us as an organization.

Now that doesn't mean everybody in the organization knows about us yet.

We just have been going through, Jeff's going to talk about the process we've been going through around our community-based organizations and also consumers and community members.

We've been doing a lot to try and engage those folks.

So today I would say people who are connected and know about the waiver and are really interested in being a partner know about us, but not everybody and we're working on that.

Just to add on a little, I think that as we begin the funds flow process, where we actually begin to reimburse folks for providing the care, obviously, then that and allowing these agencies to hire community health workers.

All of those things will obviously sort of bring all of this forward very quickly once we're sort of later this year when we're at that stage.

Yes.

Yeah.

Well, and results, and that we can really demonstrate that.

And I think one of the unique things, and Jeff alluded to it, about Healthier Here, again, I go back to because we are not, we're a standalone organization.

We're represented by every sector in our community as being part of our governing board.

So really trying to be community driven, but really can focus on what's best for the people and not any single sector or organization.

So we do get the word out.

One of our values is that all of the transformation is driven by those individuals that are living the system and having the experiences in it.

And so that they really are the ones that can identify the solution.

So we're working on mechanisms to create that in a more sustainable way.

The opioid project just really quickly focuses really on three areas.

We want those doctors that are and individuals that are prescribing opioids to do them in line with the state and national guidelines.

Make sure we're being conservative about that and preventing opiate use disorders.

And then increasing access to medication-assisted treatment and overdose prevention.

And we are really, as you know, there is a lot of work around the heroin and opiate addiction going on.

The city's been involved in the county for a couple of years now.

There's a lot of federal money.

coming into the region to address the opioid crisis.

And so we are really working with all of the partners who are receiving that money and trying to implement things to streamline and align so that we're working towards those common goals.

So the opioid addiction is something that we all at this table have been focused on since the Seattle-King County report came out several years ago now.

And I know, Jeff, you've been involved in that from the beginning.

So a couple of, again, these roadblocks that we hear about is, whereas buprenorphine may be really good for some, methadone may be better for others, but having it available where the people are is critical.

As I think it was Dr. Caleb Green who said to me, I'm not going to drive to Renton to get my morning cup of coffee.

And I think that's similar here.

We're learning that buprenorphine is available in many more locations than we knew.

Dozens across the city that hospitals may have it, some clinics may have it, but having our general practitioners sign up and be willing to be a provider, what I hear is that, well, they really don't want to focus their practice just on people who have addictions, so that there's maybe a little reluctance in having more and more people getting to the level where that they're able to prescribe.

So that said, we're just looking for, we know that there's no silver bullet, but there's silver buckshot here, and I think you're doing some good workforce, but if there's federal money flowing into our region and it can be used for more clinics or more doctors or helping people get the training that they need to be able to do the prescribing, I'd just like to broaden those, open those gates a little bit to see what we can do.

Because we know treatment on demand and especially this medically assisted treatment can really work.

Yeah.

Yes, absolutely.

So I'm trying to continue to be conscious of the fact that you're not a grant, that you are a pay-for-performance contract between the federal government and the state, and between the state and Healthier here.

And Healthier here is one element of Healthier Washington.

Okay, so your role is to make sure that we are receiving funding in our region from these federal dollars by improving health outcomes and more integrated and you're doing that by creating more integrated care and Thinking about the social determinants of health in terms of how we create greater economic health stability so you there's a number of partners that you've mentioned I think a What would be helpful for me is to have a better sense of who those partners are, specifically as we think about the opioid crisis in our region.

Who are some of these partners that we're working on?

What are some of the types of services that have changed?

And have you seen a notable or measurable impact since you all have been working together to try to have greater integration and coordination across providers, especially in this area.

I just feel like we're on a hamster wheel.

And, you know, Dr. Sukumar, Jeff, I just, I upgraded you to a doctor because, yes, our healthcare expert, Sukumar here, knows better than anyone, you know, we are losing ground, especially on opioid addiction issues.

And despite our best efforts at the city to try to create, you know, a safe place for overdose prevention sites, we continue to hit roadblocks, especially with the federal government, but other cities are facing the same thing.

Specific on this issue, can you tell us, is there any key partners that you've been working with and anything that you think the city of Seattle needs to do to step up to help on this?

So the short answer is, yes, I can tell you, but not off the top of my head.

So I will get you a list of all of our Medicaid-funded providers that are working with us directly and on which projects, because not everybody signed up for every project.

And then Jeff's gonna talk a little bit about our community-based organizations.

We are still in the kind of winnowing down of social service agencies that will partner with us, so I won't have that kind of finalized list until probably May, but then I can get that to you, and then what we'll be doing is bringing those clinical and community partners together to actually build out the innovation strategies.

But some of that work is beginning, and so I can get you the names of those.

You just said winnowing down, Susan.

I thought we were trying to expand.

Well, we are.

So let me say that we have a limited amount of time, a limited amount of money, and a limited amount of capacity.

So we can't work with, especially when you talk about community-based social service organizations in King County, where there's over 500, we can't work with everybody all at the same time.

And when you're talking about also connecting that community social determinant work to the health care delivery system in a new and different way, That's not happening at all right now, barely.

There's maybe little pockets of partnerships.

But for the most part, if I'm a primary care doctor in a clinic, I don't really know where to send people for housing supports or to get, you know, tech get access to healthy food and so forth.

And so we're building that out.

So we can't do that with 500 providers all at once.

So the winnowing down is to find, you know, that, you know, some amount of smaller number of providers that we can start with.

and that we can design the care models and work out kind of all of the kinks in it.

And then in, so we would do that in 2019 so that in 2020 our investments can really focus on scaling it and bringing it to other providers.

Yeah.

Yeah, that sort of takes us directly into the next slide here where Again, a lot of the work that we've been doing, the engagement of the healthcare providers, both behavioral health and physical health providers, has been pretty straightforward.

Because these are agencies or entities that have worked with Medicaid for many, many years and sort of have a head start, if you will.

But I think that the real change here is really sort of being able to help community-based organizations to be a part of this process.

And in that, what we do is that we really start to begin doing interventions as opposed to the work of the healthcare provider sort of toward, sort of after a person already has a health condition.

And so this is the really exciting part, at least for me, of this.

transformation process.

So as Susan said, you know, the first step has been just to sort of kind of throw out the net and see who wants to sort of be a part of this.

And there, you know, there's some work that they have to sort of engage in.

But the beauty of the waiver project and what you saw in the first year, first year one and year two is that we have been able to provide a lot of these agencies some upfront funding to really kind of assess their ability to participate and to understand what it means to be a part of this process.

So that is what has gone on.

As Susan said, we will be selecting a cohort of organizations to begin working initially.

Obviously, that can expand over time as well.

And it is to really have that linkage that Susan talked about.

This is really about where we begin to make sure.

that the individuals that are being seen in our community-based agencies are also connected to healthcare.

But not just that the connections are made, but that the actual sort of care planning and sort of looking at the person and their total being as to how we can best improve their health and prevent disease.

I have to tell you, I love this slide, the long-term, what success looks like.

Oh, thank you.

I kind of skipped over that one just for the interest of time.

But this is work that our governing board did in 2017. We said, OK, we have a limited amount of time, five years, and a limited amount of money.

We can't do everything.

At the end of five years, if we were to say, how is the region different?

This is what the board came up with, these four things on this slide.

So yeah, thank you.

So the other thing that I wanted to talk real briefly about is sort of the actual governing structure that we are working under and that one-third of our board is community, consumer tribes and community-based organizations, that we have a very specific community and consumer voice committee that is a formal part of everything that we do, that everything that Any decision that we sort of move forward on is passed through this committee and they provide both the input in its development as well as sort of recommendations about how the governing board should move forward.

And also, as we talked about previously, is getting money out to a lot of entities initially just to be able to have folks participate up to this level via small grants.

And what do you use small grants for?

I mean, $3,700 doesn't strike me as going to make much of a difference.

So the specific small grants program that we ran in 2018 was specifically to work with community-based organizations that are embedded in various communities to actually run focus groups and survey their Medicaid individuals.

about the health care system, what's working, what's not working, what can we improve upon.

And so it really depended on the size of the organization.

And if they were doing some organization said, well, we can do two focus groups.

Others said we can get 250 surveys done by people.

And so that's the range.

You can see that we ended up with 908 individuals who are receiving Medicaid.

to complete surveys about their experience with the healthcare delivery system in 11 different languages.

And so we're really trying to reach a broad base of folks.

When you do provide the information on the community partners that you're working with, it would be helpful on these two slides, too, to have a breakdown of the organizations based on who they're serving, communities of color, lower income folks.

When you talked about community, what are they called?

Work, community health workers, what I was thinking is promotoras from the CMR model.

So if you could give us those demographics, I think that'd be super helpful for us to get a better sense of who you're all working with in King County.

Absolutely.

So the next slide that I was going to touch on briefly, and obviously something that aligns very much with the work that we are doing in the city here, and that's really about workforce development.

So a piece of the funding that we will be working with is really going to be focused on trying to answer some very complex questions around sort of building the capacity for us to serve all of the individuals that we'd like to serve.

So that...

It's ensuring that we have a trained workforce in some of the areas, particularly around, obviously, health and behavioral health.

Build capacity in areas of care coordination and the community health workers and peer support specialists.

Obviously, there are models in various places of how those group programs can work effectively.

And so we would obviously use those models and figure out a way to, again, build the capacity here in our county.

And then align with other initiatives, and this is where the city comes in, because we too, within the city, have a variety of different workforce development initiatives that we would like to sort of align with in our process.

Can you talk a little bit more about that?

Does that mean access to high quality union jobs in the healthcare industry?

So it is about the development of the healthcare workforce.

So we have recently connected with the health industry leadership table through the city.

I think it's through the economic development and the Seattle Jobs Initiative is a big part of that.

That is really looking into and that some of the labor unions are involved in the health industry leadership table as well, which is how do we, you know, go all the way into our middle schools and high schools to get people excited about healthcare jobs, but also when we pull, as people come into sort of entry-level jobs in health systems, for example, they might be a janitor or somebody that works in the hospital cafeteria, that they're actually putting mechanisms in place to expose those individuals to a wide variety of jobs within the healthcare delivery system and creating what they call upscale programs so that I may come in as a janitor and I might have access to English as a second language courses and other kinds of opportunities and maybe I didn't even know I could be a medical assistant or something else and so they're creating pathways.

to move into jobs that will pay more livable wages.

Maybe you just said that and I missed it, but are we working with our promise, the two years of going into local colleges for this?

One of the things that I've learned from my favorite friends in the construction unions is oftentimes if they can reach kids at the high school level to help them with math skills, basic math skills, whether it's you just need fractions on taking a measurement, whatever it might be, If we can start early, then it really helps people be ready for these kinds of jobs.

And I have to believe that the same thing is true about the medical world.

We had not.

So thank you for that suggestion.

I will absolutely look into that as well.

Yeah, and I know that.

Rick Burke, and he's on the Seattle Public School Board.

These apprenticeship opportunities and internship opportunities are really high on his list.

So if you're looking at reaching out to the community, I would just suggest that you contact him and feel free to let him know that you've been at this committee.

Thank you very much.

I will do that.

So at the health industry table, did I get that right?

Health industry leadership table, the HILT.

Table.

You mentioned union partners, so UFCW 21, SEIU 1199 are the two sort of health nurse unions that I can think of.

UFCW 36. Five, three, six, seven, I think.

Yeah, your knowledge is beyond mine in terms of rattling out all the numbers.

I believe the last meeting that I was at, and actually another one of my staff people has been attending much more regularly, but both the SEIU and the other union that you mentioned were represented.

I'm not sure about the, I think I think 1099 was the SEIU, but I'm not sure about the other one.

And this also folds into our conversation around housing too, because we know that a big barrier to folks getting into the healthcare industry, especially, I shouldn't say industry, healthcare field profession, is that they struggle to make good living wage jobs.

And so as we think about creating more affordable housing, And so we've now filled that with community organizations with an orientation towards health.

And there's a dental training program.

There is a nurse training program there.

And it's run by partners from our Seattle College system that are housed there.

to create affordable housing for folks on that north lot.

So it all connects here.

And I'm glad to hear that you're working with those union partners.

It's critical.

Yeah.

And where we had our last board.

Did we have our meeting there recently?

Oh, yes, we do.

Our board does meet over at Pack Tower.

Yeah, yeah, occasionally.

So I'm going to talk a little bit about our investment strategy.

I'm sure you ask questions about the money and tell you all about it.

What I will say is that it sounds like a lot of money.

And when you start to sort of divvy it up by when you get it, how you earn it, whether or not you earn all of it, and all the people that want some of it, it goes really quickly.

We have a responsibility at Healthier Here and ultimately the governing board to figure out as we think about making the investments in this huge opportunity that's in front of us, how can we be the most impactful in change knowing that we're not going to get it all done in five years with the waiver.

creating a balance between how much goes to individual provider organizations versus system-level investments that benefit everybody, like the Community Information Exchange isn't money that would go to a single provider, but rather is a system-level investment that connects providers together.

and we need to do both in order to make this work.

We also have to make sure we balance investments between kind of the traditional healthcare delivery system and our community-based organizations and tribes and areas of significant underfunded if we really wanna bring them together in a leveled way.

Big hospitals and health systems don't need as much resource from us as a small community-based organization who is trying to provide coordination for, for example, the Somali community or something like that.

So that is part of the strategy going forward.

I'll also point out that while we do have money and investing in transformation is a big, significant, important role for us, we do have other roles that we are playing in this region.

We've talked a lot about convening partners and stakeholders, again, because healthier here is this multi-stakeholder approach.

We don't represent any single organization or sector.

We are well-posed to bring partners together to talk about really critical issues that affect the whole system.

Shared care planning, how do we standardize the collection of social determinant information and so forth.

We also have a policy role.

We are participating both in local and statewide policymaking related to our transformation goals.

There are a number of policy barriers that while you have providers who want to deliver integrated care, there's rules and regulations that prevent them from doing it.

Sometimes it's around credentialing and licensing issues.

Sometimes it's around what kinds of codes can be used on the same day.

And so we need to remove those barriers if we want people to actually deliver integrated whole person care.

And then the last piece is sustainability.

We are making these pretty significant investments in transformation.

Because this isn't a grant fund and we don't want it to work like a grant fund, we don't want the good work to go away when the money goes away.

So we are working with the health care authority.

We'll be working with our managed care organizations.

When we identify care models that really work, we want to find ways through value-based payment arrangements for those care models to be fully covered and resourced under the Medicaid program where it's appropriate and where it's not.

We have to identify other resources to sustain it.

So we will be working on that as well.

What happens at the end of five years?

So, it depends.

So, the 1115 waivers and the delivery system reform incentive programs are renewable.

It's given with the current federal administration, it's highly unlikely.

And in fact, New York, who is ahead of ours, was trying to renew their waiver and they weren't able to get there.

If there's an administration change, our waiver will not end until 2021, so if there's an administration change or new thoughts on the value of this, there's the potential for a renewal.

If we don't draw down all of our funding, we can do a no-cost extension to continue to be able to draw down the funding.

Those are kind of the main options with the waiver.

And then there's other options, as I mentioned, with regard to some of the individual investments and projects that we do if we can create mechanisms to have them sustained under a Medicaid contract or through another mechanism.

A different Medicaid contract is different from the waiver.

Yes.

So there's money out there in different buckets?

Yes.

Actually, that's a really good and important question.

So the state has a Medicaid state plan to provide health and behavioral health services and long-term care services and developmental disabilities.

Those contracts are not changing today.

They are the same, and that money still flows exactly the same.

This is actually new money coming into the system and what makes it a waiver and what makes it so unique is it basically waives the rules of Medicaid and allows the state to use it in new innovative ways to pay for things Medicaid doesn't today pay for under the Medicaid contract to test new ways of innovation.

Now, the trade-off in all of that is that at the end of the day, the waiver has to be budget neutral to the federal government.

So the way I kind of describe it is the federal government is fronting the state money that they would have spent anyway through the Medicaid program and the state is agreeing to reduce the total Medicaid spend, the trajectory of the Medicaid spend by a certain amount so that it's budget neutral to the federal government.

This is an area that I just love.

So let's anticipate that things go well.

Will revenue neutral mean that they will look at system-wide investments?

So back to our low acuity.

If we can demonstrate that our fire department saves money because it's not sending out eight guys or first responders in ladder trucks, and they're not taking an individual to Harborview Medical Center, which is, if you just assume all that is a $2,000 response, a $2,000 overnight, if you can say, OK, we've saved the system $4,000, will that inure to our benefit?

Or will people say, well, it's kind of like, it's not really budget neutral because the fire department eats it, or DESC has a nurse Mary on site that they have to pay for.

How are we going to really demonstrate that it's revenue neutral?

Yeah.

So in that sense, it's less about demonstrating the revenue neutral to the feds.

That's like a formula that the state just has to meet.

I think what you're really talking about is how do we ensure if we're saving money to the system that that money is getting reinvested in these less expensive things that really work.

And that is the goal and that is the hope.

And you probably know from the positions that you sit in and the work that you do that it's sometimes easier said than done.

And identifying where the savings accrue to whom.

is a big factor in that.

Certainly when you're reducing emergency department visits and inpatient hospital stays, it's accruing at the health plans, the savings.

And so you want them to reinvest.

There's other ways where savings might be accruing to the criminal justice system or other.

So we have to kind of figure that out.

The idea is to figure it out.

So there is an evaluation.

We didn't really talk about that.

But there will be an evaluation of all the work that happens both locally and statewide.

And the hope is to, yes, to say, you know what, this is working better and more effectively and saving money.

Let's actually move our resources and reallocate them here because it's going to generate savings.

And to the extent possible, we really do want people that are experiencing those savings to reinvest those resources in the community.

And we'll be doing some negotiation around that as well.

Please keep us informed on that, Susan.

That is such a tricky area, but we know just experientially and just common sense says if you can save $4,000 from one run up to Harborview, that's a really good thing.

Let's reinvest that money in our fire department.

I'm going to ask us to wrap it up.

30 minutes.

I just want to tell you about the money so you have the whole picture really quickly.

So our Healthier Here is total available anticipated budget for the five-year waiver is $97 million.

This shows you the amounts across the years and down the left-hand side are just use categories, which you can take a look at.

But the most important thing is $97 million across the five years.

It's based on certain assumptions.

So there is a chance we could earn more than that.

But we need to be conservative because we don't want to kind of go off a cliff.

75 million of that, 97 million is the project incentive dollars that we've been talking about.

So if you flip to the next slide, that 75 million then gets divided amongst Medicaid providers, community-based organizations, tribes, and a little bit to healthier here to support the implementation.

And so again, this is for the five years.

You can see how it's divided up.

So that's the money that will go into the system over the next several years for this transformation work.

And as we move into implementation this year, as I said, we're happy to come back and give kind of regular updates about where we're investing and what's working and what's not working and lessons learned.

Thank you so much for the time.

Sorry we ran over, but this has been such a great conversation.

Yeah, well, super excited.

I think there's lots of opportunity for partnership and alignment, so I look forward to follow up.

Go ahead.

And you can really see why, as a member of the governing board with this really diverse group of folks, that we are so lucky to have Susan sort of leading this process here.

And the staff, she has an amazing staff that she has put together as well.

Great.

1,000 2nd Avenue, so not too far from here between Spring and Madison on 2nd.

So I was excited to learn about all that you're doing I hear a lot about Accountable communities of health and it doesn't really actually give you a vision of what's happening So what you've just articulated today really paints a picture of how our community partners are involved I think with a better understanding of who you're working with once you've narrowed that down to us your core group that will be helpful for us to know and While I'm excited, I'm also sort of nervous about this need to have Medicaid dollars be neutral to the federal government.

And to me, that really means that we have to get this housing stability, economic stability area of the social determinants of health right in our county.

And the city is gonna play a huge role in that.

If in the future, future Medicaid reimbursement dollars, I know they're stable for now, but if they're somehow affected by dollars needing to be offset by the front loading of investment into the transformation waiver, maybe that don't materialize later and a future federal administration decides that they're going to reduce our dollar amount for overall Medicaid reimbursement, that could be pretty traumatizing.

Yes.

So I think there's a lot of opportunity here, but it does feel like, you know, there's also a lot of factors that may be out of your control.

It's specific to your network or your partners.

And that, I think, is a huge role for us to play.

So I'd love to stay engaged.

I'd love to come to one of your community meetings or whatever you think would be helpful.

Oh, please do.

Yeah, all of our meetings are open public.

I'll also, with some of the follow-up material, send you a link to our website that tells the dates and times of the various meetings.

And then the last thing I think is what Council Member Bagshaw was asking about, which is I'm also very interested in the succession of this after the five-year period.

You know, maybe Congresswoman Jayapal's bill will be successful and we'll have a different way of implementing health care in the future.

But at this point, you know, we'd love to work with you to make sure that that five-year mark doesn't equal a cliff.

And thank you.

Thank you.

And your board for all that you're doing.

Yeah.

Thank you very much.

And thanks for allowing your staff to be represented on our board.

It's very helpful.

Yeah, absolutely.

We're excited.

Well, thank you so much.

We're going to move into item number two on our agenda.

Farideh, could you read the second item of business into the record?

Item number two, Seattle Housing Authority update for briefing and discussion.

Thank you, Farideh.

And we are going to be joined at the table by Andrew Lofton and Jarrett Kummer.

Is there anyone else who's joining you today?

OK.

Hi, guys.

Welcome.

Thank you for reaching out to our office with this good news about the projects that you're working on.

We, I think, have teed up well why we have integrated health and housing into one committee, not to mention workers' rights and making sure that folks have greater access to economic stability.

So looking forward to hearing more from you about your work to preserve access to affordable housing and the ways in which maybe city council can be helpful.

Thank you.

It's a pleasure to be here.

I appreciate the opportunity to share with you the new program that we are embarking upon.

There are also a few other questions that were raised, and I thought I would do a couple of things.

I would touch on four things, three very briefly, very high level, and then fourth is the acquisition program and going to some depth with that.

But I thought I would talk a little bit, give you a snapshot on where we are with Yesler Terrace, a snapshot on where we are with the Home from School program, which is connected with Yesler Terrace, and give you a little background on where we are with that.

Talk some also about our work on our housing stability efforts.

that are underway, and then spend the rest of the time on the acquisition and preservation program.

So I'll try to do very high level on those other three.

We'll be back to you on Yesler Terrace, I believe, because we usually do an annual report to you on where we're doing with that, so I won't spend a lot of time on that.

So at Yesler, I guess at a high level of the snapshot to think that we are very pleased with the progress there.

So just by the numbers, we have completed or will have completed by the end of this month, 298 of the 561 replacement units.

We are very excited about that.

The opening of the Red Cedar, which is our fifth building, which will be completed sometime in the next 30 days, will bring those replacement housing units up to 298. In addition to that, we have two more projects in the pipeline, one that will get started this spring or late this summer, Hinoki, and another which is in a partnership with South Chinatown, International District, PDA, and Capital Housing on the old county record site.

They will be doing 156 units of affordable housing, 92 of which will be replacement housing.

And the project that we're doing, the Hinoki project that's going to be started later this year, will add another 139 units.

88 of which will be replacement housing.

With the completion of those two projects, we will have 85% of all the replacement housing done.

So, Hinoki starts sometime this summer, and the record site project is still in discussions and design, so they won't probably get started for another year or so.

We're very excited about the pace that has been happening.

We're very close to, particularly with the completion of those two buildings, completion of all the replacement housing.

We are about a third of the way already with the 60% tax credit housing.

We've got a third of that completed.

We're scheduled to do 300 units there.

We've got a little over 100 done.

With these two buildings that we're talking about, we'll be two-thirds of the way to finish with all the tax credit housing.

And then the market rate and 80% housing is also moving along very well.

We will have a third market rate building complete in about a month as well.

And then we have two additional market rate projects that are currently under construction.

So things are moving along very well there.

Our buildings that have been opened are full.

The market rate buildings have been, the leasing pace has been very, very strong.

So we are pleased with the response to the market.

I think that's a really important clarification.

Yesterday, unfortunately, there were some folks who were misinformed about what's happening up at Yesler Terrace.

I think people see these beautiful buildings and they assume that all of them are market rate.

What you have done, which you've just described, is you've actually improved the conditions.

It is absolutely within the city's roles and responsibilities to recognize when we have housing that may be unhealthy or unaccessible to our growing population by its low height, Rebuild to create additional height to create an inclusive community.

That's mixed income folks who came to testify yesterday unfortunately in the planning committee Assumed that there weren't folks who were previously living there getting in and what you've just said is that there's going to be 85% of the replacement housing being built on site and that you have a We have a number, 92 replacement housing units coming in, 88 replacement housing coming in, and currently 298 unit replacement housing options available now is what I heard.

That's correct.

298 have been completed.

The other figures you used, the 92 and 88, those are in the planning stage.

that will be completed so those will be done.

Those collection of buildings equal 85% of our replacement housing.

All 100% of the replacement housing will be built on site.

So this just represents the progress.

So we are meeting our commitments that we have made to the community.

Individual residents also who have moved off site are able to come back on site.

They have first call on those units and they are taking advantage of that.

So we'll have a fuller report on that for you when we come to talk to you about yes, those are terrorists.

But here I just wanted to give you a snapshot to share with you the good news and the progress that has been made there.

And if there are additional questions before we come back to you, we're more than willing to come back and give you a further briefing on that.

Thank you.

I want to acknowledge how much work you've done.

And I'm looking back to when I first started on this council.

The designs were just coming to fruition.

And to see how many people now are coming back is exciting.

Can you remind me what the total numbers, what the anticipated numbers are?

So we have the very low income.

We are bringing people back.

The 500, I believe, that were.

Yeah, there were 561 units.

There were 498 families at the time.

So all 561 units will be replaced on site.

All 498 households have the guaranteed right to return to those units.

Many of them are taking advantage of that.

Many of them did not relocate off-site.

They relocated to properties that were existing, and so they moved a couple of times because they did not want to leave the facility.

We will work with them to meet their needs.

Rough numbers, what are the percentages of people that are choosing to come back?

More than half?

More than half, yeah.

Probably in the 70% range.

When you say come back, since many of them didn't leave, I was trying to factor that in.

But so the majority of folks who lived at Yesler Terrace will be able to return to Yesler Terrace.

Nice.

And what is the overall total increase?

So we've got the replacement units, the 561 replacement units, and then when you're thinking about market rate or affordable rate, how many more units are we building up there?

So just the round numbers, we're replacing all 561 public housing units.

We're creating an additional 300 tax credit units at 60% of area median income.

We're also creating an additional 800 to 850 units that are targeted at 80% of area median income and below.

800?

Yes, almost 850. And the balance of the units will be market rate.

So somewhere between 2,500 and 3,000 market rate units will then be built in addition to that.

So all told, we are creating a roughly 4,500 to 5,000 total units.

in that strata.

So basically tenfold.

You used to have 561 units and now you've created more than 5,000 units on the same property.

That's correct.

Thank you for that.

I am hopeful that the people who came to testify yesterday hear this message and that you have clarified for the record.

We will continue to clarify as well.

It is erroneous to believe that anybody was displaced for that development, which has been absolutely inclusive.

I had a chance to tour.

I don't know if you had the chance to tour as well, but would encourage all of our council members to go and go on that great tour as well.

Have you walked around and seen the new soccer field and just seen the kids up there and saw some of the Storm players up working with the kids?

And then we've got the streetcar.

It's an amazing effort, so I thank you for that.

Absolutely fabulous.

Yes, thank you.

And you will be receiving an invitation to the opening of Red Cedar.

As I said, it will be completed later this month, and we'll be scheduling an open house and would invite all of you to come and take a look at not only the Red Cedar, but also the entire project.

Great.

Thank you.

Secondly, one of the emphasis at Yesler Terrace has been focusing on Bailey-Gatzert and creating an opportunity to improve the quality of the school.

One issue is the significance of homeless families, homeless students that are attending Bailey-Gatzert.

So we created a program to house the students, families who are homeless going to Bailey-Gatzert.

a couple of three years ago.

We have seen, had about 50, over the three years, including this year, about 51 families referred to us.

We have issued them 36, out of those 51, we've issued 36 vouchers, and 28 of those were housed And 25 of them remain housed.

So we're working continually with the school and the school's homeless counselors to identify students who are experiencing homelessness that are going to Baytogaz or trying to find housing solutions for them.

And then provide them some light services to help them through the transition from homelessness to So that program is, we're pleased with it.

It is helping to stabilize the school itself, which is what the design was so that the education experience for the students that are going there, mostly of which are living at Yeser Terrace.

is improved and we've got some data that shows that that's that's occurring and we'll be able to share that with you when we come back later on for a briefing on yesterterris.

And then finally, there's been a lot of effort on our part as we focus on housing stability.

And by that we mean keeping our residents housed.

As we house them, there are challenges that some run into around their ability to meet all of their obligations and We're trying to figure out ways in which we can be more supportive of our residents so that we have fewer That ultimately end up in having to leave our housing So we've worked with some community members to identify some areas that were of concern.

We've worked with our own staff to try to streamline our processes to make sure that we're considering all the factors that go into the situation that the individual is in.

We are reaching out to a lot of our community partners who provide services to our residents so that they shift a little bit of their focus to really housing stability, working with the family very directly on obligations and what has to happen and what are the the options that we have to work with them with so that they can prevent a necessary termination of their housing.

And that's been, we think, successful.

We have, to begin with, less than 1% of our residents have to go through an eviction process in any event.

With some of the changes we've made, that's gone down to less than one half of 1%.

So we're continuing to work through that.

We're continuing to see if there are ways in which we can be much more supportive of our residents and do it earlier so that it doesn't become a crisis situation.

We're not always able to do that, but that's our goal.

And so we'll continue to keep you apprised of how we're doing in that area.

What is the number, one half of 1%?

So in 2017, I believe it was 51 individuals.

And in 2018, it was about 28.

Okay, so you almost halved it.

When you come back to do a presentation on Yesler Terrace, could we do a little overview of the policies that you put in place?

Absolutely.

I think it's important for Those changes to be recognized and you know to the extent that we can help on anything else One of the things that I want to make sure is that we correct the narrative if folks believe that there's higher rates of eviction at Seattle Housing Authority homes and you've gone through this process to really change that.

Internal process, the number was relatively low at the beginning, but also you're on your way to zero.

We want to recognize that and then see what else we can do.

So if we could come back to that when you come again.

I appreciate that.

We'd be delighted to do that.

Thank you very much.

So now I want to turn to our Acquisition and Preservation Program.

Now we're getting to the real deal.

And this is an effort that our board was very excited about.

It is an effort that meets the goals of our strategic plan, which is fundamentally predicated on serving more people, more low-income people with affordable housing.

And this is a program that we think will help us do that, help us do that at a lower cost, and help us do that more expeditiously.

I'm going to turn it over to Jared Kummer, who is our Director of Housing Finance and Asset Management, who is kind of the architect of this, and I'll let him walk you through the goals of the program and how we think it'll work.

Thank you.

So as Andrew was saying, the primary goals of this program is aligning with our strategic plan to expand housing opportunities to serve more people, also to promote quality communities, and by that, meaning more in the preservation realm, but also adding affordable units into areas of the city where low-income people are a lot of barriers to access due to the high cost of housing in there.

But also, we are losing affordable housing as the years go on, so preserving what we can to make sure that the stock is still there.

And then finally just We know that the costs are very high So not only promoting the financial stability of our ability to continue to provide low-income housing to Seattle residents But also the stability of residents themselves so that we have various levels of housing for income income ranges so that we can serve from extremely low income, homeless, 30% of area median income, all the way up to 80% of area median income, so you have the whole spectrum there.

So the program itself, the initial phase of the program that we took to the board was the acquisition of 500 units.

And this strategy was designed to purchase and either create or preserve 500 new units.

Obviously we want to create a number of units and where we ended up Right now, we are going to be doing that.

But what we're trying to, our goals are, our initial goals are 50% of those units, so 250 units are gonna serve 30% of area median income or below.

So they would align with our current preference for our public housing program and our voucher program that serves homeless and below 30%.

And then the other 50 units would serve 60 to 80% of area median income.

And there can be a range in there.

And we're still working on what that part of the program looks like and how many at 60, how many at 70, and how many at 80. But that's the range there.

Can I just clarify?

Sure.

So you said 50% of units at 30% AMI to 60, is that?

No, 30 or below.

30 or below.

Yeah, so.

And then the other one was 60 to 80.

What about the between 30 and 60?

So between 30 and 60 is a difficult area to serve based on what the funding that is available for us.

And the needs that we're seeing based on our wait lists and who we serve at the Housing Authority is a high demand, obviously below 30% of area median income.

But then also, because the tax credit rules allow you to go up to 60% AMI, but no higher, there is a gap for households that may be working and earn just over, because it's a bright line.

If you earn 62% of area median income, you do not qualify for a tax credit unit.

So this is an idea.

I'm not a massive fan of calling it workforce housing, but a lot of people would call it more workforce housing.

of 60 to 80, it'd be people who are working but don't qualify for the other subsidy programs.

And then, that's super helpful, and I think that that's something that we'll want to continue to work on.

Between 30 and 60, there really is this gap of funding, and part of what I applauded our friends at Microsoft for, you know, what they've done with half of the amount of money that they've allocated out is impact investment loans.

My understanding was that would go to areas that really were sort of missing this funding.

Is that 30 to 60% funding where impact investment loans for companies, organizations who have additional cash reserve is really needed?

That's a gap area that others could potentially fill?

Yeah, I would say that that could definitely be a use.

One of the reasons 30 to 60 is so difficult is that the way the funding programs are set up is you have to make between like 50 and 60% of area median income to afford the tax credit rent without an additional subsidy.

And if you're kind of on the cusp of that or you're below it, It's difficult.

There's not really a lot of shallow subsidy programs that are out there.

Shallow subsidy?

Which word, sorry?

Shallow subsidy so shallow subsidy would be something where you're providing a little bit of subsidy not to the extent of say a voucher or that's similar to the public housing unit but there's a little bit to offset some of the operating costs that can't be covered by the rents that are paid or other ways are is more investment like what you're talking about to buy down the costs so you don't have debt to pay or other costs like that.

Okay, that's helpful for us to know.

Thank you.

Yeah, no problem.

So, just kind of sticking, oh, back to that slide, sorry.

Where we're at right now in what we've currently acquired and what we are in negotiations on is we're looking at 260 units of preservation and they will serve households at 30% of area median income or below, so we're, a little bit north of what our target was, but that's good.

We're able to serve more extremely low-income households.

And then, and I'll talk about it in a few slides, we've acquired one building already that serves 60 to 80% of area median income, and then we're currently out looking for more buildings to fulfill our total number.

Talk about preservation.

You probably know about this program that we're looking at for legislation right now in the legislature.

Beth Dolio, Representative Dolio, and Eric Pettigrew have put forward something that's called PACER financing.

And my understanding of how this works, and it may not work for you, but it's focused on private investments that an individual can borrow money.

And then it attaches to a lien on the property, and they don't have to pay it off or pay the property taxes, I understand it, until they sell.

So it encourages investments, especially in unreinforced masonry.

And I'm only just scratching the surface.

I don't think it is as complicated as I just made it sound.

But I'm delighted that there are these mechanisms encouraging the private investors to get involved.

And if they don't have to pay the interest back, or they can actually attach it to the property, then when the property sells.

that it just goes along with the cost of the property.

Anything, everything that we can do to try to find more spaces for people to be, and frankly, to preserve some of these older, beautiful URMs, it's really worthy.

Now, that said, and you're talking about preservation, specifically, do you have certain buildings in mind?

We do.

We're negotiating on three different buildings right now, and I have a slide and a bit on that.

We're still in the negotiation phase, so we're not able to share the exact locations and the details like that, but we definitely give you a high level of where they are in the city and who they're serving and bedroom sizes and things like that.

One of the other things, this is just a preview, everybody, of something that I'd like to bring to this committee later with input from our colleagues, the community, and you all at SHA.

We've talked to some of our community partners in the housing world about a piece of legislation that was actually passed by my predecessor, Councilmember Burgess and Councilmember Clark, that required buildings that had at least one unit that was at 80% AMI or below, I should say required, ask them, because it's voluntary, to notify the city if that unit was going up for sale so that our partners, maybe nonprofit developers or partners at SHA could get notification of a potential building that would go up that would potentially have affordable units within it.

My understanding is since that legislation was passed, only nine sellers have notified the city because it's voluntary.

And it's for units that have five, or for apartment complexes that have five units or more.

So one of the things that I'm trying to explore, being a renter, living in a building that has eight units, We didn't get notification when our building was sold and I think there's a lot of us in there who would have wished that we could have had notification so potentially we could have cobbled together funding exactly and purchased it ourselves and had our first-time home ownership options.

It could have been operated as individual condos potentially, or as a co-op, if you will, in partnership with community partners.

Or potentially if SHA had been notified, you know, that's an unreinforced masonry building, perhaps there was opportunities for SHA to step in and help create more affordable units, especially in an area like Queen Anne, with access to neighborhood parks and libraries and really great bus lines.

So my point is, one of the things that I'd like to do is to reduce the number of units that are required.

So if it's any building that has two units or more, work with you all to see what we could do in terms of notification.

So maybe SHA gets better notification and some of our nonprofit friends do as well.

and that the tenants get notification themselves of when a unit is coming up.

Obviously, I'm not assuming that every tenant would be able to cobble together funding within a 60-day period.

It's very cumbersome, as you know, on an individual basis, let alone for our community partners.

But what I'm thinking is, You know as we hear more about your acquisition strategy, what could the city do to also change policies like that?

So maybe you get notification of more units that potentially would be coming online because what I'm hearing here is you're not actually you're broadening out the number of I'm wondering if you have any interest in any of the different complexes or apartments that SHA could potentially have ownership of so that you can help maintain some level of affordability.

Would something like that, a tenant notice or a city notice of units with more than two or more apartment units within it, be of interest to SHA?

It would dovetail nicely with this program to keep us informed of the stock that's out there that could conceivably be characterized as part of the program.

And if we knew about them, then yeah, that's the first step, right, is kind of having some knowledge about what is available on the market.

And we would welcome the information about that.

So I talked with Steve Norman recently from our King County Housing Authority, and I know for 20 years that he's been working over there.

They've been going after buildings and then holding them so that that's one of the ways that they're able to offer units that aren't as expensive as the private market.

Have we done something similar to that?

Well, this is similar.

It's a little bit different than King County's because we're not Generally not bringing any new subsidy into the building.

We're trying to have the building perform on its own.

But it's the same concept of identifying opportunity buildings who are in areas that we can then sustain in our ownership in perpetuity and keep it affordable.

Yes.

Exciting.

So the total program cost itself, we estimate, we're hoping to do this over the next two years, acquire these 500 units.

It's going to cost us right around $100 million.

We're looking to finance that through a combination of our own funding that we have available to do it, but also a lot through tax-exempt bond issuances.

So we have bonding capacity to do that.

And as well as we'll make use of the low income housing tax credits where it makes sense to do so.

One of the key things that we worked for quite some time with on the board, well internally and then with the board, was what's the criteria for selecting buildings and what would be of most benefit to residents that are on our wait list but also low-income residents in the city.

As well as ensure that the housing authority remains financially stable and we're able to continue to provide the level of service that we do right now to the residents of the city.

So we came up with this six.

set of criteria that we're evaluating each of the acquisitions based on.

So first and foremost, you know, are we able to serve more low-income households in the city?

Secondly, does it maintain our financial strength?

Are we, we don't want to be in a position as Andrew was mentioning of having to take from some of our other programs that are already serving people through either the voucher program or through the public housing program to go out and purchase more units because we're not really getting a net gain there.

Thirdly, as tax credit projects and other projects that were funded by the federal government in the 70s and 80s are aging and the regulatory requirements of those are timing off.

We're going to be seeing projects that need to be preserved.

So are there opportunities for us to step in and say, okay, this is a building in an area where it's providing a benefit to residents, benefit to the city, it's providing subsidy potentially.

Can we purchase this building and maintain it in perpetuity?

So that's kind of the key around that.

The other thing is, pardon me, does the acquisition increase our inventory and opportunity areas?

So we've been focused a lot on providing access for households into areas that there's a lot of barriers to entry due to just like Queen Anne or where I live in Magnolia.

very difficult to get into if you're a low-income household, next to impossible if you're an extremely low-income household.

So that's the other area of focus that we're using there.

The other thing is, large family units.

The Housing Authority owns almost a quarter of the entire subsidized large family unit stock in the city of Seattle, three fours and five bedrooms.

So that's largely in our public housing program, as well as through our voucher program, but a large number is in our public housing program.

So, we have high demand and we feel that demand and pressure for these units as we have large families, large low-income families that need places to live and it's difficult for a family of five or six, seven or more to live in a two-bedroom unit.

I don't know exactly how many are more than two bedrooms.

I can tell you that we have in what we call our scattered site inventory, which is single-family homes, townhouses, and small mid-rises, like less than 20 units.

We have 711 units in 236 buildings across the city, and that ranges from South Seattle all the way to literally on the shoreline Seattle border.

So we're all across there.

And within that grouping there, it's between 35 and 40% are three and four and five bedroom units.

I would say in that portfolio.

And then we have been adding some in Yesler threes and I think a few fours.

A few fours in Yesler as well.

We can get to the number of the, yeah, sure.

that so often that families come together or extended families, which is really what is happening and what we want to encourage.

Frankly, I'd rather have people grouping together with a good solid roof over their head with rooms that they have.

space for themselves and each other.

But, you know, if we're looking at 200 units, when we know that the demand is in the thousands, it's tough for us.

Yeah.

So let us get you a better overall figure, because that's just for the scattered site program.

That's just a real subset of the entire portfolio.

Our entire portfolio is around 8,000 units.

Total.

Total that we own.

or manage.

And so we'll get you sort of the breakdown by bedroom size of that.

Thank you.

I would also offer, because we've struggled in this city due to lawsuits, but also sort of the pace at which we're trying to rezone, if we think of units that are, sorry, if we think of complexes that are two or more units potentially coming online for your potential purchase for the scattered program option, I can imagine duplexes and triplexes being a really good alternative so that families can stay together.

You know, if there's a separate entrance for mom and dad and the kids, you know, who have their own infants have another entrance, you can imagine family units staying together.

So I think a lot of folks think about large apartment complexes, even 20 or less, you know, may feel large to some of our community partners.

We'd love to work with you as we think about potential options for the city to purchase or for Seattle Housing Authority to purchase smaller units, if that means two or three or more units in a complex.

Potentially that's another way for families to stay together and for more folks to have access to high opportunity neighborhoods.

So I hadn't thought about that until now, but that's a really good intergenerational commitment as well, which is also healthy for our community.

And then our our last area is just the with the sheer cost increases that the city has been experiencing in Regards to development.

It's becoming more and more expensive to build new units.

So One way to serve more people is to look to buy units that cost less than our development costs So that's another key criteria.

We were looking at as a way to leverage our funds further so So one of the acquisitions that we've already completed is in the Lake City neighborhood.

It's called the Spring Lake Apartments.

There's 69 units there, one studio, 55 one bedrooms, and 13 two bedrooms, and it's in three buildings.

It was built in 1986. It's in fairly good shape.

We purchased this building, we closed in the end of November for just about $15.5 million.

So we were able to purchase this building for $225,000 a unit, which is a good value.

And now this building, as long as the Housing Authority owns it, and our record of selling is I don't have one really, is going to be guaranteed for as long as the Housing Authority is around.

So this property itself had some of our tenant-based vouchers in it already.

So there were already some extremely low-income households making use of that.

And then the rents themselves were between 60 and 70% of area median income rents right now.

So we kind of, what we did is we acquired a naturally affordable building and now have been able to ensure its affordability in the long term, so.

Do you ever blow the walls out on something like this so that you actually take two studios, for example, and, you know, you enlarge them so that people can deal with the space, but is that ever an option?

Yeah, actually, in fact, not in this building, but we are doing in the scattered site portfolio that I was just mentioning.

We have undertaken a conversion program where we are taking unused spaces, whether we have unfinished basements, garages, bonus rooms that aren't really good use of space, and increasing the bedroom sizes.

So we're able to take three and four bedroom units to five bedroom units.

In fact, we found a single family home in our portfolio that had three bedrooms, but the previous owner, whoever we bought it from, had boarded up the attic, and the attic was actually a one and a half storey, so that attic could be converted to another two bedrooms with a bathroom up there.

So we were able to increase the number of bedrooms.

So yes, and we're actively looking at these new properties as we bring them in if there's opportunities to do that there.

So I just wanted to touch on some of the three properties I was talking about that we were in negotiations on that we hope to have under contract and closed in the next two to three months.

It's a total of 262 units.

a large number of one bedrooms, some twos and some threes.

And they're located in three different areas of the city.

So the Lake City, the Black Lake City dot in the far right corner, that's the Spring Lake apartment that I just spoke about.

The one right by the locks in Ballard there, that's where the other building is located in that part of Ballard.

The other one is more in the Central District.

It's close to our Yesler development.

And then the other one is just south of, if you'll remember, our new Holly, Hope 6 development, where we have just over 600 units down there.

The other property is down in the Rainier Valley, down in that area.

So...

You have three property locations, but you got four dots.

The fourth is the Spring Lake, the one that we've already purchased.

That's the Lake City.

Yeah, up in Lake City.

So that's what we are up to.

We are, as Jared has indicated, we closed a property last November, and so we're in negotiations with three more, and we'll be continuing to search for good bargain opportunities that we can preserve the affordability and create opportunities for new housing.

Do we have any opportunities for some of the aging motels around here?

No, we haven't focused on that.

We've been focusing on larger buildings and residential structures, and we haven't really focused on the aging hotels.

Yeah, motels, of course, don't have kitchens, so it'd probably be very expensive to retrofit.

It is a really interesting idea, especially as we think about how single-room occupancy buildings were used in the past, especially during the Depression era.

And when folks, as we heard during the labor presentation, came into Seattle in the thousands to get good living wage jobs in the shipyards.

You know, as we see more and more people come in to get good jobs here in the tech industry, I'm thinking about how that pressure has created more people getting pushed out of the city or pushed into the street.

Perhaps looking at single room occupancy buildings or units is a new layer that we should consider.

Obviously, it's not a good long-term solution, but potentially it could help us.

That's something that you can invest in or are you prohibited by your rules?

to invest in SROs?

I don't think we're prohibited.

It's not something we've, as I said, focused on.

A lot of our interest currently, for sure, has been around families and creating opportunities for families.

But I don't think there's anything I don't think that prohibits us from investing in this.

We'd like to know more.

Clearly, this isn't the direction you're going, but if there are investors that are interested in this, I had talked with someone who, 20 years ago, did something down in Eugene, Oregon, and they built, I believe they built it from scratch.

I don't think it was a conversion.

But what they did was have single rooms, but community space and study space, but they had like essentially a dormitory kitchen.

Continues to this day.

And I talked to somebody recently who moved from Seattle down there, I mean she's somebody who is...

You know in her mid-50s, but it was less expensive down there.

She loved the idea She said she hates to cook she didn't want to this offered her three meals a day and gave her space to continue her career and It just it striked.

I mean it's one of those things where Nobody's going to jump up, raise your hand, and say, that's what I want to do.

But it's like, well, we're trying to think of every option possible to get people with roofs over their heads at an affordable rate.

And another take on that is a lot of the new modern shared living space concepts.

When I had the chance to visit Germany, I met with actually a contact that came from one of our urbanist friends here.

I met this individual who's a renowned housing expert in Germany.

and he lives in a shared housing facility.

His family has one unit, but then there's a shared living and dining room area, and they all take turns making dinner, they all garden together, and it creates a more affordable option with greater social cohesion.

And it's good for the footprint of our city because it's obviously a smaller unit overall.

So we're really excited about this.

Just one more question for you.

I thought that I saw in a press release or an announcement that you sent us, a 2,000 number.

Was that 2,000 number incorporating part of this or should I follow up with you on that afterwards?

I thought the number, the actual total number was bigger than 500. Is that the long-term goal?

Help me with this.

I can see it, but I can't remember what it said.

Yeah, I think in the press release it referenced the number of affordable units that we were involved in, not necessarily acquiring with this, that this would add to an inventory of affordable units.

Okay.

The difference between 2,000 and 8,000?

So the 8,000 would include public housing units.

So there's 6,000 public housing units and then there's another 2,000 units that are, including this, that are classified as affordable units.

So not serving the 30% and below AMI.

So public housing, if I can categorize it, is below 30% AMI, and in theory, someone gets a voucher to live there?

Well, the public housing, they would be admitted specifically through a low-income public housing program.

And that's a program that we own the unit and manage the unit, et cetera.

So that's a hard unit at which the housing authority actually owns and manages.

And gets a subsidy for the tenant that lives there, because they would qualify for living there based upon their income, which in our preference system would be 30%.

They would have to earn 30% or below of area median income, and then they would qualify to live in that unit.

in the affordable unit, their income could be greater and they could afford to pay a little bit more and we wouldn't have as deep a subsidy into the unit itself.

Public housing by definition is your 30% and below?

Yes, that's correct.

So this has been fascinating and yeah, I just love working with Councilmember Bagshot because I think we're passionate about the same issues.

Thank you for staying a little late so that we can ask these questions.

I'm really looking forward to having you guys come back, talk about Yes or Terrorist, the eviction prevention program that you've I worked on improving great statistics there.

Thank you for sharing some of that.

I'm also really interested in how we take the information about the 30 to 60% restraints that folks have for 30 to 60% AMI.

It sounds like that's in line with what we heard at the select committee where perhaps what we need to do to help folks from falling deeper into poverty or from losing their house in some cases is just cash assistance sometimes to help people get through a really tough period.

I think we heard from Mark Jones who provided that comprehensive report on how to restructure our homeless services.

You know, sometimes you just need to give folks the $200 and stop asking questions and don't make them fill out that, you know, intense survey or to, you know, spend down in order to receive it.

Really, that could be a homelessness prevention strategy.

And I think what I've heard from you all is, especially in that 30 to 60 percent area median income range, We potentially could be looking at more tools in that to help people buffer from falling into further poverty.

So this is very exciting.

We will follow up with you as well on the Potential Opportunity to Purchase Act.

I don't know what we want to call it, the Tenant Notification Act.

So that we can also make sure that it's a helpful tool for SHA.

And I'm just really excited about this as well.

We are about a week and a half away from passing the mandatory housing affordability legislation that the council's been working on for years.

And as we do, you know, we're also reminded that this is just one piece of the puzzle.

This is just one ingredient in the mix to try to help create more affordable housing across the board.

I want to take this chance to notify the public and our colleagues that we're going to be having a work session or a lunch and learn on the 21st of March, which will give us a chance to say MHA passed, now what?

How do we work to help do displacement mitigation strategies?

What are the other building opportunities?

What are the other zoning changes in the future that we may want to consider?

And it'll give us a chance to talk a little bit about the housing 2019 agenda as well.

And we'll be bringing in community partners.

So I see it sort of as a celebration but a recognition that we have so much more to do to create affordable housing for all and this information We'd love to have as part of that a roundtable discussion on the 21st Thank you, and then also We'll go ahead and wrap up today's meeting our next meeting for the Housing Health Energy and Workers Rights Committee will be on March 21st at 930 a.m.

And we are gonna have the Domestic Workers Standard Board Appointments more of those the City Light Review Panel appointments briefing on the health care health care for low-income workers and And a Seattle City Lights Gadget Environmental Endowment Commission Budget.

That sounds fascinating.

Part of the High Ross Treaty with Canada.

So we'll make sure that our friends know about all of that.

And look forward to seeing you all on the 21st.

Packed agenda that day.

Thank you.

Thank you, guys.

Thank you, Farideh, for shepherding us through today's agenda.

And that is it.

Our meeting is adjourned.