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DATE: |
November 4, 2025 |
04 |
SUBJECT
Title
HEALTH AND HUMAN SERVICES AGENCY ADMINISTRATIVE CODES AND BOARD POLICY SUNSET REVIEW 2025 (DISTRICTS: ALL)
Body
OVERVIEW
In accordance with San Diego County Board of Supervisors (Board) Policy A-76, Sunset Review Process, the County of San Diego (County) Health and Human Services Agency (HHSA) periodically reviews County Administrative Code and Board Policy to ensure policies reflect current Board standards and practices.
Today’s actions seek Board approval to amend the following Administrative Codes and Board Policy and extend the sunset review date for:
• Article IIIa Advisory Council for Aging and Independence Services
• Article XLVIII San Diego County Military and Veterans Advisory Council
• A-99 - Tobacco and Electronic Smoking Device Use, Prevention, and Cessation
Additionally, today’s actions seek Board approval to retire Board Policy A-133 - Provide Guidelines for Staff Levels in the Health and Human Services Agency.
This item supports the County vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically underserved as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. The Sunset Review process is an opportunity for HHSA to reflect on current policies through an equity lens and recommend changes that allow for greater transparency, in alignment with the Board’s commitment to transparency and open government.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Determine no change is necessary and approve the sunset review date of December 31, 2032 for the following County Administrative Codes:
a. Article IIIa Advisory Council for Aging and Independence Services
b. Article XLVIII San Diego County Military and Veterans Advisory Council
2. Approve amendments to Board Policy A-99 - Tobacco and Electronic Smoking Device Use, Prevention, and Cessation, and extend the sunset review date to December 31, 2032.
3. Approve the retirement of Board Policy A-133 - Provide Guidelines for Staff Levels in the Health and Human Services Agency.
EQUITY IMPACT STATEMENT
Through an equity lens, the County of San Diego (County) Health and Human Services Agency annually reviews Board Policies and County Administrative and Regulatory Codes that are sunsetting to ensure alignment with current San Diego County Board of Supervisors values and adherence to applicable laws and regulations. The current policies recommended for continuation demonstrate County efforts to engage the community in important conversations surrounding the preparation, development, and evaluation of County programs. Stakeholder feedback helps determine where focused efforts and resources are needed and should be invested.
SUSTAINABILITY IMPACT STATEMENT
Today’s actions support County of San Diego (County) Sustainability Goal #1 to engage the community in meaningful ways, Goal #2 to provide the region with just and equitable access to County services and resources, and lastly Goal #4 to protect the health and wellbeing of everyone in the region. The County’s annual review of sunsetting Board Policies and County Administrative Regulatory Codes ensures that programs and plans continue to meet the needs of all county residents, as intended, and remain relevant and responsive to evolving needs. By aligning with the County Sustainability Goals, the changes reflect more equitable, sustainable, and impactful practices.
FISCAL IMPACT
There is no fiscal impact associated with the recommendations. There will be no change in net general fund costs and no additional staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
On August 21, 2025, the San Diego Military and Veterans Advisory Council received an update on Article XLVIII San Diego County Military and Veterans Advisory Council as an informational item and had no concerns.
On September 16, 2025, the Health Services Advisory Board received an update on Board Policy A-99 - Tobacco and Electronic Smoking Device Use, Prevention, and Cessation as an informational item and had no concerns.
On October 13, 2025, the Aging & Independence Services Advisory Council received an update on Article IIIa Advisory Council for Aging and Independence Services as an informational item and had no concerns.
BACKGROUND
In accordance with San Diego County Board of Supervisors (Board) Policy A-76, Sunset Review Process, the County of San Diego (County) Health and Human Services Agency (HHSA) periodically reviews Board Policies and the County Administrative Code and Regulatory Code. Revisions to Board Policies and the County Administrative Code are recommended to reflect current Board standards and practices and to reflect any changes in laws, policies, and regulations that govern County departmental operations and services.
Recommendation 1
County staff have reviewed the County Administrative Code Articles below. Staff recommend no changes and request approval of a new sunset date of December 31, 2032, for:
• Article IIIa Advisory Council for Aging and Independence Services; and
• Article XLVIII San Diego County Military and Veterans Advisory Council.
Recommendation 2
The proposed revisions to Board Policy A-99, Tobacco and Electronic Smoking Device Use, Prevention, and Cessation include:
• Modifying language throughout various sections for clarity and conciseness;
• Adding more recent data related to national and State statistics on tobacco-related deaths, the prevalence of tobacco use among youth, and costs associated with smoking;
• Updating definition of “tobacco product” to align with State definition;
• Adding language to incorporate an oral health component to the risks associated with tobacco use;
• Adding a new provision under “Policy”, Section 10 to state “Educate, facilitate, and assist city and County policymakers, staff, and residents with adopting and implementing tobacco and smoke-free policies, reducing tobacco product waste in outdoor environments, and ending the sale of tobacco products”;
• Updating the Sunset Review date to December 31, 2032; and
• Adding the most recent Board action date.
Recommendation 3
Staff request to retire Board Policy A-133 - Provide Guidelines for Staff Levels in the Health and Human Services Agency upon the sunset date of December 31, 2025. When HHSA was established in 1997, the Board set a staffing-to-population ratio of 1 employee for 500 county residents to ensure efficient and effective HHSA operations and maximization of front-line service delivery. The only exceptions to exceeding the ratio are:
• To protect the County against liability and/or risk resulting in staffing levels that are inadequate to carry out mandated program functions delegated to HHSA by the federal or State government;
• If strict adherence to the staffing ratio would compromise equitable distribution of funds to the County and create future funding inequities from federal or State funding sources, when those sources use a formula for allocating health and social services revenue based on current need and historical expenses; and
• If unforeseen events, such as changing demographics or economic downturns, require additional provision of mandated health and social services by merit civil service employees, such as public health, adult, and child protection services.
Over the years, HHSA has continued meeting these exceptions granted by Board Policy A-133 due to evolving State and federal mandates and increasing demands associated with public health emergency response. As such, the previously established staff-to-resident ratio of 1 to 500 is no longer applicable.
This is demonstrated by the expansion of the Affordable Care Act, which went into effect in 2014, and extended healthcare coverage via Medicaid to an increased number of populations not previously eligible. This included individuals under the age of 65 earning up to 138% of the federal poverty level. In January 2014 to December 2024, Medi-Cal beneficiaries (California’s state-specific name for Medicaid), increased by 99.5% in the County. In response, the County adjusted the staffing needed to administer the rising caseloads, and in doing so, protected the County against liability and/or risk resulting in inadequate staffing levels to carry out mandated federal or State program functions.
The COVID-19 pandemic is another example of the County pivoting staffing in response to changes in federal or State funding due to unforeseen economic and public health downturns. The global pandemic unveiled an urgent need for a more robust public health infrastructure, nationwide. In recognition of this, the State allocated approximately $14,000,000 annually to County Public Health Services to strengthen local public health infrastructure. In doing so, the additional County staff hired were able to deliver vital services to vulnerable populations.
Today’s actions recommend the Board approve an extension of the sunset review date of Article IIIa Advisory Council for Aging and Independence Services to December 31, 2032; approve an extension of the sunset review date of Article XLVIII San Diego County Military and Veterans Advisory Council to December 31, 2032; approve amendments Board Policy A-99, Tobacco and Electronic Smoking Device use, Prevention, and Cessation, and an extension of the sunset review date to December 31, 2032; and, retire Board Policy A-133, Provide Guidelines for Staff Levels in the Health and Human Services Agency upon the sunset date of December 31, 2025.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed actions support the County of San Diego (County) 2025-2030 Strategic Plan Initiatives of Sustainability (Climate), Equity (Health), and Community (Engagement and Quality of Life), and the regional Live Well San Diego vision by ensuring County policies are transparent, data-informed, sustainable, and culturally responsive to support the health and social services provided to the residents of San Diego County.
Respectfully submitted,
ebony n. shelton
Chief Administrative Officer
ATTACHMENT(S)
Attachment A - Article IIIa Advisory Council for Aging and Independence Services (No changes)
Attachment B - Article XLVIII San Diego County Military and Veterans Advisory Council (No changes)
Attachment C - Board Policy A-99, Tobacco and Electronic Smoking Device Use, Prevention, and Cessation (Clean)
Attachment D - Board Policy A-99, Tobacco and Electronic Smoking Device Use, Prevention, and Cessation (Strikethrough)
Attachment E - Board Policy A-133 - Provide Guidelines for Staff Levels in the Health and Human Services Agency (Informational Copy)